Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures

2018 ◽  
Vol 128 (5) ◽  
pp. 880-890 ◽  
Author(s):  
Atul Gupta ◽  
Junaid Nizamuddin ◽  
Dalia Elmofty ◽  
Sarah L. Nizamuddin ◽  
Avery Tung ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Operating Room ◽  
Healthcare Utilization ◽  
Cohort Analysis ◽  
Hospital Costs ◽  
Hospital Length ◽  
Opioid Abuse ◽  
Hospital Length Of Stay ◽  
Opioid Overdose ◽  
Readmission Rates

Abstract Background Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. Methods A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Results Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Conclusions Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.

Impact of Frailty on Outcomes Following Spine Surgery: A Prospective Cohort Analysis of 668 Patients

Neurosurgery ◽  
2020 ◽  
Author(s):  
Nitin Agarwal ◽  
Ezequiel Goldschmidt ◽  
Tavis Taylor ◽  
Souvik Roy ◽  
Stefanie C Altieri Dunn ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spine Surgery ◽  
Cohort Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Quality Improvement Initiative ◽  
Exact Test ◽  
Frail Patients ◽  
Increased Risk ◽  
Venous Thromboembolic

Abstract BACKGROUND With an aging population, elderly patients with multiple comorbidities are more frequently undergoing spine surgery and may be at increased risk for complications. Objective measurement of frailty may predict the incidence of postoperative adverse events. OBJECTIVE To investigate the associations between preoperative frailty and postoperative spine surgery outcomes including mortality, length of stay, readmission, surgical site infection, and venous thromboembolic disease. METHODS As part of a system-wide quality improvement initiative, frailty assessment was added to the routine assessment of patients considering spine surgery beginning in July 2016. Frailty was assessed with the Risk Analysis Index (RAI), and patients were categorized as nonfrail (RAI 0-29) or prefrail/frail (RAI ≥ 30). Comparisons between nonfrail and prefrail/frail patients were analyzed using Fisher's exact test for categorical data or by Wilcoxon rank sum tests for continuous data. RESULTS From August 2016 through September 2018, 668 patients (age of 59.5 ± 13.3 yr) had a preoperative RAI score recorded and underwent scheduled spine surgery. Prefrail and frail patients suffered comparatively higher rates of mortality at 90 d (1.9% vs 0.2%, P < .05) and 1 yr (5.1% vs 1.2%, P < .01) from the procedure date. They also had longer in-hospital length of stay (LOS) (3.9 d ± 3.6 vs 3.1 d ± 2.8, P < .001) and higher rates of 60 d (14.6% vs 8.2%, P < .05) and 90 d (15.8% vs 9.8%, P < .05) readmissions. CONCLUSION Preoperative frailty, as measured by the RAI, was associated with an increased risk of readmission and 90-d and 1-yr mortality following spine surgery. The RAI can be used to stratify spine patients and inform preoperative surgical decision making.

Surgical Site Infection After Pediatric Cardiothoracic Surgery

2016 ◽  
Vol 8 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Anthony A. Sochet ◽  
Alexander M. Cartron ◽  
Aoibhinn Nyhan ◽  
Michael C. Spaeder ◽  
Xiaoyan Song ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Heart Surgery ◽  
Hospital Costs ◽  
Congenital Heart Surgery ◽  
Hospital Length ◽  
Cardiothoracic Surgery ◽  
Hospital Length Of Stay ◽  
Published Data ◽  
Site Infection

Background: Surgical site infection (SSI) occurs in 0.25% to 6% of children after cardiothoracic surgery (CTS). There are no published data regarding the financial impact of SSI after pediatric CTS. We sought to determine the attributable hospital cost and length of stay associated with SSI in children after CTS. Methods: We performed a retrospective, matched cohort study in a 26-bed cardiac intensive care unit (CICU) from January 2010 through December 2013. Cases with SSI were identified retrospectively and individually matched to controls 2:1 by age, gender, Risk Adjustment for Congenital Heart Surgery score, Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery category, and primary cardiac diagnosis and procedure. Results: Of the 981 cases performed during the study period, 12 with SSI were identified. There were no differences in demographics, clinical characteristics, or intraoperative data. Median total hospital costs were higher in participants with SSI as compared to controls (US$219,573 vs US$82,623, P < .01). Children with SSI had longer median CICU length of stay (9 vs 3 days, P < .01), hospital length of stay (18 vs 8.5 days, P < .01), and duration of mechanical ventilation (2 vs 1 day, P < .01) and vasoactive administration (4.5 vs 1 day, P < .01). Conclusions: Children with SSI after CTS have an associated increase in hospital costs of US$136,950/case and hospital length of stay of 9.5 days/case. The economic burden posed by SSI stress the importance of infection control surveillance, exhaustive preventative measures, and identification of modifiable risk factors.

