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Park DY, Singireddy S, Mangalesh S, Fishman E, Ambrosini A, Jamil Y, Vij A, Sikand NV, Ahmad Y, Frampton J, Nanna MG. The association of timing of coronary artery bypass grafting for non-ST-elevation myocardial infarction and clinical outcomes in the contemporary United States. Coron Artery Dis 2024; 35:261-269. [PMID: 38164979 DOI: 10.1097/mca.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND In contrast to the timing of coronary angiography and percutaneous coronary intervention, the optimal timing of coronary artery bypass grafting (CABG) in non-ST-elevation myocardial infarction (NSTEMI) has not been determined. Therefore, we compared in-hospital outcomes according to different time intervals to CABG surgery in a contemporary NSTEMI population in the USA. METHODS We identified all NSTEMI hospitalizations from 2016 to 2020 where revascularization was performed with CABG. We excluded NSTEMI with high-risk features using prespecified criteria. CABG was stratified into ≤24 h, 24-72 h, 72-120 h, and >120 h from admission. Outcomes of interest included in-hospital mortality, perioperative complications, length of stay (LOS), and hospital cost. RESULTS A total of 147 170 NSTEMI hospitalizations where CABG was performed were assessed. A greater percentage of females, Blacks, and Hispanics experienced delays to CABG surgery. No difference in in-hospital mortality was observed, but CABG at 72-120 h and at >120 h was associated with higher odds of non-home discharge and acute kidney injury compared with CABG at ≤24 h from admission. In addition to these differences, CABG at >120 h was associated with higher odds of gastrointestinal hemorrhage and need for blood transfusion. All 3 groups with CABG delayed >24 h had longer LOS and hospital-associated costs compared with hospitalizations where CABG was performed at ≤24 h. CONCLUSION CABG delays in patients with NSTEMI are more frequently experienced by women and minority populations and are associated with an increased burden of complications and healthcare cost.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, Illinois
| | | | - Sridhar Mangalesh
- Department of Medicine, Army College of Medical Sciences, New Delhi, Delhi, India
| | | | | | - Yasser Jamil
- Department of Medicine, Yale-Waterbury Hospital, New Haven, Connecticut
| | - Aviral Vij
- Division of Cardiology, Cook County Health
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Nikhil V Sikand
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Frampton
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Skinner S, Pascal L, Polazzi S, Chollet F, Lifante JC, Duclos A. Economic analysis of surgical outcome monitoring using control charts: the SHEWHART cluster randomised trial. BMJ Qual Saf 2024; 33:284-292. [PMID: 37553238 DOI: 10.1136/bmjqs-2022-015390] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/27/2023] [Indexed: 08/10/2023]
Abstract
IMPORTANCE Surgical complications represent a considerable proportion of hospital expenses. Therefore, interventions that improve surgical outcomes could reduce healthcare costs. OBJECTIVE Evaluate the effects of implementing surgical outcome monitoring using control charts to reduce hospital bed-days within 30 days following surgery, and hospital costs reimbursed for this care by the insurer. DESIGN National, parallel, cluster-randomised SHEWHART trial using a difference-in-difference approach. SETTING 40 surgical departments from distinct hospitals across France. PARTICIPANTS 155 362 patients over the age of 18 years, who underwent hernia repair, cholecystectomy, appendectomy, bariatric, colorectal, hepatopancreatic or oesophageal and gastric surgery were included in analyses. INTERVENTION After the baseline assessment period (2014-2015), hospitals were randomly allocated to the intervention or control groups. In 2017-2018, the 20 hospitals assigned to the intervention were provided quarterly with control charts for monitoring their surgical outcomes (inpatient death, intensive care stay, reoperation and severe complications). At each site, pairs, consisting of one surgeon and a collaborator (surgeon, anaesthesiologist or nurse), were trained to conduct control chart team meetings, display posters in operating rooms, maintain logbooks and design improvement plans. MAIN OUTCOMES Number of hospital bed-days per patient within 30 days following surgery, including the index stay and any acute care readmissions related to the occurrence of major adverse events, and hospital costs reimbursed for this care per patient by the insurer. RESULTS Postintervention, hospital bed-days per patient within 30 days following surgery decreased at an adjusted ratio of rate ratio (RRR) of 0.97 (95% CI 0.95 to 0.98; p<0.001), corresponding to a 3.3% reduction (95% CI 2.1% to 4.6%) for intervention hospitals versus control hospitals. Hospital costs reimbursed for this care per patient by the insurer significantly decreased at an adjusted ratio of cost ratio (RCR) of 0.99 (95% CI 0.98 to 1.00; p=0.01), corresponding to a 1.3% decrease (95% CI 0.0% to 2.6%). The consumption of a total of 8910 hospital bed-days (95% CI 5611 to 12 634 bed-days) and €2 615 524 (95% CI €32 366 to €5 405 528) was avoided in the intervention hospitals postintervention. CONCLUSIONS Using control charts paired with indicator feedback to surgical teams was associated with significant reductions in hospital bed-days within 30 days following surgery, and hospital costs reimbursed for this care by the insurer. TRIAL REGISTRATION NUMBER NCT02569450.
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Affiliation(s)
- Sarah Skinner
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Léa Pascal
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Stéphanie Polazzi
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | | | - Jean-Christophe Lifante
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Department of Endocrine Surgery, Hospices Civils de Lyon, Lyon, France
| | - Antoine Duclos
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital - Harvard Medical School, Boston, MA, USA
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Trippoli S, Fadda V, Messori A. In-hospital expenditure for medical devices: basic benchmarks for interpreting local data. Eur J Hosp Pharm 2024; 31:285-286. [PMID: 37369594 PMCID: PMC11042459 DOI: 10.1136/ejhpharm-2023-003885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
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4
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He ZQ, Mao YL, Lv TR, Liu F, Li FY. A meta-analysis between robotic hepatectomy and conventional open hepatectomy. J Robot Surg 2024; 18:166. [PMID: 38587718 DOI: 10.1007/s11701-024-01882-1] [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] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/22/2024] [Indexed: 04/09/2024]
Abstract
Current meta-analysis was performed to compare robotic hepatectomy (RH) with conventional open hepatectomy (OH) in terms of peri-operative and postoperative outcomes. PubMed, EMBASE, and the Cochrane Library were all searched up for comparative studies between RH and OH. RevMan5.3 software and Stata 13.0 software were used for statistical analysis. Nineteen studies with 1747 patients who received RH and 23,633 patients who received OH were included. Pooled results indicated that patients who received RH were generally younger than those received OH (P < 0.00001). Moreover, RH was associated with longer operative time (P = 0.0002), less intraoperative hemorrhage (P < 0.0001), lower incidence of intraoperative transfusion (P = 0.003), lower incidence of postoperative any morbidity (P < 0.00001), postoperative major morbidity (P = 0.0001), mortalities with 90 days after surgery (P < 0.0001), and shorter length of postoperative hospital stay (P < 0.00001). Comparable total hospital costs were acquired between RH and OH groups (P = 0.46). However, even at the premise of comparable R0 rate (P = 0.86), RH was associated with smaller resected tumor size (P < 0.00001). Major hepatectomy (P = 0.02) and right posterior hepatectomy (P = 0.0003) were less frequently performed in RH group. Finally, we concluded that RH was superior to OH in terms of peri-operative and postoperative outcomes. RH could lead to less intraoperative hemorrhage, less postoperative complications and an enhanced postoperative recovery. However, major hepatectomy and right posterior hepatectomy were still less frequently performed via robotic approach. Future more powerful well-designed studies are required for further exploration.
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Affiliation(s)
- Zhi-Qiang He
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ya-Ling Mao
- Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tian-Run Lv
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fei Liu
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fu-Yu Li
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Azimuddin A, Tzeng CWD, Prakash LR, Bruno ML, Arvide EM, Dewhurst WL, Newhook TE, Kim MP, Ikoma N, Snyder RA, Lee JE, Perrier ND, Katz MH, Maxwell JE. Postoperative Global Period Cost Reduction Using 3 Successive Risk-Stratified Pancreatectomy Clinical Pathways. J Am Coll Surg 2024; 238:451-459. [PMID: 38180055 DOI: 10.1097/xcs.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND We hypothesized that iterative revisions of our original 2016 risk-stratified pancreatectomy clinical pathways would be associated with decreased 90-day perioperative costs. STUDY DESIGN From a single-institution retrospective cohort study of consecutive patients with 3 iterations: "version 1" (V1) (October 2016 to January 2019), V2 (February 2019 to October 2020), and V3 (November 2020 to February 2022), institutional data were aggregated using revenue codes and adjusted to constant 2022-dollar value. Grand total perioperative costs (primary endpoint) were the sum of pancreatectomy, inpatient care, readmission, and 90-day global outpatient care. Proprietary hospital-based costs were converted to ratios using the mean cost of all hospital operations as the denominator. RESULTS Of 814 patients, pathway V1 included 363, V2 229, and V3 222 patients. Accordion Grade 3+ complications decreased with each iteration (V1: 28.4%, V2: 22.7%, and V3: 15.3%). Median length of stay decreased (V1: 6 days, interquartile range [IQR] 5 to 8; V2: 5 [IQR 4 to 6]; and V3: 5 [IQR 4 to 6]) without an increase in readmissions. Ninety-day global perioperative costs decreased by 32% (V1 cost ratio 12.6, V2 10.9, and V3 8.6). Reduction of the index hospitalization cost was associated with the greatest savings (-31%: 9.4, 8.3, and 6.5). Outpatient care costs decreased consistently (1.58, 1.41, and 1.04). When combining readmission and all outpatient costs, total "postdischarge" costs decreased (3.17, 2.59, and 2.13). Component costs of the index hospitalization that were associated with the greatest savings were room or board costs (-55%: 1.74, 1.14, and 0.79) and pharmacy costs (-61%: 2.20, 1.61, and 0.87; all p < 0.001). CONCLUSIONS Three iterative risk-stratified pancreatectomy clinical pathway refinements were associated with a 32% global period cost savings, driven by reduced index hospitalization costs. This successful learning health system model could be externally validated at other institutions performing abdominal cancer surgery.
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Affiliation(s)
- Ahad Azimuddin
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
- Texas A&M School of Medicine, Houston, TX (Azimuddin)
| | - Ching-Wei D Tzeng
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Laura R Prakash
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Morgan L Bruno
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Elsa M Arvide
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Whitney L Dewhurst
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Timothy E Newhook
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Michael P Kim
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Naruhiko Ikoma
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Rebecca A Snyder
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Jeffrey E Lee
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Nancy D Perrier
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Matthew Hg Katz
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Jessica E Maxwell
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
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Martínez-Briseño D, Fernández-Plata R, Pérez-Padilla R, Higuera-Iglesias A, Castillejos-López M, Casas-Medina G, Sierra-Vargas P, Ahumada-Topete VH. Determinants of COVID-19 Hospitalization Costs in a Referral Hospital for Respiratory Diseases. Arch Bronconeumol 2024; 60:246-249. [PMID: 38350818 DOI: 10.1016/j.arbres.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/15/2024]
Affiliation(s)
- David Martínez-Briseño
- Hospital Epidemiology and Infectology Unit, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
| | - Rosario Fernández-Plata
- Hospital Epidemiology and Infectology Unit, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico.
| | - Rogelio Pérez-Padilla
- Department of Research in Tobacco and COPD, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico.
| | - Anjarath Higuera-Iglesias
- Hospital Epidemiology and Infectology Unit, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
| | - Manuel Castillejos-López
- Hospital Epidemiology and Infectology Unit, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
| | - Guillermo Casas-Medina
- Department of Health Economics, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
| | - Patricia Sierra-Vargas
- Clinical Research Subdirectorate, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
| | - Víctor Hugo Ahumada-Topete
- Hospital Epidemiology and Infectology Unit, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
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Hubbell B, Riddle S. Beyond intrinsic value: Gauging hospitalist economic worth in a complex system. J Hosp Med 2024; 19:344-345. [PMID: 38200666 DOI: 10.1002/jhm.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Brittany Hubbell
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sarah Riddle
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Noguchi H, Shingaki K, Sato Y, Kubo S, Kaku K, Okabe Y, Nakamura M. Outcomes and Cost Comparison of 3 Different Laparoscopic Approach for Living Donor Nephrectomy: A Retrospective, Single-Center, Inverse Probability of Treatment Weighting Analysis of 551 Cases. Transplant Proc 2024; 56:482-487. [PMID: 38331594 DOI: 10.1016/j.transproceed.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND At our institution, we switched from hand-assisted retroperitoneal laparoscopic donor nephrectomy (HRN) to hand-assisted transperitoneal laparoscopic donor nephrectomy (HTN); we later switched to standard retroperitoneal laparoscopic donor nephrectomy (SRN). This study was performed to evaluate outcomes and hospital costs among the 3 techniques. METHODS This retrospective, observational, single-center, inverse probability of treatment weighting analysis study compared the outcomes among 551 cases of living donor kidney transplantation between 2014 and 2022. RESULTS After the inverse probability of treatment weighting analysis, there were 114 cases in the HRN group, 204 cases in the HTN group, and 213 cases in the SRN group. Donor complication rates were lowest in the SRN group but did not differ between the HRN and HTN groups (1.1 vs 4.4 and 5.9%, P = .021). Donors in the SRN group had the lowest serum C-reactive protein concentrations on postoperative day 1 (4.3 vs 10.5 and 7.8 mg/dL, P < .001) and the shortest postoperative stay (4.3 vs 7.4 and 8.4 days, P < .001). Donors in the SRN group had the lowest total cost among the 3 groups (8868 vs 9709 and 10,592 USD, P < .0001). Donors in the SRN group also had the lowest costs in terms of "basic medical fees," "medication and injection fees," "Intraoperative drug and material costs," and "testing fees." Furthermore, the presence of complications was significantly correlated with higher total hospital costs (P < .001). CONCLUSION SRN appeared to have the least invasive and complication, and a potential cost savings compared with the HRN and HTN.
