Predictive Factors of Hospital Length of Stay in Patients with Operatively Treated Ankle Fractures

SLR- February 2014- Ryan Ohlgart

Reference: McDonald M, Sathiyakumar V, Apfeld J, Hooe B, Ehrenfeld J, Obremskey W, Sethi M. Predictive Factors of Hospital Length of Stay in Patients with Operatively Treated Ankle Fractures. Journal of Orthopaedic Traumatolgy (2013 Dec).  DOI 10.1007/s10195-013-0280-9

Scientific Literature Review
 

Reviewed By: Ryan Ohlgart, DPM
Residency Program: Detroit Medical Center

Podiatric Relevance: With evolving changes in healthcare and reimbursement, it is imperative that the podiatric surgeon understands factors that can influence length of stay for operatively treated ankle fractures.
 

Methods: A retrospective Level III review was performed between January 1, 2004 and December 31, 2010 of six hundred twenty-two patients with ankle fractures that underwent operative repair. Factors reviewed were gender, length of operative procedure, methods offixation, American Society of Anesthesiologists (ASA) physical status score, medical comorbidities, and postoperative length of stay.

Results: Using a line arregression analysis, ASA status and length of stay was shown to have a statistically significant relationship. A one unit increase in ASA classification resulted in a 3.42 day increase in average length of stay. Using an average per-day inpatient cost of $4,503, the one unit ASA increase resulted in an increase cost of $15,490.

Conclusions: ASA criteria is a powerful predictor for the podiatric surgeon and hospital system to use inconsidering length of stay for patients undergoing operative fixation of ankle fractures. Quality measures and outcomes can better be understood when factoring in the ASA criteria. The study provides a basis for a more in depth look at length of stay and ankle fractures.