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Relationship between the Charlson Comorbidity Index and cost of treating hip fractures: implications for bundled
Daniel J Johnson1, Sarah E Greenberg, Vasanth Sathiyakumar
1The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, TN, 37221, USA, Daniel.j.johnson@vanderbilt.edu.
Insights
Higher Charlson Comorbidity Index (CCI) scores in hip fracture patients significantly increase hospital length of stay and healthcare costs. This highlights CCI as a valuable tool for predicting resource utilization in elderly hip fracture care.
Area of Science:
- Geriatric Medicine
- Health Services Research
- Orthopedic Surgery
Background:
- Hip fractures are a significant cause of morbidity and mortality in elderly patients.
- Comorbidity burden impacts patient outcomes and healthcare resource utilization.
- The Charlson Comorbidity Index (CCI) is a widely used measure of disease burden.
Purpose of the Study:
- To evaluate the association between the Charlson Comorbidity Index (CCI) and length of stay (LOS) in hip fracture patients.
- To determine the impact of CCI scores on healthcare costs for hip fracture treatment.
- To assess the utility of CCI for risk stratification in bundled payment models for hip fractures.
Main Methods:
- Retrospective analysis of 615 patients over 60 with low-energy hip fractures at an Urban level I trauma center.
- Data collected included patient demographics, comorbidities, and LOS.
- CCI scores were calculated, and institutional costs were determined using an average daily inpatient cost of $4,530.
Main Results:
- Each one-unit increase in CCI score was associated with a significant increase in LOS and hospital costs (effect size = 0.21, p = 0.014).
- Patients with a CCI score of 2 incurred an average of 1.92 additional hospital days and $8,697.60 in extra costs compared to those with a CCI score of 0.
- Multivariate linear regression confirmed the positive correlation between CCI score and both LOS and cost.
Conclusions:
- The Charlson Comorbidity Index (CCI) is a significant predictor of increased length of stay and healthcare costs in hip fracture patients.
- CCI can serve as an effective tool for risk assessment and resource allocation within bundled payment frameworks for hip fracture care.
- These findings underscore the importance of considering patient comorbidities in managing hip fracture cases to optimize outcomes and control costs.
Background:
The aim of this study is to investigate how the Charlson Comorbidity Index (CCI) scores contribute to increased length of stay (LOS) and healthcare costs in hip fracture patients.
Materials And Methods:
Through retrospective analysis at an Urban level I trauma center, charts for all patients over the age of 60 years who presented with low-energy hip fracture were evaluated. 615 patients who underwent operative fixation of hip fracture or hemiarthroplasty secondary to hip fracture were identified using Current Procedural Terminology (CPT) codes search and included in the study. Data was collected on patient demographics, medical comorbidities, and hospitalization length; from this, the CCI score and the cost to the institution (with an average cost/day of inpatient stay of $4,530) were calculated.
Results:
Multivariate linear regression analysis modeled the length of stay as a function of CCI score. Each unit increase in the CCI score corresponded to an increase in length of hospital stay and hospital costs incurred [effect size = 0.21; (0.0434-0.381); p = 0.014]. Patients with a CCI score of 2 (compared to a baseline CCI score of 0), on average, stayed 1.92 extra days in the hospital, and incurred $8,697.60 extra costs.
Conclusions:
The CCI score is associated with length of stay and hospital costs incurred following treatment for hip fracture. The CCI score may be a useful tool for risk assessment in bundled payment plans.
Level Of Evidence:
Level III.
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