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Affiliation(s)
- Hiroshi Noguchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kodai Shingaki
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Sato
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinsuke Kubo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keizo Kaku
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Sosa MA, Soares M, Patel S, Trujillo K, Ashley D, Smith E, Shukla B, Parekh D, Ferreira T, Gershengorn HB. The Impact of Adding a 2-Way Video Monitoring System on Falls and Costs for High-Risk Inpatients. J Patient Saf 2024; 20:186-191. [PMID: 38345404 DOI: 10.1097/pts.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVES We aimed to investigate the value of adding a video monitoring (VM) system with falls and costs for patients at high risk. METHODS We conducted a retrospective, historically controlled study of adults (≥18 y old) at high risk of fall admitted at the University of Miami Hospital and Clinics from January 1 to November 30, 2020 (pre-VM) and January 1 to November 30, 2021 (post-VM); in-person sitters were available in both periods. Fall risk assessment was conducted on admission and at every nursing shift; we defined patients as high risk if their Morse Fall Scale was ≥60. We conducted a multivariable logistic regression model to evaluate the association of period (pre- versus post-VM) with falls and performed a cost analysis. RESULTS Our primary cohort consisted of 9,034 patients at high risk of falls, 4,207 (46.6%) in the pre-VM and 4,827 (53.4%) in the post-VM period. Fall rates were higher in the pre- than the post-VM periods (3.5% versus 2.7%, P = 0.043). After adjustment, being admitted during the post-VM period was associated with a lower odds of fall (odds ratio [95% confidence interval], 0.49 [0.37-0.64], P < 0.001). The median adjusted hospital cost (in 2020 dollars) was $1,969 more for patients who fell than for patients who did not (interquartile range, $880-$2,273). Considering start-up and ongoing costs, we estimate VM implementation to partly replace in-person monitoring has potential annual cost savings of >$800,000 for a hospital similar to ours. CONCLUSIONS Video monitoring to augment in-person sitters is an effective fall prevention initiative for patients at high risk of falls, which is likely also cost-effective.
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Affiliation(s)
- Marie Anne Sosa
- From the Department of Medicine, University of Miami Miller School of Medicine
| | - Marcio Soares
- From the Department of Medicine, University of Miami Miller School of Medicine
| | - Samira Patel
- Quality Department of the University of Miami Hospital and Clinics, Miami, Florida
| | | | - Doreen Ashley
- Nursing Department of the University of Miami Hospital and Clinics
| | - Elizabeth Smith
- Nursing Department of the University of Miami Hospital and Clinics
| | - Bhavarth Shukla
- From the Department of Medicine, University of Miami Miller School of Medicine
| | - Dipen Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Tanira Ferreira
- From the Department of Medicine, University of Miami Miller School of Medicine
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Ng AP, Chervu N, Porter G, Mallick S, Le N, Benharash P, Lee H. Cost variation of nonelective surgery for ulcerative colitis across the United States. J Gastrointest Surg 2024; 28:488-493. [PMID: 38583900 DOI: 10.1016/j.gassur.2024.01.036] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/07/2024] [Accepted: 01/27/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Although clinical outcomes of surgery for ulcerative colitis (UC) have improved in the modern biologic era, expenditures continue to increase. A contemporary cost analysis of UC operative care is lacking. The present study aimed to characterize risk factors and center-level variation in hospitalization costs after nonelective resection for UC. METHODS All adults with UC in the 2016-2020 Nationwide Readmissions Database undergoing nonelective colectomy or rectal resection were identified. Mixed-effects models were developed to evaluate patient and hospital factors associated with costs. Random effects were estimated and used to rank hospitals by increasing risk-adjusted center-level costs. High-cost hospitals (HCHs) in the top decile of expenditure were identified, and their association with select outcomes was subsequently assessed. RESULTS An estimated 10,280 patients met study criteria with median index hospitalization costs of $40,300 (IQR, $26,400-$65,000). Increased time to surgery was significantly associated with a +$2500 increment in costs per day. Compared with low-volume hospitals, medium- and high-volume centers demonstrated a -$5900 and -$8200 reduction in costs, respectively. Approximately 19.2% of variability in costs was attributable to interhospital differences rather than patient factors. Although mortality and readmission rates were similar, HCH status was significantly associated with increased complications (adjusted odds ratio [AOR], 1.39), length of stay (+10.1 days), and nonhome discharge (AOR, 1.78). CONCLUSION The present work identified significant hospital-level variation in the costs of nonelective operations for UC. Further efforts to optimize time to surgery and regionalize care to higher-volume centers may improve the value of UC surgical care in the United States.
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Affiliation(s)
- Ayesha P Ng
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Giselle Porter
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Nguyen Le
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, California, United States; Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Hanjoo Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, United States.
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Huang V, Ciciriello S, Nikpour M, Oon S, Day J. Diagnosing and characterizing inflammatory myopathies at an Australian tertiary public hospital: Resource utilization and direct healthcare costs. Int J Rheum Dis 2024; 27:e15153. [PMID: 38661316 DOI: 10.1111/1756-185x.15153] [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] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/19/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
AIM To determine the direct health service costs and resource utilization associated with diagnosing and characterizing idiopathic inflammatory myopathies (IIMs), and to assess for limitations and diagnostic delay in current practice. METHODS A retrospective, single-center cohort analysis of all patients diagnosed with IIMs between January 2012 and December 2021 in a large tertiary public hospital was conducted. Demographics, resource utilization and costs associated with diagnosing IIM and characterizing disease manifestations were identified using the hospital's electronic medical record and Health Intelligence Unit, and the Medicare Benefits Schedule. RESULTS Thirty-eight IIM patients were identified. IIM subtypes included dermatomyositis (34.2%), inclusion body myositis (18.4%), immune-mediated necrotizing myopathy (18.4%), polymyositis (15.8%), and anti-synthetase syndrome (13.2%). The median time from symptom onset to diagnosis was 212 days (IQR: 118-722), while the median time from hospital presentation to diagnosis was 30 days (8-120). Seventy-six percent of patients required emergent hospitalization during their diagnosis, with a median length of stay of 8 days (4-15). The average total cost of diagnosing IIM was $15 618 AUD (STD: 11331) per patient. Fifty percent of patients underwent both MRI and EMG to identify affected muscles, 10% underwent both pan-CT and PET-CT for malignancy detection, and 5% underwent both open surgical and percutaneous muscle biopsies. Autoimmune serology was unnecessarily repeated in 37% of patients. CONCLUSION The diagnosis of IIMs requires substantial and costly resource use; however, our study has identified potential limitations in current practice and highlighted the need for streamlined diagnostic algorithms to improve patient outcomes and reduce healthcare-related economic burden.
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Affiliation(s)
- Victoria Huang
- Department of Rheumatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Sabina Ciciriello
- Department of Rheumatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Mandana Nikpour
- The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
- The University of Sydney, Camperdown, New South Wales, Australia
- Royal Prince Alfred Hospital Sydney, Camperdown, New South Wales, Australia
| | - Shereen Oon
- Department of Rheumatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Jessica Day
- Department of Rheumatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
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Wang C, Dong L, Liu J, Zhang Y, Wang K, Liu P, Yang X, Lv M, Zhang Y. Pipeline embolization device versus Atlas stent assisted coiling for intracranial aneurysm treatment: a retrospective, propensity score matched study with a focus on midterm outcomes and hospital costs. J Neurointerv Surg 2024; 16:379-384. [PMID: 37230749 DOI: 10.1136/jnis-2023-020173] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Stent assisted coiling (SAC) and flow diverters (FDs) are common endovascular treatments for wide necked cerebral aneurysms, but studies comparing the new generation Atlas SAC and FDs are scarce. We performed a propensity score matched (PSM) cohort study to compare the Atlas SAC and the pipeline embolization device (PED) for proximal internal carotid artery (ICA) aneurysms. METHODS Consecutive ICA aneurysms treated at our institution with either the Atlas SAC or PED were studied. PSM was used to control for age, sex, smoking, hypertension, and hyperlipidemia, and the rupture status, maximal diameter, and neck size of the aneurysm (aneurysms >15 mm and non-saccular aneurysms were excluded). Midterm outcomes and hospital costs were compared between these two devices. RESULTS A total of 309 patients with 316 ICA aneurysms were included. Following PSM, 178 aneurysms treated with the Atlas SAC and PED were matched (n=89 in each group). Aneurysms treated with the Atlas SAC required a slightly longer procedure time, but had lower hospital costs than those treated with the PED (115.2±24.6 vs 102.4±40.8 min, P=0.012; $27 650.2±$6961.4 vs $34 107.0±$3707.2, P<0.001). Atlas SAC and PED treatments showed equivalent aneurysm occlusion rates (89.9% vs 86.5%, P=0.486), complication rates (5.6% vs 11.2%, P=0.177), and a favorable functional outcome (96.6% vs 97.8%, P=1.0) at follow-up (8.2±3.0 vs 8.4±4.2 months, P=0.652). CONCLUSION In this PSM study, midterm outcomes of the PED and Atlas SAC in the treatment of ICA aneurysms were similar. However, SAC required a longer operation time, and the PED may increase the economic cost of inpatients in Beijing, China.
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Affiliation(s)
- Chao Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggen Dong
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Lüdemann C, Gerken M, Hülsbeck M. The role of human capital and stress for cost awareness in the healthcare system: a survey among German hospital physicians. BMC Health Serv Res 2024; 24:310. [PMID: 38454403 PMCID: PMC10921634 DOI: 10.1186/s12913-024-10748-z] [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] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Germany has the highest per capita health care spending among EU member states, but its hospitals face pressure to generate profits independently due to the government's withdrawal of investment cost coverage. The diagnosis related groups (DRG) payment system was implemented to address the cost issue, challenging hospital physicians to provide services within predefined prices and an economic target corridor to reduce costs. This study examines the extent of cost awareness among medical personnel in German hospitals and its influencing factors. METHODS We developed an online survey in which participants across all specialties in hospitals estimated the prices in euros of four common interventions and answered questions about their human capital and perceived stress on the workplace. As a measure of cost awareness, we used the probability of estimating the prices correctly within a reasonable margin. We employed logit logistic regression estimators to identify influencing factors in a sample of 86 participants. RESULTS The results revealed that most of the respondents were unaware of the costs of common interventions. General human capital, acquired through prior education, and job-specific human capital had no influence on cost awareness, whereas domain-specific human capital, that is, gaining economic knowledge based on self-interest, had a positive nonlinear effect on cost awareness. Furthermore, an increased stress level negatively influenced cost awareness. CONCLUSIONS This paper is the first of its kind for the German health care sector that contributes responses to the question whether health care professionals in German hospitals have cost awareness and if not, what reasons lie behind this lack of knowledge. Our findings show that the cost awareness desired by the introduction of the DRG system has yet to be achieved by medical personnel.
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Affiliation(s)
- Christoph Lüdemann
- Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455, Witten, Germany
| | - Maike Gerken
- Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455, Witten, Germany.
| | - Marcel Hülsbeck
- University of Applied Sciences Munich, Hohenzollernstr. 102, 80796, Munich, Germany
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Ciminata G, Burton JK, Quinn TJ, Geue C. Understanding Pathways into Care-homes using Data (UnPiCD study): a two-part model to estimate inpatient and care-home costs using national linked health and social care data. BMC Health Serv Res 2024; 24:281. [PMID: 38443919 PMCID: PMC10916167 DOI: 10.1186/s12913-024-10675-z] [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] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Pathways into care-homes have been under-researched. Individuals who move-in to a care-home from hospital are clinically distinct from those moving-in from the community. However, it remains unclear whether the source of care-home admission has any implications in term of costs. Our aim was to quantify hospital and care-home costs for individuals newly moving-in to care homes to compare those moving-in from hospital to those moving-in from the community. METHODS Using routinely-collected national social care and health data we constructed a cohort including people moving into care-homes from hospital and community settings between 01/04/2013-31/03/2015 based on records from the Scottish Care-Home Census (SCHC). Individual-level data were obtained from Scottish Morbidity Records (SMR01/04/50) and death records from National Records of Scotland (NRS). Unit costs were identified from NHS Scotland costs data and care-home costs from the SCHC. We used a two-part model to estimate costs conditional on having incurred positive costs. Additional analyses estimated differences in costs for the one-year period preceding and following care-home admission. RESULTS We included 14,877 individuals moving-in to a care-home, 8,472 (57%) from hospital, and 6,405 (43%) from the community. Individuals moving-in to care-homes from the community incurred higher costs at £27,117 (95% CI £ 26,641 to £ 27,594) than those moving-in from hospital with £24,426 (95% CI £ 24,037 to £ 24,814). Hospital costs incurred during the year preceding care-home admission were substantially higher (£8,323 (95% CI£8,168 to £8,477) compared to those incurred after moving-in to care-home (£1,670 (95% CI£1,591 to £1,750). CONCLUSION Individuals moving-in from hospital and community have different needs, and this is reflected in the difference in costs incurred. The reduction in hospital costs in the year after moving-in to a care-home indicates the positive contribution of care-home residency in supporting those with complex needs. These data provide an important contribution to inform capacity planning on care provision for adults with complex needs and the costs of care provision.
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Affiliation(s)
- G Ciminata
- Health Economics and Health Technology Assessment, School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, U.K..
| | - J K Burton
- Academic Geriatric Medicine, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, Scotland, U.K
| | - T J Quinn
- Academic Geriatric Medicine, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, Scotland, U.K
| | - C Geue
- Health Economics and Health Technology Assessment, School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, U.K
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Sinpho K, Rojmahamongkol P. Costs of Receiving Developmental Services for Children With Global Developmental Delay at Siriraj Hospital in Bangkok, Thailand. Value Health Reg Issues 2024; 40:63-69. [PMID: 37979313 DOI: 10.1016/j.vhri.2023.09.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/30/2023] [Accepted: 09/01/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES To identify the cost from the societal, caregiver, and hospital perspectives for receiving developmental services for children with global developmental delay (GDD) at Siriraj Hospital. METHODS This descriptive study collected data from children under 5 years old with GDD from November, 2021 to October, 2022. The hospital's perspective cost and caregivers' direct medical costs were obtained from the Siriraj database. Caregivers were interviewed about their expenses for direct nonmedical and indirect costs. Caregivers and hospital perspective costs were summed to total societal perspective. RESULTS Of the 100 caregivers, most (39%) of their children had Universal Coverage; however, 22% of the caregivers decided not to use any healthcare coverage. The median annual cost of the societal perspective was 209.81 (range 14.51-2134.08) US dollar (USD)/child. Median annual caregiver's perspective, direct medical, direct nonmedical and indirect costs were 119.82 (range 9.20-2068.91), 0 (range 0-231.89), 68.96 (range 2.87-2068.91), and 0 (range 0-1293.07) USD/child, respectively. The mean proportion of the expenses of each child among direct medical, direct nonmedical, and indirect costs was 11:71:18. The median annual hospital perspective cost was 71.38 (range 5.17-807.13) USD/child. CONCLUSION The annual societal economic burden for each Thai child with GDD was 209.81 USD. The direct nonmedical cost, especially transportation, was the largest proportion of the total cost from the caregiver's perspective. Effective referral system, proper specialist allocation throughout the country, and developing of the service system are crucial for the alleviation of this burden.
