scholarly journals Higher Incidence of TTP in African Americans and Females: An Analysis of Demographics, Cost and Length of Stay in Teaching and Nonteaching Hospitals for Thrombotic Thrombocytopenic Purpura Between 1999 and 2013

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4735-4735
Author(s):  
William Lee ◽  
Stuthi Perimbeti ◽  
Mariola Vazquez Martinez ◽  
Nausheen Hakim ◽  
Daniel Kyung ◽  
...  
Keyword(s):  
African Americans ◽  
Length Of Stay ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Teaching Hospitals ◽  
Short Term ◽  
Thrombocytopenic Purpura ◽  
Total Cost ◽  
Chi Square Analysis ◽  
The Cost ◽  
The U.S

Abstract Background: Limited studies compare the differences in care for Thrombotic Thrombocytopenic Purpura (TTP) patients in teaching versus nonteaching hospitals. TTP is a rare, life-threatening disease marked by widespread aggregation of platelets throughout the body, resulting in multi-organ sequelae including neurological dysfunction and renal insufficiency: a timely diagnosis is imperative for successful treatment. Academic centers generally have more individuals involved in each patient's care. This was considered in the evaluation of demographics, cost, length of stay, and disposition at discharge in the different settings. Methods: Adult admissions with a primary diagnosis of TTP for a 15-year period between 1999 and 2013 were extracted from the National Inpatient Sample database using the ICD-9 code 446.2 during a 15 year period between 1999 and 2013 (N=6,292, for a weighted N=30,011). The sample was weighted to approximate the full inpatient population of the U.S. over the time period. Teaching and nonteaching hospitals were compared within the parameters of gender, race, total cost, insurance, length of stay, mortality, and disposition. Chi square analysis was performed to examine differences in the categorical variables. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. Results: The total number of admission for TTP was weighted N=28,058, divided between 20,426 for teaching and 8,082 for nonteaching hospitals. 67.6% of TTP admissions were female in both categories but a greater percentage of African Americans with TTP were admitted to teaching (N=6,842; 33.50%) than nonteaching hospitals (N=1,962; 24.28%) (p < 0.0001). More Caucasians with TTP were admitted to non-teaching (N=2,707; 33.50%) than teaching hospitals (N=6,834; 32.46%) (p <0.0001). The overall length of stay for TTP hospitalizations was 12.30 days +/- 0.16, with teaching hospitals being found to have a shorter length of stay at 11.26 +/- 0.28 days compared to nonteaching hospitals with 13.15 +/- 0.20 days (p < 0.0001). There was a slightly higher mortality rate in nonteaching hospitals: 8.92% in teaching hospitals versus 9.32% in nonteaching hospitals (p <0.6232). Overall hospital mortality decreased from 12.1% in 1999 to 6.0% in 2013. At discharge, more patients from nonteaching hospitals were transferred to short term facilities than those from teaching: 1,877 (23.23%) non-teaching patients versus 2,038 (9.98%) teaching patients (p = 0.0001). The overall cost of a TTP hospitalization was $106,184.94 +/- $1,762.57. Nonteaching hospitals had more costly hospitalizations at $113,437.87 +/- $2247.78 than teaching hospitals, which cost $99,481.35 +/- $3093.53 (p <0.0001). Medicare paid 26.23% of TTP hospitalizations in nonteaching hospitals and 22.91% in teaching hospitals (p <0.0006). Medicaid paid for 18.12% of TTP hospitalizations in teaching hospitals and 12.89% in nonteaching hospitals (p <0.0006). An increase in the cost for admissions for TTP was noted from 1999 to 2013. While the total charge of TTP admission was $58,437 in 1999, it was found to be $153,643 in 2013, or $109,878 when adjusted for inflation. This amounted to an adjusted 88% increase despite an essentially unchanged average length of stay, 12.5 days in 1999 and 12.6 days in 2013. Conclusion: In comparing TTP hospitalizations, teaching hospitals had a shorter length of stay, lesser cost of stay, and sent fewer patients to short term facilities upon discharge. However, these factors did not play a statistically significant role in decreasing mortality. Additionally, a trend of increasing total charges was noted from 1999 to 2013 despite an unchanged length of hospitalization and a decrease in mortality. Advanced age is associated with worse outcome in TTP and this is reflected by the higher mortality and higher percentage of Medicare payment in nonteaching hospitals. Medicaid was responsible for a higher percentage of payment in teaching hospitals and correlated with an improved mortality. Both African Americans and females were found to have more admissions regardless of hospital type, with African Americans being admitted more often to teaching than nonteaching hospitals. Further studies are necessary to determine the etiology of this significant rise in the cost of TTP treatment and to investigate the disproportionately higher incidence of TTP in African Americans and females. Disclosures No relevant conflicts of interest to declare.

