scholarly journals Does Indoor Daylight Level Affect Hospital Costs and Length of Stay of Patients? A Retrospective Cohort Study

2021 ◽  
Author(s):  
Xiawei Li ◽  
Jianyao Lou ◽  
Aiguang Shi ◽  
Ning Wang ◽  
Lin Zhou ◽  
...  
Keyword(s):  
Length Of Stay ◽  
General Surgery ◽  
Hospital Costs ◽  
Design Guidelines ◽  
Environmental Benefits ◽  
Psychological State ◽  
Total Hospital ◽  
Light Levels ◽  
Large Patient ◽  
Significant Difference

Abstract BackgroundIndoor daylight levels can directly affect people’s physical and psychological state. However, the effect of indoor daylight levels on patient’s clinical recovery process remains controversial. To evaluate the effect of indoor daylight levels on hospital costs and average length of stay (LOS) of a large patient population in general surgery wards.MethodsData were collected retrospectively and analysed of patients in the Second Affiliated Hospital of Zhejiang University, School of Medicine between January 2015 and August 2020. We measured light levels in the patient rooms of general surgery and assessed their association with patients’ total hospital costs and LOS.ResultsA total of 2,998 patients were included in this study with 1,478 each assigned to two light level groups after matching. Overall comparison of hospital total costs and LOS among patients according to light levels did not show a significant difference. Subgroup analysis showed when exposed to higher intensity of indoor daylight, illiterate patients had lower total hospital costs and shorter LOS as compared to those exposed to lower intensity.ConclusionsIndoor daylight levels were not associated with the hospital costs and LOS of patients in the wards of general surgery, except for those who were illiterate. It might be essential to design guidelines for medical staff and healthcare facilities to enhance indoor environmental benefits of daylight for some specific population.

The Effect of Indoor Daylight Levels on Patients Admitted to General Surgery

2020 ◽  
Author(s):  
Xiawei Li ◽  
Jianyao Lou ◽  
Aiguang Shi ◽  
Ning Wang ◽  
Lin Zhou ◽  
...  
Keyword(s):  
General Surgery ◽  
Average Length ◽  
Hospital Costs ◽  
Design Guidelines ◽  
Environmental Benefits ◽  
Psychological State ◽  
Total Hospital ◽  
Light Levels ◽  
Large Patient ◽  
Significant Difference

Abstract BackgroundIndoor daylight levels can directly affect people’s physical and psychological state. However, the effect of indoor daylight levels on patient’s clinical recovery process remains controversial.AimTo evaluate the effect of indoor daylight levels on hospital costs and average length of stay (LOS) of a large patient population in general surgery wards.MethodsData were collected retrospectively and analysed of patients in the Second Affiliated Hospital of Zhejiang University, School of Medicine between January 2015 and August 2020. We measured light levels in the patient rooms of general surgery and assessed their association with patients’ total hospital costs and LOS.ResultsA total of 2,998 patients were included in this study with 1,478 each assigned to two light level groups after matching. Overall comparison of hospital total costs and LOS among patients according to light levels did not show a significant difference. Subgroup analysis showed when exposed to higher intensity of indoor daylight, illiterate patients had lower total hospital costs and shorter LOS as compared to those exposed to lower intensity.ConclusionsIndoor daylight levels were not associated with the hospital costs and LOS of patients in the wards of general surgery, except for those who were illiterate. It might be essential to design guidelines for healthcare facilities to enhance indoor environmental benefits of daylight for some specific population.

scholarly journals Analysis of an overlapping surgery policy change on costs in a high-volume neurosurgical department

2019 ◽  
Vol 131 (3) ◽  
pp. 903-910 ◽  
Author(s):  
Jian Guan ◽  
Michael Karsy ◽  
Andrea A. Brock ◽  
William T. Couldwell ◽  
John R. W. Kestle ◽  
...  
Keyword(s):  
Policy Change ◽  
Linear Regression Analysis ◽  
Hospital Costs ◽  
Medical Community ◽  
Neurosurgical Procedures ◽  
Multivariate Linear Regression Analysis ◽  
Neurosurgical Department ◽  
Total Hospital ◽  
Entire Cohort ◽  
Significant Difference

