scholarly journals Previous palliative care encounter is associated with lower total hospital charge and shorter length of stay in patients with metastatic cancer

2017 ◽  
Vol 28 ◽  
pp. v500
Author(s):  
Y. Liu
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Metastatic Cancer ◽  
Hospital Charge ◽  
Total Hospital ◽  
Total Hospital Charge

A cost analysis of managing cancer-related pain among hospitalized US cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7079-7079
Author(s):  
Olatunji B. Alese ◽  
Chao Zhang ◽  
Katerina Mary Zakka ◽  
Sungjin Kim ◽  
Christina Wu ◽  
...  
Keyword(s):  
Pain Management ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Metastatic Cancer ◽  
Hospital Charge ◽  
Hospital Charges ◽  
Total Charge ◽  
Total Hospital ◽  
Total Hospital Charge ◽  
The Cost

7079 Background: Pain is a common symptom of cancer, affecting patients' function and quality of life. It is also a common cause of hospitalization for cancer patients. The aim of this study was to evaluate the cost of in-hospital pain management among US cancer patients. Methods: A retrospective analysis of data from all US hospitals that contributed to the National Inpatient Sample for 2011-2015 was conducted. All cancer patients admitted for pain management were included in the analysis. Main outcomes were factors significantly associated with hospital length of stay, total charge per hospital stay, and in-hospital mortality. Weighted chi-square test was used for categorical covariates and univariate analysis was performed using a logistic model. Results: 122,776 patient discharges were identified. Mean age was 59.3 years and 52.3% were female. 65.9% stayed in the hospital for longer than 72 hours, with a median total hospital charge of $48,156. Conversely, the median total hospital charge for those spending less than 72 hours on admission was $15,966. Median total charge per hospital stay was similar among insured and uninsured/self-pay patients ($32,879 vs. $32,323; p=0.013), but higher in patients without metastatic disease ($33,315 vs. $29,369; p<0.001). It was also higher in those with the highest income quartile when compared with lowest income patients ($38,223 vs. $30,047; p<0.001). Co-morbid medical illnesses were more prevalent in those with longer hospital stay (15 vs. 12; p<0.001) and the overall in-hospital mortality rate was 8.2%. There was no significant difference in median total hospital charges between those who died in, or those discharged from the hospital ($33,746 vs. $32,795; p<0.001). On multivariate analyses, gender, race, insurance status, diagnosis of metastatic cancer, age, number of co-morbid medical illnesses, year of diagnosis, and median income were significant predictors of length of stay. Race, insurance payor, metastatic cancer, age, and number of co-morbid medical illnesses were significant predictors of total hospital charges, after adjusting for other covariates. Conclusions: In-patient pain management of cancer patients is associated with significant health care costs. Optimization of outpatient pain management strategies could significantly lower the cost of care for cancer.

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.

scholarly journals Lung involvement in systemic sclerosis is associated with adverse hospital outcomes: insights from the National Inpatient Sample

2021 ◽  
pp. jim-2020-001743
Author(s):  
Jesse Osemudiamen Odion ◽  
Armaan Guraya ◽  
Chukwudi Charles Modijeje ◽  
Osahon Nekpen Idolor ◽  
Eseosa Jennifer Sanwo ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Hospital Charge ◽  
Hospital Length Of Stay ◽  
Lung Involvement ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Total Hospital Charge ◽  
Icd 10 ◽  
Secondary Outcomes

This study aimed to compare outcomes of systemic sclerosis (SSc) hospitalizations with and without lung involvement. The primary outcome was inpatient mortality while secondary outcomes were hospital length of stay (LOS) and total hospital charge. Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. This database is the largest collection of inpatient hospitalization data in the USA. The NIS was searched for SSc hospitalizations with and without lung involvement as principal or secondary diagnosis using International Classification of Diseases 10th Revision (ICD-10) codes. SSc hospitalizations for patients aged ≥18 years from the above groups were identified. Multivariate logistic and linear regression analysis was used to adjust for possible confounders for the primary and secondary outcomes, respectively. There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 62,930 hospitalizations were for adult patients who had either a principal or secondary ICD-10 code for SSc. 5095 (8.10%) of these hospitalizations had lung involvement. Lung involvement group had greater inpatient mortality (9.04% vs 4.36%, adjusted OR 2.09, 95% CI 1.61 to 2.73, p<0.0001), increase in mean adjusted LOS of 1.81 days (95% CI 0.98 to 2.64, p<0.0001), and increase in mean adjusted total hospital charge of $31,807 (95% CI 14,779 to 48,834, p<0.0001), compared with those without lung involvement. Hospitalizations for SSc with lung involvement have increased inpatient mortality, LOS and total hospital charge compared with those without lung involvement. Collaboration between the pulmonologist and the rheumatologist is important in optimizing outcomes of SSc hospitalizations with lung involvement.

scholarly journals Kidney-Pancreas Transplant Recipients Experience Higher Risk of Complications Compared to the General Population after Undergoing Coronary Artery Bypass Grafting

