scholarly journals Opioid-Induced Respiratory Depression Increases Hospital Costs and Length of Stay in Patients Recovering on the General Care Floor

2021 ◽  
Author(s):  
Ashish Khanna ◽  
Leif Saager ◽  
Sergio Bergese ◽  
Carla Jungquist ◽  
Hiroshi Morimatsu ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Length Of Stay ◽  
Respiratory Depression ◽  
Economic Burden ◽  
Hospital Cost ◽  
Hospital Costs ◽  
Prediction Tool ◽  
Patients At Risk ◽  
General Care

Abstract Background: Opioid-induced respiratory depression is common on the general care floor. However, the clinical and economic burden of respiratory depression is not well-described. The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial created a prediction tool to identify patients at risk of respiratory depression. The purpose of this retrospective sub-analysis was to examine healthcare utilization and hospital cost associated with respiratory depression.Methods: 1,335 patients (N=769 United States patients) enrolled in the PRODIGY trial received parenteral opioids and underwent continuous capnography and pulse oximetry monitoring. Cost data was retrospectively collected for 420 United States patients. Differences in healthcare utilization and costs between patients with and without ≥1 respiratory depression episode were determined. The impact of respiratory depression on hospital cost per patient was evaluated using a propensity weighted generalized linear model.Results: Patients with ≥1 respiratory depression episode had a longer length of stay (6.4 ± 7.8 days vs 5.0 ± 4.3 days, p=0.009) and higher hospital cost ($21,892 ± $11,540 vs $18,206 ± $10,864, p=0.002) compared to patients without respiratory depression. Patients at high risk for respiratory depression, determined using the PRODIGY risk prediction tool, who had ≥1 respiratory depression episode had higher hospital costs compared to high risk patients without respiratory depression ($21,948 ± $9,128 vs $18,474 ± $9,767, p=0.0495). Propensity weighted analysis identified 17% higher costs for patients with ≥1 respiratory depression episode (p=0.007). Length of stay significantly increased total cost, with cost increasing exponentially for patients with ≥1 respiratory depression episode as length of stay increased.Conclusions: Respiratory depression on the general care floor is associated with a significantly longer length of stay and increased hospital costs. Early identification of patients at risk for respiratory depression may reduce the incidence of respiratory depression and its associated clinical and economic burden.Trial registration: ClinicalTrials.gov, NCT02811302

scholarly journals Opioid-induced respiratory depression increases hospital costs and length of stay in patients recovering on the general care floor

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ashish K. Khanna ◽  
Leif Saager ◽  
Sergio D. Bergese ◽  
Carla R. Jungquist ◽  
Hiroshi Morimatsu ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Length Of Stay ◽  
Respiratory Depression ◽  
Economic Burden ◽  
Hospital Cost ◽  
Hospital Costs ◽  
Prediction Tool ◽  
Patients At Risk ◽  
General Care

Abstract Background Opioid-induced respiratory depression is common on the general care floor. However, the clinical and economic burden of respiratory depression is not well-described. The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial created a prediction tool to identify patients at risk of respiratory depression. The purpose of this retrospective sub-analysis was to examine healthcare utilization and hospital cost associated with respiratory depression. Methods One thousand three hundred thirty-five patients (N = 769 United States patients) enrolled in the PRODIGY trial received parenteral opioids and underwent continuous capnography and pulse oximetry monitoring. Cost data was retrospectively collected for 420 United States patients. Differences in healthcare utilization and costs between patients with and without ≥1 respiratory depression episode were determined. The impact of respiratory depression on hospital cost per patient was evaluated using a propensity weighted generalized linear model. Results Patients with ≥1 respiratory depression episode had a longer length of stay (6.4 ± 7.8 days vs 5.0 ± 4.3 days, p = 0.009) and higher hospital cost ($21,892 ± $11,540 vs $18,206 ± $10,864, p = 0.002) compared to patients without respiratory depression. Patients at high risk for respiratory depression, determined using the PRODIGY risk prediction tool, who had ≥1 respiratory depression episode had higher hospital costs compared to high risk patients without respiratory depression ($21,948 ± $9128 vs $18,474 ± $9767, p = 0.0495). Propensity weighted analysis identified 17% higher costs for patients with ≥1 respiratory depression episode (p = 0.007). Length of stay significantly increased total cost, with cost increasing exponentially for patients with ≥1 respiratory depression episode as length of stay increased. Conclusions Respiratory depression on the general care floor is associated with a significantly longer length of stay and increased hospital costs. Early identification of patients at risk for respiratory depression, along with early proactive intervention, may reduce the incidence of respiratory depression and its associated clinical and economic burden. Trial registration ClinicalTrials.gov, NCT02811302.

