Image Guidance for Ventricular Shunt Surgery: An Analysis of Hospital Charges

Neurosurgery ◽  
2019 ◽  
Vol 85 (4) ◽  
pp. E765-E770 ◽  
Author(s):  
Sonia Ajmera ◽  
Mustafa Motiwala ◽  
Nickalus R Khan ◽  
Lydia J Smith ◽  
Kim Giles ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Image Guidance ◽  
De Novo ◽  
Hospital Charges ◽  
Shunt Revision ◽  
Postanesthesia Care Unit ◽  
Shunt Surgery ◽  
Clinical Scenarios ◽  
The Difference ◽  
The Cost

Abstract BACKGROUND Image guidance for shunt surgery results in more accurate proximal catheter placement. However, reduction in shunt failure remains unclear in the literature. There have been no prior studies evaluating the cost effectiveness of neuronavigation for shunt surgery. OBJECTIVE To perform a cost analysis using available hospital charges of hypothetical shunt surgery performed with/without electromagnetic neuronavigation (EMN). METHODS Hospital charges were collected for physician fees, radiology, operating room (OR) time and supplies, postanesthesia care unit, hospitalization days, laboratory, and medications. Index shunt surgery charges (de novo or revision) were totaled and the difference calculated. This difference was compared with hospital charges for shunt revision surgery performed under 2 clinical scenarios: (1) same hospital stay as the index surgery; and (2) readmission through the emergency department. RESULTS Costs for freehand de novo and revision shunt surgery were $23 946.22 and $23 359.22, respectively. For stealth-guided de novo and revision surgery, the costs were $33 646.94 and $33 059.94, a difference of $9700.72. The largest charge increase was due to additional OR time (34 min; $4794), followed by disposable EMN equipment ($2672). Total effective charges to revise the shunt for scenarios 1 and 2 were $34 622.94 and $35 934.94, respectively. The cost ratios between the total revision charges for both scenarios and the difference in freehand vs EMN-assisted shunt surgery ($9700.72) were 3.57 and 3.70, respectively. CONCLUSION From an economic standpoint and within the limitations of our models, the number needed to prevent must be 4 or less for the use of neuronavigation to be considered cost effective.

Commentary: Image Guidance for Ventricular Shunt Surgery: An Analysis of Hospital Charges

Neurosurgery ◽  
2019 ◽  
Vol 85 (4) ◽  
pp. E771-E772
Author(s):  
Michael M McDowell ◽  
Taylor J Abel
Keyword(s):  
Image Guidance ◽  
Hospital Charges ◽  
Shunt Surgery

scholarly journals The Preventable Shunt Revision Rate: a potential quality metric for pediatric shunt surgery

2016 ◽  
Vol 18 (1) ◽  
pp. 7-15 ◽  
Author(s):  
Garrett T. Venable ◽  
Nicholas B. Rossi ◽  
G. Morgan Jones ◽  
Nickalus R. Khan ◽  
Zachary S. Smalley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Operating Room ◽  
Revision Surgery ◽  
Revision Rate ◽  
Catheter Placement ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Shunt Surgery ◽  
Distal Catheter ◽  
Quality Metric