2021 ◽  
Author(s):  
Jordyn M. Perdue ◽  
Alejandro C. Ortiz ◽  
Afshin Parsikia ◽  
Jorge Ortiz
Keyword(s):  
General Population ◽  
Kidney Transplant ◽  
Artery Bypass ◽  
Hospital Charge ◽  
Pancreas Transplant ◽  
Bypass Grafting ◽  
Transplant Recipients ◽  
Total Hospital ◽  
Total Hospital Charge ◽  
History Of

AbstractThis retrospective analysis aims to identify differences in surgical outcomes between pancreas and/or kidney transplant recipients compared with the general population undergoing coronary artery bypass grafting (CABG). Using Nationwide Inpatient Sample (NIS) data from 2005 to 2014, patients who underwent CABG were stratified by either no history of transplant, or history of pancreas and/or kidney transplant. Multivariate analysis was used to calculate odds ratio (OR) to evaluate in-hospital mortality, morbidity, length of stay (LOS), and total hospital charge in all centers. The analysis was performed for both nonemergency and emergency CABG. Overall, 2,678 KTx (kidney transplant alone), 184 PTx (pancreas transplant alone), 254 KPTx (kidney-pancreas transplant recipients), and 1,796,186 Non-Tx (nontransplant) met inclusion criteria. KPTx experienced higher complication rates compared with Non-Tx (78.3 vs. 47.8%, p < 0.01). Those with PTx incurred greater total hospital charge and LOS. On weighted multivariate analysis, KPTx was associated with an increased risk for developing any complication following CABG (OR 3.512, p < 0.01) and emergency CABG (3.707, p < 0.01). This risk was even higher at transplant centers (CABG OR 4.302, p < 0.01; emergency CABG OR 10.072, p < 0.001). KTx was associated with increased in-hospital mortality following emergency CABG, while PTx and KPTx had no mortality to analyze. KPTx experienced a significantly higher risk of complications compared with the general population after undergoing CABG, in both transplant and nontransplant centers. These outcomes should be considered when providing perioperative care.

Influence of timing of goals of care discussion on hospitalization outcomes in metastatic cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18183-e18183
Author(s):  
Oluwadunni Emiloju ◽  
Djeneba Audrey Djibo ◽  
Jean G Ford
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Hospital Readmission ◽  
Metastatic Cancer ◽  
Hospital Readmissions ◽  
Stage Iv ◽  
Continuous Variables ◽  
Goals Of Care

e18183 Background: Cancer patients often require acute hospitalizations, many of which are unplanned. These hospitalizations have been shown to increase in frequency near the end of life. The American College of Physicians recommends that goals of care (GOC) discussions be initiated early for metastatic cancers. We hypothesize that discussing GOC during hospitalization will help reduce readmissions and improve patient satisfaction, by helping to ensure that patients receive goal-congruent care. We aim to examine the association between the timing of GOC discussion and the patient's length of stay and the time to hospital readmission. Methods: We conducted a retrospective review of medical records of patients with stage IV solid tumors who were hospitalized acutely between August 2017 and July 2018 (N = 241). We assessed demographics, clinical information, timing of GOC discussion, use of palliative care services and hospital readmissions within 90 days. Chi-square tests were used to identify independent associations with having a GOC discussion; and anova was used for continuous variables. We used logistic regression to examine the association with a hospital readmission within 90 days, controlling for potential confounders. Results: The subjects were 26-92 years old and 40.6% were female. Only 43% (n = 106) of patients had a GOC discussion. Age, gender, tumor site, and presenting complaint were not independently associated with having a GOC discussion (p > 0.05). Overall, 34.4% (n = 83) had a palliative care encounter. Having a palliative care consult and being admitted to critical care were independently associated with having a GOC discussion. Early timing of GOC discussion was inversely associated with admission to critical care units (p < 0.05). Length of stay was positively correlated with having a GOC discussion. Thirty-seven percent (n = 91) had unplanned hospital readmission within 90 days. Having any GOC discussion reduced the odds of an unplanned hospital readmission within 90 days by 75% [OR = 0.25, 95% confidence interval (CI) 0.14-0.45]. Conclusions: Among hospitalized patients with stage IV cancer, performing an early GOC discussion is associated with better hospitalization outcomes. It is therefore important to perform GOC discussion early when such patients are acutely hospitalized.

