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

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]

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A cost analysis of managing cancer-related pain among hospitalized US cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7079 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7079-7079

Author(s):

Olatunji B. Alese ◽

Chao Zhang ◽

Katerina Mary Zakka ◽

Sungjin Kim ◽

Christina Wu ◽

...

Keyword(s):

Pain Management ◽

Hospital Stay ◽

Cancer Patients ◽

Metastatic Cancer ◽

Hospital Charge ◽

Hospital Charges ◽

Total Charge ◽

Total Hospital ◽

Total Hospital Charge ◽

The Cost

7079 Background: Pain is a common symptom of cancer, affecting patients' function and quality of life. It is also a common cause of hospitalization for cancer patients. The aim of this study was to evaluate the cost of in-hospital pain management among US cancer patients. Methods: A retrospective analysis of data from all US hospitals that contributed to the National Inpatient Sample for 2011-2015 was conducted. All cancer patients admitted for pain management were included in the analysis. Main outcomes were factors significantly associated with hospital length of stay, total charge per hospital stay, and in-hospital mortality. Weighted chi-square test was used for categorical covariates and univariate analysis was performed using a logistic model. Results: 122,776 patient discharges were identified. Mean age was 59.3 years and 52.3% were female. 65.9% stayed in the hospital for longer than 72 hours, with a median total hospital charge of $48,156. Conversely, the median total hospital charge for those spending less than 72 hours on admission was $15,966. Median total charge per hospital stay was similar among insured and uninsured/self-pay patients ($32,879 vs. $32,323; p=0.013), but higher in patients without metastatic disease ($33,315 vs. $29,369; p<0.001). It was also higher in those with the highest income quartile when compared with lowest income patients ($38,223 vs. $30,047; p<0.001). Co-morbid medical illnesses were more prevalent in those with longer hospital stay (15 vs. 12; p<0.001) and the overall in-hospital mortality rate was 8.2%. There was no significant difference in median total hospital charges between those who died in, or those discharged from the hospital ($33,746 vs. $32,795; p<0.001). On multivariate analyses, gender, race, insurance status, diagnosis of metastatic cancer, age, number of co-morbid medical illnesses, year of diagnosis, and median income were significant predictors of length of stay. Race, insurance payor, metastatic cancer, age, and number of co-morbid medical illnesses were significant predictors of total hospital charges, after adjusting for other covariates. Conclusions: In-patient pain management of cancer patients is associated with significant health care costs. Optimization of outpatient pain management strategies could significantly lower the cost of care for cancer.

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CERVICAL SPINE REOPERATION RATES AND HOSPITAL RESOURCE UTILIZATION AFTER INITIAL SURGERY FOR DEGENERATIVE CERVICAL SPINE DISEASE IN 12 338 PATIENTS IN WASHINGTON STATE

Neurosurgery ◽

10.1227/01.neu.0000360347.10596.bd ◽

2009 ◽

Vol 65 (6) ◽

pp. 1011-1023 ◽

Cited By ~ 35

Author(s):

Joseph T. King ◽

Khalid M. Abbed ◽

Grahame C. Gould ◽

Edward C. Benzel ◽

Zoher Ghogawala

Keyword(s):

Cervical Spine ◽

Length Of Stay ◽

Primary Diagnosis ◽

Hospital Charges ◽

Fusion Surgery ◽

Cervical Spine Surgery ◽

Degenerative Cervical Spine ◽

Reoperation Rates ◽

Spine Disease ◽

Degenerative Cervical Spine Disease

Abstract OBJECTIVE Patients undergoing surgery for degenerative cervical spine disease may require future surgery for disease progression. We investigated factors related to the rate of additional cervical spine surgery, the associated length of stay, and hospital charges. METHODS The was a longitudinal retrospective cohort study using Washington state's 1998 to 2002 state inpatient databases and International Classification of Diseases–Ninth Revision–Clinical Modification (ICD-9) codes to analyze patients undergoing degenerative cervical spine surgery. Multivariate Poisson regression to identify patient and surgical factors associated with reoperation for degenerative cervical spine disease was used. Multivariate linear regressions to identify factors associated with length of stay and hospital charges adjusted for age, sex, year of surgery, primary diagnosis, payment type, discharge status, and comorbidities were also used. RESULTS A total of 12 338 patients underwent initial cervical spine surgeries from 1998 to 2002; the mean follow-up duration was 2.3 years, and 688 patients (5.6%) underwent a reoperation (2.5% per year). Higher reoperation rates were independently associated with younger patients (P < 0.001) and a primary diagnosis of disc herniation with myelopathy (P = 0.011). Ventral surgery (P < 0.001) and fusion (P < 0.001) were both associated with lower rates of reoperation; however, a high correlation (Spearman's rho = 0.82; P < 0.001) made it impossible to determine which factor was dominant. Longer length of stay was independently associated with nonventral approaches (+1.0 day; P < 0.001) and fusion surgery (+0.8 day; P < 0.001). Greater hospital charges were independently associated with nonventral approaches (+$2900; P < 0.001) and fusion surgery (+$9600; P < 0.001). CONCLUSION Patients undergoing surgery for degenerative cervical spine disease undergo reoperations at the rate of 2.5% per year. An initial ventral approach and/or fusion seem to be associated with lower reoperation rates. An initial nonventral approach and fusion were more expensive.

