1
|
Bruyneel A, Lucchini A, Hoogendoorn ME. The challenge of assessing workload in intensive care units. Intensive Crit Care Nurs 2024; 84:103722. [PMID: 38772786 DOI: 10.1016/j.iccn.2024.103722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
| | - Alberto Lucchini
- Foundazione IRCCS San Gerardo dei Tintori, General Adult and Paediatric Intensive Care Unit, Italy
| | | |
Collapse
|
2
|
Giglio A, Reccius A, Regueira T, Carvajal C, Pedreros C, Pino M, Riquelme C, Aguilera S, Ferre A, Suarez JI. Coma Prevalence in Critical Care Units in Chile: Results of a Cross-Sectional Survey on World Coma Day. Neurocrit Care 2024; 41:393-399. [PMID: 38649652 DOI: 10.1007/s12028-024-01986-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/20/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The purpose of this study was to assess the prevalence of coma among patients in critical care units in Chile. We also aimed to provide insight into the demographic characteristics, etiologies, and complications associated with coma. METHODS A single day cross-sectional study was conducted through a national survey of public and private hospitals with critical and intensive cardiac care units across Chile. Data were collected using an online questionnaire that contained questions regarding critically ill patients' information, demographic characteristics, etiology and duration of coma, medical complications, and support requirements. RESULTS A total of 84% of all health facilities answered, accounting for a total of 2,708 patients. The overall coma prevalence was 2.9%. The median age of the comatose patients was 61 years (interquartile range 50-72) and 66.2% were male. The median coma duration was five days (interquartile range 2-9). Cerebral hemorrhage was the most common etiology, followed by severe hypoxic-ischemic encephalopathy, acute ischemic stroke, and traumatic brain injury. A total of 48.1% of coma patients experienced acute and ongoing treatment complications, with pneumonia being the most common complication, and 97.4% required support during comatose management. CONCLUSIONS This study provides an overview of the prevalence of coma in Chilean critical and cardiac care units. Coma is a common condition. Comatose patients frequently experience medical complications during their hospitalization.
Collapse
Affiliation(s)
- Andrés Giglio
- Critical Care Department, Finis Terrae University, Pedro de Valdivia 1509 Providencia, Santiago, Chile.
- Critical Care Center, Clinica Las Condes Hospital, Estoril 450, Las Condes, Santiago, Chile.
| | - Andrés Reccius
- Critical Care Department, Finis Terrae University, Pedro de Valdivia 1509 Providencia, Santiago, Chile
- Critical Care Center, Clinica Las Condes Hospital, Estoril 450, Las Condes, Santiago, Chile
| | - Tomás Regueira
- Critical Care Unit, Clinica Santa María, Santiago, Chile
| | | | - Cesar Pedreros
- Critical Care Department, Finis Terrae University, Pedro de Valdivia 1509 Providencia, Santiago, Chile
- Critical Care Center, Clinica Las Condes Hospital, Estoril 450, Las Condes, Santiago, Chile
| | - Monserrat Pino
- Critical Care Center, Clinica Las Condes Hospital, Estoril 450, Las Condes, Santiago, Chile
| | - Carolina Riquelme
- Critical Care Center, Clinica Las Condes Hospital, Estoril 450, Las Condes, Santiago, Chile
| | - Sergio Aguilera
- Neurosurgery Department of Herminda Martin Hospital, Chillán, Chile
- Universidad de Valparaiso, Valparaiso, Chile
| | - Andrés Ferre
- Critical Care Department, Finis Terrae University, Pedro de Valdivia 1509 Providencia, Santiago, Chile
- Critical Care Center, Clinica Las Condes Hospital, Estoril 450, Las Condes, Santiago, Chile
| | - José Ignacio Suarez
- Neuroscience Critical Care Division, Departments of Neurology, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
3
|
Biancari F, Hérve A, Peterss S, Radner C, Buech J, Pettinari M, Rodriguez Lega J, Pinto AG, Fiore A, Onorati F, Francica A, Wisniewski K, Demal T, Conradi L, Rocek J, Kacer P, Gatti G, Vendramin I, Rinaldi M, Ferrante L, Pruna-Guillen R, Quintana E, DI Perna D, Mariscalco G, Jormalainen M, Field M, Harky A, Dell'aquila AM, Juvonen T, Mäkikallio T, Perrotti A. Predictors, prognosis and costs of prolonged intensive care unit stay after surgery for type A aortic dissection. Minerva Anestesiol 2024; 90:654-661. [PMID: 39021141 DOI: 10.23736/s0375-9393.24.18210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND The outcomes after prolonged treatment in the intensive care unit (ICU) after surgery for Stanford type A aortic dissection (TAAD) have not been previously investigated. METHODS This analysis included 3538 patients from a multicenter study who underwent surgery for acute TAAD and were admitted to the cardiac surgical ICU. RESULTS The mean length of stay in the cardiac surgical ICU was 9.9±9.5 days. The mean overall costs of treatment in the cardiac surgical ICU 24086±32084 €. In-hospital mortality was 14.8% and 5-year mortality was 30.5%. Adjusted analyses showed that prolonged ICU stay was associated with significantly lower risk of in-hospital mortality (adjusted OR 0.971, 95%CI 0.959-0.982), and of five-year mortality (adjusted OR 0.970, 95%CI 0.962-0.977), respectively. Propensity score matching analysis yielded 870 pairs of patients with short ICU stay (2-5 days) and long ICU stay (>5 days) with balanced baseline, operative and postoperative variables. Patients with prolonged ICU stay (>5 days) had significantly lower in-hospital mortality (8.9% vs. 17.4%, <0.001) and 5-year mortality (28.2% vs. 30.7%, P=0.007) compared to patients with short ICU-stay (2-5 days). CONCLUSIONS Prolonged ICU stay was common after surgery for acute TAAD. However, when adjusted for multiple baseline and operative variables as well as adverse postoperative events and the cluster effect of hospitals, it was associated with favorable survival up to 5 years after surgery.