Influence of timing of goals of care discussion on hospitalization outcomes in metastatic cancer patients.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 219-219
Author(s):  
Oluwadunni Emiloju ◽  
Jean G Ford ◽  
Djeneba Audrey Djibo
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Hospital Readmission ◽  
Metastatic Cancer ◽  
Hospital Readmissions ◽  
Stage Iv ◽  
Continuous Variables ◽  
Goals Of Care

219 Background: Cancer patients often require acute hospitalizations, and these hospitalizations have been shown to increase in frequency near the end of life. The American College of Physicians recommends that goals of care (GOC) discussions be initiated early for metastatic cancers. Discussing GOC during hospitalization can help reduce readmissions and improve patient satisfaction, by helping to ensure that patients receive goal-congruent care. We aim to examine the association between the timing of GOC discussion and the patient's length of stay and the time to hospital readmission. Methods: We conducted a retrospective review of medical records of patients with stage IV solid tumors who were hospitalized acutely between August 2017 and July 2018. We assessed demographics, timing of GOC discussion, use of palliative care services and hospital readmissions within 90 days. Chi-square tests were used to identify independent associations with having a GOC discussion; and anova was used for continuous variables. We used logistic regression to examine the association with a hospital readmission within 90 days, controlling for potential confounders. Results: The subjects were 26-92 years old and 40.6% were female. Only 46% (n = 112) of patients had a GOC discussion. Age, tumor site, and presenting complaint were not independently associated with having a GOC discussion (p > 0.05). Overall, 34% (n = 82) had a palliative care encounter. Having a palliative care consult and being admitted to critical care were independently associated with having a GOC discussion. Early timing of GOC discussion was inversely associated with admission to critical care units (p < 0.05). Length of stay was positively correlated with having a GOC discussion. Thirty-eight percent (n = 92) had unplanned hospital readmission within 90 days. Having any GOC discussion reduced the odds of an unplanned hospital readmission within 90 days by 79% [OR = 0.21, 95% confidence interval 0.12-0.37]. Conclusions: Among hospitalized patients with stage IV cancer, performing an early GOC discussion is associated with better hospitalization outcomes. It is therefore important to perform GOC discussion early when such patients are acutely hospitalized.

scholarly journals Diabetes Does Not Worsen Outcomes of Patients Admitted for Hyperthyroidism: Analysis of the National Inpatient Sample

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A410-A410
Author(s):  
Hafeez Shaka ◽  
Emmanuel Akuna ◽  
Dimeji Olukunmi Williams ◽  
Iriagbonse Asemota ◽  
Ehizogie Edigin ◽  
...  
Keyword(s):  
Linear Regression Analysis ◽  
The United States ◽  
Hospital Charge ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Secondary Diagnosis ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Total Hospital Charge

Abstract Introduction: Both diabetes mellitus (DM) and hyperthyroidism are common diseases. However, it is unclear if co-existing DM worsens outcomes in patients with hyperthyroidism. This study aims to compare the outcomes of patients primarily admitted for hyperthyroidism with and without a secondary diagnosis of DM. Methods: Data were extracted 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 hyperthyroidism as principal diagnosis with and without DM as secondary diagnosis using ICD 10 codes. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges and NSTEMI were secondary outcomes of interest. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million hospitalizations in the combined NIS 2016 and 2017 database. Out of 17,705 hospitalizations for hyperthyroidism, 2,160 (15.9%) had DM. Hospitalizations for hyperthyroidism with DM had similar inpatient mortality [0.35% vs 0.50%, AOR 0.25, 95% CI (0.05–1.30), P= 0.101], total hospital charge [$47,001 vs $36,978 P=0.220], LOS [4.50 vs 3.48 days, P=0.050] and NSTEMI compared to those without DM. Conclusion: Hospitalizations for hyperthyroidism with DM had similar inpatient mortality, total hospital charges, LOS and odds of undergoing ablation compared to those without obesity.

Abstract 16225: Protein Energy Malnutrition is Associated With Increased Inpatient Mortality in Patients Admitted for Atrial Fibrillation: Analysis of the National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Emmanuel Akuna ◽  
Iriagbonse Asemota ◽  
Ehizogie Edigin ◽  
Hafeez Shaka ◽  
Precious O Eseaton ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Protein Energy Malnutrition ◽  
The United States ◽  
Hospital Charge ◽  
National Database ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Total Hospital Charge ◽  
Protein Energy

Introduction: Various forms of protein energy malnutrition (PEM) has been shown to affect different heart pathologies through its underlying pathogenesis of unabating chronic inflammation. The effect of PEM on atrial fibrillation (AF) is unclear. Our study sought to estimate the impact of PEM on clinical outcomes of hospitalizations for AF using a national database Methods: We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without PEM as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were hospital length of stay (LOS) and total hospital charge. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,629 AF hospitalizations, 3% had PEM. Hospitalization for AF with PEM had a statistically significant increase in mortality (5.2% vs 0.8%, AOR 2.33, 95% CI 1.96 - 2.78, P<0.0001), with an adjusted increase in mean hospital charge of $15,862 (95% CI 11,999 - 19,725, P<0.0001) and a 2 day increase in LOS (95% CI 2.00 - 2.50, P= <0.0001) compared to those without PEM. Conclusion: In conclusion, PEM resulted in increased mortality, LOS and total hospital charge in patients hospitalized with AF. Nutritional rehabilitation in patients with PEM and concomittant AF may be needed to improve outcomes.

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