American Society of Anesthesiologists' Status Association With Cost and Length of Stay in Lumbar Laminectomy and Fusion: Results From an Institutional Database.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Mar 2020
01 Mar 2020
Historique:
entrez:
8
2
2020
pubmed:
8
2
2020
medline:
18
11
2020
Statut:
ppublish
Résumé
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. 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective cohort study.
OBJECTIVE
OBJECTIVE
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).
SUMMARY OF BACKGROUND DATA
BACKGROUND
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.
METHODS
METHODS
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.
RESULTS
RESULTS
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).
CONCLUSION
CONCLUSIONS
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.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 32032340
doi: 10.1097/BRS.0000000000003257
pii: 00007632-202003010-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
333-338Références
DiPaola CP, Molinari RW. Posterior lumbar interbody fusion. J Am Acad Orthop Surg 2008; 16:130–139.
Youssef JA, Orndorff DO, Patty CA, et al. Current status of adult spinal deformity. Global Spine J 2013; 3:51–62.
Ghogawala Z, Dziura J, Butler WE, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 2016; 374:1424–1434.
Cowan JA Jr, Dimick JB, Wainess R, et al. Changes in the utilization of spinal fusion in the United States. Neurosurgery 2006; 59:15–20.
Weiss AJ, Elixhauser A, Andrews RM. Characteristics of Operating Room Procedures in U.S. Hospitals, 2011: Statistical Brief #170. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006.
Rajaee SS, Bae HW, Kanim LE, et al. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine (Phila Pa 1976) 2012; 37:67–76.
Bae HW, Rajaee SS, Kanim LE. Nationwide trends in the surgical management of lumbar spinal stenosis. Spine (Phila Pa 1976) 2013; 38:916–926.
Sankar A, Johnson SR, Beattie WS, et al. Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth 2014; 113:424–432.
Fitz-Henry J. The ASA classification and peri-operative risk. Ann R CollSurg Engl 2011; 93:185–187.
Dripps RD, Lamont A, Eckenhoff JE. The role of anesthesia in surgical mortality. JAMA 1961; 178:261–266.
Basques BA, Anandasivam NS, Webb ML, et al. Risk factors for blood transfusion with primary posterior lumbar fusion. Spine (Phila Pa 1976) 2015; 40:1792–1797.
Carreon LY, Glassman SD, Shaffrey CI, et al. Predictors of health-related quality-of-life after complex adult spinal deformity surgery: a scoli-RISK-1 secondary analysis. Spine Deform 2017; 5:139–144.
Deyo RA, Hickam D, Duckart JP, et al. Complications after surgery for lumbar stenosis in a veteran population. Spine (Phila Pa 1976) 2013; 38:1695–1702.
Lim S, Carabini LM, Kim RB, et al. Evaluation of American Society of Anesthesiologists classification as 30-day morbidity predictor after single-level elective anterior cervical discectomy and fusion. Spine J 2017; 17:313–320.
Phan K, Kim JS, Lee NJ, et al. Relationship between ASA scores and 30-day readmissions in patients undergoing anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 2017; 42:85–91.
Sathiyakumar V, Molina CS, Thakore RV, et al. ASA score as a predictor of 30-day perioperative readmission in patients with orthopaedic trauma injuries: an NSQIP analysis. J Orthop Trauma 2015; 29:e127–e132.
Vogt AW, Henson LC. Unindicated preoperative testing: ASA physical status and financial implications. J Clin Anesth 1997; 9:437–441.
Kay HF, Sathiyakumar V, Yoneda ZT, et al. The effects of American Society of Anesthesiologists physical status on length of stay and inpatient cost in the surgical treatment of isolated orthopaedic fractures. J Orthop Trauma 2014; 28:e153–e159.
Fineberg SJ, Nandyala SV, Marquez-Lara A, et al. Incidence and risk factors for postoperative delirium after lumbar spine surgery. Spine (Phila Pa 1976) 2013; 38:1790–1796.
