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Çetin B, Çilesiz NC, Ozkan A, Onuk Ö, Kır G, Balci MBC, Özdemir E. Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Length of Hospital Stay in Radical Cystectomy: A Prospective Randomized Controlled Study. Cureus 2024; 16:e55460. [PMID: 38571847 PMCID: PMC10988186 DOI: 10.7759/cureus.55460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/05/2024] Open
Abstract
Enhanced recovery after surgery (ERAS) protocols challenge the conventional and rigid methods of surgery and anesthesia and bring about novel changes that are quite drastic. The core principle of the protocol is to minimize the metabolic disturbance caused by surgical injury, facilitate the restoration of functions in a brief period, and promote the resumption of normal activity at the earliest. To compare the outcomes of ERAS and standard protocol for patients who have undergone radical cystectomy (RC) with ileal conduit urinary diversion. This prospective randomized controlled study was performed between 2015 and 2023. The 77 patients were divided into two groups ERAS (n=39) and Standard (n=38) by sequential randomization. These two groups are divided according to protocols of bowel preparation, anesthesia, and postoperative nutrition. The clinical and demographic characteristics of the patients, and the American Society of Anesthesiologists (ASA) and Eastern Cooperative Oncology Group (ECOG) scores were recorded. Perioperative findings, the degree of complications according to the Clavien-Dindo classification, and the total cost of treatment were recorded and analyzed. Length of hospital stay (18.82±9.25 day vs 27.34±15.05 day), and cost of treatment (2168,2±933$ 2879±1806$) were higher in the standard group. The rate of nausea and vomiting and the use of antiemetics were higher in the ERAS group compared to the standard group. In patients undergoing RC, the ERAS protocol was found to shorten the duration of hospitalization and reduce the total cost of hospital stay.
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Affiliation(s)
- Buğra Çetin
- Urology, Altınbaş University Medicalpark Bahçelievler Hospital, Istanbul, TUR
| | | | | | - Özkan Onuk
- Urology, Biruni University Hospital, Istanbul, TUR
| | - Gülay Kır
- Anesthesiology and Reanimation, Koç University, Istanbul, TUR
| | - M B Can Balci
- Urology, Taksim Training and Research Hospital, Istanbul, TUR
| | - Enver Özdemir
- Urology, Gaziosmanpaşa Training and Research Hospital, Istanbul, TUR
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Lemley BA, Wu L, Roberts AL, Shinohara RT, Quarshie WO, Qureshi AM, Smith CL, Dori Y, Gillespie MJ, Rome JJ, Glatz AC, Amaral S, O'Byrne ML. Trends in Ductus Arteriosus Stent Versus Blalock-Taussig-Thomas Shunt Use and Comparison of Cost, Length of Stay, and Short-Term Outcomes in Neonates With Ductal-Dependent Pulmonary Blood Flow: An Observational Study Using the Pediatric Health Information Systems Database. J Am Heart Assoc 2023; 12:e030575. [PMID: 38038172 PMCID: PMC10727347 DOI: 10.1161/jaha.123.030575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The modified Blalock-Taussig-Thomas shunt is the gold standard palliation for securing pulmonary blood flow in infants with ductal-dependent pulmonary blood flow. Recently, the ductus arteriosus stent (DAS) has become a viable alternative. METHODS AND RESULTS This was a retrospective multicenter study of neonates ≤30 days undergoing DAS or Blalock-Taussig-Thomas shunt placement between January 1, 2017 and December 31, 2020 at hospitals reporting to the Pediatric Health Information Systems database. We performed generalized linear mixed-effects modeling to evaluate trends in intervention and intercenter variation, propensity score adjustment and inverse probability weighting with linear mixed-effects modeling to analyze length of stay and cost of hospitalization, and generalized linear mixed modeling to analyze differences in 30-day outcomes. There were 1874 subjects (58% male, 61% White) from 45 centers (29% DAS). Odds of DAS increased with time (odds ratio [OR] 1.23, annually, P<0.01 [95% CI, 1.10-1.38]) with significant intercenter variation (median OR, 3.81 [95% CI, 2.74-5.91]). DAS was associated with shorter hospital length of stay (ratio of geometric means, 0.76 [95% CI, 0.63-0.91]), shorter intensive care unit length of stay (ratio of geometric means, 0.77 [95% CI, 0.61-0.97]), and less expensive hospitalization (ratio of geometric means, 0.70 [95% CI, 0.56-0.87]). Intervention was not significantly associated with odds of 30-day transplant-free survival (OR,1.18 [95% CI, 0.70-1.99]) or freedom from catheter reintervention (OR, 1.02 [95% CI, 0.65-1.58]), but DAS was associated with 30-day freedom from composite adverse outcome (OR, 1.51 [95% CI, 1.11-2.05]). CONCLUSIONS Use of DAS is increasing, but there is variability across centers. Though odds of transplant-free survival and reintervention were not significantly different after DAS, and DAS was associated with shorter length of stay and lower in-hospital costs.
