Abstract TP322: The Selection of Enteral Nutrition in Stroke Influence on In-Hospital Infection Control and Hospital Cost

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Hidetaka Onodera ◽  
Takuma Mogamiya ◽  
Shinya Matsushima ◽  
Kimiyuki Kawaguchi ◽  
Taigen Sase ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Hospital Stay ◽  
Acute Phase ◽  
Hospital Costs ◽  
Liquid Diet ◽  
Hospital Infection ◽  
Stroke Patients ◽  
The Mean ◽  
The Impact ◽  
Selection Of

Background: Infection is a common complication after stroke and is strongly associated with an unfavorable functional outcome of patients. Although nutritional intervention reduces the risk of post-operative infection, the impact of differences of products has not been clarified. Less examination of infection and use of antibiotics not only show a high-quality care. In DPC hospital (Japanese style of DRG / PPS), it is important from the hospital management point of view to reduce the comprehensive costs such as medicines and inspections as much as possible. The purpose of this study is to investigate whether the selection of enteral nutrition in the acute phase of stroke patients can contribute to inflectional control and hospital costs. Methods: Retrospective analysis in a single center was performed in 50 acute stroke patients who were received enteral nutrition from April 2017 to March 2019. Nutrients gradually over 7 days of hospitalization, the patients were classified into two groups: 1.0-group (general nutrition 1.0 kcal/mL, 25 patients) and 1.5+α-group (started with high protein whey peptide-digested liquid diet (1.5 kcal/mL) and were, later, switched to highly fermentable dietary fiber contained liquid diet (1.5 kcal/mL) after 4 days, 25 patients). Lengths of hospital stay, days of antibiotic use (except during intraoperative), serious infection including methicillin-resistant Staphylococcus aureus , Extended spectrum β -lactamase producing Enterobacteriaceae and Clostridium difficile infection, and total medical costs were analyzed. Results: The baseline characteristics were similar in the both groups. The mean of lengths of hospital stay were 48.0 and 47.8 days in 1.0-group and 1.5+α-group, respectively. The mean of days of antibiotics use during hospitalization in 1.0-group (16.5 days (34.4%)) were larger than that in 1.5+α-group (11.3 days (23.6%)). The serious infections were developed in six and four cases in 1.0-group and 1.5+α-group, respectively. The total hospital costs were reduced by approximately 500 USD/patient in 1.5+α group as compared to 1.0 group. Conclusions: The selection of enteral nutrition in the acute phase of stroke patients affects the risk of in-hospital infection and reduces hospital costs.

Propensity-adjusted cost analysis of radial versus femoral access for neuroendovascular procedures

2020 ◽  
pp. neurintsurg-2020-016728
Author(s):  
Joshua S Catapano ◽  
Andrew F Ducruet ◽  
Stefan W Koester ◽  
Tyler S Cole ◽  
Jacob F Baranoski ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Diagnostic Procedures ◽  
Femoral Access ◽  
Catheter Size ◽  
The Mean ◽  
The Difference ◽  
Procedure Type ◽  
Angiographic Findings

BackgroundTransradial artery (TRA) access for neuroendovascular procedures is associated with fewer complications than transfemoral artery (TFA) access. This study compares hospital costs associated with TRA access to those associated with TFA access for neurointerventions.MethodsElective neuroendovascular procedures at a single center were retrospectively analyzed from October 1, 2018 to May 31, 2019. Hospital costs for each procedure were obtained from the hospital financial department. The primary outcome was the difference in the mean hospital costs after propensity adjustment between patients who underwent TRA compared with TFA access.ResultsOf the 338 elective procedures included, 63 (19%) were performed through TRA versus 275 (81%) through TFA access. Diagnostic procedures were more common in the TRA cohort (51 of 63, 81%) compared with the TFA cohort (197 of 275, 72%), but the difference was not significant (p=0.48). The TRA cohort had a shorter length of hospital stay (mean (SD) 0.3 (0.5) days) compared with the TFA cohort (mean 0.7 (1.3) days; p=0.02) and lower hospital costs (mean $12 968 ($6518) compared with the TFA cohort (mean $17 150 ($10 946); p=0.004). After propensity adjustment for age, sex, symptoms, angiographic findings, procedure type, sheath size, and catheter size, TRA access was associated with a mean hospital cost of $2514 less than that for TFA access (95% CI −$4931 to −$97; p=0.04).ConclusionNeuroendovascular procedures performed through TRA access are associated with lower hospital costs than TFA procedures. The lower cost is likely due to a decreased length of hospital stay for TRA.

scholarly journals P129 THORACIC VS. ABDOMINAL APPROACHES FOR DIAPHRAGMATIC HERNIA REPAIR: A NATIONWIDE STUDY OF CLINICAL OUTCOMES

