Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC.
Department of Orthopedic Surgery, Duke University, Durham, NC.
J Arthroplasty. 2021 May;36(5):1621-1625. doi: 10.1016/j.arth.2020.12.016. Epub 2020 Dec 15.
Body mass index (BMI), American Society of Anesthesiologists (ASA) score, and Elixhauser Comorbidity Index are measures that are utilized to predict perioperative outcomes, though little is known about their comparative predictive effects. We analyzed the effects of these indices on costs, operating room (OR) time, and length of stay (LOS) with the hypothesis that they would have a differential influence on each outcome variable.
A retrospective review of the institutional database was completed on primary TKA patients from 2015 to 2018. Univariable and multivariable models were constructed to evaluate the strength of BMI, ASA, and Elixhauser comorbidities for predicting changes to total hospital and surgical costs, OR time, and LOS.
In total, 1313 patients were included. ASA score was independently predictive of all outcome variables (OR time, LOS, total hospital and surgical costs). BMI, however, was associated with intraoperative resource utilization through time and cost, but only remained predictive of OR time in an adjusted model. Total Elixhauser comorbidities were independently predictive of LOS and total hospital cost incurred outside of the operative theater, though they were not predictive of intraoperative resource consumption.
Although ASA, BMI, and Elixhauser comorbidities have the potential to impact outcomes and cost, there are important differences in their predictive nature. Although BMI is independently predictive of intraoperative resource utilization, other measures like Elixhauser and ASA score were more indicative of cost outside of the OR and LOS. These data highlight the differing impact of BMI, ASA, and patient comorbidities in impacting cost and time consumption throughout perioperative care.
体重指数（BMI）、美国麻醉医师协会（ASA）评分和 Elixhauser 合并症指数是用于预测围手术期结局的指标，但对于它们的比较预测效果知之甚少。我们分析了这些指标对成本、手术室（OR）时间和住院时间（LOS）的影响，假设它们对每个结果变量有不同的影响。
对 2015 年至 2018 年接受初次全膝关节置换术（TKA）的患者进行了机构数据库的回顾性分析。构建了单变量和多变量模型，以评估 BMI、ASA 和 Elixhauser 合并症对总医院和手术成本、OR 时间和 LOS 变化的预测能力。
共纳入 1313 例患者。ASA 评分独立预测所有结局变量（OR 时间、LOS、总医院和手术成本）。然而，BMI 与术中资源利用的时间和成本相关，但仅在调整后的模型中与 OR 时间相关。总 Elixhauser 合并症独立预测 LOS 和手术室外的总医院费用，但与术中资源消耗无关。
尽管 ASA、BMI 和 Elixhauser 合并症有可能影响结局和成本，但它们的预测性质存在重要差异。虽然 BMI 独立预测术中资源利用，但其他指标如 Elixhauser 和 ASA 评分更能说明 OR 外的成本和 LOS。这些数据突出了 BMI、ASA 和患者合并症在影响围手术期护理期间成本和时间消耗方面的不同影响。
