558 Relationship Between Patient Characteristics and Number of Procedures as Well as Length of Stay for Patients Surviving Severe Burn Injuries: Analysis of the American Burn Association National Burn Repository

Abstract Introduction Published information on the relationship between patient characteristics such as total body surface area (TBSA) of burn on number of procedures and length of stay (LOS) is not widely available in the United States. Clinical expertise assumes a “rule of thumb” of 1 day stay per percentage TBSA, but deviations based on burn and patient characteristics is rarely explored. The American Burn Association NBR version 8.0 (2002–2011) was analyzed to understand the relationship between key patient and burn characteristics for surviving, severe (TBSA 10–60%) burn patients and number of procedures or LOS. Methods Outcomes include the number of procedures autograft, debridement, and excision procedures and LOS. Independent variables considered were TBSA, TBSA of partial-thickness and full-thickness (FT) burn, age (linear, squared and cubed to account for non-linearity), hospital-acquired infection (HAI), other infection, inhalation injury, female gender and diabetes status. Statistical regression models were developed to control for the independent variables and predict the number of procedures and LOS based on such characteristics. Results Among 21,175 surviving burn patients (TBSA 10–60%), the mean age was 33 years old, and the mean TBSA was 19.9%. Number of excision and autografting procedures increased with TBSA. All independent variables were retained in the LOS model. After adjusting for gender, age and comorbidities, predicted LOS for adults (18+) was 16.4, 29.5, 42.7 and 56.0 days for 10%, 20%, 30% and 40% TBSA respectively. Similarly, predicted LOS for pediatrics (age< 18) was 12.9, 26.0, 28.6 and 55.4 days for each TBSA group, respectively. Conclusions When considering all independent variables, the LOS per percent TBSA is estimated at approximately 1.12 days for adults and 1.01 for pediatrics. However, when considering patient (age, comorbidity status) and burn (burn depth, TBSA) characteristics, the observed LOS could vary by 66% more, as seen with detailed investigations into trends for patients with TBSA 20%. Using the predictive equations from this study, burn centers can generate tailored rule-of-thumb estimates for LOS/%TBSA that better reflect the influence of factors beyond burn center practice patterns. Applicability of Research to Practice

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Relationship Between Patient Characteristics and Number of Procedures as well as Length of Stay for Patients Surviving Severe Burn Injuries: Analysis of the American Burn Association National Burn Repository

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa040 ◽

2020 ◽

Vol 41 (5) ◽

pp. 1037-1044 ◽

Cited By ~ 1

Author(s):

Eliza Kruger ◽

Stacey Kowal ◽

S Pinar Bilir ◽

Eileen Han ◽

Kevin Foster

Keyword(s):

Length Of Stay ◽

Total Body Surface Area ◽

Patient Characteristics ◽

The United States ◽

Ordinary Least Squares ◽

Inhalation Injury ◽

Regression Methods ◽

Diabetes Status ◽

Total Body ◽

The One

Abstract This study establishes important, national benchmarks for burn centers to assess length of stay (LOS) and number of procedures across patient profiles. We examined the relationship between patient characteristics such as age and total body surface area (TBSA) burned and number of procedures and LOS in the United States, using the American Burn Association National Burn Repository (NBR) database version 8.0 (2002–2011). Among 21,175 surviving burn patients (TBSA > 10–60%), mean age was 33 years, and mean injury size was 19.9% TBSA. Outcomes included the number of debridement, excision, autograft procedures, and LOS. Independent variables considered were: age (linear, squared, and cubed to account for nonlinearity), TBSA, TBSAs of partial-thickness and mixed/full-thickness burns, sex, hospital-acquired infection, other infection, inhalation injury, and diabetes status. Regression methods included a mixed-effects model for LOS and ordinary least squares for number of procedures. A backward stepwise procedure (P <0.2) was used to select variables. Number of excision and autografting procedures increased with TBSA; however, this relationship did not hold for debridement. After adjusting for sex, age, and comorbidities, predicted LOS for adults (18+) was 12.1, 21.7, 32.2, 43.7, and 56.1 days for 10, 20, 30, 40, and 50% TBSA, respectively. Similarly, predicted LOS for pediatrics (age < 18) was 8.1, 18.8, 33.2, 47.6, and 56.1 days for the same TBSA groups, respectively. While average estimates for adults (1.12 days) and pediatrics (1.01) are close to the one day/TBSA rule-of-thumb, consideration of other important patient and burn features in the NBR can better refine predictions for LOS.

