Codding Jason L, Zmistowski Benjamin M, Davis Daniel E, Maltenfort Mitchell G, Pedowitz David I
Thomas Jefferson University Hospital (JLC, BMZ, DED), Philadelphia, Pennsylvania.
The Rothman Institute at the Thomas Jefferson University (MGM, DIP), Philadelphia, Pennsylvania.
Foot Ankle Spec. 2018 Jun;11(3):230-235. doi: 10.1177/1938640017720748. Epub 2017 Jul 8.
Total ankle arthroplasty (TAA) is commonly performed for end-stage ankle osteoarthritis. Given rising costs and declining reimbursements, identifying variables increasing length of stay (LOS) and total inpatient charges (TICs) of TAA is necessary for providing cost-effective care. The National Inpatient Sample (NIS) database was reviewed between 1993 and 2010, identifying LOS and TIC for TAA. Using a multivariate analysis, patient comorbidities, demographics, payment, and hospital details were evaluated. Median LOS decreased from 5 to 2 days, whereas median TICs increased from $21 382.53 to $62 028.00. Regionally, the South and Midwest had decreased TICs, whereas the West had an increased TIC. There was no significant difference in LOS geographically. Rural hospitals demonstrated decreased TICs, whereas urban private hospitals showed decreased LOS and decreased TICs. Large hospitals were associated with increased LOS and TICs. Compared with Medicare, private insurers demonstrated decreased LOS with equivalent TICs. Diabetics significantly increased mean LOS by 1 day, without a significantly increased TIC. Despite a decreased LOS, hospital charges have increased between 1993 and 2010 in TAA. We found that regional differences and hospital characteristics were associated with differences in LOS and TICs. Identification of these factors provides important information to facilities and surgeons.
Level IV: Economic/decision analysis.
全踝关节置换术（TAA）常用于终末期踝关节骨关节炎。鉴于成本上升和报销费用下降，识别增加TAA住院时间（LOS）和总住院费用（TICs）的变量对于提供具有成本效益的护理至关重要。回顾了1993年至2010年的全国住院患者样本（NIS）数据库，确定了TAA的LOS和TIC。采用多变量分析，评估了患者的合并症、人口统计学特征、支付方式和医院详细信息。中位LOS从5天降至2天，而中位TICs从21382.53美元增至62028.00美元。在地区方面，南部和中西部的TICs有所下降，而西部的TICs有所上升。LOS在地理上没有显著差异。农村医院的TICs有所下降，而城市私立医院的LOS和TICs均有所下降。大型医院与LOS和TICs的增加有关。与医疗保险相比，私人保险公司的LOS有所下降，而TICs相当。糖尿病患者的平均LOS显著增加1天，而TICs没有显著增加。尽管LOS有所下降，但1993年至2010年TAA的医院费用仍有所增加。我们发现地区差异和医院特征与LOS和TICs的差异有关。识别这些因素可为医疗机构和外科医生提供重要信息。
四级：经济/决策分析。