The Impact of an Enhanced Recovery After Surgery Program on Patients Treated for Gynecologic Cancer in the Community Hospital Setting

2018 ◽  
Vol 28 (3) ◽  
pp. 581-585 ◽  
Author(s):  
Alberto A. Mendivil ◽  
Justin R. Busch ◽  
David C. Richards ◽  
Heather Vittori ◽  
Bram H. Goldstein
Keyword(s):  
Enhanced Recovery ◽  
Gynecologic Oncology ◽  
Hospital Costs ◽  
Hospital Setting ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Readmission Rates ◽  
Historical Cohort ◽  
Eras Protocol ◽  
The Impact

ObjectivesThe purpose of this study was to compare the outcomes of gynecologic oncology patients treated in the community hospital setting either under the auspices of an enhanced recovery after surgery (ERAS) protocol or in accordance with physician discretion.MethodsWe retrospectively evaluated a series of consecutive gynecologic oncology patients who were managed via open surgery in coincident with an ERAS pathway from January 2015 to December 2016. They were compared with a historical open surgery cohort who was treated from November 2013 to December 2014. The primary clinical end points encompassed hospital length of stay, hospital costs, and patient readmission rates.ResultsThere were 86 subjects accrued in the ERAS group and 91 patients in the historical cohort. The implementation of ERAS occasioned a greater than 3-day mean reduction in hospital stay (8.04 days for the historical group vs 4.88 days for the ERAS subjects; P = 0.001) and correspondingly diminished hospital costs ($11,877.47/patient vs $9305.26/patient; P = 0.04). Moreover, there were 2 readmissions (2.3%) in the ERAS group compared with 4 (4.4%) in the historical cohort (P = 0.282).ConclusionsThe results from our investigation suggest that adhering to an ERAS protocol confers beneficial hospital length of stay and hospital cost outcomes, without compromising patient readmission rates. Additional investigation scrutinizing the impact of ERAS enactment with more defined study variables in a larger, randomized setting is warranted.

ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta-analysis

2021 ◽  
pp. 019459982110196
Author(s):  
Kevin Chorath ◽  
Neil Luu ◽  
Beatrice C. Go ◽  
Alvaro Moreira ◽  
Karthik Rajasekaran
Keyword(s):  
Length Of Stay ◽  
Odds Ratio ◽  
Perioperative Management ◽  
Meta Analysis ◽  
Hospital Costs ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Parathyroid Surgery ◽  
Inclusion Criteria

Objective Enhanced recovery after surgery (ERAS) protocols are evidenced-based multidisciplinary programs implemented in the perioperative setting to improve postoperative recovery and attenuate the surgical stress response. However, evidence on their effectiveness in thyroid and parathyroid surgery remains sparse. Therefore, our goal was to investigate the clinical benefits and cost-effectiveness of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. Data Source A systematic review of Medline, Scopus, Embase, and gray literature was performed to identify studies of ERAS or clinical care protocols for thyroidectomy and parathyroidectomy. Review Methods Two reviewers screened studies using predetermined inclusion criteria. Our primary outcomes included hospital length of stay and hospital costs. Readmission and postoperative complication rates composed our secondary outcomes. Meta-analysis was performed to compare outcomes for patients enrolled in the ERAS protocol versus standard of care. Results A total of 450 articles were identified; 7 (1.6%) met inclusion criteria with a total of 3082 patients. Perioperative components in ERAS protocols varied across the studies. Nevertheless, patients enrolled in ERAS protocols had reduced hospital length of stay (mean difference, –0.64 days [95% CI, −0.92 to −0.37]) and hospital costs (in US dollars; mean difference, –307.70 [95% CI, −346.49 to −268.90]), without an increase in readmission (odds ratio, 0.75 [95% CI, 0.29-1.94]) or complication rates (odds ratio, 1.14 [95% CI, 0.82-1.57]). Conclusion There is growing literature supporting the role of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. These protocols significantly reduce hospital length of stay and costs without increasing complications or readmission rates.

