Gholson J J, Noiseux Nicolas O, Otero Jesse E, Gao Yubo, Shah Apurva S
University of Iowa Hospitals and Clinics Department of Orthopaedics and Rehabilitation 200 Hawkins Drive Iowa Cijy, IA 52242 E-mail:
Iowa Orthop J. 2017;37:233-237.
As the United States healthcare system evolves towards improved value delivery, patient outcomes and healthcare costs are increasingly used to evaluate physicians and provider organizations. One such metric is hospital length of stay, which has the potential to be influenced by a variety of patient characteristics and comorbidities. Determining factors influencing length of stay represents an opportunity to increase value in healthcare delivery.
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2006-2012) was utilized to identify a cohort of 92,266 patients having one of 14 common orthopaedic procedures. A generalized linear model was utilized to identify patient factors that increase hospital length of stay.
During the six-year study period, length of stay decreased significantly in the total joint arthroplasty population. Nine variables were independently associated with increased length of stay. Congestive heart failure and underweight status increased length of stay the most, at 1.46 and 1.01 days, respectively. Other factors increasing length of stay include: non-white race (0.69 days), chronic obstructive pulmonary disease (0.50 days), diabetes mellitus (0.25 days), morbid obesity (0.23 days), hypertension (0.10 days), and patient age (0.02 days for each additional year).
In conclusion, congestive heart failure and underweight status are the greatest predictors of increased length of stay. COPD, diabetes, morbid obesity, and hypertension represent other modifiable risk factors that increase length of stay. This data can be used to counsel patients and their families regarding anticipated duration of hospitalization. Systematic targeting of patient factors known to increase length of stay represents an opportunity for cost reduction and improved value delivery. When utilizing hospital length of stay as a metric for evaluation, it is important to incorporate the factors that increase length of stay, so that orthopaedic surgeons and provider organizations can be evaluated based on representative patient population characteristics.
随着美国医疗保健系统朝着提高价值交付的方向发展，患者预后和医疗成本越来越多地用于评估医生和医疗服务机构。住院时间就是这样一个指标，它可能受到多种患者特征和合并症的影响。确定影响住院时间的因素为提高医疗保健交付的价值提供了契机。
利用美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库（2006 - 2012年），确定了92266例接受14种常见骨科手术之一的患者队列。采用广义线性模型确定增加住院时间的患者因素。
在六年的研究期间，全关节置换人群的住院时间显著缩短。九个变量与住院时间延长独立相关。充血性心力衰竭和体重不足状态使住院时间延长最多，分别为1.46天和1.01天。其他导致住院时间延长的因素包括：非白人种族（0.69天）、慢性阻塞性肺疾病（0.50天）、糖尿病（0.25天）、病态肥胖（0.23天）、高血压（0.10天）以及患者年龄（每增加一岁增加0.02天）。
总之，充血性心力衰竭和体重不足状态是住院时间延长的最大预测因素。慢性阻塞性肺疾病、糖尿病、病态肥胖和高血压是其他可改变的增加住院时间的风险因素。这些数据可用于向患者及其家属提供有关预期住院时间的咨询。系统地针对已知会增加住院时间的患者因素是降低成本和提高价值交付的契机。在将住院时间用作评估指标时，纳入增加住院时间的因素很重要，这样骨科医生和医疗服务机构才能根据具有代表性的患者人群特征进行评估。
