High Radical Prostatectomy Surgical Volume is Related to Lower Radical Prostatectomy Total Hospital Charges

Background: There is little data to support level of care decisions for lower risk intracerebral hemorrhage (ICH) patients. The addition of a dedicated stroke unit (SU) at our institution allowed for a comparison of such patients cared for in the intensive care unit (ICU) or SU. We hypothesized that SU care of select ICH patients would not change functional outcome, and result in reduced costs. Methods: Two retrospective cohorts of consecutive patients with small (<20 cc) supratentorial ICH and the absence of anticoagulation were enrolled. In the first study period from August 1, 2008 to February 1, 2011, patients were admitted to the neurological or medical ICU (historical control). In the second study period from August 1, 2012 to January 30, 2014, patients were admitted to a dedicated SU. Intubated patients, those requiring vasopressors, osmotic therapy, or ventriculostomy were excluded. Primary outcomes were discharge modified Rankin Score (mRS) and total hospital charges. Multivariate analyses were used for predicting mRS and early complications. Results: There were 104 patients included in the analysis (41 ICU, 63 SU). Mean age, gender and race did not differ significantly between groups. Mean ICH volume was 6cc in the SU group and 8cc in the ICU group (P>.05). Prior antiplatelet use, ICH location, and ICH score did not differ between groups. Intraventricular hemorrhage and hydrocephalus were more common in the ICU group (P<.001). Two SU patients transferred to the ICU for pneumonia and acute myocardial infarction. There were no significant differences in complications such as ICH expansion, use of osmotic therapy, seizures, or pneumonia. There was no difference in discharge mRS between groups (P>.05). Median hospital length of stay was 6 days in the ICU group and 3 days in SU group (P<.001). Median direct costs for the ICU group were $5,859 (IQR 4,782-9,733) and were $4,078 (IQR 2,861-6,865) for the SU group (P<.001). Unit of admission was not a significant predictor of early complication (P=.73) or discharge mRS (P=.43) in multivariate analysis. Conclusions: This preliminary retrospective study provides support for select low-risk ICH patients to be safely cared for in a lower intensity setting with potential for reducing costs.

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Comparison of acute kidney injury in patients prescribed vancomycin in combination with piperacillin–tazobactam or cefepime for diabetic foot infections

Journal of Investigative Medicine ◽

10.1136/jim-2020-001594 ◽

2021 ◽

pp. jim-2020-001594

Author(s):

Sarah R Piccuirro ◽

Anthony M Casapao ◽

Alyssa M Claudio ◽

Carmen Isache ◽

Christopher A Jankowski

Keyword(s):

Acute Kidney Injury ◽

Diabetic Foot ◽

Group Versus ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Hospital Charges ◽

Diabetic Patients ◽

Concomitant Therapy ◽

Total Hospital ◽

Diabetic Foot Infections

Concomitant therapy with vancomycin (VAN) and piperacillin–tazobactam (PTZ) has been associated with acute kidney injury (AKI). Diabetic patients may be more susceptible to AKI due to various factors. In an observational, retrospective, cohort study of adults treated for diabetic foot infections (DFIs), rates of AKI were compared between groups receiving VAN+PTZ versus VAN+cefepime (CFP). Among 356 patients screened for inclusion, 210 were analyzed. Forty-nine of 140 patients (35%) in the VAN+PTZ group and 5 of 70 patients (7%) in the VAN+CFP group developed AKI according to the Acute Kidney Injury Network criteria (OR 7.00 (95% CI 2.64 to 18.53), p<0.001). After adjusting for baseline differences, VAN+PTZ was an independent predictor of AKI (OR 6.21 (95% CI 2.30 to 16.72), p<0.001). Time to AKI was 102.1 hours (IQR 47–152.7) in the VAN+PTZ group versus 78.3 hours (IQR 39.8–100.6) in the VAN+CFP group (p>0.999). Median length of stay was significantly higher in the VAN+PTZ group at 11.9 days (IQR 7.9–17.8) versus 7.8 days (IQR 4.9–12.1) in the VAN+CFP group (p<0.001). VAN+PTZ was also associated with higher total hospital charges at US$99,742.83 (IQR US$69,342.50–US$165,549.59) compared with US$74,260.25 (IQR US$48,446.88–US$107,396.99) in the VAN+CFP arm (p<0.001). In conclusion, VAN+CFP should be the preferred empiric regimen in patients with severe DFI.

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The effects of major depression disorder on neurogenic thoracic outlet syndrome surgery outcomes

Vascular ◽

10.1177/17085381211062747 ◽

2021 ◽

pp. 170853812110627

Author(s):

Khaled I Alnahhal ◽

Suhas Penukonda ◽

Ranjana Lingutla ◽

Ali Irshad ◽

Genève M Allison ◽

...

