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Am J Phys Med Rehabil. 2013 Mar;92(3):203-14. doi: 10.1097/PHM.0b013e31827446eb.

Factors associated with total inpatient costs and length of stay during surgical hospitalization among veterans who underwent lower extremity amputation.

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Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, PA, USA.



The aim of this study was to identify patient- and facility-level factors associated with total inpatient costs and length of stay (LOS) among veterans who underwent lower extremity amputation.


Patient data for 1536 veterans were compiled from nine databases from the Veterans Health Administration between October 1, 2002, and September 30, 2003. Linear mixed models were used to identify the factors associated with the natural logarithm of total inpatient costs and LOS.


Statistically significant factors associated with both higher total inpatient costs and longer LOS included admission by transfer from another hospital, systemic sepsis, arrhythmias, chronic blood loss anemia, fluid and electrolyte disorders, weight loss, specialized inpatient rehabilitation, and higher hospital bed counts. Device infection, coagulopathy, solid tumor without metastasis, Commission on Accreditation of Rehabilitation Facilities accreditation, and the Medicare Wage Index were associated with only higher total inpatient costs. The factors associated with only longer LOS included older age, not being married, previous amputation complication, congestive heart failure, deficiency anemias, and paralysis.


Most drivers of total inpatient costs were similar to those that increased LOS, with a few exceptions. These findings may have implications for projecting future healthcare costs and thus could be important in efforts to reducing costs, understanding LOS, and refining payment and budgeting policies.

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