Abstract 289: Factors Associated with Costs, Resource Utilization, and Mortality in Bentall Procedures

Abstract INTRODUCTION Recent changes in healthcare policies implemented as per the Affordable Care Act (ACA) have resulted in providers and hospitals seeking ways to optimize resource utilization and improve patient outcomes. Length of stay (LOS) after surgery has increasingly been used as a surrogate for resource utilization. In the current study, we investigated factors associated with longer LOS after surgery for grade 1 spondylolisthesis. METHODS We queried the Quality Outcomes Database for patients with grade 1 lumbar degenerative spondylolisthesis undergoing a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multi-side study investigating the impact of fusion on clinical and patient reported outcomes (PROs) among patients with grade 1 spondylolisthesis were evaluated. A multivariable (MV) proportional odds regression model was fitted to determine factors associated with longer LOS. RESULTS A total of 608 patients undergoing surgery were identified (555 single-level, 53 2-level surgeries). Median LOS was 3 d (IQR: 2-4 d). On MV analysis, factors found to be independently predictive of longer LOS included nonroutine home discharge (home with healthcare: OR: 3.5 (1.9-6.8); postacute care: OR: 9.6 (5.2-17.7)), higher baseline ODI (interquartile OR: 1.44 (1.21-1.86)), longer operative time (OR: 1.98 (1.56-2.51), 2-level surgery (OR: 2.91 (1.37-6.21), ref = 1-level surgery); assisted ambulation (OR: 1.9 (1.1-3.3)) and higher American Society of Anesthesiologists (ASA) score (OR: 1.6 (1.1-2.3) while decompression alone (OR: 0.05 (0.03-0.09)), anterior/lateral approaches (OR: 0.25 (0.11-0.56, ref = posterior) and use of MIS (OR: 0.42 (0.30-0.59) were associated with shorter length of stay. Predictor importance analysis revealed that type of surgery (decompression vs fusion), discharge disposition, operative time, use of Minimally invasive spine surgery (MIS) and surgical approach were the top predictors determining duration of stay. CONCLUSION These results from a multi-site study of patients undergoing surgery for grade I spondylolisthesis indicate that patients undergoing fusion, discharged to nonhome, with longer operative time and posterior surgical approaches may have longer LOS. Type of surgery and discharge destination are top predictors determining length of stay.

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Drivers of Healthcare resource Utilization and factors associated with increased resource use in Patients with Fibromyalgia: an evaluation using Electronic Medical Records

Value in Health ◽

10.1016/j.jval.2015.03.1776 ◽

2015 ◽

Vol 18 (3) ◽

pp. A305

Author(s):

J. Margolis ◽

E.T. Masters ◽

J.C. Cappelleri ◽

D.M. Smith ◽

S.T. Faulkner ◽

...

Keyword(s):

Electronic Medical Records ◽

Resource Utilization ◽

Resource Use ◽

Medical Records ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Factors Associated

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Health-care resource utilization associated with peanut allergy management under allergen avoidance among commercially insured individuals

Allergy and Asthma Proceedings ◽

10.2500/aap.2021.42.210047 ◽

2021 ◽

Vol 42 (4) ◽

pp. 333-342 ◽

Cited By ~ 1

Author(s):

J. Allen Meadows ◽

Shengsheng Yu ◽

Steve L. Hass ◽

Annie Guerin ◽

Dominick Latremouille-Viau ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Resource Utilization ◽

