Healthcare utilization and costs associated with GI cancers in the United States.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 361-361
Author(s):  
Aileen Deng ◽  
Atrayee Basu Mallick
Keyword(s):  
Bile Duct ◽  
Length Of Stay ◽  
Healthcare Utilization ◽  
Pancreas Cancer ◽  
Hospital Admissions ◽  
Intrahepatic Bile Duct ◽  
Hospital Charges ◽  
Gi Cancer ◽  
The Mean ◽  
Gi Cancers

361 Background: In 2009, adults had 4.7 million cancer-related hospitalizations. Adult hospital stays with cancer identified as the principal diagnosis cost $20.1 billion and accounted for 6% of adult inpatient hospital costs. GI cancer-related healthcare utilization has not been well-defined. The aim of this study was to evaluate the trends in the incidence and costs of GI cancer-related hospital admissions in the U.S. Methods: We reviewed the National Inpatient Sample Database (NIS) from 1997-2014. All patients with principle discharge diagnoses of esophageal, stomach, colon, rectum and anus, liver and intrahepatic bile duct and pancreas cancer were analyzed. Temporal trends in the number of hospital admissions, length of stay, hospitalization cost and mortality rates were obtained by HCUPnet. Results: GI cancer-related hospital admissions decreased from 230,537 in 1997 to 221,220 in 2014. Although the number of hospital admissions decreased for esophageal (12,157 to 11,885), stomach (23,528 to 21,800), colon (110,939 to 90,135), rectum and anus cancer (43,807 to 40,160), it has increased for liver and intrahepatic bile duct (11,243 to 21,775, p < 0.001) and pancreas cancer (28,862 to 35,465, p < 0.001). While the mean length of stay decreased from 9.6 days in 1997 to 7.6 days in 2014, the mean hospital charges per patient (adjusted for inflation) increased 127% from $34,747 in 1997 to $78,742 in 2014. The highest increase in mean hospital charges per patient were in liver and intrahepatic bile duct ($27,128 to $74,619 (175%), p < 0.001), rectum and anus ($32,566 to $80,789 (148%), p < 0.001) and pancreas cancer ($33,562 to $75,981 (126%), p < 0.001). Conclusions: GI cancer-related hospital admissions decreased from 1997 to 2014. Despite decrease in the mean length of hospital stay, the costs of hospitalizations have increased substantially, especially in liver and intrahepatic bile duct, rectum and anus and pancreas cancer. Our study suggests that shorter length of stay alone has not reduced costs of hospitalizations in GI cancers. There remains a growing need to understand healthcare costs and to develop effective value-based interventions in GI cancer-related hospital admissions.

Performance of a blood-based test for the detection of multiple cancer types.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 283-283
Author(s):  
Brian M. Wolpin ◽  
Donald A. Richards ◽  
Allen Lee Cohn ◽  
Xiaoji Chen ◽  
Joerg Bredno ◽  
...  
Keyword(s):  
Bile Duct ◽  
Extrahepatic Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Simultaneous Detection ◽  
Cancer Type ◽  
Gi Tract ◽  
Multiple Cancer ◽  
Gi Cancer ◽  
Cancer Types ◽  
Gi Cancers

283 Background: Cancers of the esophagus, stomach, pancreas, gallbladder, liver, bile duct, colon and rectum will account for 17% of incident cancer diagnoses and 26% of cancer-related deaths in the US in 2019. We developed a methylation-based cfDNA early multi-cancer detection test that also can predict the tissue of origin (TOO) of these and other cancers types; performance of this test for gastrointestinal (GI) tract cancers is reported here. Methods: The Circulating Cell-free Genome Atlas (CCGA; NCT02889978) study is a prospective, multi-center, observational, case-control study with longitudinal follow-up, enrolling individuals with cancer ( > 20 cancers, all stages, newly diagnosed) and without cancer. Plasma cfDNA was subjected to a cross-validated targeted methylation (TM) sequencing assay. Methylation fragments were combined across targeted genomic regions and assigned a probability of cancer and a predicted TOO. GI cancer classes were upper GI (esophagus/stomach, n = 67), pancreas/gallbladder/extrahepatic bile duct (n = 95), liver/intrahepatic bile duct (n = 29), and colon/rectum (n = 121). Results: Detection across all GI cancers was 82% (95% CI 77-86) at a > 99% pre-set specificity. Overall predicted TOO accuracy was 92% (88-95) among the samples for which TOO was predicted (6/255 had indeterminate predicted TOO). The table shows performance by GI cancer type. Conclusions: Simultaneous detection at high specificity ( > 99%) of multiple cancer types, including GI cancers across stages at high sensitivity (82%), was shown using TM analysis of cfDNA. Accurate (92%) localization of cancers to specific regions of the GI tract was also achieved. Detection of multiple GI cancers from a single noninvasive blood test could be a practical method for detecting GI and other cancers, and may facilitate diagnostic work-ups. Clinical trial information: NCT02889978. [Table: see text]