scholarly journals Cost implications and oncological outcomes for laparoscopic versus open surgery for right hemicolectomy

2016 ◽  
Vol 98 (03) ◽  
pp. 212-215
Author(s):  
K Habib ◽  
S Daniels ◽  
M Lee ◽  
V Proctor ◽  
A Saha
Keyword(s):  
Laparoscopic Surgery ◽  
Length Of Stay ◽  
Open Surgery ◽  
Cost Benefit ◽  
Right Hemicolectomy ◽  
Healthcare Management ◽  
Cost Of Treatment ◽  
Total Cost ◽  
Wide Range ◽  
The Cost

Introduction Recent studies have suggested that laparoscopic surgery for colorectal resection confers a cost benefit compared with open surgery. These studies have considered a wide range of colorectal operations together rather than focusing on a single procedure. Our study compared direct clinical costs for laparoscopic versus open right hemicolectomy. Methods Clinicopathological data and cost of treatment for all patients who underwent a right hemicolectomy between 2012 and 2013 were collected. The primary outcome was total cost of treatment. Secondary outcomes were length of stay, operative time and morbidity. The minimum follow-up duration was 12 months. Costs for laparoscopic and open surgery for elective resection alone were compared. Further analyses were performed comparing emergency cases with elective cases and cancer with non-cancer cases. Results There were 83 patients who underwent a right hemicolectomy during the study period and of these, 65 had an elective procedure. The total cost of a laparoscopic procedure was £3,998.12 compared with £3,427.50 for open surgery (p=0.039). The length of stay was shorter for laparoscopic surgery while the cost of an emergency right hemicolectomy was significantly greater than for elective surgery. Conclusions Although the length of stay for laparoscopic surgery was shorter, this did not translate to a reduction in cost. The cost benefit from a shorter length of stay was offset by a greater cost of consumables. Cost effectiveness analyses should be designed carefully, and they should consider individual operations separately when making healthcare management and funding decisions.

First Symptoms In Idiopathic Thrombotic Thrombocytopenic Purpura (TTP): What Are They and When Do They Occur?.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1427-1427 ◽  
Author(s):  
Drees Griffin ◽  
Zayd al-Nouri ◽  
Darrshini Muthurajah ◽  
John Ross ◽  
Riley Ballard ◽  
...  
Keyword(s):  
African Americans ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Hemolytic Anemia ◽  
Conflicts Of Interest ◽  
Fatal Outcome ◽  
First Episode ◽  
Microangiopathic Hemolytic Anemia ◽  
Thrombocytopenic Purpura ◽  
Neurologic Symptoms ◽  
Severe Deficiency

