The shift from inpatient to outpatient hysterectomy for endometrial cancer in the United States: trends, enabling factors, cost, and safety

2021 ◽  
pp. ijgc-2020-002192
Author(s):  
Serena Cappuccio ◽  
Yanli Li ◽  
Chao Song ◽  
Emeline Liu ◽  
Gretchen Glaser ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Abdominal Hysterectomy ◽  
The United States ◽  
Inpatient Setting ◽  
Significant Shift ◽  
Robotic Hysterectomy ◽  
Post Discharge ◽  
Enabling Factors ◽  
Healthcare Database ◽  
The Impact

ObjectiveTo evaluate trends in outpatient versus inpatient hysterectomy for endometrial cancer and assess enabling factors, cost and safety.MethodsIn this retrospective cohort study, patients aged 18 years or older who underwent hysterectomy for endometrial cancer between January 2008 and September 2015 were identified in the Premier Healthcare Database. The surgical approach for hysterectomy was classified as open/abdominal, vaginal, laparoscopic or robotic assisted. We described trends in surgical setting, perioperative costs and safety. The impact of patient, provider and hospital characteristics on outpatient migration was assessed using multivariate logistic regression.ResultsWe identified 41 246 patients who met inclusion criteria. During the time period studied, we observed a 41.3% shift from inpatient to outpatient hysterectomy (p<0.0001), an increase in robotic hysterectomy, and a decrease in abdominal hysterectomy. The robotic hysterectomy approach, more recent procedure (year), and mid-sized hospital were factors that enabled outpatient hysterectomies; while abdominal hysterectomy, older age, Medicare insurance, black ethnicity, higher number of comorbidities, and concomitant procedures were associated with an inpatient setting. The shift towards outpatient hysterectomy led to a $2500 savings per case during the study period, in parallel to the increased robotic hysterectomy rates (p<0.001). The post-discharge 30-day readmission and complications rate after outpatient hysterectomy remained stable at around 2%.ConclusionsA significant shift from inpatient to outpatient setting was observed for hysterectomies performed for endometrial cancer over time. Minimally invasive surgery, particularly the robotic approach, facilitated this migration, preserving clinical outcomes and leading to reduction in costs.

scholarly journals Unique Molecular Features in High-Risk Histology Endometrial Cancers

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1665 ◽  
Author(s):  
Pooja Pandita ◽  
Xiyin Wang ◽  
Devin E. Jones ◽  
Kaitlyn Collins ◽  
Shannon M. Hawkins
Keyword(s):  
Endometrial Cancer ◽  
High Risk ◽  
Early Stage ◽  
Standard Of Care ◽  
The United States ◽  
Model Systems ◽  
Low Grade ◽  
Cell Of Origin ◽  
Molecular Features ◽  
The Impact

Endometrial cancer is the most common gynecologic malignancy in the United States and the sixth most common cancer in women worldwide. Fortunately, most women who develop endometrial cancer have low-grade early-stage endometrioid carcinomas, and simple hysterectomy is curative. Unfortunately, 15% of women with endometrial cancer will develop high-risk histologic tumors including uterine carcinosarcoma or high-grade endometrioid, clear cell, or serous carcinomas. These high-risk histologic tumors account for more than 50% of deaths from this disease. In this review, we will highlight the biologic differences between low- and high-risk carcinomas with a focus on the cell of origin, early precursor lesions including atrophic and proliferative endometrium, and the potential role of stem cells. We will discuss treatment, including standard of care therapy, hormonal therapy, and precision medicine-based or targeted molecular therapies. We will also discuss the impact and need for model systems. The molecular underpinnings behind this high death to incidence ratio are important to understand and improve outcomes.

scholarly journals Clinical and Pregnancy Outcomes of COVID-19 Among Hospitalized Pregnant Women in the United States

2021 ◽  
Author(s):  
Christina M Ackerman ◽  
Jennifer L Nguyen ◽  
Swapna Ambati ◽  
Maya Reimbaeva ◽  
Birol Emir ◽  
...  
Keyword(s):  
United States ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Negative Impact ◽  
Invasive Mechanical Ventilation ◽  
Age Groups ◽  
The United States ◽  
Supplemental Oxygen ◽  
Healthcare Database ◽  
The Impact

