scholarly journals Sjogren’s Syndrome is associated with higher healthcare utilization after primary hip, but not primary knee arthroplasty: A U.S. cohort study

2020 ◽  
Author(s):  
Jasvinder A Singh ◽  
John D. Cleveland
Keyword(s):  
Hospital Stay ◽  
Healthcare Utilization ◽  
Length Of Hospital Stay ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Hospital Charges ◽  
Implant Infection ◽  
Home Setting ◽  
Primary Thas ◽  
Primary Tkas

Abstract Objective: To assess whether Sjogren’s Syndrome (SS) is associated with outcomes after total knee or hip arthroplasty (TKA/THA). Methods: We used the 1998-2014 U.S. National Inpatient Sample data. We performed multivariable-adjusted logistic regression analyses to assess the association of SS with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital complications (implant infection, revision, transfusion, mortality), controlling for important covariates and confounders. In sensitivity analyses, we additionally adjusted the main models for hospital location/teaching status, bed size, and region . Results: We examined 4,116,485 primary THAs and 8,127,282 primary TKAs performed from 1998-2014; 12,772 (0.2%) primary TKAs and 6,222 (0.2%) primary THAs were done in people with SS. In multivariable-adjusted models, SS was associated with a statistically significant higher odds ratio (OR; 95% confidence interval (CI)) of discharge to a rehabilitation/inpatient facility post-THA, 1.13 (1.00, 1.28), but not post-TKA, 0.93 (0.86, 1.02). We noted no differences in the length of hospital stay or hospital charges. SS was associated with significantly higher adjusted odds of in-hospital transfusion post-THA, 1.37 (1.22, 1.55) and post-TKA, 1.21 (1.10, 1.34). No significant differences by SS diagnosis were seen in hospital stay, hospital charges implant infection, implant revision or mortality rates. Conclusions: People with SS had higher transfusion rate post-TKA/THA, and higher rate of discharge to non-home setting post-THA. The lack of association of SS with post-arthroplasty complications should reassure patients, surgeons and policy-makers about the utility of TKA/THA in people with SS undergoing these procedures.

scholarly journals Sjogren’s Syndrome is associated with higher healthcare utilization after primary hip, but not primary knee arthroplasty: A U.S. cohort study

2020 ◽  
Author(s):  
Jasvinder A Singh ◽  
John D. Cleveland
Keyword(s):  
Hospital Stay ◽  
Healthcare Utilization ◽  
Length Of Hospital Stay ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Hospital Charges ◽  
Implant Infection ◽  
Home Setting ◽  
Primary Thas ◽  
Primary Tkas

Abstract Objective: To assess whether Sjogren’s Syndrome (SS) is associated with outcomes after total knee or hip arthroplasty (TKA/THA).Methods: We used the 1998-2014 U.S. National Inpatient Sample data. We performed multivariable-adjusted logistic regression analyses to assess the association of SS with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital complications (implant infection, revision, transfusion, mortality), controlling for important covariates and confounders. In sensitivity analyses, we additionally adjusted the main models for hospital location/teaching status, bed size, and region.Results: We examined 4,116,485 primary THAs and 8,127,282 primary TKAs performed from 1998-2014; 12,772 (0.2%) primary TKAs and 6,222 (0.2%) primary THAs were done in people with SS. In multivariable-adjusted models, SS was associated with a statistically significant higher odds ratio (OR; 95% confidence interval (CI)) of discharge to a rehabilitation/inpatient facility post-THA, 1.13 (1.00, 1.28), but not post-TKA, 0.93 (0.86, 1.02). We noted no differences in the length of hospital stay or hospital charges. SS was associated with significantly higher adjusted odds of in-hospital transfusion post-THA, 1.37 (1.22, 1.55) and post-TKA, 1.21 (1.10, 1.34). No significant differences by SS diagnosis were seen in hospital stay, hospital charges implant infection, implant revision or mortality rates.Conclusions: People with SS had higher transfusion rate post-TKA/THA, and higher rate of discharge to non-home setting post-THA. The lack of association of SS with post-arthroplasty complications should reassure patients, surgeons and policy-makers about the utility of TKA/THA in people with SS undergoing these procedures.

scholarly journals Serious Infections in People with Scleroderma: A National U.S. Study

2020 ◽  
Author(s):  
Jasvinder Singh ◽  
John D. Cleveland
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Healthcare Utilization ◽  
Time Trends ◽  
Opportunistic Infections ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Home Setting ◽  
Serious Infection ◽  
Serious Infections

