Analysis of Cost Variation in Craniotomy for Tumor Using 2 National Databases

Neurosurgery ◽  
2017 ◽  
Vol 81 (6) ◽  
pp. 972-979 ◽  
Author(s):  
Corinna C Zygourakis ◽  
Caterina Y Liu ◽  
Seungwon Yoon ◽  
Christopher Moriates ◽  
Christy Boscardin ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Multivariate Analyses ◽  
Private Insurance ◽  
Western United States ◽  
Teaching Hospitals ◽  
Total Hospital Cost ◽  
Cost Variation ◽  
Hospital Factors ◽  
National Databases

Abstract BACKGROUND There is a significant increase and large variation in craniotomy costs. However, the causes of cost differences in craniotomies remain poorly understood. OBJECTIVE To examine the patient and hospital factors that underlie the cost variation in tumor craniotomies using 2 national databases: the National Inpatient Sample (NIS) and Vizient, Inc. (Irving, Texas). METHODS For 41 483 patients who underwent primary surgery for supratentorial brain tumors from 2001 to 2013 in the NIS, we created univariate and multivariate models to evaluate the effect of several patient factors and hospital factors on total hospital cost. Similarly, we performed multivariate analysis with 15 087 cases in the Vizient 2012 to 2015 database. RESULTS In the NIS, the mean inflation-adjusted cost per tumor craniotomy increased 30%, from $23 021 in 2001 to $29 971 in 2013. In 2001, the highest cost region was the Northeast ($24 486 ± $1184), and by 2013 the western United States was the highest cost region ($36 058 ± $1684). Multivariate analyses with NIS data showed that male gender, white race, private insurance, higher mortality risk, higher severity of illness, longer length of stay, elective admissions, higher wage index, urban teaching hospitals, and hospitals in the western United States were associated with higher tumor craniotomy costs (all P < .05). Multivariate analyses with Vizient data confirmed that longer length of stay and the western United States were significantly associated with higher costs (P < .001). CONCLUSION After controlling for patient/clinical factors, hospital type, bed size, and wage index, hospitals in the western United States had higher costs than those in other parts of the country, based on analyses from 2 separate national databases.

Trends and presentation patterns of acute rheumatic fever hospitalisations in the United States

2019 ◽  
Vol 29 (11) ◽  
pp. 1387-1390
Author(s):  
Tyler Bradley-Hewitt ◽  
Chris T. Longenecker ◽  
Vuyisile Nkomo ◽  
Whitney Osborne ◽  
Craig Sable ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Rheumatic Fever ◽  
Private Insurance ◽  
Case Fatality ◽  
The United States ◽  
Hospital Charges ◽  
The South ◽  
Asian Pacific Islanders ◽  
Asian Pacific

AbstractObjective:Rheumatic fever, an immune sequela of untreated streptococcal infections, is an important contributor to global cardiovascular disease. The goal of this study was to describe trends, characteristics, and cost burden of children discharged from hospitals with a diagnosis of RF from 2000 to 2012 within the United States.Methods:Using the Kids’ Inpatient Database, we examined characteristics of children discharged from hospitals with the diagnosis of rheumatic fever over time including: overall hospitalisation rates, age, gender, race/ethnicity, regional differences, payer type, length of stay, and charges.Results:The estimated national cumulative incidence of rheumatic fever in the United States between 2000 and 2012 was 0.61 cases per 100,000 children. The median age was 10 years, with hospitalisations significantly more common among children aged 6–11 years. Rheumatic fever hospitalisations among Asian/Pacific Islanders were significantly over-represented. The proportion of rheumatic fever hospitalisations was greater in the Northeast and less in the South, although the highest number of rheumatic fever admissions occurred in the South. Expected payer type was more likely to be private insurance, and the median total hospital charges (adjusted for inflation to 2012 dollars) were $16,000 (interquartile range: $8900–31,200). Median length of stay was 3 days, and the case fatality ratio for RF in the United States was 0.4%.Conclusions:Rheumatic fever persists in the United States with an overall downwards trend between 2003 and 2012. Rheumatic fever admissions varied considerably based on age group, region, and origin.

