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Taneja K, Diaz MJ, Taneja T, Patel K, Batchu S, Oak S, Zhang A, Joshi A, Patel UK. Trends in Volume and Charges of Retinal Tear Patients in the Emergency Department. Ophthalmic Epidemiol 2024; 31:55-61. [PMID: 37083477 DOI: 10.1080/09286586.2023.2203227] [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: 08/04/2022] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To characterize retinal tears (RTs) and calculate the economic burden of RTs that present to the emergency department (ED) in the US. METHODS We used a large national ED database to retrospectively analyze RTs that presented to the ED from 2006 to 2019. Using extrapolation methods, national of the RT patient ED volume, demographics, comorbidities, disposition, inpatient (IP) charges, and ED charges were calculated. RESULTS During the period between 2006 and 2019, 15841 ED encounters had RT listed as the primary diagnosis. The average annual RT ED encounters was 2,640 ± 856 and comprised an average of 6.4 × 10 - 5 % of all ED visits annually. The number and ED percentage of RT encounters did not change during this time period (p = .22, p = .67, respectively). Most patients were males, Caucasian, paid with private insurance, and admitted to EDs in the Northeast. The most common comorbidities were hypertension (19%), a history of cataracts (15%), and diabetes (7.2%). During this time period, RTs charges added up to more than $79 million and $33 million in the ED and IP settings, respectively. Mean per-encounter ED and IP charges increased by 145% (p = .0008) and 86% (p = .0047), respectively. CONCLUSION Despite the stable number of RT patients presenting to the ED, RTs place a significant economic burden to the healthcare system, which increases yearly. We recommend physicians and policy makers to work together to pass laws that could prevent the increasing healthcare charges.
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Affiliation(s)
- Kamil Taneja
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Michael Joseph Diaz
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Tanisha Taneja
- IB Program, Hillsborough High School, Tampa, Florida, USA
| | - Karan Patel
- Cooper Medical School, Rowan University, Camden, New Jersey, USA
| | | | - Solomon Oak
- Cooper Medical School, Rowan University, Camden, New Jersey, USA
| | - Alex Zhang
- Cooper Medical School, Rowan University, Camden, New Jersey, USA
| | - Aditya Joshi
- Cooper Medical School, Rowan University, Camden, New Jersey, USA
| | - Urvish K Patel
- Department of neurology, Icahn School of Medicine, Mount Sinai, New York, New York, USA
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Diaz A, Pawlik T. Association of ICD-10 Clinical Modification Codes for Social Determinants of Health with Surgical Outcomes and Hospital Charges Among Cancer Patients. Ann Surg Oncol 2024; 31:1171-1177. [PMID: 38006529 DOI: 10.1245/s10434-023-14501-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/11/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION We sought to characterize the impact of social determinants of health (SDOH)-related codes on outcomes among patients with a cancer diagnosis. METHODS Patients diagnosed with lung, pancreas, colon, or rectal cancer between 2017 and 2020 were identified in the California Department of Healthcare Access and Information Patient Discharge Database. Data on concomitant SDOH-related codes (International Classification of Diseases, Tenth Revision [ICD-10] Z55-Z65) designating health hazards related to socioeconomic and psychosocial circumstances were obtained. The association of these SDOH codes with postoperative outcomes was evaluated. RESULTS Among 10,421 patients who underwent an operation from 2017 to 2020, median age was 66 years (interquartile range [IQR] 56-75) and nearly half of the cohort was male (n = 551,252.9%). In total, 102 (1%) patients had a concurrent ICD-10 SDOH diagnosis. After controlling for competing risk factors, the risk-adjusted probability of in-hospital death was 4.1% (95% confidence interval [CI] 1.0-7.2) among patients with an SDOH diagnosis compared with 2.9% (95% CI 2.5-3.2) among patients without an SDOH diagnosis (odds ratio [OR] 1.52, 95% CI 0.63-3.66; p = 0.258); postoperative complications were 27.0% (95% CI 20.0-34.1) compared with 24.9% (95% CI 24.1-25.6) among patients without an SDOH diagnosis (OR 1.15, 95% CI 0.73-1.82; p = 0.141), and length of stay was 10.6 days (95% CI 10.0-11.2) compared with 9.4 days (95% CI 9.3-9.5) among patients without an SDOH diagnosis. Patients with an SDOH diagnosis had a 5.19 (95% CI 3.23-8.34; p < 0.005) higher odds of being discharged to a skilled nursing facility versus patients without an SDOH diagnosis. CONCLUSION Uptake and utilization of ICD-10 SDOH was 1% among California patients with lung, pancreas, colon, or rectal cancer. Patients with a concomitant ICD-10 SDOH code had longer length of stay and had higher odds of being discharged to a skilled nursing facility.
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Affiliation(s)
- Adrian Diaz
- Department of Surgery, The Ohio State University, Columbus, OH, USA.
| | - Timothy Pawlik
- Department of Surgery, The Ohio State University, Columbus, OH, USA
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Robinson JC, Whaley C, Dhruva SS. Hospital Prices for Physician-Administered Drugs for Patients with Private Insurance. N Engl J Med 2024; 390:338-345. [PMID: 38265645 DOI: 10.1056/nejmsa2306609] [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: 01/25/2024]
Abstract
BACKGROUND Hospitals can leverage their position between the ultimate buyers and sellers of drugs to retain a substantial share of insurer pharmaceutical expenditures. METHODS In this study, we used 2020-2021 national Blue Cross Blue Shield claims data regarding patients in the United States who had drug-infusion visits for oncologic conditions, inflammatory conditions, or blood-cell deficiency disorders. Markups of the reimbursement prices were measured in terms of amounts paid by Blue Cross Blue Shield plans to hospitals and physician practices relative to the amounts paid by these providers to drug manufacturers. Acquisition-price reductions in hospital payments to drug manufacturers were measured in terms of discounts under the federal 340B Drug Pricing Program. We estimated the percentage of Blue Cross Blue Shield drug spending that was received by drug manufacturers and the percentage retained by provider organizations. RESULTS The study included 404,443 patients in the United States who had 4,727,189 drug-infusion visits. The median price markup (defined as the ratio of the reimbursement price to the acquisition price) for hospitals eligible for 340B discounts was 3.08 (interquartile range, 1.87 to 6.38). After adjustment for drug, patient, and geographic factors, price markups at hospitals eligible for 340B discounts were 6.59 times (95% confidence interval [CI], 6.02 to 7.16) as high as those in independent physician practices, and price markups at noneligible hospitals were 4.34 times (95% CI, 3.77 to 4.90) as high as those in physician practices. Hospitals eligible for 340B discounts retained 64.3% of insurer drug expenditures, whereas hospitals not eligible for 340B discounts retained 44.8% and independent physician practices retained 19.1%. CONCLUSIONS This study showed that hospitals imposed large price markups and retained a substantial share of total insurer spending on physician-administered drugs for patients with private insurance. The effects were especially large for hospitals eligible for discounts under the federal 340B Drug Pricing Program on acquisition costs paid to manufacturers. (Funded by Arnold Ventures and the National Institute for Health Care Management.).
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Affiliation(s)
- James C Robinson
- From the University of California, Berkeley, Berkeley (J.C.R.); Brown University, Providence, RI (C.W.); and the University of California, San Francisco, School of Medicine, San Francisco (S.S.D.)
| | - Christopher Whaley
- From the University of California, Berkeley, Berkeley (J.C.R.); Brown University, Providence, RI (C.W.); and the University of California, San Francisco, School of Medicine, San Francisco (S.S.D.)
| | - Sanket S Dhruva
- From the University of California, Berkeley, Berkeley (J.C.R.); Brown University, Providence, RI (C.W.); and the University of California, San Francisco, School of Medicine, San Francisco (S.S.D.)
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4
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Patel VS, Beamer MR, H Sanford T, V Wiener S. Laser enucleation of the prostate (LEP) vs. simple prostatectomy: an analysis of hospital charges and comparison of practice trends. Int Urol Nephrol 2023; 55:3051-3056. [PMID: 37584861 DOI: 10.1007/s11255-023-03742-7] [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: 06/26/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Laser enucleation of the prostate (LEP) and simple prostatectomy (SP) are surgical treatment options for large gland Benign Prostatic Hyperplasia. While multiple studies compare clinical outcomes of these procedures, there are limited data available comparing hospital charges in the United States. Here, we present current practice trends and a hospital charge analysis on a national level using an annual insurance claims data repository. METHODS The Healthcare Cost and Utilization Project National Inpatient Sample and Nationwide Ambulatory Surgery Sample databases for 2018 were queried. CPT and ICD-10PCS codes identified patients undergoing LEP or SP, who were then compared for practice setting, total hospital charges, and payor. Laser type for LEP and surgical approach for SP could not be differentiated. RESULTS The median hospital charge of 5782 LEPs and 973 SPs is $26,689 and $51,250 (p < 0.001), respectively. LEP independently predicts a decreased hospital charge of $16,464 (p < 0.001) per case. Medicare is the primary payor for both procedures. More LEP procedures are completed in the outpatient setting (87.8%) vs. SPs (5.7%, p < 0.001). Median length of stay is longer for SP (LEP: 0, IQR: 0; SP: 3, IQR: 2-4; p < 0.001). In the Western region, LEP is least commonly performed (184, p < 0.001), most expensive ($43,960; p < 0.001), and has longer length of stay (2, p < 0.001). CONCLUSIONS LEP should be considered a cost-effective alternative to SP. Regions of the U.S. that perform more LEPs have shorter length of stay and lower hospital charges associated with the procedure.
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Affiliation(s)
- Valmic S Patel
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, USA
| | - Matthew R Beamer
- Department of Urology, SUNY Upstate Medical University, Syracuse, USA
| | | | - Scott V Wiener
- Department of Urology, SUNY Upstate Medical University, Syracuse, USA.
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Rhee BS, Kalliainen LK. Ongoing Challenges With Price Transparency in Hospital Charges for Hand Procedures. J Hand Surg Am 2023; 48:1263-1267. [PMID: 37676189 DOI: 10.1016/j.jhsa.2023.07.019] [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: 02/05/2023] [Revised: 04/21/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023]
Abstract
In 2020, the Centers for Medicare & Medicaid Services issued a historic rule on price transparency that aimed to better inform Americans about their health care costs by requiring hospitals to publicly provide pricing information on their items and services. In this review article, we describe the current gaps in transparency that persist after the implementation of the rule, from incomplete pricing files to noncompliance despite the issuance of monetary penalties by Centers for Medicare & Medicaid Services. Price transparency is vital for hand and upper extremity procedures, given their cost variation and patient desire for more financial discussions with their physicians regarding these procedures. Further improvements and interventions by various stakeholders are necessary to improve the current state of hospital price transparency and cost information for these patients and for anyone who seeks to make informed health care decisions. Policymakers should enforce stronger financial interventions and penalties and promote the use of bundled payments to facilitate better compliance by hospitals through a more expanded and accessible display of health care service costs. To help increase health care financial literacy among consumers, hand surgeons and hospital staff should engage in more dialog regarding health care prices and financial considerations with their patients.