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Delaying an Appendectomy: Is it Safe?

The American Surgeon ◽

10.1177/000313481207800827 ◽

2012 ◽

Vol 78 (8) ◽

pp. 897-900 ◽

Cited By ~ 17

Author(s):

Kamal Nagpal ◽

Navalkishor Udgiri ◽

Niraj Sharma ◽

Ernesto Curras ◽

John Morgan Cosgrove ◽

...

Keyword(s):

Length Of Stay ◽

Patient Outcomes ◽

Early Group ◽

Perforation Rate ◽

Exclusion Criteria ◽

Open Conversion ◽

Urgent Operation ◽

The Mean ◽

The Relationship ◽

Late Group

Appendicitis has always been an indication for an urgent operation, as delay is thought to lead to disease progression and therefore worse outcomes. Recent studies suggest that appendectomy can be delayed slightly without worse outcomes, however the literature is contradictory. The goal of our study was to examine the relationship between this delay to surgery and patient outcomes. We reviewed all patients that underwent an appendectomy in our institution from January 2009 to December 2010. We recorded the time of surgical diagnosis from when both the surgical consult and the CT scan (if done) were completed. The delay from surgical diagnosis to incision was measured, and patients were divided into two groups: early (≤6 hours delay) and late (>6 hours delay). Outcome measures were 30-day complication rate, length of stay, perforation rate, and laparoscopic to open conversion rate. Three hundred and seventy-seven patients had appendectomies in the study period, and 35 patients were excluded as per the exclusion criteria leaving 342 in the study: 269 (78.7%) in the early group and 73 (21.3%) in the late group. Complications occurred in 21 patients (6.1%) with no difference between the groups: 16/253 (5.9%) in the early group and 5/73 (6.8%) in the late group ( P = 0.93, χ2). The mean (± standard deviation) length of stay was 86.1 ± 67.1 hours in the early group, and 95.9 ± 73.0 hours in the late group. This difference was not significant ( P = 0.22). Delaying an appendectomy more than 6 hours, but less than 24 hours from diagnosis is safe and does not lead to worse outcomes. This can help limit the disruption to the schedules of both the surgeon and the operating room.

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Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke

Stroke Research and Treatment ◽

10.1155/2020/1920583 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Majdi Al Qawasmeh ◽

Belal Aldabbour ◽

Aiman Momani ◽

Deema Obiedat ◽

Kefah Alhayek ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Length Of Stay ◽

Large Artery ◽

Median Length ◽

Nihss Score ◽

Prolonged Length ◽

Independent Variables ◽

Stroke Etiology ◽

The Mean

Objective. To identify the risk factors, etiologies, length of stay, severity, and predictors of disability among patients with the first ischemic stroke in Jordan. Methods. A retrospective cohort study of 142 patients who were admitted to the Neurology Department at King Abdullah University Hospital between July/2017 and March/2018 with a first ischemic stroke. Etiology was classified according to the TOAST criteria. Severity was represented by NIHSS score, disability by mRS score, and prolonged length of stay as hospitalizations more than 75th percentile of the cohort’s median length of stay. Analysis of the sample demographics and descriptive statistics were done, including frequencies of prevalence of independent variables (risk factors) and frequencies of stroke and etiology work-up. Chi-square and univariate analysis of variance “ANOVA” were used to investigate the relationship between risk factors and type of stroke. Finally, logistic regression analysis was used to measure the contribution of each of the independent variables. IRB approval was obtained as necessary. Results. The mean age for the cohort was 66.5 years. The most common risk factors were hypertension (78.8%), diabetes mellitus (60.5%), and ischemic heart disease (29.4%). The most common stroke etiology was small-vessel occlusion (54.2%). Median length of stay was 4 days. Prolonged length of stay was observed in 23.23% of patients, which was associated with several factors, the most common of which were persistent dysphagia (57.5%), nosocomial infection (39.3%), and combined dysphagia and nosocomial infection (21.2%). The mean admission NIHSS score was 7.94, and on discharge was 5.76. In-hospital mortality was 2.81%, while 50% of patients had a favorable outcome on discharge (mRS score between 0-2). The mean discharge mRS score for the cohort was 2.47 (SD±1.79). Large artery atherosclerosis was associated with the highest residual disability with a mean score of 3.67 (SD±1.88), while the stroke of undetermined etiology was associated with the lowest residual disability with a mean score of 1.60 (SD±1.78). Significant predictors of mRS score were smoking (t 3.24, P<0.001), age (t 1.98, P<0.049), and NIHSS score (t 9.979, P 0.000). Conclusion. Ischemic strokes have different etiologies that are associated with different levels of impact on the patient’s clinical status and prognosis. Large artery atherosclerosis was associated with the highest residual disability. Regarding predictors of prognosis, current smoking status, age above 50, gender, and NIHSS on admission appear to be the strongest predictors of prognosis. Finally, higher NIHSS score on admission resulted in a longer hospital stay.

