Objectives: To investigate what factors contribute to increased length of stay (LOS) and increased costs in treatment of elderly patients with hip fractures.
Design: Retrospective chart review.
Setting: All patients who presented to a large tertiary care center between January 2000 and December 31, 2009.
Participants: Charts for all patients older than 60 years who presented with isolated low-energy hip fractures were reviewed. Of the 719 patients identified, 660 were included.
Intervention: Patients who underwent operative fixation or hemiarthroplasty secondary to hip fracture were identified using a search of Current Procedural Terminology (CPT) codes search.
Main outcome measurements: Gender, height, weight, body mass index, length of procedure, American Society of Anesthesiologists (ASA) classification, and medical comorbidities were gathered and compared with LOS and direct daily inpatient hospital cost.
Results: No correlation existed between body mass index or specific comorbidities and LOS, but ASA classification was a predictor. For each ASA increase of 1, average LOS increased 2.053 days (P < 0.001). Given total daily cost to the hospital for these patients was $4530, each increase in ASA classification translated to an increase of $9300.
Conclusions: ASA classification proved useful in estimating LOS and cost for patients undergoing operative fixation of hip fractures. Because ASA classification and cost are universally collected, this method can be employed in almost any hospital. This highlights a role for ASA classification in preoperative estimation of the elderly patient's cost and a potential advantage for incorporating patient factors in the development of tiered reimbursement models.
Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.