scholarly journals PSY31 GREATER SEVERITY OF ILLNESS, RISK OF MORTALITY, LENGTH-OF-STAY, AND HOSPITAL COSTS IN PATIENTS WITH HYPONATREMIA

2008 ◽  
Vol 11 (3) ◽  
pp. A161-A162
Author(s):  
FR Ernst ◽  
B Seal ◽  
M Richmond
Keyword(s):  
Length Of Stay ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Risk Of Mortality

The Effect of Patient and Hospital Characteristics on Total Costs of Peripheral Bypass in New York State

2021 ◽  
pp. 153857442199331
Author(s):  
Nicole Ilonzo ◽  
Cody Goldberger ◽  
Songhon Hwang ◽  
Ajit Rao ◽  
Peter Faries ◽  
...  
Keyword(s):  
New York ◽  
Length Of Stay ◽  
Bypass Surgery ◽  
New York State ◽  
Severity Of Illness ◽  
Factors Associated ◽  
Peripheral Bypass ◽  
Extreme Risk ◽  
Risk Of Mortality ◽  
Fourth Quartile

Introduction: With the aging U.S. population, peripheral vascular procedures will become increasingly common. The objective of this study is to characterize the factors associated with increased total costs after peripheral bypass surgery. Methods: Data for 34,819 patients undergoing peripheral bypass surgery in NY State were extracted using the Statewide Planning and Research Cooperative System (SPARCS) database for years 2009-2017. Patient demographics, All Patient Refined Diagnostic Related Groups (APR) severity score, mortality risk, hospital volume, and length of stay data were collected. Primary outcomes were total costs and length of stay. Data were analyzed using univariate and multivariate analysis. Results: 28.1% of peripheral bypass surgeries were performed in New York City. 7.9% of patients had extreme APR severity of illness whereas 32.0% had major APR severity of illness. 6.3% of patients had extreme risk of mortality and 1 in every 5 patients (20%) had major risk of mortality. 24.9% of patients were discharged to a facility. The mean length of stay (LOS) was 9.9 days. Patient LOS of 6-11 days was associated with +$2,791.76 total costs. Mean LOS of ≥ 12 days was associated with + $27,194.88 total costs. Multivariate analysis revealed risk factors associated with an admission listed in the fourth quartile of total costs (≥$36,694.44) for peripheral bypass surgery included NYC location (2.82, CI 2.62-3.04), emergency surgery (1.12, CI 1.03-1.22), extreme APR 2.08, 1.78-2.43, extreme risk of mortality (2.73, 2.34-3.19), emergency room visit (1.68, 1.57-1.81), discharge to a facility (1.27, CI 1.15-1.41), and LOS in the third or fourth quartile (11.09, 9.87-12.46). Conclusion: The cost of peripheral bypass surgery in New York State is influenced by a variety of factors including LOS, patient comorbidity and disease severity, an ER admission, and discharge to a facility.

Hospital Costs and Severity of Illness in Three Types of Elective Surgery

1997 ◽  
Vol 86 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Alex Macario ◽  
Terry S. Vitez ◽  
Brian Dunn ◽  
Tom McDonald ◽  
Byron Brown
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Operating Room ◽  
Knee Replacement ◽  
Charlson Comorbidity Index ◽  
Elective Surgery ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Total Hospital ◽  
Comorbidity Index