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The Relationship between Demographic Factors in Adult Patients with Stroke

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.7n.4p.14 ◽

2020 ◽

Vol 7 (4) ◽

pp. 14

Author(s):

Samad Shams-Vahdati ◽

Alireza Ala ◽

Eliar Sadeghi-Hokmabad ◽

Neda Parnianfard ◽

Nasim Ahmadi Sepehri ◽

...

Keyword(s):

Significant Relationship ◽

Demographic Data ◽

Demographic Factors ◽

Patient Characteristics ◽

Developed Countries ◽

Adult Patients ◽

Stroke Severity ◽

Statistical Population ◽

The Mean ◽

The Relationship

Background: Developing countries are challenging with stroke as the third cause of death in developed countries and the most popular neurologic disease which results in disability. This study was designed to assess the relationship between demographic factors and early outcome in adult patients with difference type of stroke. Methods and Materials: A retrospective register review was performed from March 2017 to March 2018. ED medical document (chart) were reviewed by a neurologist or physician to obtain the clinical diagnosis, patient characteristics. Their demographic data (such as age, gender), NIHSS score and MRS score were filled in questionnaire. the significant variables were verified in a multivariable model to achieve an attuned estimate of effect. Results: A total of 861 patients with stroke were included in the analysis; the male and female sex in the statistical population were 56% and 43%; the mean age of the patients was 14.32 ± 61.74. The mean NIHSS (16.08±10.51) & MRS (3.66) scores were evaluated, respectively 47% severe stroke (NICHSS>16). There was no significant relationship between age increase and NIHSS increase (P = 0.86). Conclusion: Aging has a significant relationship with increased stroke. Gender and age differences in risk of stroke outcomes are mostly described by variations in physical characteristics and stroke severity of the patients.

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Comparison of characteristics and outcomes of patients admitted to hospital with COVID-19 during wave 1 and wave 2 of the current pandemic

Internal and Emergency Medicine ◽

10.1007/s11739-021-02842-5 ◽

2021 ◽

Author(s):

David Fluck ◽

Suzanne Rankin ◽

Andrea Lewis ◽

Jonathan Robin ◽

Jacqui Rees ◽

...

Keyword(s):

Length Of Stay ◽

Confidence Intervals ◽

Patient Characteristics ◽

Index Score ◽

Interquartile Range ◽

Risk Of Death ◽

Male Patients ◽

The Mean ◽

Reduction Of Mortality ◽

Age And Sex

AbstractIn this study of patients admitted with COVID-19, we examined differences between the two waves in patient characteristics and outcomes. Data were collected from the first COVID-19 admission to the end of study (01/03/2020–31/03/2021). Data were adjusted for age and sex and presented as odds ratios (OR) with 95% confidence intervals (CI). Among 12,471 admissions, 1452 (11.6%) patients were diagnosed with COVID-19. On admission, the mean (± SD) age of patients with other causes was 68.3 years (± 19.8) and those with COVID-19 in wave 1 was 69.4 years (± 18.0) and wave 2 was 66.2 years (± 18.4). Corresponding ages at discharge were 67.5 years (± 19.7), 63.9 years (± 18.0) and 62.4 years (± 18.0). The highest proportion of total admissions was among the oldest group (≥ 80 years) in wave 1 (35.0%). When compared with patients admitted with other causes, those admitted with COVID-19 in wave 1 and in wave 2 were more frequent in the 40–59 year band: 20.8, 24.6 and 30.0%; consisted of more male patients: 47.5, 57.6 and 58.8%; and a high LACE (Length of stay, Acuity of admission, Comorbidity and Emergency department visits) index (score ≥ 10): 39.4, 61.3 and 50.3%. Compared to wave-2 patients, those admitted in wave 1 had greater risk of death in hospital: OR = 1.58 (1.18–2.12) and within 30 days of discharge: OR = 2.91 (1.40–6.04). Survivors of COVID-19 in wave 1 stayed longer in hospital (median = 6.5 days; interquartile range = 2.9–12.0) as compared to survivors from wave 2 (4.5 days; interquartile range = 1.9–8.7). Patient characteristics differed significantly between the two waves of COVID-19 pandemic. There was an improvement in outcomes in wave 2, including shorter length of stay in hospital and reduction of mortality.