Analysis of National Rates, Cost, and Sources of Cost Variation in Adult Spinal Deformity

Neurosurgery ◽  
2017 ◽  
Vol 82 (3) ◽  
pp. 378-387 ◽  
Author(s):  
Corinna C Zygourakis ◽  
Caterina Y Liu ◽  
Malla Keefe ◽  
Christopher Moriates ◽  
John Ratliff ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Severity Of Illness ◽  
Total Hospital Cost ◽  
Median Income ◽  
Cost Variation ◽  
Time Period ◽  
Spinal Deformity Surgery ◽  
The Mean

Abstract BACKGROUND Several studies suggest significant variation in cost for spine surgery, but there has been little research in this area for spinal deformity. OBJECTIVE To determine the utilization, cost, and factors contributing to cost for spinal deformity surgery. METHODS The cohort comprised 55 599 adults who underwent spinal deformity fusion in the 2001 to 2013 National Inpatient Sample database. Patient variables included age, gender, insurance, median income of zip code, county population, severity of illness, mortality risk, number of comorbidities, length of stay, elective vs nonelective case. Hospital variables included bed size, wage index, hospital type (rural, urban nonteaching, urban teaching), and geographical region. The outcome was total hospital cost for deformity surgery. Statistics included univariate and multivariate regression analyses. RESULTS The number of spinal deformity cases increased from 1803 in 2001 (rate: 4.16 per 100 000 adults) to 6728 in 2013 (rate: 13.9 per 100 000). Utilization of interbody fusion devices increased steadily during this time period, while bone morphogenic protein usage peaked in 2010 and declined thereafter. The mean inflation-adjusted case cost rose from $32 671 to $43 433 over the same time period. Multivariate analyses showed the following patient factors were associated with cost: age, race, insurance, severity of illness, length of stay, and elective admission (P < .01). Hospitals in the western United States and those with higher wage indices or smaller bed sizes were significantly more expensive (P < .05). CONCLUSION The rate of adult spinal deformity surgery and the mean case cost increased from 2001 to 2013, exceeding the rate of inflation. Both patient and hospital factors are important contributors to cost variation for spinal deformity surgery.

scholarly journals The Impact of Winter Months on Patients with Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE), a Retrospective Analysis of Hospital Outcomes in the United States (US) from 1998-2011

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4451-4451
Author(s):  
Danielle Krol ◽  
Parshva Patel ◽  
Konstantine Halkidis ◽  
Gaurav Varma ◽  
Ravindra Sangitha ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
The United States ◽  
Mortality Rates ◽  
Teaching Hospitals ◽  
Hospital Outcomes ◽  
North Central ◽  
Increased Risk ◽  
The Us ◽  
The Impact

