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 < 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 3517 Cancer-Related Pain is a Predictor of In-hospital Opioid Overdose among Postoperative patients

2019 ◽  
Vol 3 (s1) ◽  
pp. 36-36
Author(s):  
Nnaemeka E Onyeakusi ◽  
Fahad Mukhtar ◽  
Adebamike Oshunbade ◽  
Semiu Gbadamosi ◽  
Adeyinka Adejumo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Charges ◽  
P Value ◽  
Opioid Overdose ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Patients With Cancer ◽  
Cancer Management ◽  
Cancer Pathogenesis ◽  
Diagnosis Of Cancer

OBJECTIVES/SPECIFIC AIMS: Our study’s primary aim is to determine if there is an association between cancer-related pain among patients who underwent major elective procedures and postoperative opioid overdose. In addition, the relationship between cancer-related pain in this population and inpatient mortality, total hospital charge and length of stay was assessed. METHODS/STUDY POPULATION: Our study sample consisted of adults 18 years and older who had at least one of eight elective procedures. Data was obtained from the National Inpatient Sample (NIS). Variables were identified using ICD-9 codes. Our primary predictor was cancer-related pain while our primary outcome was opioid overdose. Secondary outcomes were inpatient mortality, length of stay and total charge. Propensity-matched regression models were employed in assessing the association between cancer-related pain and outcomes of interest. RESULTS/ANTICIPATED RESULTS: Among 4,085,355 selected patients, 0.8% (n = 2,665) had cancer-related pain while 99.92% (n = 4,082,690) had no diagnosis of cancer-related pain. All subjects with cancer-related pain (n = 2,665) were successfully matched to subjects with no diagnosis of cancer-related pain in a 1:5 ratio yielding 13,325 controls. Patients with cancer-related pain had significantly higher odds of opioid overdose (aOR 4.82 [95% CI [2.68-8.67]; p-value <0.0001) and inpatient mortality (aOR 1.39[1.11-1.74]; p-value 0.0043). Patients with cancer-related pain were also likely to stay significantly longer in the hospital (12.76 days vs. 7.88 days) with significantly higher total hospital charges ($140,220 vs. $88,316). DISCUSSION/SIGNIFICANCE OF IMPACT: Pain is a common complication of cancer pathogenesis, diagnosis or treatment. Though a rare outcome, opioid overdose could lead to undesirable outcomes. Cancer patients undergo invasive diagnostic and therapeutic procedures as part of their cancer management or for conditions not related to their primary cancer diagnosis. Safety measures including alternatives to opioids are recommended to prevent the poor clinical outcomes and higher healthcare utilization indices associated with opioid overdose in this population.

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.

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.

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.

Association of for-profit hospital ownership status with intracranial hemorrhage outcomes and cost of care

2020 ◽  
Vol 133 (6) ◽  
pp. 1939-1947
Author(s):  
Ryan G. Chiu ◽  
Blake E. Murphy ◽  
David M. Rosenberg ◽  
Amy Q. Zhu ◽  
Ankit I. Mehta
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Hospital Charges ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Nonprofit Hospitals ◽  
For Profit ◽  
Ownership Status ◽  
Profit Centers

OBJECTIVEMuch of the current discourse surrounding healthcare reform in the United States revolves around the role of the profit motive in medical care. However, there currently exists a paucity of literature evaluating the effect of for-profit hospital ownership status on neurological and neurosurgical care. The purpose of this study was to compare inpatient mortality, operation rates, length of stay, and hospital charges between private nonprofit and for-profit hospitals in the treatment of intracranial hemorrhage.METHODSThis retrospective cohort study utilized data from the National Inpatient Sample (NIS) database. Primary outcomes, including all-cause inpatient mortality, operative status, patient disposition, hospital length of stay, total hospital charges, and per-day hospital charges, were assessed for patients discharged with a primary diagnosis of intracranial (epidural, subdural, subarachnoid, or intraparenchymal) hemorrhage, while controlling for baseline demographics, comorbidities, and interhospital differences via propensity score matching. Subgroup analyses by hemorrhage type were then performed, using the same methodology.RESULTSOf 155,977 unique hospital discharges included in this study, 133,518 originated from private nonprofit hospitals while the remaining 22,459 were from for-profit hospitals. After propensity score matching, mortality rates were higher in for-profit centers, at 14.50%, compared with 13.31% at nonprofit hospitals (RR 1.09, 95% CI 1.00–1.18; p = 0.040). Surgical operation rates were also similar (25.38% vs 24.42%; RR 0.96, 95% CI 0.91–1.02; p = 0.181). Of note, nonprofit hospitals appeared to be more intensive, with intracranial pressure monitor placement occurring in 2.13% of patients compared with 1.47% in for-profit centers (RR 0.69, 95% CI 0.54–0.88; p < 0.001). Discharge disposition was also similar, except for higher rates of absconding at for-profit hospitals (RR 1.59, 95% CI 1.12–2.27; p = 0.018). Length of stay was greater among for-profit hospitals (mean ± SD: 7.46 ± 11.91 vs 6.50 ± 8.74 days, p < 0.001), as were total hospital charges ($141,141.40 ± $218,364.40 vs $84,863.54 ± $136,874.71 [USD], p < 0.001). These findings remained similar even after segregating patients by subgroup analysis by hemorrhage type.CONCLUSIONSFor-profit hospitals are associated with higher inpatient mortality, lengths of stay, and hospital charges compared with their nonprofit counterparts.

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.

scholarly journals Hospital competition and the expenses for treatments of acute and non-acute common diseases: evidence from China

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chenhui Deng ◽  
Jay Pan
Keyword(s):  
Service Provision ◽  
Elective Surgery ◽  
Financial Burden ◽  
Hospital Charges ◽  
Chinese Government ◽  
Hospital Competition ◽  
Total Hospital ◽  
Discharge Data ◽  
Total Hospital Charge ◽  
Common Diseases

Abstract Background Because there is heterogeneity in disease types, competition among hospitals could be influenced in various ways by service provision for diseases with different characteristics. Limited studies have focused on this matter. This study aims to evaluate and compare the relationships between hospital competition and the expenses of prostatectomies (elective surgery, representing treatments of non-acute common diseases) and appendectomies (emergency surgery, representing treatments of acute common diseases). Methods Multivariable log-linear models were constructed to determine the association between hospital competition and the expenses of prostatectomies and appendectomies. The fixed-radius Herfindahl-Hirschman Index was employed to measure hospital competition. Results We collected data on 13,958 inpatients from the hospital discharge data of Sichuan Province in China from September to December 2016. The data included 3578 prostatectomy patients and 10,380 appendectomy patients. The results showed that greater competition was associated with a lower total hospital charge for prostatectomy (p = 0.006) but a higher charge for appendectomy (p <  0.001). The subcategory analysis showed that greater competition was consistently associated with lower out-of-pocket (OOP) and higher reimbursement for both surgeries. Conclusions Greater competition was significantly associated with lower total hospital charges for prostatectomies, while the opposite was true for appendectomies. Furthermore, greater competition was consistently associated with lower OOP but higher reimbursement for both surgeries. This study provides new evidence concerning the heterogeneous roles of competition in service provision for non-acute and acute common diseases. The findings of this study indicate that the pro-competition policy is a viable option for the Chinese government to relieve patients’ financial burden (OOP). Our findings also provide references and insights for other countries facing similar challenges.

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