Background If patients who are more severely ill have greater hospital costs for surgery, then health-care reimbursements need to be adjusted appropriately so that providers caring for more seriously ill patients are not penalized for incurring higher costs. The authors' goal for this study was to determine if severity of illness, as measured by either the American Society of Anesthesiologists Physical Status (ASA PS) or the comorbidity index developed by Charlson, can predict anesthesia costs, operating room costs, total hospital costs, or length of stay for elective surgery. Methods The authors randomly selected 224 inpatients (60% sampling fraction) having either colectomy (n = 30), total knee replacement (n = 100), or laparoscopic cholecystectomy (n = 94) from September 1993 to September 1994. For each surgical procedure, backward-elimination multiple regression was used to build models to predict (1) total hospital costs, (2) operating room costs, (3) anesthesia costs, and (4) length of stay. Explanatory candidate variables included patient age (years), sex, ASA PS, Charlson comorbidity index (which weighs the number and seriousness of coexisting diseases), and type of insurance (Medicare/Medicaid, managed care, or indemnity). These analyses were repeated for the pooled data of all 224 patients. Costs (not patient charges) were obtained from the hospital cost accounting software. Results Mean total hospital costs were $3,778 (95% confidence interval +/- 299) for laparoscopic cholecystectomy, $13,614 (95% CI +/- 3,019) for colectomy, and $18,788 (95% CI +/- 573) for knee replacement. The correlation (r) between ASA PS and Charlson comorbidity scores equaled 0.34 (P < .001). No consistent relation was found between hospital costs and either of the two severity-of-illness indices. The Charlson comorbidity index (but not the ASA PS) predicted hospital costs only for knee replacement (P = .003). The ASA PS, but not the Charlson index, predicted operating room and anesthesia costs only for colectomy (P < .03). Conclusions Severity of illness, as categorized by ASA PS categories 1-3 or by the Charlson comorbidity index, was not a consistent predictor of hospital costs and lengths of stay for three types of elective surgery. Hospital resources for these lower-risk elective procedures may be expended primarily to manage the consequences of the surgical disease, rather than to manage the patient's coexisting diseases.

scholarly journals Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 26
Author(s):  
Christopher Fang ◽  
Andrew Hagar ◽  
Matthew Gordon ◽  
Carl T. Talmo ◽  
David A. Mattingly ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Total Joint Arthroplasty ◽  
Hospital Costs ◽  
Cost Effective ◽  
Joint Arthroplasty ◽  
Nursing Facilities ◽  
Activity Based Costing ◽  
Skilled Nursing ◽  
Value Based Care ◽  
Hospital Expenses

The proportion of patients over the age of 90 years continues to grow, and the anticipated demand for total joint arthroplasty (TJA) in this population is expected to rise concomitantly. As the country shifts to alternative reimbursement models, data regarding hospital expenses is needed for accurate risk-adjusted stratification. The aim of this study was to compare total in-hospital costs following primary TJA in octogenarians and nonagenarians, and to determine the primary drivers of cost. This was a retrospective analysis from a single institution in the U.S. We used time-drive activity-based costing (TDABC) to capture granular total hospital costs for each patient. 889 TJA’s were included in the study, with 841 octogenarians and 48 nonagenarians. Nonagenarians were more likely to undergo total hip arthroplasty (THA) (70.8% vs. 42.4%; p < 0.0001), had higher ASA classification (2.6 vs. 2.4; p = 0.049), and were more often privately insured (35.4% vs. 27.8%; p = 0.0001) as compared to octogenarians. Nonagenarians were more often discharged to skilled nursing facilities (56.2% vs. 37.5%; p = 0.0011), experienced longer operating room (OR) time (142 vs. 133; p = 0.0201) and length of stay (3.7 vs. 3.1; p = 0.0003), and had higher implant and total in-hospital costs (p < 0.0001 and 0.0001). Multivariate linear regression showed implant cost (0.700; p < 0.0001), length of stay (0.546; p < 0.0001), and OR time (0.288; p < 0.0001) to be the strongest associations with overall costs. Primary TJA for nonagenarians was more expensive than octogenarians. Targeting implant costs, length of stay, and OR time can reduce costs for nonagenarians in order to provide cost-effective value-based care.

Infections Acquired by Adults Who Receive Extracorporeal Membrane Oxygenation Risk Factors and Outcome

2013 ◽  
Vol 34 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Cecile Aubron ◽  
Allen C. Cheng ◽  
David Pilcher ◽  
Tim Leong ◽  
Geoff Magrin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Extracorporeal Membrane Oxygenation ◽  
Unit Length ◽  
Severity Of Illness ◽  
Infectious Complications ◽  
Hospital Length ◽  
Interquartile Range ◽  
Hospital Length Of Stay ◽  
Membrane Oxygenation

