scholarly journals Potential Opioid-Related Adverse Drug Events Are Associated With Decreased Revenue in Hip Replacement Surgery in the Older Population

2020 ◽  
Vol 11 ◽  
pp. 215145932091532
Author(s):  
Justin Baker ◽  
Ethan Y. Brovman ◽  
Nikhilesh Rao ◽  
Sascha S. Beutler ◽  
Richard D. Urman
Keyword(s):  
Risk Factors ◽  
Hip Replacement ◽  
Older Patients ◽  
Adverse Drug Events ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Hospital Revenue ◽  
The Mean

Introduction: Opioid-related adverse drug events (ORADEs) are an increasingly recognized complication associated with the common prescription of opioids after orthopedic surgery. In this study, we attempted to understand how potential ORADEs following hip replacement surgery in older patients affected hospital length of stay, hospital revenue, and their association with specific risk factors and clinically relevant diseases occurring during hospitalization. Methods: We conducted a retrospective study using the Centers for Medicare and Medicaid Services Administrative Database to analyze Medicare discharges after hip replacement surgery to identify potential ORADEs. The impact of potential ORADEs on mean hospital length of stay (LOS) and hospital revenue was analyzed. Results: The potential ORADE rate in patients who underwent hip replacement surgery was 8.6%. The mean LOS for discharges with a potential ORADE was 1.41 days longer than that for discharges without an ORADE. The mean hospital revenue per day with a potential ORADE was US$1708 less than without an ORADE. Potential ORADEs were also found to be strongly associated with poor patient outcomes such as pneumonia, septicemia, and shock. Discussion: Potential ORADEs in hip replacement surgery in older patients are associated with longer hospitalizations, decreased hospital revenue per day, certain patient risk factors, and clinically relevant diseases occurring during hospitalizations. Our finding of an association between potential ORADEs and decreased hospital revenue per day may be attributed to the management of these adverse events, as a patient may need to undergo additional testing, may need additional treatment regimens, and may need a higher level of care. Conclusion: By reducing the use of opioids and employing a multimodal analgesic approach, we may improve patient care, decrease hospital lengths of stay, and increase hospital revenue

scholarly journals Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery

Rheumatology ◽  
2009 ◽  
Vol 49 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Bert Vander Cruyssen ◽  
Elisa Muñoz-Gomariz ◽  
Pilar Font ◽  
Juan Mulero ◽  
Kurt de Vlam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ankylosing Spondylitis ◽  
Hip Replacement ◽  
Factors Associated ◽  
Replacement Surgery ◽  
Hip Replacement Surgery

Morbidity and Mortality Following Total Hip Replacement in Dogs

2018 ◽  
Vol 31 (03) ◽  
pp. 218-221 ◽  
Author(s):  
Sarah Israel ◽  
William Liska
Keyword(s):  
Cause Of Death ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
System Failure ◽  
Total Hip ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
The Mean

Objective The objective of this study was to determine morbidity and mortality rates in dogs that had undergone a total hip replacement surgery with implantation of either a cemented or a cementless prosthesis (BioMedtrix LLC, Whippany, NJ). Methods The survival time after surgery, the date of death and the cause of death were collated from an ongoing registry maintained on consecutive total hip replacement procedures by a single surgeon. Results A review of the 1,864 dogs entered in the total hip replacement registry revealed 642 in which the date of death and cause of death were known. The mean life span of the dogs in this study was 11.3 years, with the longest being 17.1 years. The mean survival after total hip replacement was 4.66 years, with the longest being 16.1 years. Multiorgan system failure was more common than any single organ system failure. The most common pathophysiological process leading to death was neoplasia. Clinical Significance Morbidity and mortality rates are helpful for surgeons to compare outcomes and to inform animal owners about anaesthesia and procedural risks when contemplating this surgery. This information can be used for a better understanding of expectations for a dog's health after total hip replacement surgery.

