Characterizing the costs of complications after cystectomy: Can we target the primary drivers?

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 304-304
Author(s):  
Matthew Mossanen ◽  
Ross E Krasnow ◽  
Matthew Ingham ◽  
Adam S Kibel ◽  
Mark A Preston ◽  
...  
Keyword(s):  
Soft Tissue ◽  
High Volume ◽  
Healthcare Research ◽  
Teaching Hospitals ◽  
Complication Rates ◽  
Discharge Disposition ◽  
The Us ◽  
Clinical Classification Software ◽  
Primary Driver ◽  
Continent Diversion

304 Background: Radical Cystectomy (RC) is subject to substantial morbidity and patients face complication rates as high as 64% at 90-days. Understanding the costs of complications after RC is essential to improving care. We studied the financial cost of different categories of complications after RC in order to identify drivers of expenditures. Methods: Using the Premier Hospital Database we identified adult patients who underwent RC for bladder cancer from 600 hospitals across the US from 2003-2013. Ninety-day complications were captured using ICD9 codes. Complications were categorized according to Agency for Healthcare Research and Quality Clinical Classification Software. The primary outcome was cost of complication and secondary outcomes were mortality, length of stay (LOS), and discharge disposition. A generalized liner model conforming to a gamma distribution was used to evaluate cost data. Analyses were survey weighted, and all models were adjusted for patient (age, race, obesity, marital status, payer), hospital (bed size, teaching affiliation, rural, region), and surgery characteristics (lymphadenectomy, continent diversion, robotic, operative time, transfusion, surgeon volume, hospital volume) and clustered by hospital. Results: We identified 9,137 RC patients, representing a weighting population of 57,553 patients. The top four most costly complications were venous thromboembolism (VTE $17547), soft tissue ($13523), gastrointestinal (GI $8663), and infectious (non-wound, i.e. sepsis, $7930). Pharmacy related costs were the primary driver of VTE costs. LOS was increased in each complication by 1.7 days for infectious, 4.5 days for soft tissue, 3.5 days for GI, and 3 days for VTE. Being married, having fewer comorbidities, larger hospitals, teaching hospitals, shorter operations, lack of transfusions, high volume hospitals, and high volume surgeons were associated with statistically significantly lower costs of complications after cystectomy. Conclusions: VTE, soft tissue, and GI complications are the most expensive complications after cystectomy, and thereby highlight potential candidates for future quality improvement initiatives.

A national analysis of 9655 pediatric cerebrovascular malformations: effect of hospital volume on outcomes

2019 ◽  
Vol 24 (4) ◽  
pp. 397-406
Author(s):  
Vijay M. Ravindra ◽  
Michael Karsy ◽  
Arianna Lanpher ◽  
Robert J. Bollo ◽  
Julius Griauzde ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
High Volume ◽  
Complication Rates ◽  
Case Volume ◽  
Patient Demographics ◽  
The Us ◽  
Hospital Pediatric ◽  
National Analysis ◽  
National Trends ◽  
Inpatient Database

OBJECTIVEComprehensive multicenter data on the surgical treatment of pediatric cerebrovascular malformations (CVMs) in the US are lacking. The goal of this study was to identify national trends in patient demographics and assess the effect of hospital case volume on outcomes.METHODSAdmissions for CVMs (1997–2012) were identified from the nationwide Kids’ Inpatient Database. Admissions with and without craniotomy were reviewed separately. Patients were categorized by whether they were treated at low-, medium-, or high-volume centers (< 10, 10–40, > 40 cases/year, respectively). A generalized linear model was used to evaluate the association of hospital pediatric CVM case volume and clinical variables assessing outcomes.RESULTSAmong the 9655 patients, 1828 underwent craniotomy and 7827 did not. Patient age and race differed in the two groups, as did the rate of private medical payers. High-volume hospitals had fewer nonroutine discharges (11.2% [high] vs 16.4% [medium] vs 22.3% [low], p = 0.0001). For admissions requiring craniotomy, total charges ($106,282 [high] vs $126,215 [medium] vs $134,978 [low], p < 0.001) and complication rates (0.09% [high] vs 0.11% [medium] vs 0.16% [low], p = 0.001) were lower in high-volume centers.CONCLUSIONSThis study revealed that further investigation may be needed regarding barriers to surgical treatment of pediatric CVMs. The authors found that surgical treatment of pediatric CVM at high-volume centers is associated with significantly fewer complications, better dispositions, and lower costs, but for noncraniotomy patients, low-volume centers had lower rates of complications and death and lower costs. These findings may support the consideration of appropriate referral of CVM patients requiring surgery or with intracranial hemorrhage toward high-volume, specialized centers.

Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003–2010

2014 ◽  
Vol 20 (2) ◽  
pp. 125-141 ◽  
Author(s):  
Mayur Sharma ◽  
Ashish Sonig ◽  
Sudheer Ambekar ◽  
Anil Nanda
Keyword(s):  
Household Income ◽  
Nationwide Inpatient Sample ◽  
Young Patients ◽  
High Volume ◽  
Teaching Hospitals ◽  
Median Household Income ◽  
Inpatient Mortality ◽  
Discharge Disposition ◽  
Comorbidity Index ◽  
The Mean

Object The aim of this study was to analyze the incidence of adverse outcomes and inpatient mortality following resection of intramedullary spinal cord tumors by using the US Nationwide Inpatient Sample (NIS) database. The overall complication rate, length of the hospital stay, and the total cost of hospitalization were also analyzed from the database. Methods This is a retrospective cohort study conducted using the NIS data from 2003 to 2010. Various patient-related (demographic categories, complications, comorbidities, and median household income) and hospital-related variables (number of beds, high/low case volume, rural/urban location, region, ownership, and teaching status) were analyzed from the database. The adverse discharge disposition, in-hospital mortality, and the higher cost of hospitalization were taken as the dependent variables. Results A total of 15,545 admissions were identified from the NIS database. The mean patient age was 44.84 ± 19.49 years (mean ± SD), and 7938 (52%) of the patients were male. Regarding discharge disposition, 64.1% (n = 9917) of the patients were discharged to home or self-care, and the overall in-hospital mortality rate was 0.46% (n = 71). The mean total charges for hospitalization increased from $45,452.24 in 2003 to $76,698.96 in 2010. Elderly patients, female sex, black race, and lower income based on ZIP code were the independent predictors of other than routine (OTR) disposition (p < 0.001). Private insurance showed a protective effect against OTR disposition. Patients with a higher comorbidity index (OR 1.908, 95% CI 1.733–2.101; p < 0.001) and with complications (OR 2.214, 95% CI 1.768–2.772; p < 0.001) were more likely to have an adverse discharge disposition. Hospitals with a larger number of beds and those in the Northeast region were independent predictors of the OTR discharge disposition (p < 0.001). Admissions on weekends and nonelective admission had significant influence on the disposition (p < 0.001). Weekend and nonelective admissions were found to be independent predictors of inpatient mortality and the higher cost incurred to the hospitals (p < 0.001). High-volume and large hospitals, West region, and teaching hospitals were also the predictors of higher cost incurred to the hospitals (p < 0.001). The following variables (young patients, higher median household income, nonprivate insurance, presence of complications, and a higher comorbidity index) were significantly correlated with higher hospital charges (p < 0.001), whereas the variables young patients, nonprivate insurance, higher median household income, and higher comorbidity index independently predicted for inpatient mortality (p < 0.001). Conclusions The independent predictors of adverse discharge disposition were as follows: elderly patients, female sex, black race, lower median household income, nonprivate insurance, higher comorbidity index, presence of complications, larger hospital size, Northeast region, and weekend and nonelective admissions. The predictors of higher cost incurred to the hospitals were as follows: young patients, higher median household income, nonprivate insurance, presence of complications, higher comorbidity index, hospitals with high volume and a large number of beds, West region, teaching hospitals, and weekend and nonelective admissions.

