Hospital Costs and Severity of Illness in Three Types of Elective Surgery

1997 ◽  
Vol 41 (6) ◽  
pp. 334
Author(s):  
ALEX MACARIO ◽  
TERRY S. VITEZ ◽  
BRIAN DUNN ◽  
TOM MCDONALD ◽  
BYRON BROWN ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Hospital Costs ◽  
Severity Of Illness

Hospital Costs and Severity of Illness in Three Types of Elective Surgery

1997 ◽  
Vol 86 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Alex Macario ◽  
Terry S. Vitez ◽  
Brian Dunn ◽  
Tom McDonald ◽  
Byron Brown
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Operating Room ◽  
Knee Replacement ◽  
Charlson Comorbidity Index ◽  
Elective Surgery ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Total Hospital ◽  
Comorbidity Index

Background If patients who are more severely ill have greater hospital costs for surgery, then health-care reimbursements need to be adjusted appropriately so that providers caring for more seriously ill patients are not penalized for incurring higher costs. The authors' goal for this study was to determine if severity of illness, as measured by either the American Society of Anesthesiologists Physical Status (ASA PS) or the comorbidity index developed by Charlson, can predict anesthesia costs, operating room costs, total hospital costs, or length of stay for elective surgery. Methods The authors randomly selected 224 inpatients (60% sampling fraction) having either colectomy (n = 30), total knee replacement (n = 100), or laparoscopic cholecystectomy (n = 94) from September 1993 to September 1994. For each surgical procedure, backward-elimination multiple regression was used to build models to predict (1) total hospital costs, (2) operating room costs, (3) anesthesia costs, and (4) length of stay. Explanatory candidate variables included patient age (years), sex, ASA PS, Charlson comorbidity index (which weighs the number and seriousness of coexisting diseases), and type of insurance (Medicare/Medicaid, managed care, or indemnity). These analyses were repeated for the pooled data of all 224 patients. Costs (not patient charges) were obtained from the hospital cost accounting software. Results Mean total hospital costs were $3,778 (95% confidence interval +/- 299) for laparoscopic cholecystectomy, $13,614 (95% CI +/- 3,019) for colectomy, and $18,788 (95% CI +/- 573) for knee replacement. The correlation (r) between ASA PS and Charlson comorbidity scores equaled 0.34 (P < .001). No consistent relation was found between hospital costs and either of the two severity-of-illness indices. The Charlson comorbidity index (but not the ASA PS) predicted hospital costs only for knee replacement (P = .003). The ASA PS, but not the Charlson index, predicted operating room and anesthesia costs only for colectomy (P < .03). Conclusions Severity of illness, as categorized by ASA PS categories 1-3 or by the Charlson comorbidity index, was not a consistent predictor of hospital costs and lengths of stay for three types of elective surgery. Hospital resources for these lower-risk elective procedures may be expended primarily to manage the consequences of the surgical disease, rather than to manage the patient's coexisting diseases.

scholarly journals Economic Impact of Ventilator-Associated Pneumonia in a Large Matched Cohort

2012 ◽  
Vol 33 (3) ◽  
pp. 250-256 ◽  
Author(s):  
Marin H. Kollef ◽  
Cindy W. Hamilton ◽  
Frank R. Ernst
Keyword(s):  
Mechanical Ventilation ◽  
Economic Impact ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Cost Effective ◽  
The United States ◽  
Absolute Difference ◽  
Ventilator Associated Pneumonia ◽  
Matched Cohort ◽  
Hospitalization Costs