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Affiliation(s)
- Ben S Rhee
- The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Loree K Kalliainen
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
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Amoroso EM. Regional differences in the utilization and outcomes of cerebral embolic protection during transcatheter aortic valve replacement: an analysis of the National Inpatient Sample from 2017 through 2019. J Comp Eff Res 2023; 12:e230010. [PMID: 37724712 PMCID: PMC10690440 DOI: 10.57264/cer-2023-0010] [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: 01/29/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023] Open
Abstract
Aim: To evaluate the utilization and outcomes of cerebral embolic protection (CEP) during transcatheter aortic valve replacement (TAVR) by USA region, using discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Patients & methods: All TAVR discharge encounters from June 2017-2019 were included in the analysis. Discharge encounters with bicuspid anatomy were excluded. Regional CEP utilization rates were reported. For TAVR cases performed with the Sentinel CEP device (Boston Scientific, MA, USA), multivariable logistic regression was performed to model regional differences in TAVR outcomes including: stroke, transient ischemic attack (TIA), stroke/TIA combined, and in-hospital all-cause mortality. Generalized linear regression models were used to assess regional differences in length of stay (LOS) and hospital charges. Results: The Northeast had the greatest overall CEP utilization rate (11.3%), followed by the Midwest (11.1%), West (8.7%), then South (3.1%). Compared with the Northeast, the South was associated with a lower risk of stroke (OR: 0.267, 95% CI: 0.106-0.673; p = 0.005), and the West a higher risk of stroke (OR: 1.583, 95% CI: 1.044-2.401; p = 0.031). Compared with the Northeast, the West was associated with a higher risk of stroke/TIA combined (OR: 1.618, 95% CI: 1.107-2.364; p = 0.013). Compared with the Northeast, the Midwest (OR: 4.501, 95% CI: 2.229-9.089; p < 0.001) and West (OR: 5.316, 95% CI: 2.611-10.824; p < 0.001) were associated with a higher risk of in-hospital all-cause mortality. Adjusted charges and LOS were highest in the West. Conclusion: Within the USA, there are regional differences in the utilization and outcomes of CEP use during TAVR. To prevent regional disparities and ensure consistent quality of care in the USA, further research is needed to determine what variable(s) may be responsible for regional differences in TAVR outcomes, with or without CEP.
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Affiliation(s)
- Elisa M Amoroso
- Department of Health Services Administration, Xavier University, Cincinnati, OH 45207, USA
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Shaftel KA, Cole TS, Little AS. In Reply: Nationwide Readmission Rates and Hospital Charges for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 1-Craniotomy. Neurosurgery 2023; 92:e65. [PMID: 36729631 DOI: 10.1227/neu.0000000000002304] [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: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Kelly A Shaftel
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Mejía JA, Garcia Rairan L, Figueredo L, Niño C. Letter: Nationwide Readmission Rates and Hospital Charges for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 1-Craniotomy. Neurosurgery 2023; 92:e63-e64. [PMID: 36700703 DOI: 10.1227/neu.0000000000002303] [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: 10/06/2022] [Accepted: 10/20/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
| | | | - Luisa Figueredo
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Claudia Niño
- Department of Neurosurgery, Fundación Santa Fe, Bogotá, Colombia
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Bogdan P, Walocha D, Gordon AM, Lam A, Ng MK, Saleh A, Razi AE. The Divergence Between Hospital Charges and Reimbursements For Primary 1-2-level Lumbar Fusion Has Increased Over Time: A Medicare Administrative Claims Analysis. Clin Spine Surg 2023; 36:E1-E5. [PMID: 35759770 DOI: 10.1097/bsd.0000000000001361] [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: 12/05/2021] [Accepted: 05/18/2022] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A retrospective cohort study was performed for patients undergoing 1-2-level lumbar fusion (1-2LF) from 2005 to 2014 using an administrative claims database. OBJECTIVE The objective of this study was to determine changes in: (1) annual charges; (2) annual reimbursement rates; and (3) annual difference (charges minus reimbursements) in patients undergoing 1-2LF. SUMMARY OF BACKGROUND DATA With implementation of value-based care in orthopaedics, coupled with the rise in number of patients undergoing 1-2LF, understanding the discordance in hospital charges and reimbursements is needed. The difference in hospital charges to reimbursements specifically for 1-2LF for degenerative disc disease has not been studied. MATERIALS AND METHODS A Medicare administrative claims database was queried for patients undergoing primary lumbar fusion using ICD-9 procedural code 81.04-81.08. Patients specifically undergoing 1-2LF were filtered from this cohort using ICD-9 procedural code 81.62. The query yielded 547,067 patients who underwent primary 1-2LF. Primary outcomes analyzed included trends in charges, reimbursement rates, and net difference in cost over time and per annual basis. Linear regression evaluated the change in costs over time with a P -value less than 0.05 considered significant. RESULTS From 2005 to 2014, total charges increased from $6,085,838,407 to $19,621,979,956 and total reimbursements increased from $1,677,764,831 to $4,656,702,685 (all P <0.001). Per patient charges increased 92.10% from 2005 to 2014 for patients undergoing primary 1-2LF from $129,992 to $249,697 ( P <0.001). Similarly, an increase in reimbursement per patient of 65.35% from $35,836 to $59,258 ( P <0.001) was noted. The annual difference in charges to reimbursements increased 102.26% during the study interval from $94,155 to $190,439 ( P <0.001). CONCLUSIONS Per patient charges and reimbursements both increased over the study period; however, charges increased 30% more than reimbursements. Further breakdown of hospital, surgeon, and anesthesiologist reimbursements for 1-2LF is needed. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Paulina Bogdan
- Department of Orthopedic Surgery Maimonides Medical Center
- State University of New York (SUNY) Downstate, College of Medicine, Brooklyn, NY
| | - Daniel Walocha
- Department of Orthopedic Surgery Maimonides Medical Center
- State University of New York (SUNY) Downstate, College of Medicine, Brooklyn, NY
| | - Adam M Gordon
- Department of Orthopedic Surgery Maimonides Medical Center
| | - Aaron Lam
- Department of Orthopedic Surgery Maimonides Medical Center
| | - Mitchell K Ng
- Department of Orthopedic Surgery Maimonides Medical Center
| | - Ahmed Saleh
- Department of Orthopedic Surgery Maimonides Medical Center
| | - Afshin E Razi
- Department of Orthopedic Surgery Maimonides Medical Center
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Kim J, Jacobs MA, Schmidt S, Brimhall BB, Salazar CI, Wang CP, Wang Z, Manuel LS, Damien P, Shireman PK. Retrospective cohort study comparing surgical inpatient charges, total costs, and variable costs as hospital cost savings measures. Medicine (Baltimore) 2022; 101:e32037. [PMID: 36550805 PMCID: PMC9771214 DOI: 10.1097/md.0000000000032037] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We analyzed differences (charges, total, and variable costs) in estimating cost savings of quality improvement projects using reduction of serious/life-threatening complications (Clavien-Dindo Level IV) and insurance type (Private, Medicare, and Medicaid/Uninsured) to evaluate the cost measures. Multiple measures are used to analyze hospital costs and compare cost outcomes across health systems with differing patient compositions. We used National Surgical Quality Improvement Program inpatient (2013-2019) with charge and cost data in a hospital serving diverse socioeconomic status patients. Simulation was used to estimate variable costs and total costs at 3 proportions of fixed costs (FC). Cases (Private 1517; Medicare 1224; Medicaid/Uninsured 3648) with patient mean age 52.3 years (Standard Deviation = 14.7) and 47.3% male. Medicare (adjusted odds ratio = 1.55, 95% confidence interval = 1.16-2.09, P = .003) and Medicaid/Uninsured (adjusted odds ratio = 1.41, 95% confidence interval = 1.10-1.82, P = .008) had higher odds of complications versus Private. Medicaid/Uninsured had higher relative charges versus Private, while Medicaid/Uninsured and Medicare had higher relative variable and total costs versus Private. Targeting a 15% reduction in serious complications for robust patients undergoing moderate-stress procedures estimated variable cost savings of $286,392. Total cost saving estimates progressively increased with increasing proportions of FC; $443,943 (35% FC), $577,495 (50% FC), and $1184,403 (75% FC). In conclusion, charges did not identify increased costs for Medicare versus Private patients. Complications were associated with > 200% change in costs. Surgical hospitalizations for Medicare and Medicaid/Uninsured patients cost more than Private patients. Variable costs should be used to avoid overestimating potential cost savings of quality improvement interventions, as total costs include fixed costs that are difficult to change in the short term.
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Affiliation(s)
- Jeongsoo Kim
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Michael A. Jacobs
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Bradley B. Brimhall
- Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- University Health, San Antonio, TX, USA
| | | | - Chen-Pin Wang
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Zhu Wang
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Laura S. Manuel
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Paul Damien
- Department of Information, Risk, and Operations Management, Red McCombs School of Business, University of Texas, Austin, TX, USA
| | - Paula K. Shireman
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
- University Health, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
- Departments of Primary Care and Rural Medicine and Medical Physiology, School of Medicine, Texas A&M Health, Bryan, TX, USA
- * Correspondence: Paula K. Shireman, Office of the Dean, School of Medicine, Texas A&M Health, 8447 Riverside Parkway, Bryan TX 77807, USA (e-mail: )
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11
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Kim DJ, Kim SJ. Is Hospital Hospice Service Associated with Efficient Healthcare Utilization in Deceased Lung Cancer Patients? Hospital Charges at Their End of Life. Int J Environ Res Public Health 2022; 19:15331. [PMID: 36430054 PMCID: PMC9690857 DOI: 10.3390/ijerph192215331] [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] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
In July 2015, South Korea began applying National Health Insurance reimbursement to inpatient hospice service. It is now appropriate and relevant to evaluate how hospice care is associated with healthcare utilization in terminal lung cancer patients. We used nationwide NHI claims data of lung cancer patients from 2008-2018 and identified a sample of patients deceased after July 2016. We transposed the dataset into a retrospective cohort design where a unit of analysis was each lung cancer patients' healthcare utilization. The differences in hospital charges per day were investigated depending on the patient's use of hospice service before death with the Generalized Linear Model (GLM) analysis. Additionally, subgroup analysis and the propensity score matching method were used to validate the model using the claims information of 25,099 patients. About 17.0% of patients used hospice services (N = 4260). With other variables adjusted, hospice service utilization by deceased lung cancer patients was associated with statistically significant lower hospital charges per day at the end of life (1 month, 3 months, and 6 months before death) compared to non-users. A similar trend was found in the propensity score matching model analysis. We found lower end-of-life hospital charges per day among lung cancer patients who received hospice services near death. The ever-expanding aging population requires health policymakers and the National Health Insurance program to expand hospice services for terminal cancer patients in underserved regions and hospitals that do not provide hospice.
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Affiliation(s)
- Dong Jun Kim
- Division of Cancer Control and Policy, National Cancer Center, Goyang 10408, Republic of Korea
| | - Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan 31538, Republic of Korea
- Center for Healthcare Management Science, Soonchunhyang University, Asan 31538, Republic of Korea
- Department of Software Convergence, Soonchunhyang University, Asan 31538, Republic of Korea
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Higuera L, Ismyrloglou E, Lu X, Hinnenthal J, Holbrook R. Collection of economic data using UB-04s: Is it worth the effort? Evidence from two clinical trials. PLoS One 2022; 17:e0277685. [PMID: 36395168 PMCID: PMC9671305 DOI: 10.1371/journal.pone.0277685] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/01/2022] [Indexed: 11/19/2022] Open
Abstract
Cost collection using UB-04 forms for economic evaluation is challenging, as UB-04 collection is time and effort intensive and compliance is imperfect. Alternative data sources could overcome those challenges. The objective of this study is to determine the usefulness of UB-04 data in estimating hospital costs compared to clinical case report form (CRF) data. Health care utilization costs were compared from financial information in UB-04s and from an assignment process using CRF data, from the WRAP-IT (23 infections) and the Micra IDE trials (61 adverse events and 108 implants). Charge-based costs were calculated by multiplying charges in UB-04s and hospital-specific Cost-to-Charge ratios from the Centers for Medicare and Medicaid Services cost reports. The cost assignment process used clinical information to find comparable encounters in real world data and assigned an average cost. Paired difference tests evaluated whether both methods yield similar results. The mean difference in total infection related costs between methods in the WRAP-IT trial was $152 +/-$22,565. In the Micra IDE trial, the mean difference in total adverse event related costs between methods was -$355 +/-$8,298 while the mean difference in total implant related costs between methods was $-3,488 +/-$13,859. Wilcoxon tests and generalized linear models could not reject the difference in costs between methods in the first two cases. Cost assignment methods achieve results similar to costs obtained through UB-04s, without the additional investment in time and effort. The use of UB-04 information for services that are not mature in a health care system may present unexpected challenges, necessitating a tradeoff with other methods of cost assignment.