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Andrea Carolina Quiroga Centeno ◽  
Orlando Navas ◽  
Juan Paulo Serrano ◽  
Sergio Alejandro Gómez Ochoa
Keyword(s):  
Hospital Stay ◽  
Diaphragmatic Hernia ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Surgical Approaches ◽  
Multivariate Logistic Regression Model ◽  
Abdominal Repair ◽  
Lower Health ◽  
The Impact

Abstract Aim “To compare the outcomes of different surgical approaches for diaphragmatic hernia (DH) repair.” Material and Methods “Adult patients with a principal admitting diagnosis of uncomplicated DH registered in the National Inpatient Sample in the period 2010-2015 were included. Patients with obstruction, gangrene, or congenital hernias were excluded. The primary outcome was in-hospital mortality. Secondary outcomes were the incidence of complications, length of stay, and hospital charges. A multivariate logistic regression model adjusted by age, sex, elective admission, comorbidities, and hospital characteristics was used to analyze the impact of the surgical approach on the evaluated outcomes.” Results “A total of 14910 patients with DH were included (median age 65 years, 74% women). Abdominal approaches were the most commonly performed (78.9% laparoscopy and 13.6% open). Patients that underwent open abdominal and thoracic repairs had a higher risk of complications (sepsis, pneumonia, surgical site infection, prolonged postoperative ileus, and acute myocardial infarction), longer hospital stay, higher total hospital costs, and a significantly higher risk of mortality (OR 2.62. 95% CI 1.59-4.30 and OR 4.60; 95% CI 2.37-8.91, respectively) compared to patients that underwent laparoscopic abdominal repair. Individuals whose DH repair was performed through thoracoscopy had a similar mortality risk to those who underwent laparoscopic abdominal repair (OR 0.87; 95% CI 0.11-6.43).” Conclusions “Nowadays, laparoscopy has become the most used approach for DH repair. In the present cohort, it was associated with better outcomes in terms of complications, length of hospital stay, and mortality, as well as lower health costs. Additional studies assessing hernia characteristics are required to validate this result.”

scholarly journals In hospital cost assessment and prevalence of Total Hip Arthroplasty in China: A 10-years real-world study

2020 ◽  
Author(s):  
Mingcheng Yuan ◽  
Hirose Shakya ◽  
Hao-Yang Wang ◽  
Zhenyu Luo ◽  
Ke Xiao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Hospital Cost ◽  
Hospital Costs ◽  
Labor Cost ◽  
Total Charge ◽  
Strongly Correlated ◽  
Total Hip ◽  
The Mean

Abstract Background: The rising costs of total hip arthroplasty (THA) have resulted in a substantial economic burden to the people of China and Chinese health-care system. The objective of this study was to assess the in-hospital costs associated with primary total hip arthroplasty and efforts to contain these costs by ascertaining factors responsible for the rise in cost.Methods: In-hospital costs of 8111 patients (3878 male and 42337female) who underwent elective primary unilateral hip arthroplasty were extracted from our institution between January 2009 and December 2018 and reviewed. The number of yearly procedures was recorded. All hospital related charges were categorized into 9 groups based on hospital-based supplies and services. The correlation between total in hospital cost and 9 groups were assessed using Pearson’s coefficient. The same method was used for correlating hospital stay and bed charge.Results: The substantial rise in yearly procedure volume was observed. The number of procedures had risen from 306 in 2009 to 1024 in 2018, an incidence increased by more than threefold. The average cost for THAs procedure was ¥53468.03 ± 4833 in 2009 that rose by approximately 10% in 2018 (¥58593.62 ± 4801). The mean cost observed over the study period was ¥62980.21 ± 6314.673. The charges analyzed in all categories expect the hospital bed cost increased during the study period. The joint implant was the most expensive supply item contributing ~ 75% of the total in-hospital cost. Labor cost covered only ~ 10% and bed charge 0.93% of the total charge. The rise in total in-hospital cost strongly correlated with increase in implant cost (Pearson’s correlation (r) = 0.908, α > 0.05). The mean total hospital stays declined from 16.11 ± 8.19 days in 2009 to 6.13 ± 2.65 days in 2018. The mean post-operative stay had also reduced from 9.12 ± 4.88 to a third (3.01 ± 1.80) during the same period. The hospital cost and bed charge also strongly correlated (r = 0.931, α > 0.05)Conclusions: The number of hip arthroplasty procedures performed annually in China is growing rapidly. An incidence rose by threefold over 10-year period in the present study and we predict an unprecedented rise in the incidence in coming years due to an aging population and improving economic conditions in China. The hospital stay was significantly reduced and early discharge within 3 days postoperatively was a noteworthy outcome. Implant cost remained the largest single expense. As a result, some patients who are medical candidates for total joint arthroplasty, may not have access to care due to relatively high financial barrier. Hence it is important to note that significant patient benefits may be realized by efforts to reduce the cost of the prosthesis in China.