Abstract Background: DVT and PE are common complications in hospitalized patients. Many hospitals have implemented EMR-based protocols to identify patients who could benefit from prophylactic anticoagulation, because of the increased morbidity, mortality, and cost associated with thrombotic disease. Several groups have sought to characterize the potential seasonal and winter variation in the incidence of DVT and PE, with several international studies supporting a so called "Winter effect" (Damnjanović et al., Hippokratia 2013); however, no study has demonstrated a "Winter effect" on patients within the US (Stein et al., Am J Cardiol 2004). Objective: (1) To compare mortality rates and length of stay (LOS) in hospitals by month to identify a "Winter effect" in patients diagnosed with either DVT or PE; and (2) characterize other factors that might influence mortality and LOS, using the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Methods: The NIS was queried from 1998-2011. Inclusion criteria were a diagnosis of DVT (ICD-9 453.4X, 453.8X) and/or PE (ICD-9 415.1X) in patients aged 18 years or more. The sample was weighted to approximate the full inpatient population of the United States over the period of interest. Admission data was then analyzed to compare mortality rates over those years by month. Demographics, Charlson Comorbidity Index (CCI), length of stay, hospital region, and admission type (emergent/urgent versus elective admissions) were assessed. Linear and logistic models were generated for complex survey design to assess predictors of mortality and LOS. Results: A total of 1,449,113 DVT/PE cases were identified in the NIS (weighted n = 7,150,613). 54.7% of admission were for females, 56.4% were white, and 49% of admissions were at a teaching facility. Mortality over the 12 months was 6.4% and was noted to be higher in four months: November (6.52%), December (6.9%), January (6.94%), and February (6.93%), as indicated in the graph below. A similar trend was noted on a regional basis with higher mortality noted in winter months for all hospital regions (Northeast, Midwest or North Central, South, and West). No significant trend was noted in DVT/PE hospitalization rates between regions over 12 months (p=0.7674). Mortality in the total cohort was found to be significantly higher in December, OR 1.10 (95% CI: 1.06-1.14), p<0.0001; January, OR 1.11 (95% CI: 1.08-1.15), p<0.0001; and February, OR 1.11 (95% CI: 1.07-1.15), p<0.0001 compared to June (Table 1). Mortality was significantly lower in the Midwest or North Central, OR 0.78 (95% CI: 0.72-0.83), p<0.0001; and West, OR 0.80 (95% CI: 0.73-0.87), p<0.0001 compared to the Northeast. Mortality was also significantly higher in teaching hospitals than in nonteaching hospitals (OR 1.16 [95% CI: 1.10-1.22], p<0.0001), with mortality higher in teaching hospitals in all months. Length of stay was also significantly increased in the winter months. Similar results were noted in the subgroups of patients greater than age 80 or with a CCI score of 2 or more. Conclusion: This national study identified an increased risk of mortality and increased LOS associated with hospitalizations for DVT/PE during the winter months (December, January, and February), supporting the existence of a "Winter effect" on hospital outcomes. Our data differs from previous reports on seasonal variation in DVT/PE in the US because of the database used (Bekkers et al., Clin Orthop Relat Res 2014). Since no regional variation was shown, decreased activity or cold temperature is unlikely to be the cause of this phenomenon. Alternative explanations should be sought. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Demographics, Treatment Outcomes and Resource Utilization Among Patients Hospitalized with Adult Onset Hemophagocytic Lymphohistiocytosis (HLH): A Nationwide Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4784-4784
Author(s):  
Prabhjot Singh Bedi ◽  
Manoj P Rai ◽  
Samanjit Kaur Kandola ◽  
Justin D. Kaner ◽  
Mark Mujer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Board Of Directors ◽  
Resource Utilization ◽  
Research Funding ◽  
Private Insurance ◽  
Charlson Index ◽  
Hospital Charges ◽  
Teaching Hospitals ◽  
Advisory Committees ◽  
Teaching Status