Impact of facility volume on complications from immunotherapy for renal cell carcinoma.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 672-672
Author(s):  
Eugene Blanchard Cone ◽  
Ye Wang ◽  
Stephen Reese ◽  
Steven Lee Chang
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
High Volume ◽  
Teaching Hospitals ◽  
Hospital Treatment ◽  
Complication Rates ◽  
Advanced Cancer Patients ◽  
Low Volume

672 Background: Better outcomes have been generally associated with higher volume providers/hospitals. Recent work found an association between higher volume facilities and survival for advanced cancer patients. Volume and treatment complications for medical cancer therapy is unexplored. We studied a retrospective cohort of patients with metastatic renal cell carcinoma receiving immunotherapy at high and low volume hospitals. Methods: We used Premier Healthcare Data, which includes administrative data from all payors at over 700 community and academic hospitals, and captures 20% of all hospital discharges in the US, including infusions performed in hospital clinics. Using ICD9 codes we identified patients with metastatic renal cell carcinoma treated with nivolumab from 2015-17. Clinicodemographic data were obtained for patients and hospitals. The primary exposure was dichotomized hospital treatment volume (top quartile = high volume). Outcomes were immunotherapy-related complications for which the patient re-presented to the Emergency Department or was readmitted, and readmission for other cause. We performed mixed effects logistic regression adjusting for complex survey design to achieve national representation. Results: We included 15,724 weighted hospital encounters (5,835 at low-volume hospitals and 9,889 at high-volume hospitals). Urban, teaching hospitals were more likely to be high volume, but all patient factors were balanced. We observed 1,457 complications at high volume hospitals and 1,734 at low volume hospitals. There were no significant differences by volume of hospital in overall rates of complications (OR 0.92, 95% CI 0.82-1.09) or in rates of individual complications, with the exception of ocular complications (n=11, all low volume hospitals). We observed that high volume hospitals significantly reduced odds for readmission (OR 0.09, 0.03-0.24) unrelated to immunotherapy complications. Conclusions: We found no difference in immunotherapy-related complication rates by facility volume. This is reassuring for community administration of immunotherapy. Further study is needed to elucidate why we saw significantly more therapy-unrelated readmissions at lower volume hospitals.

Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload

2005 ◽  
Vol 102 (6) ◽  
pp. 977-986 ◽  
Author(s):  
William T. Curry ◽  
Michael W. McDermott ◽  
Bob S. Carter ◽  
Fred G. Barker
Keyword(s):  
Mortality Rate ◽  
Hospital Discharge ◽  
High Volume ◽  
Mortality Rates ◽  
Content Type ◽  
Relative Mortality ◽  
Discharge Disposition ◽  
The Us ◽  
Meningioma Surgery ◽  
Fine Print

Object. The goal of this study was to determine the risk of adverse outcomes after contemporary surgical treatment of meningiomas in the US and trends in patient outcomes and patterns of care. Methods. The authors performed a retrospective cohort study by using the Nationwide Inpatient Sample covering the period of 1988 to 2000. Multivariate regression models with disposition end points of death and hospital discharge were used to test patient, surgeon, and hospital characteristics, including volume of care, as outcome predictors. Multivariate analyses revealed that larger-volume centers had lower mortality rates for patients who underwent craniotomy for meningioma (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.59–0.93, p = 0.01). Adverse discharge disposition was also less likely at high-volume hospitals (OR 0.71, 95% CI 0.62–0.80, p < 0.001). With respect to the surgeon caseload, there was a trend toward a lower rate of mortality after surgery when higher-caseload providers were involved, and a significantly less frequent adverse discharge disposition (OR 0.71, 95% CI 0.62–0.80, p <, 0.001). The annual meningioma caseload in the US increased 83% between 1988 and 2000, from 3900 patients/year to 7200 patients/year. In-hospital mortality rates decreased 61%, from 4.5% in 1988 to 1.8% in 2000. Reductions in the mortality rates were largest at high-volume centers (a 72% reduction in the relative mortality rate at largest-volume-quintile centers, compared with a 6% increase in the relative mortality rate at lowest-volume-quintile centers). The number of US hospitals where craniotomies were performed for meningiomas increased slightly. Fewer centers hosted one meningioma resection annually, whereas the largest centers had disproportionate increases in their caseloads, indicating a modest centralization of meningioma surgery in the US during this interval. Conclusions. The mortality and adverse hospital discharge disposition rates were lower when meningioma surgery was performed by high-volume providers. The annual US caseload increased, whereas the mortality rates decreased, especially at high-volume centers.

