scholarly journals 3517 Cancer-Related Pain is a Predictor of In-hospital Opioid Overdose among Postoperative patients

2019 ◽  
Vol 3 (s1) ◽  
pp. 36-36
Author(s):  
Nnaemeka E Onyeakusi ◽  
Fahad Mukhtar ◽  
Adebamike Oshunbade ◽  
Semiu Gbadamosi ◽  
Adeyinka Adejumo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Charges ◽  
P Value ◽  
Opioid Overdose ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Patients With Cancer ◽  
Cancer Management ◽  
Cancer Pathogenesis ◽  
Diagnosis Of Cancer

OBJECTIVES/SPECIFIC AIMS: Our study’s primary aim is to determine if there is an association between cancer-related pain among patients who underwent major elective procedures and postoperative opioid overdose. In addition, the relationship between cancer-related pain in this population and inpatient mortality, total hospital charge and length of stay was assessed. METHODS/STUDY POPULATION: Our study sample consisted of adults 18 years and older who had at least one of eight elective procedures. Data was obtained from the National Inpatient Sample (NIS). Variables were identified using ICD-9 codes. Our primary predictor was cancer-related pain while our primary outcome was opioid overdose. Secondary outcomes were inpatient mortality, length of stay and total charge. Propensity-matched regression models were employed in assessing the association between cancer-related pain and outcomes of interest. RESULTS/ANTICIPATED RESULTS: Among 4,085,355 selected patients, 0.8% (n = 2,665) had cancer-related pain while 99.92% (n = 4,082,690) had no diagnosis of cancer-related pain. All subjects with cancer-related pain (n = 2,665) were successfully matched to subjects with no diagnosis of cancer-related pain in a 1:5 ratio yielding 13,325 controls. Patients with cancer-related pain had significantly higher odds of opioid overdose (aOR 4.82 [95% CI [2.68-8.67]; p-value <0.0001) and inpatient mortality (aOR 1.39[1.11-1.74]; p-value 0.0043). Patients with cancer-related pain were also likely to stay significantly longer in the hospital (12.76 days vs. 7.88 days) with significantly higher total hospital charges ($140,220 vs. $88,316). DISCUSSION/SIGNIFICANCE OF IMPACT: Pain is a common complication of cancer pathogenesis, diagnosis or treatment. Though a rare outcome, opioid overdose could lead to undesirable outcomes. Cancer patients undergo invasive diagnostic and therapeutic procedures as part of their cancer management or for conditions not related to their primary cancer diagnosis. Safety measures including alternatives to opioids are recommended to prevent the poor clinical outcomes and higher healthcare utilization indices associated with opioid overdose in this population.

Cancer-Related Pain Is an Independent Predictor of In-Hospital Opioid Overdose: A Propensity-Matched Analysis

Pain Medicine ◽  
2019 ◽  
Vol 20 (12) ◽  
pp. 2552-2561 ◽  
Author(s):  
Nnaemeka E Onyeakusi ◽  
Fahad Mukhtar ◽  
Semiu O Gbadamosi ◽  
Adebamike Oshunbade ◽  
Adeyinka C Adejumo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Postoperative Pain Management ◽  
Hospital Charge ◽  
Primary Objective ◽  
Hospital Charges ◽  
Opioid Overdose ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Total Hospital Charge ◽  
Secondary Objective

Abstract Background About 50% of patients with cancer who have undergone surgery suffer from cancer-related pain (CP). The use of opioids for postoperative pain management presents the potential for overdose, especially among these patients. Objective The primary objective of this study was to determine the association between CP and postoperative opioid overdose among inpatients who had undergone major elective procedures. The secondary objective was to assess the relationship between CP and inpatient mortality, total hospital charge, and length of stay in this population. Methods Data of adults 18 years and older from the National Inpatient Sample (NIS) were analyzed. Variables were identified using ICD-9 codes. Propensity-matched regression models were employed in evaluating the association between CP and outcomes of interest. Results Among 4,085,355 selected patients, 0.8% (N = 2,665) had CP, whereas 99.92% (N = 4,082,690) had no diagnosis of CP. We matched patients with CP (N = 2,665) and no CP (N = 13,325) in a 1:5 ratio. We found higher odds of opioid overdose (adjusted odds ratio [aOR] = 4.82, 95% confidence interval [CI] = 2.68–8.67, P &lt; 0.0001) and inpatient mortality (aOR = 1.39, 95% CI = 1.11–1.74, P = 0.0043) in patients with CP vs no CP. Also, patients with CP were more likely to stay longer in the hospital (12.76 days vs 7.88 days) with higher total hospital charges ($140,220 vs $88,316). Conclusions CP is an independent risk factor for opioid overdose, increased length of stay, and increased total hospital charges.