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Affiliation(s)
- Krittaporn Sinpho
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pat Rojmahamongkol
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Quinn K, Bredfeldt C. The Revival of US Hospital Care, 2004-2019. Med Care 2024; 62:140-150. [PMID: 38241080 DOI: 10.1097/mlr.0000000000001967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Between 2004 and 2019, the US hospital industry reversed the 21-year decline in its share of national health spending. OBJECTIVE To measure and explain changes in hospital utilization, cost, charges, and inpatient case mix. DATA SOURCES Principal sources were the American Hospital Association annual survey, the National Inpatient Sample, and the Healthcare Cost Reporting Information System. The study included all US community hospitals (n=5141 in 2019). ANALYTIC APPROACH We used factor decomposition to separate the impacts of population, utilization, unit cost, and charge markups on the growth in cost and charges for inpatient and outpatient care nationwide and for each state. For unit cost, we separated the impacts of input price inflation and treatment intensity. To measure the inpatient case mix, we applied an all-patient diagnosis-related groups algorithm. RESULTS Between 2004 and 2019, charges more than tripled to $4.11 trillion. The cost more than doubled to $911 billion. For inpatient care, discharges fell 5%, discharges per person fell 15%, cost per discharge increased 88%, and charge markups rose 43%. For outpatient care, visits rose 36%, visits per person rose 21%, cost per visit rose 119%, and charge markups rose 52%. Treatment intensity increased by 33% per discharge and 55% per visit. Nationwide, the inpatient case mix increased by 34%, reflecting sicker patients and better clinical documentation. CONCLUSIONS We quantified 3 important trends: rapid growth in outpatient visits, increased treatment intensity, and sustained increases in markups. Increased treatment intensity was the largest factor behind $491 billion in hospital cost growth between 2004 and 2019.
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Feng X, Navakatikyan M, Eckermann S, Astell-Burt T. Show me the money! Associations between tree canopy and hospital costs in cities for cardiovascular disease events in a longitudinal cohort study of 110,134 participants. Environ Int 2024; 185:108558. [PMID: 38490071 DOI: 10.1016/j.envint.2024.108558] [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] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/10/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
Health benefits from urban greening are assumed to translate into reduced healthcare expenditure, yet few studies have tested this. A total of 110,134 participants in the Sax Institute's 45 and Up Study in the Australian cities of Sydney, Newcastle, or Wollongong were linked with hospital cost data for cardiovascular disease (CVD) events (e.g., acute myocardial infarctions) up to 30 June 2018. Associations between percentages of total green space, tree canopy, and open grass within 1.6 km of participants homes and annual per person measured CVD-related hospital costs were analysed using generalised linear model (GLM) with gamma density as a component of a two-part mixture model, adjusting for confounders. Overall, 26,243 participants experienced a CVD-related hospitalisation. Incidence was lower among participants with 10 % more tree canopy (OR 0.98, 95 %CI 0.96, 0.99), but not with higher total green space or open grass percentages. Total costs of hospitalisations per year were lower with 10 % more tree canopy (means ratio 0.96, 95 %CI 0.95, 0.98), but also higher with 10 % more open grass (means ratio 1.04, 95 %CI 1.02, 1.06). It was estimated that raising tree canopy cover to 30 % or more for individuals with currently less than 10 % could lead to a within-sample annual saving per person of AU$ 193 overall and AU$ 569 for those who experienced one or more CVD-related hospital admissions. This projects to an estimated annual health sector cost reduction of AU$ 19.3 million per 100,000 individuals for whom local tree canopy cover is increased from less than 10 % to 30 % or higher. In conclusion, this longitudinal study is among the first to analyse measured healthcare cost data in relation to urban green space in general, and with differentiation between major types of greenery relevant to urban planning policies in cities around the world. In sum, this study advances an increasingly important and international focus of research by reporting on the lower burden of CVD and fewer associated hospitalisations stemming from upstream investments that protect and restore urban tree canopy, which not only translates into substantial reduced costs for the health sector, but also helps to create regenerative cities and flourishing communities.
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Affiliation(s)
- Xiaoqi Feng
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; George Institute of Global Health, Sydney, NSW, Australia; Population Wellbeing and Environment Research Lab (PowerLab), Sydney, NSW, Australia
| | - Michael Navakatikyan
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; Population Wellbeing and Environment Research Lab (PowerLab), Sydney, NSW, Australia
| | - Simon Eckermann
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), Sydney, NSW, Australia; School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia; School of Health and Society, University of Wollongong, Wollongong, NSW, Australia.
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Armellini A, Chew S, Johnston S, Muralidharan V, Nikfarjam M, Weinberg L. The hospital costs of complications following major abdominal surgery: a retrospective cohort study. BMC Res Notes 2024; 17:59. [PMID: 38414013 PMCID: PMC10900687 DOI: 10.1186/s13104-024-06720-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 02/14/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE Postoperative complications following major abdominal surgeries is a pressing concern for hospital care and health economics. Given the paucity of available cost data for patients undergoing major abdominal surgery, we evaluated the number and the severity of postoperative complications following major abdominal surgeries and calculated the costs borne by a single centre university hospital within an Australian healthcare system. RESULTS The overall incidence of postoperative complications for 1790 adult patients undergoing major abdominal surgeries (i.e., colonic, liver, small bowel resections and Whipple procedures) between January 2013 and June 2018 was 75.2%. Of these complications, 56.9% were minor (Clavien-Dindo (CVD) Grades I or II) and 15.5% were major (CVD Grades III or IV). As the severity of complications increased, median adjusted total hospital costs rose significantly, with a median (interquartile range [IQR]) of AUD 29,519.70 (IQR 21,828.80-40,527.90) in CVD Grade II versus AUD 50,702.40 (IQR 35,866.00-69,296.80) in CVD Grade III (p <.001). Further, developing one, two or three complications resulted in significantly increased hospital costs by AUD 2618.30 (13.3% increase), AUD 3605.50 (16.2% increase) and AUD 3173.00 (12.3% increase) (p <.0001), respectively, with an exponential spike in costs incurred by patients who developed more than three complications (AUD 23,719.70; 81.7% increase; p < 0001).
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Affiliation(s)
| | - Shaun Chew
- Department of Anaesthesia, Austin Health, Heidelberg, Australia
| | - Samuel Johnston
- Department of Anaesthesia, Austin Health, Heidelberg, Australia
| | | | - Mehrdad Nikfarjam
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Australia.
- Department of Critical Care, The University of Melbourne, Austin Health, Heidelberg, Australia.
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Dokollari A, Sicouri S, Prendergrast G, Ramlawi B, Mahmud F, Kjelstrom S, Wertan M, Sutter F. Robotic-Assisted Versus Traditional Full-Sternotomy Coronary Artery Bypass Grafting Procedures: A Propensity-Matched Analysis of Hospital Costs. Am J Cardiol 2024; 213:12-19. [PMID: 38012991 DOI: 10.1016/j.amjcard.2023.10.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/24/2023] [Revised: 10/08/2023] [Accepted: 10/28/2023] [Indexed: 11/29/2023]
Abstract
We aim to compare hospital costs of robotic-assisted coronary artery bypass grafting (CABG) versus conventional CABG. All consecutive 1,173 patients who underwent conventional and robotic-assisted CABG between January 2018 and June 2021 were included. After propensity-matching, 267 patients in each group (robotic-assisted vs conventional) were included in the study. Patient selection for each group was decided by a treating surgeon with a heart team based on clinical factors. Syntax score was not assessed. Total costs (direct + indirect hospital costs) of patients who underwent robotic-assisted and conventional CABG were compared. Direct cost expenses included surgical operating time, hospital stay, surgical implants and supplies, catheterization laboratory, pharmacy, radiology and ultrasound imaging, blood bank, cardiology, and so on. Indirect cost expenses included general administration medical records, and so on. Using the propensity-matched groups (n = 267), we summed the total cost by year. Results for 267 propensity-matched patients (each group) evidenced that total conventional CABG costs were $9.5 million (average of $35,580/patient), whereas robotic-assisted CABG costs were $5 million ($18,726/patient). Therefore, the differences between robotic-assisted and conventional CABG costs were $4.5 million ($16,853/patient), favoring robotic-assisted over conventional CABG. Differences in direct and indirect costs were $2.2 million and $1.8 million, respectively. When the cost of the Da Vinci robot was added ($1,200,000), the total cost was $3.3 million ($12,359 × patient) lower in the robotic-assisted CABG group. Multivariate analysis showed that, mainly, the shorter hospital length of stay (7 vs 5 days) accounts for the reduced costs observed in the robotic-assisted CABG group. In conclusion, in a mature practice, robotic-assisted CABG decreases hospital length of stay, leading to reduced hospital costs compared with conventional CABG.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Serge Sicouri
- Department of Cardiac Surgery, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - George Prendergrast
- Department of Cardiac Surgery, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania; Main Line Health Center for Population Health Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania; Cardiac Surgery Department, Lankenau Institute Heart Center, Wynnewood, Pennsylvania
| | - Farah Mahmud
- Department of Cardiac Surgery, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Stephanie Kjelstrom
- Department of Cardiac Surgery, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Maryann Wertan
- Main Line Health Center for Population Health Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania; Cardiac Surgery Department, Lankenau Institute Heart Center, Wynnewood, Pennsylvania
| | - Francis Sutter
- Main Line Health Center for Population Health Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania; Cardiac Surgery Department, Lankenau Institute Heart Center, Wynnewood, Pennsylvania
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Cao X, Li R, Tang W, Wang W, Ji J, Yin C, Niu L, Gao Y, Ma Q. How health risk factors affect inpatient costs among adults with stroke in China: the mediating role of length of stay. BMC Geriatr 2024; 24:131. [PMID: 38373895 PMCID: PMC10877923 DOI: 10.1186/s12877-024-04656-4] [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] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND As stroke has become the leading cause of death and disability in China, it has induced a heavy disease burden on society, families, and patients. Despite much attention within the literature, the effect of multiple risk factors on length of stay (LOS) and inpatient costs in China is still not fully understood. AIM To analyse the association between the number of risk factors combined and inpatient costs among adults with stroke and explore the mediating effect of LOS on inpatient costs. METHODS A retrospective cross-sectional study was conducted among stroke patients in a tertiary hospital in Nantong City from January 2018 to December 2019. Lifestyle factors (smoking status, exercise), personal disease history (overweight, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation), family history of stroke, and demographic characteristics were interviewed by trained nurses. Inpatient costs and LOS were extracted from electronic medical records. Hierarchical multiple linear regression models and mediation analysis were used to examine the direct and indirect effects of the number of risk factors combined for stroke on inpatient costs. RESULTS A total of 620 individuals were included, comprising 391 ischaemic stroke patients and 229 haemorrhagic stroke patients, and the mean age was 63.2 years, with 60.32% being male. The overall mean cost for stroke inpatients was 30730.78 CNY ($ 4444.91), and the average length of stay (LOS) was 12.50 days. Mediation analysis indicated that the greater number of risk factors was not only directly related to higher inpatient costs (direct effect = 0.16, 95%CI:[0.11,0.22]), but also indirectly associated with inpatient cost through longer LOS (indirect effect = 0.08, 95% CI: [0.04,0.11]). Furthermore, patients with high risk of stroke had longer LOS than those in low-risk patients, which in turn led to heavier hospitalization expenses. CONCLUSIONS Both the greater number of risk factors and high-risk rating among stroke patients increased the length of stay and inpatient costs. Preventing and controlling risk behaviors of stroke should be strengthened.
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Affiliation(s)
- Xin Cao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Ruyu Li
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Weiwei Tang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu Province, 211166, China
| | - Wenjun Wang
- Affiliated Hospital, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Jingya Ji
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Chengjie Yin
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Luyao Niu
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Yuexia Gao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China.
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China.
| | - Qiang Ma
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China.
- Affiliated Hospital, Nantong University, Nantong, Jiangsu Province, 226019, China.
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Lo BD, Pippa A, Sherd I, Scott AV, Thomas AJ, Hendricks EA, Ness PM, Chaturvedi S, Resar LMS, Frank SM. Clinical Outcomes, Blood Utilization, and Ethical Considerations for Pediatric Patients in a Bloodless Medicine and Surgery Program. Anesth Analg 2024; 138:465-474. [PMID: 38175737 DOI: 10.1213/ane.0000000000006776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Pediatric patients requesting bloodless care represent a challenging clinical situation, as parents cannot legally refuse lifesaving or optimal interventions for their children. Here, we report clinical outcomes for the largest series of pediatric inpatients requesting bloodless care and also discuss the ethical considerations. METHODS We performed a single-institution retrospective cohort study assessing 196 pediatric inpatients (<18 years of age) who requested bloodless care between June 2012 and June 2016. Patient characteristics, transfusion rates, and clinical outcomes were compared between pediatric patients receiving bloodless care and those receiving standard care (including transfusions if considered necessary by the clinical team) (n = 37,271). Families were informed that all available measures would be undertaken to avoid blood transfusions, although we were legally obligated to transfuse blood if the child's life was threatened. The primary outcome was composite morbidity or mortality. Secondary outcomes included percentage of patients transfused, individual morbid events, length of stay, total hospital charges, and total costs. Subgroup analyses were performed after stratification into medical and surgical patients. RESULTS Of the 196 pediatric patients that requested bloodless care, 6.1% (n = 12) received an allogeneic blood component, compared to 9.1% (n = 3392) for standard care patients ( P = .14). The most common indications for transfusion were perioperative bleeding and anemia of prematurity. None of the transfusions were administered under a court order. Overall, pediatric patients receiving bloodless care exhibited lower rates of composite morbidity compared to patients receiving standard care (2.6% vs 6.2%; P = .035). There were no deaths in the bloodless cohort. Individual morbid events, length of stay, and total hospital charges/costs were not significantly different between the 2 groups. After multivariable analysis, bloodless care was not associated with a significant difference in composite morbidity or mortality (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.12-1.11; P = .077). CONCLUSIONS Pediatric patients receiving bloodless care exhibited similar clinical outcomes compared to patients receiving standard care, although larger studies with adequate power are needed to confirm this finding. There were no mortalities among the pediatric bloodless cohort. Although a subset of our pediatric bloodless patients received an allogeneic transfusion, no patients required a court order. When delivered in a collaborative and patient-centered manner, blood transfusions can be safely limited among pediatric patients.
