353: United States Lung Allocation Score Predicts Hospital Charges Post-Transplant

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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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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Regional Disparities in Transplantation With Deceased Donor Kidneys With Kidney Donor Profile Index Less Than 20% Among Candidates With Top 20% Estimated Post Transplant Survival

Progress in Transplantation ◽

10.1177/1526924819874699 ◽

2019 ◽

Vol 29 (4) ◽

pp. 354-360 ◽

Cited By ~ 1

Author(s):

S. Ali Husain ◽

Kristen L. King ◽

Geoffrey K. Dube ◽

Demetra Tsapepas ◽

David J. Cohen ◽

...

Keyword(s):

United States ◽

Research Question ◽

Deceased Donor ◽

The United States ◽

Strongly Correlated ◽

Kidney Donor ◽

Donor Kidney ◽

Transplant Survival ◽

Post Transplant ◽

Deceased Donor Kidney

Introduction: The Kidney Allocation System in the United States prioritizes candidates with Estimated Post-Transplant Survival (EPTS) ≤20% to receive deceased donor kidneys with Kidney Donor Profile Index (KDPI) ≤20%. Research Question: We compared access to KDPI ≤ 20% kidneys for EPTS ≤ 20% candidates across the United States to determine whether geographic disparities in access to these low KDPI kidneys exist. Design: We identified all incident adult deceased donor kidney candidates wait-listed January 1, 2015, to March 31, 2018, using United Network for Organ Sharing data. We calculated the proportion of candidates transplanted, final EPTS, and KDPI of transplanted kidneys for candidates listed with EPTS ≤ 20% versus >20%. We compared the odds of receiving a KDPI ≤ 20% deceased donor kidney for EPTS ≤ 20% candidates across regions using logistic regression. Results: Among 121 069 deceased donor kidney candidates, 28.5% had listing EPTS ≤ 20%. Of these, 16.1% received deceased donor kidney transplants (candidates listed EPTS > 20%: 17.1% transplanted) and 12.3% lost EPTS ≤ 20% status. Only 49.4% of transplanted EPTS ≤ 20% candidates received a KDPI ≤ 20% kidney, and 48.3% of KDPI ≤ 20% kidneys went to recipients with EPTS > 20% at the time of transplantation. Odds of receiving a KDPI ≤ 20% kidney were highest in region 6 and lowest in region 9 (odds ratio 0.19 [0.13 to 0.28]). The ratio of KDPI ≤ 20% donors per EPTS ≤ 20% candidate and likelihood of KDPI ≤ 20% transplantation were strongly correlated ( r 2 = 0.84). Discussion: Marked geographic variation in the likelihood of receiving a KDPI ≤ 20% deceased donor kidney among transplanted EPTS ≤ 20% candidates exists and is related to differences in organ availability within allocation borders. Policy changes to improve organ sharing are needed to improve equity in access to low KDPI kidneys.

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Laparoscopic Appendectomy Trends and Outcomes in the United States: Data from the Nationwide Inpatient Sample (NIS), 2004–2011

The American Surgeon ◽

10.1177/000313481408001035 ◽

2014 ◽

Vol 80 (10) ◽

pp. 1074-1077 ◽

Cited By ~ 44

Author(s):

Hossein Masoomi ◽

Ninh T. Nguyen ◽

Matthew O. Dolich ◽

Steven Mills ◽

Joseph C. Carmichael ◽

...