Association of for-profit hospital ownership status with intracranial hemorrhage outcomes and cost of care

2020 ◽  
Vol 133 (6) ◽  
pp. 1939-1947
Author(s):  
Ryan G. Chiu ◽  
Blake E. Murphy ◽  
David M. Rosenberg ◽  
Amy Q. Zhu ◽  
Ankit I. Mehta
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Hospital Charges ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Nonprofit Hospitals ◽  
For Profit ◽  
Ownership Status ◽  
Profit Centers

OBJECTIVEMuch of the current discourse surrounding healthcare reform in the United States revolves around the role of the profit motive in medical care. However, there currently exists a paucity of literature evaluating the effect of for-profit hospital ownership status on neurological and neurosurgical care. The purpose of this study was to compare inpatient mortality, operation rates, length of stay, and hospital charges between private nonprofit and for-profit hospitals in the treatment of intracranial hemorrhage.METHODSThis retrospective cohort study utilized data from the National Inpatient Sample (NIS) database. Primary outcomes, including all-cause inpatient mortality, operative status, patient disposition, hospital length of stay, total hospital charges, and per-day hospital charges, were assessed for patients discharged with a primary diagnosis of intracranial (epidural, subdural, subarachnoid, or intraparenchymal) hemorrhage, while controlling for baseline demographics, comorbidities, and interhospital differences via propensity score matching. Subgroup analyses by hemorrhage type were then performed, using the same methodology.RESULTSOf 155,977 unique hospital discharges included in this study, 133,518 originated from private nonprofit hospitals while the remaining 22,459 were from for-profit hospitals. After propensity score matching, mortality rates were higher in for-profit centers, at 14.50%, compared with 13.31% at nonprofit hospitals (RR 1.09, 95% CI 1.00–1.18; p = 0.040). Surgical operation rates were also similar (25.38% vs 24.42%; RR 0.96, 95% CI 0.91–1.02; p = 0.181). Of note, nonprofit hospitals appeared to be more intensive, with intracranial pressure monitor placement occurring in 2.13% of patients compared with 1.47% in for-profit centers (RR 0.69, 95% CI 0.54–0.88; p < 0.001). Discharge disposition was also similar, except for higher rates of absconding at for-profit hospitals (RR 1.59, 95% CI 1.12–2.27; p = 0.018). Length of stay was greater among for-profit hospitals (mean ± SD: 7.46 ± 11.91 vs 6.50 ± 8.74 days, p < 0.001), as were total hospital charges ($141,141.40 ± $218,364.40 vs $84,863.54 ± $136,874.71 [USD], p < 0.001). These findings remained similar even after segregating patients by subgroup analysis by hemorrhage type.CONCLUSIONSFor-profit hospitals are associated with higher inpatient mortality, lengths of stay, and hospital charges compared with their nonprofit counterparts.

scholarly journals Severe Vision Impairment and Blindness in Hospitalized Patients: A Nationwide Study

2020 ◽  
Author(s):  
Che Harris ◽  
Scott M Wright
Keyword(s):  
Length Of Stay ◽  
Visual Impairment ◽  
Hospitalized Patients ◽  
Mean Difference ◽  
Vision Impairment ◽  
Hospital Charges ◽  
Total Hospital ◽  
Obesity Epidemic ◽  
Charlson Comorbidity Score ◽  
Attention To Detail