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Affiliation(s)
- Lucas Higuera
- Medtronic Inc, Cardiac Rhythm & Heart Failure, Mounds View, Minnesota, United States of America
- * E-mail:
| | | | - Xiaoxiao Lu
- Medtronic Inc, Cardiac Rhythm & Heart Failure, Mounds View, Minnesota, United States of America
| | - Jennifer Hinnenthal
- Medtronic Inc, Cardiac Rhythm & Heart Failure, Mounds View, Minnesota, United States of America
| | - Reece Holbrook
- Medtronic Inc, Cardiac Rhythm & Heart Failure, Mounds View, Minnesota, United States of America
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Pressley JC, Pawlowski E, Hines LM, Bhatta S, Bauer MJ. Motor Vehicle Crash and Hospital Charges in Front- and Rear-Seated Restrained and Unrestrained Adult Motor Vehicle Occupants. Int J Environ Res Public Health 2022; 19:13674. [PMID: 36294253 PMCID: PMC9603584 DOI: 10.3390/ijerph192013674] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED There are reports that historically higher mortality observed for front- compared to rear-seated adult motor vehicle (MV) occupants has narrowed. Vast improvements have been made in strengthening laws and restraint use in front-, but not rear-seated occupants suggesting there may be value in expanding the science on rear-seat safety. METHODS A linked 2016-2017 hospital and MV crash data set, the Crash Outcomes Data Evaluation System (CODES), was used to compare characteristics of front-seated (n = 115,939) and rear-seated (n = 5729) adults aged 18 years and older involved in a MV crash in New York State (NYS). A primary enforced seat belt law existed for front-seated, but not rear-seated occupants. Statistical analysis employed SAS 9.4. RESULTS Compared to front-seated occupants, those rear-seated were more likely to be unrestrained (21.2% vs. 4.3%, p < 0.0001) and to have more moderate-to-severe injury/death (11.9% vs. 11.3%, p < 0.0001). Compared to restrained rear-seated occupants, unrestrained rear-seated occupants had higher moderate-to-severe injury/death (21.5% vs. 7.5%, p < 0.0001) and 4-fold higher hospitalization. More than 95% of ejections were unrestrained and had 7-fold higher medical charges. Unrestrained occupants' hospital stays were longer, charges and societal financial costs higher. CONCLUSIONS These findings extend the science of rear-seat safety in seriously injured rear-seated occupants, document increased medical charges and support the need to educate consumers and policy makers on the health and financial risks of adults riding unrestrained in the rear seat. The lack of restraint use in adult rear-seated motor vehicle occupants consumes scarce health care dollars for treatment of this serious, but largely preventable injury.
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Affiliation(s)
- Joyce C. Pressley
- Departments of Epidemiology and Health Policy and Management, Columbia University, New York, NY 10032, USA
| | - Emilia Pawlowski
- New York State Department of Health, Bureau of Occupational Health and Injury Prevention, Albany, NY 12237, USA
| | - Leah M. Hines
- New York State Department of Health, Bureau of Occupational Health and Injury Prevention, Albany, NY 12237, USA
| | - Sabana Bhatta
- New York State Department of Health, Bureau of Occupational Health and Injury Prevention, Albany, NY 12237, USA
| | - Michael J. Bauer
- New York State Department of Health, Bureau of Occupational Health and Injury Prevention, Albany, NY 12237, USA
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Milto AJ, El Bitar Y, Scaife SL, Thuppal S. Differences in hospital length of stay and total hospital charge by income level in patients hospitalized for hip fractures. Osteoporos Int 2022; 33:1067-1078. [PMID: 34988626 PMCID: PMC8731208 DOI: 10.1007/s00198-021-06260-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/01/2021] [Indexed: 12/15/2022]
Abstract
UNLABELLED This study examines the difference in length of stay and total hospital charge by income quartile in hip fracture patients. The length of stay increased in lower income groups, while total charge demonstrated a U-shaped relationship, with the highest charges in the highest and lowest income quartiles. INTRODUCTION Socioeconomic factors have an impact on outcomes in hip fracture patients. This study aims to determine if there is a difference in hospital length of stay (LOS) and total hospital charge between income quartiles in hospitalized hip fracture patients. METHODS National Inpatient Sample (NIS) data from 2016 to 2018 was used to determine differences in LOS, total charge, and other demographic/clinical outcomes by income quartile in patients hospitalized for hip fracture. Multivariate regressions were performed for both LOS and total hospital charge to determine variable impact and significance. RESULTS There were 860,045 hip fracture patients were included this study. With 222,625 in the lowest income quartile, 234,215 in the second, 215,270 in the third, and 190,395 in the highest income quartile. LOS decreased with increase in income quartile. Total charge was highest in the highest quartile, while it was lowest in the middle two-quartiles. Comorbidities with the largest magnitude of effect on both LOS and total charge were lung disease, kidney disease, and heart disease. Time to surgery post-admission also had a large effect on both outcomes of interest. CONCLUSION The results demonstrate that income quartile has an effect on both hospital LOS and total charge. This may be the result of differences in demographics and other clinical variables between quartiles and increased comorbidities in lower income levels. The overall summation of these socioeconomic, demographic, and medical factors affecting patients in lower income levels may result in worse outcomes following hip fracture.
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Affiliation(s)
- Anthony J Milto
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, P.O. Box 19679, Springfield, IL, 62794, USA
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St, Springfield, IL, 62702, USA
| | - Youssef El Bitar
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, P.O. Box 19679, Springfield, IL, 62794, USA
| | - Steven L Scaife
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St, Springfield, IL, 62702, USA
| | - Sowmyanarayanan Thuppal
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, P.O. Box 19679, Springfield, IL, 62794, USA.
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St, Springfield, IL, 62702, USA.
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15
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Etcheson JI, Mohamed NS, Dávila Castrodad IM, Remily EA, Wilkie WA, Edwards WO, Keleman MN, Nace J, Delanois RE. National Trends for Reverse Shoulder Arthroplasty After the Affordable Care Act: An Analysis From 2011 to 2015. Orthopedics 2022; 45:97-102. [PMID: 34978514 DOI: 10.3928/01477447-20211227-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies have investigated nationwide patient trends and health care costs for reverse shoulder arthroplasty (RSA) after 2014. This study uses a large validated nationwide database to retrospectively assess changes in patient and hospital demographic features, hospital costs, and hospital charges for inpatient RSA procedures before and after implementation of the Affordable Care Act. The National Inpatient Sample database was used to identify all patients who underwent RSA between January 2011 and December 2015, yielding 163,171 patients (63.4% female; mean age, 72 years). Categorical data were assessed with chi-square/Fisher's exact test, and continuous data were assessed with analysis of variance. There was an increased proportion of RSA recipients identifying as Hispanic (4.1% to 4.8%) and Native American (0.1% to 0.4%; P<.0001). The proportion of patients who had Medicaid (1.4% to 2.4%) and private insurance (15.1% to 16.6%) increased as well (P<.0001). A decrease in mean hospital costs occurred between 2011 and 2015 (-$256; P=.002), whereas an increase occurred in hospital charges (+$6,314; P<.001). These findings provide insight on RSA use and patient demographic trends in the United States. Additionally, these results help to capture the effects of extended health coverage and new reimbursement models on hospital costs and charges. [Orthopedics. 2022;45(2):97-102.].
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Abstract
OBJECTIVES To evaluate the contribution of PICU care to increasing hospital charges for patients with bronchiolitis over a 10-year study period. DESIGN In this retrospective multicenter study, changes in annual hospital charges (adjusted for inflation) were analyzed using linear regression for subjects admitted to the PICU with invasive mechanical ventilation (PICU + IMV) and without IMV (PICU - IMV), and for children not requiring PICU care. SETTING Free-standing children's hospitals contributing to the Pediatric Health Information System (PHIS) database. SUBJECTS Children less than 2 years with bronchiolitis discharged from a PHIS hospital between July 2009 and June 2019. Subjects were categorized as high risk if they were born prematurely or had a chronic complex condition. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS PICU patients were 26.5% of the 283,006 included subjects but accrued 66% of the total $14.83 billion in charges. Annual charges increased from $1.01 billion in 2009-2010 to $2.07 billion in 2018-2019, and PICU patients accounted for 83% of this increase. PICU + IMV patients were 22% of all PICU patients and accrued 64% of all PICU charges, but PICU - IMV patients without a high-risk condition had the highest relative increase in annual charges, increasing from $76.7 million in 2009-2010 to $377.9 million in 2018-2019 (374% increase, ptrend < 0.001). CONCLUSIONS In a multicenter cohort study of children hospitalized with bronchiolitis, PICU patients, especially low-risk children without the need for IMV, were the highest driver of increased hospital charges over a 10-year study period.
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Affiliation(s)
- Katherine N Slain
- Department of Pediatrics, Division of Pediatric Critical Care, Rainbow Babies & Children's Hospital, Cleveland, OH
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sindhoosha Malay
- Department of Pediatrics, Division of Pediatric Critical Care, Rainbow Babies & Children's Hospital, Cleveland, OH
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Steven L Shein
- Department of Pediatrics, Division of Pediatric Critical Care, Rainbow Babies & Children's Hospital, Cleveland, OH
- Case Western Reserve University School of Medicine, Cleveland, OH
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Affiliation(s)
- Donna Franklin
- Gold Coast University Hospital, Children's Emergency and Critical Care Research, Southport, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, VIC, Australia
- Wesley Medical Research, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
| | - Andreas Schibler
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, VIC, Australia
- Wesley Medical Research, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
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18
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Swindall R, Roden-Forman JW, Conflitti J, Cook A, Wadle C, Boyle J, Ward J, Gross B, Rogers F, Le TD, Norwood S. Elderly trauma associated with high-risk recreational activity: A population-based study, United States, 2010 through 2016. Surgery 2021; 171:1677-1686. [PMID: 34955287 DOI: 10.1016/j.surg.2021.11.014] [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: 08/26/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Understanding trends in prevalence and etiology is critical to public health strategies for prevention and management of injury related to high-risk recreation in elderly Americans. METHODS The National Emergency Department Sample from 2010 through 2016 was queried for patients with a principal diagnosis of trauma (ICD-9 codes 800.0-959.9) and who were 55 years and older. High-risk recreation was determined from e-codes a priori. Primary outcome measures were mortality and total hospital charges. RESULTS Of the 29,491,352 patient cohort, 458,599 (1.56%) engaged in high-risk activity, including those age 85 and older. High-risk cases were younger (median age 61 vs 70) and majority male (71.87% vs 39.24%). The most frequent activities were pedal cycling (45.81%), motorcycling (29.08%), and off-road vehicles (9.13%). Brain injuries (8.82% vs 3.88%), rib/sternal fractures (13.35% vs 3.53%), and cardiopulmonary injury (5.25% vs 0.57%) were more common among high-risk cases. Mortality (0.75% vs 0.40%) and total median hospital charges ($3,360 vs $2,312) were also higher for high-risk admissions, where the odds of mortality increased exponentially per year of age (odds ratio, 1.06; 99.5% CI, 1.05-1.08). High-risk recreation was associated with more than $1 billion in total hospital charges and more than 100 deaths among elderly Americans per year. CONCLUSION Morbidity, mortality, and resource utilization due to high-risk recreation extend into the ninth decade of life. The patterns of injury described here offer opportunities for targeted injury prevention education to minimize risk among this growing segment of the United States population.
