AHRQ data show rising hospital charges, falling hospital stays

AbstractUnlike most European and Asian countries, radical vaginal hysterectomy (RVH) is not performed often in the United States, especially among older women. To examine the changes in RVH over the years, trends in hospital stay, hospital charges, and patient survival, we studied women aged 65 years and older undergoing RVH and compared them with patients receiving radical abdominal hysterectomy (RAH). During the study period there were a total of 288 RVH surgeries compared with 4,835 RAH surgeries. There were no significant changes in the number or proportion of RVH patients over 8 years (p =.50, trend test). On the average, RVH patients were significantly older and had shorter hospital stays. Among patients without cancer, there were no significant differences in the age, race, or survival of patients having either RVH or RAH. Similar results were obtained for patients with cancer.

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Hospital Stays, Hospital Charges, and In-Hospital Deaths Among Infants With Selected Birth Defects—United States, 2003

JAMA ◽

10.1001/jama.297.8.802 ◽

2007 ◽

Vol 297 (8) ◽

pp. 802 ◽

Cited By ~ 1

Keyword(s):

United States ◽

Birth Defects ◽

Hospital Charges ◽

Hospital Deaths ◽

Hospital Stays

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What are the True Advantages of a Pediatric Appendicitis Clinical Pathway?

The American Surgeon ◽

10.1177/000313480607201009 ◽

2006 ◽

Vol 72 (10) ◽

pp. 885-889 ◽

Cited By ~ 10

Author(s):

Sherif Emil ◽

Michael Taylor ◽

Fombe Ndiforchu ◽

Nam Nguyen

Keyword(s):

Clinical Pathway ◽

Patient Discharge ◽

Antibiotic Use ◽

Infectious Complications ◽

Complicated Appendicitis ◽

Hospital Charges ◽

Clinical Criteria ◽

Primary Wound Closure ◽

Group I ◽

Hospital Stays

Multiple protocols have been described for pediatric appendicitis, but few have been compared with off-protocol treatment. We performed such a comparison. Children treated for appendicitis by three pediatric surgeons over a 28-month period were studied. A protocol of primary wound closure without drains, standardized use of antibiotics, and patient discharge according to predetermined clinical criteria was compared with individualized drain use, antibiotic selection, and discharge timing. Three hundred ninety-seven children were treated, 43 per cent on pathway (Group I) and 57 per cent off pathway (Group II). The two groups showed similar incidence of acute (45% vs 46%), complicated (50% vs 49%), and normal (5%) appendix. Among patients with simple appendicitis, Group I had less postoperative antibiotic use (16% vs 80% P < 0.001), shorter hospital stays (1.44 vs 1.89 days, P = 0.001), and decreased hospital charges ($9,289 vs $10,751, P = 0.001). Among patients with complicated appendicitis, Group I had less drain placement (4% vs 27%, P < 0.001), less use of discharge antibiotics (13% vs 39%, P < 0.001), and no readmission (0% vs 5%, P = 0.05). Infectious complications were similar between the two groups. A clinical pathway decreases the use of unnecessary antibiotics, hospital stay, and charges for simple appendicitis. It decreases the use of unnecessary drains, and eliminates readmissions after complicated appendicitis.

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Influence of Obesity Diagnosis With Organ Dysfunction, Mortality, and Resource Use Among Children Hospitalized With Infection in the United States

Journal of Intensive Care Medicine ◽

10.1177/0885066616631325 ◽

2016 ◽

Vol 32 (5) ◽

pp. 339-345 ◽

Cited By ~ 5

Author(s):

Nidhi Maley ◽

Achamyeleh Gebremariam ◽

Folafoluwa Odetola ◽

Kanakadurga Singer

Keyword(s):

Organ Dysfunction ◽

Multivariable Analysis ◽

Clinical Manifestations ◽

Severity Of Illness ◽

The United States ◽

Hospital Charges ◽

Obesity Status ◽

Hospital Stays ◽

Us Children ◽

The Impact

Background: Sepsis induces inflammation in response to infection and is a major cause of mortality and hospitalization in children. Obesity induces chronic inflammation leading to many clinical manifestations. Our understanding of the impact of obesity on diseases, such as infection and sepsis, is limited. The objective of this study was to evaluate the association of obesity with organ dysfunction, mortality, duration, and charges during among US children hospitalized with infection. Methods: Retrospective study of hospitalizations in children with infection aged 0 to 20 years, using the 2009 Kids’ Inpatient Database. Results: Of 3.4 million hospitalizations, 357 701 were for infection, 5685 of which were reported as obese children. Obese patients had higher rates of organ dysfunction (7.35% vs 5.5%, P < .01), longer hospital stays (4.1 vs 3.5 days, P < .001), and accrued higher charges (US$29 019 vs US$21 200, P < .001). In multivariable analysis, mortality did not differ by obesity status (odds ratio: 0.56, 95% confidence interval: 0.23-1.34), however severity of illness modified the association between obesity status and the other outcomes. Conclusions: While there was no difference in in-hospital mortality by obesity diagnosis, variation in organ dysfunction, hospital stay, and hospital charges according to obesity status was mediated by illness severity. Findings from this study have significant implications for targeted approaches to mitigate the burden of obesity on infection and sepsis.