Abstract Objective: To study incidence, time-trends and outcomes of serious infections in scleroderma. Methods: We used the 1998-2016 U.S. National Inpatient Sample data. We examined the epidemiology, time-trends and outcomes of five serious infections (opportunistic infections (OI), skin and soft tissue infections (SSTI), urinary tract infection (UTI), pneumonia, and sepsis/bacteremia) in hospitalized people with scleroderma. We performed multivariable-adjusted logistic regression analyses to analyze independent association of factors with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital mortality. Results: There were 49,904,955 hospitalizations with serious infections in people without scleroderma and 61,615 in those with scleroderma. During 1998-2016, the most common serious infections in scleroderma were pneumonia (45%), sepsis (32%), SSTI (19%), UTI (3%) and OI (3%). In 2013-14, sepsis surpassed pneumonia as the most common serious infection; by 2015-16, sepsis was 1.8-times more common than pneumonia. Over the study period, hospital charges increased, while length of hospital stay and in-hospital mortality decreased, overall and for each serious infection. Multivariable-adjusted analyses showed that sepsis, age ≥80 years and Deyo-Charlson score ≥2 were associated with significantly higher odds of healthcare utilization and in-hospital mortality; and Medicare or Medicaid insurance payer, Northeast location, urban teaching or non-teaching hospital, and medium or large hospital bed size with significantly higher odds of healthcare utilization. Conclusions: Outcomes in people with scleroderma hospitalized with serious infections have improved over time, except higher hospital charges. Identification of factors associated with higher healthcare utilization and in-hospital mortality allows for developing interventions to improve outcomes.

scholarly journals Serious Infections in People with Systemic sclerosis: A National U.S. Study

2020 ◽  
Author(s):  
Jasvinder Singh ◽  
John D. Cleveland
Keyword(s):  
Systemic Sclerosis ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Healthcare Utilization ◽  
Time Trends ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Home Setting ◽  
Serious Infection ◽  
Serious Infections

Abstract Objective: To study incidence, time-trends and outcomes of serious infections in systemic sclerosis (SSc). Methods: We used the 1998-2016 U.S. National Inpatient Sample data. We examined the epidemiology, time-trends and outcomes of five serious infections (opportunistic infections (OI), skin and soft tissue infections (SSTI), urinary tract infection (UTI), pneumonia, and sepsis/bacteremia) in hospitalized people with SSc. We performed multivariable-adjusted logistic regression analyses to analyze independent association of factors with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital mortality. Results: There were 49,904,955 hospitalizations with serious infections in people without SSc and 61,615 in those with SSc. During 1998-2016, the most common serious infections in SSc were pneumonia (45%), sepsis (32%), SSTI (19%), UTI (3%) and OI (3%). In 2013-14, sepsis surpassed pneumonia as the most common serious infection; by 2015-16, sepsis was 1.8-times more common than pneumonia. Over the study period, hospital charges increased, while length of hospital stay and in-hospital mortality decreased, overall and for each serious infection. Multivariable-adjusted analyses showed that sepsis, age ≥80 years and Deyo-Charlson score ≥2 were associated with significantly higher odds of healthcare utilization and in-hospital mortality; and Medicare or Medicaid insurance payer, Northeast location, urban teaching or non-teaching hospital, and medium or large hospital bed size with significantly higher odds of healthcare utilization. Conclusions: Outcomes in people with SSc hospitalized with serious infections have improved over time, except higher hospital charges. Identification of factors associated with higher healthcare utilization and in-hospital mortality allows for developing interventions to improve outcomes.

scholarly journals P129 THORACIC VS. ABDOMINAL APPROACHES FOR DIAPHRAGMATIC HERNIA REPAIR: A NATIONWIDE STUDY OF CLINICAL OUTCOMES

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Andrea Carolina Quiroga Centeno ◽  
Orlando Navas ◽  
Juan Paulo Serrano ◽  
Sergio Alejandro Gómez Ochoa
Keyword(s):  
Hospital Stay ◽  
Diaphragmatic Hernia ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Surgical Approaches ◽  
Multivariate Logistic Regression Model ◽  
Abdominal Repair ◽  
Lower Health ◽  
The Impact

