scholarly journals Association of Interfacility Transfer and Patient and Hospital Characteristics With Thumb Replantation After Traumatic Amputation

2021 ◽  
Vol 4 (2) ◽  
pp. e2036297
Author(s):  
Jessica I. Billig ◽  
Jacob S. Nasser ◽  
Hoyune E. Cho ◽  
Ching-Han Chou ◽  
Kevin C. Chung
Keyword(s):  
Traumatic Amputation ◽  
Hospital Characteristics

Pediatric Replantation after Traumatic Amputation at the Distal Forearm: Rehabilitation Protocol and Outcomes

2020 ◽  
Author(s):  
Nicholas C. Oleck ◽  
Radhika Malhotra ◽  
Haripriya S. Ayyala ◽  
Ramazi O. Datiashvili
Keyword(s):  
Operating Room ◽  
Multidisciplinary Team ◽  
Distal Forearm ◽  
Left Forearm ◽  
Traumatic Amputation ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Microsurgical Technique ◽  
Optimal Function ◽  
And Function

AbstractMajor limb replantation is a formidable task, especially in the pediatric setting. While meticulous microsurgical technique is required in the operating room, the authors aim to highlight the importance of postoperative rehabilitation therapy for optimal function. We highlight the case of a 12-year-old boy who suffered complete traumatic amputation through the distal left forearm. The limb was successfully replanted with successful restoration of sensation and function with the aid of intensive postoperative occupational therapy. A multidisciplinary team is of paramount importance to maximize function of a replanted upper extremity.

The effect of hospital characteristics on pediatric neuromuscular scoliosis fusion cost

2019 ◽  
Vol 24 (6) ◽  
pp. 713-721
Author(s):  
Jonathan Dallas ◽  
Chevis N. Shannon ◽  
Christopher M. Bonfield
Keyword(s):  
Spinal Fusion ◽  
Economies Of Scale ◽  
Hospital Costs ◽  
Neuromuscular Scoliosis ◽  
Teaching Hospitals ◽  
Inclusion Criteria ◽  
Cost Information ◽  
Nonprofit Hospitals ◽  
Disease Etiology ◽  
Hospital Characteristics

OBJECTIVESpinal fusion is used in the treatment of pediatric neuromuscular scoliosis (NMS) to improve spine alignment and delay disease progression. However, patients with NMS are often medically complex and require a higher level of care than those with other types of scoliosis, leading to higher treatment costs. The purpose of this study was to 1) characterize the cost of pediatric NMS fusion in the US and 2) determine hospital characteristics associated with changes in overall cost.METHODSPatients were identified from the National Inpatient Sample (2012 to the first 3 quarters of 2015). Inclusion criteria selected for patients with NMS, spinal fusion of at least 4 vertebral levels, and elective hospitalization. Patients with no cost information were excluded. Sociodemographics, treating hospital characteristics, disease etiology/severity, comorbidities, length of stay, and hospital costs were collected. Univariable analysis and multivariable gamma log-link regression were used to determine hospital characteristics associated with changes in cost.RESULTSA total of 1780 weighted patients met inclusion criteria. The median cost was $68,815. Following multivariable regression, both small (+$11,580, p < 0.001) and medium (+$6329, p < 0.001) hospitals had higher costs than large hospitals. Rural hospitals had higher costs than urban teaching hospitals (+$32,438, p < 0.001). Nonprofit hospitals were more expensive than both government (–$4518, p = 0.030) and investor-owned (–$10,240, p = 0.001) hospitals. There was significant variability by US census division; compared with the South Atlantic, all other divisions except for the Middle Atlantic had significantly higher costs, most notably the West North Central (+$15,203, p < 0.001) and the Pacific (+$22,235, p < 0.001). Hospital fusion volume was not associated with total cost.CONCLUSIONSA number of hospital factors were associated with changes in fusion cost. Larger hospitals may be able to achieve decreased costs due to economies of scale. Regional differences could reflect uncontrolled-for variability in underlying patient populations or systems-level and policy differences. Overall, this analysis identified multiple systemic patterns that could be targets of further cost-related interventions.

scholarly journals Hospital Microbiologic Culture Results to Predict the Use of Anti–methicillin-Resistant Staphylococcus aureus (MRSA)

2020 ◽  
Vol 41 (S1) ◽  
pp. s40-s40
Author(s):  
Hsiu Wu ◽  
Tyler Kratzer ◽  
Liang Zhou ◽  
Minn Soe ◽  
Jonathan Edwards ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Risk Adjustment ◽  
Negative Binomial ◽  
Average Length ◽  
Negative Binomial Regression ◽  
Drug Resistant ◽  
Gram Positive ◽  
Average Length Of Stay ◽  
Control And Prevention ◽  
Hospital Characteristics