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Moral Disengagement and Aggression in Fight Sport Athletes

Journal of Education and Training Studies ◽

10.11114/jets.v7i7.4244 ◽

2019 ◽

Vol 7 (7) ◽

pp. 118

Author(s):

Burcu Güvendi ◽

Ayşe Türksoy Işım

Keyword(s):

Moral Disengagement ◽

Pearson Correlation ◽

Verbal Aggression ◽

Mean Value ◽

Independent Variables ◽

Significant Difference ◽

Pearson Correlation Analysis ◽

The Mean ◽

The Relationship ◽

Positive Significant Correlation

The goal of this study is to investigate the moral disengagement and aggression levels of fight sport athletes according to several independent variables and reveal the relationship among them. The study group consisted of totally 207 fight sport athletes, 88 females and 119 males with age = 21,99 ± 4,92 and year of sport = 6,14 ± 5,42. “The Scale of Moral Disengagement in Sport” and “The Questionnaire of Buss-Perry Aggression” were used as data collection tools. Descriptive statistics, t test, ANOVA and Pearson Correlation analysis were used in the analysis of data. While the mean of physical aggression of athletes was found as the highest, verbal aggression had the lowest mean value within the sub-dimensions of aggression, and they stated that they somewhat disagreed with the moral disengagement. It was found that there was a moderate positive significant correlation between moral disengagement and sub-dimensions of anger, hostility, physical and verbal aggressions of aggression scale. Significant difference was observed in the dimension of moral disengagement in accordance with age and year of sport. Physical and verbal aggression scores of males are significantly higher according to gender. The aggression and moral disengagement scores of kickboxers are significantly higher than those of taekwondo athletes in line with the branch. To conclude, it was determined that fight sport athletes did not approve moral disengagement in sport, however, the case of moral disengagement of athletes, who were younger and started the sport recently, was higher and they mostly showed the behaviour of aggression physically.

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Association of postoperative glycemic control with outcomes after carotid procedures

Vascular ◽

10.1177/1708538119866528 ◽

2019 ◽

Vol 28 (1) ◽

pp. 16-24

Author(s):

Jonathan Bath ◽

Robin L Kruse ◽

Jamie B Smith ◽

Naveen Balasundaram ◽

Todd R Vogel

Keyword(s):