OBJECTIVEOverlapping surgery remains a controversial topic in the medical community. Although numerous studies have examined the safety profile of overlapping operations, there are few data on its financial impact. The authors assessed direct hospital costs associated with neurosurgical operations during periods before and after a more stringent overlapping surgery policy was implemented.METHODSThe authors retrospectively reviewed the records of nonemergency neurosurgical operations that took place during the periods from June 1, 2014, to October 31, 2014 (pre–policy change), and from June 1, 2016, to October 31, 2016 (post–policy change), by any of the 4 senior neurosurgeons authorized to perform overlapping cases during both periods. Cost data as well as demographic, surgical, and hospitalization-related variables were obtained from an institutional tool, the Value-Driven Outcomes database.RESULTSA total of 625 hospitalizations met inclusion criteria for cost analysis; of these, 362 occurred prior to the policy change and 263 occurred after the change. All costs were reported as a proportion of the average total hospitalization cost for the entire cohort. There was no significant difference in mean total hospital costs between the prechange and postchange period (0.994 ± 1.237 vs 1.009 ± 0.994, p = 0.873). On multivariate linear regression analysis, neither the policy change (p = 0.582) nor the use of overlapping surgery (p = 0.273) was significantly associated with higher total hospital costs.CONCLUSIONSA more restrictive overlapping surgery policy was not associated with a reduction in the direct costs of hospitalization for neurosurgical procedures.

Abstract 246: Length of Stay and Its Association With Get With the Guidelines-stroke Award Recognition

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Theresa Hamm ◽  
Angela Overton ◽  
Kathie Thomas ◽  
Renee Sednew
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Average Length ◽  
Hospital Costs ◽  
Stroke Patients ◽  
Improvement Program ◽  
Recommended Care ◽  
Award Winning ◽  
Significant Difference ◽  
Get With The Guidelines

Background and Objectives: The average length of stay (ALOS) provides important information regarding care efficiency and the financing of hospitals. A shorter ALOS helps to reduce hospital costs, increase capacity optimization, and improve hospital efficiency. A longer ALOS can be associated with reduced readmission rates and mortality rates. The objective of this study was to analyze the ALOS for stroke patients based on etiology subtype and Get With The Guidelines (GWTG)-Stroke award recognition. Methods: A retrospective review of the ALOS for hemorrhagic and ischemic stroke patients was conducted for the states of Illinois, Iowa, and Michigan from 99 hospitals using GWTG-Stroke from July 2014 through December 2015. Stroke subsets, GWTG award status, and ALOS were examined. Results: The national ALOS is 5.22 days for ischemic stroke, 12.75 days for subarachnoid hemorrhage (SAH), and 8.5 days for intracerebral hemorrhage (ICH). The ALOS for ischemic stroke was 4.36 days for non-award winning hospitals and 4.52 days for award winning hospitals. The ALOS for SAH was 7.51 days for non-award winning hospitals and 10.77 days for award winning hospitals. The ALOS for ICH was 18.63 days for non-award winning hospitals and 6.80 days for award winning hospitals. Further broken down, hospitals with a higher award (gold vs silver), had longer ALOS for both SAH and ICH (11.11 vs 8.72 and 7.07 vs 5.84 respectively), while there was no significant difference in ALOS for ischemic stroke. Conclusions: This study demonstrated that GWTG-Stroke award winning hospitals have a shorter ALOS for ICH and a higher ALOS for SAH than non-award winning hospitals. Those hospitals that have attained gold award status more closely align with national ALOS. Thus, hospitals that are more adherent to guideline recommended care via a quality improvement program may be more efficient when providing care, which impacts hospitals costs.

Hospital Costs and Severity of Illness in Three Types of Elective Surgery

1997 ◽  
Vol 86 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Alex Macario ◽  
Terry S. Vitez ◽  
Brian Dunn ◽  
Tom McDonald ◽  
Byron Brown
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Operating Room ◽  
Knee Replacement ◽  
Charlson Comorbidity Index ◽  
Elective Surgery ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Total Hospital ◽  
Comorbidity Index