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Affiliation(s)
- Rebecca Swindall
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX.
| | - Jacob W Roden-Forman
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Joseph Conflitti
- Department of Surgery, Trauma Program, UT Health East Texas, Tyler, TX
| | - Alan Cook
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Carly Wadle
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Julianna Boyle
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Jeanette Ward
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Brian Gross
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Fred Rogers
- Department of Surgery, University of Vermont College of Medicine, Burlington, VT
| | - Tuan D Le
- United States Army Institute of Surgical Research, Fort Sam Houston, TX
| | - Scott Norwood
- Department of Surgery, Trauma Program, UT Health East Texas, Tyler, TX
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Sinh P, Tabibian JH, Biyani PS, Mehta K, Mansoor E, Loftus EV, Dave M. Inflammatory Bowel Disease Does Not Impact Mortality but Increases Length of Hospitalization in Patients with Acute Myocardial Infarction. Dig Dis Sci 2021; 66:4169-4177. [PMID: 33492533 DOI: 10.1007/s10620-020-06818-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 12/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Inflammatory bowel diseases (IBD) have been associated with increased risk of cardiovascular events. We aimed to investigate the outcomes of myocardial infarction (MI) in patients with IBD. METHODS We performed a cross-sectional study utilizing data from the Nationwide Inpatient Sample from the years 1998 to 2010. ICD-9-CM codes were used to identify patients with Crohn's disease (CD) (555.X), ulcerative colitis (UC) (556.X), and acute MI (410.X). Outcomes in patients with MI with and without IBD were compared. Univariate analysis was performed. Multivariate logistic regression was used to determine the effect of UC and CD on in-hospital MI mortality after adjusting for confounders. RESULTS A total of 2,629,161 MI, 3,607 UC and 3784 CD patients were analyzed. UC (odds ratio [OR], 1.12; 95% CI 0.98-1.29) and CD (OR 0.99; 95% CI 0.86-1.15) did not affect in-hospital mortality in patients with MI. There was no difference between in-hospital mortality in patients with MI with or without UC (7.75% vs. 7.05%; p = 0.25) or in patients with MI with or without CD (6.50% vs. 6.59%; p = 0.87). The length of stay (LOS) was higher in IBD patients and total charges were statistically higher in patients with UC as compared to non-IBD patients ($65,182 vs. $53,542; p < 0.001). CONCLUSIONS This study shows that IBD does not impact in-hospital mortality from MI. However, patients with MI with IBD have longer LOS. Patients with UC have higher total hospitalization charges than patients with MI without IBD. Further prospective studies are needed to assess the outcomes of MI in IBD patients.
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Affiliation(s)
- Preetika Sinh
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Hub for Collaborative Medicine, Milwaukee, WI, 53226, USA
- Division of Gastroenterology and Liver Diseases, Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, UCLA-Olive View Medical Center, 14445 Olive View Dr. 2B182, Sylmar, CA, 91342, USA
| | - Prachi S Biyani
- Ohio Gastroenterology Group, 3400 Olentangy River Rd, Columbus, OH, 43202, USA
| | - Kathan Mehta
- Division of Medical Oncology, Kansas University Medical Center, 2330, Shawnee Mission Parkway, Westwood, KS, 66205, USA
| | - Emad Mansoor
- Division of Gastroenterology and Liver Diseases, Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Maneesh Dave
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, UC Davis Health, University of California Davis School of Medicine, 4150 V Street, Ste 3500, Sacramento, CA, 95817, USA.
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20
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Argueta PP, Salazar M, Vohra I, Corral JE, Lukens FJ, Vargo JJ, Chahal P, Simons-Linares CR. Thirty-Day Readmission Among Patients with Alcoholic Acute Pancreatitis. Dig Dis Sci 2021; 66:4227-4236. [PMID: 33469806 DOI: 10.1007/s10620-020-06765-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/09/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Alcoholic acute pancreatitis (AAP) comprises the second most common cause of acute pancreatitis in the USA, and there is lack of data regarding 30-day specific readmission causes and predictors. We aim to identify 30-day readmission rate, causes, and predictors of readmission. METHODS Retrospective analysis of the 2016 National Readmission Database of adult patients readmitted within 30 days after an index admission for AAP. RESULTS Totally, 76,609 AAP patients were discharged from the hospital in 2016. The 30-day readmission rate was 12%. The main cause of readmission was another episode of AAP. Readmission was not associated with higher mortality (1.3% vs. 1.2%; P = 0.21) or prolonged length of stay (5.2 vs. 5.0 days; P = 0.06). The total health care economic burden was $354 million in charges and $90 million in costs. Independent predictors of readmission were having Medicaid insurance, a Charlson comorbidity index score ≥ 3, use of total parenteral nutrition, opioid abuse disorder, prior pancreatic cyst, chronic alcoholic pancreatitis, and other chronic pancreatitis. Obesity was associated with lower odds of readmission. CONCLUSION Readmission rate for AAP is high and its primary cause are recurrent episodes of AAP. Alcohol and substance abuse pose a high burden on our health care system. Public health strategies should be targeted to provide alcohol abuse disorder rehabilitation and cessation resources to alleviate the burden on readmission, the health care system and to improve patient outcomes.
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Affiliation(s)
- Pedro Palacios Argueta
- Internal Medicine Department, John Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Miguel Salazar
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Ishaan Vohra
- Internal Medicine Department, John Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Juan E Corral
- Gastroenterology and Hepatology Department, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Frank J Lukens
- Gastroenterology and Hepatology Department, Mayo Clinic Florida, Jacksonville, FL, USA
| | - John J Vargo
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Prabhleen Chahal
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - C Roberto Simons-Linares
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Abstract
The association between anemia and Takotsubo cardiomyopathy (TCM) has not been well studied. To assess the effect of anemia on patients hospitalized with TCM, we identified 4733 patients with a primary diagnosis of TCM from the 2016 to 2018 National Inpatient Sample (NIS) database (the United States) using the International Classification of Diseases, 10th edition, Clinical Modification (ICD-10-CM) code. Of these, 603 (12.7%) patients had a comorbidity of anemia and 4130 did not. After propensity score matching, we compared the in-hospital outcomes between the 2 groups (anemia vs nonanemia, n = 594 vs 1137). Patients with TCM with anemia had significantly higher rates of in-hospital complications, including cardiogenic shock (11.4% vs 4.0%, P < .001), ventricular arrhythmia (6.6% vs 3.6%, P = .008), acute kidney injury (22.7% vs 13.1%, P < .001), acute respiratory failure (22.6% vs 13.1%, P < .001), longer length of hospital stay (5.6 ± 5.8 days vs 3.6 ± 3.6 days, P < .001), and higher total charges (US$79 586 ± 10 2436 vs US$50 711 ± 42 639, P < .001). In conclusion, patients with anemia who were admitted for TCM were associated with a higher incidence of in-hospital complications compared with those without anemia.
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Affiliation(s)
- Xiaojia Lu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
| | - Pengyang Li
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, the United States
| | - Catherine Teng
- Department of Medicine, Yale New Haven Health-Greenwich Hospital, Greenwich, CT, the United States
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, the United States
| | - Bin Wang
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
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Mohamed NS, Remily EA, Wilkie WA, Jean-Pierre M, Jean-Pierre N, Edalatpour A, Abraham MM, Delanois RE. Closing the Socioeconomic Gap in Massachusetts: Trends in Total Hip Arthroplasty From 2013 to 2015. Orthopedics 2021; 44:e167-e172. [PMID: 33316822 DOI: 10.3928/01477447-20201210-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To extend insurance coverage to all residents, Massachusetts legislation expanded Medicaid eligibility and added new private insurance categories. To date, no one has analyzed the effect of these changes and compared recent trends in total hip arthroplasty (THA) utilization. Therefore, this study sought to update the current trends of THA utilization in Massachusetts from 2013 to 2015. The Massachusetts State Inpatient Database was queried for all patients who underwent primary THA between 2013 and 2015, and 30,308 patients were identified. Analyzed variables included age, sex, race, Charlson Comorbidity Index, median household income, primary payer, discharge disposition, length of stay, hospital charges, hospital costs, and complications. Categorical and continuous variables were assessed using chi-square analyses and analyses of variance, respectively. Between 2013 and 2015, annual THAs increased from 9361 to 10,562. Race did not vary significantly (P=.447), although an increase in patients using Medicaid and a decrease in patients using other insurance was observed (P<.001). Patients with an income quartile of 1 increased, whereas the number of THA patients in quartile 3 decreased (P<.001). There was a decrease in both hospital charges (P<.001) and costs (P<.001). Mean length of stay decreased (P<.001), and the number of patients with complications decreased (P<.001). Massachusetts has been successful in increasing access to THA procedures for low-income patients and increasing the number of patients who use Medicaid for THAs. The current delivery of health care in Massachusetts has shown improvement for its residents, serving as an example that other states can learn from. [Orthopedics. 2021;44(2):e167-e172.].
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Wilkie WA, Mohamed NS, Remily EA, Etcheson JI, Dávila Castrodad IM, Walker AJ, Delanois RE. Complications Associated With Same-Day Bilateral Total Knee Arthroplasties. Orthopedics 2021; 44:e407-e413. [PMID: 34039205 DOI: 10.3928/01477447-20210414-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Same-day bilateral total knee arthroplasties (SBTKAs) are associated with shorter rehabilitation and lower cost. However, controversy surrounding the safety of SBTKAs exists. Recent studies are lacking to determine whether patient selection has brought SBTKA in line with unilateral total knee arthroplasty (UTKA). Therefore, the authors evaluated and compared patient characteristics, hospital characteristics, and inpatient course between UTKA and SBTKA from 2009 to 2016. The National Inpatient Sample was queried from 2009 to 2016 for UTKA and SBTKA patients. Of the 5,329,466 patients identified, 5,084,328 (95.4%) patients received UTKAs and 245,138 (4.6%) patients underwent SBTKAs. Incidence, rate, patient and hospital characteristics, health status, length of stay (LOS), discharge disposition, hospital charges, hospital costs, and complications were analyzed and statistically compared. The incidence (-1.4%) and rate (15.8%) of SBTKAs decreased (both P<.001). The SBTKA cohort had more patients who were younger, male, White, obese, healthier, and using private insurance (P<.001 for all). The SBTKA cohort had longer LOS, a higher proportion of discharges to skilled nursing facilities, higher cost and charges, and more complications, including deep venous thromboses/pulmonary emboli (DVT/PE) and transfusions (P<.001 for all). Conversely, SBTKA was associated with fewer myocardial infarctions (P<.001). Although improved from previous literature, SBTKA is still associated with longer LOS, higher cost and charges, and more complications, including DVT/PE and transfusions, although with a lower rate of myocardial infarction. However, studies are needed to determine whether the risk of 1 SBTKA outweighs the cumulative risk of staged UTKAs. [Orthopedics. 2021;44(3):e407-e413.].
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Wu SS, Cai Y, Sunshine K, Boas SR, Kumar AR. Evaluating the Effects of Enhanced Recovery Pathways in Craniosynostosis: National Trends in Hospitalization Charges and Length of Stay in Craniosynostosis Surgery. Ann Plast Surg 2021; 87:S60-S64. [PMID: 33833184 DOI: 10.1097/sap.0000000000002808] [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: 11/25/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) pathways are multimodal approaches aimed at minimizing postoperative surgical stress, reducing hospitalization time, and lowering hospitalization charges. Enhanced Recovery After Surgery is broadly and increasingly implemented in hospitals across the country. Early reports have shown ERAS to reduce length of stay (LOS) after commonly performed pediatric surgeries. However, LOS and hospital charges after craniosynostosis have not been studied. We hypothesized that extended hospital LOS is correlated with increased hospitalization charges associated with open cranial vault surgery (CVS) and that over a multiyear timeframe, LOS and cost would decrease because of the increased adoption of ERAS in pediatric surgery. METHODS The Healthcare Cost and Utilization Project's National Inpatient Sample database was analyzed from January 2007 to December 2014. All patients who were diagnosed with craniosynostosis who underwent CVS were included. Variables of interest included demographic data, hospital characteristics, hospitalization data, and total hospital charges. Univariate and generalized linear regression models were used to examine associations between selected variables and the hospitalization charges. RESULTS There were 54,583 patients diagnosed with craniosynostosis between 2007 and 2014. Of these patients, 22,916 (41.9%) received CVS. The median total hospital charge was $66,605.77 (interquartile range, $44,095.60-$101,071.17). The median LOS was 3 days (interquartile range, 2-4 days), and there was no significant change in LOS by year (P = 0.979). However, despite a stable LOS, mean hospitalization charge increased significantly by year (P < 0.01). Regression analysis demonstrated the proportion of eligible patients who underwent CVS substantially increased over the selected timeframe (P < 0.01). Most procedures were performed in urban teaching hospitals and high-volume hospitals. There was no significant association between hospital volume and hospitalization charge (P = 0.331). CONCLUSIONS Increasing hospital charges despite constant LOS for craniosynostosis CVS procedures was observed between 2007 and 2014. Although ERAS has reduced LOS for common pediatric surgical procedures, no decrease in LOS for CVS has been observed. The charges significantly increased over the same period including high-volume centers. Further study to safely lower LOS and hospitalization charges for this procedure may reduce the overall health care burden.