Abstract Background Pregnant women with coronavirus disease 19 (COVID-19) may be at greater risk of poor maternal and pregnancy outcomes. This retrospective analysis reports clinical and pregnancy outcomes among hospitalized pregnant women with COVID-19 in the United States. Methods The Premier Healthcare Database – Special Release was used to examine the impact of COVID-19 among pregnant women aged 15–44 years who were hospitalized and who delivered compared with pregnant women without COVID-19. Outcomes evaluated were COVID-19 clinical progression, including the use of supplemental oxygen therapy, intensive care unit admission, critical illness, receipt of invasive mechanical ventilation/extracorporeal membrane oxygenation, and maternal death, and pregnancy outcomes, including preterm delivery and stillbirth. Results Overall, 473,902 hospitalized pregnant women were included, of whom 8584 (1.8%) had a COVID-19 diagnosis (mean [SD] age 28.4 [6.1] years; 40% Hispanic). The risk of poor clinical and pregnancy outcomes was greater among pregnant women with COVID-19 compared with pregnant women without a COVID-19 diagnosis in 2020; the risk of poor clinical and pregnancy outcomes increased with increasing age. Hispanic and Black non-Hispanic women were consistently observed to have the highest relative risk of experiencing poor clinical or pregnancy outcomes across all age groups. Conclusions Overall, COVID-19 had a significant negative impact on maternal health and pregnancy outcomes. These data help inform clinical practice and counselling to pregnant women regarding the risks of COVID-19. Clinical studies evaluating the safety and efficacy of vaccines against severe acute respiratory syndrome coronavirus 2 in pregnant women are urgently needed.

Adverse Drug Events as a Reason for Adult Hospitalization: A Nationwide Readmission Study

2018 ◽  
Vol 53 (6) ◽  
pp. 557-566 ◽  
Author(s):  
James A. G. Crispo ◽  
Dylan P. Thibault ◽  
Allison W. Willis
Keyword(s):  
Home Health Care ◽  
Adverse Drug Events ◽  
The United States ◽  
Post Discharge ◽  
Discharge Disposition ◽  
Nationally Representative ◽  
Survey Weighting ◽  
The Impact ◽  
Nationwide Readmission Database ◽  
Hospital Characteristics

Background: Adverse drug events (ADEs) are common; however, there are limited data on the impact of ADEs on post-discharge outcomes. Objectives: To identify ADEs responsible for readmission within 6 months of hospital discharge in the United States. Secondary objectives were to examine whether demographic, clinical, and hospital characteristics were associated with ADE readmission. Methods: We identified all adults hospitalized between January and June using the 2014 Nationwide Readmission Database. Nationally representative estimates of hospitalization outcomes and ADE-related readmissions, excluding ADEs from illicit drug use and intentional overdose, were computed using survey weighting methods. Associations between patient, clinical, and hospital characteristics, and ADE readmission were assessed using unconditional logistic regression. Results: We identified 10 889 282 hospitalizations meeting inclusion criteria. The 6-month readmission rate was 17.8% (n = 1 943 111). A total of 6964 readmissions were attributed to an ADE, most frequently “poisoning by opiates and related narcotics” (18.3%), “poisoning by benzodiazepines” (11.9%), and “dermatitis due to drugs and medicines taken internally” (9.4%). Factors identified as being positively associated with ADE readmission included age <60 years (adjusted odds ratio [AOR] = 1.69; 95% CI = 1.45-1.97), Medicare insurance (AOR = 2.93; 95% CI = 2.55-3.38), and discharge to home health care (AOR = 1.42; 95% CI = 1.28-1.59). Conclusion and Relevance: Readmissions caused by ADEs are frequently attributed to opiate and benzodiazepine poisonings, and factors such as age, insurance status, and discharge disposition were found to be associated with ADE readmission. Future studies are needed to examine whether ADE readmissions are preventable.

scholarly journals “Brown Bag Clinic”: A Pharmacist-led Approach to Reduce Heart Failure Hospital Readmission

2021 ◽  
Vol 12 (4) ◽  
pp. 11
Author(s):  
Maggie N. Faraj ◽  
Ileana L. Piña ◽  
Candice Garwood
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
The United States ◽  
Control Group ◽  
Post Discharge ◽  
Academic Medical ◽  
The Impact

Objectives: Heart failure (HF) affects approximately 6 million in the United States and despite guideline-directed medical therapy (GDMT), still more than 20% of patients are readmitted within 30 days.1,2 This study evaluated the impact of a “pharmacist-led HF Brown Bag Clinic” (BBC) on HF patient outcomes including readmissions and mortality. Methods: This retrospective study, conducted at an academic medical center, included adult patients 18 to 89 years old with HF presenting to the BBC 7-14 days post HF hospitalization. Those failing to attend the BBC within 30 days of hospital discharge were in the control group. Our electronic medical records were used to capture patients’ baseline characteristics and describe pharmacists’ interventions. Thirty- and ninety-day post-discharge HF readmission and all-cause mortality were evaluated. Results: A total of 32 patients met the inclusion criteria; 15 receiving intervention and 17 controls. A total of 18 HF hospital readmissions occurred, 4 (22%) readmissions in the intervention group and 14 (78%) in the control group (p= 0.06). Hospital readmissions within 30 days and 90 days were greater in the control group compared with the intervention group (18% vs. 7% and 41% vs. 21% respectively). Conclusion: A pharmacist-led post-discharge clinic demonstrated numerically fewer HF hospital readmissions compared with a scheduled but “no show” control group.