Abstract Abstract 1427 Introduction: Thrombotic thrombocytopenic purpura (TTP) is a syndrome characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA) without an alternative explanation, caused by systemic platelet thrombi. Although TTP may be secondary to underlying diseases or drugs, it is often idiopathic. The latter is associated with severe deficiency (defined as ≤10% activity) of the plasma protease ADAMTS13. Low ADAMTS13 is caused by autoantibodies and allows for the accumulation of unusually large multimers of von Willebrand factor in the circulation, which causes spontaneous platelet aggregates and microvascular thrombosis. Therapeutic plasma exchange (TPE) decreases TTP mortality from 90% to 10%. Unfortunately, approximately 30% of treated patients will experience a relapse and require TPE again. The University of Alabama at Birmingham (UAB) Hospital is a referral center for TTP patients from throughout the state. The Oklahoma TTP-Hemolytic Uremic Syndrome (HUS) Registry is a population-based inception cohort of all consecutive patients treated for TTP in central-western Oklahoma since 1989. The aim of this collaboration between the two centers was to characterize the first symptoms experienced by patients with idiopathic TTP preceding their first episode and the timing of these symptoms in relation to the diagnosis (defined as the day TPE was started). Methods: We conducted a retrospective chart review of patients seen at the two centers from January 1, 2007 to June 30, 2010. Using apheresis and electronic medical records, we completed a data collection form with demographic information, clinical presentation, pre-existing risk factors, and clinical course. Results: At UAB, 31 patients were treated for idiopathic TTP; 26 had their first episode during the study window and were included in the analysis. At Oklahoma, 28 patients were identified and 23 fulfilled criteria for inclusion. Of the combined 49 patients, 35 (71%) were female and 14 (29%) were male (gender distribution almost identical between the two centers). The average age of the group was 46 years old (median: 44). At UAB, most patients were African-Americans (77%), followed by Caucasians (19%) and Asians (4%). In Oklahoma, 74% of patients were Caucasian, 18% were African-Americans, and 4% each were American-Indian or Other. These 49 patients reported 27 different first symptoms, with the most common in order of frequency being: abdominal pain (n = 9; 18%), nausea (n = 5; 10%), headache (n = 4; 8%), vomiting (n = 4; 8%), severe neurologic symptoms such as coma, seizures, aphasia (n = 3; 6%), and weakness (n = 3; 6%). Overall, 20 patients (41%) initially noted neurologic symptoms, 13 patients (26.5%) localized their symptoms to the gastrointestinal tract, and 5 patients (10%) reported hematologic symptoms such as mucocutaneous bleeding or signs of hemolysis. The median time to treatment from the onset of symptoms was 5 days (range: 0–132 days), while 82% of patients reported symptoms for 10 days or less. Of 45 patients in whom ADAMTS13 activity was measured, the median result was 4% (range: 4–100%), and 34 of them (75.5%) had an activity of ≤10%, which defines severe deficiency. Two patients (4%) died and the other 47 had resolution of their hematologic abnormalities. Conclusions: Our data confirm the heterogeneity of presentation and nonspecific nature of signs and symptoms of TTP. Thus, physician education and vigilance is necessary to suspect TTP and refer patients for TPE. While many patients were likely to have TTP for several days prior to the diagnosis, TPE must begin promptly once the findings of thrombocytopenia and microangiopathic hemolytic anemia without an alternative diagnosis are noted, in order to avoid a fatal outcome. Disclosures: No relevant conflicts of interest to declare.

The Cost of Hospital Stay for Operable Breast Cancer

1992 ◽  
Vol 78 (6) ◽  
pp. 359-362 ◽  
Author(s):  
Stefano Capri ◽  
Edoardo Majno ◽  
Maurizio Mauri
Keyword(s):  
Breast Cancer ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Average Length ◽  
Operable Breast Cancer ◽  
Cost Component ◽  
Homogeneous Groups ◽  
Total Cost ◽  
Average Length Of Stay ◽  
The Cost

The cost of the first hospital stay for operable breast cancer was deducted by analysing a random sample of 100 admissions to the National Institute of Cancer during the period January-December 1989. The aims of the study were: (1) to describe and calculate the cost component of the stay; (2) to analyse whether any procedure, service rended or stage of the pathology might explain differences in the total costs of the stay; and (3) to acquire a better knowledge of the organizational aspects to be improved. With an average length of stay of 14.1 days, the overall total cost observed was 4.9 million lira (US $ 3.800, 1989 US dollars). A significant correlation between total cost and duration of stay was found (R2 = 0.982), while no or very little correlation was found between cost and the anatomical extent of disease (TNM stage) and different cost items (laboratory, imaging tests, operating room, etc.). Two homogeneous groups of cases were found: patients with quadrantectomy and patients with mastectomy. The cost of the latter was 40% greater than that of the former (P < 0.001) with a length of stay 52% longer (p < 0.001). This study does not concern the costs immediately following the stay, which namely are higher for the quadrantectomy because the radiotherapy outpatient procedures. Attention should be paid to reducing the length of stay, keeping waiting time for organizational procedures to a minimum during the stay.

scholarly journals Cost savings to hospital of rituximab use in severe autoimmune acquired thrombotic thrombocytopenic purpura