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Affiliation(s)
- Brian D Lo
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Pippa
- Department of Anesthesiology and Critical Care Medicine
| | | | | | | | | | - Paul M Ness
- Department of Pathology (Transfusion Medicine)
| | | | - Linda M S Resar
- Center for Bloodless Medicine and Surgery, Department of Medicine (Hematology), Oncology, Pathology & Institute for Cellular Engineering
| | - Steven M Frank
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Health System Blood Management Program, Faculty, The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Matz E, Dutta R, Tsivian M, Terlecki R, Matthews C. The impact of verbal goal setting on operating room turnover time: a randomized trial. Int Urogynecol J 2024; 35:363-367. [PMID: 37962631 DOI: 10.1007/s00192-023-05680-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Operating room turnover times are highly variable, with longer times having a significant negative impact on hospital costs, surgeon volume, and satisfaction. The primary aim of this randomized trial was to examine the impact of a verbalized time goal on the likelihood of meeting institutional goals. METHODS This is a prospective, single-blind, randomized study conducted across four operative sites: inpatient main campus and three outpatient centers. Sequential cases for the same surgeon in the same room were randomized to receive a verbal prompt versus usual care, in which no goal setting was verbalized. Multivariate and univariate statistical analyses were performed. RESULTS From July through October 2022, five attending surgeons randomized 88 cases (44 verbal prompt, 44 usual care). Of these, 30 were at the main inpatient hospital. The case mixture included 36% vaginal, 27% endoscopy, 8% open, 10% robotic, and others. Average turnover time was 51.7 and 35.3 min for inpatient and outpatient cases respectively. Overall, only 39.8% of cases hit the institutional turnover time goal. Verbal prompting did not significantly increase the likelihood of achieving the institutional goal (38.4% vs 43.4% p = 0.352) except for in minor surgery (64.0 vs 39.0%, p = 0.0477). A verbal prompt reduced turnover time in major surgery (59.7 vs 47.8 min, p = 0.0445). CONCLUSION Our academic center achieved goal turnover times in only 39.8% of cases. Although verbal prompting did not significantly improve the likelihood of meeting institutional goals in the group as a whole, some subgroups were significantly improved.
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Affiliation(s)
- Ethan Matz
- Department of Urology, University of Texas, Southwestern, 5323 Harry Hines Blvd, MC 9110, Dallas, TX, 75390, USA.
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA.
| | - Rahul Dutta
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
- Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Matvey Tsivian
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
| | - Ryan Terlecki
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
| | - Catherine Matthews
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
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Arora S, Chen I, Bronkema C, Chiarelli G, Finati M, Cirulli GO, Majdalany SE, Rakic I, Sood A, Trinh QD, Rogers CG, Peabody JO, Menon M, Abdollah F. Admission Rates, Healthcare Utilization, and Inpatient Cost of Radiation Cystitis in the United States. Urology 2024; 184:94-100. [PMID: 38160761 DOI: 10.1016/j.urology.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To assess the incidence, cumulative healthcare burden, and financial impact of inpatient admissions for radiation cystitis (RC), while exploring practice differences in RC management between teaching and nonteaching hospitals. METHODS We focused on 19,613 patients with a diagnosis of RC within the National Inpatient Sample (NIS) from 2008 to 2014. ICD-9 diagnosis and procedure codes were used. Complex-survey procedures were used to study the descriptive characteristics of RC patients and the procedures received during admission, stratified by hospital teaching status. Inflation-adjusted cost and cumulative annual cost were calculated for the study period. Multivariable logistic regression was used to study the impact of teaching status on the high total cost of admission. RESULTS Median age was 76 (interquartile range 67-82) years. Most of the patients were males (73%; P < .001). 59,571 (61%) patients received at least one procedure, of which, 24,816 (25.5%) received more than one procedure. Median length of stay was 5days (interquartile range 2-9). Female patients and patients with a higher comorbidity score were more frequently treated at teaching hospitals. A higher proportion of patients received a procedure at a teaching hospital (64% vs 59%; P < .001). The inflation-adjusted cost was 9207 USD and was higher in teaching hospitals. The cumulative cost of inpatient treatment of RC was 63.5 million USD per year and 952.2 million USD over the study period. CONCLUSION The incidence of RC-associated admissions is rising in the US. This disease is a major burden to US healthcare. The awareness of the inpatient economic burden and healthcare utilization associated with RC may have funding implications.
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Affiliation(s)
- Sohrab Arora
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - Irene Chen
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | - Chandler Bronkema
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | - Giuseppe Chiarelli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Marco Finati
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Ottone Cirulli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Sami E Majdalany
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - Ivan Rakic
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | | | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Craig G Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - James O Peabody
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - Mani Menon
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI.
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Moon TJ, Blackburn CW, Du JY, Marcus RE. What Are the Differences in Hospital Cost Associated With the Use of Cemented Versus Cementless Femoral Stems in Hemiarthroplasty and Total Hip Arthroplasty for the Treatment of Femoral Neck Fracture? J Arthroplasty 2024; 39:313-319.e1. [PMID: 37572717 DOI: 10.1016/j.arth.2023.08.017] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/29/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine if there is a difference in hospital costs associated with the use of cemented versus cementless femoral stems in hemiarthroplasty (HA) and total hip arthroplasty (THA) for the treatment of femoral neck fracture (FNF). METHODS This retrospective cohort study utilizes the 2019 Medicare Provider Analysis and Review Limited Data Set. Patients undergoing arthroplasty for the treatment of FNF were identified. Patients were grouped by cemented or cementless femoral stem fixation. There were 16,148 patients who underwent arthroplasty for FNF available: 4,913 THAs (3,705 patients who had cementless femoral stems and 1,208 patients who had cemented femoral stems) and 11,235 HAs (6,099 patients who had cementless femoral stems and 5,136 who had cemented femoral stems). Index hospital costs were estimated by multiplying total charges by cost-to-charge ratios. Costs were analyzed using univariable and multivariable generalized linear models. RESULTS Cemented femoral stem THA generated 1.080 times (95% confidence interval, 1.06 to 1.10; P < .001), or 8.0%, greater index hospital costs than cementless femoral stem THA, and cemented femoral stem HA generated 1.042 times (95% confidence interval, 1.03 to 1.05; P < .001), or 4.2%, greater index hospital costs than cementless femoral stem HA. CONCLUSIONS Cemented femoral stems for FNF treated with either THA or HA are associated with only a small portion of increased cost compared to cementless femoral stems. Providers may choose the method of arthroplasty stem fixation for the treatment of FNF based on what they deem most appropriate for the specific patient.
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Affiliation(s)
- Tyler J Moon
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Collin W Blackburn
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jerry Y Du
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Randall E Marcus
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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25
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Rondelet B, Dehanne F, Van Den Bulcke J, Martins D, Belhaj A, Libert B, Leclercq P, Pirson M. Daly/Cost comparison in the management of peripheral arterial disease at 17 Belgian hospitals. BMC Health Serv Res 2024; 24:109. [PMID: 38243251 PMCID: PMC10797854 DOI: 10.1186/s12913-023-10535-2] [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] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 12/28/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Peripheral arterial disease (PAD) is a manifestation of atherosclerosis that affects the lower extremities and afflicts more than 200 million people worldwide. Because of limited resources, the need to provide quality care associated with cost control is essential for health policies. Our study concerns an interhospital comparison among seventeen Belgian hospitals that integrates the weighting of quality indicators and the costs of care, from the hospital perspective, for a patient with this pathology in 2018. METHODS The disability-adjusted life years (DALYs) were calculated by adding the number of years of life lost due to premature death and the number of years of life lost due to disability for each in-hospital stay. The DALY impact was interpreted according to patient safety indicators. We compared the hospitals using the adjusted values of costs and DALYs for their case mix index, obtained by relating the observed value to the predicted value obtained by linear regression. RESULTS We studied 2,437 patients and recorded a total of 560.1 DALYs in hospitals. The in-hospital cost average [standard deviation (SD)] was €8,673 (€10,893). Our model identified the hospitals whose observed values were higher than predicted; six needed to reduce the costs and impacts of DALYs, six needed to improve one of the two factors, and four seemed to have good results. The average cost (SD) for the worst performing hospitals amounted to €27,803 (€28,358). CONCLUSIONS Studying the costs of treatment according to patient safety indicators permits us to evaluate the entire chain of care using a comparable unit of measurement.
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Affiliation(s)
- Benoît Rondelet
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, CHU UCL Namur, UCLouvain, Avenue G. Therasse, 1, 5530, Yvoir, Belgium.
- Chief Medical Officer Department, CHU UCL Namur, UCLouvain, Yvoir, Belgium.
| | - Fabian Dehanne
- Chief Executive Officer Department, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- Health and Society Research Institute (IRSS) - UCLouvain, Louvain-La-Neuve, Belgium
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Van Den Bulcke
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Dimitri Martins
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Asmae Belhaj
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, CHU UCL Namur, UCLouvain, Avenue G. Therasse, 1, 5530, Yvoir, Belgium
| | - Benoît Libert
- Chief Executive Officer Department, CHU UCL Namur, UCLouvain, Yvoir, Belgium
| | - Pol Leclercq
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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26
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Dugan MM, Ross SB, Sucandy I, Slavin M, Pattilachan TM, Christodoulou M, Rosemurgy A. Cost comparison between medicare and private insurance for robotic transhiatal esophagectomy. J Robot Surg 2024; 18:30. [PMID: 38231356 DOI: 10.1007/s11701-023-01762-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/01/2023] [Indexed: 01/18/2024]
Abstract
Esophageal cancer is a significant health concern, with the robotic platform being increasingly adopted for transhiatal esophagectomy (THE). While literature exists regarding the cost of robotic THE and its benefits, there is limited data analyzing cost and concurrent hospital reimbursement based on payor or provider. This study aimed to compare hospital reimbursement after robotic THE for patients with Medicare versus private insurance. With IRB approval, a prospective study of 85 patients from 2012 to 2022 who underwent robotic THE was conducted. Private insurance was defined as coverage excluding Medicare, Medicaid, or self-pay. Statistical analyses involved Student's t test, Chi-square test, and Fisher's exact test, with p ≤ 0.05 considered statistically significant. Data are presented as median (mean ± standard deviation). Among the 85 patients, 64 had Medicare, and 21 had private insurance. Medicare patients exhibited more frequent history of prior abdominal or thoracic surgeries (41% vs 10%, p < 0.01). Both groups showed no differences in factors like sex, body mass index, ASA classification, operative duration, estimated blood loss, conversions to 'open', tumor size, and major postoperative complications (Clavien-Dindo ≥ III). Similarly, metrics such as hospital stay duration, in-hospital mortality, 30-day readmission, and various financial components including total and variable costs, hospital reimbursement, and net margin were consistent across both. Despite Medicare patients being older and often having a broader operative history, hospital costs and reimbursements did not differ from patients with private insurance post-robotic THE. The robotic platform appears to mitigate potential disparities in hospitalization costs and hospital reimbursement for THE between Medicare and private insurance.
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Affiliation(s)
- Michelle M Dugan
- Florida Atlantic University Schmidt College of Medicine, Boca Raton, FL, USA
- Digestive Health Institute, AdventHealth Tampa, University of Central Florida (UCF), 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
| | - Sharona B Ross
- Digestive Health Institute, AdventHealth Tampa, University of Central Florida (UCF), 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA.
| | - Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, University of Central Florida (UCF), 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
| | - Moran Slavin
- Digestive Health Institute, AdventHealth Tampa, University of Central Florida (UCF), 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tara M Pattilachan
- Digestive Health Institute, AdventHealth Tampa, University of Central Florida (UCF), 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
| | - Maria Christodoulou
- Digestive Health Institute, AdventHealth Tampa, University of Central Florida (UCF), 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
| | - Alexander Rosemurgy
- Digestive Health Institute, AdventHealth Tampa, University of Central Florida (UCF), 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
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Towe CW, Bachman KC, Ho VP, Pieracci F, Worrell SG, Moorman ML, Linden PA, Badrinathan A. Early Repair of Rib Fractures Is Associated with Superior Length of Stay and Total Hospital Cost: A Propensity Matched Analysis of the National Inpatient Sample. Medicina (Kaunas) 2024; 60:153. [PMID: 38256413 PMCID: PMC10819862 DOI: 10.3390/medicina60010153] [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] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/01/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Previous studies have suggested that early scheduling of the surgical stabilization of rib fractures (SSRF) is associated with superior outcomes. It is unclear if these data are reproducible at other institutions. We hypothesized that early SSRF would be associated with decreased morbidity, length of stay, and total charges. Materials and Methods: Adult patients who underwent SSRF for multiple rib fractures or flail chest were identified in the National Inpatient Sample (NIS) by ICD-10 code from the fourth quarter of 2015 to 2016. Patients were excluded for traumatic brain injury and missing study variables. Procedures occurring after hospital day 10 were excluded to remove possible confounding. Early fixation was defined as procedures which occurred on hospital day 0 or 1, and late fixation was defined as procedures which occurred on hospital days 2 through 10. The primary outcome was a composite outcome of death, pneumonia, tracheostomy, or discharge to a short-term hospital, as determined by NIS coding. Secondary outcomes were length of hospitalization (LOS) and total cost. Chi-square and Wilcoxon rank-sum testing were performed to determine differences in outcomes between the groups. One-to-one propensity matching was performed using covariates known to affect the outcome of rib fractures. Stuart-Maxwell marginal homogeneity and Wilcoxon signed rank matched pair testing was performed on the propensity-matched cohort. Results: Of the 474 patients who met the inclusion criteria, 148 (31.2%) received early repair and 326 (68.8%) received late repair. In unmatched analysis, the composite adverse outcome was lower among early fixation (16.2% vs. 40.2%, p < 0.001), total hospital cost was less (USD114k vs. USD215k, p < 0.001), and length of stay was shorter (6 days vs. 12 days) among early SSRF patients. Propensity matching identified 131 matched pairs of early and late SSRF. Composite adverse outcomes were less common among early SSRF (18.3% vs. 32.8%, p = 0.011). The LOS was shorter among early SSRF (6 days vs. 10 days, p < 0.001), and total hospital cost was also lower among early SSRF patients (USD118k vs. USD183k late, p = 0.001). Conclusion: In a large administrative database, early SSRF was associated with reduced adverse outcomes, as well as improved hospital length of stay and total cost. These data corroborate other research and suggest that early SSRF is preferred. Studies of outcomes after SSRF should stratify analyses by timing of procedure.