Abstract Background: Outcomes among hospitalized patients with severe vision impairment or blindness have not been extensively explored. This study sought to determine clinical and resource utilization outcomes in patients with severe vision impairment/blindness (SVI/B). Because the obesity epidemic is also on the rise and underrecognized in hospital settings, we also sought to understand its impact among patients with SVI/B.Methods: We conducted a retrospective study using the National Inpatient Sample for the year 2017; hospitalized adults with and without SVI/B were compared. In addition, for all patients with SVI/B, we compared those with and without obesity. Multiple logistic regression and linear analysis were used to evaluate mortality, disposition, length of stay, and hospital charges. We adjusted for age, sex, race, comorbidities, insurance, and income.Results: 30,420,907 adults were hospitalized, of whom 37,200 had SVI/B. Patients with SVI/B were older (mean age ± SEM: 66.4±0.24 vs. 57.9±0.09 years, p <0.01), less likely to be female (50% vs 57.7%, p <0.01), more frequently insured by Medicare (75.7% vs 49.2%, p <0.01), and had more comorbidities (Charlson comorbidity score ≥ 3: 53.2% vs 27.8%, p <0.01). Patients with SVI/B had a higher in-hospital mortality rate (3.9% vs 2.2%; p<0.01), and they were less likely discharged home (adjusted Odds Ratio {aOR} =0.54, [Confidence Interval (CI) 0.51-0.58]; p <0.01) compared to those without visual impairment. Hospital charges were not significantly different (adjusted Mean Difference {aMD} = $247 CI [-$2,474-2,929]; p=0.85) but length of stay was longer (aMD= 0.5 days CI [0.3-0.7]; p<0.01) for those with SVI/B. Visually impaired patients who were also obese had higher total hospital charges compared to those without obesity (mean difference: $9,821 [CI $1,375-$18,268]; p =0.02).Conclusion: Patients admitted to American hospitals in 2017 who had severe vision impairment or blindness had worse clinical outcomes and greater resources utilization. Hospital-based healthcare professionals should recognize that because those with visual impairment are at risk for worse outcomes, extra attention to detail may be warranted to minimize the propagation of such disparity.

scholarly journals 394. Impact of Day of Admission and Time to Diagnostic Arthrocentesis on Mortality and Other Outcomes in Solid-Organ Transplant Recipients with Septic Arthritis: A Nationwide Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S202-S202
Author(s):  
Gustavo Contreras Anez ◽  
Ana B Arevalo ◽  
Shane E Murray ◽  
Christian Olivo Freites
Keyword(s):  
Length Of Stay ◽  
Septic Arthritis ◽  
Organ Transplant ◽  
Mortality Rates ◽  
Solid Organ Transplant ◽  
Hospital Charges ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Total Hospital ◽  
Solid Organ Transplant Recipients

Abstract Background Multiple cases have been reported assessing the outcomes for solid-organ transplant recipients (SOTR) admitted to the hospital with septic arthritis of a native joint (SANJ); however, there are no data evaluating the outcome of these patients when they are admitted on the weekend compared with the rest of the week. Methods The NIS database of the year 2016 was utilized to identify all SOTR with SANJ using ICD-10 codes. SOTR status was defined as those adults with a history of a transplanted organ including heart, lungs, a combined heart and lung, liver, kidney, intestine or pancreas. Admissions between midnight Friday and midnight Sunday were classified as weekend admissions. Early arthrocentesis was defined as percutaneous arthrocentesis performed within 24 hours of admission. Odds ratios (OR) were calculated for primary and secondary outcomes including in-hospital mortality rate, rates of diagnostic arthrocentesis and early arthrocentesis, length o¬f stay and total hospital charges. These results were compared after univariable and multivariable logistic regression adjusted for age, gender, race, day of admission, Charlson comorbidity index and median household yearly income in the patient’s zip code. We used STATA-15 for statistical analysis. Results We identified 319 SOTR with SANJ. Compared with SOTR admitted with SANJ on weekdays, those admitted on weekends had increased in-hospital mortality rates (odds ratio[OR] 11; 95% [CI] 1.2–97.9, P < 0.05), but similar, length of stay (P > 0.05) and hospital charges (P > 0.05). However, regardless of the day of admission those who received an early arthrocentesis had a lower length of stay (P < 0.05), and lower total hospital charges (P < 0.05). Conclusion Our study showed that compared with SOTR admitted with SANJ on weekdays, those admitted on weekends had increased mortality rates but similar length of stays and total hospital charges. However, patients who received an early arthrocentesis had a significantly lower length of stay and hospital charges regardless of the day of admission. These results add weight to the hypothesis of negative outcomes in weekend admissions. Moreover, we believe that our findings require further investigation to establish the role of early arthrocentesis in the management of septic arthritis. Disclosures All authors: No reported disclosures.