Background If patients who are more severely ill have greater hospital costs for surgery, then health-care reimbursements need to be adjusted appropriately so that providers caring for more seriously ill patients are not penalized for incurring higher costs. The authors' goal for this study was to determine if severity of illness, as measured by either the American Society of Anesthesiologists Physical Status (ASA PS) or the comorbidity index developed by Charlson, can predict anesthesia costs, operating room costs, total hospital costs, or length of stay for elective surgery. Methods The authors randomly selected 224 inpatients (60% sampling fraction) having either colectomy (n = 30), total knee replacement (n = 100), or laparoscopic cholecystectomy (n = 94) from September 1993 to September 1994. For each surgical procedure, backward-elimination multiple regression was used to build models to predict (1) total hospital costs, (2) operating room costs, (3) anesthesia costs, and (4) length of stay. Explanatory candidate variables included patient age (years), sex, ASA PS, Charlson comorbidity index (which weighs the number and seriousness of coexisting diseases), and type of insurance (Medicare/Medicaid, managed care, or indemnity). These analyses were repeated for the pooled data of all 224 patients. Costs (not patient charges) were obtained from the hospital cost accounting software. Results Mean total hospital costs were $3,778 (95% confidence interval +/- 299) for laparoscopic cholecystectomy, $13,614 (95% CI +/- 3,019) for colectomy, and $18,788 (95% CI +/- 573) for knee replacement. The correlation (r) between ASA PS and Charlson comorbidity scores equaled 0.34 (P < .001). No consistent relation was found between hospital costs and either of the two severity-of-illness indices. The Charlson comorbidity index (but not the ASA PS) predicted hospital costs only for knee replacement (P = .003). The ASA PS, but not the Charlson index, predicted operating room and anesthesia costs only for colectomy (P < .03). Conclusions Severity of illness, as categorized by ASA PS categories 1-3 or by the Charlson comorbidity index, was not a consistent predictor of hospital costs and lengths of stay for three types of elective surgery. Hospital resources for these lower-risk elective procedures may be expended primarily to manage the consequences of the surgical disease, rather than to manage the patient's coexisting diseases.

scholarly journals Major Adverse Kidney Events in Pediatric Sepsis

2019 ◽  
Vol 14 (5) ◽  
pp. 664-672 ◽  
Author(s):  
Scott L. Weiss ◽  
Fran Balamuth ◽  
Cary W. Thurm ◽  
Kevin J. Downes ◽  
Julie C. Fitzgerald ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Length Of Stay ◽  
Confidence Interval ◽  
Hospital Costs ◽  
Kidney Dysfunction ◽  
Total Hospital ◽  
All Cause Mortality ◽  
Kidney Replacement Therapy ◽  
Pediatric Sepsis ◽  
Major Adverse Kidney Events

Background and objectivesMajor adverse kidney events, a composite of death, new kidney replacement therapy, or persistent kidney dysfunction, is a potential patient-centered outcome for clinical trials in sepsis-associated kidney injury. We sought to determine the incidence of major adverse kidney events within 30 days and validate this end point in pediatric sepsis.Design, setting, participants, & measurementsWe conducted a retrospective observational study using the Pediatric Health Information Systems Plus database of patients >6 months to <18 years old with a diagnosis of severe sepsis/septic shock; orders for bacterial blood culture, antibiotics, and at least one fluid bolus on hospital day 0/1; and known hospital disposition between January 2007 and December 2011. The primary outcome was incidence of major adverse kidney events within 30 days. Major adverse kidney events within 30 days were validated against all-cause mortality at hospital discharge, hospital length of stay, total hospital costs, hospital readmission within 30 days and 1 year, and lowest eGFR between 3 months and 1 year after discharge. We reported incidence of major adverse kidney events within 30 days with 95% confidence intervals using robust SEM and used multivariable logistic regression to test the association of major adverse kidney events within 30 days with hospital costs and mortality.ResultsOf 1685 admissions, incidence of major adverse kidney events within 30 days was 9.6% (95% confidence interval, 8.1% to 11.0%), including 4.5% (95% confidence interval, 3.5% to 5.4%) death, 1.7% (95% confidence interval, 1.1% to 2.3%) kidney replacement therapy, and 5.8% (95% confidence interval, 4.7% to 6.9%) persistent kidney dysfunction. Patients with versus without major adverse kidney events within 30 days had higher all-cause mortality at hospital discharge (28% versus 1%; P<0.001), higher total hospital costs ($61,188; interquartile range, $21,272–140,356 versus $28,107; interquartile range, $13,056–72,697; P<0.001), and higher proportion with eGFR<60 ml/min per 1.73 m2 between 3 months and 1 year after discharge (19% versus 4%; P=0.001). Major adverse kidney events within 30 days was not associated with length of stay or readmissions.ConclusionsIn children with sepsis, major adverse kidney events within 30 days are common, feasible to measure, and a promising end point for future clinical trials.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_04_18_CJASNPodcast_19_05_.mp3