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Affiliation(s)
- Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Katelynn C Bachman
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Vanessa P Ho
- MetroHealth Medical Center, Department of Surgery, Division of Trauma, Critical Care, Burns, & Acute Care Surgery, Cleveland, OH 44109, USA
| | - Fredric Pieracci
- Department of Surgery Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80045, USA
| | - Stephanie G Worrell
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Matthew L Moorman
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Avanti Badrinathan
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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Tian SH, Jiang R, Chen Y. Incentive mechanism for sharing and using EHR in medical consortiums based on performance evaluation. Front Public Health 2024; 11:1324228. [PMID: 38249396 PMCID: PMC10796444 DOI: 10.3389/fpubh.2023.1324228] [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] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024] Open
Abstract
Background The construction of medical consortiums not only promotes active cooperation among hospitals, but also further intensifies active competition among them. The shared use of electronic health records (EHR) breaks the original pattern of benefit distribution among hospitals. Objective The purpose of this paper is to establish an incentive mechanism for the shared use EHR, and to reveal the incentive effect and mechanism of key factors, and to put forward management suggestions for solving the real conflicts. Methods We constructed a basic incentive model and an incentive model that introduces performance evaluation as a supervisory signal, based on analyzing the hospital cost function, the hospital benefit function, and the incentive contract function. Finally, the incentive effects of key factors before and after the introduction of performance evaluation were verified and compared using MATLAB simulation method. Results The profit level and incentive coefficient of hospitals sharing EHR are independent of the amount of one-time government subsidies. Regardless of whether a performance evaluation supervisory signal is introduced or not, the incentive coefficients are increasing functions with respect to ρ, τ, but decreasing functions with respect to β, δ, γ. After the inclusion of supervisory signal of performance evaluation in the model, the ability of hospitals to use EHR has a higher impact effectiveness on improving both incentive effects and benefit levels. The impact of the value-added coefficient on the level of earnings is consistently greater than it would have been without the inclusion of the performance evaluation supervisory signal. Conclusions Enhancing the capacity of hospitals to use EHR and tapping and expanding the value-added space of EHR are 2 key paths to promote sustainable shared use of EHR. Substantive performance evaluation plays an important role in stabilizing incentive effects.
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Affiliation(s)
- Sheng Hu Tian
- Business School, Yunnan University of Finance and Economics, Kunming, China
- Yunnan Key Laboratory of Service Computing, Yunnan University of Finance and Economics, Kunming, China
- School of Management and Economics, Kunming University of Science and Technology, Kunming, China
| | - Rong Jiang
- Yunnan Key Laboratory of Service Computing, Yunnan University of Finance and Economics, Kunming, China
| | - Yu Chen
- School of Management and Economics, Kunming University of Science and Technology, Kunming, China
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29
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Alexiadis A, Reynolds P, Al-Mouazzen L, Toms A, Phillips J, Waterson B. Revision total knee replacement finances: a detailed cost-analysis of operative practice at a regional tertiary referral centre. BMC Health Serv Res 2024; 24:19. [PMID: 38178040 PMCID: PMC10768223 DOI: 10.1186/s12913-023-10316-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The revision knee complexity classification (RKCC) stratifies knee revision operations depending on their level of complexity from simple revisions (R1) to highly complex cases (R3). Current financial codes used for calculation of reimbursement for knee revision services provided at the Trust, rely on patients' comorbidities. However, previous research has demonstrated that this approach may not yield an accurate financial account of knee revision arthroplasty cost. This is a single centre study from a secondary and tertiary revision unit, with work previously presented by the authors demonstrating that the majority of complex revision knee replacement within the region, take place in this unit. The aims of this study were to illustrate the current cost profile and renumeration service currently in place for revision knee and show the differences in cost based on complexity of the operation. METHODS In this retrospective study, 90 cases who underwent revision knee operations in 2019 were analysed. Data was obtained from a tertiary referral centre where the episodes had occurred. Mean cost, tariff, and subsequent deficit were calculated for the R1, R2 and R3 episodes. RESULTS R2 and R3 episodes were significantly more expensive than R1 episodes. The increase in cost between R3 and R2 episodes was not significant. The total cost of the revision operations was £1,162,343. Tariffs received for R2 and R3 revision operations were significantly more expensive than R1 operations. However, the increase in tariffs received for R3 operations was not significant in relation to R2 operations. The total amount of tariffs received by the Trust was £ 770,996 generating a net deficit of - £ 391,347. CONCLUSION Current financial coding for revision knee does not accurately predict costs associated with revision knee surgery. Net deficit varies depending on the RKCC grade of the knee revision episode with more complex operations resulting in a higher mean net deficit. Implementation of the RKCC could prove to be a useful tool in generating an accurate prediction of the cost associated with knee revision surgery.
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Affiliation(s)
- Aris Alexiadis
- Royal Devon University Healthcare NHS Foundation Trust (Wonford), Barrack Road, Exeter, EX2 5DW, UK.
- University of Exeter Medical School, University of Exeter, Exeter, EX1 2HZ, UK.
| | - Patrick Reynolds
- Royal Devon University Healthcare NHS Foundation Trust (Wonford), Barrack Road, Exeter, EX2 5DW, UK.
| | - Louay Al-Mouazzen
- Royal Devon University Healthcare NHS Foundation Trust (Wonford), Barrack Road, Exeter, EX2 5DW, UK
| | - Andrew Toms
- Royal Devon University Healthcare NHS Foundation Trust (Wonford), Barrack Road, Exeter, EX2 5DW, UK
- University of Exeter Medical School, University of Exeter, Exeter, EX1 2HZ, UK
| | - John Phillips
- Royal Devon University Healthcare NHS Foundation Trust (Wonford), Barrack Road, Exeter, EX2 5DW, UK
| | - Ben Waterson
- Royal Devon University Healthcare NHS Foundation Trust (Wonford), Barrack Road, Exeter, EX2 5DW, UK
- University of Exeter Medical School, University of Exeter, Exeter, EX1 2HZ, UK
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Gray J, McCarthy A, Samarakoon D, McMeekin P, Sharples L, Sastry P, Crawshaw P, Bicknell C. Costs of endovascular and open repair of thoracic aortic aneurysms. Br J Surg 2024; 111:znad378. [PMID: 38091972 PMCID: PMC10763539 DOI: 10.1093/bjs/znad378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Repair of thoracic aortic aneurysms with either endovascular repair (TEVAR) or open surgical repair (OSR) represents major surgery, is costly and associated with significant complications. The aim of this study was to establish accurate costs of delivering TEVAR and OSR in a cohort of UK NHS patients suitable for open and endovascular treatment for the whole treatment pathway from admission and to discharge and 12-month follow-up. METHODS A prospective study of UK NHS patients from 30 NHS vascular/cardiothoracic units in England aged ≥18, with distal arch/descending thoracic aortic aneurysms (CTAA) was undertaken. A multicentre prospective cost analysis of patients (recruited March 2014-July 2018, follow-up until July 2019) undergoing TEVAR or OSR was performed. Patients deemed suitable for open or endovascular repair were included in this study. A micro-costing approach was adopted. RESULTS Some 115 patients having undergone TEVAR and 35 patients with OSR were identified. The mean (s.d.) cost of a TEVAR procedure was higher £26 536 (£9877) versus OSR £17 239 (£8043). Postoperative costs until discharge were lower for TEVAR £7484 (£7848) versus OSR £28 636 (£23 083). Therefore, total NHS costs from admission to discharge were lower for TEVAR £34 020 (£14 301), versus OSR £45 875 (£43 023). However, mean NHS costs for 12 months following the procedure were slightly higher for the TEVAR £5206 (£11 585) versus OSR £5039 (£11 994). CONCLUSIONS Surgical procedure costs were higher for TEVAR due to device costs. Total in-hospital costs were higher for OSR due to longer hospital and critical care stay. Follow-up costs over 12 months were slightly higher for TEVAR due to hospital readmissions.
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Affiliation(s)
- Joanne Gray
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Andrew McCarthy
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Dilupa Samarakoon
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Peter McMeekin
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Linda Sharples
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Priya Sastry
- Department of Cardiac Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Paul Crawshaw
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Colin Bicknell
- Department of Surgery and Cancer, Imperial College, London, UK
- Imperial Vascular Unit, Imperial Healthcare NHS Trust, London, UK
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Jeganathan N, Sathananthan M. Interstitial lung disease hospitalizations, outcomes, and costs in the United States from 2008 to 2018. Respir Med 2024; 221:107502. [PMID: 38141861 DOI: 10.1016/j.rmed.2023.107502] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Interstitial lung diseases (ILD) are associated with frequent hospitalizations, however, limited studies have evaluated the hospitalization rates and outcomes. STUDY DESIGN AND METHODS We extracted hospitalization data for ILD patients using the National Inpatient Sample Database. Regression models were used to assess trends in hospitalizations and outcomes. RESULTS There were 345,063 hospitalizations with a principal diagnosis of ILD from 2008 to 2018. Hospitalization rates were higher in females, older age groups, and those living in rural areas. Rates were lower in those with income levels at or above the median and in the western U.S. Of those hospitalized, 5.1 % died, and ∼37 % required skilled nursing facility/home health. Deaths were lower among females and in those with Medicaid and private insurance. Rates were higher in the older age groups, those with median and above income levels, and those living in medium/small metro and rural areas. The overall hospitalization rate decreased by ∼23 % during this period. The percentage of deaths remained stable (except in rural hospitals) during this period. The average length of stay (LOS) was 5.5 days. The average hospital cost was $10,438 which increased by ∼38 %. INTERPRETATION Hospitalizations for ILD have been decreasing, however, the death percentage has been stable. The LOS has remained stable, but hospital costs have been increasing. We identified differences in ILD hospitalization rates and outcomes/costs based on patient and hospital characteristics. Identifying the causes for these differences would be important in reducing health disparities in ILD patients. CLINICAL TRIAL REGISTRATION n/a.
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Affiliation(s)
- Niranjan Jeganathan
- Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University Health, 11234 Anderson Street, Room 6424, Loma Linda, CA, 92354, USA.
| | - Matheni Sathananthan
- Department of Medicine, Loma Linda University Health, Loma Linda, CA, 92354, USA
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Filiberto AC, Adiyeke E, Ozrazgat-Baslanti T, Jacobs CR, Fazzone B, Bihorac A, Upchurch GR, Cooper M. Persistent Acute Kidney Injury is Associated with Poor Outcomes and Increased Hospital Cost in Vascular Surgery. Ann Vasc Surg 2024; 98:342-349. [PMID: 37423327 PMCID: PMC10964738 DOI: 10.1016/j.avsg.2023.06.023] [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] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Postoperative acute kidney injury (AKI) is common after major surgery and is associated with increased morbidity, mortality, and cost. Additionally, there are recent studies demonstrating that time to renal recovery may have a substantial impact on clinical outcomes. We hypothesized that patients with delayed renal recovery after major vascular surgery will have increased complications, mortality, and hospital cost. METHODS A single-center retrospective cohort of patients undergoing nonemergent major vascular surgery between 6/1/2014 and 10/1/2020 was analyzed. Development of postoperative AKI (defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria: >50% or > 0.3 mg/dl absolute increase in serum creatinine relative to reference after surgery and before discharge) was evaluated. Patients were divided into 3 groups: no AKI, rapidly reversed AKI (<48 hours), and persistent AKI (≥48 hours). Multivariable generalized linear models were used to evaluate the association between AKI groups and postoperative complications, 90-day mortality, and hospital cost. RESULTS A total of 1,881 patients undergoing 1,980 vascular procedures were included. Thirty five percent of patients developed postoperative AKI. Patients with persistent AKI had longer intensive care unit and hospital stays, as well as more mechanical ventilation days. In multivariable logistic regression analysis, persistent AKI was a major predictor of 90-day mortality (odds ratio 4.1, 95% confidence interval 2.4-7.1). Adjusted average cost was higher for patients with any type of AKI. The incremental cost of having any AKI ranged from $3,700 to $9,100, even after adjustment for comorbidities and other postoperative complications. The adjusted average cost for patients stratified by type of AKI was higher among patients with persistent AKI compared to those with no or rapidly reversed AKI. CONCLUSIONS Persistent AKI after vascular surgery is associated with increased complications, mortality, and cost. Strategies to prevent and aggressively treat AKI, specifically persistent AKI, in the perioperative setting are imperative to optimize care for this population.
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Affiliation(s)
| | - Esra Adiyeke
- Intelligent Critical Care Center (IC3), University of Florida, Gainesville, FL; Department of Medicine, University of Florida, Gainesville, FL
| | - Tezcan Ozrazgat-Baslanti
- Intelligent Critical Care Center (IC3), University of Florida, Gainesville, FL; Department of Medicine, University of Florida, Gainesville, FL
| | | | - Brian Fazzone
- Department of Surgery, University of Florida, Gainesville, FL
| | - Azra Bihorac
- Intelligent Critical Care Center (IC3), University of Florida, Gainesville, FL; Department of Medicine, University of Florida, Gainesville, FL
| | | | - Michol Cooper
- Department of Surgery, University of Florida, Gainesville, FL.
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Sherman JJZ, Sayeed S, Craft S, Reeves BC, Hengartner AC, Fernandez T, Koo AB, DiLuna M, Elsamadicy AA. Influence of affective disorders on outcomes after suboccipital decompression for adult Chiari I malformation. Clin Neurol Neurosurg 2024; 236:108104. [PMID: 38171050 DOI: 10.1016/j.clineuro.2023.108104] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/25/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Affective disorders (AD) have been shown to influence patient outcomes and healthcare resource utilization across several pathologies, though this relationship has not been described in patients with Chiari I malformations (CM-I). The aim of this study was to determine the impact of comorbid AD on postoperative events and healthcare resource utilization in adults following suboccipital decompression for CM-I. METHODS A retrospective study was performed using the 2016-2019 National Inpatient Sample database. Adults who underwent suboccipital decompression for CM-I were identified using ICD-10-CM codes. Patients were stratified into two cohorts, those with AD and those without (No AD). Patient demographics, comorbidities, operative characteristics, perioperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of prolonged length of stay (LOS), exorbitant admission costs, and non-routine discharge (NRD). RESULTS A total of 3985 patients were identified, of which 2780 (69.8%) were in the No AD cohort and 1205 (30.2%) were in the AD cohort. Patient demographics were similar, except for a greater proportion of Female patients than the No AD cohort (p = 0.004). Prevalence of some comorbidities varied between cohorts, including obesity (p = 0.030), ADHD (p < 0.001), GERD (p < 0.001), smoking (p < 0.001), and chronic pulmonary disease (p < 0.001). The AD cohort had a greater proportion of patients with 1-2 (p < 0.001) or ≥ 3 comorbidities (p < 0.001) compared to the No AD cohort. A greater proportion of patients in the AD cohort presented with headache compared to the No AD cohort (p = 0.003). Incidence of syringomyelia was greater in the No AD cohort (p = 0.002). A greater proportion of patients in the No AD cohort underwent duraplasty only (without cervical laminectomy) compared to the AD cohort (p = 0.021). Healthcare resource utilization was similar between cohorts, with no significant differences in mean LOS (No AD: 3.78 ± 3.51 days vs. 3.68 ± 2.71 days, p = 0.659), NRD (No AD: 3.8% vs. AD: 5.4%, p = 0.260), or mean admission costs (No AD: $20,254 ± 14,023 vs. AD: $29,897 ± 22,586, p = 0.284). On multivariate analysis, AD was not independently associated with extended LOS [OR (95%CI): 1.09 (0.72-1.65), p = 0.669], increased hospital costs [OR (95%CI): 0.98 (0.63-1.52), p = 0.930], or NRD [OR (95%CI): 1.39 (0.65-2.96), p = 0.302]. CONCLUSION Our study suggests that the presence of an AD may not have as much of an impact on postoperative events and healthcare resource utilization in adult patients undergoing Chiari decompression. Additional studies may be warranted to identify other potential implications that AD may have in other aspects of healthcare in this patient population.