scholarly journals Delirium and Associated Length of Stay and Costs in Critically Ill Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Claudia Dziegielewski ◽  
Charlenn Skead ◽  
Toros Canturk ◽  
Colleen Webber ◽  
Shannon M. Fernando ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Hospital Costs ◽  
Hospital Length ◽  
Mean Difference ◽  
Hospital Length Of Stay ◽  
The Mean ◽  
The Impact

Purpose. Delirium frequently affects critically ill patients in the intensive care unit (ICU). The purpose of this study is to evaluate the impact of delirium on ICU and hospital length of stay (LOS) and perform a cost analysis. Materials and Methods. Prospective studies and randomized controlled trials of patients in the ICU with delirium published between January 1, 2015, and December 31, 2020, were evaluated. Outcome variables including ICU and hospital LOS were obtained, and ICU and hospital costs were derived from the respective LOS. Results. Forty-one studies met inclusion criteria. The mean difference of ICU LOS between patients with and without delirium was significant at 4.77 days ( p < 0.001 ); for hospital LOS, this was significant at 6.67 days ( p < 0.001 ). Cost data were extractable for 27 studies in which both ICU and hospital LOS were available. The mean difference of ICU costs between patients with and without delirium was significant at $3,921 ( p < 0.001 ); for hospital costs, the mean difference was $5,936 ( p < 0.001 ). Conclusion. ICU and hospital LOS and associated costs were significantly higher for patients with delirium, compared to those without delirium. Further research is necessary to elucidate other determinants of increased costs and cost-reducing strategies for critically ill patients with delirium. This can provide insight into the required resources for the prevention of delirium, which may contribute to decreasing healthcare expenditure while optimizing the quality of care.

Disparities in Mangement of Patients with Benign Colorectal Disease: Impact of Urbanization and Specialized Care

2016 ◽  
Vol 82 (11) ◽  
pp. 1046-1051 ◽  
Author(s):  
Viraj Pandit ◽  
Mazhar Khalil ◽  
Bellal Joseph ◽  
Jana Jandova ◽  
Tahereh Orouji Jokar ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Confidence Interval ◽  
Surgical Management ◽  
Surgical Intervention ◽  
Hospital Costs ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Specialized Care ◽  
Colorectal Surgeons ◽  
Colorectal Diseases

Disparities in the management of patients with various medical conditions are well established. Colorectal diseases continue to remain one of the most common causes for surgical intervention. The aim of this study was to assess disparities (rural versus urban) in the surgical management of patients with noncancerous benign colorectal diseases. We hypothesized that there is no difference among rural versus urban centers (UC) in the surgical management for noncancerous benign colorectal diseases. The national estimates of surgical procedures for benign colorectal diseases from the National Inpatient Sample database 2011 representing 20 per cent of all in-patient admissions were abstracted. Patients undergoing procedures (abscess drainage, hemmoroidectomy, fistulectomy, and bowel resections) were included. Patients with colon cancer and those who underwent emergency surgery were excluded. The population was divided into two groups: urban and rural, based on the location of treatment. Outcome measures were in-hospital complications, mortality, and hospital costs. Subanalysis of UC was preformed: centers with colorectal surgeons and centers without colorectal surgeons. Regression analysis was performed. A total of 20,617 patients who underwent surgical intervention for benign colorectal diseases across 496 (urban: 342, rural: 154) centers, were included. Of the UC, 38.3 per cent centers had colorectal surgeons. Patients managed in UC had lower complication rate (7.6% vs 10.2%, P < 0.001), shorter hospital length of stay (4.7 ± 3.1 vs 5.9 ± 3.6 days, P < 0.001), and higher hospital costs ($56,820 ± $27,691 vs $49,341 ± $2,598, P < 0.001) compared with rural centers. On subanalysis, patients managed in UC with colorectal surgeons had 11 per cent lower incidence of in-hospital complications [odds ratio: 0.89 (95% confidence interval: 0.76–0.94)] and a shorter hospital length of stay [Beta: -0.72 (95% confidence interval: —0.81 to —0.65)] when compared with patients managed in UC without colorectal specialization. Disparities exit in outcomes of the patients with noncancerous benign colorectal diseases managed surgically in urban versus rural centers. Specialized care with colorectal surgeons at UC helps reduce adverse patient outcomes. Steps to provide effective and safe surgical care in a cost-effective manner across rural as well as UC are warranted. Level of evidence: Level III, retrospective cohort analysis.

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