Associated risk factors with worse functional prognosis and hip replacement surgery in ankylosing spondylitis

2012 ◽  
Vol 79 (1) ◽  
pp. 94-96 ◽  
Author(s):  
Wafa Hamdi ◽  
Zeineb Alaya ◽  
Mohamed Mehdi Ghannouchi ◽  
Manel Haouel ◽  
Mohamed Montacer Kchir
Keyword(s):  
Risk Factors ◽  
Ankylosing Spondylitis ◽  
Hip Replacement ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Associated Risk Factors

Relationship Between Fibrinogen Proteolysis, Platelet Release And Fibrin Deposition Following Total Hip Replacement

1981 ◽  
Author(s):  
D A Lane ◽  
T G Allen-Mersh ◽  
H Ireland ◽  
S Wolff ◽  
S Jennings ◽  
...  
Keyword(s):  
Hip Replacement ◽  
Thrombus Formation ◽  
Major Surgery ◽  
Fibrin Deposition ◽  
Mean Values ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Activation Products ◽  
Before And After ◽  
The Mean

It has been postulated that fibrin deposition is controlled by the relative competition of thrombin and plasmin for fibrin I. We have tested this hypothesis by measuring haemostatic activation products in the plasma of patients undergoing hip replacement. Thrombin sensitive fragment fibrinopeptide A (FpA), plasmin sensitive fragment Bβ1-42 and β thromboglobulin (βTG) have been measured before and after operation (n=26). The incidence of venous thrombosis was assessed by phlebography and I125 fibrinogen scanning. The mean preoperative FpA, Bβ1-42 and βTG concentrations were 1.80, 4.22 and 0.99 pmol/ml respectively. The mean FpA and βTG levels rose to 3.07 and 1.56 pmol/ml respectively on the sixth day after operation but the mean Bβ1-42 level rose more rapidly to a maximum of 10.9 pmol/ml on the fourth day after operation. In those patients who developed a thrombosis (n=9), the mean FpA level was higher on the first day after operation (2.83 pmol/ml) than in those patients (n=17) in whom thrombosis did not occur (1.66 pmol/ml). Conversly, the mean Bβ1-42 level was lower (4.76 pmol/ml) in those who developed a thrombus than in those without thrombus (6.79 pmol/ml). When the postoperative day 1 results were expressed as a ratio of FpA/Bβ1-42, the corresponding mean values of this ratio for the two groups of patients were 0.74 and 0.37. These results demonstrate that (a) there is an activation of the coagulation and fibrinolytic systems, and of platelets following hip replacement surgery (b) thrombus formation following major surgery is characterised by an increased action of thrombin on fibrinogen and a reduced action of plasmin on either fibrinogen or fibrin I (c) assays for FpA and Bβ1-42 may be useful for the detection of developing thrombi.

scholarly journals The effects of competition and bundled payment on patient reported outcome measures after hip replacement surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fanny Goude ◽  
Sverre A. C. Kittelsen ◽  
Henrik Malchau ◽  
Maziar Mohaddes ◽  
Clas Rehnberg
Keyword(s):  
Hip Replacement ◽  
Health Gain ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Economic Incentives ◽  
Bundled Payment ◽  
Treatment Groups ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Patient Reported

Abstract Background Competition-promoting reforms and economic incentives are increasingly being introduced worldwide to improve the performance of healthcare delivery. This study considers such a reform which was initiated in 2009 for elective hip replacement surgery in Stockholm, Sweden. The reform involved patient choice of provider, free establishment of new providers and a bundled payment model. The study aimed to examine its effects on hip replacement surgery quality as captured by patient reported outcome measures (PROMs) of health gain (as indicated by the EQ-5D index and a visual analogue scale (VAS)), pain reduction (VAS) and patient satisfaction (VAS) one and six years after the surgery. Methods Using patient-level data collected from multiple national registers, we applied a quasi-experimental research design. Data were collected for elective primary total hip replacements that were carried out between 2008 and 2012, and contain information on patient demography, the surgery and PROMs at baseline and at one- and six-years follow-up. In total, 36,627 observations were included in the analysis. First, entropy balancing was applied in order to reduce differences in observable characteristics between treatment groups. Second, difference-in-difference analyses were conducted to eliminate unobserved time-invariant differences between treatment groups and to estimate the causal treatment effects. Results The entropy balancing was successful in creating balance in all covariates between treatment groups. No significant effects of the reform were found on any of the included PROMs at one- and six-years follow-up. The sensitivity analyses showed that the results were robust. Conclusions Competition and bundled payment had no effects on the quality of hip replacement surgery as captured by post-surgery PROMs of health gain, pain reduction and patient satisfaction. The study provides important insights to the limited knowledge on the effects of competition and economic incentives on PROMs.

scholarly journals 182. Missed Opportunities to Discontinue Unnecessary Vancomycin During Pharmacist Therapeutic Monitoring