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

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.361 ◽

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.

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

Blood ◽

10.1182/blood.v124.21.5966.5966 ◽

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.

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The Impact of Methicillin Resistance in Staphylococcus aureus Bacteremia on Patient Outcomes: Mortality, Length of Stay, and Hospital Charges

Infection Control and Hospital Epidemiology ◽

10.1086/502522 ◽

2005 ◽

Vol 26 (2) ◽

pp. 166-174 ◽

Cited By ~ 597

Author(s):

Sara E. Cosgrove ◽

Youlin Qi ◽

Keith S. Kaye ◽

Stephan Harbarth ◽

Adolf W. Karchmer ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Length Of Stay ◽

Methicillin Resistance ◽

Tertiary Care ◽

Multivariable Analysis ◽

Bloodstream Infections ◽

Hospital Charge ◽

Hospital Charges ◽

The Impact ◽

Length Of Hospitalization

AbstractObjective:To evaluate the impact of methicillin resistance in Staphylococcus aureus on mortality, length of hospitalization, and hospital charges.Design:A cohort study of patients admitted to the hospital between July 1, 1997, and June 1, 2000, who had clinically significant S. aureus bloodstream infections.Setting:A 630-bed, urban, tertiary-care teaching hospital in Boston, Massachusetts.Patients:Three hundred forty-eight patients with S. aureus bacteremia were studied; 96 patients had methicillin-resistant S. aureus (MRSA). Patients with methicillin-susceptible S. aureus (MSSA) and MRSA were similar regarding gender, percentage of nosocomial acquisition, length of hospitalization, ICU admission, and surgery before S. aureus bacteremia. They differed regarding age, comorbidities, and illness severity score.Results:Similar numbers of MRSA and MSSA patients died (22.9% vs 19.8%; P = .53). Both the median length of hospitalization after S. aureus bacteremia for patients who survived and the median hospital charges after S. aureus bacteremia were significantly increased in MRSA patients (7 vs 9 days, P = .045; $19,212 vs $26,424, P = .008). After multivariable analysis, compared with MSSA bacteremia, MRSA bacteremia remained associated with increased length of hospitalization (1.29 fold; P = .016) and hospital charges (1.36 fold; P = .017). MRSA bacteremia had a median attributable length of stay of 2 days and a median attributable hospital charge of $6,916.Conclusion:Methicillin resistance in S. aureus bacteremia is associated with significant increases in length of hospitalization and hospital charges.

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Pengaruh Perubahan Status Gizi Pasien Dewasa terhadap Lama Rawat Inap dan Biaya Rumah Sakit

Jurnal Gizi Klinik Indonesia ◽

10.22146/ijcn.15359 ◽

2004 ◽

Vol 1 (1) ◽

pp. 35

Author(s):

R Dwi Budiningsari

Keyword(s):

Length Of Stay ◽

Nutritional Status ◽

Global Assessment ◽

Reference Group ◽

Hospital Charge ◽

Hospitalized Patients ◽

Adult Patients ◽

Hospital Charges ◽

Subjective Global Assessment ◽

Hospital Outcomes

Background: The decline in nutritional status of hospitalized patients was reported to be assossiated with longer length of stay and higher hospital charges. However, the effect of changes in nutritional status on hospital outcomes in Indonesia is still unknown.Objective: To determine the effect of changes in nutritional status on length of stay and hospital charge among adult hospitalized patients.Method: A total subjects of 262 adult patients who were admitted to internal and neurology departments of Dr. Sardjito, Dr.M.Jamil, and Sanglah hospitals were included in this study. Nutritional status of each patient was assessed using Subjective Global Assessment (SGA) method. Information on length of stay and hospital charge was collected based on medical records.Results: Subjects with nutritional status declined from normally to moderately, normally to severely, and moderately to severely malnourished were 6,3 (OR=6.32, 95% CI=1,3-29,8); 11,9 (OR=11.94, 95% CI=1,02-139,1); and 6,90 (OR=6.9, 95%CI=1,5-32,0 )times more likely to stay longer than those with nutritional status stayed normal during hospitalitation. They also had 3,3; unlimited; and 1,76 times risk on higher hospital charges than reference group (95% CI=1,123-9,529; unlimited; and 0,590-5,245).Conclusions: The declines of nutritional status from normally to moderately, normally to severely, and moderately to severely malnourished in hospitalized patients influenced to longer length of stay. Normally to moderately and normally to severely malnourished in hospitalized patients influenced to higher hospital charges.

