scholarly journals Elective Splenectomy in Immune Thrombocytopenic Purpura: An Analysis of National Inpatient Sample (NIS) Database between Years 2006 and 2014

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4672-4672
Author(s):  
Sunny R K Singh ◽  
Sindhu Malapati ◽  
Rohit Kumar ◽  
Prasanth Lingamaneni ◽  
Leila Khaddour ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Immune Thrombocytopenic Purpura ◽  
Charlson Comorbidity Index ◽  
Geographic Region ◽  
Teaching Hospitals ◽  
Insurance Status ◽  
Inpatient Mortality ◽  
Thrombocytopenic Purpura ◽  
Comorbidity Index ◽  
Income Quartile

Background: Over the years, splenectomy has dropped out of favor as a treatment option for Immune Thrombocytopenic Purpura (ITP) and is now considered only for patients who have failed multiple lines of therapy. One of the major concerns is surgical morbidity. We aim to study in-hospital outcomes following elective splenectomy in this population Methods: This is a retrospective cohort analysis of NIS database (years 2006 to 2014). Patients ≥18 years of age, who had an elective admission associated with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedure code for splenectomy were included in the study. Our cohort of interest was patients with ITP who underwent elective splenectomy (ITP ES). ICD-9-CM diagnosis codes were used to identify patients with ITP. All other patients who underwent elective splenectomy were labeled as non-ITP ES. Utilization of intensive care services was identified by procedure codes associated with vasopressor use, cardiopulmonary resuscitation, mechanical ventilation and initiation of dialysis in the absence of pre-existing end stage renal disease. Primary outcome was inpatient mortality and secondary outcome was length of stay (LOS). Associated factors were analyzed using multivariate logistic regression analysis. A p-value <0.05 was considered significant. We used STATA for statistical analysis. Results: A total of 102,698 admissions for elective splenectomies (ES) in adults were identified between the years 2006 and 2014,of which 11.36% (n= 11,668) were ITP ES. Inpatient mortality and mean LOS for all patients undergoing ES was 2.53% and 8.51 days respectively. Inpatient mortality and mean LOS in the ITP ES cohort was 0.86% and 4.37 days respectively. In the entire cohort of ES, inpatient mortality was lower in those with ITP versus non-ITP (OR 0.36, p<0.001). Also females had lower mortality when compared to men (OR 0.50, p<0.001). Inpatient mortality was higher with increasing age (OR 1.03, p<0.001) and Charlson Comorbidity Index (CCI) ≥3 vs 0 (OR 1.54, p <0.001). Mean length of stay was lower in those with ITP vs non ITP by 3.3 days (p<0.001). Within the ITP-ES cohort, mortality was higher with increasing age (OR 1.12, p <0.001), CCI ≥3 vs 0 (OR 18.39, p< 0.0001) and CCI 2 vs 0 (OR 8.61, p 0.008). Inpatient mortality was lower in teaching hospitals compared to non-teaching hospitals with a trend towards significance (OR 0.35, p 0.05). Gender, insurance status, income quartile, geographic region and hospital size did not affect odds of inpatient mortality in this cohort. Length of stay (LOS) in ITP ES cohort had positive correlation with age (coefficient 0.038, p<0.001), income quartile 51-75th vs 0-25th percentile (coefficient 0.81, p 0.03), CCI ≥3 vs 0 (coefficient 3.29, p<0.001), CCI 2 vs 0 (coefficient 2.11, p<0.001), CCI 1 vs 0 (coefficient 0.86, p<0.001). There was no association of gender, insurance status and geographic region with LOS within this cohort. Conclusion: Inpatient mortality and length of stay in admissions for elective splenectomy was significantly lower in ITP patients compared to non ITP patients. Also, in ITP patients undergoing elective splenectomy, older age and a charlson comorbidity index of 2 or above were associated with higher odds of dying in the same admission.These findings from real world data have practical implications for clinicians and patients, as they weigh the pros and cons of splenectomy as a treatment option for ITP. Table Disclosures Donthireddy: Viracta: Other: PI for Clinical Trial.