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Affiliation(s)
- Shannon S Wu
- From the Case Western Reserve University School of Medicine, Cleveland, OH
| | - Yida Cai
- From the Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kerrin Sunshine
- From the Case Western Reserve University School of Medicine, Cleveland, OH
| | - Samuel R Boas
- From the Case Western Reserve University School of Medicine, Cleveland, OH
| | - Anand R Kumar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
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Chen DQ, Quinlan ND, Browne JA, Werner BC. Increased Reimbursement for Surgical Fixation of Hip Fractures: The Difference Between the Hospital and the Surgeon. J Orthop Trauma 2021; 35:339-344. [PMID: 34131086 DOI: 10.1097/bot.0000000000002092] [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] [Accepted: 02/18/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate trends and variations in hospital charges and payments relative to surgeon charges and payments for surgical treatment of hip fractures in the US Medicare population. METHODS Hospital and surgeon charges and payments after treatment of hip fractures by closed reduction and percutaneous pinning (CRPP), open reduction internal fixation (ORIF), or intramedullary nail (IMN), along with corresponding patient demographics, 90-day and 1-year mortality, Charlson Comorbidity Index (CCI), and length of stay (LOS) from 2005 to 2014 were captured from the 5% Medicare Standard Analytic Files. The ratio of hospital to surgeon charges (CM: Charge Multiplier) and the ratio of hospital to surgeon payments (PM: Payment Multiplier) were calculated for each year and region of the United States and trended over time. Correlations between the CM and PM and LOS were evaluated using a Pearson correlation coefficient (r). RESULTS Three thousand twenty-eight patients who underwent CRPP and 25,341 patients who underwent ORIF/IMN were included. The CM for CRPP increased from 10.1 to 15.6, P < 0.0001. The CM for ORIF/IMN increased from 11.9 to 17.2, P < 0.0001. The PM for CRPP increased from 15.1 to 19.2, P < 0.0001. The PM for ORIF/IMN increased from 11.5 to 17.4, P < 0.0001. CONCLUSIONS Hospital charges and payments have continually increased relative to surgeon charges and payments for treatment of hip fractures despite decreasing LOS.
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Affiliation(s)
- Dennis Q Chen
- Department of Orthopaedic Surgery, UVA Health System, Charlottesville, VA
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Kesler AM, Kröner PT, Wijarnpreecha K, Palmer WC. Increased rates of spinal fusion surgery in patients with hereditary hemochromatosis: a five-year propensity matched cohort analysis. Eur J Gastroenterol Hepatol 2021; 33:899-904. [PMID: 32568803 DOI: 10.1097/meg.0000000000001810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECT Spinal arthropathy is associated with hereditary hemochromatosis and has been linked to calcium pyrophosphate dehydrate crystal deposition (CPPD) which resembles ankylosing spondylitis on radiograph, yet lacks clinical findings of inflammatory spinal arthritis. The aim of our study was to assess the use of spinal surgery and its outcomes in the US inpatient population with hereditary hemochromatosis from 2012 to 2016 by using the US Nationwide Inpatient Sample (NIS) database. METHODS The observational retrospective cohort study uses the NIS 2012 to 2016. All patients with hereditary hemochromatosis were included using International Classification of Diseases 9th and 10th revisions, Clinical Modification codes. The cohort was stratified according to having undergone spinal surgery and substratified by the type of surgery. The primary outcome was determining the use of spinal surgery in patients with hereditary hemochromatosis. Secondary outcomes were determining length of hospital stay and total hospital charges and costs. RESULTS A total of 39 780 patients with hereditary hemochromatosis were identified and propensity matched to nonhereditary hemochromatosis controls. The mean patient age was 61 years, and 65% were females. For the primary outcome patients with hereditary hemochromatosis underwent significantly more spinal fusion surgery compared to patients without hereditary hemochromatosis odds of 2.13 (P = 0.05). While there was no difference in mean LOS, or costs, patients with hereditary hemochromatosis had higher hospital charges. CONCLUSION Hereditary hemochromatosis is associated with higher odds of spinal fusion. It is a major complication not improved by phlebotomy, and there are currently no therapies to prevent this joint disease.
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Affiliation(s)
| | - Paul T Kröner
- Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Karn Wijarnpreecha
- Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - William C Palmer
- Departments of Medicine
- Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Theodorou CM, Nuño M, Yamashiro KJ, Brown EG. Increased mortality in very young children with traumatic brain injury due to abuse: A nationwide analysis of 10,965 patients. J Pediatr Surg 2021; 56:1174-1179. [PMID: 33752910 PMCID: PMC8131228 DOI: 10.1016/j.jpedsurg.2021.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is the leading cause of death and disability in young children; however, the impact of mechanism on outcomes has not been fully evaluated. We hypothesized that children with TBI due to abuse would have a higher mortality than children with accidental TBI due to motor vehicle collisions (MVC). METHODS We performed a retrospective review of the National Kids' Inpatient (KID) hospitalizations database of children <2 years old with TBI due to abuse or MVC (2000-2016). The primary outcome was mortality. Secondary outcomes were length of stay (LOS) and hospital charges. We investigated predictors of mortality with multivariable regression. RESULTS Of 10,965 children with TBI, 65.2% were due to abuse. Overall mortality was 9.8% (n = 1074). Abused children had longer LOS (5.7 vs 1.6 days, p < 0.0001) and higher hospital charges ($34,314 vs $19,360, p < 0.0001) than children with TBI due to MVC. The odds of mortality were 42% higher in children with abusive head trauma (OR 1.42, 95% CI 1.10-1.83, p = 0.007) compared to MVCs after adjusting for age, race, sex, neurosurgical intervention, injury severity, and insurance. CONCLUSION Children with abusive traumatic brain injury have increased risk of mortality, longer LOS, and higher hospital charges compared to children with TBI due to motor vehicle collision after adjusting for relevant confounders. Resources must be directed at prevention and early identification of abuse.
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Affiliation(s)
- Christina M Theodorou
- University of California Davis Medical Center, Department of Pediatric General, Thoracic, and Fetal Surgery. Sacramento, CA USA.
| | - Miriam Nuño
- University of California Davis, Department of Public Health Sciences, Division of Biostatistics. Sacramento, USA
| | - Kaeli J Yamashiro
- University of California Davis Medical Center, Department of Pediatric General, Thoracic, and Fetal Surgery. Sacramento, CA USA
| | - Erin G Brown
- University of California Davis Medical Center, Department of Pediatric General, Thoracic, and Fetal Surgery. Sacramento, CA USA
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Chauvet D, Bourdillon P, Rogers A, Kourilsky A, Simonneau A, Aldea S, Alkhairy A, Belaid H, Lot G, Le Guerinel C. Letter to the Editor Regarding "Laparoscopic-Assisted Ventriculoperitoneal Shunt Placement and Reduction in Operative Time and Total Hospital Charges". World Neurosurg 2020; 140:441. [PMID: 32797964 DOI: 10.1016/j.wneu.2020.05.053] [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: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Dorian Chauvet
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France.
| | - Pierre Bourdillon
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Alister Rogers
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Antoine Kourilsky
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Adrien Simonneau
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Sorin Aldea
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Abdu Alkhairy
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Hayat Belaid
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Guillaume Lot
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
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Wu P, Chew-Graham CA, Maas AH, Chappell LC, Potts JE, Gulati M, Jordan KP, Mamas MA. Temporal Changes in Hypertensive Disorders of Pregnancy and Impact on Cardiovascular and Obstetric Outcomes. Am J Cardiol 2020; 125:1508-1516. [PMID: 32273052 DOI: 10.1016/j.amjcard.2020.02.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Received: 11/19/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 12/13/2022]
Abstract
Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity. However, short-term outcomes of HDP subgroups remain unknown. Using National Inpatient Sample database, all delivery hospitalizations between 2004 and 2014 with or without HDP (preeclampsia/eclampsia, chronic hypertension, superimposed preeclampsia on chronic hypertension, and gestational hypertension) were analyzed to examine the association between HDP and adverse in-hospital outcomes. We identified >44 million delivery hospitalizations, within which the prevalence of HDP increased from 8% to 11% over a decade with increasing comorbidity burden. Women with chronic hypertension have higher risks of myocardial infarction, peripartum cardiomyopathy, arrhythmia, and stillbirth compared to women with preeclampsia. Out of all HDP subgroups, the superimposed preeclampsia population had the highest risk of stroke (odds ratio [OR] 7.83, 95% confidence interval [CI] 6.25 to 9.80), myocardial infarction (OR 5.20, 95% CI 3.11 to 8.69), peripartum cardiomyopathy (OR 4.37, 95% CI 3.64 to 5.26), preterm birth (OR 4.65, 95% CI 4.48 to 4.83), placental abruption (OR 2.22, 95% CI 2.09 to 2.36), and stillbirth (OR 1.78, 95% CI 1.66 to 1.92) compared to women without HDP. In conclusion, we are the first to evaluate chronic systemic hypertension without superimposed preeclampsia as a distinct subgroup in HDP and show that women with chronic systemic hypertension are at even higher risk of some adverse outcomes compared to women with preeclampsia. In conclusion, the chronic hypertension population, with and without superimposed preeclampsia, is a particularly high-risk group and may benefit from increased antenatal surveillance and the use of a prognostic risk assessment model incorporating HDP to stratify intrapartum care.
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Affiliation(s)
- Pensée Wu
- Keele Cardiovascular Research Group, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, UK; Academic Unit of Obstetrics and Gynaecology, University Hospital of North Midlands, Stoke-on-Trent, UK..
| | - Carolyn A Chew-Graham
- School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, UK; National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands, Keele University, Stoke-on-Trent, UK
| | - Angela Hem Maas
- Department of Cardiology, Women's Cardiac Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lucy C Chappell
- Women's Health Academic Centre, King's College London, London, UK
| | - Jessica E Potts
- Keele Cardiovascular Research Group, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, UK
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, AZ
| | - Kelvin P Jordan
- School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, UK; The Heart Centre, University Hospital of North Midlands, Stoke-on-Trent, UK
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Stedman M, Lunt M, Davies M, Livingston M, Duff C, Fryer A, Anderson SG, Gadsby R, Gibson M, Rayman G, Heald A. Cost of hospital treatment of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) compared to the non-diabetes population: a detailed economic evaluation. BMJ Open 2020; 10:e033231. [PMID: 32376746 PMCID: PMC7223153 DOI: 10.1136/bmjopen-2019-033231] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Other than age, diabetes is the largest contributor to overall healthcare costs and reduced life expectancy in Europe. This paper aims to more exactly quantify the net impact of diabetes on different aspects of healthcare provision in hospitals in England, building on previous work that looked at the determinants of outcome in type 1 diabetes (T1DM) and type 2 diabetes (T2DM). SETTING NHS Digital Hospital Episode Statistics (HES) in England was combined with the National Diabetes Audit (NDA) to provide the total number in practice of people with T1DM/T2DM. OUTCOME MEASURES We compared differences between T1DM/T2DM and non-diabetes individuals in relation to hospital activity and associated cost. RESULTS The study captured 90% of hospital activity and £36 billion/year of hospital spend. The NDA Register showed that out of a total reported population of 58 million, 2.9 million (6.5%) had T2DM and 240 000 (0.6%) had T1DM. Bed-day analysis showed 17% of beds are occupied by T2DM and 3% by T1DM. The overall cost of hospital care for people with diabetes is £5.5 billion/year. Once the normally expected costs including the older age of T2DM hospital attenders are allowed for this fell to £3.0 billion/year or 8% of the total captured secondary care costs. This equates to £560/non-diabetes person compared with £3280/person with T1DM and £1686/person with T2DM. For people with diabetes, the net excess impact on non-elective/emergency work is £1.2 billion with additional estimated diabetes-related accident & emergency attendances at 440 000 costing the NHS £70 million/year. T1DM individuals required five times more secondary care support than non-diabetes individuals. T2DM individuals, even allowing for the age, require twice as much support as non-diabetes individuals. CONCLUSIONS This analysis shows that additional cost of provision of hospital services due to their diabetes comorbidities is £3 billion above that for non-diabetes, and that within this, T1DM has three times as much cost impact as T2DM. We suggest that supporting patients in diabetes management may significantly reduce hospital activity.