Abstract Aim “To compare the outcomes of different surgical approaches for diaphragmatic hernia (DH) repair.” Material and Methods “Adult patients with a principal admitting diagnosis of uncomplicated DH registered in the National Inpatient Sample in the period 2010-2015 were included. Patients with obstruction, gangrene, or congenital hernias were excluded. The primary outcome was in-hospital mortality. Secondary outcomes were the incidence of complications, length of stay, and hospital charges. A multivariate logistic regression model adjusted by age, sex, elective admission, comorbidities, and hospital characteristics was used to analyze the impact of the surgical approach on the evaluated outcomes.” Results “A total of 14910 patients with DH were included (median age 65 years, 74% women). Abdominal approaches were the most commonly performed (78.9% laparoscopy and 13.6% open). Patients that underwent open abdominal and thoracic repairs had a higher risk of complications (sepsis, pneumonia, surgical site infection, prolonged postoperative ileus, and acute myocardial infarction), longer hospital stay, higher total hospital costs, and a significantly higher risk of mortality (OR 2.62. 95% CI 1.59-4.30 and OR 4.60; 95% CI 2.37-8.91, respectively) compared to patients that underwent laparoscopic abdominal repair. Individuals whose DH repair was performed through thoracoscopy had a similar mortality risk to those who underwent laparoscopic abdominal repair (OR 0.87; 95% CI 0.11-6.43).” Conclusions “Nowadays, laparoscopy has become the most used approach for DH repair. In the present cohort, it was associated with better outcomes in terms of complications, length of hospital stay, and mortality, as well as lower health costs. Additional studies assessing hernia characteristics are required to validate this result.”

scholarly journals Prevalence, Length of Stay, and Hospitalization of Acute Kidney Injury in Patients With and Without Sjogren’s Syndrome

2020 ◽  
Vol 7 ◽  
pp. 205435812097009
Author(s):  
Mohamedanwar Ghandour ◽  
Hammam Shereef ◽  
Mowyad Khalid ◽  
Omeralfaroug Adam ◽  
Ahmed Hashim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Sjögren’S Syndrome ◽  
Sjögren's Syndrome ◽  
Kidney Injury ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Hospital Charges ◽  
Study Population ◽  
Sjögren‘S Syndrome

Background: Literature on the outcome of acute kidney injury (AKI) in Sjogren’s syndrome (SJS) is quite scanty. Acute kidney injury has emerged as a significant cause of morbidity and mortality in patients with autoimmune diseases such as systemic lupus erythematosus. Objective: To examine the outcome of AKI with and without SJS. To achieve this, we examined the prevalence, mortality, outcomes, length of stay (LOS), and hospital charges in patients with AKI with SJS compared with patients without SJS from a National Inpatient Sample (NIS) database in the period 2010 to 2013. Design: A retrospective cohort study using NIS. Setting: United States. Sample: Cohort of 977 055 weighted patient discharges with AKI from the NIS. Measurements: Not applicable. Methods: Data were retrieved from the NIS for adult patients admitted with a principal diagnosis of AKI between 2010 and 2013, using the respective International Classification of Diseases, Ninth Revision ( ICD-9) codes. The study population divided into 2 groups, with and without Sjogren’s disease. Multivariate and linear regression analysis conducted to adjust for covariates. We omitted patients with systemic sclerosis and rheumatoid arthritis from the analysis to avoid any discrepancy as they were not meant to be a primary outcome in our study. Results: The study population represented 977 055 weighted patient discharges with AKI. Analysis revealed AKI patients with Sjogren’s compared with patients without Sjogren’s had statistically significant lower hyperkalemia rates (adjusted odds ratio: 0.65, confidence interval: 0.46-0.92; P = .017. There was no statistically significant difference in mortality, LOS, hospital charges, and other outcomes. Limitations: Study is not up to date as data are from ICD-9 which are testing data from 2010 to 2013, and data were obtained through SJS codes, which have their limitations. Also, limitations included lack of data on metabolic acidosis, hypokalemia, and not including all causes of AKI. Conclusions: At present, our study is unique as it has examined prevalence, mortality, and outcomes of Sjogren’s in patients with AKI. Patients with Sjogren’s had significantly lower hyperkalemia during the hospitalization. Further research is needed to identify the underlying protective mechanisms associated with Sjogren’s that resulted in lower hyperkalemia. Trial registration: Not applicable.