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Affiliation(s)
- Bethan A. Lemley
- Division of CardiologyLurie Children’s HospitalChicagoILUSA
- Department of PediatricsFeinberg School of Medicine Northwestern UniversityChicagoILUSA
| | - Lezhou Wu
- Department of Biomedical and Health InformaticsChildren’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Amy L. Roberts
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, and InformaticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - William O. Quarshie
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Athar M. Qureshi
- Division of CardiologyTexas Children’s HospitalHoustonTXUSA
- Department of Pediatrics Baylor College of MedicineHoustonTXUSA
| | - Christopher L. Smith
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Yoav Dori
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Matthew J. Gillespie
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Jonathan J. Rome
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Andrew C. Glatz
- Division of CardiologySt. Louis Children’s HospitalSt. LouisMOUSA
- Department of PediatricsWashington University School of MedicineSt. LouisMOUSA
| | - Sandra Amaral
- Division of NephrologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of PediatricsPerelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Michael L. O'Byrne
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
- Clinical Futures, The Children’s Hospital of Philadelphia and Leonard Davis Institute and Cardiovascular Outcomes, Quality, and Evaluative Research CenterPerelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
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Palal D, Jadhav SL, Gangurde S, Thakur K, Rathod H, S J, Verma P, Nallapu S, Revikumar A, Nair GR. People's Perspective on Out-of-Pocket Expenditure for Healthcare: A Qualitative Study From Pune, India. Cureus 2023; 15:e34670. [PMID: 36909087 PMCID: PMC9993438 DOI: 10.7759/cureus.34670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Background Out-Of-Pocket Expenditure (OOPE) directly reflects the burden of health expenses that households bear. Despite the availability of social security schemes providing healthcare benefits, a high proportion of Indian households are still incurring OOPE. In order to recognize the reasons behind OOPE, a comprehensive understanding of people's attitudes and behavior is needed. Methodology By purposive sampling, 16 in-depth interviews were conducted using an interview guide in the catchment area of urban and rural health centers of a tertiary healthcare hospital. Interviews were conducted in Marathi and Hindi and were audio tape-recorded after taking informed consent. The interviews were transcribed and translated into English, followed by a thematic analysis. Results Although most participants knew that government hospitals provide facilities and experienced doctors, inconvenience and unsatisfactory quality deter them from utilizing government facilities. A few had experiences with government schemes; almost all concur that the formality and procedure of claiming insurance are cumbersome and all have had bad experiences. Cost of medications and consultation accounted for the majority of the healthcare expenditures. While some participants had benefitted from insurance, few regretted not enrolling in one. Conclusion The awareness regarding government schemes was derisory. Government-financed health insurance schemes and their utilization are crucial to reducing OOPE. Efforts should be made to increase accessibility to public healthcare services. Nevertheless, there is potential to redress the barriers to improve scheme utilization.