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Affiliation(s)
| | - Mark Lunt
- ARC Epidemiology Unit, University of Manchester, Manchester, UK
| | - Mark Davies
- Health Research, Res Consortium, Andover, UK
| | - Mark Livingston
- Clinical Biochemistry, Walsall Healthcare NHS Trust, Walsall, Walsall, UK
| | - Christopher Duff
- Department of Clinical Biochemistry, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Anthony Fryer
- Institute for Science & Technology in Medicine, Keele University, Stoke on Trent, UK
| | - Simon George Anderson
- The George Alleyne Chronic Disease Research Centre, University of the West Indies Cave Hill Campus, Bridgetown, Saint Michael, Barbados
| | - Roger Gadsby
- Medical School, University of Warwick, Coventry, Coventry, UK
| | - Martin Gibson
- Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
| | - Gerry Rayman
- The Ipswich Diabetes Centre and Research Unit, Ipswich Hospital NHS Trust, Colchester, Essex, UK
| | - Adrian Heald
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
- Faculty of Biology, Medicine & Health, and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
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Matsuo K, Mandelbaum RS, Matsuzaki S, Licon E, Roman LD, Klar M, Grubbs BH. Cesarean radical hysterectomy for cervical cancer in the United States: a national study of surgical outcomes. Am J Obstet Gynecol 2020; 222:507-511.e2. [PMID: 31981506 DOI: 10.1016/j.ajog.2020.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/12/2020] [Accepted: 01/15/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA.
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Ernesto Licon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
| | - Brendan H Grubbs
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
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Abstract
IMPORTANCE A shift in the setting of care delivery for children with a new diagnosis of type 1 diabetes led to a reorganization of treatment. OBJECTIVE To determine whether a new diagnosis of pediatric diabetes can be successfully managed in a day hospital model. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study used retrospectively collected data on pediatric patients with a new diagnosis of diabetes who completed an inpatient program for education and insulin titration prospectively compared with patients completing a diabetes day hospital program. Baseline data were collected over 12 months (January-December 2015) and intervention data collected over 14 months (March 2016-May 2017). The study was conducted at a single institution and judged as a nonhuman participant project. The referral local base included a 100-mile radius. Patient inclusion was a new diagnosis of diabetes, age 5 years or older, and no biochemical evidence of diabetic ketoacidosis. Ninety-six patients completed the day hospital program and 192 patients completed an inpatient program. EXPOSURES All patients received 2 consecutive days of insulin titration and education in either a day hospital or inpatient setting. MAIN OUTCOMES AND MEASURES Primary outcomes included the mean length of stay, patient charge, and insurance denial/reimbursement rates. The hypothesis was that a day hospital program would be associated with a reduced length of stay, which would directly affect patient charges and insurance denials. RESULTS Among the 96 day hospital patients, the mean (SD) age was 12.2 (4.7) years (range 5-20.3), with no patients experiencing diabetic ketoacidosis or hypernatremia. Among the 192 inpatient patients, the mean (SD) age was 9.4 (4.7) years (range, 1.6-20.1). The mean (SD) length of stay reduction in the day hospital was 46 (14.1) to 14 (5.1) hours. The mean day hospital patient charge was $2800, compared with a mean (SD) baseline carge of $24 103 ($9401). Within the first year, there was a cumulative reduction in patient charges of more than $2.1 million. CONCLUSIONS AND RELEVANCE This study's findings suggest that a diabetes day hospital setting was associated with reductions in length of stay and patient charges, with an increase in insurance reimbursements and a decrease in insurance denials. This study demonstrates an effective way to streamline new-onset diabetes education, which may reduce length of stay and patient charges. Reimbursement rates for patients with a new diagnosis of diabetes increased from 52% to 72% and reimbursement denial rates decreased from 80% to 0%.
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Affiliation(s)
- Sarah Lawson
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Endocrinology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jacob M. Redel
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Endocrinology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Allison Smego
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Endocrinology, University of Cincinnati College of Medicine, Cincinnati, Ohio
- The University of Utah, Salt Lake City
| | - Melanie Gulla
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Endocrinology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Pamela J. Schoettker
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mary Jolly
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Farida Mostajabi
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lindsey Hornung
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics & Epidemiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Quinlan ND, Chen DQ, Browne JA, Werner BC. Surgeon Reimbursement Unchanged as Hospital Charges and Reimbursements Increase for Total Joint Arthroplasty. J Arthroplasty 2020; 35:605-612. [PMID: 31679974 DOI: 10.1016/j.arth.2019.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/19/2019] [Revised: 09/22/2019] [Accepted: 10/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite increasing demands on physicians and hospitals to increase value and reduce unnecessary costs, reimbursement for healthcare services has been under downward pressure for several years. This study aimed to analyze the trend in hospital charges and payments relative to corresponding surgeon charges and payments in a Medicare population for total hip (THA) and knee arthroplasty (TKA). METHODS The 5% Medicare sample database was used to capture hospital and surgeon charges and payments related to 56,228 patients who underwent primary THA and 117,698 patients who underwent primary TKA between 2005 and 2014. Two values were calculated: (1) the charge multiplier (CM), the ratio of hospital to surgeon charges and (2) the payment multiplier (PM), the ratio of hospital to surgeon payments. Year-to-year variation and regional trends in patient demographics, Charlson Comorbidity Index, length of stay (LOS), CM, and PM were evaluated. RESULTS Hospital charges were significantly higher than surgeon charges and increased substantially for both THA (CM increased from 8.7 to 11.5, P < .0001) and TKA (CM increased from 7.9 to 11.4, P < .0001). PM followed a similar trend, increasing for both THA and TKA (P < .0001). LOS decreased significantly for both THA and TKA (P < .0001), while Charlson Comorbidity Index remained stable. Both CM (r2 = 0.84 THA, 0.90 TKA) and PM (r2 = 0.75 THA, 0.84 TKA) were strongly negatively associated with LOS. CONCLUSION Hospital charges and payments relative to surgeon charges and payments have increased substantially for THA and TKA despite stable patient complexity and decreasing LOS.
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Affiliation(s)
| | - Dennis Q Chen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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Michel M, Alberti C, Carel JC, Chevreul K. Socioeconomic Status of Newborns and Hospital Efficiency: Implications for Hospital Payment Methods. Value Health 2020; 23:335-342. [PMID: 32197729 DOI: 10.1016/j.jval.2019.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/26/2019] [Revised: 10/10/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Studies have shown a consistent impact of socioeconomic status at birth for both mother and child; however, no study has looked at its impact on hospital efficiency and financial balance at birth, which could be major if newborns from disadvantaged families have an average length of stay (LOS) longer than other newborns. Our objective was therefore to study the association between socioeconomic status and hospital efficiency and financial balance in that population. METHODS A study was carried out using exhaustive national hospital discharge databases. All live births in a maternity hospital located in mainland France between 2012 and 2014 were included. Socioeconomic status was estimated with an ecological indicator and efficiency by variations in patient LOS compared with different mean national LOS. Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level by the difference in aggregated revenues and production costs for said hospital. Multivariate regression models studied the association between those indicators and socioeconomic status. RESULTS A total of 2 149 454 births were included. LOS was shorter than the national means for less disadvantaged patients and longer for the more disadvantaged patients, which increased when adjusted for gestational age, birth weight, and severity. A 1% increase in disadvantaged patients in a hospital's case mix significantly increased the probability that the hospital would be in deficit by 2.6%. CONCLUSIONS Reforms should be made to hospital payment methods to take into account patient socioeconomic status so as to improve resource allocation efficiency.
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Affiliation(s)
- Morgane Michel
- AP-HP, Hôtel Dieu, URC Eco Ile-de-France, Paris, France; AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France.
| | - Corinne Alberti
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France; French National Institute of Health and Medical Research, Clinical Investigation Centers, CIC, Paris, France
| | - Jean-Claude Carel
- AP-HP, Hôpital Robert Debré, Pediatric Endocrinology and Diabetology Department and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Paris, France; INSERM, NeuroDiderot, Université de Paris, Paris, France
| | - Karine Chevreul
- AP-HP, Hôtel Dieu, URC Eco Ile-de-France, Paris, France; AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France
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Benison L. If Scotland can, why not England? Br J Community Nurs 2020; 25:57. [PMID: 32040363 DOI: 10.12968/bjcn.2020.25.2.57] [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] [Indexed: 06/10/2023]
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Perez AJ, Strassle PD, Sadava EE, Gaber C, Schlottmann F. Nationwide Analysis of Inpatient Laparoscopic Versus Open Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A 2020; 30:292-298. [PMID: 31934801 DOI: 10.1089/lap.2019.0656] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/12/2022] Open
Abstract
Background: Inguinal hernia repair is one of the more common procedures performed in the United States. The optimal surgical approach, however, remains controversial. We aimed to compare the postoperative outcomes and costs between laparoscopic and open inpatient inguinal hernia repairs in a national cohort. Materials and Methods: We performed a retrospective analysis of the National Inpatient Sample during the period 2009-2015. Adult patients (≥18 years old) undergoing laparoscopic and open inguinal hernia repair were included. Multivariable logistic, generalized logistic, and linear regression were used to assess the effect of the laparoscopic approach on postoperative complications, mortality, length of stay, and hospital charges. Results: A total of 41,937 patients undergoing open inguinal hernia repair (N = 36,575) and laparoscopic inguinal hernia repair (N = 5282) were included. Patients undergoing laparoscopic inguinal hernia repair were less likely to have postoperative wound complications (odds ratio [OR]: 0.64, 95% confidence interval [CI]: 0.41-0.98), infection (OR: 0.34, 95% CI: 0.27-0.42), bleeding (OR: 0.72, 95% CI: 0.63-0.82), cardiac failure (OR: 0.72, 95% CI: 0.64-0.82), renal failure (OR: 0.54, 95% CI: 0.47-0.62), respiratory failure (OR: 0.70, 95% CI: 0.58-0.85), and inpatient mortality (OR: 0.27, 95% CI: 0.17-0.40). On average, the laparoscopic approach reduced length of stay by 1.28 days (95% CI: -1.58 to -1.18), and decreased hospital costs by $2400 (95% CI: -$4700 to -$700). Conclusion: Laparoscopic hernia repair is associated with significantly lower rates of postoperative morbidity and mortality, shorter length of hospital stays, and lower hospital costs for inpatient repairs. The laparoscopic approach should be encouraged for the management of appropriate patients with inpatient inguinal hernias.
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Affiliation(s)
- Arielle J Perez
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paula D Strassle
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emmanuel E Sadava
- Department of General Surgery, Hospital Aleman, Buenos Aires, Argentina
| | - Charles Gaber
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Francisco Schlottmann
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of General Surgery, Hospital Aleman, Buenos Aires, Argentina
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Kelekar U, Naavaal S. Dental visits and associated emergency department-charges in the United States: Nationwide Emergency Department Sample, 2014. J Am Dent Assoc 2019; 150:305-312.e1. [PMID: 30922460 DOI: 10.1016/j.adaj.2018.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Use of hospital emergency department (ED) for dental care is on the rise. This study estimates the total ED dental visits and determines mean charges by the type of disease and other patient characteristics. METHODS Using the first-listed diagnosis from the 2014 National Emergency Department Sample, the number and types of dental visits in the ED were identified and descriptive statistics were summarized. Using bivariate analyses, we determined the mean ED charges for adults and children by the type of dental disease and other sociodemographic correlates, comorbidity index, income, disposition, and payer. RESULTS There were 2.43 million dental-related ED visits in 2014 with average charge of $992: $994 for adults and $971 for children under age 18. Bivariate analyses suggested that ED visits were higher among adults aged 19 through 45, those from urban areas, low-income neighborhoods, with higher comorbidity index, or those uninsured/Medicaid. A P-value of ≤ .05 was considered significant. CONCLUSIONS High number of ED visits result due to dental problems. Our results provide most current estimates of volume and charges of dental-related ED visits. PRACTICAL IMPLICATIONS Dental treatment in emergency room is costly. Collaborative care approaches need to be identified and tested to provide effective care for dental patients in the ED.