2020 ◽  
Vol 4 (3) ◽  
pp. 539-545
Author(s):  
George Goshua ◽  
Amit Gokhale ◽  
Jeanne E. Hendrickson ◽  
Christopher Tormey ◽  
Alfred Ian Lee
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Cost Savings ◽  
Cost Of Care ◽  
Inpatient Admission ◽  
Inpatient Cost ◽  
Inpatient Setting ◽  
Thrombocytopenic Purpura ◽  
Academic Center ◽  
The Cost ◽  
Barrier To Care

Abstract Patients with severe autoimmune thrombotic thrombocytopenic purpura (TTP) experience acute hematologic emergencies during disease flares and a lifelong threat for relapse. Rituximab, in addition to steroids and therapeutic plasma exchange (TPE), has been shown to mitigate relapse risk. A barrier to care in initiating rituximab in the inpatient setting has been the presumed excessive cost of medication to the hospital. Retrospectively reviewing TTP admissions from 2004 to 2018 at our academic center, we calculated the actual inpatient cost of care. We then calculated the theoretical cost to the hospital of initiating rituximab in the inpatient setting for both initial TTP and relapse TTP cohorts, with the hypothesis that preventing sufficient future TTP admissions offsets the cost of initiating rituximab in all patients with TTP. At a median follow-up of 55 months in the initial TTP cohort, rituximab use produced a projected cost savings of $905 906 and would have prevented 185 inpatient admission days and saved 137 TPE procedures. In the relapse TTP setting, rituximab use produced a projected cost savings of $425 736 and would have prevented 86 inpatient admission days and saved 64 TPE procedures. From a hospital cost standpoint, cost of rituximab should no longer be a barrier to initiating inpatient rituximab in both initial and relapse TTP settings.

scholarly journals Acute Myeloid Leukemia in the Elderly: Trends in Mortality Rates, Hospital Cost, Length of Stay, and Complication Rates in Patients Aged 60 and Older

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2359-2359
Author(s):  
Ankit Shah ◽  
Stuthi Perimbeti ◽  
Parshva Patel ◽  
Rachel Nathan ◽  
Seema Niphadkar ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Bone Marrow Transplant ◽  
Marrow Transplant ◽  
Teaching Hospitals ◽  
Complication Rates ◽  
Total Cost ◽  
Significant Difference ◽  
Acute Myeloid