Objective.To evaluate the economic impact of ventilator-associated pneumonia (VAP) on length of stay and hospital costs.Design.Retrospective matched cohort study.Setting.Premier database of hospitals in the United States.Patients.Eligible patients were admitted to intensive care units (ICUs), received mechanical ventilation for ≥2 calendar-days, and were discharged between October 1, 2008, and December 31, 2009.Methods.VAP was defined by International Classification of Diseases, Ninth Revision (ICD-9), code 997.31 and ventilation charges for ≥2 calendar-days. We matched patients with VAP to patients without VAP by propensity score on the basis of demographics, administrative data, and severity of illness. Cost was based on provider perspective and procedural cost accounting methods.Results.Of 88,689 eligible patients, 2,238 (2.5%) had VAP; the incidence rate was 1.27 per 1,000 ventilation-days. In the matched cohort, patients with VAP (n = 2,144) had longer mean durations of mechanical ventilation (21.8 vs 10.3 days), ICU stay (20.5 vs 11.6 days), and hospitalization (32.6 vs 19.5 days; all P< .0001) than patients without VAP (n = 2,144). Mean hospitalization costs were $99,598 for patients with VAP and $59,770 for patients without VAP (P< .0001), resulting in an absolute difference of $39,828. Patients with VAP had a lower in-hospital mortality rate than patients without VAP (482/2,144 [22.5%] vs 630/2,144 [29.4%]; P<.0001).Conclusions.Our findings suggest that VAP continues to occur as defined by the new specific ICD-9 code and is associated with a statistically significant resource utilization burden, which underscores the need for cost-effective interventions to minimize the occurrence of this complication.Infect Control Hosp Epidemiol 2012;33(3):250-256

scholarly journals Severity of illness in the case-mix specification and performance: A study for Italian public hospitals

2013 ◽  
Vol 3 (1) ◽  
pp. 23
Author(s):  
Pinto Claudio
Keyword(s):  
Public Health ◽  
Technical Efficiency ◽  
Statistical Tests ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Public Hospitals ◽  
Case Mix ◽  
Local Health ◽  
Case Mix Index ◽  
Use Of Resources

Background: Public hospitals’ expenditures in Italy is approximately 45% of total public health financing. The reduction of public debt requires reducing total public health, as well as hospital expenditures in the public sector. Past health reforms introduced rules to improve the efficiency in controlling hospital costs with a better use of resources. The objective of this study is to derive technical efficiency as a performance measurement in the directly managed public hospitals in Italy under different case-mix specifications, as well as to discover the effect of it on technical efficiency. Methods: Two different Data Envelopment Analysis (DEA) models are solved. To control for the influence of the case-mix complexity/severity of illness on technical efficiency, the distributions of DEA efficiency scores are compared applying statistical tests developed in the non-parametric efficiency analysis. Results: On average, in the year 2007, the technical efficiency in the sample is lower (0.8071) in model B (output mix with weighted Case Mix Index) than in model A (0.8748). The bootstrap-corrected efficiency scores of models B and A are respectively 0.7185 and 0.8106. On average, the case mix index in the sample is 0.87859. Statistical tests confirm that the differences in the efficiency scores distribution are statistically significant, confirming that treatment complexity has influenced technical efficiency. At the individual hospital level, the effect is more evident, modifying the rank and the technical efficiency of the hospitals. Conclusions: The different case-mix specifications adjusted with Case Mix Index, generate statistically significant differences in the distribution of the efficiency scores. This evidence permits us to conclude that the performance of the Local Health Trust’s directly managed public Italian hospitals is influenced by the hospitals’ case-mix severity/complexity. As a policy indication, we can observe that the need for policy makers and hospital managers to reduce hospital costs conflicts with the need to guarantee an optimum level of hospital resources with different case-mix complexities of the treated cases.

scholarly journals The Cost of Ignoring Acute Cholecystectomy

2009 ◽  
Vol 91 (1) ◽  
pp. 39-42 ◽  
Author(s):  
JP Garner ◽  
SK Sood ◽  
J Robinson ◽  
W Barber ◽  
K Ravi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Elective Surgery ◽  
Waiting Times ◽  
Hospital Costs ◽  
Cost Savings ◽  
The Uk ◽  
Elective Cholecystectomy ◽  
First Admission