Abstract Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease in which impaired natural killer and cytotoxic T-cell function results in excessive immune activation. It is predominantly seen in children; most of the available data comes from the pediatric population so it cannot be generalized to adult HLH. Treatment of HLH usually involves either treating the underlying cause in the secondary form (i.e. malignancy with chemotherapy, rheumatologic with immune suppression) or chemotherapy and stem cell transplantation for primary, familial etiology, multiple courses of intensive chemotherapy, with stem cell transplantation for relapse and familial disease. Recently, increasing adult HLH cases have been reported. The goal of this study is to describe the association between patient factors, geography, hospital resource utilization, and mortality among adult HLH patients. Methods: We performed a retrospective cohort analysis of the National Inpatient Sample 2012, 2013 and 2014 Databases (HCUP-NIS). Patients were included in the study if they had a principal diagnosis of HLH and were older than 18 years. We used descriptive statistics to characterize the cohort in terms of personal demographic factors (age, race, sex, insurance type, community-level income level), hospital characteristics (size, region, teaching status, and urban or rural location), and admission timing (weekend or weekday). We performed univariate and multivariate regression to analyze the association of the following factors with length of stay and mortality: age, sex, Charlson index, hospital region (Northeast NE, Midwest MW, South, West), income, insurance, hospital size, weekend versus weekday, hospital location (rural versus urban), teaching status. All analyses applied the HCUP-NIS weights. Results: The cohort comprised 760 patients, the majority of whom were male (57.9%), aged 21-30 years (26.3%), white (56.3%), and treated in large (78.9%) and/or teaching (92.1%) hospitals, third quartile for median household income (30.4%), covered by private insurance (43.4%), and treated in the southern US (32.2%). Per hospitalization, the average total hospital charges were $210,526 (95% CI $176,251 to $244,801) and the average length of stay (ALOS) was 18 days (95% CI 16 to 20). On multivariate analysis, ALOS was significantly longer with patients at teaching hospitals (AMD 5.10 95% CI 0.57 to 9.64, p=0.03) or with self-pay status (AMD 29.05 95% CI 21.62 to 36.48, p <0.01). Coverage with private insurance was associated with reduced ALOS (AMD -5.04 95% CI -10.19 to 0.11, p=0.05). Hospital charges was lower with age (AMD -4434 95% CI -7786 to -1082, p=<0.01); however Charlson index increased hospital charges (AMD 33876 95% CI 6043 to 61708, p=0.02). For mortality, age (OR 1.03, 95% CI 1.01-1.05, p=0.002), Charlson index (OR 1.29, 95% CI 1.05-1.57, p=0.013), and Medicaid coverage (OR 0.19, 95% CI 0.049 to 0.698, p=0.013) were statistically significant on univariate analysis, however only age (OR 1.02 95% CI 1.00 to 1.04, p=0.045) was statistically significant on multivariate analysis. Discussion: HLH in adults remains a rare disease which requires prolonged hospitalization and high resource utilization. Receiving care in teaching hospitals increases the length of stay most likely reason is that sicker and more complex patients often end up at teaching hospitals. Private insurance coverage reduced ALOS and self pay increased it. We hypothesize that the shorter ALOS with private insurance is due to increased scrutiny by the insurance provider, while the longer ALOS with self pay is related to difficulties ensuring outpatient follow up. In addition, we hypothesize that the decrease in hospital charges with increasing age may be because of early mortality among these patients. However, further studies are required to investigate the above noted associations. Table. Table. Disclosures Bussel: Rigel: Consultancy, Research Funding; Amgen Inc.: Consultancy, Research Funding; Protalex: Consultancy; Momenta: Consultancy; Novartis: Consultancy, Research Funding; Uptodate: Honoraria; Prophylix: Consultancy, Research Funding. Marks:UPMC: Employment; Heron: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Equity Ownership; Lilly: Membership on an entity's Board of Directors or advisory committees; Odonate: Membership on an entity's Board of Directors or advisory committees.

Abstract 16121: The Decade of Change: Survival Following Out-of-hospital Cardiac Arrest in Teaching versus Nonteaching Hospitals in the United States: 2000-2012

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shaker M Eid ◽  
Aiham Albaeni ◽  
Bolanle Akinyele ◽  
Lekshmi N Raghavakurup ◽  
Nisha Chandra-Strobos
Keyword(s):  
United States ◽  
Length Of Stay ◽  
The United States ◽  
Neurologic Outcome ◽  
Teaching Hospitals ◽  
Dramatic Improvement ◽  
Comorbidity Burden ◽  
Teaching Status ◽  
Good Neurologic Outcome ◽  
Total Charges