Background: To provide a standardized, risk-adjusted method for summarizing antimicrobial use (AU), the Centers for Disease Control and Prevention developed the standardized antimicrobial administration ratio, an observed-to-predicted use ratio in which predicted use is estimated from a statistical model accounting for patient locations and hospital characteristics. The infection burden, which could drive AU, was not available for assessment. To inform AU risk adjustment, we evaluated the relationship between the burden of drug-resistant gram-positive infections and the use of anti-MRSA agents. Methods: We analyzed data from acute-care hospitals that reported ≥10 months of hospital-wide AU and microbiologic data to the National Healthcare Safety Network (NHSN) from January 2018 through June 2019. Hospital infection burden was estimated using the prevalence of deduplicated positive cultures per 1,000 admissions. Eligible cultures included blood and lower respiratory specimens that yielded oxacillin/cefoxitin–resistant Staphylococcus aureus (SA) and ampicillin-nonsusceptible enterococci, and cerebrospinal fluid that yielded SA. The anti-MRSA use rate is the total antimicrobial days of ceftaroline, dalbavancin, daptomycin, linezolid, oritavancin, quinupristin/dalfopristin, tedizolid, telavancin, and intravenous vancomycin per 1,000 days patients were present. AU rates were modeled using negative binomial regression assessing its association with infection burden and hospital characteristics. Results: Among 182 hospitals, the median (interquartile range, IQR) of anti-MRSA use rate was 86.3 (59.9–105.0), and the median (IQR) prevalence of drug-resistant gram-positive infections was 3.4 (2.1–4.8). Higher prevalence of drug-resistant gram-positive infections was associated with higher use of anti-MRSA agents after adjusting for facility type and percentage of beds in intensive care units (Table 1). Number of hospital beds, average length of stay, and medical school affiliation were nonsignificant. Conclusions: Prevalence of drug-resistant gram-positive infections was independently associated with the use of anti-MRSA agents. Infection burden should be used for risk adjustment in predicting the use of anti-MRSA agents. To make this possible, we recommend that hospitals reporting to NHSN’s AU Option also report microbiologic culture results.Funding: NoneDisclosures: None

An Investigation of Service Quality—Willingness to Recommend Relationship across Patient and Hospital Characteristics

2016 ◽  
Vol 18 (1) ◽  
pp. 49-69 ◽  
Author(s):  
Ugur Yavas ◽  
Emin Babakus ◽  
Kevin W. Westbrook ◽  
Cori Cohen Grant ◽  
George D. Deitz ◽  
...  
Keyword(s):  
Service Quality ◽  
Willingness To Recommend ◽  
Hospital Characteristics

scholarly journals Regional differences in quality of care for heart failure: the role of patient, physician, and hospital characteristics

2002 ◽  
Vol 39 ◽  
pp. 452-453
Author(s):  
Edward P. Havranek ◽  
Pam Wolfe ◽  
Frederick A. Masoudi ◽  
Harlan M. Krumholz ◽  
Saif S. Rathore ◽  
...  
Keyword(s):  
Heart Failure ◽  
Quality Of Care ◽  
Regional Differences ◽  
Hospital Characteristics

scholarly journals Comparison of Ischemic Stroke Outcomes and Patient and Hospital Characteristics by Race/Ethnicity and Socioeconomic Status

Stroke ◽  
2013 ◽  
Vol 44 (2) ◽  
pp. 469-476 ◽  
Author(s):  
Amresh D. Hanchate ◽  
Lee H. Schwamm ◽  
Wei Huang ◽  
Elaine M. Hylek
Keyword(s):  
Socioeconomic Status ◽  
Ischemic Stroke ◽  
Stroke Outcomes ◽  
Race Ethnicity ◽  
Hospital Characteristics

Impact of atrial fibrillation on inpatient cost for ischemic stroke in the USA

2018 ◽  
Vol 14 (2) ◽  
pp. 159-166 ◽  
Author(s):  
Kumar Mukherjee ◽  
Khalid M Kamal
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Discharge ◽  
Significant Risk ◽  
Primary Diagnosis ◽  
Inpatient Cost ◽  
Targeted Interventions ◽  
Hospital Discharge Records ◽  
Hospital Characteristics

Background Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. Aims To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. Methods Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010–2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. Results Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean = $13,072, median = $9270.87) significantly (p < 0.0001) higher compared to all discharge records without ischemic stroke (mean = $12,543.07, median = $7517.13). The mean length of stay for all records was 4.55 days (95% CI = 4.53–4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI = $2708–$2949) and mean length of stay was greater by 0.85 (95% CI = 0.81–0.89) for those with atrial fibrillation compared to those without. Conclusions The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population.

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