OBJECTIVE Shunt surgery consumes a large amount of pediatric neurosurgical health care resources. Although many studies have sought to identify risk factors for shunt failure, there is no consensus within the literature on variables that are predictive or protective. In this era of “quality outcome measures,” some authors have proposed various metrics to assess quality outcomes for shunt surgery. In this paper, the Preventable Shunt Revision Rate (PSRR) is proposed as a novel quality metric. METHODS An institutional shunt database was queried to identify all shunt surgeries performed from January 1, 2010, to December 31, 2014, at Le Bonheur Children's Hospital. Patients' records were reviewed for 90 days following each “index” shunt surgery to identify those patients who required a return to the operating room. Clinical, demographic, and radiological factors were reviewed for each index operation, and each failure was analyzed for potentially preventable causes. RESULTS During the study period, there were 927 de novo or revision shunt operations in 525 patients. A return to the operating room occurred 202 times within 90 days of shunt surgery in 927 index surgeries (21.8%). In 67 cases (33% of failures), the revision surgery was due to potentially preventable causes, defined as inaccurate proximal or distal catheter placement, infection, or inadequately secured or assembled shunt apparatus. Comparing cases in which failure was due to preventable causes and those in which it was due to nonpreventable causes showed that in cases in which failure was due to preventable causes, the patients were significantly younger (median 3.1 vs 6.7 years, p = 0.01) and the failure was more likely to occur within 30 days of the index surgery (80.6% vs 64.4% of cases, p = 0.02). The most common causes of preventable shunt failure were inaccurate proximal catheter placement (33 [49.3%] of 67 cases) and infection (28 [41.8%] of 67 cases). No variables were found to be predictive of preventable shunt failure with multivariate logistic regression. CONCLUSIONS With economic and governmental pressures to identify and implement “quality measures” for shunt surgery, pediatric neurosurgeons and hospital administrators must be careful to avoid linking all shunt revisions with “poor” or less-than-optimal quality care. To date, many of the purported risk factors for shunt failure and causes of shunt revision surgery are beyond the influence and control of the surgeon. We propose the PSRR as a specific, meaningful, measurable, and—hopefully—modifiable quality metric for shunt surgery in children.

scholarly journals Return to system within 30 days of discharge following pediatric shunt surgery

2014 ◽  
Vol 13 (5) ◽  
pp. 525-531 ◽  
Author(s):  
Joshua J. Chern ◽  
Markus Bookland ◽  
Javier Tejedor-Sojo ◽  
Jonathan Riley ◽  
Mohammadali M. Shoja ◽  
...  
Keyword(s):  
Improve Patient Care ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Neurosurgical Procedures ◽  
Shunt Surgery ◽  
Multivariate Regression Model ◽  
Clinical Events ◽  
Clinical Scenarios ◽  
Shunt Occlusion ◽  
Improve Patient

Object The rate of readmission after CSF shunt surgery is significant and has caught the attention of purchasers of health care. However, a detailed description of clinical scenarios that lead to readmissions and reoperations after index shunt surgery is lacking in the medical literature. Methods This study included 1755 shunt revision and insertion surgeries that were performed at a single institution between May 1, 2009, and April 30, 2013. Demographic, socioeconomic, and clinical characteristics were prospectively collected in the administrative, business, and operating room databases. Clinical events within the 30 days following discharge were reviewed and analyzed. Two events of interest, Emergency Department (ED) utilization and reoperation, were further analyzed for risk factor associations by using multivariate logistic regression. Results There were 290 readmissions within 30 days of discharge (16.5%). Admission sources included ED (n = 216), hospital transfers (n = 23), and others. Of the 290 readmissions, 184 were associated with an operation, but only 165 of these were performed by the neurosurgical service. These included surgeries for shunt occlusion and externalization (n = 150), wound revision (n = 7), and other neurosurgical procedures that were not shunt related (n = 8). The remaining readmissions (n = 106) were not associated with an operation, and only 59 patients were admitted for issues related to the index shunt surgery. When return to the ED was the dependent variable in a multivariate regression model, patients who returned to the ED were more likely to be from the Atlanta metropolitan area and to be either uninsured or insured with public assistance. When reoperation was the dependent variable, patients whose surgery started after 3 p.m. were more likely to undergo subsequent CSF shunt revision surgery on readmission. Conclusions Of the readmissions within 30 days of shunt surgery, 74.5% were related to the index shunt surgery. Whether and to what extent these readmissions are preventable continues to be controversial. Further study is needed to identify modifiable risk factors that may eventually improve patient care.

