Abstract 118: Factors and Hospital Charges Associated With Prolonged Length of Hospitalization in Patients Admitted With Ischemic Stroke in the United States

Background and Purpose: The duration of hospitalization and associated factors are not well studied in national cohorts. We identified the proportion and determinants of prolonged hospitalization and determined the impact on hospital charges using nationally representative data. Methods: National estimates of length of stay, mortality, and hospital charges incurred in patients admitted with primary diagnosis of ischemic stroke (ICD-9 CM diagnosis-related code 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91, and 436) using Nationwide Inpatient Sample data from 2010 to 2015. Nationwide Inpatient Sample is the largest all-payer inpatient care database in the United States. Patient who were transferred from another acute hospital or had mortality within 2 days of admission were excluded from the analysis. All the variables pertaining to hospitalization were compared in four quartiles based on distribution data for length of hospital stay (≤2, 3 to 4, 5 to 6 and ≥7 days). Results: A total of 2,490,136 patients were admitted with the diagnosis of ischemic attack during the study period. The median length of stay for hospitalization was 4 days. The length of hospitalization was ≤2, 3 to 4, 5 to 6 and ≥7 days in 706,550 (28.4%), 842,872 (33.8%), 417,592 (16.8%) and 523,122 (21.0%) patients, respectively. The mean hospitalization charges were $22,819, $32,593, $ 45,486 and $97,868 for patients hospitalized in four quartiles, respectively. In the multivariate analysis, the following patient factors and in hospital complications were associated with above median length of hospitalization of ≥4 days: age >65 years (odds ratio [OR], 1.06), women (OR, 1.07), history of alcohol use (OR, 1.29), deep venous thrombosis (OR, 2.67), urinary tract infection (OR, 1.68), pneumonia (OR, 1.53), sepsis (OR, 1.85), pulmonary embolism (OR, 1.48), admission to urban teaching hospitals (OR, 1.07), Medicaid insurance (OR, 1.53), and hospital location in Northeast US region (OR, 1.86; all P values <0.0001). Conclusions: The hospital stay in more than half of patients admitted with ischemic stroke is 4 days or greater. Strategies that focus on modifiable factors associated with prolonged hospital stay may reduce the hospitalization charges in United States.

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Abstract 45: Thrombolytic Treatment for In-Hospital Ischemic Strokes in United States

Stroke ◽

10.1161/str.44.suppl_1.a45 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Tenbit Emiru ◽

Malik M Adil ◽

Adnan I Qureshi

Keyword(s):

United States ◽

Ischemic Stroke ◽

Length Of Stay ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Clinical Characteristics ◽

The United States ◽

Treated Group ◽

Hospital Charges ◽

Thrombolytic Treatment

BACKGROUND: Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital acute ischemic stroke, there is little data on rates and outcomes of patients receiving thrombolytics for in-hospital ischemic strokes. OBJECTIVE: To determine the rates of in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated with thrombolytics on admission. DESIGN/METHODS: We analyzed a seven-year data (2002-2009) from the National Inpatient Survey (NIS), a nationally representative inpatient database in the United States. We identified patients who had in-hospital ischemic strokes (defined by thrombolytic treatment after one day of hospitalization) and those who received thrombolytics on the admission day. We compared demographics, baseline clinical characteristics, in hospital complications, length of stay, hospitalization charges, and discharge disposition, between the two patient groups. RESULT: A total of 18036 (21.5%) and 65912 (78.5%) patients received thrombolytics for in-hospital and on admission acute ischemic stroke, respectively. In hospital complications such as pneumonia (5.0% vs. 3.4%, p=0.0006), deep venous thrombosis (1.9% vs. 0.6%, p<0.0001) and pulmonary embolism (0.8% vs. 0.4%, p=0.01) were significantly higher in the in-hospital group compared to on admission thrombolytic treated group. Hospital length of stay and mean hospital charges were not different between the two groups. Patients who had in-hospital strokes had had higher rates of in hospital mortality (12.1% vs. 10.6%, p=0.02). In a multivariate analysis, in-hospital thrombolytic treated group had higher in-hospital mortality after adjustment for age, gender and baseline clinical characteristics (odds ratio 0.84, 95% confidence interval 0.74-0.95, p=0.008). CONCLUSION/RELEVANCE: In current practice, one out of every five acute ischemic stroke patients treated with thrombolytics is receiving treatment for in-hospital strokes. The higher mortality and complicated hospitalization in such patients needs to be recognized.

