Incisional Hernia in the United States: Trends in Hospital Encounters and Corresponding Healthcare Charges

2018 ◽  
Vol 84 (1) ◽  
pp. 118-125 ◽  
Author(s):  
Valeriy Shubinets ◽  
Justin P. Fox ◽  
Michael A. Lanni ◽  
Michael G. Tecce ◽  
Eric M. Pauli ◽  
...  
Keyword(s):  
United States ◽  
Adverse Events ◽  
Incisional Hernia ◽  
Private Insurance ◽  
The United States ◽  
Hospital Charges ◽  
Hospital Discharges ◽  
Serious Adverse Events ◽  
Comorbidity Index ◽  
Primary Payer

Incisional hernia (IH) is a challenging, potentially morbid condition. This study evaluates recent trends in hospital encounters associated with IH care in the United States. Using Nationwide Inpatient Sample databases from 2007 to 2011, annual estimates of IH-related hospital discharges, charges, and serious adverse events were identified. Significance in observed trends was tested using regression modeling. From 2007 to 2011, there were 583,054 hospital discharges associated with a diagnosis of IH. 81.1 per cent had a concurrent procedure for IH repair. The average discharge included a female patient (63.2%), 59.8 years of age, with either Medicare (45.3%) or Private insurance (38.3%) as the anticipated primary payer. Comparing 2007 to 2011, significant increases in IH discharges (12%; 2007 = 109,702 vs 2011 = 123,034, P = 0.009) and IH repairs (10%; 2007 = 90,588 vs 2011 = 99,622, P < 0.001) were observed. This was accompanied by a 37 per cent increase in hospital charges (2007 = $44,587 vs 2011 = $60,968, P < 0.001), resulting in a total healthcare bill of $7.3 billion in 2011. Significant trends toward greater patient age (2007 = 59.7 years vs 2011 = 60.2 years, P < 0.001), higher comorbidity index (2007 = 3.0 vs 2011 = 3.5, P < 0.001), and increased frequency of serious adverse events (2007 = 13.5% vs 2011 = 17.7%, P < 0.001) were noted. Further work is needed to identify interventions to mitigate the risk of IH development.

Serious Adverse Events Reported with Dietary Supplement Use in the United States: A 2.5 Year Experience

2018 ◽  
Vol 17 (2) ◽  
pp. 227-248 ◽  
Author(s):  
Stephen M. Schmitz ◽  
Hector L. Lopez ◽  
Douglas Mackay ◽  
Haiuyen Nguyen ◽  
Paula E. Miller
Keyword(s):  
United States ◽  
Adverse Events ◽  
Dietary Supplement ◽  
The United States ◽  
Serious Adverse Events ◽  
Supplement Use ◽  
Dietary Supplement Use

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

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.

scholarly journals The rate of smallpox vaccine-associated adverse events in the United States, and smallpox preparedness activities by the Netherlands, Germany, and WHO

2003 ◽  
Vol 7 (9) ◽  
Author(s):  
Keyword(s):  
United States ◽  
Adverse Events ◽  
Signs And Symptoms ◽  
The United States ◽  
Smallpox Vaccine ◽  
Smallpox Vaccination ◽  
Serious Adverse Events ◽  
Control And Prevention ◽  
Life Threatening ◽  
Ongoing Surveillance

The Centers for Disease Control and Prevention (CDC) and state health departments in the United States are conducting ongoing surveillance for adverse effects due to smallpox vaccine during the civilian smallpox vaccination programme (1). Out of 4213 civilian healthcare workers vaccinated between 24 January and 14 February 2003, no potentially life threatening or moderate to severe adverse events have been reported. Seven vaccine recipients were reported to have non-serious adverse events. The most common signs and symptoms were fever (n=two), rash (n=two), malaise (n=two), pruritis (n=two), hypertension (n=two), and pharyngitis (n=two) (Table).