Abstract 3023: The Association of Insurance Status, Quality of Care, and In-Hospital Outcomes among Patients Hospitalized with Intracerebral Hemorrhage: Findings from GWTG-Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Michael L James ◽  
Julian P Yand ◽  
Maria Grau-Sepulveda ◽  
DaiWai M Olson ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Reference Group ◽  
Private Insurance ◽  
Quality Measures ◽  
Geographic Region ◽  
Insurance Status ◽  
Hospital Outcomes

Introduction Intracerebral hemorrhage (ICH) can be a devastating condition, requiring intensive intervention. Yet, few studies have examined whether patient insurance status is associated with ICH care or acute outcomes. Methods Using data from 1,711 sites participating in GWTG-Stroke database from April 2003 to April 2011, we identified 156,848 non-transferred subjects with ICH who had known discharge status. Insurance status was categorized as private, Medicaid, Medicare or none. We explored associations between lack of insurance (using private insurance status as the reference group) and in-hospital outcomes (mortality, ambulatory status, & length of stay) and quality of care measures (DVT prophylaxis, smoking cessation, dysphagia screening, stroke education, imaging times, & rehabilitation). We utilized multiple individual (including demographics and medical history) and hospital (including size, geographic region and academic teaching status)lcharacteristics as covariates. Results Subjects without insurance (n=10647) were younger (54.4 v. 71 years), more likely men (60.6 v. 50.8%), more likely black (33.2 v. 17.4%) or Hispanic (15.8 v. 7.9%), from the South (50.6 v. 38.9%), and had fewer vascular risk factors with the exception of smoking when compared with the overall subject population. Further, subjects without insurance were more likely to experience in-hospital mortality (25.9 v. 23.9%; adjusted OR 1.29) and longer length of stay (11.4 v. 7.8 days), but were more likely to receive all quality measures of care, be discharged home (52.1 v. 36.1%), and ambulate independently (47.5 v. 38.5%) at discharge compared with subjects with private insurance (n=40033). Conclusions Among GWTG-Stroke participating hospitals, ICH patients without insurance were more likely to die while in the hospital but experienced higher quality measures of care and were more likely to ambulate independently at discharge should they survive.

scholarly journals Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay, Costs and Mortality among Older Adults Hospitalised for Acute Stroke

2018 ◽  
Vol 15 (11) ◽  
pp. 2532 ◽  
Author(s):  
Richard Ofori-Asenso ◽  
Ella Zomer ◽  
Ken Chin ◽  
Si Si ◽  
Peter Markey ◽  
...  
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Acute Stroke ◽  
Charlson Comorbidity Index ◽  
Negative Binomial ◽  
Cox Regression ◽  
Negative Binomial Regression ◽  
Tertiary Hospital ◽  
Hospital Death ◽  
Comorbidity Index

The burden of comorbidity among stroke patients is high. The aim of this study was to examine the effect of comorbidity on the length of stay (LOS), costs, and mortality among older adults hospitalised for acute stroke. Among 776 older adults (mean age 80.1 ± 8.3 years; 46.7% female) hospitalised for acute stroke during July 2013 to December 2015 at a tertiary hospital in Melbourne, Australia, we collected data on LOS, costs, and discharge outcomes. Comorbidity was assessed via the Charlson Comorbidity Index (CCI), where a CCI score of 0–1 was considered low and a CCI ≥ 2 was high. Negative binomial regression and quantile regression were applied to examine the association between CCI and LOS and cost, respectively. Survival was evaluated with the Kaplan–Meier and Cox regression analyses. The median LOS was 1.1 days longer for patients with high CCI than for those with low CCI. In-hospital mortality rate was 18.2% (22.1% for high CCI versus 11.8% for low CCI, p < 0.0001). After controlling for confounders, high CCI was associated with longer LOS (incidence rate ratio [IRR]; 1.35, p < 0.0001) and increased likelihood of in-hospital death (hazard ratio [HR]; 1.91, p = 0.003). The adjusted median, 25th, and 75th percentile costs were AUD$2483 (26.1%), AUD$1446 (28.1%), and AUD$3140 (27.9%) higher for patients with high CCI than for those with low CCI. Among older adults hospitalised for acute stroke, higher global comorbidity (CCI ≥ 2) was associated adverse clinical outcomes. Measures to better manage comorbidities should be considered as part of wider strategies towards mitigating the social and economic impacts of stroke.