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Affiliation(s)
- Josiah J Z Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Sumaiya Sayeed
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Astrid C Hengartner
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tiana Fernandez
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
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Brinster CJ, Money SR, Hayson A, Gurdian R, Milner R, Polcari K, Asirwatham M, Arnaoutakis DJ, Li C, Maldonado T, Cheung D, Meltzer A. Current Medicare reimbursement for complex endovascular aortic repair is inadequate based on results from a multi-institutional cost analysis. J Vasc Surg 2024; 79:3-10. [PMID: 37734569 DOI: 10.1016/j.jvs.2023.09.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Complex endovascular juxta-, para- and suprarenal abdominal aortic aneurysm repair (comEVAR) is frequently accomplished with commercially available fenestrated (FEVAR) devices or off-label use of aortoiliac devices with parallel branch stents (chEVAR). We sought to evaluate the implantable vascular device costs incurred with these procedures as compared with standard Medicare reimbursement to determine the financial viability of comEVAR in the modern era. METHODS Five geographically distinct institutions with high-volume, complex aortic centers were included. Implantable aortoiliac and branch stent device cost data from 25 consecutive, recent, comEVAR in the treatment of juxta-, para-, and suprarenal aortic aneurysms at each center were analyzed. Cases of rupture, thoracic aneurysms, reinterventions, and physician-modified EVAR were excluded, as were ancillary costs from nonimplantable equipment. Data from all institutions were combined and stratified into an overall cost group and two, individual cost groups: FEVAR or chEVAR. These groups were compared, and each respective group was then compared with weighted Medicare reimbursement for Diagnosis-Related Group codes 268/269. Median device costs were obtained from an independent purchasing consortium of >3000 medical centers, yielding true median cost-to-institution data rather than speculative, administrative projections or estimates. RESULTS A total of 125 cases were analyzed: 70 FEVAR and 53 chEVAR. Two cases of combined FEVAR/chEVAR were included in total cost analysis, but excluded from direct FEVAR vs chEVAR comparison. Median Medicare reimbursement was calculated as $35,755 per case. Combined average implantable device cost for all analyzed cases was $28,470 per case, or 80% of the median reimbursement ($28,470/$35,755). Average FEVAR device cost per case ($26,499) was significantly lower than average chEVAR cost per case ($32,122; P < .002). Device cost was 74% ($26,499/$35,755) of total reimbursement for FEVAR and 90% ($32,122/$35,755) for chEVAR. CONCLUSIONS Results from this multi-institutional analysis show that implantable device cost alone represents the vast majority of weighted total Medicare reimbursement per case with comEVAR, and that chEVAR is significantly more costly than FEVAR. Inadequate Medicare reimbursement for these cases puts high-volume, high-complexity aortic centers at a distinct financial disadvantage. In the interest of optimizing patient care, these data suggest a reconsideration of previously established, outdated, Diagnosis-Related Group coding and Medicare reimbursement for comEVAR.
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Affiliation(s)
| | - Samuel R Money
- Vascular Surgery Section, Ochsner Health, New Orleans, LA
| | - Aaron Hayson
- Vascular Surgery Section, Ochsner Health, New Orleans, LA
| | - René Gurdian
- Vascular Surgery Section, Ochsner Health, New Orleans, LA
| | - Ross Milner
- Section of Vascular Surgery and Endovascular Therapy, University of Chicago Health Center, Chicago, IL
| | - Kayla Polcari
- Section of Vascular Surgery and Endovascular Therapy, University of Chicago Health Center, Chicago, IL
| | - Mark Asirwatham
- Division of Vascular Surgery, University of South Florida Health, Tampa, FL
| | - Dean J Arnaoutakis
- Division of Vascular Surgery, University of South Florida Health, Tampa, FL
| | - Chong Li
- NYU Langone Vascular and Endovascular Surgery Associates, NYU Langone Health, New York, NY
| | - Thomas Maldonado
- NYU Langone Vascular and Endovascular Surgery Associates, NYU Langone Health, New York, NY
| | - Dillon Cheung
- Vascular and Endovascular Surgery, Mayo Clinic Scottsdale, Scottsdale, AZ
| | - Andrew Meltzer
- Vascular and Endovascular Surgery, Mayo Clinic Scottsdale, Scottsdale, AZ
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Sabajo CR, Ten Cate DWG, Heijmans MHM, Koot CTG, van Leeuwen LVL, Slooter GD. Prehabilitation in colorectal cancer surgery improves outcome and reduces hospital costs. Eur J Surg Oncol 2024; 50:107302. [PMID: 38043359 DOI: 10.1016/j.ejso.2023.107302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Increasing evidence suggests that multimodal prehabilitation programs reduce postoperative complication rates and length of stay. Nevertheless, prehabilitation is not standard care yet, also as financial consequences of such programs are lacking. Aim of this study was to analyse clinical outcomes and effects on hospital resources if prehabilitation is implemented for patients who are planned for colorectal surgery. MATERIALS AND METHODS Patients undergoing elective colorectal surgery and who received either prehabilitation or standard care between January 2017 and March 2022 in a regional Dutch hospital were included. Outcome parameters were length of hospital stay, 30-day postoperative complications, 30-day ICU admission, readmission rates and hospital costs. RESULTS A total of 196 patients completed prehabilitation whereas 390 patients received standard care. Lower overall complication rates (31 % vs 40 %, p = 0.04) and severe complication rates (20 % vs 31 %, p = 0.01) were observed in the prehabilitation group compared to standard care. Length of stay was shorter in the prehabilitation group (mean 5.80 days vs 6.71 days). In hospital cost savings were €1109 per patient, while the calculated investment for prehabilitation was €969. CONCLUSION Implementation of a multimodal prehabilitation program in colorectal surgery reduces postoperative complication rates, length of stay and hospital costs.
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Affiliation(s)
- Charissa R Sabajo
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands; Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - David W G Ten Cate
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Margot H M Heijmans
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Christian T G Koot
- Department of Finance and Control, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Lisanne V L van Leeuwen
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, the Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
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Findlay MC, Hamrick FA, Kim RB, Twitchell S, Mahan MA. Hospital cost differences between open and endoscopic lumbar spine decompression surgery. J Neurosurg Spine 2024; 40:77-83. [PMID: 37856388 DOI: 10.3171/2023.8.spine23439] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/17/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE In recent years, fully endoscopic decompression surgery for degenerative spine disease has become increasingly popular in the US. Although an endoscopic approach has demonstrated some benefits compared with open procedures in randomized controlled trials, the cost of advanced technologies remains contested. The authors evaluated the differences in costs and cost drivers between open and endoscopic decompression surgical procedures performed at a single institution. METHODS Using associated Current Procedural Terminology codes, the authors identified all open and endoscopic decompression lumbar surgical procedures performed from January 1, 2016, through December 31, 2022. Preoperative comorbidities, surgical characteristics, and postoperative outcomes were captured. The costs of index surgery-related readmission for revision, washout, or other complications were included in the index surgery expenses. Associated in-hospital costs were collected; these were reported in comparative percentages with open surgical procedures as the baseline because of an institutional agreement. Univariate and multivariate analyses were performed. RESULTS The retrospective search identified 633 open surgical procedures and 195 endoscopic surgical procedures for inclusion. The two patient cohorts were similar, with clinically nonrelevant but statistically significant differences in mean age (open 55.7 years vs endoscopic 59.4 years, p = 0.01) and mean American Society of Anesthesiologists physical status class (open 2.3 vs endoscopic 2.4, p = 0.03). Postoperatively, patients who underwent open surgical procedures had significantly longer mean hospital stays (open 1.4 days vs endoscopic 0.7, p < 0.01) and more perioperative complications (open 7.9% of patients vs endoscopic 3.1%, p = 0.02), and they required washout surgical procedures in some cases (open 1.3% vs endoscopic 0%, p = 0.12). The largest cost difference between open and endoscopic surgical procedures was the significantly greater cost of disposable supplies for endoscopic cases (10.1% vs 31.7% of the total cost of open procedures, p < 0.01), and open surgical procedures were generally less costly in total (100.0% vs 115.1%, p < 0.01). In multivariate linear regression, endoscopic surgery was independently associated with greater total costs (standardized beta 15.9%, p < 0.01), although length of hospital stay (standardized beta 34.0%) and readmissions (standardized beta 30.0%, p < 0.01) had larger effects on cost. CONCLUSIONS The endoscopic approach was associated with greater total in-hospital costs compared with open procedures. The findings of further cost evaluations, including those of patient-reported outcomes, social cost, and capital costs per procedure type, need to be included in operational and clinical decisions.
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Affiliation(s)
| | - Forrest A Hamrick
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Robert B Kim
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Spencer Twitchell
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Mark A Mahan
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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Yang K, Sambandam S. Total hip arthroplasty in patients with colostomy: impact on inpatient complications, hospital costs, and length of stay. Arch Orthop Trauma Surg 2024; 144:509-516. [PMID: 37755481 DOI: 10.1007/s00402-023-05060-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION The presence of permanent end-colostomy is traditionally thought of as a risk factor for complications following orthopedic joint replacement; however, literature supporting this association is scarce. This study aims to discern how length of stay, cost of stay, and inpatient complications following total hip arthroplasty (THA) are impacted by presence of colostomy. METHODS Data from the National Inpatient Sample was analyzed by International Classification of Diseases, 10th Revision, Clinical Modification regarding THA in patients with and without end-colostomy. Unmatched and matched analyses comparing length of stay, cost of stay, and post-operative adverse outcomes between the two groups were conducted. In the unmatched analysis, 445 THA patients with colostomy were compared to 367,449 THA patients without colostomy. The colostomy patients were then matched for age, sex, race, diabetes, obesity, and the matched groups consisted of 445 patients with and 425 patients without colostomy, respectively. RESULTS Compared to the THA without colostomy group, the colostomy group was significantly older, had longer hospital stays, and greater cost of stay. When matched for age and comorbidities, length of hospital stay (p < 0.001) and cost of stay (p = 0.002) remained significantly higher. The colostomy group was at significantly increased risk for periprosthetic fracture, dislocation, and infection compared to all THA patients. When matched for age and common comorbidities, the colostomy group had significantly higher risk in only periprosthetic dislocation [p = 0.003, OR 11.8 (1.6-4.6, 95% CI)] and periprosthetic infection [p < 0.05, OR 2.7 (0.97-7.7 95% CI)]. CONCLUSION Patients with colostomy are at risk of longer hospital courses and greater incurred costs following THA compared to patients without colostomy. They are additionally at significantly increased risk of periprosthetic dislocation and periprosthetic infection, warranting treatment as high-risk patients. STUDY DESIGN Retrospective cohort study.
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Affiliation(s)
- Kristine Yang
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Xie R, Wallace LA, Lindeman BM, Porterfield JR, Chu DI, Chen H, Wang TN. Physician-Targeted Interventions Reduce Surgical Expense and Improve Value-Driven Health Outcomes. J Surg Res 2023; 292:79-90. [PMID: 37597453 DOI: 10.1016/j.jss.2023.07.031] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Increasing health-care costs in the United States have not translated to superior outcomes in comparison to other developed countries. The implementation of physician-targeted interventions to reduce costs may improve value-driven health outcomes. This study aimed to evaluate the effectiveness of physician-targeted interventions to reduce surgical expenses and improve care for patients undergoing total thyroidectomies. METHODS Two separate face-to-face interventions with individual surgeons focusing on surgical expenses associated with thyroidectomy were implemented in two surgical services (endocrine surgery and otolaryngology) by the surgical chair of each service in Jun 2016. The preintervention period was from Dec 2014 to Jun 2016 (19 mo, 352 operations). The postintervention period was from July 2016 to January 2018 (19 mo, 360 operations). Descriptive statistics were utilized, and differences-in-differences were conducted to compare the pre and postintervention outcomes including cost metrics (total costs, fixed costs, and variable costs per thyroidectomy) and clinical outcomes (30-d readmission rate, days to readmission, and total length of stay). RESULTS Patient demographics and characteristics were comparable across pre- and post-intervention periods. Post-intervention, both costs and clinical outcomes demonstrated improvement or stability. Compared to otolaryngology, endocrine surgery achieved additional savings per surgery post-intervention: mean total costs by $607.84 (SD: 9.76; P < 0.0001), mean fixed costs by $220.21 (SD: 5.64; P < 0.0001), and mean variable costs by $387.82 (SD: 4.75; P < 0.0001). CONCLUSIONS Physician-targeted interventions can be an effective tool for reducing cost and improving health outcomes. The effectiveness of interventions may differ based on specialty training. Future implementations should standardize these interventions for a critical evaluation of their impact on hospital costs and patient outcomes.