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A Nationwide Study Examining Deafness Among Hospitalized Adults

American Journal of Audiology ◽

10.1044/2021_aja-20-00156 ◽

2021 ◽

pp. 1-6

Author(s):

Ché Matthew Harris ◽

Susrutha Kotwal ◽

Scott Mitchell Wright

Keyword(s):

Odds Ratio ◽

Retrospective Cohort ◽

Nationwide Inpatient Sample ◽

Mean Difference ◽

Hospital Charges ◽

Hospital Outcomes ◽

Diagnostic Codes ◽

Charlson Comorbidity Score ◽

Utilization Data ◽

Hospital Stays

Background It is unknown whether hospital outcomes differ among nonspeaking deaf patients compared to those without this disability. Objective This article aims to compare clinical outcomes and utilization data among patients with and without deafness. Design This study used a retrospective cohort study. Setting and Participants The participants included Nationwide Inpatient Sample, year 2017, hospitalized adults with and without diagnostic codes related to deafness and inability to speak. Method Multiple logistic and linear regression were used to compare in-hospital outcomes. Results Thirty million four hundred one thousand one hundred seventeen adults were hospitalized, and 7,180 had deafness and inability to speak related coding. Patients with deafness were older (mean age ± SEM : 59.2 ± 0.51 vs. 57.9 ± 0.09 years, p = .01), and less likely female (47.0% vs. 57.7%, p < .01) compared to controls. Those with deafness had more comorbidities compared to the controls (Charlson comorbidity score ≥ 3: 31.2% vs. 27.8%, p < .01). Mortality was higher among deaf versus controls (3.6% vs. 2.2%; p < .01); this translated into higher adjusted odds of mortality (adjusted odds ratio = 1.7. [confidence interval (CI) 1.3–2.4]; p = .01). Deaf patients had lower odds of being discharged home compared to controls {aOR} = 0.6, (CI) 0.55–0.73]; p < .01. Length of stay was longer (adjusted mean difference = 1.5 days CI [0.7–2.3]; p < .01) and hospital charges were higher, but not significantly so (adjusted mean difference = $4,193 CI [−$1,935–$10,322]; p = .18) in patients with deafness. Conclusions Hospitalized nonspeaking deaf patients had higher mortality and longer hospital stays compared to those without this condition. These results suggest that specialized attention may be warranted when deaf patients are admitted to our hospitals in hopes of reducing disparities in outcomes. Supplemental Material https://doi.org/10.23641/asha.14336663

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113. Understanding the Changes in Infective Endocarditis Admission in Pennsylvania During the Opioid Crisis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.188 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S88-S88

Author(s):

Jessica A Meisner ◽

Judith A Anesi ◽

Xinwei Chen ◽

Dave Grande

Keyword(s):

Infective Endocarditis ◽

Health Care Cost ◽

Acute Care Hospital ◽

Hospital Charges ◽

Care Hospital ◽

Opioid Crisis ◽

Care Models ◽

Hiv Serostatus ◽

The Face ◽

Hospital Stays

Abstract Background Nationwide, there has been a rise in cases of infective endocarditis (IE) correlating with the rise of the opioid crisis. Pennsylvania (PA) has the third highest rate of drug overdose deaths in the country, with Allegheny and Philadelphia counties having the highest rates in the country. With this study, we evaluated how IE has changed in the face of the opioid crisis with respect to the population impacted and associated healthcare utilization in PA. Methods We performed a retrospective cohort study of all adults admitted to an acute care hospital in PA between January 2013 and March 2017 with a diagnosis of IE. Patients were identified through the Pennsylvania Health Care Cost Containment Council (PHC4) via billing codes. Exposed patients were those with drug use-associated IE (DU-IE); the unexposed group was those with non-DU-IE. We determined the number of admissions and geographical distribution of IE and DU-IE in the state. We then assessed for differences in hepatitis C (HCV) and HIV serostatus, length of stay (LOS), insurance status, total hospital charges, and rates of valve surgery between the two groups. Results There were 17,224 admissions for IE in PA during the study period, of which 11.2% were DU-IE. In Allegheny and Philadelphia counties, 14.4% and 20.5% were from DU-IE, respectively. DU-IE cases increased from 6% in 2013 to 17% in 2017, P < 0.001. We found several significant differences between the DU-IE and non-DU-IE groups: DU-IE group was younger (median 33 vs. 69 years old, P < 0.001); the LOS was longer in the DU-IE group (10 vs. 7 days, P < 0.001); the percentage of patients leaving Against Medical Advice was higher in DU-IE group (15.7% vs. to 1.1%, P < 0.001); a higher proportion of the DU-IE group were HCV and HIV seropositive (27.1% vs. 3.3% for HCV, 2.4% vs. 0.74% for HIV, P < 0.001). See figures for complete results. Conclusion Pennsylvania had an increase in the number of IE cases over the last 4 years, driven by the opioid crisis, with Philadelphia and Alleghany counties being the most impacted areas. While this study is limited by the use of claims data, it demonstrates the downstream effects of the opioid crisis on the patient population at risk and the healthcare system due to longer and costlier hospital stays. This study supports the need for innovative and integrative care models to support them. Disclosures All authors: No reported disclosures.

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