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Haghnazarian E, Hu J, Song AY, Friedlich PS, Lakshmanan A. The association of Trisomy 13 and 18 and hospital discharge outcomes among neonates in California: A retrospective cohort study. Pediatr Neonatol 2019; 60:617-622. [PMID: 30935949 PMCID: PMC7062359 DOI: 10.1016/j.pedneo.2019.02.007] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/06/2018] [Accepted: 02/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite Trisomy 13 and 18 being among the most fatal congenital anomalies, limited information exists about resource utilization and factors associated with length of stay (LOS) and total hospital charges (THC) for these anomalies. METHODS We studied data sets of the patient discharge data set from the California Office of Statewide Health Planning and Development from 2006 to 2010, to determine differences in resource utilization for survivors and non-survivors and identify the predictors of LOS and total hospital charges. Descriptive statistics were assessed for demographic and clinical characteristics. General linear regression models were used to identify predictors of LOS and THC. RESULTS Seventy-six Trisomy 13 and 115 Trisomy 18 patients were identified, for whom inpatient mortality was 27.6% and 20.9%, respectively. In patients with Trisomy 13, after adjusting for gender, ethnicity, advanced directive (DNR), insurance and co-morbidities on multivariate analysis, the provision of more than 96 h of mechanical ventilation was associated with significantly increased LOS (standard error, SE) by 18.0 ± 5.3 days and THC (SE) by $399,000 ± $85,000. In terms of insurance type, patients with private coverage had 10.8 ± 4.9 days more than patients with Medicaid. In patients with Trisomy 18, on multivariate analysis, after adjusting for gender, ethnicity, DNR, insurance and co-morbidities, more than 96 h of mechanical ventilation was associated with increased LOS (SE) by 36.8 ± 6.8 days and THC (SE) by $365,000 ± $59,000. CONCLUSION Understanding predictors that are associated with longer LOS and higher THC may be associated in hospital resource allocation for this vulnerable population of infants.
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Affiliation(s)
- Edith Haghnazarian
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States
| | - Jiaqi Hu
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States
| | - Ashley Y Song
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States
| | - Philippe S Friedlich
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States
| | - Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 90089, United States; USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States.
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Garcia M, Gerber A, Zakhary B, Finco T, Kazi A, Zhang X, Brenner M, Coimbra R. Management and Outcomes of Acute Appendicitis in the Presence of Cirrhosis: A Nationwide Analysis. Am Surg 2019; 85:1129-1133. [PMID: 31657308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Best management for acute appendicitis (AA) in adults with liver cirrhosis is controversial and needs more investigation. We aimed to examine the impact of different treatment modalities on outcomes in this complex patient population. The Nationwide Inpatient Sample database from 2012 to 2014 was queried to identify AA patients with no cirrhosis, compensated cirrhosis (CC), and decompensated cirrhosis (DC). Each cohort was further stratified according to the treatment type: nonoperative management, open appendectomy, and laparoscopic appendectomy (LA). Chi-square, ANOVA, and binary regression analyses were used to determine differences between groups and risk factors for mortality and complications, with P < 0.05 considered statistically significant. A total of 108,289 AA patients were analyzed; of those, 304 with CC and 134 with DC were identified. Compared with CC and no cirrhosis, DC patients had significantly higher mortality, higher cost, and longer hospital length of stay. LA is accompanied by higher survival, lower cost, shorter duration of hospitalization, and lower incidence of complications across all groups. We conclude that LA is the best management strategy for AA in cirrhotic patients. Even in decompensated cirrhotics, which are associated with worse clinical outcomes, LA is still a favorable option over open appendectomy and nonoperative management.
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Westerhausen D, Perkins AJ, Conley J, Khan BA, Farber M. Burden of Substance Abuse-Related Admissions to the Medical ICU. Chest 2019; 157:61-66. [PMID: 31494083 DOI: 10.1016/j.chest.2019.08.2180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/01/2019] [Revised: 08/03/2019] [Accepted: 08/24/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Admissions to the ICU related to alcohol, prescription drugs, and illicit drugs are shown to be widespread and costly. In 1993, a study revealed 28% of ICU admissions at Johns Hopkins Hospital were related to substance abuse and accrued 39% of costs. Since then, health-care expenditures have increased, and substance abuse treatment admissions have risen. We conducted a study to provide updated data on ICU utilization and costs related to licit and illicit abuse at a large county hospital in Indianapolis, Indiana. METHODS All admissions to the medical ICU at Eskenazi Hospital from March to October 2017 were reviewed. Demographics, reason for admission, relation to substance abuse and specific substance, ICU and hospital length of stay, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, mortality, insurance status, and hospital charges were collected based on chart review. RESULTS A total of 611 admissions generated $74,587,280.35 in charges. A total of 25.7% of admissions related to substance abuse accounted for 23.1% of total charges. Illicit drugs were 13% of total admissions, generating 11% of charges. Alcohol-related admissions were 9.5% of total admissions, generating 7.6% of charges. Prescription drugs were 2.9% of admissions, generating 4.2% of charges. Of the substance abuse admissions, patients were generally men and 40 to 64 years of age, with longer ICU stay, higher APACHE II scores, and higher mortality. CONCLUSIONS Substance abuse admissions make up almost a one-quarter of resources used by our ICU. Patients tend to be younger and sicker with a higher risk of death. Identifying and accurately describing the landscape of this current health crisis will help us take appropriate action in the future.
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Affiliation(s)
| | | | | | - Babar A Khan
- Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN
| | - Mark Farber
- Indiana University School of Medicine, Indianapolis, IN
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Schultz B, Fogel N, Finlay A, Collinge C, Githens MF, Higgins T, Mehta S, O'Toole RV, Summers H, Bishop JA, Gardner MJ. Orthopedic Surgeons Have Inadequate Knowledge of the Cost of Trauma-Related Imaging Studies. Orthopedics 2019; 42:e454-e459. [PMID: 31269218 DOI: 10.3928/01477447-20190627-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023]
Abstract
Radiographic imaging is integral to the diagnosis and treatment of orthopedic injuries. Previous studies have shown that orthopedists consistently underestimate the price of implants, but their knowledge of imaging charges is unknown. This study evaluated whether orthopedic residents and faculty could accurately estimate charges of imaging modalities at their respective institutions. A survey with 10 common imaging studies was sent to 8 academic level I trauma centers. Participants estimated the total charge of each imaging modality. This was compared with the actual charge at their institution. Seven centers produced 162 responders: 74 faculty and 88 residents. The differences between the estimated cost and the billing charge were calculated and broken down by training level and imaging modality. Overall, imaging charges were underestimated by 31% (P<.001), with 19.4% of estimates being within 20% of actual charges (95% confidence interval, 19.1-19.9). There was no difference between training levels (P=.69). There was greater than 1000% variation in charges between institutions. Orthopedists across training levels underestimate hospital charges associated with common imaging studies, and there is a large variation in charges between centers. Awareness of charges is important because charges affect clinical decision making and are relevant to practicing both cost-conscious and clinically sound medicine. [Orthopedics. 2019; 42(5):e454-e459.].
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Kleiner JE, Eltorai AEM, Rubin LE, Daniels AH. Matched Cohort Analysis of Total Hip Arthroplasty in Patients With and Without Parkinson's Disease: Complications, Mortality, Length of Stay, and Hospital Charges. J Arthroplasty 2019; 34:S228-S231. [PMID: 30982760 DOI: 10.1016/j.arth.2019.03.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/01/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Increased complication rate has been reported in Parkinson's disease (PD) patients following total hip arthroplasty (THA). However, this has not previously been studied on a national scale. The purpose of this study was to determine whether PD patients had increased cost, complication, mortality, and length of stay following THA using a national database. METHODS The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was evaluated for the years 2000-2014. PD patients were matched 1:3 with non-PD control patients for age, gender, Charlson Comorbidity Index, and year of admission using a propensity score matching procedure. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort. RESULTS 794,689 THAs were performed from 2000-2014. 4003 patients (0.50%) had comorbid Parkinson's disease. Before matching, arthroplasty patients with PD were significantly older (P < .001), more frequently male (P < .001), and had greater Charlson Comorbidity Index (P < .001). In the matched cohort, PD was associated with increased length of stay (3.1 vs 2.7 days, P < .001), total hospital charges ($49,061 vs $45,571, P < .001), and in-hospital complication rate (14.6% vs 11.7%, P < .001). There was no difference in-hospital mortality (0.50% vs 0.47%, P = .781). CONCLUSIONS Matched cohort analysis demonstrated increases in complication rate, length, and cost of hospitalization for THA in patients with PD. However, in-hospital mortality rate in PD patients was not increased. Of note, the elevation in per-episode cost ($3490) may be of concern when considering PD patients for surgery within the evolving "bundled payment" model of care. LEVEL OF EVIDENCE Prognostic- Level III.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/mortality
- Cohort Studies
- Databases, Factual
- Female
- Health Care Costs
- Hospital Charges
- Hospital Mortality
- Hospitalization
- Humans
- Inpatients
- Length of Stay
- Logistic Models
- Male
- Middle Aged
- Osteoarthritis, Hip/complications
- Osteoarthritis, Hip/mortality
- Osteoarthritis, Hip/surgery
- Parkinson Disease/complications
- Parkinson Disease/mortality
- Parkinson Disease/surgery
- Patient Safety
- Postoperative Complications/etiology
- Propensity Score
- Retrospective Studies
- United States
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Affiliation(s)
- Justin E Kleiner
- Department of Orthopaedic Surgery, Brown University, Providence, RI
| | - Adam E M Eltorai
- Department of Orthopaedic Surgery, Brown University, Providence, RI
| | - Lee E Rubin
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Yale University, New Haven, CT
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University, Providence, RI
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Abstract
BACKGROUND Sepsis is a major cause of child mortality and morbidity. To enhance outcomes, children with severe sepsis or septic shock often require escalated care for organ support, sometimes necessitating interhospital transfer. The association between transfer admission for the care of pediatric severe sepsis or septic shock and in-hospital patient survival and resource use is poorly understood. METHODS Retrospective study of children 0-20 years old hospitalized for severe sepsis or septic shock, using the 2012 Kids' Inpatient Database. After descriptive and bivariate analysis, multivariate regression methods assessed the independent relationship between transfer status and outcomes of in-hospital mortality, duration of hospitalization, and hospital charges, after adjustment for potential confounders including illness severity. RESULTS Of an estimated 11,922 hospitalizations (with transfer information) for pediatric severe sepsis and septic shock nationally in 2012, 25% were transferred, most often to urban teaching hospitals. Compared to non-transferred children, transferred children were younger, and had a higher frequency of extreme illness severity (84% vs. 75%, p < .01), and of multiple organ dysfunction (32% vs. 24%, p < .01). They also had higher use of invasive medical devices including arterial catheters, invasive mechanical ventilation, and central venous catheters; and of specialized technology, including renal replacement therapy (6.2% vs. 4.6%, p < .01) and extracorporeal membrane oxygenation (5.7% vs. 1.8%, p < .01). Transferred children had longer hospitalization and accrued higher charges than non-transferred children (p < .01). Crude mortality was higher among transferred than non-transferred children (21.4% vs.15.0%, p < .01), a difference no longer statistically significant after multivariate adjustment for potential confounders (Odds Ratio:1.04, 95% Confidence interval: 0.88-1.24). Similarly, adjusted length of hospital stay and hospital charges were not statistically different by transfer status. CONCLUSION One in four children with severe sepsis or septic shock required interhospital transfer for specialized care associated with greater use of invasive medical devices and specialized technology. Despite higher crude mortality and resource consumption among transferred children, adjusted mortality and resource use did not differ by transfer status. Further research should identify quality-of-care factors at the receiving hospitals that influence clinical outcomes and resource use.