Perianal disease remains an understudied and difficult complication in leukemia patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19016-e19016
Author(s):  
Shreya Gupta ◽  
Nirav Patil ◽  
Emily Steinhagen-Golbig ◽  
Benjamin Kent Tomlinson ◽  
Sharon Stein ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Cost ◽  
Hospital Costs ◽  
Perianal Abscess ◽  
Lymphocytic Leukemia ◽  
Operative Intervention ◽  
Perianal Disease ◽  
Categorical Variables ◽  
Continuous Variables

e19016 Background: Perianal infection is a rare and poorly understood complication of patients with acute myeloid/lymphocytic leukemia (AML/ALL). With the advancements in oncology, patients are living longer in an immunocompromised state and thus bearing the inherent problems such as infections that arise with it. Perianal infection and its management impacts patients' quality of life as well as interrupts their ongoing oncologic treatment. The optimal treatment strategy for perianal infections in this highly immunocompromised group remains unclear, as does the selection and outcomes of patients for operative intervention. The aim of this study is to identify patient characteristics associated with perianal infection and to delineate outcomes in patients that undergo operative intervention. Methods: The National Inpatient Sample (NIS) database was used to identify hospitalized patients with diagnoses of perianal abscess and AML/ALL between 2007 and 2015. Patient data were weighted to obtain national estimates. Demographics and clinical characteristics were compared between patients with and without perianal disease using Rao-Scott Chi-square test for categorical variables, and weighted simple linear regression for continuous variables. Characteristics and outcomes were compared between patients who underwent operative or non-operative management. Results: There were 12,626 (0.7%) patients with perianal disease among 1,782,778 AML/ALL patient admissions. Patients with perianal disease were more likely to be younger (43.9 (42.5 – 45.3) years, p < 0.001), male (67.4% vs 32.6%, p < 0.001) and white (65.8% vs 54.8%, p < 0.001). Length of stay (18.4 days vs 9 days, p < 0.001) and hospital cost ($54K vs $25K, p < 0.001) were higher in those with perianal disease, but there was no difference in in-hospital mortality (5.5% in those with perianal diseases vs 6.2% in those without, p = 0.150). Greater proportion of patients without perianal disease were discharged to hospice (12.6% patients without perianal disease vs 5.1% patients with perianal disease, p < 0.001). Receiving a surgical intervention did not improve outcomes with respect to in-hospital mortality (5.9% operative vs 5.4 non-operative, p = 0.596), length of stay (20.2 days vs 18.2 days, p = 0.582) or hospital cost ($67K vs $53K, p = 0.525). Conclusions: Perianal disease is a rare but distressing complication in AML/ALL patients associated with longer hospital stays and higher hospital costs. Operative intervention for perianal disease did not reduce rates of in-hospital mortality, length of stay or hospital cost but it does impact the probability of discharge to hospice. Non-operative and operative intervention both remain equivocal in changing the outcomes these patients. Further studies are required to examine these associations and determine best practices for treatment of this condition in this complex patient population.

scholarly journals Economics of implementing an early deterioration detection solution for general care patients at a US hospital

2021 ◽  
Author(s):  
Belinda A Mohr ◽  
Diane Bartos ◽  
Stephen Dickson ◽  
Libby Bucsi ◽  
Mariska Vente ◽  
...  
Keyword(s):  
At Risk ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Database Analysis ◽  
Patients At Risk ◽  
Retrospective Database Analysis ◽  
General Care ◽  
Retrospective Database ◽  
Discharge Length

Aim: This study estimates the costs and outcomes pre- versus post-implementation of an early deterioration detection solution (EDDS), which assists in identifying patients at risk of clinical decline. Materials & methods: A retrospective database analysis was conducted to assess average costs per discharge, length of stay (LOS), complications, in-hospital mortality and 30-day all-cause re-admissions pre- versus post-implementation of an EDDS. Results: Average costs per discharge were significantly reduced by 18% (US$16,201 vs $13,304; p  = 0.007). Average LOS was also significantly reduced (6 vs 5 days; p  = 0.033), driven by a reduction in general care LOS of 1 day (p  = 0.042). Complications, in-hospital mortality and 30-day all-cause re-admissions were similar. Conclusion: Costs and LOS were lower after implementation of an EDDS for general care patients.