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Corey J Medler ◽  
Mary Whitney ◽  
Juan Galvan-Cruz ◽  
Ron Kendall ◽  
Rachel Kenney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Adverse Drug Events ◽  
Academic Medical Center ◽  
Total Duration ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Therapeutic Monitoring ◽  
Resistant Bacteria ◽  
Therapeutic Drug ◽  
Missed Opportunities

Abstract Background Unnecessary and prolonged IV vancomycin exposure increases risk of adverse drug events, notably nephrotoxicity, which may result in prolonged hospital length of stay. The purpose of this study is to identify areas of improvement in antimicrobial stewardship for vancomycin appropriateness by clinical pharmacists at the time of therapeutic drug monitoring (TDM). Methods Retrospective, observational cohort study at an academic medical center and a community hospital. Inclusion: patient over 18 years, received at least three days of IV vancomycin where the clinical pharmacy TDM service assessed for appropriate continuation for hospital admission between June 19, 2019 and June 30, 2019. Exclusion: vancomycin prophylaxis or administered by routes other than IV. Primary outcome was to determine the frequency and clinical components of inappropriate vancomycin continuation at the time of TDM. Inappropriate vancomycin continuation was defined as cultures positive for methicillin-susceptible Staphylococcus aureus (MRSA), vancomycin-resistant bacteria, and non-purulent skin and soft tissue infection (SSTI) in the absence of vasopressors. Data was reported using descriptive statistics and measures of central tendency. Results 167 patients met inclusion criteria with 38.3% from the ICU. SSTIs were most common indication 39 (23.4%) cases, followed by pneumonia and blood with 34 (20.4%) cases each. At time of vancomycin TDM assessment, vancomycin continuation was appropriate 59.3% of the time. Mean of 4.22 ± 2.69 days of appropriate vancomycin use, 2.18 ± 2.47 days of inappropriate use, and total duration 5.42 ± 2.94. 16.4% patients developed an AKI. Majority of missed opportunities were attributed to non-purulent SSTI (28.2%) and missed MRSA nares swabs in 21% pneumonia cases (table 1). Conclusion Vancomycin is used extensively for empiric treatment of presumed infections. Appropriate de-escalation of vancomycin therapy is important to decrease the incidence of adverse effects, decreasing hospital length of stay, and reduce development of resistance. According to the mean duration of inappropriate therapy, there are opportunities for pharmacy and antibiotic stewardship involvement at the time of TDM to optimize patient care (table 1). Missed opportunities for vancomycin de-escalation Disclosures All Authors: No reported disclosures

scholarly journals Risk factors on admission associated with hospital length of stay in patients with COVID-19: a retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anping Guo ◽  
Jin Lu ◽  
Haizhu Tan ◽  
Zejian Kuang ◽  
Ying Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Liver Disease ◽  
Length Of Stay ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Hospital Length ◽  
Clinical Treatment ◽  
Hospital Length Of Stay ◽  
Female Sex

AbstractTreating patients with COVID-19 is expensive, thus it is essential to identify factors on admission associated with hospital length of stay (LOS) and provide a risk assessment for clinical treatment. To address this, we conduct a retrospective study, which involved patients with laboratory-confirmed COVID-19 infection in Hefei, China and being discharged between January 20 2020 and March 16 2020. Demographic information, clinical treatment, and laboratory data for the participants were extracted from medical records. A prolonged LOS was defined as equal to or greater than the median length of hospitable stay. The median LOS for the 75 patients was 17 days (IQR 13–22). We used univariable and multivariable logistic regressions to explore the risk factors associated with a prolonged hospital LOS. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated. The median age of the 75 patients was 47 years. Approximately 75% of the patients had mild or general disease. The univariate logistic regression model showed that female sex and having a fever on admission were significantly associated with longer duration of hospitalization. The multivariate logistic regression model enhances these associations. Odds of a prolonged LOS were associated with male sex (aOR 0.19, 95% CI 0.05–0.63, p = 0.01), having fever on admission (aOR 8.27, 95% CI 1.47–72.16, p = 0.028) and pre-existing chronic kidney or liver disease (aOR 13.73 95% CI 1.95–145.4, p = 0.015) as well as each 1-unit increase in creatinine level (aOR 0.94, 95% CI 0.9–0.98, p = 0.007). We also found that a prolonged LOS was associated with increased creatinine levels in patients with chronic kidney or liver disease (p < 0.001). In conclusion, female sex, fever, chronic kidney or liver disease before admission and increasing creatinine levels were associated with prolonged LOS in patients with COVID-19.

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