Can the Choice of Cementless Implants and Bearings during Total Hip Arthroplasty Have an Impact on the Overall Costs within a Bundled Payment Model?

2020 ◽  
Vol 04 (02) ◽  
pp. 066-076
Author(s):  
Stephen Duncan ◽  
Ankur Patel ◽  
Gary Delhougne ◽  
Corey Patrick
Keyword(s):  
Health Care ◽  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Hospital Costs ◽  
P Value ◽  
Total Hospital ◽  
Bundled Payment ◽  
Total Hip ◽  
Oxidized Zirconium

AbstractThe comprehensive care for joint replacement model from the Center for Medicare and Medicaid Services and similar programs from other payers make hospitals and health care systems more responsible for better clinical and economic outcomes of total hip arthroplasty (THA) patients. The objective of the study was to evaluate hospital-related clinical and economic outcomes of using the cementless R3 cup and Polarstem with an oxidized zirconium bearing compared with other cementless hip systems using a ceramic bearing in THA patients. We retrospectively reviewed primary THA patients from the premier perspective database between 2014 and 2018Q3. Patients with R3 cup and Polarstem with an oxidized zirconium bearing were identified using appropriate keywords from billing records and compared against cementless and ceramic-on-polyethylene (CoP) THA patients who did not meet the keywords' criteria. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision THA; bilateral THA in same discharge or different discharges. 1:3 propensity score matching was used to control patients' demographic, clinical, and hospital characteristics. Generalized estimating equation model with appropriate distribution and link function was used to estimate hospital-related cost while logistic regression models were used to estimate discharged status, transfusion, and 30-days readmission. The study matched 818 R3/Polarstem with oxidized zirconium bearing patients with 2,454 CoP cementless THA patients. Length of stay for the R3/Polarstem patients (mean = 1.61 days; confidence interval [CI] = 1.41–1.80) was significantly lower (p-value ≤ 0.0001) than CoP THA patients (mean = 2.06 days; CI = 1.95–2.17). R3/Polarstem hip patients were 36% (odds ratio [OR] = 1.36; CI = 1.07–1.72; p-value = 0.0112) more likely to be discharged to home/home health care, 18% (OR = 0.82; CI = 0.63–1.06; p-value = 0.1235) less likely to be discharged to a skilled nursing facility (SNF), 84% less likely to have transfusion (OR = 0.16; CI = 0.09–0.29; p-value ≤ 0.0001), and 44% (OR = 0.56; CI = 0.32–0.98; p-value = 0.0412) less likely to readmitted within 30 days than CoP THA patients. Mean total hospital costs was marginally higher for R3/Polarstem patients (mean = $15,611; vs. $15,002; p-value = 0.0041) than CoP THA patients. While the total hospital costs for the R3/Polarstem was higher than CoP, the reduced length of stay, reduced discharge to SNF, and lower readmission rates can help to save money in the bundled payment and make the use of certain cementless hip systems a potential cost saving solution.

Pharmacoeconomic Analysis of Cefmenoxime Dual Individualization in the Treatment of Nosocomial Pneumonia

1994 ◽  
Vol 28 (3) ◽  
pp. 384-389 ◽  
Author(s):  
Joseph A. Paladino ◽  
Robert E. Fell
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Length Of Stay ◽  
Pharmacoeconomic Analysis ◽  
Hospital Costs ◽  
Cost Effective ◽  
Total Hospital ◽  
Similar Reduction ◽  
Cost Effective Method ◽  
A Prospective Study