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Affiliation(s)
- Rongbing Xie
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Lauren A Wallace
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, North Carolina
| | - Brenessa M Lindeman
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - John R Porterfield
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Herbert Chen
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Thomas N Wang
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Belouaer A, Cossu G, Al-Tayyari S, Bubenikova A, Caliman C, Agri F, Perez MH, Chanez V, Boegli Y, Mury C, Daniel RT, Messerer M. The Enhanced Recovery After Surgery protocol for the surgical management of craniosynostosis: Lausanne experience. Neurosurg Focus 2023; 55:E14. [PMID: 38039522 DOI: 10.3171/2023.9.focus23540] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/28/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Over the past decade, the Enhanced Recovery After Surgery (ERAS) program has demonstrated its effectiveness and efficiency in improving postoperative care and enhancing recovery across various surgical fields. Preliminary results of ERAS protocol implementation in craniosynostosis surgery are presented. METHODS An ERAS protocol was developed and implemented for cranial pediatric neurosurgery, focusing on craniosynostosis repair. The study incorporated a pre-ERAS group consisting of a consecutive series of patients who underwent craniosynostosis repair surgery prior to the implementation of the ERAS protocol; the results were compared with a consecutive group of patients who had been prospectively collected since the introduction of the ERAS for craniosynostosis protocol. The safety, feasibility, and efficiency of the ERAS protocol in pediatric neurosurgery was evaluated, through the collection of clinical data from the pre-, intra-, and postoperative phase. Surgery-related complications were evaluated according to the Clavien-Dindo classification. Costs of the stays were obtained using a microcosting approach. RESULTS A total of 35 pre-ERAS patients and 10 ERAS patients were included. Scaphocephaly was the most common pathology in both groups. The overall compliance with the pre-, intra-, and postoperative criteria significantly increased-from 35.5%, 64.4%, and 54.7%, respectively, in each phase to 94%, 90%, and 84% (p < 0.001). The authors noticed a reduction in the average opioid dose used per patient in the ERAS group (p = 0.004), and they observed a trend toward a decreased mean length of stay from 5.2 days in the pre-ERAS group to 4.6 days in the ERAS group, without an increase of the rate of readmission within 30 days of surgery. The rate of complications decreased but this difference was not statistically significant. The hospital costs lowered significantly: from 21,958 Confederatio Helvetica Francs (CHF) in the pre-ERAS group to 18,936 CHF in the ERAS group (p = 0.02). CONCLUSIONS The ERAS protocol represents a safe and cost-effective tool for the perioperative management of craniosynostosis. It showed its positive impact on the analgesia provided and on the reduction of in-hospital costs for these patients. ERAS protocols may thus be interesting options in the pediatric neurosurgical field.
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Affiliation(s)
- Amani Belouaer
- 1Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Giulia Cossu
- 1Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Soulayma Al-Tayyari
- 1Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Adela Bubenikova
- 2Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Catalina Caliman
- 1Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Fabio Agri
- 3Department of Administration and Finance, Lausanne University
| | - Maria-Helena Perez
- 4Department of Pediatrics, Pediatric Intensive and Intermediate Care Units, Women-Mother-Child Department, Lausanne University Hospital and University of Lausanne; and
| | - Vivianne Chanez
- 4Department of Pediatrics, Pediatric Intensive and Intermediate Care Units, Women-Mother-Child Department, Lausanne University Hospital and University of Lausanne; and
| | - Yann Boegli
- 5Department of Anesthesiology, Pediatric Unit, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Caroline Mury
- 5Department of Anesthesiology, Pediatric Unit, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Roy Thomas Daniel
- 1Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Mahmoud Messerer
- 1Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital and University of Lausanne, Switzerland
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Grimsley EA, Janjua HM, Herron T, Read MD, Lorch S, Cha JY, Farach SM, Douglas GP, Kuo PC. Patient outcomes and cost in robotic emergency general surgery. J Robot Surg 2023; 17:2937-2944. [PMID: 37856059 DOI: 10.1007/s11701-023-01739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
The use of robotic technology in general surgery continues to increase, though its utility for emergency general surgery remains under-studied. This study explores the current trends in patient outcomes and cost of robotic emergency general surgery (REGS). The Florida Agency for Healthcare Administration database (2018-2020) was queried for adult patients undergoing intra-abdominal emergency general surgery within 24 h of admission and linked to CMS Cost Reports/Hospital Compare, American Hospital Association, and Rand Corporation Hospital datasets. Patients from the four most common REGS procedures were propensity matched to laparoscopic equivalents for hospital cost analysis. A telephone survey was performed with the top 10 REGS hospitals to identify key qualities for successful REGS programs. 181 hospitals (119 REGS, 62 non-REGS) performed 60,733 emergency surgeries. Six-percent were REGS. The most common REGS were cholecystectomy, appendectomy, inguinal and ventral hernia repairs. Before and after propensity matching, total cost for these four procedures were significantly higher than their laparoscopic equivalents, which was due to higher surgical cost as the non-operative costs did not differ. There were no differences in mortality, individual complications, or length of stay for most of the four procedures. REGS volume significantly increased each year. The survey found that 8/10 hospitals have robotic-trained staff available 24/7. Although REGS volume is increasing in Florida, cost remains significantly higher than laparoscopy. Given higher costs and lack of significantly improved outcomes, further study should be undertaken to better inform which specific patient populations would benefit from REGS.
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Affiliation(s)
- Emily A Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Haroon M Janjua
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Thomas Herron
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Meagan D Read
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Steven Lorch
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - John Y Cha
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Sandra M Farach
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Geoffrey P Douglas
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA.
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Fodero R, Bailey J. Comparing hospital costs and length of stay for cancer patients in New York State Comprehensive Cancer Centers versus nondesignated academic centers and community hospitals. Health Serv Res 2023; 58:1178-1188. [PMID: 37534691 PMCID: PMC10622293 DOI: 10.1111/1475-6773.14209] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE To explore differences in costs and lengths of stay for cancer patients admitted to National Cancer Institute-designated Comprehensive Cancer Centers, nondesignated academic medical centers, and community hospitals in New York State. DATA SOURCES We use patient-level data from the New York State Statewide Planning and Research Cooperative System Hospital Inpatient Discharges dataset for the years 2017-2019. STUDY DESIGN We employ ordinary least squares and Poisson regressions to compare hospital costs and length of stay for cancer patients, controlling for hospital type, patient demographics, and patient health. Our key outcomes are differences in costs and lengths of stay. DATA COLLECTION We use data on patient demographics, total treatment costs, and lengths of stay for patients discharged from New York hospitals with cancer-related diagnoses between 2017 and 2019. PRINCIPAL FINDINGS We determine that inpatient costs were 27% higher (95% CI 0.252, 0.285), but length of stay was 12% shorter (95% CI -0.131, -0.100), in Comprehensive Cancer Centers relative to community hospitals. CONCLUSIONS The results imply that, in New York State, Comprehensive Cancer Centers are a magnet for more complex oncology cases and administer more expensive treatments. That expertise, however, seems to be responsible for more efficient care delivery and thorough discharge planning, allowing for shorter average lengths of stay.
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Affiliation(s)
- Ryan Fodero
- Department of EconomicsProvidence CollegeProvidenceRhode IslandUSA
| | - James Bailey
- Department of EconomicsProvidence CollegeProvidenceRhode IslandUSA
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Rudolph MI, Azimaraghi O, Salloum E, Wachtendorf LJ, Suleiman A, Kammerer T, Schaefer MS, Eikermann M, Kiyatkin ME. Association of reintubation and hospital costs and its modification by postoperative surveillance: A multicenter retrospective cohort study. J Clin Anesth 2023; 91:111264. [PMID: 37722150 DOI: 10.1016/j.jclinane.2023.111264] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE We estimated hospital costs associated with postoperative reintubation and tested the hypothesis that prolonged surveillance in the post-anesthesia care unit (PACU) modifies the hospital costs of reintubation. DESIGN Retrospective observational research study. SETTING Two tertiary care academic healthcare networks in the Bronx, New York and Boston, Massachusetts, USA. PATIENTS 68,125 adult non-cardiac surgical patients undergoing general anesthesia between 2016 and 2021. INTERVENTIONS The exposure variable was unplanned reintubation within 7 days of surgery. MEASUREMENTS The primary outcome was direct hospital costs associated with patient care related activities. We used a multivariable generalized linear model based on log-transformed costs data, adjusting for pre- and intraoperative confounders. We matched our data with data from the Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP-NIS). In the key secondary analysis, we examined if prolonged postoperative surveillance, defined as PACU utilization (≥4 h) modifies the association between reintubation and costs of care. MAIN RESULTS 1759 (2.6%) of patients were re-intubated within 7 days after surgery. Reintubation was associated with higher direct hospital costs (adjusted model estimate 2.05; 95% CI: 2.00-2.10) relative to no reintubation. In the HCUP-NIS matched cohort, the adjusted absolute difference (ADadj) in costs amounted to US$ 18,837 (95% CI: 17,921-19,777). The association was modified by the duration of PACU surveillance (p-for-interaction <0.001). In patients with a shorter PACU length of stay, reintubation occurred later (median of 2 days; IQR 1, 5) versus 1 days (IQR 0, 2; p < .001), and was associated with magnified effects on hospital costs compared to patients who stayed in the PACU longer (ADadj of US$ 23,444, 95% CI: 21,217-25,799 versus ADadj of US$ 17,615, 95% CI: 16,350-18,926; p < .001). CONCLUSION Postoperative reintubation is associated with 2-fold higher hospital costs. Prolonged surveillance in the recovery room mitigated this effect. The cost-saving effect of longer PACU length of stay was likely driven by earlier reintubation in patients who needed this intervention.
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Affiliation(s)
- Maíra I Rudolph
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department for Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Omid Azimaraghi
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Elie Salloum
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Luca J Wachtendorf
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Aiman Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Anesthesia and Intensive Care, Faculty of Medicine, The University of Jordan, Amman, Jordan.
| | - Tobias Kammerer
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Anesthesiology, Dϋsseldorf University Hospital, Dϋsseldorf, Germany.
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany.
| | - Michael E Kiyatkin
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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Kumar A, Hammond N, Abbenbroek B, Thompson K, Taylor C, Venkatesh B, Delaney A, Finfer S. Sepsis-coded hospitalisations and associated costs in Australia: a retrospective analysis. BMC Health Serv Res 2023; 23:1319. [PMID: 38031109 PMCID: PMC10688047 DOI: 10.1186/s12913-023-10223-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To report trends in Australian hospitalisations coded for sepsis and their associated costs. DESIGN Retrospective analysis of Australian national hospitalisation data from 2002 to 2021. METHODS Sepsis-coded hospitalisations were identified using the Global Burden of Disease study sepsis-specific ICD-10 codes modified for Australia. Costs were calculated using Australian-Refined Diagnosis Related Group codes and National Hospital Cost Data Collection. RESULTS Sepsis-coded hospitalisations increased from 36,628 in 2002-03 to 131,826 in 2020-21, an annual rate of 7.8%. Principal admission diagnosis codes contributed 13,843 (37.8%) in 2002-03 and 44,186 (33.5%) in 2020-21; secondary diagnosis codes contributed 22,785 (62.2%) in 2002-03 and 87,640 (66.5%) in 2020-21. Unspecified sepsis was the most common sepsis code, increasing from 15,178 hospitalisations in 2002-03 to 68,910 in 2020-21. The population-based incidence of sepsis-coded hospitalisations increased from 18.6 to 10,000 population (2002-03) to 51.3 per 10,000 (2021-21); representing an increase from 55.1 to 10,000 hospitalisations in 2002-03 to 111.4 in 2020-21. Sepsis-coded hospitalisations occurred more commonly in the elderly; those aged 65 years or above accounting for 20,573 (55.6%) sepsis-coded hospitalisations in 2002-03 and 86,135 (65.3%) in 2020-21. The cost of sepsis-coded hospitalisations increased at an annual rate of 20.6%, from AUD199M (€127 M) in financial year 2012 to AUD711M (€455 M) in 2019. CONCLUSION Hospitalisations coded for sepsis and associated costs increased significantly from 2002 to 2021 and from 2012 to 2019, respectively.
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Affiliation(s)
- Ashwani Kumar
- Critical Care Program, The George Institute for Global Health, Sydney, NSW, Australia.
- University of New South Wales, Sydney, Australia.
| | - Naomi Hammond
- Critical Care Program, The George Institute for Global Health, Sydney, NSW, Australia
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, Australia
| | - Brett Abbenbroek
- Critical Care Program, The George Institute for Global Health, Sydney, NSW, Australia
- University of New South Wales, Sydney, Australia
| | - Kelly Thompson
- Critical Care Program, The George Institute for Global Health, Sydney, NSW, Australia
- Nepean Blue Mountains LHD, Sydney, NSW, Australia
- University of New South Wales, Sydney, Australia
| | - Colman Taylor
- Critical Care Program, The George Institute for Global Health, Sydney, NSW, Australia
- University of New South Wales, Sydney, Australia
| | - Bala Venkatesh
- Critical Care Program, The George Institute for Global Health, Sydney, NSW, Australia
- Princess Alexandra Hospital, Brisbane, QLD, Australia
- University of New South Wales, Sydney, Australia
| | - Anthony Delaney
- Critical Care Program, The George Institute for Global Health, Sydney, NSW, Australia
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, Australia
| | - Simon Finfer
- Critical Care Program, The George Institute for Global Health, Sydney, NSW, Australia
- School of Public Health, Imperial College London, London, UK
- University of New South Wales, Sydney, Australia
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Daikh A, Reymond F, Lombardo D, Thuillier C, Bedouch P, Faucheron JL. Retrospective study of sacral neuromodulator implantations in a French hospital center: Lifespan and hospital costs assessment. Int J Colorectal Dis 2023; 38:273. [PMID: 38015254 DOI: 10.1007/s00384-023-04569-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Sacral nerve neuromodulation (SNM) is a safe and effective therapy for the management of fecal and/or urinary incontinence. The generators InterStim™ and InterStim™ II (Medtronic™) are non-rechargeable active implantable medical devices with a limited lifespan. The aims of this study were to assess the generators' median lifespan for all indications and the long-term hospital costs of the therapy. METHODS This was a retrospective monocentric study that included 215 patients aged over 18 years who were treated by SNM for fecal incontinence and/or urinary incontinence. Lifespan was considered as the amount of time between definitive implantation and observed battery depletion by the surgeon and was assessed by the Kaplan-Meier method. Costs were assessed according to the activity-based pricing of the French public health care system. RESULTS The median observed lifetime of stimulators implanted in our center was 7.29 years and 5.9 years for InterStim™ and InterStim™ II, respectively. The difference observed between the two generations was statistically significant. The modelling of primary implantation and renewal costs allowed us to observe that the decrease in the lifetime of Interstim™ II is associated with an increase in hospital costs over time. The retrospective study design is one limitation and we did not take into consideration stimulation's settings. CONCLUSIONS The InterStim™ II lifespan is shorter than the first-generation device. This is associated with an increase of the long-term hospital costs. Additional information about the new neuromodulator will be required to choose the most appropriate IPG for the patient while optimizing the costs.