Abstract 186: Rates and Causes of Short Term Rehospitalization Across the Spectrum of Age and Insurance Types in the United States

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Jordan B Strom ◽  
Daniel B Kramer ◽  
Yun Wang ◽  
Jason H Wasfy ◽  
Bruce E Landon ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Private Insurance ◽  
Random Effect ◽  
The United States ◽  
Charge Ratio ◽  
Hospital Charges ◽  
Hospital Discharges ◽  
Admission Source ◽  
Substance Abuse Disorders ◽  
Dual Eligible

Background: Few studies have examined rates, characteristics, and costs of 30-day readmissions across the spectrum of age and insurance. In this setting, the relative impact of non-Medicare readmissions is unknown. Methods: Discharges of patients ≥18 hospitalized for any cause 1/1/13 - 11/30/13 at 2,006 hospitals in the Nationwide Readmissions Database (NRD), an 85% sample of hospital discharges from 21 states, were included. Results were stratified by age (18-44, 45-64, ≥65) and insurance (Medicare, Medicaid, private insurance, self-pay, and unknown). Outcomes included rates of 30-day readmission, index hospitalization diagnoses associated with readmission, and total direct costs of readmissions determined using hospital charges and the NRD Cost to Charge ratio. A hierarchical logistic regression model was used to examine the association between insurance and readmission risk, adjusting for age, admission source, and Elixhauser comorbidities, including a random effect for hospital. Dual eligible patients are classified according to primary insurance in the NRD. Results: Among 12,533,551 discharges, 1,818,093 (14.5%) resulted in readmission within 30 days. Medicaid insurance was associated with the highest adjusted odds ratio (AOR) for readmission both in those ≥65 years old (AOR 1.12, 95%CI 1.10-1.14; p <0.001), and 45-64 (AOR 1.67, 95% CI 1.66-1.69; p < 0.001), and Medicare in the 18-44 group (Medicare vs. private insurance: AOR 1.99, 95% CI 1.96-2.01; p <0.001). Discharges for psychiatric or substance abuse disorders, septicemia, and heart failure accounted for the largest numbers of readmissions, 5.0%, 4.7%, and 4.6% of total readmissions, with readmission rates of 24.0%, 17.9%, 22.9% respectively ( Table ). Total costs for readmissions were 50.7 billion USD, highest for Medicare (29.6 billion USD [58%]), with non-Medicare costs exceeding 21 billion USD (42%). Conclusions: Costs of non-Medicare readmissions are large. Medicaid patients have the highest odds of readmission in individuals older than age 44, commonly due to hospitalizations for psychiatric illness and substance abuse disorders. Medicaid patients represent a population at uniquely high risk for readmission.

Herpes Zoster–Related Hospitalizations and Expenditures Before and After Introduction of the Varicella Vaccine in the United States

2008 ◽  
Vol 29 (12) ◽  
pp. 1157-1163 ◽  
Author(s):  
Mitesh S. Patel ◽  
Achamyeleh Gebremariam ◽  
Matthew M. Davis
Keyword(s):  
United States ◽  
Herpes Zoster ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Hospital Charges ◽  
Varicella Vaccination ◽  
Severe Illness ◽  
Zoster Vaccine ◽  
Hospital Discharges ◽  
Total Charges

Objective.With childhood varicella vaccination in the United States have come concerns that the incidence of herpes zoster may increase, because of diminishing natural exposure to varicella and consequent reactivation of latent varicella zoster virus. We wanted to estimate the rate of herpes zoster-related hospitalizations and the associated hospital charges before and during the promotion of varicella vaccination in the United States.Design.A retrospective study of patients from the Nationwide Inpatient Sample for the years 1993–2004 who were hospitalized due to herpes zoster infection.Methods.We searched for diagnoses of herpes zoster (using the International Classification of Diseases, Ninth Revison, Clinical Modification codes starting with 053) in all 15 diagnostic-code fields included for hospital discharges in the Nationwide Inpatient Sample during 1993–2004. We designed our analysis to examine the rates of severe illness due to herpes zoster that resulted in hospitalization, as measured by the rates of herpes zoster-related hospital discharges (HZHDs). The annual population-adjusted rate of HZHDs (per 10,000 US population) and the annual inflation-adjusted total charges for HZHDs were the primary outcomes. Secondary outcomes included mean charges for HZHDs and the distribution of total charges for HZHDs by expected primary payer. Varicella-related hospital discharges (VRHDs) were identified by use of similar diagnosis-based methods, which were described in our previous study.Results.Population-adjusted rates of HZHDs did not change significantiy from the prevaccination years (1993–1995) through the initial 5 years of the varicella vaccination period. Beginning in 2001, however, the rate of HZHDs overall began to increase, and by 2004 the overall rate was 2.5 HZHDs (95% confidence interval, 2.38–2.62) per 10,000 US population, significantly higher than any of the rates calculated during the years prior to 2002. Hospital charges for HZHDs overall increased by more than $700 million annually by 2004; in particular, we found that the herpes zoster vaccine–eligible population (ie, persons aged 60 years or older) accounted for 74% of the total annual hospital charges in 2004. The annual rate of VRHDs and the associated hospital charges decreased significantly from 1993 through 2004, but the decrease in hospitalizations and charges for VRHDs was less than the increase in hospitalizations and charges for HZHDs.Conclusions.AS the rates of VRHDs and the associated charges have decreased, there has been a significant increase in HZHDs and associated charges, disproportionately among older adults. Herpes zoster vaccine may mitigate these trends for HZHDs.

