Abstract WP370: Inpatient Outcomes and Resource Utilization Among Patients With Large Hemispheric Infarction Who Developed Cerebral Edema: An Analysis of U.S. Real-World Data

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shih-Yin Chen ◽  
Philippe Thompson-Leduc ◽  
Robert N Sawyer ◽  
Monica Macheca ◽  
Iman Fakih ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Resource Utilization ◽  
Cerebral Edema ◽  
Real World ◽  
Infarct Volume ◽  
Hospital Charges ◽  
Published Data ◽  
Icu Admission ◽  
Inpatient Outcomes ◽  
Hemispheric Infarction

Introduction: Patients with large hemispheric infarction (LHI) may suffer from life-threatening complications, including cerebral edema. Published data among these patients in real-world settings are limited. This study describes inpatient outcomes and resource utilization associated with cerebral edema among hospitalized patients with LHI. Methods: A retrospective cohort study was conducted using the MarketScan Hospital Drug Database (2015Q3-2017Q4). As infarct volume is not captured in the data, patients were included based on diagnosis codes for infarction of the middle cerebral artery or carotid artery, which are most closely associated with LHI. Within this group, cerebral edema was determined based on a diagnosis code of cerebral edema (ICD-10-CM G93.6) or herniation (G93.5), or a craniectomy procedure. Logistic regressions, comparing patients with edema vs. those without edema, were used to estimate the odds ratio of death, ICU admission, and tracheostomy/intubation during the hospital stay. Linear regression models were used to estimate the mean difference in length of hospital stay, length of ICU stay, and hospital charges. All models controlled for age, sex, and admission type. Results: A total of 11,772 patients were designated as likely LHI cases; 869 (7%) were identified with cerebral edema. Table 1 compares inpatient outcomes and resource utilization in patients with vs. without cerebral edema. Patients with cerebral edema had significantly higher odds of death, ICU admission and tracheostomy/intubation. They also had longer hospital stays, longer stays in the ICU, and higher hospital charges. Conclusion: This study provides evidence in a real-world setting, highlighting the substantial clinical and economic burden associated with cerebral edema among patients hospitalized with LHI. Given the unmet needs, management strategies and interventions focusing on reducing cerebral edema among patients with LHI are warranted.

Abstract P267: Healthcare Resource Utilization and Costs of US Patients With Possible Large Hemispheric Infarction: A Real-World Assessment of Burden Associated With Cerebral Edema

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nicole Tsao ◽  
Qiang Hou ◽  
Shih-Yin Chen ◽  
Steven MESSE
Keyword(s):  
Resource Utilization ◽  
Cerebral Edema ◽  
Resource Use ◽  
Real World ◽  
Linear Models ◽  
Healthcare Resource ◽  
Cerebral Arteries ◽  
Index Hospitalization ◽  
Post Discharge ◽  
Hemispheric Infarction

Introduction: Severe cerebral edema further compromises survival and functional outcomes in patients suffering from large hemispheric infarction (LHI). This study aims to compare the healthcare resource use and costs during the acute hospitalization and post-discharge, in a cohort of US patients with possible LHI with and without cerebral edema (CED). Methods: Using IBM MarketScan Commercial, Medicaid, and Medicare databases (2016Q1-2018Q4), a cohort of patients aged 18-85 were identified using ICD10 codes for hospitalization due to occlusion of the carotid or middle cerebral arteries, which are most closely associated with LHI. We classified patients with ICD10 codes G93.5 (compression of brain), G93.6 (cerebral edema), or a craniectomy procedure as having had CED. In addition to the inpatient resource use and outcomes, annualized frequency of resource utilization and costs during the follow-up period were reported in those who survived and continued to be enrolled in their health plan post-index hospitalization. Logistic regression was used to estimate the odds ratio of mortality, generalized linear models for mean in healthcare utilization and costs between those with and without CED, adjusting for age, sex, and comorbidity. Results: Of the 7,336 commercial, 1,946 Medicaid, and 5,015 Medicare patients with possible LHI, we found 7.8%, 6.9%, and 4.3% had CED, respectively. Those with CED had higher length of stay, mortality, and costs during the index hospitalization across the populations examined (Table). CED was also consistently associated with higher post-discharge resource utilization and costs in the commercially-insured population (Table). Conclusions: This real-world evidence from private and public health plans highlights the substantial clinical and economic burden during the index hospitalization and post-discharge in patients who develop cerebral edema after LHI.

