The impact of medical complications on optimal hospital payment

Introduction: Perioperative blood transfusion is not without risk and effort should be made to limit patients’ exposure to allogeneic blood. However, there is conflicting data regarding the impact of anaemia on postoperative recovery in patients with repaired hip fractures. It is hypothesised that for a given baseline functional status and fracture type, lower postoperative haemoglobin will increase rehabilitation time and prolong total length of hospital stay. Methods: This is a retrospective study on data collected prospectively on patients entered into the Clinical Pathway aged >65 years admitted to Queen Mary Hospital (QMH) with a fractured neck of femur during 2011–2013. Potential predictor variables were analysed with linear regression with respect to total length of stay and those that reached a significance level of 0.05 were included in further analysis. Results: 1092 patients were admitted to QMH with a suspected fractured neck of femur; data from 747 patients were analysed. The fracture sites were neck of femur (50%), intertrochanteric (48%) and subtrochanteric fracture (2%). Approximately 30% of patients received blood transfusions. Of these only the development of postoperative medical complications statistically prolonged hospital stay. No relationship was seen with haemoglobin levels cut-off above and below 10 g/dl with the result remaining non-significant down to a cut-off of above and below 8 g/dl. Discussion: This study revealed that post-surgical haemoglobin level of between 8 g/dl and 10 g/dL did not have an impact on the total length of hospital stay. The development of postoperative medical complications was the only factor that prolonged the total length of stay.

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Impact of Biological Sex on Complications, Lengths of Stay, Readmission Rates, and Costs of Care Following Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0041-1723014 ◽

2021 ◽

Author(s):

Samuel J. Swiggett ◽

Angelo Mannino ◽

Rushabh M. Vakharia ◽

Joseph O. Ehiorobo ◽

Martin W. Roche ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Medical Complications ◽

Administrative Claims ◽

Readmission Rates ◽

Costs Of Care ◽

Lengths Of Stay ◽

Total Knee ◽

The Impact

AbstractThe impact of gender on total knee arthroplasty (TKA) postoperative complications, readmission rates, and costs of care has not been often evaluated. Therefore, the purpose of this study was to investigate which sex had higher rates of: (1) medical complications; (2) implant complications; (3) lengths of stay (LOSs); (4) readmission rates; and (5) costs after TKA. A query was performed using an administrative claims database from January 1, 2005, to March 31, 2015. Patients who had TKAs were identified using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Males and females were filtered separately and matched according to age and various medical comorbidities leading to 1,590,626 patients equally distributed. Primary outcomes analyzed included 90-day medical complications, LOSs, 90-day readmission rates, in addition to day of surgery and total global 90-day episode of care costs. Pearson's chi-square analyses were used to compare medical complications and readmission rates. Welch's t-tests were used to test for significance in matching outcomes and costs. A p-value of less than 0.01 was considered statistically significant. Males had a smaller risk of complications than women (1.35 vs. 1.40%, p < 0.006) and higher rates of implant-related complications (2.28 vs. 1.99%, p < 0.0001). Mean LOSs were lower for males: 3.16 versus 3.34 days (p < 0.0001). The 90-day readmission rates were higher in men (9.67 vs. 8.12%, p < 0.0001). This study demonstrated that males undergoing primary TKA have lower medical complications and shorter LOSs then their female counterparts. However, males have higher implant-related complications, readmission rates, and costs of care.

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The Impact of Age on Perioperative Complications after Extremity Reconstruction with the Free Gracilis Flap: A Retrospective Cohort Study Involving 153 Patients

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1677455 ◽

2019 ◽

Vol 35 (06) ◽

pp. 395-410 ◽

Cited By ~ 1

Author(s):

Laurenz Weitgasser ◽

Amro Amr ◽

Michaela Hladik ◽

Gottfried Wechselberger ◽

Adrien Daigeler ◽

...

Keyword(s):