Renal Failure ◽

Carotid Artery ◽

Length Of Stay ◽

Carotid Endarterectomy ◽

Glucose Control ◽

Carotid Artery Stenting ◽

Patient Characteristics ◽

Adverse Outcomes ◽

Cardiac Complications ◽

The Relationship

Objective There are limited data evaluating the impact of postoperative hyperglycemia in patients undergoing vascular procedures. This study evaluated the relationship between suboptimal glucose control and adverse outcomes after carotid artery stenting and carotid endarterectomy. Methods Patients admitted for elective carotid procedures were selected from the Cerner Health Facts® (2008–2015) database using ICD-9-CM diagnosis and procedure codes. We examined the relationship between patient characteristics, postoperative hyperglycemia (any value > 180 mg/dL), and complications with chi-square analysis. A multivariable model examined the association between patient characteristics, procedure type, and glucose control with infection, renal failure, stroke, respiratory and cardiac complications, and length of stay over 10 days. Results Of the 4287 patients admitted for an asymptomatic carotid procedure, 788 (18%) underwent carotid artery stenting and 3499 (82%) underwent carotid endarterectomy. Most patients (87%) had optimal postoperative glucose control (80–180 mg/dL); 13% had suboptimal glucose control. On average, patients with suboptimal glucose control experienced: higher stroke rates (6.2% vs. 2.7%; p < 0.001); more cardiac complications (5.1% vs. 2.0%; p < 0.001); longer hospital stays (3.1 vs. 1.8 days; p < .001); higher rates of post-procedure infection (4.0% vs. 1.8%; p = .001); and more complications than patients with optimal glucose control. Multivariable logistic regression demonstrated that patients with suboptimal glucose control had higher odds of having an infectious (pneumonia, cellulitis, surgical site, etc.) complication (OR 1.91, 95% CI 1.10–3.34), renal failure (OR 3.36, 95% CI 1.95–5.78), respiratory complications (OR 1.81, 95% CI 1.21–2.71), stroke (OR 1.82, 95% CI 1.15–2.88), or length of stay > 10 days (OR 4.07, 95% CI 2.02–8.20). Conclusions Suboptimal glucose control was associated with adverse events after carotid artery stenting and carotid endarterectomy, independent of a diabetes diagnosis. Several adverse outcomes were associated with hyperglycemia, including stroke. Given the singular role of carotid procedures in preventing stroke, we suggest that incorporating rigorous post-operative glucose control into best medical treatment of carotid disease should be considered as a standard practice.

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Acceptance towards Goods and Services Tax (GST) among local business communities

Journal of Emerging Economies and Islamic Research ◽

10.24191/jeeir.v5i4.8837 ◽

2017 ◽

Vol 5 (4) ◽

pp. 62

Author(s):

Shahariah Asmuni ◽

Sabariah Yusoff ◽

Nur Syuhadah Mohd Ses

Keyword(s):

Regression Analysis ◽

Multiple Regression Analysis ◽

Multiple Regression ◽

Business Community ◽

Key Factors ◽

Business People ◽

Independent Variables ◽

Goods And Services ◽

The Mean ◽

The Relationship

The Goods and Services Tax (GST) has been introduced in Malaysia to replace the Sales and Services Tax (SST) to improve the efficiency of indirect tax collection. However, its implementation has not been fully understood by business people. This research aims to examine the key factors that have contributed to the level of acceptance towards GST among business communities in a local city, Johor Bharu. In this study, three variables were selected namely awareness, understanding and attitude. Using questionnaire as a research instrument, 100 sets of questionnaires were distributed. Multiple regression analysis was used to test the relationship among awareness, understanding and attitude with the level of acceptance among business communities towards GST. The results revealed that the mean score for all independent variables is moderate. Awareness and attitude were found to have significant impact on the level of acceptance among business community towards GST, while understanding is not significant. The business community in Johor Bahru shows a moderate or positive level of acceptance and attitude towards GST.

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Financial Impact of Tumor Lysis Syndrome Among Inpatients in the United States

Blood ◽

10.1182/blood.v124.21.5966.5966 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5966-5966

Author(s):

Ranjan Pathak ◽

Smith Giri ◽

Madan Raj Aryal ◽

Paras Karmacharya ◽

Vijaya R. Bhatt ◽

...

Keyword(s):