Outcomes and resource use of patients with large hemispheric infarction and cerebral edema: analysis of real-world data

2021 ◽  
pp. 1-8
Author(s):  
Shih-Yin Chen ◽  
Philippe Thompson-Leduc ◽  
Robert N. Sawyer ◽  
Iman Fakih ◽  
Hoi Ching Cheung ◽  
...  
Keyword(s):  
Cerebral Edema ◽  
Resource Use ◽  
Real World ◽  
Real World Data ◽  
World Data ◽  
Hemispheric Infarction

scholarly journals Neurological Critical Care Services’ Influence Following Large Hemispheric Infarction and Their Impact on Resource Utilization

2018 ◽  
Vol 4 (1) ◽  
pp. 5-11
Author(s):  
Syed Omar Shah ◽  
Yu Kan Au ◽  
Fred Rincon ◽  
Matthew Vibbert
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Resource Utilization ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Residual Variance ◽  
Total Hospital ◽  
Over Time ◽  
Hemispheric Infarction

AbstractIntroduction:Acute ischemic stroke (AIS) is the fourth leading cause of death in the US. Numerous studies have demonstrated the use of comprehensive stroke units and neurological intensive care units (NICU) in improving outcomes after stroke. We hypothesized that an expanded neurocritical care (NCC) service would decrease resource utilization in patients with LHI.Methods:Retrospective data from consecutive admissions of large hemispheric infarction (LHI) patients requiring mechanical ventilation were acquired from the hospital medical records. Between 2011-2013, there were 187 consecutive patients admitted to the Jefferson Hospital for Neuroscience (Philadelphia, USA) with AIS and acute respiratory failure. Our intention was to determine the number of tracheostomies done over time. The primary outcome measure was the number of tracheostomies over time. Secondary outcomes were, ventilator-free days (Vfd), total hospital charges, intensive care unit length of stay (ICU-LOS), and total hospital length of stay (hospital-LOS), including ICU LOS. Hospital charges were log-transformed to meet assumptions of normality and homoscedasticity of residual variance terms. Generalized Linear Models were used and ORs and 95% CIs calculated. The significance level was set at α = 0.05.Results: Of the 73 patients included in this analysis, 33% required a tracheostomy. There was a decrease in the number of tracheostomies undertaken since 2011. (OR 0.8; 95% CI 0.6-0.9: p=0.02).Lower Vfd were seen in tracheostomized patients (OR 0.11; 95%CI 0.1-0.26: p<0.0001). The log-hospital charges decreased over time but not significantly (OR 0.9; 95%CI 0.78-1.07: p=0.2) and (OR 0.99; 95%CI 0.85-1.16: p=0.8) from 2012 to 2013 respectively.The ICU-LOS at 23 days vs 10 days (p=0.01) and hospital-LOS at 33 days vs 11 days (p=0.008) were higher in tracheostomized patients.Conclusion: The data suggest that in LHI-patients requiring mechanical ventilation, a dedicated NCC service reduces the overall need for tracheostomy, increases Vfd, and decreases ICU and hospital-LOS.

Impact of failure to thrive on inpatient mortality and resource utilization in patients with head and neck cancer: A nationwide analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18531-e18531
Author(s):  
Binav Baral ◽  
Prasanth Lingamaneni ◽  
Fred R. Rosen ◽  
Trilok Shrivastava ◽  
Krishna Rekha Moturi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head And Neck Cancer ◽  
Hospital Stay ◽  
Head And Neck ◽  
Resource Utilization ◽  
Neck Cancer ◽  
Temporal Trends ◽  
Failure To Thrive ◽  
Hospital Charges ◽  
Inpatient Mortality

e18531 Background: Failure to thrive (FTT), encompassing malnutrition and cachexia, is a common comorbidity afflicting Head and Neck cancer (HNC), brought about either by progression of disease or complications of treatment. FTT can exacerbate infections or cytopenias and delay wound healing, and has shown to affect survival in HNC. This study aims to explore the effects of FTT on mortality and resource utilization among hospitalized patients with HNC. Methods: Adult patients with HNC admitted from 2012-2017 were identified from the Nationwide Inpatient Sample database. Temporal trends of resource utilization across six years were evaluated. Multivariable logistic regression was used to evaluate risk factors for malnutrition and mortality in patients with HNC. Results: A total of 448,255 patients met inclusion criteria, of which 27.2% had FTT. Mean age was 66.3 years. Patients were predominantly male (71.8%) and white (70.4%). Patients with FTT had higher mortality (6.3% vs. 3.6%, p<0.0001), longer hospital stay (9.1 vs. 5.7 days, p<0.0001) and higher hospital charges ($23k vs. $18k, p<0.0001). On multivariate analysis, risk factors for FTT included male sex, African American (AA) race and higher comorbidity burden. After adjusting for confounders, patients with FTT had higher inpatient mortality (OR 1.71, 95% CI 1.60-1.83, p<0.001). There is an increasing trend of FTT in HNC over the years, from 22.7% to 32.6% (p trend <0.001). Temporal trends in mortality, length of stay and hospital charges in those with FTT did not change significantly. Conclusions: Patients with HNC and FTT had higher inpatient mortality than those without FTT. AA patients especially were at higher risk of FTT. Inpatients with HNC and FTT had longer mean hospital stay by 3 days incurring higher healthcare costs. The study highlights an under acknowledged paradigm in HNC care and warrants further steps towards more vigilant nutritional surveillance and interventions, such as early/prophylactic enteral feeding in HNC patients. This could greatly improve quality of life and objective outcomes in HNC patients. [Table: see text]

scholarly journals SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323364
Author(s):  
Sanjay Pandanaboyana ◽  
John Moir ◽  
John S Leeds ◽  
Kofi Oppong ◽  
Aditya Kanwar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Organ Failure ◽  
Collaborative Study ◽  
Length Of Hospital Stay ◽  
Secondary Outcome ◽  
Icu Admission ◽  
Local Complications ◽  
Persistent Organ Failure ◽  
Increased Risk

ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

scholarly journals The healthcare costs of antimicrobial resistance in Lebanon: a multi-centre prospective cohort study from the payer perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katia Iskandar ◽  
Christine Roques ◽  
Souheil Hallit ◽  
Rola Husni-Samaha ◽  
Natalia Dirani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antimicrobial Resistance ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Prospective Cohort ◽  
Healthcare Costs ◽  
Hospital Charges ◽  
Resistant Bacteria ◽  
Matched Cohort ◽  
Payer Perspective

Abstract Background Our aim was to examine whether the length of stay, hospital charges and in-hospital mortality attributable to healthcare- and community-associated infections due to antimicrobial-resistant bacteria were higher compared with those due to susceptible bacteria in the Lebanese healthcare settings using different methodology of analysis from the payer perspective . Methods We performed a multi-centre prospective cohort study in ten hospitals across Lebanon. The sample size consisted of 1289 patients with documented healthcare-associated infection (HAI) or community-associated infection (CAI). We conducted three separate analysis to adjust for confounders and time-dependent bias: (1) Post-HAIs in which we included the excess LOS and hospital charges incurred after infection and (2) Matched cohort, in which we matched the patients based on propensity score estimates (3) The conventional method, in which we considered the entire hospital stay and allocated charges attributable to CAI. The linear regression models accounted for multiple confounders. Results HAIs and CAIs with resistant versus susceptible bacteria were associated with a significant excess length of hospital stay (2.69 days [95% CI,1.5–3.9]; p < 0.001) and (2.2 days [95% CI,1.2–3.3]; p < 0.001) and resulted in additional hospital charges ($1807 [95% CI, 1046–2569]; p < 0.001) and ($889 [95% CI, 378–1400]; p = 0.001) respectively. Compared with the post-HAIs analysis, the matched cohort method showed a reduction by 26 and 13% in hospital charges and LOS estimates respectively. Infections with resistant bacteria did not decrease the time to in-hospital mortality, for both healthcare- or community-associated infections. Resistant cases in the post-HAIs analysis showed a significantly higher risk of in-hospital mortality (odds ratio, 0.517 [95% CI, 0.327–0.820]; p = 0.05). Conclusion This is the first nationwide study that quantifies the healthcare costs of antimicrobial resistance in Lebanon. For cases with HAIs, matched cohort analysis showed more conservative estimates compared with post-HAIs method. The differences in estimates highlight the need for a unified methodology to estimate the burden of antimicrobial resistance in order to accurately advise health policy makers and prioritize resources expenditure.

scholarly journals Neuroprotective mechanisms of erythropoietin in a rat stroke model

2020 ◽  
Vol 11 (1) ◽  
pp. 48-59
Author(s):  
Martin Juenemann ◽  
Tobias Braun ◽  
Nadine Schleicher ◽  
Mesut Yeniguen ◽  
Patrick Schramm ◽  
...  
Keyword(s):  
Blood Flow ◽  
Infarct Size ◽  
Cerebral Edema ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Lesion Volume ◽  
Ischemic Lesion ◽  
Human Erythropoietin ◽  
Male Wistar Rats ◽  
Cerebral Artery Occlusion

AbstractObjectiveThis study was designed to investigate the indirect neuroprotective properties of recombinant human erythropoietin (rhEPO) pretreatment in a rat model of transient middle cerebral artery occlusion (MCAO).MethodsOne hundred and ten male Wistar rats were randomly assigned to four groups receiving either 5,000 IU/kg rhEPO intravenously or saline 15 minutes prior to MCAO and bilateral craniectomy or sham craniectomy. Bilateral craniectomy aimed at elimination of the space-consuming effect of postischemic edema. Diagnostic workup included neurological examination, assessment of infarct size and cerebral edema by magnetic resonance imaging, wet–dry technique, and quantification of hemispheric and local cerebral blood flow (CBF) by flat-panel volumetric computed tomography.ResultsIn the absence of craniectomy, EPO pretreatment led to a significant reduction in infarct volume (34.83 ± 9.84% vs. 25.28 ± 7.03%; p = 0.022) and midline shift (0.114 ± 0.023 cm vs. 0.083 ± 0.027 cm; p = 0.013). We observed a significant increase in regional CBF in cortical areas of the ischemic infarct (72.29 ± 24.00% vs. 105.53 ± 33.10%; p = 0.043) but not the whole hemispheres. Infarct size-independent parameters could not demonstrate a statistically significant reduction in cerebral edema with EPO treatment.ConclusionsSingle-dose pretreatment with rhEPO 5,000 IU/kg significantly reduces ischemic lesion volume and increases local CBF in penumbral areas of ischemia 24 h after transient MCAO in rats. Data suggest indirect neuroprotection from edema and the resultant pressure-reducing and blood flow-increasing effects mediated by EPO.

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