Keyword(s):

United States ◽

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Conversion Rate ◽

Nationwide Inpatient Sample ◽

Open Appendectomy ◽

Perforated Appendicitis ◽

The United States ◽

Hospital Charges ◽

Nationwide Inpatient Sample Database

Laparoscopic appendectomy (LA) is becoming the standard procedure of choice for appendicitis. We aimed to evaluate the frequency and trends of LA for acute appendicitis in the United States and to compare outcomes of LA with open appendectomy (OA). Using the Nationwide Inpatient Sample database, we examined patients who underwent appendectomy for acute appendicitis from 2004 to 2011. A total of 2,593,786 patients underwent appendectomy during this period. Overall, the rate of LA was 60.5 per cent (children: 58.1%; adults: 63%; elderly: 48.7%). LA rate significantly increased from 43.3 per cent in 2004 to 75 per cent in 2011. LA use increased 66 per cent in nonperforated appendicitis versus 100 per cent increase in LA use for perforated appendicitis. The LA rate increased in all age groups. The increased LA use was more significant in male patients (84%) compared with female patients (62%). The overall conversion rate of LA to OA was 6.3 per cent. Compared with OA, LA had a significantly lower complication rate, a lower mortality rate, a shorter mean hospital stay, and lower mean total hospital charges in both nonperforated and perforated appendices. LA has become an established procedure for appendectomy in nonperforated and perforated appendicitis in all rates exceeding OA. Conversion rate is relatively low (6.3%).

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Early Effects After the First Major Revision of the Lung Allocation Score (LAS) in the United States

CHEST Journal ◽

10.1378/chest.2260216 ◽

2015 ◽

Vol 148 (4) ◽

pp. 1079A ◽

Cited By ~ 1

Author(s):

Kevin Chan ◽

Liz Robbins-Callahan ◽

Maryam Valapour ◽

Melissa Skeans ◽

Thomas Wozniak ◽

...

Keyword(s):

United States ◽

The United States ◽

Lung Allocation Score ◽

Major Revision ◽

Early Effects

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4256 Association Between Injury Intent and Emergency Department and Hospital Charges for Pediatric Firearm Injuries in the United States

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.371 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 124-124

Author(s):

Diana Marie Bongiorno ◽

Gia M. Badolato ◽

Meleah D. Boyle ◽

Jon S. Vernick ◽

Joseph F. Levy ◽

...

Keyword(s):

United States ◽

Emergency Department ◽

The United States ◽

Hospital Charges ◽

Unintentional Injuries ◽

Severe Injuries ◽

Cross Sectional ◽

Emergency Department Care ◽

Sample Mean ◽

Firearm Injury

OBJECTIVES/GOALS: In 2016, more than 3,100 children died, and an estimated 17,000 children had non-fatal injuries, from firearms in the United States. In this study, we used hospital charges as a proxy for medical resource utilization, and compared differences in charges by intent of firearm injury among children. METHODS/STUDY POPULATION: In this cross-sectional study of the 2016 Nationwide Emergency Department Sample, we identified firearm injury cases among children aged 19 years or younger using ICD-10-CM external cause of morbidity codes. Injury intent was characterized as unintentional, assault, self-inflicted, undetermined, or due to legal intervention. We included patients treated and released from the emergency department (ED) or admitted alive to the hospital, and excluded those who were transferred or died in the ED. We used linear regressions with survey weighting to compare differences in mean healthcare charges by firearm injury intent, with and without adjustment for ED disposition. RESULTS/ANTICIPATED RESULTS: Among 12,469 cases in the weighted sample, mean age was 16.5 years, a majority were male (88.2%) and Medicaid-insured (57.8%), and 64% were discharged from the ED and 36% admitted. Injuries were 49.0% unintentional, 45.1% assault-related, and 1.8% self-inflicted. Compared to children with self-inflicted injuries (charges $115,224), children with assault-related injuries (charges $55,052; p<0.007) and unintentional injuries (charges $38,643; p<0.001) had lower mean charges per visit. Differences in charges were no longer significant after adjusting for ED disposition, as 85.8% of self-inflicted injuries were admitted, compared to 46.5% of assault-related and 24.3% of unintentional injuries. DISCUSSION/SIGNIFICANCE OF IMPACT: Although the majority of pediatric firearm-related injuries resulting in emergency department care are unintentional or assault-related, self-inflicted injuries result in greater per visit hospital charges, attributable to higher hospitalization rates, and likely due to more severe injuries.

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