scholarly journals Can point-of-care testing shorten hospitalization length of stay? An exploratory investigation of infectious agents using regression modelling

2018 ◽  
Vol 25 (4) ◽  
pp. 1606-1617
Author(s):  
Eliona Gkika ◽  
Anna Psaroulaki ◽  
Yannis Tselentis ◽  
Emmanouil Angelakis ◽  
Vassilis S Kouikoglou
Keyword(s):  
Length Of Stay ◽  
Infectious Diseases ◽  
Hospital Stay ◽  
Point Of Care ◽  
Length Of Hospital Stay ◽  
Laboratory Diagnosis ◽  
Final Diagnosis ◽  
Point Of Care Testing ◽  
The Mean ◽  
The Impact

This retrospective study investigates the potential benefits from the introduction of point-of-care tests for rapid diagnosis of infectious diseases. We analysed a sample of 441 hospitalized patients who had received a final diagnosis related to 18 pathogenic agents. These pathogens were mostly detected by standard tests but were also detectable by point-of-care testing. The length of hospital stay was partitioned into pre- and post-laboratory diagnosis stages. Regression analysis and elementary queueing theory were applied to estimate the impact of quick diagnosis on the mean length of stay and the utilization of healthcare resources. The analysis suggests that eliminating the pre-diagnosis times through point-of-care testing could shorten the mean length of hospital stay for infectious diseases by up to 34 per cent and result in an equal reduction in bed occupancy and other resources. Regression and other more sophisticated models can aid the financing decision-making of pilot point-of-care laboratories in healthcare systems.

The Role of Unions in Hospital Cost Inflation

ILR Review ◽  
1984 ◽  
Vol 37 (2) ◽  
pp. 252-262 ◽  
Author(s):  
Frank A. Sloan ◽  
Killard W. Adamache
Keyword(s):  
Health Insurance ◽  
Hospital Cost ◽  
Hospital Costs ◽  
Hospital Workers ◽  
Worker Productivity ◽  
Worker Compensation ◽  
The Mean ◽  
The Impact

This study examines the impact of unions on worker compensation and total costs in hospitals, both in specific departments and in the hospital as a whole. An analysis of data for 367 hospitals for the years 1974 and 1977 shows that unions raised the mean compensation of hospital workers by 8.8 percent without producing offsetting increases in worker productivity. Thus, unions do increase hospital costs, although far less than health insurance and other factors do.

The Impact of the Day of the Week and Month of Admission on the Length of Hospital Stay in Stroke Patients

2003 ◽  
Vol 16 (3) ◽  
pp. 247-252 ◽  
Author(s):  
Wolf-Peter Schmidt ◽  
Dirk Taeger ◽  
Hans-Joachim Buecker-Nott ◽  
Klaus Berger
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Stroke Patients ◽  
Day Of The Week ◽  
The Impact

Relationship Between Time from Ambulance Call to Arrival at Emergency Center and Level of Consciousness at Admission in Severe Stroke Patients

2012 ◽  
Vol 28 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Kazuhiro Ohwaki ◽  
Takehiro Watanabe ◽  
Takayuki Shinohara ◽  
Tadayoshi Nakagomi ◽  
Eiji Yano
Keyword(s):  
Clinical Information ◽  
Stroke Patients ◽  
Publication Type ◽  
Emergency Center ◽  
Severe Stroke ◽  
Level Of Consciousness ◽  
The Mean ◽  
Prehospital Delays ◽  
The Impact ◽  
Mean Time