Abstract 15296: Systemic Lupus Erythematosus Patients Admitted for Atrial Fibrillation Do Not Have Worse Outcomes: Analysis of the National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ehizogie Edigin ◽  
precious O Eseaton ◽  
Mavi M Rivera Pavon ◽  
Emmanuel Akuna ◽  
Iriagbonse R Asemota ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Lupus Erythematosus ◽  
Electrical Cardioversion ◽  
Hospital Charges ◽  
Secondary Diagnosis ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Systemic Lupus ◽  
Total Hospital ◽  
Icd 10

Introduction: Systemic Lupus Erythematosus (SLE) is known to increase the risk of atrial fibrillation (AF), however it is unclear if SLE worsens outcomes in patients admitted for AF. This study aims to compare the outcomes of patients primarily admitted for AF with and without a secondary diagnosis of SLE. Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalizations with AF as principal diagnosis with and without SLE as secondary diagnosis using ICD-10 codes. Hospitalizations for adult patients from the above groups were identified. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, pharmacologic, and electrical cardioversion were secondary outcomes of interest. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used to analyze the data. Results: There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 821,630 hospitalizations were for adult patients, who had a principal ICD-10 code for AF. 2,645 (0.3%) of these hospitalizations have co-existing SLE. SLE group were younger (67 vs 71 years, P < 0.0001) and had more females (85% vs 51%, P < 0.0001). Hospitalizations for AF with SLE had similar inpatient mortality (1.5% vs 0.91%, AOR: 1.0, 95% CI 0.47-2.14, P=0.991), LOS ( 4.2 vs 3.4 days, P=0.525), total hospital charges ( $51,351vs $39,121, P=0.056), odds of undergoing pharmacologic cardioversion ( 0.38% vs 0.38%, AOR: 0.90, 95% CI 0.22-3.69, P=0.880) and electrical cardioversion (12.9% vs 17.5%, AOR 0.87, 95% CI 0.66-1.15, P=0.324) compared to those without SLE. Hospitalizations for AF with SLE had increased odds of undergoing ablation (6.8% vs 4.2%, AOR: 1.9, 95% CI 1.3-2.7, P<0.0001) compared to those without SLE. Conclusions: Patients admitted primarily for AF with co-existing SLE had similar inpatient mortality, LOS, total hospital charges, likelihood of undergoing pharmacologic and electrical cardioversion compared to those without SLE. However, SLE group had more odds of undergoing ablation.

Abstract 15308: Psoriasis Does Not Worsen Outcomes of Patients Admitted for Atrial Fibrillation: Analysis of the National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ehizogie Edigin ◽  
precious O Eseaton ◽  
Iriagbonse R Asemota ◽  
Emmanuel Akuna ◽  
Hafeez Shaka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Linear Regression Analysis ◽  
The United States ◽  
Electrical Cardioversion ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Secondary Diagnosis ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Total Hospital

Introduction: Studies have shown that psoriasis increases the risk of atrial fibrillation (AF). However, it is unclear if co-existing psoriasis worsens outcomes in AF hospitalizations. This study aims to compare the outcomes of patients primarily admitted for AF with and without a secondary diagnosis of psoriasis. Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalizations for adult patients with AF as principal diagnosis with and without psoriasis as secondary diagnosis using ICD 10 codes. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, pharmacological, and electrical cardioversion were secondary outcomes of interest. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used to analyze the data. Results: There were over 71 million hospitalizations in the combined NIS 2016 and 2017 database. Out of 821,630 hospitalizations for AF, 4,490 (0.55%) had Psoriasis. Hospitalizations for AF with psoriasis had similar inpatient mortality [0.78% vs 0.92%, AOR 0.95, 95% CI (0.44-2.04), P=0.895], total hospital charge [$41,869 vs $39,145, P=0.572] and longer LOS [3.72 vs 3.37 days, P=0.023] compared to those without psoriasis. Odds of undergoing ablation [5.0% vs 4.2%, AOR 1.12, 95% CI (0.82-1.52), P=0.481], pharmacologic cardioversion [0.11% vs 0.38%, AOR 0.29, 95% CI (0.04-2.10), P=0.219] and electrical cardioversion [19.2% vs 17.5%, AOR 0.99, 95% CI (0.83-1.19), P=0.930] were similar in both groups. Conclusion: Hospitalizations for AF with psoriasis had longer LOS compared to those without psoriasis. AF hospitalizations with psoriasis however had similar inpatient mortality, total hospital charges, odds of undergoing ablation, pharmacologic and electrical cardioversion compared to those without psoriasis.

