Department of Orthopaedic Surgery, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
J Orthop Trauma. 2014 Jul;28(7):e153-9. doi: 10.1097/01.bot.0000437568.84322.cd.
To identify the impact of the American Society of Anesthesiologists (ASA) physical status on postoperative length of stay (LOS) and to document the cost due to LOS after surgical management of the 8 most common lower extremity and 2 most common upper extremity isolated orthopaedic fractures.
Retrospective chart review.
All patients who presented and underwent one of the 10 selected isolated orthopaedic surgical procedures at a large tertiary care center between January 1, 2000, and December 31, 2010.
PATIENTS/PARTICIPANTS: Charts for patients undergoing the 10 selected isolated orthopaedic surgical fracture procedures more than 10 years were reviewed. Thirteen thousand seven hundred seventy-six distinct operations were identified. One thousand three hundred ninety-eight distinct operations were included in analysis after selection.
This was an observational study. Patients who received operative management for isolated orthopaedic fractures were identified utilizing a CPT code search for analysis in a retrospective chart review.
LOS and cost secondary to LOS.
ASA physical status proved the strongest predictor of postoperative LOS for the 8 most common lower extremity and 2 most common upper extremity isolated orthopaedic procedures. ASA was also a significant predictor of inpatient cost for all isolated orthopaedic procedures included in the study with the exception of CPT code 27536.
ASA classification is an indicator for variance in LOS and total inpatient cost for hospitalized patients. Given that ASA classification is a universally collected data point, this method can be used in almost any hospital system and for any operative service. In addition, this study provides a foundation for many other studies to be conducted which will include multiple institutions and fracture types, such that ASA can be used as a more generalizable predictor of LOS and inpatient cost in orthopaedic trauma patients. This model may be used to accurately predict a patient's postoperative course and the expected cost to the health care system of a given procedure.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
确定美国麻醉医师学会（ASA）身体状况对术后住院时间（LOS）的影响，并记录在大型三级护理中心对 8 种最常见的下肢和 2 种最常见的上肢孤立性骨科骨折进行手术治疗后，因 LOS 导致的成本。
回顾性图表审查。
2000 年 1 月 1 日至 2010 年 12 月 31 日期间，在一家大型三级护理中心接受 10 项选定的孤立性骨科手术之一的所有患者。
患者/参与者：审查了接受 10 项选定的孤立性骨科骨折手术治疗超过 10 年的患者的图表。确定了 13776 次不同的手术。在回顾性图表审查中，通过 CPT 代码搜索对 1398 次不同的手术进行了选择分析。
这是一项观察性研究。利用 CPT 代码搜索，识别接受孤立性骨科骨折手术治疗的患者，进行回顾性图表审查分析。
术后 LOS 和 LOS 导致的成本。
ASA 身体状况被证明是 8 种最常见的下肢和 2 种最常见的上肢孤立性骨科手术术后 LOS 的最强预测因素。ASA 也是研究中包括的所有孤立性骨科手术的住院费用的显著预测因素，但 CPT 代码 27536 除外。
ASA 分类是住院患者 LOS 和总住院费用差异的指标。鉴于 ASA 分类是一个普遍收集的数据点，这种方法几乎可以在任何医院系统和任何手术服务中使用。此外，本研究为许多其他研究提供了基础，这些研究将包括多个机构和骨折类型，以便 ASA 可以作为骨科创伤患者 LOS 和住院费用的更具普遍性的预测因素。该模型可用于准确预测患者的术后病程和给定手术对医疗保健系统的预期成本。
预后 IV 级。请参阅作者说明，以获取完整的证据水平描述。