Abstract Background: Acute myeloid leukemia (AML) is associated with a high mortality rate. Advancing age is a risk factor associated with poor prognosis and an increased rate of chemotherapy-related complications in patients with AML. We aimed to evaluate trends in cost of hospitalizations, length of stay, mortality rates, and complication rates in patients aged 60 years and older who were admitted for active AML. We also sought to elucidate differences in these outcomes in teaching and non-teaching institutions. Methods:We queried the Nationwide Inpatient Sample (NIS) between 1999 and 2013 using the ICD-9 codes 205.00, 205.01, 206.00, and 206.01 for acute myeloid and acute monocytic leukemias in the primary diagnosis field. Admission data regarding total cost, length of stay (LOS), and in-hospital mortality was extracted. This data was trended over the 15-year interval and comparisons were made between teaching and nonteaching institutions. Incidence of in-hospital complications including clostridium difficile infection (CDI), bacteremia, sepsis, pneumonia, venous thromboembolism (VTE), neutropenic fever, candidiasis, urinary tract infection (UTI), and acute respiratory failure were determined and compared in subsets of teaching and nonteaching hospitals. Frequency of bone marrow transplant was also determined in both hospital settings. Results: A total of 51,684 (weighted n=247,747) admissions for AML occurred from 1999-2013. Of these 31,004 admissions (weighted n=148,683) were in patients aged 60 and older. Most of these elderly admissions occurred at teaching institutions (n=17,593, weighted n=84,829). In-hospital mortality was higher in patients aged 60 and greater (23.68%) compared to those less than 60 (13.7% (p<.0001)). For patients 60 and older, mortality has decreased by approximately 40% during the 15-year interval (p<.0001). Specifically, in-hospital mortality was 30.21% in 1999 and 18.05% in 2013. In comparing teaching and non-teaching hospitals, mortality rate was not found to have a statistically significant difference (p=.4473). Complication rates due to VTE, bacteremia, febrile neutropenia, pneumonia, and UTI increased during this time period. Rates of CDI and candidiasis did not have a statistically significant difference over time. Rates of acute respiratory failure, neutropenic fever, bacteremia, VTE, sepsis, and CDI were higher at teaching than at non-teaching institutions (p<.0001). Rates of UTI were higher at non-teaching (9.62%) than at teaching institutions (8.43% (p=.004)). Differences in the rate of pneumonia and candidiasis were not statistically significant between the two hospital settings. Rates of bone marrow transplant have roughly doubled from .23% in 1999 to .51% in 2013 (p=.0079) and occurred more frequently in teaching (0.54%) than in non-teaching (0.24%) hospitals (p=.0017). Mean LOS (days) is relatively unchanged over the 15- year interval (p=.2277), however, cost has increased dramatically (p=.0001). Total cost in 1999 was $46,833(±1,508), whereas in 2013 it was $146,965(±4,296). Mean LOS and cost were higher at teaching (17.16, $122,257±1,221) compared with nonteaching (10.57, $65,448±993) institutions (p=.0001). Conclusions: For patients admitted with a primary diagnosis of active AML, in-hospital mortality was markedly higher in patients aged 60 and older compared with those less than 60. In the elderly, in-hospital mortality decreased dramatically between 1999 and 2013. Many factors may contribute to the decrease in mortality in this population including the use of less-aggressive cytotoxic chemotherapy, such as low-dose cytarabine or hypomethylating agents, improved adherence to preventative practices including the use of high-efficiency particulate air filtration, and prophylactic antibiotics. In patients older than 60, LOS and total cost were higher in teaching institutions, although in-hospital mortality was similar. In general, complication rates were higher at teaching hospitals, which may be a consequence of increased medical complexity and more aggressive therapy offered at these hospitals. For instance, bone marrow transplant rates were much higher in teaching than in non-teaching hospitals. Further research is required to determine the exact factors and practice differences contributing to the discrepancies between teaching and non-teaching institutions. Disclosures No relevant conflicts of interest to declare.

Abstract 065: Hospital Teaching Status and TAVR Outcomes in the United States - Analysis of the National Inpatient Sample (NIS)

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Emmanuel Akintoye ◽  
Samson Alliu ◽  
Oluwole Adegbala ◽  
Haider Aldiwani ◽  
Mohamed Shokr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Kidney Injury ◽  
The United States ◽  
Teaching Hospitals ◽  
National Inpatient Sample ◽  
Mixed Effect ◽  
Significant Difference ◽  
Teaching Status ◽  
Risk Of Hemorrhage ◽  
The U.S

Background: Evidence suggest that medical service offerings vary by hospital teaching status. However, little is known about how these translate to patient outcomes. We therefore sought to evaluate this gap in knowledge in patients undergoing TAVR Methods: This study was conducted using the National Inpatient Sample (NIS) in the U.S (2011-2013). Teaching status was classified as teaching vs non-teaching and endpoints were clinical outcomes, length of stay and cost. Procedure-related complications were identified via ICD-9 coding and analysis was performed via mixed effect model Results: An estimated 17,020 TAVR procedures were performed in the U.S between 2011 and 2013, out of which 87% were in teaching hospitals. Mean (SD) age was 80 (8) and 47% were females. There was no significant difference between hospital teaching status with regards to procedure-related in-patient mortality, myocardial infarction, or other cardiac, vascular, neurological, respiratory complications, post-op DVT/PE, or sepsis (Fig 1). However, compared to non-teaching hospitals, teaching hospitals tend to have higher risk of acute kidney injury (OR: 1.47 [95% CI, 1.08-1.99]) but lower risk of hemorrhage requiring transfusion (OR: 0.67 [95% CI, 0.50-0.91]). The mean length of stay was higher in teaching hospitals (8.3 days) compared to non-teaching hospitals (7.5 days) (fig 2A), but median cost of hospitalization was higher in non-teaching hospitals (USD 59702 vs 49708) (fig 2B) Conclusion: We found that the risks of most TAVR-related complications (except for AKI and hemorrhage) are about the same in teaching compared to non-teaching hospitals. However, length of stay was higher in teaching hospitals while cost was higher in non-teaching hospitals

