Deister Jacob, Cothern Brian G, Williams Chad, Froehle Andrew W, Laughlin Richard T
Resident, Department of Orthopaedic Surgery, Sports Medicine and Rehabilitation, Boonshoft School of Medicine, Wright State University, Dayton, OH.
Resident, Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH.
J Foot Ankle Surg. 2017 Jul-Aug;56(4):805-812. doi: 10.1053/j.jfas.2017.04.006.
Delayed identification of patients requiring admission to extended care facilities (ECFs) can lead to greater healthcare costs through an increased length of hospital stay (LOHS). Previous studies of hip and knee arthroplasty identified factors associated with a likely discharge to an ECF. These issues have not been extensively studied for major hindfoot procedures. We conducted a retrospective review of 198 cases treated during a 3-year period to identify the risk factors for an extended LOHS and ECF admission after ankle arthrodesis, triple arthrodesis, pantalar arthrodesis, and subtalar arthrodesis. The primary outcomes were LOHS and ECF admission. The independent predictors included age, sex, body mass index, housing status, American Society of Anesthesiologists class, diabetes and/or diabetic neuropathy, health insurance, fixation type, and perioperative infection. Stepwise multiple regression analysis was used to determine which variables were related to a longer LOHS. Nonparametric discriminant function analysis was used to identify the preoperative factors that best predicted ECF admission. A longer LOHS was significantly related to postoperative ECF admission, Centers for Medicare and Medicaid Services (CMS) insurance, diabetic neuropathy, external fixation, and infection. ECF admission was required for 34 of 198 patients (17.2%). Discriminant analysis found that older age, living alone, external fixation, and CMS insurance predicted a greater probability of ECF admission. The function accurately classified 94% of ECF admissions and 80% of non-ECF admission patients. ECF admission and CMS insurance extended the LOHS, likely owing to the administrative process of arranging an ECF discharge. If externally validated, the function we have derived could provide preoperative identification of likely ECF discharge candidates and reduce costs by shortening the LOHS.
延迟识别需要入住长期护理机构（ECF）的患者，可能会因住院时间（LOHS）延长而导致更高的医疗成本。先前关于髋关节和膝关节置换术的研究确定了与可能出院至ECF相关的因素。对于主要的后足手术，这些问题尚未得到广泛研究。我们对3年内治疗的198例病例进行了回顾性研究，以确定踝关节融合术、三关节融合术、全距关节融合术和距下关节融合术术后LOHS延长和入住ECF的危险因素。主要结局为LOHS和入住ECF。独立预测因素包括年龄、性别、体重指数、居住状况、美国麻醉医师协会分级、糖尿病和/或糖尿病神经病变、医疗保险、固定类型和围手术期感染。采用逐步多元回归分析来确定哪些变量与更长的LOHS相关。使用非参数判别函数分析来识别最能预测入住ECF的术前因素。更长的LOHS与术后入住ECF、医疗保险和医疗补助服务中心（CMS）保险、糖尿病神经病变、外固定和感染显著相关。198例患者中有34例（17.2%）需要入住ECF。判别分析发现，年龄较大、独居、外固定和CMS保险预示着入住ECF的可能性更大。该函数准确分类了94%的入住ECF患者和80%的非入住ECF患者。入住ECF和CMS保险延长了LOHS，这可能是由于安排ECF出院的行政程序所致。如果经过外部验证，我们得出的函数可以在术前识别可能入住ECF的患者，并通过缩短LOHS来降低成本。