Objectives.To analyze infectious complications that occur in patients who receive extracorporeal membrane oxygenation (ECMO), associated risk factors, and consequences on patient outcome.Design.Retrospective observational survey from 2005 through 2011.Participants and Setting.Patients who required ECMO in an Australian referral center.Methods.Cases of bloodstream infection (BSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (YAP) that occurred in patients who received ECMO were analyzed.Results.A total of 146 ECMO procedures were performed for more than 48 hours in 139 patients, and 36 patients had a total of 46 infections (30.1 infectious episodes per 1,000 days of ECMO). They included 24 cases of BSI, 6 of them secondary to VAP; 23 cases of VAP; and 5 cases of CAUTI. The most frequent pathogens were Enterobacteriaceae (found in 16 of 46 cases), and Candida was the most common cause of BSI (in 9 of 24 cases). The Sequential Organ Failure Assessment score before ECMO initiation and the number of days of support were independenuy associated with a risk of BSI, with odds ratios of 1.23 (95% confidence interval [CI], 1.03-1.47; P = .019) and 1.08(95% CI, 1.03-1.19]; P = .006), respectively. Infected patients did not have a significantly higher mortality compared with uninfected patients (41.7% vs 32%; P = .315), but intensive care unit length of stay (16 days [interquartile range, 8-26 days] vs 11 days [IQR, 4-19 days]; P = .012) and hospital length of stay (33.5 days [interquartile range, 15.5-55.5] vs 24 days [interquartile range, 9-42 days]; P = .029) were longer.Conclusion.The probability of infection increased with the duration of support and the severity of illness before initiation of ECMO. Infections affected length of stay but did not have an impact on mortality.

scholarly journals Relationship between availability of physiotherapy services and ICU costs

2018 ◽  
Vol 44 (3) ◽  
pp. 184-189 ◽  
Author(s):  
Bruna Peruzzo Rotta ◽  
Janete Maria da Silva ◽  
Carolina Fu ◽  
Juliana Barbosa Goulardins ◽  
Ruy de Camargo Pires-Neto ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Invasive Mechanical Ventilation ◽  
Severity Of Illness ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Icu Length Of Stay ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
First Time

ABSTRACT Objective: To determine whether 24-h availability of physiotherapy services decreases ICU costs in comparison with the standard 12 h/day availability among patients admitted to the ICU for the first time. Methods: This was an observational prevalence study involving 815 patients ≥ 18 years of age who had been on invasive mechanical ventilation (IMV) for ≥ 24 h and were discharged from an ICU to a ward at a tertiary teaching hospital in Brazil. The patients were divided into two groups according to h/day availability of physiotherapy services in the ICU: 24 h (PT-24; n = 332); and 12 h (PT-12; n = 483). The data collected included the reasons for hospital and ICU admissions; Acute Physiology and Chronic Health Evaluation II (APACHE II) score; IMV duration, ICU length of stay (ICU-LOS); and Omega score. Results: The severity of illness was similar in both groups. Round-the-clock availability of physiotherapy services was associated with shorter IMV durations and ICU-LOS, as well as with lower total, medical, and staff costs, in comparison with the standard 12 h/day availability. Conclusions: In the population studied, total costs and staff costs were lower in the PT-24 group than in the PT-12 group. The h/day availability of physiotherapy services was found to be a significant predictor of ICU costs.

scholarly journals Penerapan Clinical Pathways sebagai Instrumen Pengendalian Biaya Pelayanan : Studi Penelitian Tindakan Penderita BPJS yang Menjalani Operasi Caesar dengan Sistem Pembayaran INA-CBG

2021 ◽  
Vol 4 (2) ◽  
pp. 593-599
Author(s):  
Annisa Fitria ◽  
Andri Sofa Armani ◽  
Thinni Nurul Rochmah ◽  
Bangun Trapsila Purwaka ◽  
Widodo Jatim Pudjirahardjo
Keyword(s):  
Action Research ◽  
Caesarean Section ◽  
Length Of Stay ◽  
Cesarean Section ◽  
Clinical Pathway ◽  
Average Length ◽  
Clinical Pathways ◽  
Hospital Costs ◽  
Average Length Of Stay ◽  
Length Of Hospitalization

This study aims to determine the effect of using clinical pathways to control total actual hospital costs for BPJS patients who undergo a cesarean section. The method used in this research is action research. The results showed that the average actual hospital costs were significantly higher after the application of CP with p = 0.019. The average length of stay, service costs, and hospital costs were significantly lower in the entire CP form group with p = 0.012, p = 0.013, and p = 0.012. In conclusion, this study shows that the application of clinical pathways can reduce the length of hospitalization and actual hospital costs for cesarean section patients and indicates that clinical pathways can make services more efficient.   Keywords: Hospital Costs, Clinical Pathway, Caesarean Section

scholarly journals Internações, óbitos e custos hospitalares pelas intercorrências dialíticas