OBJECTIVE: To determine if dual individualization of cefmenoxime dosing is cost-effective. DESIGN: Retrospective, pharrnacoeconomic decisionanalysis of two consecutively conductedprospective clinical studies. PATIENTS: Patientswithdocumentedgram-negative nosocomial pneumoniawere evaluated. Thirty-three patients received cefmenoximeat standarddosing and 28 patients received doses according to dual individualization methodology. MAIN OUTCOME MEASURE: Antibiotic and infection-related costs were compared between groups. The number of hospital antibiotic days and costs incurred on those days were also evaluated. A decision model was constructed to characterize differences in treatment outcome. Probabilities with in the decision tree were derived from 61 evaluable patients. Cost-effectiveness and incremental cost-effectiveness ratios were calculated. Sensitivity analysis was performed by varying out come probabilities, antibiotic prices, and hospital room costs. RESULTS: Antibiotic and infection-related costs (mean ± SEM) were $848 ± 78 for standard cefmenoxime dosing and $1123 ± 128 for dual individualization (p<0.05). Total hospital costs were $10 660 ± 1432 or standard dosing and $11 700 ± 1900 for dual individualization (p>0.05). Median antibiotic length of stay (ALOS) was 15.2 and 12.7 days for standard and dual individualization methodologies, respectively (p>0.05). Incremental analysis of cost effectiveness indicated that a similar reduction in length of stay for 259 dual individualization patients would save $321 808 annually. CONCLUSIONS: Sensitivity analysis indicates that by reducing ALOS, dual individualization could be a cost-effective method of betalactam dosing for patients with pneumonia. A prospective study should be conducted to validate these findings.

scholarly journals CV3: DO SHORT-ACTING OPIATES IN OFF-PUMP BYPASS SURGERY REDUCE LENGTH OF STAY OR TOTAL HOSPITAL COSTS?

2001 ◽  
Vol 4 (2) ◽  
pp. 55-56
Author(s):  
P Reddy ◽  
B Feret ◽  
L Kulicki ◽  
S Jordan ◽  
S Donahue ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Bypass Surgery ◽  
Hospital Costs ◽  
Total Hospital ◽  
Short Acting ◽  
Off Pump ◽  
Pump Bypass

scholarly journals Effect of IV Acetaminophen Usage on Opioid Requirements, Outcomes and Costs of Care for Postoperative Children in a Pediatric Intensive Care Unit

2020 ◽  
Vol 25 (6) ◽  
pp. 514-520
Author(s):  
Brock M. Taylor ◽  
Shawn R. Chakraborty ◽  
Aaron A. Harthan ◽  
Sandeep Tripathi ◽  
Huaping Wang ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Chart Review ◽  
Hospital Costs ◽  
Pediatric Intensive Care ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Total Hospital ◽  
Exclusion Criteria ◽  
X Ray ◽  
Significant Difference

OBJECTIVE Children admitted to the ICU are commonly treated with opioids for postoperative pain. We hypothesized that administration of IV acetaminophen in the immediate postoperative period is effective in lowering cumulative opioid use leading to other benefits. METHODS This was a retrospective chart review of patients admitted to the PICU between December 2016 and April 2019. For each patient, data including demographics, cumulative opioid usage per kilogram, oral or rectal acetaminophen, x-ray findings, hospital costs, and surgical procedure were collected. Cumulative opioid usage was determined by converting all opioids to morphine equivalents (MEs) per kg. Standard descriptive and comparative analyses were conducted using SAS 9.4 (SAS Institute, Inc, Cary, NC). RESULTS A total of 200 patients met inclusion and exclusion criteria (N = 92 in IV acetaminophen group and N = 108 in no IV acetaminophen group). There was no significant difference in ME per kilogram between the groups (0.3 ME/kg in IV acetaminophen group, IQR 0.5 ME/kg versus 0.4 ME/kg in no IV acetaminophen group, IQR 0.5 ME/kg, adjusted p = 0.38). Rate of atelectasis was not significant between the groups (47.8% in IV acetaminophen versus 45.4% in no acetaminophen group, p = 0.28). There was a significant difference in median total hospital costs between the groups ($22,456 in IV acetaminophen group, IQR $18,650 versus $18,552 in no IV acetaminophen group, IQR $13,361, adjusted p = 0.04). CONCLUSIONS IV acetaminophen in the immediate postoperative period did not lead to a decrease in cumulative opioid usage or rate of atelectasis. IV acetaminophen usage was associated with increase in overall hospital costs per patient.

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