scholarly journals P192 Crystallising care: improving hospital gout management

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Benjamin D Clarke ◽  
Mark D Russell ◽  
Andrew I Rutherford ◽  
James B Galloway ◽  
John Stack
Keyword(s):  
Length Of Stay ◽  
Hospital Admissions ◽  
British Society ◽  
Published Data ◽  
Incidence Trends ◽  
Joint Aspiration ◽  
Difficult Condition ◽  
The Mean ◽  
Clinical Records ◽  
Mean Time

Abstract Background Gout is the most common cause of a hot swollen joint, and a major contributor to inpatient rheumatology workload. Recently published data demonstrated that hospital admissions due to gout increased by 59% in England from 2006 - 2017. The mean length of stay for a gout admission was 6 days in 2017; a figure that has not changed significantly over the last decade. We hypothesised that a key contributing factor to prolonged hospital stays in patients presenting with gout attacks is delayed joint aspiration and synovial fluid analysis. We investigated time to joint aspiration, and time taken to obtain a crystal analysis result, in acute rheumatology referrals at a large tertiary centre. Methods Electronic Health Records (EHR) system data were accessed for all joint aspirate crystal analyses in a 4-month window in 2017. EHR system documentation contains all clinical notes, electronic referrals, and laboratory requests with indicative coded timestamps. Pre- and post-aspirate differential diagnoses were compiled from the clinical record. Manual verification of the clinical records ascertained whether there was any delay in discharge pertaining to a crystal analysis. For representation, time figures were rounded to the nearest hour. Results Over a 4-month period, 38 patients who had been referred to the inpatient rheumatology team at King’s College Hospital had crystal analysis performed following joint aspiration; 24 from an emergency department setting, and 14 from an inpatient ward setting. The proportions of these cases by articular distribution (with the specific joint aspirated in brackets) were: 55% monoarthritis (knee), 16% oligoarthritis (knee), 16% polyarthritis (knee), 10% polyarthritis (wrist), 3% monoarthritis (elbow). Mean time from rheumatology referral to joint aspiration was 7 hours (range 1-21; median 5; IQR 3-8). The mean time from sample acquisition to crystal analysis result was 20 hours (range 1-95; median 16; IQR 4-21). Discharges for 17/38 (45%) patients were pending crystal analysis results, of which 10/17 (59%) patients were discharged without results. Rheumatology clinician pre-test diagnostic accuracy was 55%. Comparing pre-aspirate diagnosis with final diagnosis, proportionately septic arthritis was over-diagnosed, whilst gout was under-diagnosed. Conclusion Gout remains a difficult condition to promptly differentiate and treat in hospital. Clinician workload and joint aspiration burden are rising due to global incidence trends. A move to establish a “7-day NHS” and significant bed pressures have developed since the British Society for Rheumatology (BSR) hot swollen joint guideline was published. In our centre, inadequate crystal diagnostics appear to be driving prolonged length of stay. Further evaluation of causal factors in the delay of recognition, referral and diagnostics is required. Through application of quality improvement methodology, process-mapping and driver diagrams we plan to implement a point-of-care testing (POCT) and door-to-needle (DTN) programme, researching how to improve the gout patient’s experience. Disclosures B.D. Clarke None. M.D. Russell None. A.I. Rutherford None. J.B. Galloway None. J. Stack None.