Keyword(s):

Logistic Regression ◽

Hospital Stay ◽

Thoracic Outlet Syndrome ◽

Surgical Intervention ◽

Hospital Charges ◽

Prolonged Hospital Stay ◽

Total Hospital ◽

Multivariable Logistic Regression ◽

Prolonged Hospital ◽

The Impact

Objectives Thoracic outlet syndrome (TOS) is a group of disorders caused by impingement of the neurovascular structures at the thoracic outlet. Neurogenic TOS (nTOS), which is thought to be caused by a compression of the brachial plexus, accounts for more than 90% of the cases. Although treatment for nTOS is successful through physiotherapy and/or surgical decompression, little is known about the impact of psychosocial factors, namely, major depressive disorder (MDD), on postoperative outcomes such as non-routine discharge (NRD). Here, we assess whether MDD predicts the type of discharge following nTOS surgical intervention. Methods A retrospective analysis of the National Inpatient Sample database from the years 2005–2018 was performed. Using the International Classification of Diseases Clinical Modification, Ninth and Tenth revisions, patients who underwent a surgical intervention for nTOS were identified. Our primary outcome was to investigate the effects of MDD on nTOS patient disposition status after surgical management; secondary outcomes included analysis of total hospital charges and length of stay. NRD was defined as anything beyond discharge home without healthcare services. Univariate and multivariable logistic regression analyses were conducted to assess MDD and other potential independent predictors of NRD and prolonged hospital stay (> 2 days) following surgical intervention. Results A total of 6099 patients were identified: 596 (9.77%) patients with MDD and 5503 (90.23%) without MDD. On average, patients with MDD were older (39.6 ± 12.0 years vs. 36.0 ± 13.0 years; p < 0.001), female (80.7% vs. 63.5%; p < 0.001), white (89.6% vs. 85.6%; p = 0.030), and on Medicare (9.6% vs 5.2%; p < 0.001). Univariate and multivariable logistic regression models identified MDD as an independent risk factor associated with a higher risk of NRD (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.0–2.2). Additionally, chronic kidney disease (aOR, 2.60; 95% CI, 1.2–5.4), postoperative complications (aOR, 1.87; 95% CI, 1.2–2.9), and Medicare (aOR, 2.95; 95% CI, 1.9–4.7) were statistically significant predictors for higher risk of NRD. However, MDD was not associated with prolonged hospital stay (aOR, 1.00; 95% CI, 0.8–1.2) or higher median of total charges (MDD group: $27,867 vs. non-MDD group: $28,123; p = 0.799). Conclusion Comorbid MDD was strongly associated with higher NRD rates following nTOS surgical intervention. MDD had no significant impact on length of hospital stay or total hospital charges. Additional prospective research is necessary in order to better evaluate the impact of MDD in patients with nTOS.

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Abstract 15333: Choosing Where to Live or Die: Regional Variation in Outcomes Following Out-of-hospital Cardiac Arrest (OHCA) in the United States

Circulation ◽

10.1161/circ.132.suppl_3.15333 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Aiham Albaeni ◽

May A. Beydoun ◽

Shaker M. Eid ◽

Bolanle Akinyele ◽

Lekshminarayan RaghavaKurup ◽

...

Keyword(s):

United States ◽

Care Delivery ◽

The United States ◽

Hospital Charges ◽

Trauma Patients ◽

The South ◽

The West ◽

Total Hospital ◽

North East ◽

Nationwide Inpatient Sample Database

Background: Regional Differences in health outcomes following OHCA has been poorly studied, and was the focus of this investigation. Methods: We used the 2002 to 2012 Nationwide Inpatient Sample database to identify adults ≥ 18 years old, with an ICD-9 code principal diagnosis of cardio respiratory arrest (427.5) or ventricular fibrillation (427.1). Trauma patients were excluded. In 4 predefined federal geographic regions: North East, Midwest, South and West, means and proportions of total hospital charges (adjusted to the 2012 consumer price index,) and mortality rate were calculated. Multiple linear and logistic regression models, were adjusted for patient demographics, hospital characteristics and Charlson Comorbidity Index. Trends in binary outcome were examined with YearхRegion interaction terms. Results: From 2002 to 2012, of 155,592 OHCA patients who survived to hospital admission , 26,007 (16.7%) were in the Northeast, 39,921 (25.7% ) in the Midwest, 56,263 (36.2%) in the South, and 33,401 (21.5% ) in the West. Total hospital charges (THC) rose significantly over the years across all regions of the United States ( P trend <0.0001), and were higher in the West Vs the North East (THC>$109,000/admission, AOR 1.85; 95% CI 1.53-2.24, p<0.0001), and not different in other regions. Compared to the Northeast, mortality was lower in the Midwest ( AOR 0.86, 95% CI 0.77-0.97 p=0.01), marginally lower in the South ( AOR 0.91, 95% CI 0.82-1.01 p=0.07), with no difference detected between the West and the Northeast ( AOR 1.02, 95% CI 0.90-1.16 P=0.78). Increased expenditure was not rewarded by an increase in survival, as trends in Mortality did not differ significantly between regions (YearхRegion effects P>0.05, P trend =0.29). Conclusions: Nationwide, there is a considerable variability in survival and charges associated with caring for the post arrest patient. Higher charges did not yield better outcomes. Further investigation is needed to optimize health care delivery.