Associations of Antimicrobial-Resistant Gram-Negative Bloodstream Infections with Outcomes among Hospitalized Pediatric Patients in the United States

2021 ◽  
Author(s):  
Alicen Burns Spaulding ◽  
David Watson ◽  
Jill Dreyfus ◽  
Phillip Heaton ◽  
Christina Koutsari ◽  
...  
Keyword(s):  
United States ◽  
Retrospective Cohort ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
The United States ◽  
Healthcare Database ◽  
Gram Negative ◽  
Drug Classes ◽  
Antibiotic Drug ◽  
The Impact

Abstract Objective The aim of this study was to assess the impact of pediatric antimicrobial-resistant gram-negative bloodstream infections (GNBSIs). Methods A retrospective cohort study (2009–2016) was conducted using the Premier Healthcare Database among pediatric admissions with GNBSIs at hospitals reporting microbiology data. Infections for neonates and nonneonates were classified as multidrug resistance (MDR), resistant to one or two antibiotic drug classes (1–2DR), or susceptible. Results Among 1,276 GNBSIs, 266 (20.8%) infections were 1–2DR and 23 (1.8%) MDR. Compared with susceptible GNBSIs, MDR nonneonates had higher mortality and higher costs, whereas 1–2DR neonates had longer stays and higher costs. Conclusions Antimicrobial-resistant GNBSIs were associated with worse outcomes among pediatric hospitalized patients.

scholarly journals 2851. Impact of Antimicrobial-Resistant Gram-Negative Bloodstream Infections on Outcomes Among Pediatric Hospitalizations in the United States, 2009–2016

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S73-S73
Author(s):  
Alicen B Spaulding ◽  
David Watson ◽  
Jill Dreyfus ◽  
Phillip Heaton ◽  
Anupam Kharbanda
Keyword(s):  
United States ◽  
Susceptibility Testing ◽  
Hospital Admissions ◽  
Bloodstream Infections ◽  
Healthcare Facility ◽  
The United States ◽  
Healthcare Database ◽  
Gram Negative ◽  
Patients Âgés ◽  
The Impact

Abstract Background Antimicrobial-resistant (AMR) Gram-negative bloodstream infections (GNBSIs) are more challenging to treat and may be associated with higher rates of morbidity and mortality. However, no recent studies have assessed the impact of pediatric AMR GNBSIs on outcomes. This study’s objective was to analyze the impact of AMR GNBSIs on mortality, length of stay (LOS), and costs among pediatric hospital admissions in the United States. Methods We conducted a retrospective cohort study of patients ages < 19 from the Premier Healthcare Database (2009–2016) limited to hospitals reporting ≥4 years of blood culture data and to encounters with susceptibility testing among the five most common laboratory-confirmed GNBSIs. AMR was defined per pathogen according to Centers for Disease Control and Prevention criteria. Outcomes mortality, LOS, and total patient encounter costs were compared between AMR and susceptible GNBSIs using Bayesian hierarchical regression modeling, which allowed us to analyze outcomes at the pathogen-level and to incorporate adjustment for confounding factors in order to produce risk-adjusted average differences or risk ratios (RR), and corresponding 95% credible intervals (CrI). Results Among 1,279 GNBSI encounters with susceptibility testing from 104 hospitals, 153 (12%) were AMR, but varied by pathogen. AMR GNBSI occurred more often among non-neonates (62% vs. 51%); non-neonates more often had hospital-acquired infections (27% vs. 13%) or were transferred from a healthcare facility (16% vs. 10%) vs. susceptible GNBSIs. The adjusted RR for mortality was 1.31 (95% CrI 0.62, 3.07) and adjusted average differences for LOS were 6.8 days (95% CrI: −0.3, 16.3) and for cost $23800 (95% CrI $400, $53900) comparing AMR to susceptible GNBSIs. Conclusion This study analyzed the impact of AMR GNBSIs, which were rare, on pediatric patient outcomes using laboratory-confirmed GNBSIs with susceptibility results and advanced statistical methods, finding the greatest impact of pediatric AMR on costs. Knowing the impact of AMR GNBSIs can help improve management of these serious infections, increase clinician and patient awareness of the issue, and further strengthen evidence for justifying pediatric antimicrobial stewardship. Disclosures All Authors: No reported Disclosures.