Financial Impact of Tumor Lysis Syndrome Among Inpatients in the United States

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5966-5966
Author(s):  
Ranjan Pathak ◽  
Smith Giri ◽  
Madan Raj Aryal ◽  
Paras Karmacharya ◽  
Vijaya R. Bhatt ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nationwide Inpatient Sample ◽  
Tumor Lysis Syndrome ◽  
The United States ◽  
Hospital Charge ◽  
Hospital Charges ◽  
Tumor Lysis ◽  
Significant Difference ◽  
The Us ◽  
The Mean

Abstract Background With an estimated 0.1 million cases in 2014, lymphomas and acute leukemias are the leading causes of malignancies in the US. Tumor lysis syndrome (TLS) is a potentially devastating complication associated with hematologic malignancies leading to increased morbidity and mortality. Previous European studies have shown that the financial burden of TLS is high, with an estimated cost of 7,342 Euros ($10,320 US Dollars) per admission. However, there is a paucity of data on the economic impact of TLS among US inpatients. Methods We used the Nationwide Inpatient Sample database to identify hospitalized patients aged ≥18 years with a primary diagnosis of TLS (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 277.88) from the first year the diagnosis code was introduced (2009) to 2011. Nationwide Inpatient Sample is the largest all-payer publicly available inpatient care database in the US. It contains data from five to eight million hospital stays from about 1,000 hospitals across the country and approximates a 20% sample of all US hospitals. We calculated the mean length of stay (LOS) and mean hospital charges per TLS admission and compared them with those of overall inpatient admissions. Given that renal failure occurs in severe cases, we compared the mean LOS and hospital charge between TLS patients with and without RRT (hemodialysis or peritoneal dialysis, ICD-9-CM procedure codes 39.35 and 54.98 respectively). Data analysis was done using STATA version 13.0 (College Station, TX). Results We identified 997 admissions with TLS. Mean age was 67.5 (±3.3) with 62% males and 80.4% whites. Overall mean LOS and hospital charge for TLS during the study period was 8.02 days (SE 0.83) and $ 72,840 (SE 8,083). Both the mean LOS and hospital charge for TLS were significantly higher than overall in-patient admissions (Table 1). A total of 949 patients (95%) underwent RRT. There was no significant difference in mean LOS (9.84 days vs 7.94 days, p=0.28) and mean hospital charge ($ 88,098 vs $ 71,930, p=0.58) in patients with TLS that underwent RRT compared (95.2%, n=949) to patients that did not undergo RRT (4.8%, n=48). Conclusion Our study shows that TLS is associated with a significant economic burden, with a mean cost of $ 72,840 per TLS hospitalization. Although majority of the patients hospitalized for TLS received RRT, its use was not associated with significantly higher costs. Further studies are warranted to determine the ways of optimizing current preventive measures and to explore the drivers of increased in-hospital costs in TLS patients. Table 1 Mean LOS and Hospital Charge in TLS Admissions Compared with Overall Inpatient Admissions, 2009-2011 Year Mean LOS (days) Mean hospital charge (USD) TLS admissions Overall admissions p TLS admissions Overall admissions p 2009 13.94 4.5 0.02 104,235 30,506 0.04 2010 7.62 4.6 <0.001 69,552 32,799 <0.001 2011 7.14 4.5 <0.001 69,222 35,213 <0.001 LOS=Length of Stay; TLS=Tumor Lysis Syndrome; USD=US Dollars Disclosures No relevant conflicts of interest to declare.

Increased length of stay and hospital charges in adolescents with type 1 diabetes and psychiatric illness

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Fernando A. Munoz ◽  
Cindy Chin ◽  
Samantha A. Kops ◽  
Katie Kowalek ◽  
Michael D. Seckeler
Keyword(s):  
Length Of Stay ◽  
Healthcare Utilization ◽  
Type I Diabetes ◽  
Hospital Charges ◽  
Type I ◽  
Bonferroni Correction ◽  
Psychiatric Illnesses ◽  
Severe Diabetes ◽  
Increased Risk