AbstractIntroductionTimely access to acute medical treatment can be critical for patients suffering from severe stroke. Little information is available about the impact of prehospital delays on the clinical conditions of stroke patients, but it is possible that prehospital delays lead to neurological deterioration. The aim of this study was to examine the impact of prehospital delays related to emergency medical services on the level of consciousness at admission in patients with severe stroke.MethodsThis retrospective study assessed 712 consecutive patients diagnosed with cerebrovascular diseases who were admitted to an intensive care unit in Tokyo, Japan, from April 1998 through March 2008. Data, including the time from the call to the ambulance service to the arrival of the ambulance at the patient location (on-scene), and the time from the arrival of the ambulance on-scene to its arrival at the emergency center were obtained. The following demographic and clinical information also were obtained from medical records: sex, age, and Glasgow Coma Scale (GCS) score at admission.ResultsThe mean time from ambulance call to arrival on-scene was 7 (SD=3) minutes, and the mean time from ambulance call to arrival at the center was 37 (SD=8) minutes. A logistic regression model for predicting GCS scores of 3 and 4 at admission was produced. After adjusting for sex, age, and time from arrival on-scene to arrival at the center, a longer call-to-on-scene time was significantly associated with poor GCS scores (OR = 1.056/min; 95% confidence interval, [CI] = 1.008-1.107). After adjusting for sex and age, a longer call-to-arrival at the center time also was significantly associated with poor GCS scores (OR = 1.020; 95% CI = 1.002-1.038).ConclusionsPrehospital delays were significantly associated with decreased levels of consciousness at admission in patients suffering from a stroke. As level of consciousness is the strongest predictor of outcome, reducing prehospital delays may be necessary to improve the outcomes in patients with severe stroke.OhwakiK, WatanabeT, ShinoharaT, NakagomiT, YanoE. Relationship between time from ambulance call to arrival at emergency center and level of consciousness at admission in severe stroke patients. Prehosp Disaster Med. 2012;28(1):1-4.

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.

scholarly journals The Impact of Preemptive Perianal Anaesthetic Block in Open Haemorrhoidectomy – a randomised controlled trial

2021 ◽  
Vol 15 (9) ◽  
pp. 2165-2167
Author(s):  
Wajeeha I. Andrabi ◽  
M Asadullah Khawaja ◽  
K. Fatima ◽  
S I. Hussain Andrabi ◽  
A. Shafique ◽  
...  
Keyword(s):  
Placebo Group ◽  
Hospital Stay ◽  
Pain Intensity ◽  
P Value ◽  
Open Hemorrhoidectomy ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
The Impact ◽  
Mean Time

Background: the study was conducted to analyze the efficacy of 0.75% ropicaine at perianal block for open haemrrhoidectomy with regards to pain intensity, first demand of analgesia and hospital stay. Method: 50 patients were selected for open haemrrhoidectomy under GA which were divided into two groups.it was a randomized control trial in which sealed envelope method was used for the group delegation in which Group A was designated to the patients having the perianal block with 0.75% ropivacaine while the group B was the placebo group having normal saline injected in the perianal region. The variables compared were the first demand of analgesia, pain intensity and the duration of the hospital stay. In order to make the site of injection more authentic the injections were sited under ultrasound guidance. Results: The pain intensity which was analyzed with the visual analogue score (VAS) had a median of 3.8 (high=6, low=3) in group A while 5.5 (high=8, low=4) in the Group B with the p value of < 0.05. The mean time recorded for the first demand of analgesia was 6.20 ± 1.20 hours in the Group A which had improved from 1.20 ± 1.0 hours in the Placebo Group while the p value was < 0.001, while the mean time of hospital stay got reduced from 22.5±3.30 hours to 12.4 ± 3.10 hours with the significant p value of < 0.002. Conclusion: It was observed that with preemptive analgesia with 0.75% ropivacaine administered led to a substantial reduction in pain perception, request for an analgesic and hospital stay. Therefore it is appropriate to administer it before open hemorrhoidectomy. Keywords: preemptive anaesthesia, local anesthesia, postoperative pain, ropivacaine, open hemorrhoidectomy

scholarly journals Optimization of the PNG Law for a Dual-Spin Mortar with Fixed Canards

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Pengfei Liu ◽  
Hongsong Cao ◽  
Shunshan Feng ◽  
Hengzhu Liu ◽  
Lifei Cao
Keyword(s):  
Empirical Method ◽  
Impact Point ◽  
Gravity Compensation ◽  
Proportional Navigation ◽  
Squared Error ◽  
Intelligent Optimization Algorithm ◽  
The Mean ◽  
Optimization Schemes ◽  
The Impact ◽  
Selection Of

The limited instantaneous overload available and the curved trajectory lead to adaptivity problems for the proportional navigation guidance (PNG) of a guided mortar with a fixed-canard trajectory correction fuze. In this paper, the optimization of a PNG law with gravity compensation is established. Instead of using the traditional empirical method, the selection of the proportional navigation constants is formulated as an optimization problem, which is solved using an intelligent optimization algorithm. Two optimization schemes are proposed for constructing corresponding optimization models. In schemes 1 and 2, the sum squared error between the impact point and target and the circular error probability (CEP), respectively, are taken as the objective function. Monte Carlo simulations are conducted to verify the effectiveness of the two optimization schemes, and their guidance performance is compared through trajectory simulations. The simulation results show that the impact point dispersion can be efficiently reduced under both proposed schemes. Scheme 2 achieves a lower CEP, which is approximately 2.9 m and 2.4 times smaller than that achieved by scheme 1. Moreover, the mean impact point is closer to the target.

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