Length of Stay and Hospital Charges for Heart Failure Admissions in the United States: Analysis of the National Inpatient Sample

BACKGROUND: Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital acute ischemic stroke, there is little data on rates and outcomes of patients receiving thrombolytics for in-hospital ischemic strokes. OBJECTIVE: To determine the rates of in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated with thrombolytics on admission. DESIGN/METHODS: We analyzed a seven-year data (2002-2009) from the National Inpatient Survey (NIS), a nationally representative inpatient database in the United States. We identified patients who had in-hospital ischemic strokes (defined by thrombolytic treatment after one day of hospitalization) and those who received thrombolytics on the admission day. We compared demographics, baseline clinical characteristics, in hospital complications, length of stay, hospitalization charges, and discharge disposition, between the two patient groups. RESULT: A total of 18036 (21.5%) and 65912 (78.5%) patients received thrombolytics for in-hospital and on admission acute ischemic stroke, respectively. In hospital complications such as pneumonia (5.0% vs. 3.4%, p=0.0006), deep venous thrombosis (1.9% vs. 0.6%, p<0.0001) and pulmonary embolism (0.8% vs. 0.4%, p=0.01) were significantly higher in the in-hospital group compared to on admission thrombolytic treated group. Hospital length of stay and mean hospital charges were not different between the two groups. Patients who had in-hospital strokes had had higher rates of in hospital mortality (12.1% vs. 10.6%, p=0.02). In a multivariate analysis, in-hospital thrombolytic treated group had higher in-hospital mortality after adjustment for age, gender and baseline clinical characteristics (odds ratio 0.84, 95% confidence interval 0.74-0.95, p=0.008). CONCLUSION/RELEVANCE: In current practice, one out of every five acute ischemic stroke patients treated with thrombolytics is receiving treatment for in-hospital strokes. The higher mortality and complicated hospitalization in such patients needs to be recognized.

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AN ANALYSIS OF PATIENTS HOSPITALIZED WITH CARDIAC AMYLOIDOSIS AND HEART FAILURE IN THE UNITED STATES : INSIGHT FROM THE NATIONAL INPATIENT SAMPLE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31684-3 ◽

2020 ◽

Vol 75 (11) ◽

pp. 1057

Author(s):

Lily N. Dastmalchi ◽

Adebayo Christian Atanda ◽

Joseph Krepp

Keyword(s):

United States ◽

Heart Failure ◽

Cardiac Amyloidosis ◽

The United States ◽

National Inpatient Sample

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Trends and presentation patterns of acute rheumatic fever hospitalisations in the United States

Cardiology in the Young ◽

10.1017/s1047951119002270 ◽

2019 ◽

Vol 29 (11) ◽

pp. 1387-1390

Author(s):

Tyler Bradley-Hewitt ◽

Chris T. Longenecker ◽

Vuyisile Nkomo ◽

Whitney Osborne ◽

Craig Sable ◽

...

Keyword(s):

United States ◽

Length Of Stay ◽

Rheumatic Fever ◽

Private Insurance ◽

Case Fatality ◽

The United States ◽

Hospital Charges ◽

The South ◽

Asian Pacific Islanders ◽

Asian Pacific

AbstractObjective:Rheumatic fever, an immune sequela of untreated streptococcal infections, is an important contributor to global cardiovascular disease. The goal of this study was to describe trends, characteristics, and cost burden of children discharged from hospitals with a diagnosis of RF from 2000 to 2012 within the United States.Methods:Using the Kids’ Inpatient Database, we examined characteristics of children discharged from hospitals with the diagnosis of rheumatic fever over time including: overall hospitalisation rates, age, gender, race/ethnicity, regional differences, payer type, length of stay, and charges.Results:The estimated national cumulative incidence of rheumatic fever in the United States between 2000 and 2012 was 0.61 cases per 100,000 children. The median age was 10 years, with hospitalisations significantly more common among children aged 6–11 years. Rheumatic fever hospitalisations among Asian/Pacific Islanders were significantly over-represented. The proportion of rheumatic fever hospitalisations was greater in the Northeast and less in the South, although the highest number of rheumatic fever admissions occurred in the South. Expected payer type was more likely to be private insurance, and the median total hospital charges (adjusted for inflation to 2012 dollars) were $16,000 (interquartile range: $8900–31,200). Median length of stay was 3 days, and the case fatality ratio for RF in the United States was 0.4%.Conclusions:Rheumatic fever persists in the United States with an overall downwards trend between 2003 and 2012. Rheumatic fever admissions varied considerably based on age group, region, and origin.