Length of stay and hospital costs among high-risk patients with hospital-originClostridium difficile-associated diarrhea

2013 ◽  
Vol 16 (3) ◽  
pp. 440-448 ◽  
Author(s):  
Rebecca Campbell ◽  
Bonnie Dean ◽  
Brian Nathanson ◽  
Tracy Haidar ◽  
Marcie Strauss ◽  
...  
Keyword(s):  
High Risk ◽  
Length Of Stay ◽  
Hospital Costs ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Hospital costs of Balloon Pulmonary Angioplasty (BPA) procedure and management for CTEPH patients: An observational study based on the French national hospital discharge database (PMSI)

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260483
Author(s):  
Vincent Cottin ◽  
Lionel Bensimon ◽  
Fanny Raguideau ◽  
Gwendoline Chaize ◽  
Antoinette Hakmé ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Discharge ◽  
Hospital Cost ◽  
Hospital Costs ◽  
Total Hospital Cost ◽  
National Hospital ◽  
Real World Data ◽  
Hospital Discharge Database ◽  
Balloon Pulmonary Angioplasty ◽  
Discharge Database

Introduction Since 2014, Balloon Pulmonary Angioplasty (BPA) has become an emerging and complementary strategy for chronic thromboembolic hypertension (CTEPH) patients who are not suitable for pulmonary endarterectomy (PEA) or who have recurrent symptoms after the PEA procedure. Objective To assess the hospital cost of BPA sessions and management in CTEPH patients. Methods An observational retrospective cohort study of CTEPH-adults hospitalized for a BPA between January 1st, 2014 and June 30th, 2016 was conducted in the 2 centres performing BPA in France (Paris Sud and Grenoble) using the French national hospital discharge database (PMSI-MCO). Patients were followed until 6 months or death, whichever occurred first. Follow-up stays were classified as stays with BPA sessions, for BPA management or for CTEPH management based on a pre-defined algorithm and a medical review using type of diagnosis (ICD-10), delay from last BPA procedure stay and length of stay. Hospital costs (including medical transports) were estimated from National Health Insurance perspective using published official French tariffs from 2014 to 2016 and expressed in 2017 Euros. Results A total of 191 patients were analysed; mainly male (53%), with a mean age of 64,3 years. The first BPA session was performed 1.1 years in median (IQR 0.3–2.92) after the first PH hospitalisation. A mean of 3 stays with BPA sessions per patient were reported with a mean length of stay of 8 days for the first stay and 6 days for successive stays. The total hospital cost attributable to BPA was € 4,057,825 corresponding to €8,764±3,435 per stay and €21,245±12,843 per patient. Results were sensitive to age classes, density of commune of residence and some comorbidities. Conclusions The study generated robust real-world data to assess the hospital cost of BPA sessions and management in CTEPH patients within its first years of implementation in France.

scholarly journals Evaluating hemoptysis hospitalizations among patients with bronchiectasis in the United States: a population-based cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rachel K. Lim ◽  
Alain Tremblay ◽  
Shengjie Lu ◽  
Ranjani Somayaji
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Bronchial Artery ◽  
Hospital Costs ◽  
The United States ◽  
Hospital Death ◽  
Bronchial Artery Embolization ◽  
Artery Embolization ◽  
Hospitalization Costs

Abstract Background The burden of hospitalizations and mortality for hemoptysis due to bronchiectasis is not well characterized. The primary outcome of our study was to evaluate in-hospital mortality in patients admitted with hemoptysis and bronchiectasis, as well as the rates of bronchial artery embolization, length of stay, and hospitalization costs. Methods The authors queried the Nationwide Inpatient Sample (NIS) claims database for hospitalizations between 2016 and 2017 using the ICD-10-CM codes for hemoptysis and bronchiectasis in the United States. Multivariable regression was used to evaluate predictors of in-hospital mortality, embolization, length of stay, and hospital costs. Results There were 8240 hospitalizations (weighted) for hemoptysis in the United States from 2016 to 2017. The overall in-hospital mortality was 4.5%, but higher in males compared to females. Predictors of in-hospital mortality included undergoing three or more procedures, age, and congestive heart failure. Bronchial artery embolization (BAE) was utilized during 2.1% of hospitalizations and was more frequently used in those with nontuberculous mycobacteria and aspergillus infections, but not pseudomonal infections. The mean length of stay was 6 days and the median hospitalization cost per patient was USD $9,610. Having comorbidities and procedures was significantly associated with increased length of stay and costs. Conclusion Hemoptysis is a frequent indication for hospitalization among the bronchiectasis population. In-hospital death occurred in approximately 4.5% of hospitalizations. The effectiveness of BAE in treating and preventing recurrent hemoptysis from bronchiectasis needs to be explored.