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Hospital competition and the expenses for treatments of acute and non-acute common diseases: evidence from China

BMC Health Services Research ◽

10.1186/s12913-019-4543-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Chenhui Deng ◽

Jay Pan

Keyword(s):

Service Provision ◽

Elective Surgery ◽

Financial Burden ◽

Hospital Charges ◽

Chinese Government ◽

Hospital Competition ◽

Total Hospital ◽

Discharge Data ◽

Total Hospital Charge ◽

Common Diseases

Abstract Background Because there is heterogeneity in disease types, competition among hospitals could be influenced in various ways by service provision for diseases with different characteristics. Limited studies have focused on this matter. This study aims to evaluate and compare the relationships between hospital competition and the expenses of prostatectomies (elective surgery, representing treatments of non-acute common diseases) and appendectomies (emergency surgery, representing treatments of acute common diseases). Methods Multivariable log-linear models were constructed to determine the association between hospital competition and the expenses of prostatectomies and appendectomies. The fixed-radius Herfindahl-Hirschman Index was employed to measure hospital competition. Results We collected data on 13,958 inpatients from the hospital discharge data of Sichuan Province in China from September to December 2016. The data included 3578 prostatectomy patients and 10,380 appendectomy patients. The results showed that greater competition was associated with a lower total hospital charge for prostatectomy (p = 0.006) but a higher charge for appendectomy (p < 0.001). The subcategory analysis showed that greater competition was consistently associated with lower out-of-pocket (OOP) and higher reimbursement for both surgeries. Conclusions Greater competition was significantly associated with lower total hospital charges for prostatectomies, while the opposite was true for appendectomies. Furthermore, greater competition was consistently associated with lower OOP but higher reimbursement for both surgeries. This study provides new evidence concerning the heterogeneous roles of competition in service provision for non-acute and acute common diseases. The findings of this study indicate that the pro-competition policy is a viable option for the Chinese government to relieve patients’ financial burden (OOP). Our findings also provide references and insights for other countries facing similar challenges.

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Current evidence between hospital volume and perioperative outcome: Prospective assessment of robotic radical prostatectomy safety profile in a regional center of medium annual caseload

Canadian Urological Association Journal ◽

10.5489/cuaj.6547 ◽

2020 ◽

Vol 15 (3) ◽

Author(s):

Matteo Ferrari ◽

Brunello Mazzola ◽

Enrico Roggero ◽

Eugenia D'Antonio ◽

Ricardo Pereira Mestre ◽

...

Keyword(s):

Radical Prostatectomy ◽

Safety Profile ◽

Current Evidence ◽

Nerve Sparing ◽

Transfusion Rate ◽

Surgical Volume ◽

Perioperative Outcome ◽

Robotic Radical Prostatectomy ◽

Regional Center ◽

Prospective Assessment

Introduction: We aimed to present the safety profile of robotic radical prostatectomy (RARP) performed in a single center of medium surgical volume since its introduction and identify predictors of postoperative complications. Methods: We prospectively collected clinical data from 317 consecutive patients undergoing RARP between August 2011 and November 2019 in a medium-volume center. Surgical procedures were performed by a single experienced surgeon. Complications were collected according to the Martin criteria for reporting and the Clavien-Dindo classification for rating. Preoperative, intraoperative, and postoperative data were analyzed and compared with available literature. Results: A total of 102 complications were observed in 96 (30.3%) patients and were minor in 84.4% of cases (Clavien grade 1 and 2). Transfusion rate was 1.3%. Complications of grade 4b or 5 did not occur. The most frequent complications were urinary retention (7.3%) and anastomotic leak (5.9%). At multivariate analysis, the nerve-sparing technique was an independent predictor of complications (odds ratio [OR] 0.55; p=0.02). Conclusions: The study shows that a high safety profile may be achieved in a medium-volume hospital. The nerve-sparing technique was a predictor of complications. Further studies are needed to define the current relationship between surgical volume and perioperative outcome for RARP.

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