Background: All hospitals, regardless of teaching status, need to provide care for OHCA patients. Whether outcomes differ in teaching vs nonteaching hospitals is unknown and was examined in this study. Methods: Using the National Inpatient Sample database, we selected adults ≥18 years old admitted with a principle diagnosis of non-traumatic OHCA (ICD-9 CM codes 427.5 & 427.41) between 2000 and 2012. Patients were stratified to teaching (THs) or nonteaching hospitals (NTHs). The association of hospital teaching status with length of stay, total charges/case, survival to discharge, and survival with good neurologic outcome was assessed by multivariate logistic regression or generalized linear regression models, adjusting for patient and hospital-level characteristics. Results: Of 186,483 admitted patients, 86,053 (46.15%) were treated at teaching hospitals during the study period. Overall OHCA incidence in the United States was 3.86 per 10,000 hospital admissions. Patients at teaching hospitals were more often younger, more likely to have VF, and less likely to be Caucasian [all p < 0.001] but with a similar comorbidity burden. Mean length of stay and total charges were higher in teaching hospitals (5 vs. 4 days, p<0.01 & $72,436 vs. $52,917, p<0.01). Risk-adjusted survival and survival with good neurologic outcome were significantly better in THs as compared to NTHs (odds ratio, 1.06 ; 95% CI 1.02 – 1.14 & 1.19 ; 95% CI 1.09 – 1.29 respectively). Despite a significant increase in OHCA survival at NTHs between 2000 and 2012 ( P trend <0.01), OHCA survival rate at THs remained higher without any change in trend ( P trend =0.07) during the study period. Conclusion: For OHCA patients in the US, survival has been consistently higher in teaching hospitals. However, a dramatic improvement in survival has been realized in nonteaching hospitals over the last 12 years with lesser healthcare expenditure when compared to teaching hospitals; this phenomenon is worthy of further study.

Impact of insurance type on national variation in cost of endovascular treatment for unruptured cerebral aneurysms

2020 ◽  
pp. neurintsurg-2020-016676
Author(s):  
Matthews Lan ◽  
Campbell Liles ◽  
Pious D Patel ◽  
Stephen R Gannon ◽  
Rohan V Chitale
Keyword(s):  
Multivariate Analysis ◽  
Length Of Stay ◽  
Endovascular Treatment ◽  
Private Insurance ◽  
Cerebral Aneurysms ◽  
Median Cost ◽  
Cost Variation ◽  
Insurance Type ◽  
Significant Difference ◽  
Unruptured Cerebral Aneurysms

BackgroundIdentifying drivers of nationwide variation in healthcare costs could help reduce overall cost. Endovascular treatment for unruptured cerebral aneurysms (ETUCR) is an elective neurointerventional procedure that allows for detailed analysis of cost variation. This study aimed to investigate the role of insurance type in cost variation of ETUCR.MethodsA retrospective analysis of patients undergoing ETUCR was done. Demographic and hospital data were obtained from the National Inpatient Sample 2012–2015. Multivariate analysis was done using a generalized linear model. Oaxaca–Blinder decomposition was performed to identify factors driving cost variation.ResultsThere was a significant difference in median cost ($25 331.82 vs $25 825.25, respectively, P<0.001) as well as length of stay (P<0.001) and complications (P<0.001) between patients with private insurance and Medicare. In multivariate analysis, insurance type was not predictive of increased cost. Among patients aged 65–75 years there was a higher median cost with private insurance compared to Medicare ($28 373.85 vs $25 558.25, respectively, P<0.001) but no difference in complications or length of stay. Oaxaca–Blinder decomposition showed higher marginal costs associated with private insurance patients at hospitals with greater endovascular operative volume (P=0.015).ConclusionsIn patients aged 65–75 years, private insurance is associated with higher costs compared to Medicare; however, insurance type is not predictive of increased cost in multivariate analysis. Differential treatment of private insurance and Medicare patients at hospitals with greater operative volume seems to influence this difference, likely due to differential reimbursement schemes that lead to weaker cost controls.