Collapse
Affiliation(s)
- Fausto Biancari
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland -
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland -
| | - Amelié Hérve
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Caroline Radner
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany
- German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany
- German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Javier Rodriguez Lega
- Department of Cardiovascular Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | - Angel G Pinto
- Department of Cardiovascular Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | - Antonio Fiore
- Department of Cardiac Surgery, Henri Mondor University Hospitals, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Alessandra Francica
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Jan Rocek
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Igor Vendramin
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Luisa Ferrante
- Department of Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Clinical Hospital of Barcelona, University of Barcelona, Barcelona, Spain
| | - Eduard Quintana
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Dario DI Perna
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | | | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amer Harky
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Angelo M Dell'aquila
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
- Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
| | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| |
Collapse
|
4
|
Seret J, Bruyneel A, Larcin L, Gooset F, Azzi D, Martins D, Van Den Bulcke J, Leclercq P, Pirson M. Predictors and components of inpatient asthma hospital cost: A retrospective cohort study. Analysis from a sample of 14 Belgian hospitals. J Public Health Res 2024; 13:22799036241243270. [PMID: 38711424 PMCID: PMC11072054 DOI: 10.1177/22799036241243270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/14/2024] [Indexed: 05/08/2024] Open
Abstract
Background Addressing the challenges of asthma has involved various approaches, including the examination of costs associated with hospitalization. However, there is a limited number of studies that have investigated the actual expenses incurred by hospital settings in caring for asthma patients. This study aims to describe the costs, predictors, and breakdown of expenditures in different categories. Design and methods A retrospective cohort study was conducted, involving 314 hospital stays of patients over 12 years old who were admitted for asthma and classified under APR-DRG 141 (asthma). Univariate and multiple linear regression analyses were performed. Results The median cost, regardless of DRG severity, amounted to 2.314€ (1.550€-3.847€). Significant variations were observed when the sample was stratified based on the severity of DRG, revealing a cost gradient that increases with severity. The length of stay followed a similar trend. Six predictors were identified: age, admission to intensive care, asthma severity, severity level of the DRG, winter admission, and length of stay. The cost breakdown showed that 44% constituted direct costs, 25% were indirect costs, 26% were attributed to medical procedures performed outside the patient unit, and 5% were related to medication administration. Conclusions This study initiates a discussion on the role of reducing hospital costs in strategies aiming at controlling asthma-related costs. We argue that cost reduction cannot be achieved solely at the hospital level but must be approached from a public health perspective. This includes promoting high-quality outpatient care and addressing factors leading to poor adherence to the care plan.
Collapse
Affiliation(s)
- Jehan Seret
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Lionel Larcin
- Research Centre for Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabienne Gooset
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Djohra Azzi
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Dimitri Martins
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Van Den Bulcke
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Pol Leclercq
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
5
|
Frassanito L, Di Bidino R, Vassalli F, Michnacs K, Giuri PP, Zanfini BA, Catarci S, Filetici N, Sonnino C, Cicchetti A, Arcuri G, Draisci G. Personalized Predictive Hemodynamic Management for Gynecologic Oncologic Surgery: Feasibility of Cost-Benefit Derivatives of Digital Medical Devices. J Pers Med 2023; 14:58. [PMID: 38248759 PMCID: PMC10820080 DOI: 10.3390/jpm14010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Intraoperative hypotension is associated with increased perioperative complications, hospital length of stay (LOS) and healthcare expenditure in gynecologic surgery. We tested the hypothesis that the adoption of a machine learning-based warning algorithm (hypotension prediction index-HPI) might yield an economic advantage, with a reduction in adverse outcomes that outweighs the costs for its implementation as a medical device. METHODS A retrospective-matched cohort cost-benefit Italian study in gynecologic surgery was conducted. Sixty-six female patients treated with standard goal-directed therapy (GDT) were matched in a 2:1 ratio with thirty-three patients treated with HPI based on ASA status, diagnosis, procedure, surgical duration and age. RESULTS The most relevant contributor to medical costs was operating room occupation (46%), followed by hospital stay (30%) and medical devices (15%). Patients in the HPI group had EURO 300 greater outlay for medical devices without major differences in total costs (GDT 5425 (3505, 8127), HPI 5227 (4201, 7023) p = 0.697). A pre-specified subgroup analysis of 50% of patients undergoing laparotomic surgery showed similar medical device costs and total costs, with a non-significant saving of EUR 1000 in the HPI group (GDT 8005 (5961, 9679), HPI 7023 (5227, 11,438), p = 0.945). The hospital LOS and intensive care unit stay were similar in the cohorts and subgroups. CONCLUSIONS Implementation of HPI is associated with a scenario of cost neutrality, with possible economic advantage in high-risk settings.
Collapse
Affiliation(s)
- Luciano Frassanito
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Rossella Di Bidino
- Department of Health Technology, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy; (R.D.B.); (G.A.)
| | - Francesco Vassalli
- Department of Critical Care and Perinatal Medicine, IRCCS Istituto G. Gaslini, 16147 Genoa, Italy;
| | | | - Pietro Paolo Giuri
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Bruno Antonio Zanfini
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Stefano Catarci
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Nicoletta Filetici
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Chiara Sonnino
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Americo Cicchetti
- Department of Management Studies, Faculty of Economics, Catholic University of Sacred Heart, 00168 Rome, Italy;
| | - Giovanni Arcuri
- Department of Health Technology, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy; (R.D.B.); (G.A.)
| | - Gaetano Draisci
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| |
Collapse
|