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Affiliation(s)
- Deepu Palal
- Community Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, IND
| | - Sudhir L Jadhav
- Community Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, IND
| | - Shweta Gangurde
- Community Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, IND
| | - Kavita Thakur
- Community Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, IND
| | - Hetal Rathod
- Community Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, IND
| | - Johnson S
- Community Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, IND
| | - Prerna Verma
- Community Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, IND
| | - Sandeep Nallapu
- Community Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, IND
| | - Akhil Revikumar
- Community Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, IND
| | - Gayatri R Nair
- Community Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, IND
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Taha A, Xu H, Ahmed R, Karim A, Meunier J, Paul A, Jawad A, Patel ML. Medical and economic burden of delirium on hospitalization outcomes of acute respiratory failure: A retrospective national cohort. Medicine (Baltimore) 2023; 102:e32652. [PMID: 36637939 PMCID: PMC9839276 DOI: 10.1097/md.0000000000032652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Although delirium in patients with acute respiratory failure (ARF) may evolve in any hospital setting, previous studies on the impact of delirium on ARF were restricted to those in the intensive care unit (ICU). The data about the impact of delirium on ARF hospitalizations outside of the ICU is limited. Therefore, we conducted the first national study to examine the effect-magnitude of delirium on ARF in all hospital settings, that is, in the ICU as well as on the general medical floor. We searched the 2016 and 2017 National Inpatient Sample databases for ARF hospitalizations and created "Delirium" and "No delirium" groups. The outcomes of interest were mortality, endotracheal intubation, length of stay (LOS), and hospitalization costs. We also aimed to explore any potential demographic, racial, or healthcare disparities that may be associated with the diagnosis of delirium among ARF patients. Multivariable logistic regression was used to control for demographics and comorbidities. Delirium was present in 12.7% of the sample. Racial disparities among African Americans were also significant. Delirious patients had more comorbidities, higher mortality, and intubation rates (17.5% and 9.2% vs 10.6% and 6.1% in the "No delirium" group [P < .001], respectively). Delirious patients had a longer LOS and higher hospitalization costs (5.9 days and $15,395 USD vs 3.7 days and $9393 USD in "No delirium" [P < .001], respectively). Delirium was associated with worse mortality (adjusted odds ratio 1.49, confidence interval [CI] = 1.41, 1.57), higher intubation rates (adjusted odds ratio 1.46, CI = 1.36, 1.56), prolonged LOS (adjusted mean ratio 1.40, CI = 1.37, 1.42), and increased hospitalization costs (adjusted mean ratio 1.49, CI = 1.46, 1.52). A racial disparity in the diagnosis of delirium among African Americans hospitalized with ARF was noted in our sample. Patients in small, non-teaching hospitals were diagnosed with delirium less frequently compared to large, urban, teaching centers. Delirium predicts worse mortality and morbidity for ARF patients, regardless of bed placement and severity of the respiratory failure.
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Affiliation(s)
- Ahmed Taha
- School of Medicine, Indiana University, Indianapolis, IN
- Department of Medicine, Deaconess Health System, Evansville, IN
- * Correspondence: Ahmed Taha, Deaconess Health System, 600 Mary St, Evansville, IN (e-mail: )
| | - Huiping Xu
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN
| | - Roaa Ahmed
- School of Medicine, Ahfad University for Women, Omdurman, Sudan
| | - Ahmad Karim
- Department of Medicine, Deaconess Health System, Evansville, IN
| | - John Meunier
- Department of Medicine, Deaconess Health System, Evansville, IN
| | - Amal Paul
- School of Medicine, Indiana University, Indianapolis, IN
- Department of Medicine, Deaconess Health System, Evansville, IN
| | - Ahmed Jawad
- School of Medicine, Indiana University, Indianapolis, IN
- Department of Pulmonary and Critical Care, Deaconess Health System, Evansville, IN
| | - Manish L. Patel
- Division of Pulmonary & Critical Care, Texas Tech University Health Sciences Center, Amarillo, TX