Abstract 368: Association of Atrial Fibrillation with In-hospital Outcomes in ST-Elevation Myocardial Infarction - A Propensity Matched Study

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Prakash Harikrishnan ◽  
Marjan Mujib ◽  
Tanush Gupta ◽  
Dhaval Kolte ◽  
Chandrasekar Palaniswamy ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Average Length ◽  
St Elevation Myocardial Infarction ◽  
Hospital Charges ◽  
Total Hospital ◽  
Average Length Of Stay ◽  
St Elevation

Background: Atrial fibrillation is a relatively common comorbid condition in patients with coronary artery disease. However, there are limited data on the association of atrial fibrillation (AF) with outcomes in ST-elevation myocardial infarction (STEMI). Methods: We queried the 2003-2011 Nationwide Inpatient Sample databases using the ICD-9 diagnosis codes, to identify all patients > 18 years admitted with a primary diagnosis of STEMI. We studied the association of AF with in-hospital outcomes in these patients both by regression analysis and propensity match to adjust for demographics, hospital characteristics and co-morbidities. Results: Of the total 452,772 (64.5% men) STEMI hospitalizations, AF was documented in 58,273 (12.9%) cases. Patients with AF were older (mean age 75±12 vs 64±14 years; p<0.001) and had a higher proportion of women (42.5% vs 34.5%; p<0.001) than patients without AF. STEMI patients with AF had a higher risk-adjusted in-hospital mortality (OR 1.15, 95% CI 1.12-1.19, p<0.001), longer average length of stay (7 days vs 4 days, P<0.001) and higher average total hospital charges ($74,082 vs $57,331, P<0.001) than those without AF. Using propensity matching, 57,388 STEMI patients with AF were compared with the same number of patients without AF. Within these matched cohorts, STEMI patients with AF had higher in-hospital mortality (16.7% vs 15.1%, OR 1.13, 95% CI 1.09-1.16; p<0.001), longer average length of stay (7 days vs 6 days, P<0.001), and higher average total hospital charges ($73,832 vs $65,201, P<0.001) than patients without AF. Conclusions: In patients hospitalized with STEMI, AF was independently associated with modestly higher in-hospital mortality, higher hospital charges, and longer length of stay.

scholarly journals A comparison of endoscopic and non-endoscopic biliary intervention outcomes in patients with prior bariatric surgery

2018 ◽  
Vol 06 (01) ◽  
pp. E11-E28
Author(s):  
Amrit Kamboj ◽  
Victorio Pidlaoan ◽  
Mohammad Shakhatreh ◽  
Alice Hinton ◽  
Darwin Conwell ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Nationwide Inpatient Sample ◽  
Cost Effective ◽  
Hospital Charges ◽  
Endoscopic Management ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Cost Effective Approach ◽  
History Of ◽  
The Mean

Abstract Background and study aims Endoscopic biliary intervention (BI) is often difficult to perform in patients with prior bariatric surgery (BRS). We sought to analyze outcomes of patients with prior BRS undergoing endoscopic and non-endoscopic BI. Patients and methods The Nationwide Inpatient Sample (2007 – 2011) was reviewed to identify all adult inpatients (≥ 18 years) with a history of BRS undergoing BI. The clinical outcomes of interest were in-patient mortality, length of stay (LOS), and total hospital charges. Results There were 7,343 patients with prior BRS who underwent BIs where a majority were endoscopic (4,482 vs. 2,861, P < 0.01). The mean age was 50±30.8 years and the majority were females (80.5 %). Gallstone-related disease was the most common indication for BI and managed more often with primary endoscopic management (2,146 vs. 1,132, P < 0.01). Inpatient mortality was not significantly different between patients undergoing primary endoscopic versus non-endoscopic BI (0.2 % vs. 0.7 %, P = 0.2). Patients with sepsis were significantly more likely to incur failed primary endoscopic BI (OR 2.74, 95 % CI 1.15, 6.53) and were more likely to be managed with non-endoscopic BI (OR 2.13, 95 % CI 1.3, 3.5). Primary non-endoscopic BI and failed endoscopic BI were both associated with longer LOS (by 1.77 days, P < 0.01 and by 2.17 days, P < 0.01, respectively) and higher hospitals charges (by $11,400, P < 0.01 and by $ 14,200, P < 0.01, respectively). Conclusion Primary endoscopic management may be a safe and cost-effective approach for patients with prior BRS who need BI. While primary endoscopic biliary intervention is more common, primary non-endoscopic intervention may be used more often for sepsis.

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