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To Pack or Not to Pack: Inpatient Management of Epistaxis in the Elderly

American Journal of Rhinology and Allergy ◽

10.1177/1945892418801259 ◽

2018 ◽

Vol 32 (6) ◽

pp. 539-545 ◽

Cited By ~ 4

Author(s):

Albert H. Zhou ◽

Sei Y. Chung ◽

Michael J. Sylvester ◽

Michael Zaki ◽

Peter S. Svider ◽

...

Keyword(s):

Length Of Stay ◽

Elderly Patients ◽

Hospital Mortality ◽

The Elderly ◽

Primary Diagnosis ◽

Pulmonary Complications ◽

Nasal Packing ◽

Hospital Charges ◽

Cardiac Complications ◽

The Impact

Background Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly. Methods The 2008–2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. Results A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001). Conclusion Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.

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

Blood ◽

10.1182/blood.v112.11.873.873 ◽

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.

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Cancer-Related Pain Is an Independent Predictor of In-Hospital Opioid Overdose: A Propensity-Matched Analysis

Pain Medicine ◽

10.1093/pm/pnz130 ◽

2019 ◽

Vol 20 (12) ◽

pp. 2552-2561 ◽

Cited By ~ 1

Author(s):

Nnaemeka E Onyeakusi ◽

Fahad Mukhtar ◽

Semiu O Gbadamosi ◽

Adebamike Oshunbade ◽

Adeyinka C Adejumo ◽

...

Keyword(s):

Length Of Stay ◽

Postoperative Pain Management ◽

Hospital Charge ◽

Primary Objective ◽

Hospital Charges ◽

Opioid Overdose ◽

Inpatient Mortality ◽

Total Hospital ◽

Total Hospital Charge ◽

Secondary Objective

Abstract Background About 50% of patients with cancer who have undergone surgery suffer from cancer-related pain (CP). The use of opioids for postoperative pain management presents the potential for overdose, especially among these patients. Objective The primary objective of this study was to determine the association between CP and postoperative opioid overdose among inpatients who had undergone major elective procedures. The secondary objective was to assess the relationship between CP and inpatient mortality, total hospital charge, and length of stay in this population. Methods Data of adults 18 years and older from the National Inpatient Sample (NIS) were analyzed. Variables were identified using ICD-9 codes. Propensity-matched regression models were employed in evaluating the association between CP and outcomes of interest. Results Among 4,085,355 selected patients, 0.8% (N = 2,665) had CP, whereas 99.92% (N = 4,082,690) had no diagnosis of CP. We matched patients with CP (N = 2,665) and no CP (N = 13,325) in a 1:5 ratio. We found higher odds of opioid overdose (adjusted odds ratio [aOR] = 4.82, 95% confidence interval [CI] = 2.68–8.67, P < 0.0001) and inpatient mortality (aOR = 1.39, 95% CI = 1.11–1.74, P = 0.0043) in patients with CP vs no CP. Also, patients with CP were more likely to stay longer in the hospital (12.76 days vs 7.88 days) with higher total hospital charges ($140,220 vs $88,316). Conclusions CP is an independent risk factor for opioid overdose, increased length of stay, and increased total hospital charges.

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Challenges of using asthma admission rates as a measure of primary care quality in children: An international comparison

Journal of Health Services Research & Policy ◽

10.1177/13558196211012732 ◽

2021 ◽

pp. 135581962110127

Author(s):

Irina Lut ◽

Kate Lewis ◽

Linda Wijlaars ◽

Ruth Gilbert ◽

Tiffany Fitzpatrick ◽

...

Keyword(s):

Primary Care ◽

Hospital Admission ◽

Hospital Admissions ◽

Underlying Disease ◽

Primary Diagnosis ◽

Care Quality ◽

Attendance Rates ◽

Admission Rates ◽

Primary Care Quality ◽

Hospital Administrative

Objectives To demonstrate the challenges of interpreting cross-country comparisons of paediatric asthma hospital admission rates as an indicator of primary care quality. Methods We used hospital administrative data from >10 million children aged 6–15 years, resident in Austria, England, Finland, Iceland, Ontario (Canada), Sweden or Victoria (Australia) between 2008 and 2015. Asthma hospital admission and emergency department (ED) attendance rates were compared between countries using Poisson regression models, adjusted for age and sex. Results Hospital admission rates for asthma per 1000 child-years varied eight-fold across jurisdictions. Admission rates were 3.5 times higher when admissions with asthma recorded as any diagnosis were considered, compared with admissions with asthma as the primary diagnosis. Iceland had the lowest asthma admission rates; however, when ED attendance rates were considered, Sweden had the lowest rate of asthma hospital contacts. Conclusions The large variations in childhood hospital admission rates for asthma based on the whole child population reflect differing definitions, admission thresholds and underlying disease prevalence rather than primary care quality. Asthma hospital admissions among children diagnosed with asthma is a more meaningful indicator for inter-country comparisons of primary care quality.

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