Abstract WMP32: Variation in the Rates of Acute Ischemic Stroke Transfers Between Hospitals in the United States

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Gregg Fonarow ◽  
Eric Smith ◽  
Li Liang ◽  
Robert Sutter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
High Volume ◽  
The United States ◽  
Teaching Hospitals ◽  
Large Sample Size ◽  
Stroke Registry ◽  
Intravenous Tissue Plasminogen Activator ◽  
The Us ◽  
Iv Tpa

Background: Many patients are transferred from emergency departments or inpatient units to stroke centers for advanced acute ischemic stroke (AIS) care, especially after intravenous tissue plasminogen activator (tPA). We sought to determine variation in the rates of AIS patient transfer in the US. Methods: Using data from the national Get With The Guidelines-Stroke registry, we analyzed AIS cases from 01/2010 to 03/14. Transfer-in was defined as transfer of AIS patients from other hospitals. Due to large sample size, instead of p-values, standardized differences were reported and a map of transfer-in rates across the US constructed. Results: Of the 970,390 patients discharged from 1,646 hospitals in the US, 87% were admitted via the ER or direct admission (front door) vs. 13% transferred-in. While most hospitals (61%) had transfer-in rates of < 5% of all AIS patients, a minority (17%) had high (>15%) transfer-in rates. High transfer-in hospitals were more often in the Midwest, were larger, and had higher annual AIS and IV tPA case volumes, and were also more often teaching hospitals and stroke centers (primary or comprehensive) (Table and Figure).. IV tPA was used more frequently in eligible patients in high-volume transfer-in hospitals (Table); otherwise, stroke quality of care was similar. Conclusions: There is significant regional- and state-level variability in the transfer of AIS patients. This may reflect differences in resource availability and the distribution of smaller, under-resourced hospitals that frequently transfer patients for advanced care after stabilization. Additional research is warranted to understand this variation.

scholarly journals The Social Aspects of Sexual Health: A Twitter-Based Analysis of Valentine’s Day Perception

Sexes ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 50-59
Author(s):  
Andrea Sansone ◽  
Angelo Cignarelli ◽  
Daniele Mollaioli ◽  
Giacomo Ciocca ◽  
Erika Limoncin ◽  
...  
Keyword(s):  
Social Networks ◽  
Sexual Behavior ◽  
Sexual Health ◽  
Ad Hoc ◽  
Healthcare Research ◽  
Social Aspects ◽  
The Social ◽  
The Us ◽  
Valentine's Day ◽  
The Uk

Sentiment analysis (SA) is a technique aimed at extracting opinions and sentiments through the analysis of text, often used in healthcare research to understand patients’ needs and interests. Data from social networks, such as Twitter, can provide useful insights on sexual behavior. We aimed to assess the perception of Valentine’s Day by performing SA on tweets we collected between 28 January and 13 February 2019. Analysis was done using ad hoc software. A total of 883,615 unique tweets containing the word “valentine” in their text were collected. Geo-localization was available for 48,918 tweets; most the tweets came from the US (36,889, 75.41%), the UK (2605, 5.33%) and Canada (1661, 3.4%). The number of tweets increased approaching February 14. “Love” was the most recurring word, appearing in 111,981 tweets, followed by “gift” (55,136), “special” (34,518) and “happy” (33,913). Overall, 7318 tweets mentioned “sex”: among these tweets, the most recurring words were “sexy” (2317 tweets), “love” (1394) and “gift” (679); words pertaining to intimacy and sexual activity, such as “lingerie”, “porn”, and “date” were less common. In conclusion, tweets about Valentine’s Day mostly focus on the emotions, or on the material aspect of the celebration, and the sexual aspect of Valentine’s Day is rarely mentioned.

Surgical management of soft tissue tumors of the abdominal wall: A retrospective study in a high‐volume sarcoma center

2021 ◽  
Author(s):  
Maud Neuberg ◽  
Olivier Mir ◽  
Antonin Levy ◽  
Isabelle Sourrouille ◽  
Sarah Dumont ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Soft Tissue ◽  
Abdominal Wall ◽  
Surgical Management ◽  
High Volume ◽  
Soft Tissue Tumors

Color doppler ultrasonography of soft-tissue masses

1998 ◽  
Vol 39 (4) ◽  
pp. 421-426 ◽  
Author(s):  
R. Lagalla ◽  
A. Iovane ◽  
G. Caruso ◽  
M. Lo Bello ◽  
L. E. Derchi
Keyword(s):  
Soft Tissue ◽  
Doppler Ultrasonography ◽  
Color Doppler ◽  
Soft Tissue Tumors ◽  
Color Doppler Ultrasonography ◽  
Tissue Mass ◽  
Vascular Impedance ◽  
The Us ◽  
Soft Tissue Masses ◽  
Malignant Lesions

