Ashley Blair S, Courtney Paul Maxwell, Gittings Daniel J, Bernstein Jenna A, Lee Gwo Chin, Hume Eric L, Kamath Atul F
Department of Orthopaedic Surgery, University of Pennsylvania, Penn Musculoskeletal Center, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, Rush University, Rush University Medical Center, Chicago, IL, USA.
Arthroplast Today. 2017 Aug 31;4(1):103-106. doi: 10.1016/j.artd.2017.07.005. eCollection 2018 Mar.
The validated Arthroplasty Risk Score (ARS) predicts the need for postoperative triage to an intensive care setting. We hypothesized that the ARS may also predict hospital length of stay (LOS), discharge disposition, and episode-of-care cost (EOCC).
We retrospectively reviewed a series of 704 patients undergoing primary total hip and knee arthroplasty over 17 months. Patient characteristics, 90-day EOCC, LOS, and readmission rates were compared before and after ARS implementation.
ARS implementation was associated with fewer patients going to a skilled nursing or rehabilitation facility after discharge (63% vs 74%, = .002). There was no difference in LOS, EOCC, readmission rates, or complications. While the adoption of the ARS did not change the mean EOCC, ARS >3 was predictive of high EOCC outlier (odds ratio 2.65, 95% confidence interval 1.40-5.01, = .003). Increased ARS correlated with increased EOCC ( = .003).
Implementation of the ARS was associated with increased disposition to home. It was predictive of high EOCC and should be considered in risk adjustment variables in alternative payment models.
经过验证的关节置换风险评分（ARS）可预测术后转入重症监护病房的必要性。我们假设ARS也可能预测住院时间（LOS）、出院处置方式和护理期间费用（EOCC）。
我们回顾性分析了17个月内接受初次全髋关节和膝关节置换术的704例患者。比较了实施ARS前后的患者特征、90天EOCC、LOS和再入院率。
实施ARS后，出院后前往专业护理或康复机构的患者减少（63%对74%，P = 0.002）。LOS、EOCC、再入院率或并发症方面无差异。虽然采用ARS并未改变平均EOCC，但ARS>3可预测高EOCC异常值（优势比2.65，95%置信区间1.40 - 5.01，P = 0.003）。ARS升高与EOCC增加相关（P = 0.003）。
实施ARS与增加回家处置方式相关。它可预测高EOCC，应在替代支付模式的风险调整变量中予以考虑。