Letter to the Editor: The Continuing Challenge of Evaluating RSD Impairment and Disability

1998 ◽  
Vol 3 (5) ◽  
pp. 8-10
Author(s):  
Robert L. Knobler ◽  
Charles N. Brooks ◽  
Leon H. Ensalada ◽  
James B. Talmage ◽  
Christopher R. Brigham
Keyword(s):  
Disability Evaluation ◽  
Body Part ◽  
Loss Of Function ◽  
Regulatory Requirements ◽  
Major Cardiac Event ◽  
Clinical Scenarios ◽  
Impairment Score ◽  
Occupational Activities ◽  
The Difference

Abstract The author of the two-part article about evaluating reflex sympathetic dystrophy (RSD) responds to criticisms that a percentage impairment score may not adequately reflect the disability of an individual with RSD. The author highlights the importance of recognizing the difference between impairment and disability in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides): impairment is the loss, loss of use, or derangement of any body part, system, or function; disability is a decrease in or the loss or absence of the capacity to meet personal, social, or occupational demands or to meet statutory or regulatory requirements because of an impairment. The disparity between impairment and disability can be encountered in diverse clinical scenarios. For example, a person's ability to resume occupational activities following a major cardiac event depends on medical, social, and psychological factors, but nonmedical factors appear to present the greatest impediment and many persons do not resume work despite significant improvements in functional capacity. A key requirement according to the AMA Guides is objective documentation, and the author agrees that when physicians consider the disability evaluation of people, more issues than those relating to the percentage loss of function should be considered. More study of the relationships among impairment, disability, and quality of life in patients with RSD are required.

Evaluation of aseptic loosening of knee prostheses by quantitative bone scintigraphy

2008 ◽  
Vol 47 (04) ◽  
pp. 163-166 ◽  
Author(s):  
D. Steiner ◽  
S. Laurich ◽  
R. Bauer ◽  
J. Kordelle ◽  
R. Klett
Keyword(s):  
Aseptic Loosening ◽  
Bone Scintigraphy ◽  
Revision Surgery ◽  
Predictive Value ◽  
Knee Prostheses ◽  
Treatment Regimes ◽  
Golden Standard ◽  
The Difference ◽  
Sensitivity Specificity ◽  
Asymptomatic Control

SummaryIn not infected knee prostheses bone scintigraphy is a possible method to diagnose mechanical loosening, and therefore, to affect treatment regimes in symptomatic patients. However, hitherto studies showed controversial results for the reliability of bone scintigraphy in diagnosing loosened knee prostheses by using asymptomatic control groups. Therefore, the aim of our study was to optimize the interpretation procedure and to evaluate the accuracy using results from revision surgery as standard. Methods: Retrospectively, we were able to examine the tibial component in 31 cemented prostheses. In this prostheses infection was excluded by histological or bacteriological examination during revision surgery. To quantify bone scintigraphy, we used medial and lateral tibial regions with a reference region from the contralateral femur. Results: To differentiate between loosened and intact prostheses we found a threshold of 5.0 for the maximum tibia to femur ratio of the both tibial regions and a threshold of 18% for the difference of the ratio of both tibial regions. Using these thresholds, values of 0.9, 1, 0.85, 1, and 0.94 were calculated for sensitivity, specificity, negative predictive value, positive predictive value, and accuracy, respectively. To get a sensitivity of 1, we found a lower threshold of 3.3 for the maximum tibia to femur ratio. Conclusion: Quantitative bone scintigraphy appears to be a reliable diagnostic tool for aseptic loosening of knee prostheses with thresholds evaluated by revision surgery results being the golden standard.