The Effect of Financial Constraints on Income Shifting by U.S. Multinationals

2016 ◽  
Vol 91 (6) ◽  
pp. 1601-1627 ◽  
Author(s):  
Scott D. Dyreng ◽  
Kevin S. Markle
Keyword(s):  
Multinational Corporation ◽  
Financial Constraints ◽  
Income Shifting ◽  
External Financing ◽  
Short Term ◽  
Tax System ◽  
Foreign Countries ◽  
The Mean ◽  
The Cost ◽  
The U.S

ABSTRACT When a U.S. multinational corporation shifts income from the U.S. to foreign jurisdictions, it incurs costs and reaps benefits. The benefits may be reduced if the shifted income must be returned to the U.S. as a dividend in the short term and face the same U.S. tax it would have if the income had not been shifted. Firms, then, have incentive to defer repatriation of earnings and to fund domestic cash needs with external financing. The cost of external financing, however, is increasing in financial constraints, leading to the prediction that constrained firms will be unable to defer repatriation and, therefore, will reap no benefits from shifting. Using a new methodology for measuring income shifting, we find, consistent with predictions, that financially constrained firms shift less income from the U.S. to foreign countries than their unconstrained peers. We estimate that financially constrained firms shift out 20 percent less of pre-shifted income than unconstrained firms. Translating this percentage to dollar values, the mean (median) constrained firm shifts $16 million ($7 million) out of the U.S. each year, while the mean (median) unconstrained firm shifts $321 million ($134 million) out of the U.S. each year. Assuming that the inability to defer repatriation is the primary constraint preventing the U.S. worldwide tax system from being a de facto territorial system, we use our findings to estimate that changing to a pure territorial tax system would increase outbound income shifting by U.S. multinationals by 8 percent.

scholarly journals Kajian Biaya Penggunaan Omeprazole Sebagai Terapi Profilaksis Gastritis Pada Pasien Demam Dengue dan Demam Berdarah Dengue di RSUD X daerah Jakarta Periode Januari – Desember 2014

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Marvel Marvel Marvel ◽  
Anton Bahtiar Bahtiar ◽  
Agusdini Banun Saptaningsih
Keyword(s):  
Platelet Count ◽  
Length Of Stay ◽  
Dengue Fever ◽  
Dengue Hemorrhagic Fever ◽  
Odds Ratio ◽  
Hemorrhagic Fever ◽  
T Test ◽  
Chi Square ◽  
Total Cost ◽  
The Cost