AbstractObjectivesType I diabetes mellitus (T1DM) is one of the most common chronic diseases of childhood. Diabetic ketoacidosis (DKA) in this population contributes to significant healthcare utilization, including emergency room visits, hospitalizations, and ICU care. Comorbid psychiatric illnesses (CPI) are additional risks for increased healthcare utilization. While CPI increased risk for DKA hospitalization and readmission, there are no data evaluating the relationship between CPI and hospital outcomes. We hypothesized that adolescents with T1DM and CPI admitted for DKA have increased length of stay (LOS) and higher charges compared to those without CPI.MethodsRetrospective review of 2000–2012 Healthcare Cost and Utilization Project’s (HCUP) Kids’ Inpatient Databases (KID). Patients 10–21 years old admitted with ICD-9 codes for DKA or severe diabetes (250.1–250.33) with and without ICD-9 codes for depression (296–296.99, 311) and anxiety (300–300.9). Comparisons of LOS, mortality, and charges between groups (No CPI, Depression and Anxiety) were made with one way ANOVA with Bonferroni correction, independent samples Kruskal-Wallis test with Bonferroni correction and χ2.ResultsThere were 79,673 admissions during the study period: 68,573 (86%) No CPI, 8,590 (10.7%) Depression and 12,510 (15.7%) Anxiety. Female patients comprised 58.2% (n=46,343) of total admissions, 66% of the Depression group, and 71% of the Anxiety group. Patients with depression or anxiety were older and had longer LOS and higher mean charges (p<0.001 for both).ConclusionComorbid depression or anxiety are associated with significantly longer LOS and higher charges in adolescents with T1DM hospitalized for DKA. This study adds to the prior findings of worse outcomes for patients with both T1DM and CPI, emphasizing the importance of identifying and treating these comorbid conditions.

Inpatient outcomes and predictors of mortality in patients with gastrointestinal malignancies presenting with sepsis: A nationwide analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4045-4045
Author(s):  
Parth Desai ◽  
Ishaan Vohra ◽  
Bashar Attar ◽  
Vatsala Katiyar ◽  
Prasanth Lingamaneni ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Admissions ◽  
Hospital Charge ◽  
Primary Diagnosis ◽  
Hospital Charges ◽  
Total Charge ◽  
Gastrointestinal Malignancies ◽  
Metabolic Encephalopathy ◽  
Predictors Of Mortality ◽  
Gram Negative Bacteremia

4045 Background: Sepsis is a frequent cause of morbidity and mortality in patients with malignancy. However, there is paucity of literature on mortality, hospital charges and overall healthcare utilization among patients with GI malignancy, which we hope to characterize in this study. Methods: We queried retrospective data from the Nationwide Inpatient Sample (NIS) database for the year 2016. Sepsis (Dx1) was identified using ICD-10 code as primary diagnosis in patients with known GI malignancies (Dx2). Univariate and multivariate Poisson regression analysis was done to study outcomes. Propensity score matching was done to minimize confounding factors. Primary outcome was inpatient mortality. Secondary outcomes were Length of Stay (LOS), Total Charge (TOTCHG) and ICU admission. Results: A total of 43,240 patients with GI malignancy were admitted in 2016 with sepsis. Two most common GI malignancies admitted with sepsis were colorectal (35%) and hepato-cellular cancer (HCC) (28.2%). Overall mortality in GI cancer was 19.8% vs 10.2% in all cancers (p<0.01). There was male (59%) and Caucasian (63%) preponderance. Out of all hospital admissions for GI malignancy, 41.4% were secondary to sepsis. E. coli (31%) infection and gram-negative bacteremia (15%) were the most common causes of sepsis. Sepsis with GI malignancy was associated with length of stay of 7.4 days vs 5.4 days (coef 2.44, 95% CI 2.3-6.7 p=0.04) and a mean hospital charge of $88,728 vs $ 54, 668 (coef 34,140, 95% CI 44,264-90,646, p<0.01) as compared to without sepsis. After adjusting for demographic and patient related variables, independent predictors of mortality were old age, uninsured, African Americans, septic shock requiring pressor support, AKI, inpatient hemodialysis, metabolic encephalopathy and acute respiratory failure. Conclusions: Sepsis poses a substantial healthcare burden in patients with GI malignancy and is a major cause of mortality. Early antibiotic treatment is necessary for sepsis control in patients with GI malignancy. [Table: see text]

scholarly journals Clinical application of laparoscopy combined with choledochoscopy in patients with bilioenteric anastomotic stricture with access via the jejunal loops