SELISIH BIAYA PRODUKSI SEBAGAI ALAT PENGENDALIAN MANAJEMEN PT INDO PUSAKA BERAU

2019 ◽  
Vol 3 (02) ◽  
pp. 397
Author(s):  
SAFITRI NURHIDAYATI ◽  
RIZKI AMELYA SYAM
Keyword(s):  
Raw Materials ◽  
Field Research ◽  
Analytical Tool ◽  
Production Costs ◽  
Raw Material ◽  
Labor Costs ◽  
Material Costs ◽  
Library Research ◽  
The Difference ◽  
The Cost

This study aims to analyze whether the difference that occurs in the cost of raw materials, direct labor, and factory overhead costs between the standard costs and the actual costs in PLTU LATI is a difference that is favorable or unfavorable. Data collection techniques with field research and library research. The analytical tool used is the analysis of the difference in raw material costs, the difference in direct labor costs and the difference in factory overhead costs. The hypothesis in this study is that the difference allegedly occurs in the cost of raw materials, direct labor costs, and factory overhead costs at PT Indo Pusaka Berau Tanjung Redeb is a favorable difference. The results showed that the difference in the cost of producing MWh electricity at PT Indo Pusaka Berau Tanjung Redeb in 2018, namely the difference in the price of raw material costs Rp. 548,029.80, - is favorable, the difference in quantity of raw materials is Rp. 957,216,602, - is (favorable) , the difference in direct labor costs Rp 2,602,642,084, - is (unfavorable), and the difference in factory overhead costs Rp 8,807,051,422, - is (favorable) This shows that the difference in the overall production cost budget is favorable or profitable. This beneficial difference shows that the company is really able to reduce production costs optimally in 2018.  

Costs and the cost-effectiveness threshold

2017 ◽  
Author(s):  
Jan Abel Olsen
Keyword(s):  
Societal Perspective ◽  
Threshold Value ◽  
Quality Adjusted Life Year ◽  
Healthcare Sector ◽  
The Difference ◽  
The Cost ◽  
Qaly Threshold ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold ◽  
Quality Adjusted Life

Chapter 19 starts by distinguishing between the two contrasting perspectives that an economic evaluation would take: the healthcare sector perspective versus the societal perspective. The former is considered a ‘narrow analysis’ which includes only the costs accruing within the healthcare sector, while the latter represents a ‘broad analysis’ that accounts for all resource implications in all sectors of the economy. After an investigation into various types of costs, a ‘limited societal perspective’ is suggested to be more appropriate than either of the two ‘extreme perspectives’. The chapter continues with a discussion of the cost per quality-adjusted life year (QALY) threshold and explains the difference between a demand side- versus a supply-side approach to determining a threshold value for a QALY.

Prognostic implication of CT-FFR based functional SYNTAX score in patients with de novo three-vessel disease

2020 ◽  
Author(s):  
Hong Yan Qiao ◽  
Jian Hua Li ◽  
U Joseph Schoepf ◽  
Richard R Bayer ◽  
Fiona C Tinnefeld ◽  
...  
Keyword(s):  
De Novo ◽  
Predictive Accuracy ◽  
Computed Tomographic Angiography ◽  
Syntax Score ◽  
Cardiac Events ◽  
Fractional Flow ◽  
Computed Tomographic ◽  
Flow Reserve ◽  
The Difference ◽  
Functional Syntax

Abstract Aims This study was aimed at investigating whether a machine learning (ML)-based coronary computed tomographic angiography (CCTA) derived fractional flow reserve (CT-FFR) SYNTAX score (SS), ‘Functional SYNTAX score’ (FSSCTA), would predict clinical outcome in patients with three-vessel coronary artery disease (CAD). Methods and results The SS based on CCTA (SSCTA) and ICA (SSICA) were retrospectively collected in 227 consecutive patients with three-vessel CAD. FSSCTA was calculated by combining the anatomical data with functional data derived from a ML-based CT-FFR assessment. The ability of each score system to predict major adverse cardiac events (MACE) was compared. The difference between revascularization strategies directed by the anatomical SS and FSSCTA was also assessed. Two hundred and twenty-seven patients were divided into two groups according to the SSCTA cut-off value of 22. After determining FSSCTA for each patient, 22.9% of patients (52/227) were reclassified to a low-risk group (FSSCTA ≤ 22). In the low- vs. intermediate-to-high (>22) FSSCTA group, MACE occurred in 3.2% (4/125) vs. 34.3% (35/102), respectively (P < 0.001). The independent predictors of MACE were FSSCTA (OR = 1.21, P = 0.001) and diabetes (OR = 2.35, P = 0.048). FSSCTA demonstrated a better predictive accuracy for MACE compared with SSCTA (AUC: 0.81 vs. 0.75, P = 0.01) and SSICA (0.81 vs. 0.75, P < 0.001). After FSSCTA was revealed, 52 patients initially referred for CABG based on SSCTA would have been changed to PCI. Conclusion Recalculating SS by incorporating lesion-specific ischaemia as determined by ML-based CT-FFR is a better predictor of MACE in patients with three-vessel CAD. Additionally, the use of FSSCTA may alter selected revascularization strategies in these patients.