Intensive Case Management in Suicide Attempters Following Discharge from Psychiatric Care

2007 ◽  
Vol 13 (3) ◽  
pp. 49 ◽  
Author(s):  
Diego De Leo ◽  
Travis Heller
Keyword(s):  
High Risk ◽  
Case Management ◽  
Suicide Ideation ◽  
Psychiatric Inpatient ◽  
Dropout Rate ◽  
Inpatient Setting ◽  
Intensive Case Management ◽  
Post Discharge ◽  
The Impact

Suicide risk is high in the first week, month and year following discharge from psychiatric inpatient settings. The decrease in care following discharge has been considered as contributing to the excessive suicide rate in this population. The aim of this research was to evaluate the impact of an intensive case management follow-up of these high-risk people for one year. Sixty males with a history of suicide attempts and psychiatric illness were recruited at discharge from a psychiatric inpatient setting at the Gold Coast Hospital, Queensland. Participants were randomly assigned to one of two conditions: Intensive Case Management (ICM) or Treatment As Usual (TAU). ICM featured weekly face-to-face contact with a community case manager and outreach telephone calls from experienced telephone counsellors. TAU participants were discharged under existing hospital practices. All participants completed assessment interviews at baseline, six and twelve months post-discharge. At the end of the twelve-month treatment phase, there was a dropout rate of 53.3% in the ICM condition, and 73.3% in the TAU condition, leaving a final sample of 22 (ICM=14, TAU=8). People in the ICM condition had significant improvements in depression scores, suicide ideation, and quality of life. ICM participants reported more contacts with mental and allied health services, had better relationships with therapists, and were more satisfied with the services that they did receive. No suicides were recorded in the twelve-month follow-up period. A few participants engaged in self-harming behaviours, though there were no differences between treatment conditions with regard to this aspect. Despite the high attrition rate and subsequent low sample size, initial indications are that intensive case management may be beneficial in assisting the post-discharge phase of high-risk psychiatric patients.

Geriatric assessment-driven interventions among hospitalized older adults with cancer (GAIN-HOSP): A prospective pilot study.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 52-52
Author(s):  
Leana Chien ◽  
Can-Lan Sun ◽  
Heeyoung Kim ◽  
Carolina Uranga ◽  
Enrique Soto Perez De Celis ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Stage Iv ◽  
Participation Rate ◽  
Secondary Outcome ◽  
Inpatient Setting ◽  
Post Discharge ◽  
Hospitalized Older Adults ◽  
The Impact

52 Background: Older adults with cancer often have age-associated vulnerabilities and challenges, especially during hospitalization. Geriatric assessment (GA) can help identify such vulnerabilities, generate recommendations, and guide the choice of interventions. Recently, GA-driven interventions have been shown to decrease chemotherapy toxicity among older adults with cancer in the outpatient setting. However, few studies have examined its role in the inpatient setting. Our purpose was to evaluate the feasibility of GA-driven interventions among hospitalized older adults with cancer. Methods: Hospitalized patients, age 75+, with a solid tumor malignancy were eligible. Each patient completed a GA while hospitalized at T1 (Timepoint 1) and one-month post discharge T2 (Timepoint 2). An Advanced Practice Nurse (APN) reviewed the T1 GA, provided targeted care utilizing GA results and implemented interventions based on predefined triggers built into the GA’s various domains. An APN also completed follow-up visits by phone at 1 week and 1 month post discharge. The primary outcome was feasibility, defined as the percentage of participants who received GA-guided interventions and was pre-specified as successful if > 80% were given recommendations. A secondary outcome of the study was to capture unplanned readmissions within 1 month post discharge. Results: Between 9/19/2017 and 5/3/2019, 49 patients were eligible and 40 were enrolled, an 82% participation rate. The median age was 80.5 years (range 75-88), 58% male, 63% Non-Hispanic white, 18% Hispanic, 15% Asian, 70% > a high school education, 73% married/partner, and 48% had stage IV cancer. Most common cancer types: GI (28%), GU (23%), lung (20%). All 40 patients (100%) had ≥ 1 predefined trigger in the GA generating interventions and completed ≥ 2 follow-up visits with the APN. In total, 857 interventions were recommended, and the mean number of interventions generated per patient was 11. The top 4 interventions were Occupational Therapy/Physical Therapy (n = 66), Social Work (n = 52), Nutrition (n = 39), and Pharmacy (n = 36). Overall 89% of GA-guided interventions were implemented. Unplanned hospital readmission was low with only one patient readmitted within 30 days (3%). Conclusions: Among hospitalized adults over age 75 with cancer, using GA to identify vulnerability, and provide GA-driven multidisciplinary interventions is feasible. Further studies are warranted to examine the impact of GA-driven interventions on outcomes among hospitalized older adults with cancer.