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Affiliation(s)
- Folafoluwa O. Odetola
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, 6C07, 300 North Ingalls Street, Ann Arbor, MI 48109 USA
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI 48109 USA
| | - Achamyeleh Gebremariam
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI 48109 USA
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Affiliation(s)
- David J Ballard
- Mentice AB, Gothenburg, Sweden; Department of Health Policy and Management, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill.
| | - Neil S Fleming
- Center for Clinical Effectiveness, Baylor Health Care System, Dallas, TX; Robbins Institute for Health Policy and Leadership, Hankamer School of Business Baylor University, Waco, TX
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Ang IYH, Tan CS, Nurjono M, Tan XQ, Koh GCH, Vrijhoef HJM, Tan S, Ng SE, Toh SA. Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore. BMJ Open 2019; 9:e027220. [PMID: 31122989 PMCID: PMC6538026 DOI: 10.1136/bmjopen-2018-027220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the impact on healthcare utilisation frequencies and charges, and mortality of a programme for frequent hospital utilisers and a programme for patients requiring high acuity post-discharge care as part of an integrated healthcare model. DESIGN A retrospective quasi-experimental study without randomisation where patients who received post-discharge care interventions were matched 1:1 with unenrolled patients as controls. SETTING The National University Health System (NUHS) Regional Health System (RHS), which was one of six RHS in Singapore, implemented the NUHS RHS Integrated Interventions and Care Extension (NICE) programme for frequent hospital utilisers and the NUHS Transitional Care Programme (NUHS TCP) for high acuity post-discharge care. The programmes were supported by the Ministry of Health in Singapore, which is a city-state nation located in Southeast Asia with a 5.6 million population. PARTICIPANTS Linked healthcare administrative data, for the time period of January 2013 to December 2016, were extracted for patients enrolled in NICE (n=554) or NUHS TCP (n=270) from June 2014 to December 2015, and control patients. INTERVENTIONS For both programmes, teams conducted follow-up home visits and phone calls to monitor and manage patients' post-discharge. PRIMARY OUTCOME MEASURES One-year pre- and post-enrolment healthcare utilisation frequencies and charges of all-cause inpatient admissions, emergency admissions, emergency department attendances, specialist outpatient clinic (SOC) attendances, total inpatient length of stay and mortality rates were compared. RESULTS Patients in NICE had lower mortality rate, but higher all-cause inpatient admission, emergency admission and emergency department attendance charges. Patients in NUHS TCP did not have lower mortality rate, but had higher emergency admission and SOC attendance charges. CONCLUSIONS Both NICE and NUHS TCP had no improvements in 1 year healthcare utilisation across various setting and metrics. Singular interventions might not be as impactful in effecting utilisation without an overhauling transformation and restructuring of the hospital and healthcare system.
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Affiliation(s)
- Ian Yi Han Ang
- Regional Health System Planning Office, National University Health System, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Milawaty Nurjono
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Xin Quan Tan
- Regional Health System Planning Office, National University Health System, Singapore
- National University Singapore Saw Swee Hock School of Public Health, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Hubertus Johannes Maria Vrijhoef
- Department of Patient and Care, University Hospital Maastricht, Maastricht, The Netherlands
- Vrije Universiteit Brussels, Brussels, Belgium
- Panaxea b.v., Amsterdam, The Netherlands
| | - Shermin Tan
- Department of Palliative Medicine and Community Transformation Office, Woodlands Health Campus, Singapore
| | - Shu Ee Ng
- National University Singapore Yong Loo Lin School of Medicine, Singapore
- University Medicine Cluster, National University Health System, Singapore
| | - Sue-Anne Toh
- Regional Health System Planning Office, National University Health System, Singapore
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Paine AN, Krompf BL, Osler TM, Hebert JC. Surgeons and Surgical Trainees Underestimate the Total Charges and Reimbursements Associated With Commonly Performed General Surgery Procedures ✰. J Surg Educ 2019; 76:802-807. [PMID: 30482520 DOI: 10.1016/j.jsurg.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/18/2018] [Revised: 09/17/2018] [Accepted: 11/01/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Surgical care contributes significantly to the fiscal challenges facing the US health care system. Multiple studies have demonstrated surgeons' lack of awareness of the costs associated with individual portions of surgical care, namely operating room supplies. We sought to assess surgeon and trainee awareness of the comprehensive charges and reimbursements associated with procedures they perform. METHODS We administered a voluntary anonymous survey to attending surgeons, general surgery residents, and fourth-year medical students who applied to general surgery residencies. We compared charge and reimbursement estimates for laparoscopic cholecystectomy and open inguinal hernia repair to the actual values. Additionally, we assessed the importance placed on the financial aspects of surgical care. RESULTS We had an overall response rate of 94% (n = 45). A majority of attendings, residents, and medical students underestimated charges and reimbursements for open inguinal hernia repair and laparoscopic cholecystectomy. There was no significant difference in the accuracy of charge or reimbursement estimates between attendings, residents, and students for herniorrhaphy or cholecystectomy (Charge: hernia p = 0.08, cholecystectomy p = 0.30; Reimbursement: hernia p = 0.47, cholecystectomy p = 0.89). Years of training as an attending or resident did not predict accuracy of charge or reimbursement estimates for hernia repair or cholecystectomy (p > 0.3 for all regressions). The median (interquartile range) charge estimate for inguinal hernia repair was -$5914 (-$7914 to -$2914) from the actual charge, 45.8% of the true value, and the median reimbursement estimate was -$4519 (-$5369 to -$1218) from actual reimbursement, 27.3% of the true value. The median charge estimate for cholecystectomy was -$5734 (-$8733 to +$1266) from the actual charge, 58.3% of the true value, and the median reimbursement estimate was -$4847 (-$6847 to +$153) from actual reimbursement, 38.2% of the true value. CONCLUSIONS Surgeons and their trainees underestimate the charges and reimbursements associated with commonly performed procedures.
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Affiliation(s)
- Adam N Paine
- Department of Surgery, The University of Vermont Larner College of Medicine, Burlington, Vermont; Department of Surgery, The University of Vermont Medical Center, Burlington, Vermont.
| | - Bradley L Krompf
- Department of Surgery, The University of Vermont Medical Center, Burlington, Vermont
| | - Turner M Osler
- Department of Surgery, The University of Vermont Larner College of Medicine, Burlington, Vermont; Department of Surgery, The University of Vermont Medical Center, Burlington, Vermont
| | - James C Hebert
- Department of Surgery, The University of Vermont Larner College of Medicine, Burlington, Vermont; Department of Surgery, The University of Vermont Medical Center, Burlington, Vermont
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Wang Y, Zhu Z, Li H, Sun Y, Xie G, Cheng B, Ji F, Fang X. Effects of preoperative oral carbohydrates on patients undergoing ESD surgery under general anesthesia: A randomized control study. Medicine (Baltimore) 2019; 98:e15669. [PMID: 31096498 PMCID: PMC6531268 DOI: 10.1097/md.0000000000015669] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Preoperative oral carbohydrate (POC) has been recommended as an important element of the enhanced recovery after surgery (ERAS) protocol, but its effect on patients undergoing endoscopic submucosal dissection (ESD) remains unclear. Our study aims to investigate the effects of POC for ESD surgery, with particular focus on perioperative well-being and gastric peristalsis. METHODS A prospective, randomized, and controlled study of patients undergoing ESD was conducted. Seventy-three patients were assigned to 2 groups: experiment (36 patients) and control (37 patients). The experiment group received oral carbohydrate solution 710 mL the night before and 355 mL 2 hours prior to operation. The control group fasted for 10 hours prior to operation. Gastric empty assessment, peristaltic score, and operation score were measured. In addition, visual analogue scale (VAS) scores for 6 parameters (thirst, hunger, mouth dryness, nausea, vomit, and weakness) of wellbeing were compared perioperatively. Preoperative basic conditions of patients, postoperative complications, and their clinical outcomes were also recorded. RESULTS Before anesthesia induction, gastric sonography score was higher in experiment group, while sucked fluid by gastroscopy was similar between 2 groups. And no patient had regurgitation. Moreover, gastric peristaltic score and operation score before operation were both lower in experiment group. Importantly, VAS scores for 3 parameters (thirst, hunger, and mouth dryness) were significantly lower in experiment patients. In addition, clinical outcomes including first time exhaust, first time for drinking water, the usage of hemostasis, postoperative complication, lengths of hospital stay, and in-hospital expense were not significantly different between 2 groups. CONCLUSIONS Oral administration of carbohydrates preoperatively instead of fasting improves the feelings of thirst, hunger, and mouth dryness in patients following ESD surgery without enhancing risk of regurgitation. And, avoiding preoperative fasting with POC can decrease the degree of gastric peristalsis that may facilitate the successful completion of ESD surgery.
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Affiliation(s)
| | | | - Hui Li
- Department of Anesthesiology
| | | | | | | | - Feng Ji
- Department of Digestive Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Johnson CE, Manzur MF, Wilson TA, Brown Wadé N, Weaver FA. The financial value of vascular surgeons as operative consultants to other surgical specialties. J Vasc Surg 2019; 69:1314-1321. [PMID: 30528406 PMCID: PMC8386947 DOI: 10.1016/j.jvs.2018.07.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Vascular surgeons provide assistance to other surgical specialties through planned and unplanned joint operative cases. The financial impact to the hospital of vascular surgeons as consultants in this context has yet to be quantified. We sought to quantify the financial value of services provided by consulting vascular surgeons in the performance of joint operative procedures, both planned and unplanned. METHODS Hospital financial data were reviewed for all inpatient operative cases during a 3-year period (2013-2015). Cases in which a vascular surgeon provided operative assistance as a consultant to a nonvascular surgeon were identified and designated planned or unplanned. Contribution margin, defined as hospital revenue minus variable cost, was determined for each case. In addition, the contribution margin ratio (contribution margin divided by revenue) was determined for each cohort. Financial data for consulting cases was compared with all nonconsult cases. Data analysis was performed with nonparametric statistics. RESULTS There were 208 cases with a primary nonvascular surgeon that required a vascular co-surgeon during the study period, 169 planned and 39 unplanned. For comparison, 19,594 nonconsult cases of other surgical specialties were identified. The median contribution margin was higher for vascular surgery consult cases compared with nonconsult cases ($14,406 [interquartile range, $63,192] vs $5491 [interquartile range $28,590]; P = .002). The overall contribution margin ratio was higher for vascular surgery consult cases (0.41) compared with control nonconsult cases (0.35). There was no difference in contribution margin and contribution margin ratio between planned and unplanned vascular surgery consult cases. CONCLUSIONS Vascular surgeons provide essential operative assistance to other surgical specialties. This operative assistance is frequent and provides significant financial value, with high contribution margin and contribution margin ratio. Vascular surgeons, as consulting surgeons, enable the completion of highly complex cases and in this capacity provide significant financial value to the hospital.
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Affiliation(s)
- Cali E Johnson
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Miguel F Manzur
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Todd A Wilson
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Niquelle Brown Wadé
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Fred A Weaver
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
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Rock K, Hayward RD, Edhayan E. Obesity and hospital outcomes following traumatic injury: Associations in 9 years of patient data from a single metropolitan area. Clin Obes 2019; 9:e12293. [PMID: 30657640 DOI: 10.1111/cob.12293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/19/2018] [Accepted: 12/06/2018] [Indexed: 02/06/2023]
Abstract
Traumatic injury is a leading cause of death and disability worldwide. Obesity may put trauma patients at risk for complications leading to negative clinical outcomes. Data on all hospital admissions due to traumatic injury in the Detroit metropolitan area between 2006 and 2014 were obtained from the Michigan State Inpatient Database. Generalized linear modelling was used to compare patients with and without obesity on three outcomes: mortality, length of hospital stay and total charges for care. Adjusting for demographics, patients with obesity had 26% longer hospitalization. Adjusting for demographics and length of stay, charges were 8% higher. Obesity was unrelated to mortality. Obesity had greater impact on length of stay among younger adults; its relationship with charges emerged only among older adults. Obesity has significant clinical implications for trauma care. Demands for trauma care resources, and the charges associated with providing care, are likely to increase as obesity rates rise.
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Affiliation(s)
- Kathryn Rock
- Department of Surgery, Ascension St. John Hospital, Detroit, MI, USA
| | - Richard D Hayward
- Department of Surgery, Ascension St. John Hospital, Detroit, MI, USA
| | - Elango Edhayan
- Department of Surgery, Ascension St. John Hospital, Detroit, MI, USA
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