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Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty?
BACKGROUND: As procedure rates and expenditures for total hip arthroplasty (THA) rise, hospitals are developing models to predict discharge location, a major determinant of total cost. The predictive value of existing illness rating systems such as the American Society for Anesthesiologists (ASA) Ph...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994639/ https://www.ncbi.nlm.nih.gov/pubmed/29896555 http://dx.doi.org/10.1016/j.artd.2018.01.004 |
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author | Rudasill, Sarah E. Dattilo, Jonathan R. Liu, Jiabin Nelson, Charles L. Kamath, Atul F. |
author_facet | Rudasill, Sarah E. Dattilo, Jonathan R. Liu, Jiabin Nelson, Charles L. Kamath, Atul F. |
author_sort | Rudasill, Sarah E. |
collection | PubMed |
description | BACKGROUND: As procedure rates and expenditures for total hip arthroplasty (THA) rise, hospitals are developing models to predict discharge location, a major determinant of total cost. The predictive value of existing illness rating systems such as the American Society for Anesthesiologists (ASA) Physical Classification System, Severity of Illness (SOI) scoring system, or Mallampati (MP) rating scale on discharge location remains unclear. This study explored the predictive role of ASA, SOI, and MP scores on discharge location, lengths of stay, and total costs for THA patients. METHODS: A retrospective analysis of patients undergoing elective primary or revision THA was conducted at a single institution. Multivariable regressions were utilized to assess the significant predictive factors for lengths of stay, total costs, and discharge to skilled nursing facilities (SNFs), rehabilitation centers, and home. Controls included demographic factors, insurance coverage, and the type of procedure. RESULTS: ASA scores ≥3 are the only significant predictors of discharge to SNFs (odds ratio [OR] = 1.69, confidence interval [CI] = 1.04-2.74) and home (OR = 0.57, CI = 0.34-0.98). Medicaid coverage (OR = 2.61, CI = 1.37-4.96) and African-American race (OR = 2.60, CI = 1.59-4.25) were additional significant predictors of discharge to SNF. SOI scores are the only significant predictors of length of stay (β = 1.36 days, CI = 0.53-2.19) and total cost for an episode (β = $6,234, CI = $3577-$8891). MP scores possess limited predictive power over lengths of stay only. CONCLUSIONS: These findings suggest that although ASA classifications predict discharge location and SOI scores predict length of stay and total costs, other factors beyond illness rating systems remain stronger predictors of discharge for THA patients. |
format | Online Article Text |
id | pubmed-5994639 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-59946392018-06-12 Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty? Rudasill, Sarah E. Dattilo, Jonathan R. Liu, Jiabin Nelson, Charles L. Kamath, Atul F. Arthroplast Today Original Research BACKGROUND: As procedure rates and expenditures for total hip arthroplasty (THA) rise, hospitals are developing models to predict discharge location, a major determinant of total cost. The predictive value of existing illness rating systems such as the American Society for Anesthesiologists (ASA) Physical Classification System, Severity of Illness (SOI) scoring system, or Mallampati (MP) rating scale on discharge location remains unclear. This study explored the predictive role of ASA, SOI, and MP scores on discharge location, lengths of stay, and total costs for THA patients. METHODS: A retrospective analysis of patients undergoing elective primary or revision THA was conducted at a single institution. Multivariable regressions were utilized to assess the significant predictive factors for lengths of stay, total costs, and discharge to skilled nursing facilities (SNFs), rehabilitation centers, and home. Controls included demographic factors, insurance coverage, and the type of procedure. RESULTS: ASA scores ≥3 are the only significant predictors of discharge to SNFs (odds ratio [OR] = 1.69, confidence interval [CI] = 1.04-2.74) and home (OR = 0.57, CI = 0.34-0.98). Medicaid coverage (OR = 2.61, CI = 1.37-4.96) and African-American race (OR = 2.60, CI = 1.59-4.25) were additional significant predictors of discharge to SNF. SOI scores are the only significant predictors of length of stay (β = 1.36 days, CI = 0.53-2.19) and total cost for an episode (β = $6,234, CI = $3577-$8891). MP scores possess limited predictive power over lengths of stay only. CONCLUSIONS: These findings suggest that although ASA classifications predict discharge location and SOI scores predict length of stay and total costs, other factors beyond illness rating systems remain stronger predictors of discharge for THA patients. Elsevier 2018-03-21 /pmc/articles/PMC5994639/ /pubmed/29896555 http://dx.doi.org/10.1016/j.artd.2018.01.004 Text en © 2018 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Research Rudasill, Sarah E. Dattilo, Jonathan R. Liu, Jiabin Nelson, Charles L. Kamath, Atul F. Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty? |
title | Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty? |
title_full | Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty? |
title_fullStr | Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty? |
title_full_unstemmed | Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty? |
title_short | Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty? |
title_sort | do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty? |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994639/ https://www.ncbi.nlm.nih.gov/pubmed/29896555 http://dx.doi.org/10.1016/j.artd.2018.01.004 |
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