INTRODUCTION Biliary symptoms whilst awaiting elective cholecystectomy are common, resulting in hospital admission, further investigation and increased hospital costs. Immediate cholecystectomy during the first admission is safe and effective, even when performed laparoscopically, but acute laparoscopic cholecystectomy has only recently become increasingly commonplace in the UK. This study was designed to quantify this problem in our hospital and its cost implications. PATIENTS AND METHODS The case notes of all patients undergoing laparoscopic cholecystectomy in our hospital between January 2004 and June 2005 were examined for details of hospital admissions with biliary symptoms or complications whilst waiting for elective cholecystectomy. Additional bed occupancy and radiological investigations were recorded and these costs to the trust calculated. We compared the potential tariff income to the hospital trust for the actual management of these patients and if a policy of acute laparoscopic cholecystectomy on first admission were in place. RESULTS In the 18-month study period, 259 patients (202 females) underwent laparoscopic cholecystectomy. Of these, 147 presented as out-patients and only 11% required hospital admission because of biliary symptoms whilst waiting for elective surgery. There were 112 patients who initially presented acutely and were managed conservatively. Twenty-four patients were re-admitted 37 times, which utilised 231 hospital bed-days and repeat investigations costing over £40,000. There would have been a marginal increase in tariff income if a policy of acute laparoscopic cholecystectomy had been in place. CONCLUSIONS Adoption of a policy of acute laparoscopic cholecystectomy on the index admission would result in substantial cost savings to the trust, reduce elective cholecystectomy waiting times and increase tariff income.

scholarly journals Immunonutrition for patients undergoing elective surgery for gastrointestinal cancer: impact on hospital costs

2012 ◽  
Vol 10 (1) ◽  
Author(s):  
Josephine A Mauskopf ◽  
Sean D Candrilli ◽  
Hélène Chevrou-Séverac ◽  
Juan B Ochoa
Keyword(s):  
Gastrointestinal Cancer ◽  
Elective Surgery ◽  
Hospital Costs

scholarly journals The Impact of Fluid Balances in the First 48 Hours on Mortality in the Critically Ill Patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Azrina Md Ralib ◽  
Norhalini Hamzah ◽  
Majdiah Syahirah Nasir ◽  
Mohd Basri Mat Nor
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Elective Surgery ◽  
Secondary Analysis ◽  
Severity Of Illness ◽  
Apache Ii Score ◽  
Positive Fluid Balance ◽  
The Impact ◽  
Cumulative Fluid Balance

Introduction: There has been increasing evidence of detrimental effects of cumulative positive fluid balance in critically ill patients. The postulated mechanism of harm is the development of interstitial oedema, with resultant increase morbidity and mortality. We aim to assess the impact of positive fluid balance within the first 48 hours on mortality in our local ICU population. Methods: This was a secondary analysis of a single centre, prospective observational study. All ICU patients more than 18 years were screened for inclusion in the study. Admission of less than 48 hours, post-elective surgery and ICU readmission were excluded. Cumulative fluid balance either as volume or percentage of body weight from admission was calculated over 6, 24 and 48 hour period from ICU admission. Results: A total of 143 patients were recruited, of these 33 died. There were higher cumulative fluid balances at 6, 24 and 48 hours in nonsurvivors compared to survivors. However, after adjusted for severity of illness, APACHE II Score, they were not predictive of mortality. Sensitivity analysis on sub-cohort of patients with acute kidney injury (AKI) showed only an actual 48-hour cumulative fluid balance was independently predictive of mortality (1.21 (1.03 to 1.42)). Conclusions: Cumulative fluid balance was not independently predictive of mortality in a heterogenous group of critically ill patients. However, in subcohort of patients with AKI, a 48-hour cumulative fluid balance was independently predictive of mortality. An additional tile is thus added to the mosaic of findings on the impact of fluid balance in a hetergenous group of critically ill patients, and in subcohort of AKI patients.

153 Cost of Hospitalization in Infants with Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia in a Quebec Tertiary Neonatal Intensive Care Unit and Validation of the Canadian Neonatal Network Costing Algorithm

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e105-e107
Author(s):  
Wijdan Basfar ◽  
Elias Jabbour
Keyword(s):  
Hospital Stay ◽  
Therapeutic Hypothermia ◽  
Neonatal Intensive Care ◽  
Pearson Correlation ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Hypoxic Ischemic Encephalopathy ◽  
Perinatal Medicine ◽  
Significant Difference ◽  
Ischemic Encephalopathy