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The Impact of BMI on Adult Blunt Trauma Outcomes

The American Surgeon ◽

10.1177/000313481908501229 ◽

2019 ◽

Vol 85 (12) ◽

pp. 1354-1362

Author(s):

Rahman Barry ◽

Milad Modarresi ◽

Rodrigo Aguilar ◽

Jacqueline Sanabria ◽

Thao Wolbert ◽

...

Keyword(s):

United States ◽

Mortality Rate ◽

Length Of Stay ◽

Blunt Trauma ◽

Nationwide Inpatient Sample ◽

The United States ◽

Mortality Rates ◽

Hospital Length Of Stay ◽

Obese Patients ◽

The Impact

Traumatic injuries account for 10% of all mortalities in the United States. Globally, it is estimated that by the year 2030, 2.2 billion people will be overweight (BMI ≥ 25) and 1.1 billion people will be obese (BMI ≥ 30). Obesity is a known risk factor for suboptimal outcomes in trauma; however, the extent of this impact after blunt trauma remains to be determined. The incidence, prevalence, and mortality rates from blunt trauma by age, gender, cause, BMI, year, and geography were abstracted using datasets from 1) the Global Burden of Disease group 2) the United States Nationwide Inpatient Sample databank 3) two regional Level II trauma centers. Statistical analyses, correlations, and comparisons were made on a global, national, and state level using these databases to determine the impact of BMI on blunt trauma. The incidence of blunt trauma secondary to falls increased at global, national, and state levels during our study period from 1990 to 2015, with a corresponding increase in BMI at all levels ( P < 0.05). Mortality due to fall injuries was higher in obese patients at all levels ( P < 0.05). Analysis from Nationwide Inpatient Sample database demonstrated higher mortality rates for obese patients nationally, both after motor vehicle collisions and mechanical falls ( P < 0.05). In obese and nonobese patients, regional data demonstrated a higher blunt trauma mortality rate of 2.4% versus 1.2%, respectively ( P < 0.05) and a longer hospital length of stay of 4.13 versus 3.26 days, respectively ( P = 0.018). The obesity rate and incidence of blunt trauma secondary to falls are increasing, with a higher mortality rate and longer length of stay in obese blunt trauma patients.

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Abstract WP386: Predictors of Length of Hospitalization in Patients Admitted With Intracerebral Hemorrhage in the United States

Stroke ◽

10.1161/str.51.suppl_1.wp386 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Saqib A Chaudhry ◽

Mohammad Rauf A Chaudhry ◽

Iqra N Akhtar ◽

Adnan I Qureshi ◽

Werdah Zafar

Keyword(s):