Gastritis merupakan komplikasi yang dapat terjadi pada pasien demam dengue dan demam berdarah dengue. Faktor risiko perdarahan gastrointestinal adalah trombosit <50.000/mm3. Terapi pada pasien gastritis dapat diberikan omeprazole. Penelitian ini bertujuan untuk mengevaluasi pengaruh pemberian omeprazole pada pasien demam dengue dan demam berdarah dengue terhadap biaya, hari perawatan dan biaya omeprazole di RSUD X daerah Jakarta. Rancangan penelitian yang digunakan adalah kohort retrospektif. Kriteria inklusi adalah pasien rawat inap kelas tiga dengan diagnosis demam dengue dan demam berdarah dengue pada bulan Januari sampai Desember 2014. Sampel penelitian terdiri dari 42 pasien kelompok nonkriteria (trombosit>50.000/mm3) dan 39 pasien kelompok kriteria (trombosit<50.000/mm3). Alat pengumpul data merupakan catatan rekam medik pasien. Analisis data menggunakan uji Mann-Whitney, t-test dan uji Chi-Square. Hasil penelitian menunjukkan bahwa penggunaan omeprazole tidak terdapat perbedaan total biaya perawatan (p=0,345) dan biaya omeprazole (p=0,916) antara kelompok nonkriteria dan kelompok kriteria. Terdapat perbedaan hari rawat (p=0,004) pada kelompok nonkriteria dengan kelompok kriteria. Kategori pasien yaitu kelompok pasien nonkriteria dan kelompok kriteria tidak berpengaruh terhadap total biaya dan biaya omeprazole dilihat dari nilai OR secara berturut-turut sebesar 1,191 (IK; 0,450-3,152), 1,182 (IK; 0,469-2,977). Kategori pasien berpengaruh signifikan (p=0,005) dalam peningkatan lama hari rawat dengan OR (odds ratio) = 3,963 (IK; 1,530 – 10,265). Komorbiditas merupakan faktor yang mempengaruhi terjadinya peningkatan total biaya perawatan, lama hari rawat dan biaya penggunaan omeprazole.Kata kunci : omeprazole, gastritis, demam berdarah dengue, biaya perawatan, lama rawat inapGastritis is a complication that can occur in patients with dengue fever and dengue hemorrhagic fever. Risk factor for gastrointestinal bleeding is platelet count <50.000/mm3. Omeprazole is the one of choice for gastritis prophylaxis therapy. The purpose of this study is to evaluate the effect of omeprazole in patients with dengue fever and dengue hemorrhagic fever according to the cost, length of stay and the cost of omeprazole at X Public Hospital in Jakarta. Retrospective cohort is design of the study. The inclusion criteria were third class of inpatients with a diagnosis of dengue fever and dengue hemorrhagic fever in January to December 2014. The study sample consisted of 42 patients in the noncriteria group (platelets count>50,000 / mm3) and 39 patients criteria group (platelets count<50,000 / mm3 ). Data collection tool is a patient medical record. Data analysis using the Mann-Whitney test, t-test and Chi-Square test. Results showed that use of omeprazole there is no difference in the total cost of treatment (p = 0.345) and the cost of omeprazole (p = 0.916) between the group of noncriteria and criteria group. There are differences in length of stay (p = 0.004) in the group of noncriteria with the group criteria. Noncriteria group (platelets> 50,000 / mm3) and a group of criteria (platelet count <50,000 / mm3) did not affect the total cost, and cost of omeprazole seen from the OR (odds ratio) respectively, 1,191 (CI; 0,450 - 3,152), 1,182 (CI; 0,469 - 2,977). Platelet count have a significant effect (p = 0.005) in the increased length of stay with OR = 3.963 (CI; 1.530 - 10.265). Comorbidity is a factor that affecting the increase in the total cost, length of stay and cost of omeprazole.Key words : omeprazole, gastritis, dengue hemorraghic fever, cost of hospitalization, length of stay

scholarly journals Deleterious neurological impact of diagnostic delay in immune-mediated thrombotic thrombocytopenic purpura

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260196
Author(s):  
Arthur Renaud ◽  
Aurélie Caristan ◽  
Amélie Seguin ◽  
Christian Agard ◽  
Gauthier Blonz ◽  
...  
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Diagnostic Delay ◽  
Delayed Diagnosis ◽  
Altered Mental Status ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Short Term ◽  
Thrombocytopenic Purpura ◽  
Immune Mediated ◽  
Group 1

Background Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare life-threatening thrombotic microangiopathy requiring urgent therapeutic plasma exchange (TPE). However, the exact impact of a slight delay in TPE initiation on the subsequent patients’ outcome is still controversial. Aim We aimed to study the frequency, short-term neurological consequences, and determinants of diagnostic delay in iTTP. Methods We conducted a retrospective monocentric study including patients with a first acute episode of iTTP (2005–2020) classified into 2 groups: delayed (>24h from first hospital visit, group 1) and immediate diagnosis (≤24h, group 2). Results Among 42 evaluated patients, 38 were included. Eighteen cases (47%) had a delayed diagnosis (median: 5 days). The main misdiagnosis was immune thrombocytopenia (67%). The mortality rate was 5% (1 death in each group). Neurological events (stroke/TIA, seizure, altered mental status) occurred in 67% vs 30% patients in group 1 and 2, respectively (p = 0.04). Two patients in group 1 exhibited neurological sequelae. The hospital length of stay was longer in group 1 (p = 0.02). At the first hospital evaluation, potential alternative causes of thrombocytopenia were more prevalent in group 1 (33% vs 5%, p = 0.04). Anemia was less frequent in group 1 (67% vs 95%, p = 0.04). All patients had undetectable haptoglobin levels. By contrast, 26% of schistocytes counts were <1%, mostly in group 1 (62% vs 11%, p = 0.01). Conclusion Diagnostic delay is highly prevalent in iTTP, with a significant impact on short-term neurological outcome. In patients with profound thrombocytopenia, the thorough search for signs of incipient organ dysfunction, systematic hemolysis workup, and proper interpretation of schistocytes count are the key elements of early diagnosis of TTP.