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Foster B, Liaqat A, Farooq A, Kulkarni S, Mandyam S, Patak P, Zaman M, Kaur P, Tosto S, Kendig A. Temporal Trends for Patients Hospitalized With Atrial Fibrillation in the United States: An Analysis From the National Inpatient Sample (NIS) Database 2011-2018. Cureus 2022; 14:e25694. [PMID: 35812615 PMCID: PMC9259079 DOI: 10.7759/cureus.25694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Atrial fibrillation (AF) has historically been a growing burden on the global public health system. Previously, literature on the trends associated with AF-related hospitalizations has been published. However, there seems to be a gap in up-to-date information, notably within the last decade. Purpose: This study aims to investigate the trends, outcomes, and factors associated with AF hospitalization and the continued impact of AF on the United States health system. Methods: Patient data were collected from the years 2011 to 2018 from the National Inpatient Sample (NIS) database using the International Classification of Diseases (ICD)-9 and ICD-10 codes. We selected patients hospitalized with a diagnosis of AF. Descriptive statistics, statistical analysis, and Mann-Whitney U testing were employed to compare continuous dichotomous variables. After respective adjustments, multivariate hierarchical logistic regression was used to establish mortality rates, length of stay (LOS), and hospital charges. Results: The study included 509,305 patients hospitalized with a primary diagnosis of unspecified AF. The mean age of patients hospitalized with AF was 71 years. AF hospitalizations were slightly higher in women as compared to men (51.7% vs. 48.2%). The predominant race involved was Caucasians at 77.9% followed by African Americans and Hispanics at 7.4% and 5.4%, respectively. The three most frequent coexisting conditions noted were hypertension (69.9%), diabetes mellitus (24.3%), and chronic obstructive pulmonary disease (16.4%). Medicare/Medicaid was the primary payer associated with the majority of AF hospitalizations at 72.6%. Overall in-hospital mortality associated with AF hospitalizations was 0.96%. Comorbid conditions conferring the highest mortality risks included coagulopathies (644%) and cerebral vascular accidents (597%). Mean LOS was found to be 3.35 days. Hospitalization charges increased year-over-year and correlated with an increase in the national burden of cost for these patients of $3.6 billion. Conclusions: Our study investigates the national trends surrounding AF hospitalizations. Overall in-hospital mortality rates appear to be stable as compared to prior years and past literature. Comorbid conditions conferring significantly higher mortality rates included coagulopathies, cerebral vascular accidents, acute kidney injury, and end-stage renal disease. Additionally, suboptimal insurance status was also associated with increased mortality risk. The cost of hospitalization in AF patients has increased steadily, conferring a $3.6 billion burden on the US healthcare system.
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Affiliation(s)
- Brian Foster
- Internal Medicine, Southeast Health, Dothan, USA
| | - Adnan Liaqat
- Internal Medicine, Southeast Health, Dothan, USA
| | - Awais Farooq
- Internal Medicine, Southeast Health, Dothan, USA
| | | | | | - Pooja Patak
- Internal Medicine, Southeast Health, Dothan, USA
| | - Mo Zaman
- Internal Medicine, Southeast Health, Dothan, USA
| | | | | | - Arthur Kendig
- Cardiovascular Diseases, Southeast Health, Dothan, USA
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Huang H, Zhou Q, Chen MH. High-volume hemofiltration reduces short-term mortality with no influence on the incidence of MODS, hospital stay, and hospitalization cost in patients with severe-acute pancreatitis: A meta-analysis. Artif Organs 2021; 45:1456-1465. [PMID: 34240469 DOI: 10.1111/aor.14016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/08/2021] [Accepted: 06/15/2021] [Indexed: 12/22/2022]
Abstract
This study aimed to investigate the efficiency, safety and cost-efficiency of blood purification (BP) in treating patients with severe-acute pancreatitis (SAP). A literature search was conducted using PubMed, OVID, International Clinical Trials Register (ICTRP), and Cochrane Central Register of Controlled Trials (CENTRAL). A total of 11 prospective studies and 6 retrospective studies, which reported the mortality of 1279 SAP patients, were included for analysis. Decreased short-term mortality and incidence rate of infection were observed in the high-volume hemofiltration (HVHF) group, but not in patients treated with other types of BP. There was no significant difference in the incidence of multiple-organ dysfunction (MODS), duration of hospital stay, or cost of hospitalization between the BP and non-BP groups. The starting time point, substitution fluid flow rate, filter membrane type, hemofilter change interval, anticoagulation, and sustaining times of BP varied across studies. In conclusion, HVHF may reduce the short-term mortality (<4 weeks), not long-term mortality, of SAP patients by decreasing the incidence of infection, while other types of BP did not show a significant beneficial effect. Neither HVHF nor other BP patterns affect the duration of hospital stay, cost of hospitalization, or incidence of MODS in SAP patients.