Purpose: To evaluate the capability of color Doppler ultrasonography to differentiate between benign and malignant soft-tissue tumors. Material and Methods: We reviewed the ultrasonographic (US) and color Doppler (CD) findings in 46 consecutive patients with a palpable periskeletal mass. The presence of 3 or more vascular hila and of tortuous and irregular internal vessels within the lesions was considered an indication of malignancy. The CD diagnosis was compared with that obtained at US alone. Results: The sensitivity and specificity of CD were respectively 85% and 92%; these values were higher than those obtained at US alone, respectively 75% and 50%. Arteriovenous malformations presented as lesions with large internal vessels that had low vascular impedance and were easily diagnosed. The waveform patterns within solid tumors were not specific. Conclusion: At present, US is commonly employed to confirm the presence of a suspected soft-tissue mass, to locate it accurately, and to indicate its nature. CD findings enhance the role of the US technique in such lesions. The combined use of US and CD can allow the differentiation of benign from malignant lesions, and thus provide a better basis for treatment.

Improved Outcomes Amongst High Risk Lung Transplant Patients at High Volume Centers: A Case for Regionalization in the US

2015 ◽  
Vol 34 (4) ◽  
pp. S243
Author(s):  
J.C. Grimm ◽  
J. Magruder ◽  
A. Kilic ◽  
V. Valero ◽  
S.P. Dungan ◽  
...  
Keyword(s):  
High Risk ◽  
Lung Transplant ◽  
High Volume ◽  
Transplant Patients ◽  
Improved Outcomes ◽  
The Us

Analysis of demographics and outcomes of surgical resection in the CNS of patients with melanoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21534-e21534
Author(s):  
Achuta Kumar Guddati ◽  
Takefumi Komiya ◽  
Picon Hector ◽  
Allan N. Krutchik ◽  
Gagan Kumar
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Hospital Mortality ◽  
Surgical Resection ◽  
Home Healthcare ◽  
Teaching Hospitals ◽  
Surgical Interventions ◽  
Discharge Disposition ◽  
Nationwide Inpatient Sample Database ◽  
Significant Difference

e21534 Background: Patients with melanoma frequently develop central nervous system metastases. Oligometastatic disease is often treated either by surgical resection or by stereotactic radiotherapy. This study investigates the trends and clinical outcomes of patients with melanoma who have undergone surgical procedures on the central nervous system during their hospitalization. Methods: A retrospective cohort study was performed based on admissions of adult patients who underwent craniectomy/surgical resection for metastatic melanoma from 2002 -2014 using the Nationwide Inpatient Sample database. The primary outcome measure was all-cause in-hospital mortality. Secondary outcomes included length of hospital stay(LOS) and discharge disposition (home/home with health care and skilled nursing facilities/long term acute care (SNF/LTAC)). Factors associated with in-hospital mortality were examined by multivariable logistic regression. We adjusted for patient and hospital characteristics, payer, and comorbid conditions. We also examined trends of mortality for the study years. P was kept at 0.05. Results: There were an estimated 5972 discharges of patients with melanoma undergoing craniectomy/surgical resection during the study period. Patients undergoing surgical interventions were typically males (69%) and whites (79%). 98% of procedures were performed at teaching hospitals. Unadjusted all-cause in-hospital mortality was 3.1%. There was no significant difference in mortality over 13 years. Age, gender, and race were not associated with increased in-hospital mortality. Median LOS was 5 days (IQR 3-9 days). LOS was longer in elderly and those with higher Charlson co-morbid index. Of the survivors, 76% were discharged to home or with home healthcare while 24% were discharged to SNF/LTAC. Patients with age > 65 (OR 2.9; 95%CI 2.2-3.9, p < 0.001) and those with higher Charlson co-morbid index (OR 1.2; 95%CI 1.1-1.3) had higher odds for being discharged to SNF/LTAC. Conclusions: Patients who undergo craniectomy/surgical resection for melanoma have a low in-hospital mortality rate. One quarter of patients are discharged to SNF/LTAC.

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