Logistic Regression ◽

Length Of Stay ◽

Intracerebral Hemorrhage ◽

Hospital Stay ◽

Multivariate Logistic Regression Analysis ◽

Length Of Hospital Stay ◽

The United States ◽

Multivariate Logistic Regression ◽

Median Length ◽

Length Of Hospitalization

Background: We performed this study to determine the predictors of length of hospitalization in patients admitted with intracerebral hemorrhage using nationally representative data. Methods: We used the National Inpatient Sample (NIS) from 2010 to 2015 to assess the factors associated with length of stay in patients admitted with intracerebral hemorrhage using (ICD-9 CM diagnosis-related code 431). Patients who were transferred from another acute hospital or died within 2 days of admission were excluded. All variables pertaining to hospitalization were compared in 4 quartile groups on basis of length of hospital stay distribution (≤3, 4-6, 7-10 and ≥11 days) and median length of stay was calculated. The predictors of hospital stay exceeding the median length of stay were identified using multivariate logistic regression. Results: A total of 296,792patients were admitted with the diagnosis of intracerebral hemorrhage during the study period. The length of hospitalization was (≤3, 4-6, 7-10 and ≥11 days in 79,008 (26.5%), 89,019 (30.0%), 55,555 (18.7%) and 73,211 (24.6%) patients, respectively; median length of stay for the cohort was 6 days. In the multivariate logistic regression analysis, the following clinical factors were associated with length of hospitalization of ≥6 days (median): male (odds ratio [OR] 1.10), hypertension (OR 1.41 ), APRDRG severity (OR 2.87), history of alcohol use (OR 1.27 ), and in-hospital complications such as sepsis (OR 2.73), pneumonia (OR 2.30), urine tract infection (OR 2.34), pulmonary embolism (OR 1.42), and deep vein thrombosis (OR 5.06). Similarly in-hospital procedures such as craniotomy (OR 3.40), and transfusion (OR 2.09), were associated with length of hospitalization of ≥6 days. The excess hospitalization charges associated with length of hospitalization of ≥6 days was $107,915. Conclusion: Prolonged hospitalization is associated with significantly higher cost of hospitalization. The most important determinants being pre-existing medical comorbidities and potentially preventable in-hospital complications.

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Laparoscopic Appendectomy Trends and Outcomes in the United States: Data from the Nationwide Inpatient Sample (NIS), 2004–2011

The American Surgeon ◽

10.1177/000313481408001035 ◽

2014 ◽

Vol 80 (10) ◽

pp. 1074-1077 ◽

Cited By ~ 44

Author(s):

Hossein Masoomi ◽

Ninh T. Nguyen ◽

Matthew O. Dolich ◽

Steven Mills ◽

Joseph C. Carmichael ◽

...

Keyword(s):

United States ◽

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Conversion Rate ◽

Nationwide Inpatient Sample ◽

Open Appendectomy ◽

Perforated Appendicitis ◽

The United States ◽

Hospital Charges ◽

Nationwide Inpatient Sample Database

Laparoscopic appendectomy (LA) is becoming the standard procedure of choice for appendicitis. We aimed to evaluate the frequency and trends of LA for acute appendicitis in the United States and to compare outcomes of LA with open appendectomy (OA). Using the Nationwide Inpatient Sample database, we examined patients who underwent appendectomy for acute appendicitis from 2004 to 2011. A total of 2,593,786 patients underwent appendectomy during this period. Overall, the rate of LA was 60.5 per cent (children: 58.1%; adults: 63%; elderly: 48.7%). LA rate significantly increased from 43.3 per cent in 2004 to 75 per cent in 2011. LA use increased 66 per cent in nonperforated appendicitis versus 100 per cent increase in LA use for perforated appendicitis. The LA rate increased in all age groups. The increased LA use was more significant in male patients (84%) compared with female patients (62%). The overall conversion rate of LA to OA was 6.3 per cent. Compared with OA, LA had a significantly lower complication rate, a lower mortality rate, a shorter mean hospital stay, and lower mean total hospital charges in both nonperforated and perforated appendices. LA has become an established procedure for appendectomy in nonperforated and perforated appendicitis in all rates exceeding OA. Conversion rate is relatively low (6.3%).

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Trends and presentation patterns of acute rheumatic fever hospitalisations in the United States

Cardiology in the Young ◽

10.1017/s1047951119002270 ◽

2019 ◽

Vol 29 (11) ◽

pp. 1387-1390

Author(s):

Tyler Bradley-Hewitt ◽

Chris T. Longenecker ◽

Vuyisile Nkomo ◽

Whitney Osborne ◽

Craig Sable ◽

...