2021 ◽  
Vol 49 (7) ◽  
pp. 030006052110345
Author(s):  
Yi Zhu ◽  
Jinhai Li ◽  
Minjie Xie ◽  
Jing Jin ◽  
Jianying Lou
Keyword(s):  
Bile Duct ◽  
Anastomotic Stricture ◽  
Intrahepatic Bile Duct ◽  
Perioperative Period ◽  
Outcome Analysis ◽  
Term Outcome ◽  
Estimated Blood Loss ◽  
Intrahepatic Lithiasis ◽  
The Mean ◽  
Age Range

Objective Bilioenteric anastomotic stricture is a serious complication following choledochojejunostomy. Some patients develop intrahepatic lithiasis and biliary tract infection without dilation of the intrahepatic bile duct. The present study was performed to investigate the safety and efficacy of laparoscopy combined with choledochoscopy in patients with bilioenteric anastomotic stricture with access via the jejunal loops. Methods The data of 10 patients (7 men and 3 women; mean age, 60.8 ± 9.7 years; age range, 51–76 years) with potential bilioenteric anastomotic stricture without dilation of the intrahepatic bile duct from January 2015 to December 2019 were retrospectively reviewed. Results All 10 patients underwent surgery, and their clinical parameters were recorded. The mean surgery time was 181.5 ± 35.4 minutes, and the mean estimated blood loss was 32.0 ± 15.5 mL. No patients developed serious complications during the perioperative period. The short-term outcome analysis at 12 months indicated that the stenosis had been effectively dilated and that the liver function had improved. Conclusions The results of the present study demonstrated that laparoscopy combined with choledochoscopy with access via the jejunal loops is feasible in the treatment of bilioenteric anastomotic stricture and intrahepatic lithiasis.

scholarly journals Overuse or underuse? Use of healthcare services among irregular migrants in a north-eastern Spanish region

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Luis Andrés Gimeno-Feliu ◽  
Marta Pastor-Sanz ◽  
Beatriz Poblador-Plou ◽  
Amaia Calderón-Larrañaga ◽  
Esperanza Díaz ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Healthcare Utilization ◽  
Negative Binomial ◽  
Hospital Admissions ◽  
Adult Population ◽  
Negative Binomial Regression ◽  
Healthcare Services ◽  
Drug Expenditure ◽  
Morbidity Burden ◽  
Irregular Migrants

Abstract Background There is little verified information on global healthcare utilization by irregular migrants. Understanding how immigrants use healthcare services based on their needs is crucial to establish effective health policy. We compared healthcare utilization between irregular migrants, documented migrants, and Spanish nationals in a Spanish autonomous community. Methods This retrospective, observational study included the total adult population of Aragon, Spain: 930,131 Spanish nationals; 123,432 documented migrants; and 17,152 irregular migrants. Healthcare utilization data were compared between irregular migrants, documented migrants and Spanish nationals for the year 2011. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden. Results The average annual use of healthcare services was lower for irregular migrants than for documented migrants and Spanish nationals at all levels of care analyzed: primary care (0.5 vs 4 vs 6.7 visits); specialized care (0.2 vs 1.8 vs 2.9 visits); planned hospital admissions (0.3 vs 2 vs 4.23 per 100 individuals), unplanned hospital admissions (0.5 vs 3.5 vs 5.2 per 100 individuals), and emergency room visits (0.4 vs 2.8 vs 2.8 per 10 individuals). The average annual prescription drug expenditure was also lower for irregular migrants (€9) than for documented migrants (€77) and Spanish nationals (€367). These differences were only partially attenuated after adjusting for age, sex, and morbidity burden. Conclusions Under conditions of equal access, healthcare utilization is much lower among irregular migrants than Spanish nationals (and lower than that of documented migrants), regardless of country of origin or length of stay in Spain.