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Affiliation(s)
- Assia Daikh
- Department of Pharmacy, Grenoble Alpes University Hospital, F-38000, Grenoble, France.
| | - Fabienne Reymond
- Department of Pharmacy, Grenoble Alpes University Hospital, F-38000, Grenoble, France
| | - Dorothée Lombardo
- Department of Pharmacy, Grenoble Alpes University Hospital, F-38000, Grenoble, France
| | - Caroline Thuillier
- Department of Urology, Grenoble Alpes University Hospital, F-38000, Grenoble, France
| | - Pierrick Bedouch
- Department of Pharmacy, Grenoble Alpes University Hospital, F-38000, Grenoble, France
- Faculty of Pharmacy, University Grenoble Alpes, F-38000, Grenoble, France
- TIMC-IMAG UMR5525, CNRS, University Grenoble Alpes, F-38041, Grenoble, France
| | - Jean-Luc Faucheron
- TIMC-IMAG UMR5525, CNRS, University Grenoble Alpes, F-38041, Grenoble, France
- Colorectal Surgery Unit, Department of Visceral Surgery and Acute Care Surgery, Grenoble Alpes University Hospital, F-38000, Grenoble, France
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Nur AM, Aljunid SM, Almari M. Cost of in-patient management of COVID-19 patients in a general hospital in Kuwait. BMC Health Serv Res 2023; 23:1314. [PMID: 38017444 PMCID: PMC10685622 DOI: 10.1186/s12913-023-10287-z] [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] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 11/06/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Among the GCC countries affected by COVID-19 infections, Kuwait has been significantly impacted, with 658,520 cases and 2,563 deaths reported by the WHO on September 30, 2022. However, the impact of the COVID-19 epidemic on Kuwait's economy, especially in the healthcare sector, remains unknown. OBJECTIVE This study aims to determine the total cost of managing COVID-19 in-patients in Kuwait. METHOD A cross-sectional design was employed for this study. A total of 485 COVID-19 patients admitted to a general hospital responsible for COVID-19 cases management were randomly selected for this study from May 1st to September 31st, 2021. Data on sociodemographic information, length of stay (LOS), discharge status, and comorbidities were obtained from the patients' medical records. The data on costs in this study cover administration, utility, pharmacy, radiology, laboratory, nursing, and ICU costs. The unit cost per admission was calculated using a step-down costing method with three levels of cost centers. The unit cost was then multiplied by the individual patient's length of stay to determine the cost of care per patient per admission. FINDINGS The mean cost of COVID-19 in-patient care per admission was KD 2,216 (SD = 2,018), which is equivalent to USD 7,344 (SD = 6,688), with an average length of stay of 9.4 (SD = 8.5) days per admission. The total treatment costs for COVID-19 in-patients (n = 485) were estimated to be KD 1,074,644 (USD 3,561,585), with physician and nursing care costs constituting the largest share at 42.1%, amounting to KD 452,154 (USD 1,498,529). The second and third-largest costs were intensive care (20.6%) at KD 221,439 (USD 733,893) and laboratory costs (10.2%) at KD 109,264 (USD 362,123). The average cost for severe COVID-19 patients was KD 4,626 (USD 15,332), which is almost three times higher than non-severe patients of KD 1,544 (USD 5,117). CONCLUSION Managing COVID-19 cases comes with substantial costs. This cost information can assist hospital managers and policymakers in designing more efficient interventions, especially for managing high-risk groups.
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Affiliation(s)
- Amrizal Muhammad Nur
- Department of Health Policy and Management, College of Public Health, Kuwait University, Shadadiya, Kuwait.
| | - Syed Mohamed Aljunid
- Department of Health Policy and Management, College of Public Health, Kuwait University, Shadadiya, Kuwait
- Department of Public Health and Community Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Mohammad Almari
- Department of Health Policy and Management, College of Public Health, Kuwait University, Shadadiya, Kuwait
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Marr J, Wang Y, Xu J, Bai G, Anderson G, Meiselbach MK. Hospital Prices in Medicaid Managed Care. JAMA Netw Open 2023; 6:e2344841. [PMID: 38015509 PMCID: PMC10685878 DOI: 10.1001/jamanetworkopen.2023.44841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/14/2023] [Indexed: 11/29/2023] Open
Abstract
This cross-sectional study uses hospitals’ self-disclosed pricing information to characterize Medicaid managed care hospital prices.
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Affiliation(s)
- Jeffrey Marr
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yang Wang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jianhui Xu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ge Bai
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Carey Business School, Baltimore, Maryland
| | - Gerard Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mark K. Meiselbach
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Schatz C, Plötz W, Beckmann J, Bredow K, Leidl R, Buschner P. Associations of preoperative anemia and postoperative hemoglobin values with hospital costs in total knee arthroplasty (TKA). Arch Orthop Trauma Surg 2023; 143:6741-6751. [PMID: 37306776 PMCID: PMC10258736 DOI: 10.1007/s00402-023-04929-4] [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: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Total knee arthroplasty are among the most frequently conducted surgeries, due to an aging society. Since hospital costs are subsequently rising, adequate preparation of patients and reimbursement becomes more and more important. Recent literature revealed anemia as a risk factor for enhanced length of stay (LOS) and complications. This study analyzed whether preoperative hemoglobin (Hb) and postoperative Hb were associated with total hospital costs and general ward costs. METHODS The study comprised 367 patients from a single high-volume hospital in Germany. Hospital costs were calculated with standardized cost accounting methods. Generalized linear models were applied to account for confounders, such as age, comorbidities, body mass index, insurance status, health-related quality of life, implant types, incision-suture-time and tranexamic acid. RESULTS Preoperative anemic women had 426 Euros higher general ward costs (p < 0.01), due to increased LOS. For men, 1 g/dl less Hb loss between the preoperative value and the value before discharge reduced total costs by 292 Euros (p < 0.001) and 161 Euros fewer general ward costs (p < 0.001). Total hospital costs were reduced by 144 Euros with 1 g/dl higher Hb on day 2 postoperatively for women (p < 0.01). CONCLUSION Preoperative anemia was associated with increased general ward costs for women and Hb loss with decreasing total hospital costs for men and women. Cost containment, especially reduced utilization of the general ward, may be feasible with the correction of anemia for women. Postoperative Hb values may be a factor for adjustments of reimbursement systems. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- Caroline Schatz
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany.
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany.
- Environmental Health Center at Helmholtz Munich, Munich, Germany.
| | - Werner Plötz
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Orthopaedic Praxis Munich-Nymphenburg, Munich, Germany
| | - Johannes Beckmann
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
| | - Katharina Bredow
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Reiner Leidl
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
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Oderda M, Amato A, de la Rosette J, Doizi S, Estrade V, Falcone M, Grey B, Knudsen B, Olsburgh J, Pietropaolo A, Rukin N, Sedigh O, Saeed A, Somani BK, Gontero P. The impact of single-use digital flexible cystoscope for double J removal on hospital costs and work organization: A multicentric evaluation. Urologia 2023; 90:670-677. [PMID: 37154464 DOI: 10.1177/03915603231172543] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Isiris-α® is a single-use digital flexible cystoscope with an integrated grasper designed for double J (DJ) stent removal. Aim of this study was to conduct a multicentric evaluation of the costs and criticalities of stent removals performed with Isiris®-α in different hospitals and health systems, as compared to other DJ removal procedures. METHODS After gathering 10 institutions worldwide with experience on Isiris-α®, we performed an analysis of the reported costs of DJ removal with Isiris-α®, as compared to the traditional reusable equipment used in each institution. The cost evaluation included instrument purchase, Endoscopic Room (EnR)/ Operatory Room (OR) occupancy, medical staff, instrument disposal, maintenance, repairs, decontamination or sterilization of reusable devices. RESULTS The main factor affecting the costs of the procedure was OR/EnR occupancy. Decontamination and sterilization accounted for a less important part of total costs. Isiris-α® was more profitable in institutions where DJ removal is usually performed in the EnR/OR, allowing to transfer the procedure to outpatient clinic, with a significant cost saving and EnR/OR time saving to be allocated to other activities. In the only institution where DJ removal was already performed in outpatient clinics, there is a slight cost difference in favor of reusable instruments in high-volume institutions, given a sufficient number to guarantee the turnover. CONCLUSION Isiris-α® leads to significant cost benefit in the institutions where DJ removal is routinely performed in EnR/OR, and brings significant improvement in organization, cost impact and turnover.
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Affiliation(s)
- Marco Oderda
- Dept. of Surgical Sciences, Division of Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
| | - Antonio Amato
- Dept of Renal Transplantation, Civico Hospital, Palermo, Italy
| | | | - Steve Doizi
- Dept of Urology, Tenon Hospital, Paris, France
| | | | - Marco Falcone
- Dept. of Surgical Sciences, Division of Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
| | - Ben Grey
- Dept of Urology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Bodo Knudsen
- Dept of Urology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Nick Rukin
- Dept of Urology, Redcliffe Hospital, Redcliffe, QLD, Australia
| | - Omidreza Sedigh
- Dept. of Surgical Sciences, Division of Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
| | - Alhamri Saeed
- Dept. of Urology, Dept. of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Bhaskar K Somani
- Dept of Urology, University Hospital Southampton, Southampton, UK
| | - Paolo Gontero
- Dept. of Surgical Sciences, Division of Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
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49
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Miners A, Lampe FC, Cambiano V, Schwenk A, Rodger A, Sadique Z, Rein S, Delpech V, Phillips AN. Estimating the hospital costs of care for people living with HIV in England using routinely collected data. HIV Med 2023; 24:1115-1125. [PMID: 37641541 DOI: 10.1111/hiv.13529] [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] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/19/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Understanding the health care activity and associated hospital costs of caring for people living with HIV is an important component of assessing the cost effectiveness of new technologies and for budget planning. METHODS Data collected between 2010 and 2017 from an English HIV treatment centre were combined with national reference costs to estimate the rate of hospital attendances and costs per quarter year, according to demographic and clinical factors. The final dataset included records for 1763 people living with HIV, which was analysed using negative binomial regression models and general estimating equations. RESULTS People living with HIV experienced an unadjusted average of 0.028 (standard deviation [SD] 0.20) inpatient episodes per quarter, equivalent to one every 9 years, and 1.85 (SD 2.30) outpatient visits per quarter. The unadjusted mean quarterly cost per person with HIV (excluding antiretroviral drug costs) was £439 (SD 604). Outpatient appointments and inpatient episodes accounted for 88% and 6% of total costs, respectively. In adjusted models, low CD4 count was the strongest predictor of inpatient stays and outpatient visits. Low CD4 count and new patient status (having a first visit at the Trust in the last 6 months) were the factors that most increased estimated costs. Associations were weaker or less consistent for demographic factors (age, sex/sexual orientation/ethnicity). Sensitivity analyses suggest that the findings were generally robust to alternative parameter and modelling assumptions. CONCLUSION A number of factors predicted hospital activity and costs, but CD4 cell count and new patient status were the strongest. The study results can be incorporated into future economic evaluations and budget impact assessments of HIV-related technologies.
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Affiliation(s)
- Alec Miners
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | | | - Achim Schwenk
- North London Partners in Health and Care, London, UK
| | - Alison Rodger
- Institute for Global Health, University College London, London, UK
| | - Zia Sadique
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sophia Rein
- Institute for Global Health, University College London, London, UK
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50
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Ochs V, Tobler A, Enodien B, Saad B, Taha-Mehlitz S, Wolleb J, Awar JE, Neumann K, Drews S, Rosenblum I, Stoll R, Rosenberg R, Frey DM, Cattin PC, Taha A. Development and validation of a predictive model of the hospital cost associated with bariatric surgery. Obes Res Clin Pract 2023; 17:529-535. [PMID: 37903676 DOI: 10.1016/j.orcp.2023.10.003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/23/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023]
Abstract
Hospitals are facing difficulties in predicting, evaluating, and managing cost-affecting parameters in patient treatments. Inaccurate cost prediction leads to a deficit in operational revenue. This study aims to determine the ability of Machine Learning (ML) algorithms to predict the cost of care in bariatric and metabolic surgery and develop a predictive tool for improved cost analysis. 602 patients who underwent bariatric and metabolic surgery at Wetzikon hospital from 2013 to 2019 were included in the study. Multiple variables including patient factors, surgical factors, and post-operative complications were tested using a number of predictive modeling strategies. The study was registered under Req 2022-00659 and approved by an institutional review board. The cost was defined as the sum of all costs incurred during the hospital stay, expressed in CHF (Swiss Francs). The data was preprocessed and split into a training set (80%) and a test set (20%) to build and validate models. The final model was selected based on the mean absolute percentage error (MAPE). The Random Forest model was found to be the most accurate in predicting the overall cost of bariatric surgery with a mean absolute percentage error of 12.7. The study provides evidence that the Random Forest model could be used by hospitals to help with financial calculations and cost-efficient operation. However, further research is needed to improve its accuracy. This study serves as a proof of principle for an efficient ML-based prediction tool to be tested on multi-center data in future phases of the study.
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Affiliation(s)
- Vincent Ochs
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Anja Tobler
- Department of Surgery, GZO Hospital, Wetzikon, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Bassey Enodien
- Department of Surgery, GZO Hospital, Wetzikon, Switzerland
| | - Baraa Saad
- School of Medicine, St George's University of London, London, UK
| | - Stephanie Taha-Mehlitz
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital, Basel, Switzerland
| | - Julia Wolleb
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Joelle El Awar
- School of Medicine, St George's University of London, London, UK
| | - Katerina Neumann
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susanne Drews
- Center for Gastrointestinal Diseases, Cantonal Hospital Basel-Landschaft, 4410 Liestal, Switzerland
| | - Ilan Rosenblum
- Center for Gastrointestinal Diseases, Cantonal Hospital Basel-Landschaft, 4410 Liestal, Switzerland
| | - Reinhard Stoll
- Center for Gastrointestinal Diseases, Cantonal Hospital Basel-Landschaft, 4410 Liestal, Switzerland
| | - Robert Rosenberg
- Center for Gastrointestinal Diseases, Cantonal Hospital Basel-Landschaft, 4410 Liestal, Switzerland
| | - Daniel M Frey
- Department of Surgery, GZO Hospital, Wetzikon, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Anas Taha
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland; Center for Gastrointestinal Diseases, Cantonal Hospital Basel-Landschaft, 4410 Liestal, Switzerland.
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