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Therapeutic hypothermia (TH) is the standard treatment for neonatal hypoxic ischemic encephalopathy (HIE) to improve mortality and long-term impairment. Accurate costing algorithms are essential to evaluate cost-effective interventions and identify cost drivers. Objectives We aimed to validate the Canadian Neonatal Network (CNN) costing algorithm for HIE infants treated with TH against costs obtained from hospital-based finance software (CPSS) and compare the costs of TH for infants with mild/moderate to those with severe HIE. We aimed to validate the Canadian Neonatal Network (CNN) costing algorithm for HIE infants treated with TH against costs obtained from hospital-based finance software (CPSS) and compare the costs of TH for infants with mild/moderate to those with severe HIE. Design/Methods Retrospective cohort study including 98 infants admitted with HIE and receiving TH in a tertiary NICU between 2016 and 2018. Clinical characteristics and CNN costing data were collected from the local CNN database and actual cost were obtained from CPSS. The primary outcome was the difference in total hospital stay cost between CNN algorithm and CPSS. The differences between both algorithms were also identified in 8 different cost centres such as nursing, respiratory, imaging, etc. Costs per patients using both algorithms were compared using Pearson correlation coefficient (r) and paired t-test. Characteristics and costs per infant were compared between infants with mild/moderate HIE and those with severe HIE. Results Among the 98 patients with HIE that received TH, 2 (2%) had mild HIE, 75 (77%) had moderate HIE and 21 (21%) had severe HIE on admission. Mortality rate was 10% (10/98) and median length of stay was 12 days [IQR 10-16]. Total mean cost per infant using the CNN algorithm was $32,727 (SD $23,751 and correlated highly to the CPSS mean $28.373(SD $28.989) (r=0.93, p&lt;0.01). There was no significant difference in mean total costs estimated between the algorithms ($1051, 95% CI $-1073, $3174). There was a strong correlation between cost estimates using the CNN algorithm and CPSS in nursing, physician, transfusion and indirect costs (r range 0.94-0.99) (Figure 1). Mean daily costs per infant with mild/moderate HIE ($1579, SD 808) were lower compared to infants with severe HIE ($2069, SD 1518). In both groups, daily costs were higher in the first days of hospitalization and slightly decreased over time (Figure 2). Conclusion The CNN algorithm accurately predicts hospital stay costs for infants diagnosed with HIE and received TH in our centre. Severity of encephalopathy and severity of illness are associated with higher hospital costs.

scholarly journals Impact of the SARS-CoV-2 (COVID19) pandemic on the morbidity and mortality of high risk patients undergoing surgery: a non-inferiority retrospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marta Caballero-Milán ◽  
Maria J. Colomina ◽  
Leo A. Marin-Carcey ◽  
Laura Viguera-Fernandez ◽  
Roser Bayona-Domenge ◽  
...  
Keyword(s):  
Observational Study ◽  
Severity Score ◽  
Elective Surgery ◽  
Diagnosis Related Groups ◽  
Severity Of Illness ◽  
Retrospective Observational Study ◽  
High Acuity ◽  
Specific Care ◽  
The Impact ◽  
Grade Iii

Abstract Background During the COVID-19 crisis it was necessary to generate a specific care network and reconvert operating rooms to attend emergency and high-acuity patients undergoing complex surgery. The aim of this study is to classify postoperative complications and mortality and to assess the impact that the COVID-19 pandemic may have had on the results. Methods this is a non-inferiority retrospective observational study. Two different groups of surgical patients were created: Pre-pandemic COVID and Pandemic COVID. Severity of illness was rated according to the Diagnosis-related Groups (DRG) score. Comparisons were made between groups and between DRG severity score-matched samples. Non-inferiority was set at up to 10 % difference for grade III to V complications according to the Clavien-Dindo classification, and up to 2 % difference in mortality. Results A total of 1649 patients in the PreCOVID group and 763 patients in the COVID group were analysed; 371 patients were matched for DRG severity score 3-4 (236 preCOVID and 135 COVID). No differences were found in relation to re-operation (22.5 % vs. 21.5 %) or late admission to critical care unit (5.1 % vs. 4.5 %). Clavien grade III to V complications occurred in 107 patients (45.3 %) in the PreCOVID group and in 56 patients (41.5 %) in the COVID group, and mortality was 12.7 % and 12.6 %, respectively. During the pandemic, 3 % of patients tested positive for Covid-19 on PCR: 12 patients undergoing elective surgery and 11 emergency surgery; there were 5 deaths, 3 of which were due to respiratory failure following Covid-19-induced pneumonia. Conclusions Although this study has some limitations, it has shown the non-inferiority of surgical outcomes during the COVID pandemic, and indicates that resuming elective surgery is safe. Trial registration Clinicaltrials.gov identifier: NCT04780594.

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