McCormack RA, Hunter T, Ramos N, et al. An analysis of causes of readmission after spine surgery. Spine (Phila Pa 1976) 2012; 37:1260–1266.
Lawson EH, Hall BL, Louie R, et al. Association between occurrence of a postoperative complication and readmission: implications for quality improvement and cost savings. Ann Surg 2013; 258:10–18.
Keswani A, Weiser MC, Shin J, et al. Discharge destination after revision total joint arthroplasty: an analysis of postdischarge outcomes and placement risk factors. J Arthroplasty 2016; 31: 1866-72.e1.
Smith CD. Teaching high-value, cost-conscious care to residents: the Alliance for Academic Internal Medicine-American College of Physicians Curriculum. Ann Intern Med 2012; 157:284–286.
Services CfMM. Office of the Actuary, National Health Statistics Group. National Health Expenditure Data: Projections. 2012.
McCarthy IM, Hostin RA, Ames CP, et al. Total hospital costs of surgical treatment for adult spinal deformity: an extended follow-up study. Spine J 2014; 14:2326–2333.
Deyo RA, Nachemson A, Mirza SK. Spinal-fusion surgery—the case for restraint. N Engl J Med 2004; 350:722–726.
Missios S, Bekelis K. Hospitalization cost after spine surgery in the United States of America. J Clin Neurosci 2015; 22:1632–1637.
Zygourakis CC, Liu CY, Wakam G, et al. Geographic and hospital variation in cost of lumbar laminectomy and lumbar fusion for degenerative conditions. Neurosurgery 2017; 81:331–340.
Lad SP, Babu R, Baker AA, et al. Complications, reoperation rates, and health-care cost following surgical treatment of lumbar spondylolisthesis. J Bone Joint Surg 2013; 95:e162.
Sharma M, Sonig A, Ambekar S, et al. Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003–2010. J Neurosurg Spine 2014; 20:125–141.
Singh K, Nandyala SV, Marquez-Lara A, et al. A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion. Spine J 2014; 14:1694–1701.
Puffer RC, Planchard R, Mallory GW, et al. Patient-specific factors affecting hospital costs in lumbar spine surgery. J Neurosurg Spine 2016; 24:1–6.
Whitmore RG, Stephen JH, Vernick C, et al. ASA grade and Charlson Comorbidity Index of spinal surgery patients: correlation with complications and societal costs. Spine J 2014; 14:31–38.
Schoenfeld AJ, Wahlquist TC, Bono CM, et al. Changes in the care of patients with cervical spine fractures following health reform in Massachusetts. Injury 2015; 46:1545–1550.
Cullen DJ, Apolone G, Greenfield S, et al. ASA Physical Status and age predict morbidity after three surgical procedures. Ann Surg 1994; 220:3–9.
Ivatury SJ, Louden CL, Schwesinger WH. Contributing factors to postoperative length of stay in laparoscopic cholecystectomy. Journal of the Society of Laparoendoscopic Surgeons 2011; 15:174–178.
Ngui NK, Hitos K, Ctercteko G. Preoperative factors prolonging the length of stay in elective colorectal surgery. ANZ J Surg 2011; 81:624–628.
Inneh IA, Iorio R, Slover JD, et al. Role of sociodemographic, co-morbid and intraoperative factors in length of stay following primary total hip arthroplasty. J Arthroplasty 2015; 30:2092–2097.
Siemionow K, Pelton MA, Hoskins JA, et al. Predictive factors of hospital stay in patients undergoing minimally invasive transforaminal lumbar interbody fusion and instrumentation. Spine (Phila Pa 1976) 2012; 37:2046–2054.
Gruskay JA, Fu M, Bohl DD, et al. Factors affecting length of stay after elective posterior lumbar spine surgery: a multivariate analysis. Spine J 2015; 15:1188–1195.
Hackett NJ, De Oliveira GS, Jain UK, et al. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg 2015; 18:184–190.