Length Of Stay ◽

Nationwide Inpatient Sample ◽

Tumor Lysis Syndrome ◽

The United States ◽

Hospital Charge ◽

Hospital Charges ◽

Tumor Lysis ◽

Significant Difference ◽

The Us ◽

The Mean

Abstract Background With an estimated 0.1 million cases in 2014, lymphomas and acute leukemias are the leading causes of malignancies in the US. Tumor lysis syndrome (TLS) is a potentially devastating complication associated with hematologic malignancies leading to increased morbidity and mortality. Previous European studies have shown that the financial burden of TLS is high, with an estimated cost of 7,342 Euros ($10,320 US Dollars) per admission. However, there is a paucity of data on the economic impact of TLS among US inpatients. Methods We used the Nationwide Inpatient Sample database to identify hospitalized patients aged ≥18 years with a primary diagnosis of TLS (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 277.88) from the first year the diagnosis code was introduced (2009) to 2011. Nationwide Inpatient Sample is the largest all-payer publicly available inpatient care database in the US. It contains data from five to eight million hospital stays from about 1,000 hospitals across the country and approximates a 20% sample of all US hospitals. We calculated the mean length of stay (LOS) and mean hospital charges per TLS admission and compared them with those of overall inpatient admissions. Given that renal failure occurs in severe cases, we compared the mean LOS and hospital charge between TLS patients with and without RRT (hemodialysis or peritoneal dialysis, ICD-9-CM procedure codes 39.35 and 54.98 respectively). Data analysis was done using STATA version 13.0 (College Station, TX). Results We identified 997 admissions with TLS. Mean age was 67.5 (±3.3) with 62% males and 80.4% whites. Overall mean LOS and hospital charge for TLS during the study period was 8.02 days (SE 0.83) and $ 72,840 (SE 8,083). Both the mean LOS and hospital charge for TLS were significantly higher than overall in-patient admissions (Table 1). A total of 949 patients (95%) underwent RRT. There was no significant difference in mean LOS (9.84 days vs 7.94 days, p=0.28) and mean hospital charge ($ 88,098 vs $ 71,930, p=0.58) in patients with TLS that underwent RRT compared (95.2%, n=949) to patients that did not undergo RRT (4.8%, n=48). Conclusion Our study shows that TLS is associated with a significant economic burden, with a mean cost of $ 72,840 per TLS hospitalization. Although majority of the patients hospitalized for TLS received RRT, its use was not associated with significantly higher costs. Further studies are warranted to determine the ways of optimizing current preventive measures and to explore the drivers of increased in-hospital costs in TLS patients. Table 1 Mean LOS and Hospital Charge in TLS Admissions Compared with Overall Inpatient Admissions, 2009-2011 Year Mean LOS (days) Mean hospital charge (USD) TLS admissions Overall admissions p TLS admissions Overall admissions p 2009 13.94 4.5 0.02 104,235 30,506 0.04 2010 7.62 4.6 <0.001 69,552 32,799 <0.001 2011 7.14 4.5 <0.001 69,222 35,213 <0.001 LOS=Length of Stay; TLS=Tumor Lysis Syndrome; USD=US Dollars Disclosures No relevant conflicts of interest to declare.

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National Trends for Primary and Revision Lumbar Disc Arthroplasty Throughout the United States

Global Spine Journal ◽

10.1177/2192568217726980 ◽

2017 ◽

Vol 8 (2) ◽

pp. 172-177 ◽

Cited By ~ 4

Author(s):

Comron Saifi ◽

Alejandro Cazzulino ◽

Caroline Park ◽

Joseph Laratta ◽

Philip K. Louie ◽

...

Keyword(s):

United States ◽

Length Of Stay ◽

Lumbar Disc ◽

The United States ◽

Care Utilization ◽

National Inpatient Sample ◽

Disc Arthroplasty ◽

Total Cost ◽

Lumbar Disc Arthroplasty ◽

The Mean

Study Design: Retrospective database study. Objectives: Analysis of economic and demographic data concerning lumbar disc arthroplasty (LDA) throughout the United States to improve value-based care and health care utilization. Methods: The National Inpatient Sample database was queried for patients who underwent primary or revision LDA between 2005 and 2013. Demographic and economic data included total surgeries, costs, length of stay, and frequency of routine discharge. The National Inpatient Sample database represents a 20% sample of discharges from US hospitals weighted to provide national estimates. Results: Primary LDA decreased 86% from 3059 to 420 from 2005 to 2013. The mean total cost of LDA increased 33% from $17 747 to $23 804. The mean length of stay decreased from 2.8 to 2.4 days. The mean routine discharge (home discharge without visiting nursing care) remained constant at 91%. Revision procedures (removal, supplemental fixation, or reoperation at the treated level) declined 30% from 194 to 135 cases over the study period. The mean revision burden, defined as the ratio of revision procedures to the sum of primary and revision procedures, was 12% (range 6% to 24%). The mean total cost of revisions ranged from $12 752 to $22 282. Conclusions: From 2005 to 2013, primary LDA significantly declined in the United States by 86% despite several studies pointing to improved efficacy and cost-efficiency. This disparity may be related to a lack of surgeon reimbursement from insurance companies. Congruently, the number of revision LDA cases has declined 30%, while revision burden has risen from 6% to 24%.

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