Keyword(s):

United States ◽

Length Of Stay ◽

Rheumatic Fever ◽

Private Insurance ◽

Case Fatality ◽

The United States ◽

Hospital Charges ◽

The South ◽

Asian Pacific Islanders ◽

Asian Pacific

AbstractObjective:Rheumatic fever, an immune sequela of untreated streptococcal infections, is an important contributor to global cardiovascular disease. The goal of this study was to describe trends, characteristics, and cost burden of children discharged from hospitals with a diagnosis of RF from 2000 to 2012 within the United States.Methods:Using the Kids’ Inpatient Database, we examined characteristics of children discharged from hospitals with the diagnosis of rheumatic fever over time including: overall hospitalisation rates, age, gender, race/ethnicity, regional differences, payer type, length of stay, and charges.Results:The estimated national cumulative incidence of rheumatic fever in the United States between 2000 and 2012 was 0.61 cases per 100,000 children. The median age was 10 years, with hospitalisations significantly more common among children aged 6–11 years. Rheumatic fever hospitalisations among Asian/Pacific Islanders were significantly over-represented. The proportion of rheumatic fever hospitalisations was greater in the Northeast and less in the South, although the highest number of rheumatic fever admissions occurred in the South. Expected payer type was more likely to be private insurance, and the median total hospital charges (adjusted for inflation to 2012 dollars) were $16,000 (interquartile range: $8900–31,200). Median length of stay was 3 days, and the case fatality ratio for RF in the United States was 0.4%.Conclusions:Rheumatic fever persists in the United States with an overall downwards trend between 2003 and 2012. Rheumatic fever admissions varied considerably based on age group, region, and origin.

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In-hospital Mortality and Morbidity after Surgical Treatment of Unruptured Intracranial Aneurysms in the United States, 1996–2000: The Effect of Hospital and Surgeon Volume

Neurosurgery ◽

10.1093/neurosurgery/52.5.995 ◽

2003 ◽

Vol 52 (5) ◽

pp. 995-1009

Author(s):

Fred G. Barker ◽

Sepideh Amin-Hanjani ◽

William E. Butler ◽

Christopher S. Ogilvy ◽

Bob S. Carter

Keyword(s):

United States ◽

Surgical Treatment ◽

Length Of Stay ◽

Intracranial Aneurysms ◽

High Volume ◽

The United States ◽

Surgeon Volume ◽

Hospital Charges ◽

Unruptured Aneurysms ◽

Unruptured Intracranial Aneurysms

Abstract OBJECTIVE We sought to determine the risk of adverse outcome after contemporary surgical treatment of patients with unruptured intracranial aneurysms in the United States. Patient, surgeon, and hospital characteristics were tested as potential outcome predictors, with particular attention to the surgeon's and hospital's volume of care. METHODS We performed a retrospective cohort study with the Nationwide Inpatient Sample, 1996 to 2000. Multivariate logistic and ordinal regression analyses were performed with endpoints of mortality, discharge other than to home, length of stay, and total hospital charges. RESULTS We identified 3498 patients who were treated at 463 hospitals, and we identified 585 surgeons in the database. Of all patients, 2.1% died, 3.3% were discharged to skilled-nursing facilities, and 12.8% were discharged to other facilities. The analysis adjusted for age, sex, race, primary payer, four variables measuring acuity of treatment and medical comorbidity, and five variables indicating symptoms and signs. The statistics for median annual number of unruptured aneurysms treated were eight per hospital and three per surgeon. High-volume hospitals had fewer adverse outcomes than hospitals that handled comparatively fewer unruptured aneurysms: discharge other than to home occurred after 15.6% of operations at high-volume hospitals (20 or more cases/yr) compared with 23.8% at low-volume hospitals (fewer than 4 cases/yr) (P = 0.002). High surgeon volume had a similar effect (15.3 versus 20.6%, P = 0.004). Mortality was lower at high-volume hospitals (1.6 versus 2.2%) than at hospitals that handled comparatively fewer unruptured aneurysms, but not significantly so. Patients treated by high-volume surgeons had fewer postoperative neurological complications (P = 0.04). Length of stay was not related to hospital volume. Charges were slightly higher at high-volume hospitals, partly because arteriography was performed more frequently than at hospitals that handled comparatively fewer unruptured aneurysms. CONCLUSION For patients with unruptured aneurysms who were treated in the United States between 1996 and 2000, surgery performed at high-volume institutions or by high-volume surgeons was associated with significantly lower morbidity and modestly lower mortality.