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Affiliation(s)
- Hongwei Huang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning City, China
| | - Qin Zhou
- Department of Medical Record, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning City, China
| | - Meng-Hua Chen
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning City, China
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Namdev V, Haneef G, Khan AT, Basith SA, Virani A, Canenguez Benitez JS, Sejdiu A, Mathialagan K, Majumder P. Psychiatric Comorbidities Affect the Hospitalization Course of Parkinson's Disease Patients: A Cross-Sectional Inpatient Study. Cureus 2021; 13:e16255. [PMID: 34373816 PMCID: PMC8346264 DOI: 10.7759/cureus.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives We aim to delineate the differences in demographic characteristics and hospitalization outcomes including the severity of illness, hospitalization length of stay (LOS) and cost, utilization of deep brain stimulation (DBS), and disposition in Parkinson’s disease (PD) inpatients with psychiatric comorbidities versus without psychiatric comorbidities. Methods We conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS), included 56,844 PD inpatients (age ≥40 years), and subdivided them by inpatients into those without psychiatric comorbidities (N = 38,629) and with psychiatric comorbidities (N = 18,471). We compared the distributions of demographic characteristics and hospitalization outcomes (severity of illness, utilization ofDBS, and disposition) by performing Pearson’s chi-square test, and we measured the differences in continuous variables (i.e., age, LOS, and cost) by using the independent samples t-test. Results A significantly higher proportion of PD inpatients with psychiatric comorbidities were female (44.4%) and white (83%) and had a moderate loss of functioning (48.8%) compared to those without psychiatric comorbidities. PD inpatients with psychiatric comorbidities had an increased mean LOS (4.7 days vs. 3.7 days, P <0.001) but a lower mean cost ($37,445 vs. $ 41,957, P <0.001). Also, there was a significantly lower utilization of DBS in PD inpatients with psychiatric comorbidities (19.2% vs. 26.9%, P <0.001) compared to those without psychiatric comorbidities, and an adverse disposition of transfer to a skilled nursing facility/intermediate care facility (47.1% vs. 39.6%, P <0.001) compared to PD inpatients without psychiatric comorbidities. Conclusion Although PD patients with psychiatric comorbidities had a moderate loss of functioning, there was significant underutilization of DBS. Meanwhile, psychiatric comorbidities among PD patients led to increased LOS and transfer to skilled facilities.
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Affiliation(s)
- Vaishalee Namdev
- Medicine and Surgery, Mahatma Gandhi Memorial Medical College, Indore, IND
| | - Goher Haneef
- Internal Medicine, University of Health Sciences, Lahore, PAK.,Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, USA
| | - Asma T Khan
- Internal Medicine, Larkin Community Hospital, South Miami, USA
| | - Sayeda A Basith
- Psychiatry and Behavioral Sciences, Medical University of the Americas, Charlestown, KNA
| | - Anuj Virani
- Family Medicine, Windsor University School of Medicine, Cayon, KNA
| | | | - Albulena Sejdiu
- Psychiatry, Saints Cyril and Methodius Hospital, Kumanovo, MKD
| | | | - Pradipta Majumder
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA.,Psychiatry, WellSpan Health, York, USA
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Bhatt P, Umscheid J, Parmar N, Vasudeva R, Patel KG, Ameley A, Donda K, Policano B, Dapaah-Siakwan F. Predictors of Length of Stay and Cost of Hospitalization of Neonatal Abstinence Syndrome in the United States. Cureus 2021; 13:e16248. [PMID: 34373810 PMCID: PMC8346607 DOI: 10.7759/cureus.16248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 01/23/2023] Open
Abstract
Background The incidence rate and economic burden of neonatal abstinence syndrome (NAS) are increasing in the United States (US). We explored the link between the length of stay (LOS) and hospitalization cost for neonatal abstinence syndrome in 2018. Methods This was a cross-sectional analysis of the 2018 national inpatient sample database. Newborn hospitalizations with neonatal abstinence syndrome and their accompanying comorbid conditions were identified using the International Classification of Diseases, 10th Edition diagnostic codes. Logistic regression was used to determine the impact of length of stay and the co-morbidities on inflation-adjusted hospital costs. Results The incidence of neonatal abstinence syndrome was 7.1 per 1000 births (95% CI 6.8-7.3) in 2018. The majority had Medicaid (84.1%), with a neonatal abstinence syndrome incidence of 13.2 (95% CI: 12.8-13.6). In adjusted analysis, every one-day increase in length of stay increased the hospital cost by $1,685 (95% CI: 1,639-1,731). Neonatal abstinence syndrome hospitalizations with Medicaid had a longer length of stay by 1.8 days (95% CI: 0.5-3.1). Co-morbidities further increased the length of stay: seizures: 13.8 days; sepsis: 4.1 days; respiratory complications: 4.4 days; and feeding problems: 5.8 days. Those at urban teaching hospitals had a longer length of stay by 7.3 days (95% CI: 5.8-8.8). Co-morbidities increased hospital cost as follows: seizures: $71,380; sepsis: $12,837; respiratory complications: $8,268; feeding problems: $7,737. The cost of hospitalization at large bed-size hospitals and urban teaching was higher by $5,243 and $12,005, respectively. Conclusion The incidence rate of neonatal abstinence syndrome remained high and was resource-intensive in 2018. Co-morbid conditions and hospitalization at urban teaching hospitals were major contributors to increased length of stay and hospital costs.