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In-hospital Mortality and Morbidity after Surgical Treatment of Unruptured Intracranial Aneurysms in the United States, 1996–2000: The Effect of Hospital and Surgeon Volume

Neurosurgery ◽

10.1093/neurosurgery/52.5.995 ◽

2003 ◽

Vol 52 (5) ◽

pp. 995-1009

Author(s):

Fred G. Barker ◽

Sepideh Amin-Hanjani ◽

William E. Butler ◽

Christopher S. Ogilvy ◽

Bob S. Carter

Keyword(s):

United States ◽

Surgical Treatment ◽

Length Of Stay ◽

Intracranial Aneurysms ◽

High Volume ◽

The United States ◽

Surgeon Volume ◽

Hospital Charges ◽

Unruptured Aneurysms ◽

Unruptured Intracranial Aneurysms

Abstract OBJECTIVE We sought to determine the risk of adverse outcome after contemporary surgical treatment of patients with unruptured intracranial aneurysms in the United States. Patient, surgeon, and hospital characteristics were tested as potential outcome predictors, with particular attention to the surgeon's and hospital's volume of care. METHODS We performed a retrospective cohort study with the Nationwide Inpatient Sample, 1996 to 2000. Multivariate logistic and ordinal regression analyses were performed with endpoints of mortality, discharge other than to home, length of stay, and total hospital charges. RESULTS We identified 3498 patients who were treated at 463 hospitals, and we identified 585 surgeons in the database. Of all patients, 2.1% died, 3.3% were discharged to skilled-nursing facilities, and 12.8% were discharged to other facilities. The analysis adjusted for age, sex, race, primary payer, four variables measuring acuity of treatment and medical comorbidity, and five variables indicating symptoms and signs. The statistics for median annual number of unruptured aneurysms treated were eight per hospital and three per surgeon. High-volume hospitals had fewer adverse outcomes than hospitals that handled comparatively fewer unruptured aneurysms: discharge other than to home occurred after 15.6% of operations at high-volume hospitals (20 or more cases/yr) compared with 23.8% at low-volume hospitals (fewer than 4 cases/yr) (P = 0.002). High surgeon volume had a similar effect (15.3 versus 20.6%, P = 0.004). Mortality was lower at high-volume hospitals (1.6 versus 2.2%) than at hospitals that handled comparatively fewer unruptured aneurysms, but not significantly so. Patients treated by high-volume surgeons had fewer postoperative neurological complications (P = 0.04). Length of stay was not related to hospital volume. Charges were slightly higher at high-volume hospitals, partly because arteriography was performed more frequently than at hospitals that handled comparatively fewer unruptured aneurysms. CONCLUSION For patients with unruptured aneurysms who were treated in the United States between 1996 and 2000, surgery performed at high-volume institutions or by high-volume surgeons was associated with significantly lower morbidity and modestly lower mortality.

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In-Hospital Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement in Relation to the Presence of Heart Failure in the United States: An Analysis of the National Inpatient Sample

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2019.07.516 ◽

2019 ◽

Vol 25 (8) ◽

pp. S183 ◽

Cited By ~ 1

Author(s):

Hardikkumar Patel ◽

Kevin Buda ◽

Rutu Patel

Keyword(s):

United States ◽

Heart Failure ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

The United States ◽

National Inpatient Sample ◽

Transcatheter Aortic Valve

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Female Gender Impacts Mortality and Length of Stay in Acute Pancreatitis in the United States: A Report of the National Inpatient Sample: ACG/Radhika Srinivasan Gender-Based Research Award

The American Journal of Gastroenterology ◽

10.14309/00000434-201310001-00283 ◽

2013 ◽

Vol 108 ◽

pp. S85-S86

Author(s):

Julia McNabb-Baltar ◽

Linda Lee ◽

Peter Banks ◽

Darwin Conwell

Keyword(s):

United States ◽

Acute Pancreatitis ◽

Length Of Stay ◽

Female Gender ◽

The United States ◽

National Inpatient Sample ◽

Research Award ◽

Gender Based ◽

Gender Impacts

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National Trends for Primary and Revision Lumbar Disc Arthroplasty Throughout the United States

Global Spine Journal ◽

10.1177/2192568217726980 ◽

2017 ◽

Vol 8 (2) ◽

pp. 172-177 ◽

Cited By ~ 4

Author(s):

Comron Saifi ◽

Alejandro Cazzulino ◽

Caroline Park ◽

Joseph Laratta ◽

Philip K. Louie ◽

...