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Abstract 2311: Hospitalization Costs of Stroke among Adults 18-64 Years in the United States

Stroke ◽

10.1161/str.43.suppl_1.a2311 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Guijing Wang ◽

Zefeng Zhang ◽

Carma Ayala ◽

Diane Dunet ◽

Jing Fang ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Late Effects ◽

Average Cost ◽

Hemorrhagic Stroke ◽

The United States ◽

Primary Diagnosis ◽

Secondary Diagnosis ◽

Hospitalization Costs ◽

The Impact

Background and purpose: The average cost of stroke, a leading cause of death and serious long-term disability, has been estimated to range from $468 to $146,149 worldwide, and varies 20-fold in the United States. A robust cost estimate is needed for policy makers, public health researchers and practitioners to use as a reference in making resource allocation decisions and assessing cost-effectiveness of intervention programs. This study examined the hospitalization costs of stroke using a large administrative data. Methods: We identified 97,374 hospitalizations with a primary or secondary diagnosis of stroke from pooling 2006-2008 MarketScan inpatient datasets. We investigated the costs by stratifying the hospitalizations by stroke types (hemorrhagic ICD-9 430-432, ischemic ICD-9 433-434, ill-defined ICD-9 436-437, and late-effects ICD-9 438) and diagnosis status (primary and secondary). For hospitalizations with stroke as the primary diagnosis, we identified those with a secondary diagnosis of hypertension, ischemic heart disease (IHD), and diabetes. We used multiple regression models to estimate the impact of stroke types and diagnosis status on the costs controlling age, sex, geographic region, and Charlson Comorbidity Index (CCI). Results: Of the 97,374 hospitalizations (average cost $20,396 ±23,256), the number of hospitalizations with hemorrhagic, ischemic, ill-defined, and late-effects of stroke was 16,331, 62,637, 38,312, and 14,221 with an average cost of $32,035 ±32,046, $18,963 ±21,454, $19,430 ±22,159, and $18,946±19,891, respectively. Over 61% of the hospitalizations listed stroke as a secondary diagnosis only. Regression results showed that the costs increased by at least $962 per CCI unit increase (p<0.001). Hemorrhagic stroke cost $14,499 more than ischemic stroke (p<0.001). For hospitalizations with the primary diagnosis of stroke, those with a secondary diagnosis of IHD had higher costs than those without IHD, especially among those of ischemic stroke ($9835 higher, p<0.001), while hypertension and diabetes as a secondary diagnosis lowered the costs. Hospitalizations with a primary diagnosis of ischemic stroke had $3195 lower cost than those listed as secondary diagnosis, but hospitalizations with a primary diagnosis of hemorrhagic stroke had $8001 higher cost than those listed as a secondary diagnosis. Conclusions: The costs of stroke hospitalizations were high and varied greatly by stroke types, diagnosis status, and comorbidities. Stroke types and their comorbidities should be considered when developing cost-effective strategies for stroke prevention.

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Financial Impact of Tumor Lysis Syndrome Among Inpatients in the United States

Blood ◽

10.1182/blood.v124.21.5966.5966 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5966-5966

Author(s):

Ranjan Pathak ◽

Smith Giri ◽

Madan Raj Aryal ◽

Paras Karmacharya ◽

Vijaya R. Bhatt ◽

...