Severe Maternal Morbidity and Hospital Cost among Hospitalized Deliveries in the United States

2018 ◽  
Vol 35 (13) ◽  
pp. 1287-1296 ◽  
Author(s):  
Suneet Chauhan ◽  
Sean Blackwell ◽  
Han-Yang Chen
Keyword(s):  
United States ◽  
Hospital Cost ◽  
Maternal Morbidity ◽  
Nationwide Inpatient Sample ◽  
Hospital Costs ◽  
The United States ◽  
Severe Maternal Morbidity ◽  
The Mean ◽  
Procedure Codes ◽  
Mean Cost

Objective The objective of this study was to estimate the contemporary national rate of severe maternal morbidity (SMM) and its associated hospital cost during delivery hospitalization. Study Design We conducted a retrospective study identifying all delivery hospitalizations in the United States between 2011 and 2012. We used data from the National (Nationwide) Inpatient sample of the Healthcare Cost and Utilization Project. The delivery hospitalizations with SMM were identified by having at least one of the 25 previously established list of diagnosis and procedure codes. Aggregate and mean hospital costs were estimated. A generalized linear regression model was used to examine the association between SMM and hospital costs. Results Of 7,438,946 delivery hospitalizations identified, the rate of SMM was 154 per 10,000 delivery hospitalizations. Without any SMM, the mean hospital cost was $4,300 and with any SMM, the mean hospital cost was $11,000. After adjustment, comparing to those without any SMM, the mean cost of delivery hospitalizations with any SMM was 2.1 (95% confidence interval: 2.1–2.2) times higher, and this ratio increases from 1.7-fold in those with only one SMM to 10.3-fold in those with five or more concurrent SMM. Conclusion The hospital cost with any SMM was 2.1 times higher than those without any SMM. Our findings highlight the need to identify interventions and guide research efforts to mitigate the rate of SMM and its economic burden.

Abstract WP212: Trends in Acute Ischemic Stroke Hospitalizations by Age Groups, Length of Stay, Mortality and Hospital Costs in the United States From 2000-2014

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Prashanth Rawla ◽  
Anantha Vellipuram ◽  
Rakesh Khatri ◽  
Alberto Maud ◽  
Gustavo J Rodriguez ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Hospital Costs ◽  
Age Groups ◽  
The United States

Ten-Year Trends of Utilization of Palliative Care Services and Life-Sustaining Treatments and Hospital Costs Associated With Patients With Terminally Ill Lung Cancer in the United States From 2005 to 2014

2019 ◽  
Vol 36 (12) ◽  
pp. 1105-1113 ◽  
Author(s):  
Jinwook Hwang ◽  
Jay Shen ◽  
Sun Jung Kim ◽  
Sung-Youn Chun ◽  
Mutsumi Kioka ◽  
...  
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Palliative Care ◽  
Hospital Cost ◽  
Statistical Significance ◽  
Hospital Costs ◽  
The United States ◽  
Care Services ◽  
Dying Patients ◽  
Palliative Care Services

Background: Palliative care services and life-sustaining treatments are provided to dying patients with lung cancer in the United States. However, data on the utilization trends of palliative care services and life-sustaining treatments of dying patients with lung cancer are not available. Methods: This study was a retrospective analysis of the National Inpatient Sample data (2005-2014) and included patients with lung cancer, aged ≥ 18 years, who died in the hospitals. Claims data of palliative care services and life-sustaining treatments that contained systemic procedures, local procedures, or surgeries were extracted. Compound annual growth rates (CAGRs) using Rao-Scott correction for χ2 tests were used to determine the statistical significance of temporal utilization trends of palliative care services and life-sustaining treatments and their hospital costs. Multilevel multivariate regressions were performed to identify factors associated with hospital costs. Results: A total of 120 144 weighted patients with lung cancer died in the hospitals and 41.9% of them received palliative care services. The CAGRs of systemic procedures, local procedures, surgeries, palliative care services, and hospital cost were 3.42%, 3.48%, 6.08%, 18.5%, and 5.0% (all P < .001), respectively. Increased hospital cost was attributed to systemic procedures (50.6%), local procedures (74.4%), and surgeries (68.5%; all P < .001), respectively. Palliative care services were related to decreasing hospital costs by 28.6% ( P < .001). Conclusion: The temporal trends of palliative care services indicate that their utilization has increased gradually. Palliative care services were associated with reduced hospital costs. However, life-sustaining treatments were associated with increased hospital costs.

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