Impact of Pharmacist-Driven Transitions of Care Interventions on Post-hospital Outcomes Among Patients With Coronary Artery Disease: A Systematic Review

2021 ◽  
pp. 089719002110641
Author(s):  
Erin Weeda ◽  
Rachael E. Gilbert ◽  
Shelby J. Kolo ◽  
Jason S. Haney ◽  
Linh Tran Hazard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Coronary Artery ◽  
Secondary Prevention ◽  
Hospital Readmission ◽  
The United States ◽  
Transitions Of Care ◽  
Prevention Measures ◽  
Post Discharge ◽  
Hospital Outcomes ◽  
The Impact

Background Transitions of care (ToC) aim to provide continuity while preventing loss of information that may result in poor outcomes such as hospital readmission. Readmissions not only burden patients, they also increase costs. Given the high prevalence of coronary artery diseases (CAD) in the United States (US), patients with CAD often make up a significant portion of hospital readmissions. Objective To conduct a systematic review evaluating the impact of pharmacist-driven ToC interventions on post-hospital outcomes for patients with CAD. Methods MEDLINE, Scopus, and CINAHL were searched from database inception through 03/2020 using key words for CAD and pharmacists. Studies were included if they: (1) identified adults with CAD at US hospitals, (2) evaluated pharmacist-driven ToC interventions, and (3) assessed post-discharge outcomes. Outcomes were summarized qualitatively. Results Of the 1612 citations identified, 11 met criteria for inclusion. Pharmacist-driven ToC interventions were multifaceted and frequently included medication reconciliation, medication counseling, post-discharge follow-up and initiatives to improve medication adherence. Hospital readmission and emergency room visits were numerically lower among patients receiving vs not receiving pharmacist-driven interventions, with statistically significant differences observed in 1 study. Secondary prevention measures and adherence tended to be more favorable in the pharmacist-driven intervention groups. Conclusion Eleven studies of multifaceted, ToC interventions led by pharmacists were identified. Readmissions were numerically lower and secondary prevention measures and adherence were more favorable among patients receiving pharmacist-driven interventions. However, sufficiently powered studies are still required to confirm these benefits.

scholarly journals The Feasibility of Societal Cost Equivalence between Robotic Hysterectomy and Alternate Hysterectomy Methods for Endometrial Cancer

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Neel T. Shah ◽  
Kelly N. Wright ◽  
Gudrun M. Jonsdottir ◽  
Selena Jorgensen ◽  
Jon I. Einarsson ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Operative Time ◽  
Cost Minimization ◽  
Cohort Analysis ◽  
Laparoscopic Approach ◽  
Laparoscopic Hysterectomy ◽  
Patient Characteristics ◽  
Abdominal Hysterectomy ◽  
Hospital Charges ◽  
Robotic Hysterectomy

Objectives. We assess whether it is feasible for robotic hysterectomy for endometrial cancer to be less expensive to society than traditional laparoscopic hysterectomy or abdominal hysterectomy.Methods. We performed a retrospective cohort analysis of patient characteristics, operative times, complications, and hospital charges from all () endometrial cancer patients who underwent hysterectomy in 2009 at our hospital. Per patient costs of each hysterectomy method were examined from the societal perspective. Sensitivity analysis and Monte Carlo simulation were performed using a cost-minimization model.Results. 40 (17.1%) of hysterectomies for endometrial cancer were robotic, 91 (38.9%), were abdominal, and 103 (44.0%) were laparoscopic. 96.3% of the variation in operative cost between patients was predicted by operative time (, ). Mean operative time for robotic hysterectomy was significantly longer than other methods (). Abdominal hysterectomy was consistently the most expensive while the traditional laparoscopic approach was consistently least expensive. The threshold in operative time that makes robotic hysterectomy cost equivalent to the abdominal approach is within the range of our experience.Conclusion. It is feasible for robotic hysterectomy to be less expensive than abdominal hysterectomy, but unlikely for robotic hysterectomy to be less expensive than traditional laparoscopy.

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