Keyword(s):

Length Of Stay ◽

Nationwide Inpatient Sample ◽

Tumor Lysis Syndrome ◽

The United States ◽

Hospital Charge ◽

Hospital Charges ◽

Tumor Lysis ◽

Significant Difference ◽

The Us ◽

The Mean

Abstract Background With an estimated 0.1 million cases in 2014, lymphomas and acute leukemias are the leading causes of malignancies in the US. Tumor lysis syndrome (TLS) is a potentially devastating complication associated with hematologic malignancies leading to increased morbidity and mortality. Previous European studies have shown that the financial burden of TLS is high, with an estimated cost of 7,342 Euros ($10,320 US Dollars) per admission. However, there is a paucity of data on the economic impact of TLS among US inpatients. Methods We used the Nationwide Inpatient Sample database to identify hospitalized patients aged ≥18 years with a primary diagnosis of TLS (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 277.88) from the first year the diagnosis code was introduced (2009) to 2011. Nationwide Inpatient Sample is the largest all-payer publicly available inpatient care database in the US. It contains data from five to eight million hospital stays from about 1,000 hospitals across the country and approximates a 20% sample of all US hospitals. We calculated the mean length of stay (LOS) and mean hospital charges per TLS admission and compared them with those of overall inpatient admissions. Given that renal failure occurs in severe cases, we compared the mean LOS and hospital charge between TLS patients with and without RRT (hemodialysis or peritoneal dialysis, ICD-9-CM procedure codes 39.35 and 54.98 respectively). Data analysis was done using STATA version 13.0 (College Station, TX). Results We identified 997 admissions with TLS. Mean age was 67.5 (±3.3) with 62% males and 80.4% whites. Overall mean LOS and hospital charge for TLS during the study period was 8.02 days (SE 0.83) and $ 72,840 (SE 8,083). Both the mean LOS and hospital charge for TLS were significantly higher than overall in-patient admissions (Table 1). A total of 949 patients (95%) underwent RRT. There was no significant difference in mean LOS (9.84 days vs 7.94 days, p=0.28) and mean hospital charge ($ 88,098 vs $ 71,930, p=0.58) in patients with TLS that underwent RRT compared (95.2%, n=949) to patients that did not undergo RRT (4.8%, n=48). Conclusion Our study shows that TLS is associated with a significant economic burden, with a mean cost of $ 72,840 per TLS hospitalization. Although majority of the patients hospitalized for TLS received RRT, its use was not associated with significantly higher costs. Further studies are warranted to determine the ways of optimizing current preventive measures and to explore the drivers of increased in-hospital costs in TLS patients. Table 1 Mean LOS and Hospital Charge in TLS Admissions Compared with Overall Inpatient Admissions, 2009-2011 Year Mean LOS (days) Mean hospital charge (USD) TLS admissions Overall admissions p TLS admissions Overall admissions p 2009 13.94 4.5 0.02 104,235 30,506 0.04 2010 7.62 4.6 <0.001 69,552 32,799 <0.001 2011 7.14 4.5 <0.001 69,222 35,213 <0.001 LOS=Length of Stay; TLS=Tumor Lysis Syndrome; USD=US Dollars Disclosures No relevant conflicts of interest to declare.

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Epidemiology of Surgically Treated Abdominal Aortic Aneurysms in the United States, 1988 to 2000

Vascular ◽

10.1258/rsmvasc.12.4.218 ◽

2004 ◽

Vol 12 (4) ◽

pp. 218-224 ◽

Cited By ~ 2

Author(s):

Reid M. Wainess ◽

Justin B. Dimick ◽

John A. Cowan ◽

Peter K. Henke ◽

James C. Stanley ◽

...