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Affiliation(s)
- Parth Bhatt
- Pediatrics, United Hospital Center, Bridgeport, USA
| | - Jacob Umscheid
- Pediatrics, University of Kansas School of Medicine - Wichita, Wichita, USA
| | | | - Rhythm Vasudeva
- Internal Medicine/Pediatrics, University of Kansas, Wichita, USA
| | - Kripa G Patel
- Pediatrics, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Akosua Ameley
- Pediatrics, Greater Accra Regional Hospital, Accra, GHA
| | - Keyur Donda
- Pediatrics/Neonatology, University of South Florida, Tampa, USA
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Barreto MFC, Dellaroza MSG, Fernandes KBP, Pissinati PDSC, Galdino MJQ, Haddad MDCFL. Hospitalization costs and their determining factors among patients undergoing kidney transplantation: a cross-sectional descriptive study. SAO PAULO MED J 2019; 137:498-504. [PMID: 32159635 PMCID: PMC9754272 DOI: 10.1590/1516-3180.2018.055117092019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/17/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cost evaluation is a key tool in monitoring expenditure for budget management. It increases the efficiency of possible changes through identifying potential savings and estimating the resources required to make such changes. However, there is a lack of knowledge of the total cost of hospitalization up to the clinical outcome, regarding patients admitted for kidney transplantation. Likewise, there is a lack of data on the factors that influence the amounts spent by hospital institutions and healthcare systems. OBJECTIVES To describe the costs and determining factors relating to hospitalization of patients undergoing kidney transplantation. DESIGN AND SETTING Cross-sectional descriptive study with a quantitative approach based on secondary data from 81 patients who were admitted for kidney transplantation at a leading transplantation center in southern Brazil. METHODS The direct costs of healthcare for patients who underwent kidney transplantation were the dependent variable, and included personnel, expenses, third-party services, materials and medicines. The factors that interfered in the cost of the procedure were indirect variables. The items that made up these variables were gathered from the records of the internal transplantation committee and from the electronic medical records. The billing sector provided information on the direct costs per patient. RESULTS The estimated total cost of patients' hospitalization was R$ 1,257,639.11 (US$ 571,010.44). Out of this amount, R$ 1,237,338.31 (US$ 561,793.20) was paid by the Brazilian National Health System and R$ 20,300.80 (US$ 9,217.24) by the transplantation center's own resources. The highest costs related to the length of hospital stay and clinical complications such as sepsis and pneumonia. CONCLUSIONS The costs of hospitalization for kidney transplantation relate to the length of hospital stay and clinical complications.
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Affiliation(s)
| | | | - Karen Barros Parron Fernandes
- PhD. Dentist and Professor, Rehabilitation Sciences Program, Universidade do Norte do Paraná, Londrina (PR), Brazil.
| | | | - Maria José Quina Galdino
- PhD. Nurse and Professor, Nursing Department, Universidade Estadual do Norte do Paraná, Bandeirantes (PR) Brazil.