scholarly journals A nationwide analysis of 16 year trends in cardiac transplantation for cardiac sarcoidosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Isath ◽  
S Perembeti ◽  
A Correa ◽  
A Chahal ◽  
D Padmanabhan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Heart Transplant ◽  
Cardiac Transplantation ◽  
Cardiac Sarcoidosis ◽  
Average Length ◽  
Private Insurance ◽  
The United States ◽  
Teaching Hospitals ◽  
Cardiac Transplant ◽  
The Mean

Abstract Background Orthotopic heart transplant (OHT) is indicated for end-stage heart failure due to cardiac sarcoidosis (CS). However, utilization of OHT for CS has been controversial due to concern for involvement of other organs by sarcoidosis affecting long term outcomes. Purpose Our objective was to study the trends in OHT in patients with CS in the United States using Healthcare Cost and Utilization Project (HCUP) National (nationwide) Inpatient Sample (NIS) from 1999 to 2014. Methods Using NIS data, we identified patients older than 18 years with cardiac sarcoidosis using codes ICD 9-CM codes of 135 and 425.8. Among these patients, we identified those who underwent cardiac transplantation using ICD 9-CM procedure codes 37.5 and 33.6. We presented categorical data as percentages and continuous data as mean or median as appropriate. Results A weighted total of 24231 hospitalizations for CS was extracted from 1999 to 2014 of which 248 (1.02%) CS patients underwent OHT. The trends in cardiac transplant for CS is as shown in Figure 1. The mean age of CS patients undergoing OHT was 51.7±1.1 years and 60.4% (n=150) were males. 114 (45.9%) were Caucasians and 27.8% (n=25) were African-American. 100% of the transplants were performed at medium (n=5) or large sized (n=243) teaching hospitals and 97.9% of cardiac transplants were also done at teaching hospitals. Heart transplants were mostly done in the South (36.3%) followed by Midwest (26.2%), West (25%) and Northeast (12.5%). Private insurance was the major payor source which covered 149 (60.1%) patients followed by Medicare covering 65 (26.2%) patients. A total of 10 (3.9%) cardiac sarcoidosis patients died during the same hospitalization for cardiac transplantation. Following OHT, 84.2% (n=209) were discharged home and 11.6% (n=29) to short term hospitalization. The mean cost of hospitalization for OHT in CS when adjusted for inflation was 535144±56060 dollars while the average length of stay for heart transplant for CS was 46.2±6.6 days. Conclusions Cardiac transplant trends in CS have not changed from 1999 to 2014 despite recent studies showing improved outcomes and are associated with substantial cost of hospitalization and length of stay. Majority of cardiac transplant was done in Caucasians despite cardiac sarcoidosis being more common in African-Americans. Funding Acknowledgement Type of funding source: None

Writing Time in Metaphors

2018 ◽  
Author(s):  
Jennifer J. Smith
Keyword(s):  
United States ◽  
The United States ◽  
Western United States ◽  
Entire System ◽  
Language And Culture ◽  
Space Race ◽  
Do So

Coherence of place often exists alongside irregularities in time in cycles, and chapter three turns to cycles linked by temporal markers. Ray Bradbury’s The Martian Chronicles (1950) follows a linear chronology and describes the exploration, conquest, and repopulation of Mars by humans. Conversely, Louise Erdrich’s Love Medicine (1984) jumps back and forth across time to narrate the lives of interconnected families in the western United States. Bradbury’s cycle invokes a confluence of historical forces—time as value-laden, work as a calling, and travel as necessitating standardized time—and contextualizes them in relation to anxieties about the space race. Erdrich’s cycle invokes broader, oppositional conceptions of time—as recursive and arbitrary and as causal and meaningful—to depict time as implicated in an entire system of measurement that made possible the destruction and exploitation of the Chippewa people. Both volumes understand the United States to be preoccupied with imperialist impulses. Even as they critique such projects, they also point to the tenacity with which individuals encounter these systems, and they do so by creating “interstitial temporalities,” which allow them to navigate time at the crossroads of language and culture.

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