Keyword(s):

United States ◽

Length Of Stay ◽

Lumbar Disc ◽

The United States ◽

Care Utilization ◽

National Inpatient Sample ◽

Disc Arthroplasty ◽

Total Cost ◽

Lumbar Disc Arthroplasty ◽

The Mean

Study Design: Retrospective database study. Objectives: Analysis of economic and demographic data concerning lumbar disc arthroplasty (LDA) throughout the United States to improve value-based care and health care utilization. Methods: The National Inpatient Sample database was queried for patients who underwent primary or revision LDA between 2005 and 2013. Demographic and economic data included total surgeries, costs, length of stay, and frequency of routine discharge. The National Inpatient Sample database represents a 20% sample of discharges from US hospitals weighted to provide national estimates. Results: Primary LDA decreased 86% from 3059 to 420 from 2005 to 2013. The mean total cost of LDA increased 33% from $17 747 to $23 804. The mean length of stay decreased from 2.8 to 2.4 days. The mean routine discharge (home discharge without visiting nursing care) remained constant at 91%. Revision procedures (removal, supplemental fixation, or reoperation at the treated level) declined 30% from 194 to 135 cases over the study period. The mean revision burden, defined as the ratio of revision procedures to the sum of primary and revision procedures, was 12% (range 6% to 24%). The mean total cost of revisions ranged from $12 752 to $22 282. Conclusions: From 2005 to 2013, primary LDA significantly declined in the United States by 86% despite several studies pointing to improved efficacy and cost-efficiency. This disparity may be related to a lack of surgeon reimbursement from insurance companies. Congruently, the number of revision LDA cases has declined 30%, while revision burden has risen from 6% to 24%.

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Changes in Infective Endocarditis Admissions in Pennsylvania During the Opioid Epidemic

Clinical Infectious Diseases ◽

10.1093/cid/ciz1038 ◽

2019 ◽

Vol 71 (7) ◽

pp. 1664-1670 ◽

Cited By ~ 4

Author(s):

Jessica A Meisner ◽

Judith Anesi ◽

Xinwei Chen ◽

David Grande

Keyword(s):

United States ◽

Infective Endocarditis ◽

Drug Use ◽

Length Of Stay ◽

The United States ◽

Medical Advice ◽

Hospital Charges ◽

Care Hospital ◽

Against Medical Advice ◽

Opioid Crisis

Abstract Background With the current opioid crisis in the United States, infectious complications related to injection drug use are increasingly reported. Pennsylvania is at the epicenter of the opioid crisis, with the third highest rate of drug overdose deaths in the United States. Methods A retrospective cohort study was performed using the Pennsylvania Health Care Cost Containment Council database of all residents hospitalized for infective endocarditis (IE) in an acute care hospital from 1 January 2013 through 31 March 2017. Patients were separated into those with and those without substance use via diagnosis codes. The primary outcome was length of stay. Secondarily, we evaluated demographics, infection history, hospital charges, and insurance status. Results Of the 17 224 hospitalizations, 1921 (11.1%) were in patients with drug use–associated IE (DU-IE). Total quarterly IE admissions increased 20%, with a 6.5% increase in non–drug use–associated IE (non-DU-IE) admissions and a 238% increase in DU-IE admissions. In adjusted models, DU-IE was not associated with significant changes in length of stay (incidence rate ratio, 1.02; 95% confidence interval, .975–1.072; P = .36). Patients with DU-IE were predominantly insured by Medicaid (68.3% vs 13.4% for non-DU-IE), they had higher hospital charges ($86 622 vs $66 802), and they were more likely to leave against medical advice (15.7% vs 1.1%) (all P < .001). Conclusions Our study demonstrates an increase in IE admissions, driven by an increase in admissions for DU-IE. The higher charges, proportion of patients on Medicaid, and rates of leaving against medical advice among the DU-IE group shows the downstream effects of the opioid crisis.

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