Rates of Preventable Hospitalization for Ambulatory Care Sensitive Conditions (ACSCs) among Patients with Lymphoid Malignancies (LM)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 873-873
Author(s):  
Jeffrey Alan Jones ◽  
Joseph M Flynn ◽  
John C. Byrd
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Cancer Treatment ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Research Quality ◽  
Hospital Charges ◽  
Medical Illness ◽  
Comparator Group

BACKGROUND: The influence of comorbid medical illness on treatment outcome and survival from LM has been well-characterized. Recent reports suggest that optimal management of these comorbidities may also be important. We sought to indirectly determine the effectiveness of outpatient treatment for ACSCs, conditions where good outpatient care can potentially prevent the need for hospitalization, by calculating population-based estimates of hospital admission rates among patients with LM. Methods: Data were obtained from the 2005 Nationwide Inpatient Sample. Using ICD-9CM codes, we identified all adult (age ≥20) admissions to U.S. community hospitals for LM (Hodgkin’s disease, non-Hodgkin’s lymphoma, and multiple myeloma). A comparator group without known diagnosis of cancer was created by excluding records containing any diagnosis code for malignant neoplasm or diagnosis/procedure code for cancer treatment. ACSC admissions, including those for short- and long-term complications of diabetes mellitus (DM), uncontrolled DM, asthma, hypertension (HTN), congestive heart failure (CHF), angina, and hypovolemia, were ascertained using algorithms developed and validated for the U.S. Agency for Health Care Research Quality Prevention Quality Indicators. The 2005 5-year prevalence for LM was obtained from SEER and used as the denominator for rate calculations in that group. A denominator for the no cancer group was created using U.S. Census estimates for the 2005 adult population less the SEER 5-year prevalence for all sites. Mean hospital charges were extracted for each admission and transformed into costs using Medicare cost-to-charge ratios. Length of stay, total costs, and in-hospital mortality were compared across groups for each ACSC. All means and proportions were sample weighted. Results: In 2005 there were an estimated 510,300 total LM admissions and 26,700,000 total admissions in the no cancer comparator group. Estimated hospitalization rates for each ASCS and odds ratios for the between group comparisons are detailed below. ACSC Group Admission Rate LM (per 100,000 pop) Admission Rate No Cancer (per 100,000 pop) OR (95% CI) DM Short-term Comp 74.7 33.3 2.25 (1.96–2.57) DM Long-term Comp 286.8 138.6 2.07 (1.93–2.22) DM Uncontrolled 50.4 12.06 4.18 (3.54–4.93) CHF 2360.0 465.5 5.17 (5.04–5.30) HTN 69.3 57.7 1.20 (1.04–1.38) Angina 60.0 21.9 2.74 (2.36–3.20) Asthma 255.4 81.5 3.14 (2.91–3.38) Hypovolemia 1086.5 90.1 12.2 (11.75–12.63) In-hospital mortality did not significantly differ between groups for any ACSC. Mean length of stay and hospital costs were likewise similar with the exception of costs for CHF ($8,957[95%CI 8,260–9,654] v. $7,176 [6,185–8,168]) and length of stay (5.6d [95%CI 4.8–6.3] v. 4.0d [3.9–4.1]) and costs ($8,702 [6,832–10,572] v. $5690[5,373–6,007]) for asthma admissions. Conclusions: Hospitalization of LM patients for ASCSs is common and occurs with odds generally >2 times higher than among patients without a cancer diagnosis. Future studies should be conducted to determine factors influencing these findings (e.g. rates of comorbidity, influence of cancer treatment, utilization of primary care services) and to develop potential strategies for preventing hospital admissions.