Keyword(s):

United States ◽

Length Of Stay ◽

Nationwide Inpatient Sample ◽

Operative Mortality ◽

The United States ◽

Aortic Aneurysms ◽

Benchmark Data ◽

Abdominal Aortic ◽

Complex Procedure ◽

Hospital Stays

Abdominal aortic aneurysm (AAA) repair is a complex procedure about which little information exists regarding trends in surgical practice in the United States. This study was undertaken to define benchmark data regarding performance and outcomes of conventional AAA repair that might be used in comparisons with endovascular AAA repair data. Patients undergoing repair of intact ( n = 87,728) or ruptured ( n = 16,295) AAAs in the Nationwide Inpatient Sample (NIS) for 1988 to 2000 were studied. The NIS represents a 20% stratified random sample of all discharges from US hospitals. Unadjusted and case mix-adjusted analyses of in-hospital mortality and length of stay were performed. The overall frequency of intact AAA repair remained relatively stable during the study period, ranging from 18.1 to 16.3 operations/100,000 adults between 1988 and 2000, respectively. The operative mortality rate for intact AAA repair decreased significantly ( p < .001) from 6.5% in 1988 to 4.3% in 2000. Length of stay following intact AAA repair also declined significantly ( p < .001) from a median of 11 days in 1988 (interquartile range [IQR] 9-15 days) to 7 days in 2000 (IQR 5–10 days). The incidence of ruptured AAA repair decreased significantly ( p < .001) from 4.2 to 2.6 operations/100,000 adults between 1988 and 2000, respectively. Mortality for ruptured AAA repair, averaging 45.6%, did not decrease significantly during the study period. Intact AAA repair by conventional means has become increasingly safe, with decreased operative mortality and shorter hospital stays. Ruptured AAA repair by conventional means has not become safer but has decreased in incidence, suggesting possible reductions in risk factors contributing to rupture, coupled with more timely intact AAA repairs.

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Changes in Infective Endocarditis Admissions in Pennsylvania During the Opioid Epidemic

Clinical Infectious Diseases ◽

10.1093/cid/ciz1038 ◽

2019 ◽

Vol 71 (7) ◽

pp. 1664-1670 ◽

Cited By ~ 4

Author(s):

Jessica A Meisner ◽

Judith Anesi ◽

Xinwei Chen ◽

David Grande

Keyword(s):

United States ◽

Infective Endocarditis ◽

Drug Use ◽

Length Of Stay ◽

The United States ◽

Medical Advice ◽

Hospital Charges ◽

Care Hospital ◽

Against Medical Advice ◽

Opioid Crisis

Abstract Background With the current opioid crisis in the United States, infectious complications related to injection drug use are increasingly reported. Pennsylvania is at the epicenter of the opioid crisis, with the third highest rate of drug overdose deaths in the United States. Methods A retrospective cohort study was performed using the Pennsylvania Health Care Cost Containment Council database of all residents hospitalized for infective endocarditis (IE) in an acute care hospital from 1 January 2013 through 31 March 2017. Patients were separated into those with and those without substance use via diagnosis codes. The primary outcome was length of stay. Secondarily, we evaluated demographics, infection history, hospital charges, and insurance status. Results Of the 17 224 hospitalizations, 1921 (11.1%) were in patients with drug use–associated IE (DU-IE). Total quarterly IE admissions increased 20%, with a 6.5% increase in non–drug use–associated IE (non-DU-IE) admissions and a 238% increase in DU-IE admissions. In adjusted models, DU-IE was not associated with significant changes in length of stay (incidence rate ratio, 1.02; 95% confidence interval, .975–1.072; P = .36). Patients with DU-IE were predominantly insured by Medicaid (68.3% vs 13.4% for non-DU-IE), they had higher hospital charges ($86 622 vs $66 802), and they were more likely to leave against medical advice (15.7% vs 1.1%) (all P < .001). Conclusions Our study demonstrates an increase in IE admissions, driven by an increase in admissions for DU-IE. The higher charges, proportion of patients on Medicaid, and rates of leaving against medical advice among the DU-IE group shows the downstream effects of the opioid crisis.

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