scholarly journals Malpigmentation of Common Sole (Solea solea) during Metamorphosis Is Associated with Differential Synaptic-Related Gene Expression

Animals ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 2273
Author(s):  
Menelaos Kavouras ◽  
Emmanouil E. Malandrakis ◽  
Ewout Blom ◽  
Kyriaki Tsilika ◽  
Theodoros Danis ◽  
...  
Keyword(s):  
Gene Expression ◽  
Nervous System ◽  
De Novo ◽  
Close Association ◽  
Ionic Channels ◽  
Long Term Potentiation ◽  
General Term ◽  
The Difference ◽  
Common Sole

In farmed flatfish, such as common sole, color disturbances are common. Dyschromia is a general term that includes the color defects on the blind and ocular sides of the fish. The purpose was to examine the difference in gene expression between normal pigmented and juveniles who present ambicoloration. The analysis was carried out with next-generation sequencing techniques and de novo assembly of the transcriptome. Transcripts that showed significant differences (FDR < 0.05) in the expression between the two groups, were related to those of zebrafish (Danio rerio), functionally identified, and classified into categories of the gene ontology. The results revealed that ambicolorated juveniles exhibit a divergent function, mainly of the central nervous system at the synaptic level, as well as the ionic channels. The close association of chromophore cells with the growth of nerve cells and the nervous system was recorded. The pathway, glutamate binding–activation of AMPA and NMDA receptors–long-term stimulation of postsynaptic potential–LTP (long term potentiation)–plasticity of synapses, appears to be affected. In addition, the development of synapses also seems to be affected by the interaction of the LGI (leucine-rich glioma inactivated) protein family with the ADAM (a disintegrin and metalloprotease) ones.

The Direct and Indirect Costs of Treating the Victims of the 2016 Nice Terror Attacks in a Single Pediatric Hospital

2021 ◽  
pp. 1-4
Author(s):  
Federico Solla ◽  
Eytan Ellenberg ◽  
Virginie Rampal ◽  
Julien Margaine ◽  
Charles Musoff ◽  
...  
Keyword(s):  
Indirect Costs ◽  
Medical Costs ◽  
Pediatric Hospital ◽  
Terror Attack ◽  
Direct And Indirect Costs ◽  
Terror Attacks ◽  
Direct Medical Costs ◽  
Annual Budget ◽  
The Difference ◽  
The Cost

Abstract Objective: To analyze the cost of the terror attack in Nice in a single pediatric institution. Methods: We carried out descriptive analyses of the data coming from the Lenval University Children’s Hospital of Nice database after the July 14, 2016 terror attack. The medical cost for each patient was estimated from the invoice that the hospital sent to public insurance. The indirect costs were calculated from the hospital’s accounting, as the items that were previously absent or the difference between costs in 2016 versus the previous year. Results: The costs total 1.56 million USD, corresponding to 2% of Lenval Hospital’s 2016 annual budget. Direct medical costs represented 9% of the total cost. The indirect costs were related to human resources (overtime, sick leave), revenue shortfall, and security and psychiatric reinforcement. Conclusion: Indirect costs had a greater impact than did direct medical costs. Examining the level and variety of direct and indirect costs will lead to a better understanding of the consequences of terror acts and to improved preparation for future attacks.

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