Elderly Patients ◽

Medical Condition ◽

Perioperative Complications ◽

Gracilis Muscle ◽

Assessment Tools ◽

Medical Complications ◽

Muscle Flaps ◽

Asa Score ◽

Age Related ◽

The Impact

Background The need for plastic and reconstructive surgery on elderly patients has been on the rise due to an increase in life expectancy in the past decades. Therefore, a study was conducted on young and elderly patients following microsurgical extremity reconstructions with free gracilis muscle flaps with the primary aim to investigate the influence of age and the American Society of Anesthesiologists (ASA) score on the general outcome, as well as surgical and medical complications. Methods A retrospective analysis of 153 patients receiving free gracilis muscle flaps for extremity reconstructions between November 2009 and January 2018 was performed at two partner institutions specialized in microsurgical reconstructions. A logistic regression analysis was performed to correlate age and the ASA score with postoperative complication probability. Patients younger than 70 years were directly compared with elderly patients with respect to age, gender, ASA score, preexisting comorbidities, localization, and postoperative medical and surgical complications. Results Age turned out to be not significantly associated with major flap complications (p = 0.925) but with higher ASA scores (p = 0.016). However, an age-related significant increase in minor flap complications could be observed in the elderly (p = 0.008). A significant correlation between minor medical complications and age could be observed (p = 0.001) in contrast to ASA score (p = 0.912). Conclusion An increased minor flap, as well as minor and major medical complications, must be expected in extremity reconstructions with free gracilis flaps in elderly patients. Higher ASA scores correlate with a higher incidence of major flap complications. Septuagenarians are more prone to develop perioperative major medical complications than patients younger than 70 years. Age and general medical condition, coupled with the performance of each patient, should be thoroughly assessed individually to facilitate a tailored reconstructive approach using risk assessment tools and established scoring systems.

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Impact of Neurorehabilitation on Disability in Patients with Acutely and Chronically Disabling Diseases of the Nervous System Measured by the Extended Barthel Index

Neurorehabilitation and Neural Repair ◽

10.1177/154596830101500103 ◽

2001 ◽

Vol 15 (1) ◽

pp. 15-22 ◽

Cited By ~ 8

Author(s):

Markus Jörger ◽

Serafin Beer ◽

Jürg Kesselring

Keyword(s):

Barthel Index ◽

Medical Complications ◽

Short Stay ◽

Neurologic Diseases ◽

Chronic Group ◽

Unselected Patient ◽

Acute Group ◽

The Mean ◽

Underlying Diseases ◽

The Impact

To study the impact of rehabilitation on disability in an unselected patient group with acutely and chronically disabling neurologic diseases, the Extended Barthel Index (EBI) was determined at the beginning and at the end of the rehabilitation stay in all patients admitted to our Neurorehabilitation Centre in Valens, Switzerland. Patients who reached the highest possible EBI score at entry ("ceiling effect"), with a short stay (<1 week), or with a deterioration due to other medical complications were excluded. Finally EBI data of 743 patients could be analyzed. The mean EBI at entry was 45 and 51 at discharge. The mean increase of the EBI score per week was 1.1 (SD, 1.7). The change of the EBI score was analyzed independently in patients with acute neu rologic diseases admitted in the postacute phase (acute group) and patients with chron ically disabling neurologic diseases (chronic group). As expected, the increase of the EBI score was higher in the acute group than in the chronic group; 80.8% of the acute group patients and 42.5% of the chronic group patients showed an increase of the EBI score at discharge. Both groups showed a significant EBI gain with a marked shift to higher EBI scores at discharge. The mean gain per week was 1.6 in the acute group and 0.5 in the chronic group, respectively. Analysis of EBI changes considering the different underlying diseases showed the highest increase in patients with stroke and traumatic brain injury. Key Words: Extended Barthel Index—Disability—Neuro— rehabilitation.

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The impact of the donors' and recipients' medical complications on living kidney donors' mental health

Transplant International ◽

10.1111/tri.12760 ◽

2016 ◽

Vol 29 (5) ◽

pp. 589-602 ◽

Cited By ~ 19

Author(s):

Lotte Timmerman ◽

Mirjam Laging ◽

Reinier Timman ◽

Willij C. Zuidema ◽

Denise K. Beck ◽

...

Keyword(s):

Mental Health ◽

Medical Complications ◽

Kidney Donors ◽

Living Kidney Donors ◽

The Impact

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The impact of different medical complications on the feasibility of removing the feeding tube from infants with dysphagia

Journal of Pediatric Rehabilitation Medicine ◽

10.3233/prm-200786 ◽

2021 ◽

Vol 14 (3) ◽

pp. 371-377

Author(s):

Hikari Fukatsu ◽

Kanji Nohara ◽

Nobukazu Tanaka ◽

Nami Fujii ◽

Takayoshi Sakai

Keyword(s):

Tube Feeding ◽

Feeding Tube ◽

Cardiovascular Complications ◽

Oral Feeding ◽

Medical Complications ◽

Cardiac Complications ◽

Medical Complication ◽

Feeding Tubes ◽

Tube Removal ◽

The Impact

PURPOSE: This study examined whether certain medical complications influence the feasibility of tube removal. METHODS: 42 subjects with dysphagia who were under the age of 2.5 years were nourished entirely through feeding tubes. Additionally, they were judged to have no aspiration. The following data about the infants were collected through a retroactive survey: age at which oral feeding training commenced, gender, and whether certain medical complications (cardiovascular, respiratory, digestive, neurological, or oral) had been present at birth. The data were analyzed to determine which type of medical complication affected the likelihood of removing the feeding tube from the infant at 3 years of age. RESULTS: Of the five medical complications examined, cardiovascular complications significantly affected the feasibility of tube removal (p = 0.049). CONCLUSION: Pediatric dysphagia patients with cardiac complications, compared to those with other complications, may take longer to transition off tube feeding.