The Association of Patients' Socioeconomic Characteristics with the Length of Hospital Stay and Hospital Charges within Diagnosis-Related Groups

1988 ◽  
Vol 318 (24) ◽  
pp. 1579-1585 ◽  
Author(s):  
Arnold M. Epstein ◽  
Robert S. Stern ◽  
Janet Tognetti ◽  
Colin B. Begg ◽  
Robert M. Hartley ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Diagnosis Related Groups ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Socioeconomic Characteristics

scholarly journals In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A426-A426
Author(s):  
Genaro Velazquez ◽  
Hafeez Shaka ◽  
Mukunthan Murthi ◽  
Iriagbonse Asemota ◽  
Sujitha Velagapudi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Secondary Diagnosis ◽  
Total Hospital ◽  
Mortality And Morbidity ◽  
Lower Odds ◽  
Hyperosmolar Hyperglycemic State

Abstract Background: In patients hospitalized with Hyperosmolar hyperglycemic state (HHS) the presence of comorbid conditions including hypertension, heart disease, stroke, and dementia have been variably reported to be associated with higher mortality. HTG is increasingly prevalent in patients with DM, especially those with poor glycemic control who are more likely to suffer from HHS. Elevated triglyceride levels have independently been associated with higher mortality in certain conditions like coronary artery disease and acute pancreatitis. However, data on the effect of Hypertriglyceridemia (HTG) on mortality and morbidity in hospitalized patients with HHS is sparse. Objective: We wanted to compare the outcomes for HHS hospitalizations for patients with and without HTG. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of HTG as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders. Results: Out of the 42 740 hospitalizations with HHS, about 17 040 had HTG. The in-hospital mortality for patients with HHS was 305 overall, out of which 70 patients had HTG as secondary diagnosis. Compared with patients without HTG, patients with HTG had lower odds of in- hospital mortality (0.30, 95% CI 0.157–0.56, p<0.005) when adjusted for patient and hospital characteristics. Patients with HHS and HTG had decreased length of hospital stay, less total Hospital charges, lower odds of Sepsis and Septic Shock, but similar odds of AKI and ARF in comparison to patients without HTG. Conclusion: Our study shows that HTG is associated with lower odds of in-hospital mortality in patients with HHS, even though the odds of AKI and ARF was same in both groups. A similar inverse relationship has already been reported between TG levels and mortality in stroke patients. Though the mechanism of this effect is unclear, one possible explanation could be that patients with HTG are more likely to be treated with statins and fibrates which have known anti-inflammatory effects. Further studies are required to evaluate this possible positive prognostic effect of TG.

A clinical pathway for patients undergoing primary cytoreductive surgery with rectosigmoid colectomy for advanced ovarian or primary peritoneal cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5569-5569
Author(s):  
M. A. Gerardi ◽  
A. Santillan ◽  
B. Meisner ◽  
T. P. Diaz-Montes ◽  
G. J. Gardner ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Median Time ◽  
Cytoreductive Surgery ◽  
Clinical Pathway ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Primary Peritoneal Cancer ◽  
Peritoneal Cancer ◽  
Group 2 ◽  
Group 1

5569 Background: To evaluate the safety, feasibility, and economic impact of a clinical pathway including rapid diet advancement for patients undergoing rectosigmoid colectomy as part of cytoreductive surgery for advanced ovarian or primary peritoneal cancer. Methods: Post-operative management was dictated by surgeon preference in 45 consecutive patients (Group 1) and according to the prescribed clinical pathway in 19 consecutive patients (Group 2). Critical elements of the clinical pathway included: rapid diet advancement, early discontinuance of nasogastric suction, criteria-based utilization of parenteral nutrition, selective laboratory testing, and deferring initiation of chemotherapy until after discharge. Results: The median age was 58 years for Group 1 patients and 67 years for Group 2 patients. Median time to flatus was 6 days for both groups; however, the median time to tolerating diet was 6 days for Group 1, and 4 days for Group 2. Patients in Group 1 had a median length of hospital stay of 12 days (range=5–30 days), a median total 30-day post-operative hospital charge of $42,868 (range=$19,960-$130,252), and a 30-day readmission rate of 33%, compared to 8 days (range=4–28 days) (p=0.020), $32,840 (range=$18,353-$140,283) (p=0.016), and 21% (p=0.379) for Group 2, respectively. Clinical pathway-directed management was associated with a median reduction in hospital charges of $10,027 per patient. Conclusions: A critical pathway incorporating rapid diet advancement for patients undergoing primary cytoreductive surgery with rectosigmoid colectomy for ovarian or primary peritoneal cancer is feasible, safe, and associated with a significant reduction in length of hospital stay and hospital-related charges and did not increase morbidity. No significant financial relationships to disclose.