OBSERVE-5: Comparison of Etanercept-Treated Psoriasis Patients From Canada and the United States

2018 ◽  
Vol 22 (3) ◽  
pp. 297-303
Author(s):  
Kim A. Papp ◽  
Marc Bourcier ◽  
Yves Poulin ◽  
Charles W. Lynde ◽  
Martin Gilbert ◽  
...  
Keyword(s):  
United States ◽  
Adverse Events ◽  
Maintenance Dose ◽  
Management Strategies ◽  
The United States ◽  
Incidence Rates ◽  
Serious Adverse Events ◽  
End Points ◽  
Safety Outcome ◽  
Medical Interest

Background: OBSERVE-5 surveillance registry results evaluating etanercept safety and effectiveness in patients with moderate to severe psoriasis from Canada and the United States have been reported from data collected between May 2006 and December 2012. Although both countries have an identical indicated starting dose, the maintenance dose can differ and thus affect management strategies and outcomes. Objective: To compare the long-term safety and effectiveness outcomes of etanercept in the Canadian and US cohorts. Methods: Primary end points included exposure-adjusted event incidence rates of serious adverse events and serious infectious events. Secondary end points included exposure-adjusted event incidence rates of events of medical interest and efficacy outcomes. Results: Over 5 years, Canadian patients received a higher maintenance dose of etanercept (50 mg twice/week) more frequently than those from the United States. Safety outcome comparisons revealed that Canadian patients had a significantly lower occurrence of serious adverse events than patients from the United States, with an overall exposure-adjusted event incidence rate per 100 patient-years of 4.46 (95% confidence interval [CI], 3.05-6.29) vs 7.76 (95% CI 7.04-8.54), respectively. Serious infectious event rates were not significantly different between the 2 countries. Secondary outcomes of events of medical interest and effectiveness also did not reveal significant differences between the 2 cohorts. Conclusion: After 5 years of etanercept use, safety and effectiveness outcomes were similar between patients from Canada and the United States, with the exception of a significantly lower rate of serious adverse events in the Canadian population.

scholarly journals Safety of Delafloxacin: Focus on Adverse Events of Special Interest

2018 ◽  
Vol 5 (10) ◽  
Author(s):  
Thomas Lodise ◽  
Ralph Corey ◽  
David Hooper ◽  
Sue Cammarata
Keyword(s):  
United States ◽  
Adverse Events ◽  
Special Interest ◽  
Clinical Studies ◽  
The United States ◽  
Phase Iii ◽  
Serious Adverse Events ◽  
Resistant Strains ◽  
Primary Focus ◽  
Additional Support

Abstract Background Fluoroquinolones have been widely used for a variety of Gram-positive and Gram-negative infections, and by 2002 they had become the most commonly prescribed class of antibiotics for adults in the United States. With widespread use, the class has become associated with a range of adverse events. Delafloxacin is a fluoroquinolone approved in the United States for the treatment of adults with acute bacterial skin and skin structure infections (ABSSSIs). Delafloxacin is differentiated from other fluoroquinolones due to structural differences and in its activity against methicillin-resistant Staphylococcus aureus, including quinolone-resistant strains. This paper reviews the safety profile of delafloxacin across clinical studies with an emphasis on the incidence of adverse events of special interest that are associated with fluoroquinolones. Methods Data from 2 completed phase III studies of delafloxacin for the treatment of ABSSSIs were pooled and are the primary focus of this paper. Additional support from the full safety analysis set (30 completed phase I to phase III clinical studies) is included where applicable. Results Fewer patients in the pooled delafloxacin group had AESIs than in the comparator group (7.0% vs 9.2%, respectively). Delafloxacin had a low rate of discontinuations due to treatment-related adverse events (&lt;1%). Serious adverse events occurred at similar rates in patients treated with delafloxacin vs comparators. Conclusions Serious adverse events occurred at similar rates in patients treated with delafloxacin vs nonquinolone comparators used to treat ABSSSIs. Clinicaltrials.gov identifier NCT01984684 and NCT01811732

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