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The impact of sex, age at onset, recurrence, mode of ascertainment and medical complications on the family genetic risk score profiles for alcohol use disorder

Psychological Medicine ◽

10.1017/s0033291721003317 ◽

2021 ◽

pp. 1-9

Author(s):

Kenneth S. Kendler ◽

Henrik Ohlsson ◽

Jan Sundquist ◽

Kristina Sundquist

Keyword(s):

Alcohol Use ◽

Genetic Risk ◽

Criminal Behavior ◽

Alcohol Use Disorder ◽

Genetic Risk Score ◽

Age At Onset ◽

Risk Scores ◽

Medical Complications ◽

The Family ◽

The Impact

Abstract Background Alcohol use disorder (AUD) is clinically heterogeneous. We examine its potential genetic heterogeneity as a function of sex, age, clinical features and mode of ascertainment. Methods In the Swedish population born 1932–1995 (n = 5 829 952), we examined the genetic risk profiles for AUD, major depression (MD), anxiety disorders, bipolar disorder, drug use disorder (DUD), attention deficit-hyperactivity disorder (ADHD) and criminal behavior (CB) in 361 124 cases of AUD subdivided by sex, age at onset (AAO), recurrence, mode of ascertainment and medical complications. Family genetic risk scores (FGRS), calculated from 1st to 5th-degree relatives controlling of cohabitation, assesses genetic risk from phenotypes in the family, not from DNA variants. Results FGRS profiles differed modestly across sex with all scores higher in females. Differences were more pronounced for AAO and recurrence with the FGRS for AUD, DUD, ADHD and CB substantially higher in cases with early AAO or high recurrence rates. Genetic profiles differed considerably by mode of ascertainment, with higher FGRS for AUD and most other disorders in patients seen in hospital v. primary care settings. Cases of AUD with medical complications had higher FGRS for AUD. AUD cases comorbid with MD and DUD had higher FGRS risk for AUD, but this genetic may be less specific given increases in FGRS for multiple other disorders. Conclusions From a genetic perspective, AUD differs substantially as a function of AAO, recurrence, mode of ascertainment and patterns of comorbidity, suggesting caution in cross-sample comparisons of AUD cohorts that differ in these features.

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Impact of deprivation on hospital efficiency and financial balance in paediatrics

European Journal of Public Health ◽

10.1093/eurpub/ckz185.130 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Michel ◽

C Alberti ◽

J C Carel ◽

K Chevrel

Keyword(s):

Diagnosis Related Groups ◽

Hospital Efficiency ◽

Production Costs ◽

Hospital Funding ◽

Payment Methods ◽

Paediatric Patients ◽

Hospital Payment ◽

The Difference ◽

Financial Balance ◽

The Impact

Abstract Background In healthcare systems where hospital tariffs are based on average national length of stay (LOS), deprived patients may be a source of inefficiency for hospitals as deprivation has been shown to be associated with increased LOS. They may also negatively impact hospitals’ financial balance as few hospital payment methods include deprivation. Our objective was to study the impact of deprivation on hospital efficiency and financial balance. Methods A study was carried out using an exhaustive national hospital discharge database. All inpatient stays in mainland France between 2012 and 2014 by children over 28 days and under 18 in hospitals with a paediatric ward were included. Deprivation was estimated with an ecological deprivation index divided into national quintiles. Efficiency was assessed by variations in patients’ LOS compared to different mean national LOS (paediatric LOS, LOS of admissions for a similar condition...). Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level with the difference between all revenues and production costs for said hospital. Multivariate models assessed the association between those indicators and deprivation. Results 4,124,510 inpatient stays were included. LOS was shorter than national means for less deprived patients and longer for the more deprived, and the difference was higher for diagnosis-related groups (DRGs) that included both adult and paediatric patients compared to paediatric-only DRGs. The multivariate model confirmed those significant associations. Deprivation also had a significant impact on hospitals’ financial balance, especially for hospitals with a percentage of paediatric patients in the two most deprived quintiles between 20% and 60%. Conclusions Measures to reform hospital payment methods must be encouraged to improve resource allocation efficiency and equity in access to good paediatric care. Key messages A reform of hospital funding to better account for deprivation is needed. A modulation of tariffs using an allocation key at the patient level must be considered to mitigate the effect of deprivation. DRGs specific to children should be encouraged to become the norm rather the exception to provide an adequate picture of resources used during admission and therefore an appropriate tariff.

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