scholarly journals Path Analysis of the Impact of Obesity on Postoperative Outcomes in Colorectal Cancer Patients: A Population-Based Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2904
Author(s):  
Kuan-Chih Chung ◽  
Ko-Chao Lee ◽  
Hong-Hwa Chen ◽  
Kung-Chuan Cheng ◽  
Kuen-Lin Wu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Path Analysis ◽  
Postoperative Infection ◽  
Digestive System ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Perioperative Outcomes ◽  
Total Hospital

Background: Obesity is adversely affecting perioperative outcomes; however, long-term outcomes do not appear to be affected by excess body weight (the obesity paradox). The purpose of this study is to examine the association between obesity and surgical outcomes in patients with colorectal cancer (CRC) using data from the United States National Inpatient Sample (NIS). Methods: Patients ≥20 years old diagnosed with CRC who received surgery were identified in the 2004–2014 NIS database. Patients who were obese (ICD-9-CM code: 278.0) were matched with controls (non-obese) in a 1:4 ratio for age, sex, and severity of CRC (metastasis vs. no metastasis). Linear regression and path analysis were used to compare outcomes between obese and non-obese patients. A total of 107,067 patients (53,376 males, 53,691 females) were included in the analysis, and 7.86% were obese. Results: The rates of postoperative infection, shock, bleeding, wound disruption, and digestive system complications were significantly different between the obese and non-obese groups. The obesity group had increased incidence of postoperative infection by 1.9% (∂P/∂X = 0.019), shock by 0.25% (∂P/∂X = 0.0025), postoperative bleeding by 0.5% (∂P/∂X = 0.005), wound disruption by 0.6% (∂P/∂X = 0.006), and digestive system complications by 1.35% (∂P/∂X = 0.0135). Path analysis showed that obesity group had higher in-hospital mortality through mentioned above five complications by 66.65 × 10−5%, length of hospital stay by 0.32 days, and total hospital charges by 2384 US dollars. Conclusions: Obesity increases the risk of postoperative complications in patients with CRC undergoing surgery. It also increased in-hospital mortality, length of hospital stay, and total hospital charges. Therefore, patients with obesity might require a higher level of preoperative interventions and complications monitoring to improve outcomes.

Lupus is associated with poorer outcomes after primary total hip arthroplasty

Lupus ◽  
2019 ◽  
Vol 28 (7) ◽  
pp. 834-842 ◽  
Author(s):  
J A Singh ◽  
J D Cleveland
Keyword(s):  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Hospital Charges ◽  
Care Utilization ◽  
Implant Infection ◽  
Total Hip ◽  
Inpatient Facility ◽  
Modifiable Factors ◽  
Primary Total Hip Arthroplasty

Objective The aim of this study was to assess whether lupus is associated with poorer outcomes after primary total hip arthroplasty (THA). Methods We used the 1998–2014 US National Inpatient Sample data. Multivariable-adjusted separate logistic regression models assessed the association of lupus with post-operative complications (implant infection, transfusion, THA revision and mortality) and health care utilization outcomes (total hospital charges, discharge to an inpatient facility and length of hospital stay >3 days) post-THA, adjusting for demographics, underlying diagnosis, comorbidity, insurance payer and hospital characteristics, using odds ratios (OR) and 95% confidence intervals (CI). Results Among 4,116,485 primary THA hospitalizations, 22,557 (0.5%) were in patients with lupus. Patients with lupus were younger and more likely to be female, African-American or Hispanic, living in the South, or to have Medicaid insurance, and had higher comorbidity or lower income. In multivariable-adjusted analyses, the presence of lupus was associated with significantly higher risk of implant infection, transfusion, discharge to an inpatient facility and higher hospital charges above the median, with respective ORs of 1.95 (95% CI, 1.28, 2.97), 1.34 (95% CI, 1.25, 1.43), 1.21 (95% CI, 1.01, 1.44) and 1.38 (95% CI, 1.30, 1.47). Lupus was not significantly associated with the risk of revision, mortality or hospital stay >3 days; the ORs were 1.10 (95% CI, 0.68, 1.78), 0.95 (95% CI, 0.61, 1.47) and 1.06 (95% CI, 0.99, 1.13), respectively. Conclusions Lupus was associated with a higher risk of implant infection, transfusion, discharge to an inpatient facility and higher hospital charges post-primary THA. Insight into modifiable factors associated with these outcomes may improve outcomes in patients with lupus undergoing THA.

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