Impact of race on nonroutine discharge, length of stay, and postoperative complications after surgery for spinal metastases

2021 ◽  
pp. 1-8
Author(s):  
Bethany Hung ◽  
Zach Pennington ◽  
Andrew M. Hersh ◽  
Andrew Schilling ◽  
Jeff Ehresman ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Marital Status ◽  
Functional Status ◽  
Independent Predictor ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Comprehensive Cancer Center ◽  
Insurance Status ◽  
Income Quartile

OBJECTIVE Previous studies have suggested the possibility of racial disparities in surgical outcomes for patients undergoing spine surgery, although this has not been thoroughly investigated in those with spinal metastases. Given the increasing prevalence of spinal metastases requiring intervention, knowledge about potential discrepancies in outcomes would benefit overall patient care. The objective in the present study was to investigate whether race was an independent predictor of postoperative complications, nonroutine discharge, and prolonged length of stay (LOS) after surgery for spinal metastasis. METHODS The authors retrospectively examined patients at a single comprehensive cancer center who had undergone surgery for spinal metastasis between April 2013 and April 2020. Demographic information, primary pathology, preoperative clinical characteristics, and operative outcomes were collected. Factors achieving p values < 0.15 on univariate regression were entered into a stepwise multivariable logistic regression to generate predictive models. Nonroutine discharge was defined as a nonhome discharge destination and prolonged LOS was defined as LOS greater than the 75th percentile for the entire cohort. RESULTS Three hundred twenty-eight patients who had undergone 348 operations were included: 240 (69.0%) White and 108 (31.0%) Black. On univariable analysis, cohorts significantly differed in age (p = 0.02), marital status (p < 0.001), insurance status (p = 0.03), income quartile (p = 0.02), primary tumor type (p = 0.04), and preoperative Karnofsky Performance Scale (KPS) score (p < 0.001). On multivariable analysis, race was an independent predictor for nonroutine discharge: Black patients had significantly higher odds of nonroutine discharge than White patients (adjusted odds ratio [AOR] 2.24, 95% confidence interval [CI] 1.28–3.92, p = 0.005). Older age (AOR 1.06 per year, 95% CI 1.03–1.09, p < 0.001), preoperative KPS score ≤ 70 (AOR 3.30, 95% CI 1.93–5.65, p < 0.001), preoperative Frankel grade A–C (AOR 3.48, 95% CI 1.17–10.3, p = 0.02), insurance status (p = 0.005), being unmarried (AOR 0.58, 95% CI 0.35–0.97, p = 0.04), number of levels (AOR 1.17 per level, 95% CI 1.05–1.31, p = 0.004), and thoracic involvement (AOR 1.71, 95% CI 1.02–2.88, p = 0.04) were also predictive of nonroutine discharge. However, race was not independently predictive of postoperative complications or prolonged LOS. Higher Charlson Comorbidity Index (AOR 1.22 per point, 95% CI 1.04–1.43, p = 0.01), low preoperative KPS score (AOR 1.84, 95% CI 1.16–2.92, p = 0.01), and number of levels (AOR 1.15 per level, 95% CI 1.05–1.27, p = 0.004) were predictive of complications, while insurance status (p = 0.05), income quartile (p = 0.01), low preoperative KPS score (AOR 1.64, 95% CI 1.03–2.72, p = 0.05), and number of levels (AOR 1.16 per level, 95% CI 1.05–1.30, p = 0.004) were predictive of prolonged LOS. CONCLUSIONS Race, insurance status, age, baseline functional status, and marital status were all independently associated with nonroutine discharge. This suggests that a combination of socioeconomic factors and functional status, rather than medical comorbidities, may best predict postdischarge disposition in patients treated for spinal metastases. Further investigation in a prospective cohort is merited.