Thrombotic Thrombocytopenic Purpura Predominance in the Southern United States; Trends in Regional and Seasonal Variation and Mortality of TTP Utilizing the National Inpatient Sample Database Between 1999 and 2013

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4750-4750
Author(s):  
Jordan Carter ◽  
William Lee ◽  
Stuthi Perimbeti ◽  
Ya Yu Liang ◽  
Rachel Nathan ◽  
...  
Keyword(s):  
United States ◽  
Seasonal Variation ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Categorical Variables ◽  
National Inpatient Sample ◽  
The South ◽  
Thrombocytopenic Purpura ◽  
North Central ◽  
Significant Seasonal Variation ◽  
Chi Square Analysis

Abstract Background: Few studies have been able to determine epidemiological factors associated with Thrombotic Thrombocytopenic Purpura (TTP) and no geographic distribution has been determined. Only one study to date, Giri et al., (Am J Hematol, 2015, 90:E24) has looked at regional differences in TTP and found a higher caseload of TTP in the South between 2009 and 2011. Data thus far on seasonal variations has been mixed. Park et al. (Transfusion, 2012, 52.7: 1530) reported an association between summer and presentation of TTP, and Giri et al. found a significant seasonal variation only in the Midwest with a spike in cases during the month of July, while others like Raval et al. (J Clin Apheresis, 2013, 29.2:113) reported no variation. Furthermore, mortality in TTP has traditionally been looked at in terms of data from a single center within their own regional cohort and no recent studies have analyzed the trends in mortality from TTP. Building on this, our study looked at the regional variation, seasonal variation, and national mortality of TTP using data on admissions from the National Inpatient Sample between 1999 and 2013. Methods: Adult admissions with a primary diagnosis of TTP were extracted from the National Inpatient Sample database using the ICD-9 code for TTP (446.2) during a 15 year period between 1999 and 2013 (N = 6,292, weighted N = 30,011). The sample was weighted to approximate the full inpatient population of the United States over the period of interest. Admission information studied included hospital region, which was differentiated into Northeast, Midwest or North Central, South, and West. The season of admissions over this interval was also analyzed. The Winter months were December to February, Spring: March-May, Summer: June-August, and Fall: September-November. We extrapolated seasons to be equivalent to climate. A Chi square analysis was used to analyze differences in categorical variables. To analyze differences in regional distribution, we assumed a normal distribution of 25% per region and then performed a chi squared analysis. Results: There were more cases of TTP in the South (43.50%) compared to the Midwest or North Central (23.31%), Northeast (18.36%), or West (14.82%) among 30,011 cases (p=0.001). In each year between 1999 and 2013, the admissions for TTP were higher in the South. While certain years individually appeared to have a seasonal variation, taking the years between 1999 and 2013 in summation (n=5,857) showed no statistically significant seasonal variation in presentation of TTP (p=0.694). Additionally, analyzing the seasonal data by region (n=5,857) still did not demonstrate any significant variation in the presentation of TTP (p=0.172). During the period of our analysis, overall mortality decreased from 12.12% in 1999 to its lowest level of 5.90% in 2013. Conclusion: These results not only confirm the findings from Giri et al., who showed a higher number of cases of TTP in the South for the years 2009 to 2011, but we also demonstrated this was true for the extended time period from 1999 to 2013. Our results also agree with Raval et al. who showed no seasonal association with presentation of TTP. Previous authors suggested that climate correlated with TTP admissions; however, our data showed that the climate did not have an effect on regional admissions for TTP. Extrapolating from this, even though the majority of cases of TTP occurred in the South, this is unrelated to the warmer climate seen in the South, as had been suggested by prior authors. From 1999 to 2013, hospital mortality trended downward. Perhaps trends in mortality have decreased due to recognition of effective treatment and earlier recognition of TTP. Further studies are needed to clarify why there is a regional difference in TTP and to determine if mortality will continue to decline over time. Disclosures No relevant conflicts of interest to declare.

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