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McCarthy BC, Tuiskula KA, Driscoll TP, Davis AM. Medication errors resulting in harm: Using chargemaster data to determine association with cost of hospitalization and length of stay. Am J Health Syst Pharm 2019; 74:S102-S107. [PMID: 29167147 DOI: 10.2146/ajhp160848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of an analysis of the economic impact of adverse drug events (ADEs) resulting in patient harm on hospitalization costs and length of stay (LOS) are reported. METHODS In a retrospective single-site study, medication errors among patients admitted to an academic medical center during the period April 2014-May 2015 were identified using voluntary event reporting system data and diagnosis codes. Hospitalization cases involving documented ADEs resulting in harm, as defined on a widely used medication error classification index, were matched with control cases by admission period, diagnosis-related group, and patient age and sex. Total hospitalization costs and LOS in the study groups were analyzed using an independent 2-sample Mann-Whitney U test. RESULTS Among 416 hospitalization cases evaluated for inclusion in the study, 242 were matched with 3,279 control cases for analysis. The primary drug classes implicated in the evaluated medication errors included chemotherapy agents (38%), corticosteroids (14%), and opioids (11%). Total hospitalization costs differed significantly (p = 0.044) between patients who experienced ADEs resulting in harm (median, $19,444; interquartile range [IQR], $13,481-$40,580) and those who did not (median, $17,173; IQR, $12,500-$27,125); the former group also had a significantly (p = 0.005) longer median LOS. CONCLUSION Chargemaster data for an academic medical center revealed that the median total hospitalization cost and LOS were significantly greater for hospitalizations during which a harm-causing medication error was recorded versus hospitalizations during which harm-causing medication errors were not recorded.
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Affiliation(s)
| | | | | | - Andrew M Davis
- Section of General Internal Medicine, University of Chicago, Chicago, IL
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Abstract
OBJECTIVES The prime objective of this study is to examine the trends of disease and age pattern of hospitalisation and associated costs in India during 1995-2014. DESIGN Present study used nationally representative data on morbidity and healthcare from the 52nd (1995) and 71st (2014) rounds of the National Sample Survey. SETTINGS A total of 120 942 and 65 932 households were surveyed in 1995 and 2014, respectively. MEASURES Descriptive statistics, logistic regression analyses and decomposition analyses were used in examining the changes in patterns of hospitalisation and associated costs. Hospitalisation rates and costs per hospitalisation (out-of-pocket expenditure) were estimated for selected diseases and in four broad categories: communicable diseases, non-communicable diseases (NCDs), injuries and others. All the costs are presented at 2014 prices in US$. RESULTS Hospitalisation rate in India has increased from 1661 in 1995 to 3699 in 2014 (per 100 000 population). It has more than doubled across all age groups. Hospitalisation among children was primarily because of communicable diseases, while NCDs were the leading cause of hospitalisation for the 40+ population. Costs per hospitalisation have increased from US$177 in 1995 to US$316 in 2014 (an increase of 79%). Costs per hospitalisation for NCDs in 2014 were US$471 compared with US$175 for communicable diseases. It was highest for cancer inpatients (US$942) followed by heart diseases (US$674). Age is the significant predictor of hospitalisation for all the selected diseases. Decomposition results showed that about three-fifth of the increase in unconditional costs per hospitalisation was due to increase in mean hospital costs, and the other two-fifth was due to increase in hospitalisation rates. CONCLUSION There has been more than twofold increase in hospitalisation rates in India during the last two decades, and significantly higher rates were observed among infants and older adults. Increasing hospitalisation rates and costs per hospitalisation are contributing substantially to the rising healthcare costs in India.
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Affiliation(s)
- Anshul Kastor
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Sanjay K Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
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Abstract
BACKGROUND Patients with status migrainosus often need to be admitted due to the severity of their headaches. Their hospitalization is often prolonged due to poor headache control. Large sample studies looking into the factors associated with prolonged length of stay (pLOS) in status migrainosus are lacking. METHODS We utilized the Nationwide Inpatient Sample database to identify 4325 patients with primary discharge diagnosis of status migrainosus. Length of inpatient stay (LOS) of more than 6 days (90th percentile of LOS) was defined as pLOS. Patient demographics, hospital characteristics, mood disorders, anxiety disorder, and common medical comorbidities were identified. Multivariable logistic regression was used to identify factors associated with pLOS. RESULTS We found 402 patients with pLOS. Female gender, African American race, mood disorder, obesity, opioid abuse, congestive heart failure, and chronic renal failure were significant independent predictors of pLOS. Median inflation-adjusted cost of hospitalization was USD$3829 (interquartile range: 2419-5809). CONCLUSION We were able to identify several factors associated with pLOS in status migrainosus. Most of the factors we found were similar to those known to increase the prevalence and severity of migraine in the general population. Knowledge of these factors may help physicians identify high-risk patients to institute early migraine abortive and prophylactic treatment in order to shorten the length of hospital stay.
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Affiliation(s)
- S Y Modi
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - D Dharaiya
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - A M Katramados
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - P Mitsias
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
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