Abstract TP405: IV TPA Utilization and Outcomes in Young Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Pamela Cheng ◽  
Ling Zheng ◽  
Steven Cen ◽  
Peggy Nguyen ◽  
Sebina Bulic ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Average Length ◽  
Pediatric Population ◽  
Cerebrovascular Disorders ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Total Charge ◽  
Inpatient Mortality ◽  
Stroke Patients

Objective: Cerebrovascular disorders are among the top ten causes of death in the pediatric population. The incidence is felt to be 1-2 per 100,000, although this number could be higher due to poor recognition. Our objective is to describe the incidence, tPA utilization, inpatient mortality, length of stay, and cost associated with stroke in pediatric population. Methods: Ischemic stroke cases between the ages of 1 and 17 years were obtained from the Nationwide Inpatient Sample (NIS) for the period from January 1, 2000 through December 31, 2014. The primary outcome was inpatient mortality. The secondary outcome was LOS and total cost per day. National trend estimate followed HCUP methodical standard which adopted the design change at 2012 with appropriate trend weight. Weighted estimates were made via SURVEYMEAN procedure and presented as national estimate ± standard error from sampling. SAS9.4 was used for the analysis. Results: From January 2000 through December 2014, there were an estimated 12908±1087 pediatric cases with ischemic stroke, 157±28 (1.2%±0.2%) had TPA. Pediatric ischemic stroke patients were predominantly discharged from urban, large-bed-size, teaching hospitals (40.7%±3.9%), more likely to be white (39.3%±1.8%) and male (52.5%±1.2%), most prevalent among those aged 16 years old (10.3%±0.8%). Overall inpatient mortality was 3.0±0.3 per 100 discharges. Median LOS was 4.0±0.1 days. Median total charge per day was $ 8162±348. Majority of pediatric ischemic stroke patients discharged routinely to home or self-care (75.8%±1.2%). Conclusion: This study highlights that during the prespecified time frame of four years there was an estimated 12908±1087 ischemic strokes in the pediatric population and less than 2% of children received alteplase. Hospital mortality was 3.0% ± 0.3%. The average length of stay was 4 days with an estimated cost of $8162+/- 348 per day. The majority of pediatric patients were discharged home.

Hospital Costs and Severity of Illness in Three Types of Elective Surgery

1997 ◽  
Vol 86 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Alex Macario ◽  
Terry S. Vitez ◽  
Brian Dunn ◽  
Tom McDonald ◽  
Byron Brown
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Operating Room ◽  
Knee Replacement ◽  
Charlson Comorbidity Index ◽  
Elective Surgery ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Total Hospital ◽  
Comorbidity Index

Background If patients who are more severely ill have greater hospital costs for surgery, then health-care reimbursements need to be adjusted appropriately so that providers caring for more seriously ill patients are not penalized for incurring higher costs. The authors' goal for this study was to determine if severity of illness, as measured by either the American Society of Anesthesiologists Physical Status (ASA PS) or the comorbidity index developed by Charlson, can predict anesthesia costs, operating room costs, total hospital costs, or length of stay for elective surgery. Methods The authors randomly selected 224 inpatients (60% sampling fraction) having either colectomy (n = 30), total knee replacement (n = 100), or laparoscopic cholecystectomy (n = 94) from September 1993 to September 1994. For each surgical procedure, backward-elimination multiple regression was used to build models to predict (1) total hospital costs, (2) operating room costs, (3) anesthesia costs, and (4) length of stay. Explanatory candidate variables included patient age (years), sex, ASA PS, Charlson comorbidity index (which weighs the number and seriousness of coexisting diseases), and type of insurance (Medicare/Medicaid, managed care, or indemnity). These analyses were repeated for the pooled data of all 224 patients. Costs (not patient charges) were obtained from the hospital cost accounting software. Results Mean total hospital costs were $3,778 (95% confidence interval +/- 299) for laparoscopic cholecystectomy, $13,614 (95% CI +/- 3,019) for colectomy, and $18,788 (95% CI +/- 573) for knee replacement. The correlation (r) between ASA PS and Charlson comorbidity scores equaled 0.34 (P &lt; .001). No consistent relation was found between hospital costs and either of the two severity-of-illness indices. The Charlson comorbidity index (but not the ASA PS) predicted hospital costs only for knee replacement (P = .003). The ASA PS, but not the Charlson index, predicted operating room and anesthesia costs only for colectomy (P &lt; .03). Conclusions Severity of illness, as categorized by ASA PS categories 1-3 or by the Charlson comorbidity index, was not a consistent predictor of hospital costs and lengths of stay for three types of elective surgery. Hospital resources for these lower-risk elective procedures may be expended primarily to manage the consequences of the surgical disease, rather than to manage the patient's coexisting diseases.

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