Peanut Allergy ◽

Health Care Resource ◽

Allergen Avoidance ◽

Health Care Resource Utilization ◽

Factors Associated ◽

Outpatient Visits ◽

Ed Visits

Background: Until recently, the standard approach to care for individuals with peanut allergy (PA) was limited to allergen avoidance and treatment of reactions with emergency medicines. Objectives: To assess health-care resource utilization (HRU) and costs associated with PA management under allergen avoidance and to identify risk factors associated with peanut reactions that resulted in inpatient (IP) and/or emergency department (ED) visits. Methods: Privately insured individuals with PA diagnosis codes were identified from a large U.S. administrative claims data base (January 1, 1999, to March 31, 2017). PA-related HRU, indicated by a PA diagnosis and/or diagnostic procedure codes and by epinephrine autoinjectors (EAI) prescription fills in medical and pharmacy claims, respectively, and all-cause costs were described per patient-year (PPY). Risk factors associated with peanut reactions in an IP and/or ED setting were identified by using a multivariable logistic regression model. Results: A total of 86,483 patient-years from 14,136 individuals with PA were included. At the patient-year level, 28.1% were ages 0‐3 years, 43.6% were ages 4‐11 years, 13.7% were ages 12‐17 years, and 14.5% were ages ≥ 18 years; 35.6% had PA-related outpatient visits; 50.6% had EAI fills; and 2.4% had PA-related IP and/or ED visits PPY. Younger individuals had more PA-related outpatient visits and EAI fills, with peak intensive use at ages 4‐11 years. The proportion of individuals with PA-related IP and/or ED visits was highest among those aged ≥ 18 years. Mean all-cause costs were $3084 PPY; individuals with PA-related IP and/or ED visits incurred $8902 PPY ($17,451 for those with one or more IP visits). Risk factors associated with peanut reactions that resulted in IP and/or ED visits included young adults (odds ratio [OR] 3.19 [95% confidence interval {CI}, 2.66‐3.83]), previous peanut reaction(s) (OR 1.66 [95% CI, 1.23‐2.24]), asthma (OR 1.33 [95% CI, 1.18‐1.51]), and male sex (OR 1.14 [95% CI, 1.01‐1.28]). Conclusion: Individuals with PA and under allergen avoidance had significant HRU that varied across all age groups, with more PA-related outpatient visits during preschool and/or school age and PA-related urgent care among adults. Individuals with previous peanut reaction(s), asthma, and males had a higher risk of peanut reactions that resulted in IP and/or ED visits.

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Factors Associated With Resource Utilization and Coronary Artery Dilation in Refractory Kawasaki Disease (from the Pediatric Health Information System Database)

The American Journal of Cardiology ◽

10.1016/j.amjcard.2016.08.039 ◽

2016 ◽

Vol 118 (11) ◽

pp. 1636-1640 ◽

Cited By ~ 7

Author(s):

Jennifer Y. Lo ◽

L. LuAnn Minich ◽

Lloyd Y. Tani ◽

Jacob Wilkes ◽

Qian Ding ◽

...

Keyword(s):

Information System ◽

Coronary Artery ◽

Kawasaki Disease ◽

Health Information ◽

Resource Utilization ◽

Health Information System ◽

Pediatric Health ◽

Factors Associated ◽

System Database

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Factors Associated With Increased Resource Utilization for Congenital Heart Disease

PEDIATRICS ◽

10.1542/peds.2004-2071 ◽

2005 ◽

Vol 116 (3) ◽

pp. 689-695 ◽

Cited By ~ 104

Author(s):

J. A. Connor

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Resource Utilization ◽

Congenital Heart ◽

Factors Associated

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Outcomes and Resource Utilization Among Patients Admitted to the Intensive Care Unit Following Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Journal of Intensive Care Medicine ◽

10.1177/0885066620944865 ◽

2020 ◽

pp. 088506662094486

Author(s):

Madeleine Warwick ◽

Shannon M. Fernando ◽

Shawn D. Aaron ◽

Bram Rochwerg ◽

Alexandre Tran ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Intensive Care Unit ◽

Intensive Care ◽

Resource Utilization ◽

Hospital Costs ◽

Chronic Obstructive ◽

Inhospital Mortality ◽

Total Hospital ◽

Obstructive Pulmonary Disease ◽

Factors Associated

Purpose: Chronic obstructive pulmonary disease (COPD) is a common condition, accounting for a significant number of intensive care unit (ICU) admissions. However, little is known about outcomes and costs among ICU patients admitted with acute exacerbations of COPD (AECOPD). We studied predictors of inhospital mortality and costs of ICU admissions for AECOPD. Methods: Data were obtained from a prospectively maintained registry from 2 ICUs from 2011 to 2016, including adult patients (age ≥ 18) with an ICU discharge diagnosis of AECOPD. The primary outcome was hospital mortality. Secondary outcomes included ICU length of stay, resource utilization, total hospital costs, and cost per survivor. Results: We included 390 patients, of which 27.2% died in hospital. Independent predictors of inhospital mortality included age (odds ratio [OR]: 1.95, CI: 1.58-2.67) and the presence of clinical frailty (OR: 4.12, CI: 2.26-6.95). The mean total hospital costs were Can$35 059, with a cost per survivor of Can$48 191. Factors associated with increased cost included transfer from an inpatient setting, severity of illness, and previous ICU admission. Conclusions: Approximately a quarter of patients admitted to ICU with AECOPD died during hospitalization, and these patients accrued significant costs. This study identifies important factors associated with poor outcome in this at-risk population, which has value in risk stratification and patient or family discussions addressing goals of care.

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