Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Spine (Phila Pa 1976). 2020 Mar 1;45(5):333-338. doi: 10.1097/BRS.0000000000003257.
Retrospective cohort study.
The objective of this study was to characterize the costs associated with American Society of Anesthesiologists (ASA) class, and to determine the extent to which ASA status is a predictor of increased cost and LOS following lumbar laminectomy and fusion (LLF).
Spinal fusion accounts for the highest hospital costs of any surgical procedure performed in the United States, and ASA (American Society of Anesthesiologists) status is a known risk factor for cost and length of stay (LOS) in the orthopedic literature. There is a paucity of literature that directly addresses the influence of ASA status on cost and LOS following LLF.
This is a retrospective cohort study of an institutional database of patients undergoing single-level LLF at an academic tertiary care facility from 2006 to 2016. Univariate comparisons were made using χ tests for categorical variables and t tests for continuous variables. Multivariate linear regression was utilized to estimate regression coefficients, and to determine whether ASA status is an independent risk factor for cost and LOS.
A total of 1849 patients met inclusion criteria. For every one-point increase in ASA score, intensive care unit (ICU) LOS increased by 0.518 days (P < 0.001), and hospital length of stay increased by 1.93 days (P < 0.001). For every one-point increase in ASA score, direct cost increased by $7474.62 (P < 0.001).
ASA status is a predictor of hospital LOS, ICU LOS, and direct cost. Consideration of the ways in which ASA status contributes to increased cost and prolonged LOS can allow for more accurate reimbursement adjustment and more precise targeting of efficiency and cost effectiveness initiatives.
回顾性队列研究。
本研究旨在描述与美国麻醉医师协会（ASA）分级相关的成本特征，并确定 ASA 状态在多大程度上可预测腰椎板切除术和融合术（LLF）后成本增加和住院时间（LOS）延长。
脊柱融合术是美国所有手术中费用最高的手术，ASA 状态是骨科文献中已知的成本和 LOS 的危险因素。直接评估 ASA 状态对 LLF 后成本和 LOS 影响的文献很少。
这是一项回顾性队列研究，分析了 2006 年至 2016 年在学术型三级护理机构接受单节段 LLF 的患者的机构数据库。使用 χ2 检验进行分类变量的单变量比较，使用 t 检验进行连续变量的单变量比较。利用多元线性回归估计回归系数，并确定 ASA 状态是否是成本和 LOS 的独立危险因素。
共有 1849 例患者符合纳入标准。ASA 评分每增加 1 分，重症监护病房（ICU） LOS 增加 0.518 天（P<0.001），住院时间增加 1.93 天（P<0.001）。ASA 评分每增加 1 分，直接成本增加 7474.62 美元（P<0.001）。
ASA 状态是住院 LOS、ICU LOS 和直接成本的预测因素。考虑 ASA 状态如何导致成本增加和 LOS 延长，可以更准确地调整报销，并更精确地针对效率和成本效益举措。
3 级。