2019 ◽  
Vol 13 ◽  
Author(s):  
Edison Vitório de Souza Júnior ◽  
Sarah Rodrigues Silva ◽  
Poliana Souza Lapa ◽  
Mariana Alves Soledade de Jesus ◽  
Michele Silva dos Santos ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Kidney Diseases ◽  
Average Length ◽  
Hospital Costs ◽  
Renal Dialysis ◽  
The Public ◽  
Average Value ◽  
Average Length Of Stay ◽  
Quantitative Descriptive ◽  
Dialysis Complications

Objetivo: descrever as internações, óbitos e custos hospitalares pelas intercorrências dialíticas em pacientes renais crônicos no Nordeste. Método: trata-se de um estudo quantitativo, descritivo e ecológico, voltado para a análise de dados do Sistema de Informações Hospitalares, organizados em frequências absolutas e relativas, a partir de tabelas construídas no software Excel. Resultados: notificaram-se 14.052 internações e 987 óbitos no Nordeste. Gerou-se, como consequência, um custo superior a R$ 19,6 milhões aos cofres públicos, com um valor médio de internação de R$ 1.543,09 e uma média de permanência de 9,1 dias. Destacaram-se os Estados de Alagoas, com a prevalência das internações (38,2%), e Bahia, em relação aos óbitos (40%), custos hospitalares (61,4%), média de permanência (14,4 dias) e valor médio de internação (R$ 2.794,42). Conclusão: aponta-se que as internações e óbitos pelas intercorrências dialíticas constituem um importante problema na Nefrologia, causando prejuízos diretos aos recursos financeiros públicos, especialmente, nos Estados da Bahia e Alagoas, por evidenciarem a maioria dos casos. Descritores: Saúde Pública; Nefrologia; Nefropatias; Diálise Peritoneal; Diálise Renal; Custos de Cuidados de Saúde.Abstract Objective: to describe hospitalizations, deaths and hospital costs due to dialysis complications in chronic renal patients in the Northeast. Method: this is a quantitative, descriptive and ecological study, focused on the analysis of data from the Hospital Information System, organized in absolute and relative frequencies, using tables built using Excel software. Results: 14,052 hospitalizations and 987 deaths were reported in the Northeast. As a result, the public coffers cost over R $ 19.6 million, with an average hospitalization value of R $ 1,543.09 and an average length of stay of 9.1 days. The states of Alagoas stood out, with the prevalence of hospitalizations (38.2%), and Bahia, in relation to deaths (40%), hospital costs (61.4%), average length of stay (14.4 days) and average value of hospitalization (R $ 2,794.42). Conclusion: it is pointed out that hospitalizations and deaths due to dialysis complications are an important problem in Nephrology, causing direct damage to public financial resources, especially in the states of Bahia and Alagoas, as they show the majority of cases. Descriptors:  Public Health; Nephrology; Kidney Diseases; Peritoneal Dialysis; Renal Dialysis; Health Care Costs. Resumen Objetivo: describir las hospitalizaciones, muertes y costos hospitalarios por las intercurrencias dialíticas en pacientes renales crónicos en el noreste. Método: se trata de un estudio cuantitativo, descriptivo y ecológico, destinado a analizar los datos del Sistema de Informaciones del Hospital, organizado en frecuencias absolutas y relativas, a partir de tablas construidas en el software Excel. Resultados: se reportaron 14.052 hospitalizaciones y 987 muertes en el noreste. Se generó como resultado de eso, un costo en exceso de R $ 19,6 millones para el gobierno, una hospitalización con costo promedio de R$1,543.09 y una estadía promedio de 9.1 días. Entre los estados, Alagoas tuvo una mayor prevalencia de hospitalizaciones (38,2%) y Bahía en las muertes (40%), costos hospitalarios (61,4%), duración media de la estancia (14,4 días) y media hospitalización (R $ 2.794,42). Conclusión: se observa que las hospitalizaciones y muertes debidas a las intercurrencias dialíticas se constituyen un problema importante en la nefrología, lo que implica directamente en los cofres públicos, especialmente en los Estados de Bahía y Alagoas, como evidencia de una mayor prevalencia de casos. Descriptores: Salud Pública; Nefrología; Enfermedades Renales; Diálisis Peritoneal; Diálisis Renal; Costos de la Atención en Salud. Descriptores: Salud Pública; Nefrología; Enfermedades Renales; Diálisis Peritoneal; Diálisis Renal; Costos de la Atención en Salud.  

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