Gastrointestinal Cancers: Racial and Ethnicity Differences

2021 ◽  
Author(s):  
Maharaj Singh ◽  
Santhi Konduri ◽  
Samit Datta ◽  
Wesley Papenfuss ◽  
Geoffrey Belini ◽  
...  
Keyword(s):  
Small Intestine ◽  
Bile Duct ◽  
Race And Ethnicity ◽  
Lower Risk ◽  
Extrahepatic Bile Duct ◽  
Survival Rates ◽  
Intrahepatic Bile Duct ◽  
Lower Mortality ◽  
Gi Cancers ◽  
Race Category

Abstract Objective: The purpose of this study was to examine race and ethnicity for overall survival (OS) and percent survival after 5- and 10-years for patients diagnosed with one of the gastrointestinal (GI) cancers.Method: We used national data for 12 types of GI cancers (esophagus, stomach, gallbladder, intrahepatic bile duct, extrahepatic bile duct, liver, pancreas, small intestine, colon, rectosigmoid, rectum, and anal) for the years 2004-2016. Results: A total of 2,249,213 patients diagnosed with one of the GI tract cancers with median age of 67 years were included in this study. There were 55% male, 77% non-Hispanic White (NHW), 12% were non-Hispanic Black (NHB), 6% were Hispanic, and the rest were classified as ‘Other’ race (4%). OS was higher for the Hispanics, followed by the ‘Other’, NHW and NHB (P <0.001). After adjusting for sex, income, insurance status, grade differentiation, age, and for Charlson-Dayo index, Hispanics and ‘Other’ race category had lower mortality compared to NHW (HR=0.93, 0.92-0.94, p <0.001; HR=0.92, 0.91-0.93, p <0.001), whereas NHB had higher risk compared to NHW (HR=1.09,1.08-1.09 p <0.001). Hispanics had lower mortality than NHW for 11 or 12 types (except esophagus), and ‘Other’ race category had lower risk for 10 of 12 types (except anal and small intestine). Five- and 10-year survival rates were higher for Hispanic patients (47%, 36%) followed by ‘Other’ (42%, 31%), NHW (40%, 28%), and for NHB (38%, 28%).Conclusion: Hispanics and the patients from ‘Other’ race category diagnosed with one of the GI cancers had longer survival probability and lower risk of mortality compared to NHW and NHB.

scholarly journals Use of ERCP in the United States over the past decade

2020 ◽  
Vol 08 (06) ◽  
pp. E761-E769
Author(s):  
Paul T. Kröner ◽  
Mohammad Bilal ◽  
Ronald Samuel ◽  
Shifa Umar ◽  
Marwan S. Abougergi ◽  
...  
Keyword(s):  
Bile Duct ◽  
Length Of Stay ◽  
Hospital Costs ◽  
Multivariate Regression Analysis ◽  
The United States ◽  
Hospital Length ◽  
Therapeutic Interventions ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
The Past

Abstract Background and study aims With newer imaging modalities, indications for use of endoscopic retrograde cholangiopancreatography (ERCP) have changed in the last decade. Despite advances in ERCP, paucity in recent literature regarding utilization and outcomes of ERCP exists. Thus, the aim of this study was to assess the inpatient use of ERCP, outcomes, and most common indications. Patients and methods Retrospective-cohort study using the Nationwide Inpatient Sample 2007–2016. All patients with ICD9–10CM procedural codes for ERCP were included. The primary outcome was the use of ERCP. Secondary outcomes included determining procedural specifics (stenting, sphincterotomy and dilation), complications (post-ERCP pancreatitis [PEP], bile duct perforation), hospital length of stay, total hospital costs and charges. Multivariate regression analysis was used to adjust for confounders. Results A total of 1,606,850 patients underwent inpatient ERCP. The mean age was 59 years (60 % female). The total number of ERCPs increased over the last decade. Patients undergoing ERCP in 2016 had greater odds of undergoing bile duct stent placement, pancreatic duct (PD) stenting, biliary dilation, pancreatic sphincterotomy, PEP and biliary perforation. Inpatient mortality decreased. Hospital charges increased, while length of stay (LOS) decreased. Conclusions The number of ERCPs increased in the past decade. Odds of therapeutic interventions and complications increased. The most common principal diagnoses were choledocholithiasis and gallstone-related AP. Hence, physicians must be aware to promptly diagnose and treat complications. These findings may reflect the increased case complexity and fact that ERCP continues to evolve into an increasingly interventional tool, contrasting from its former role as a predominantly diagnostic and gallstone extraction tool.

Sign in / Sign up

Export Citation Format

Share Document