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

scholarly journals Attributable Hospital Cost and Length of Stay Associated with Health Care-Associated Infections Caused by Antibiotic-Resistant Gram-Negative Bacteria

2009 ◽  
Vol 54 (1) ◽  
pp. 109-115 ◽  
Author(s):  
Patrick D. Mauldin ◽  
Cassandra D. Salgado ◽  
Ida Solhøj Hansen ◽  
Darshana T. Durup ◽  
John A. Bosso
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Confidence Interval ◽  
Hospital Cost ◽  
Hospital Costs ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Health Care Associated Infections

ABSTRACT Determination of the attributable hospital cost and length of stay (LOS) are of critical importance for patients, providers, and payers who must make rational and informed decisions about patient care and the allocation of resources. The objective of the present study was to determine the additional total hospital cost and LOS attributable to health care-associated infections (HAIs) caused by antibiotic-resistant, gram-negative (GN) pathogens. A single-center, retrospective, observational comparative cohort study was performed. The study involved 662 patients admitted from 2000 to 2008 who developed HAIs caused by one of following pathogens: Acinetobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., or Pseudomonas spp. The attributable total hospital cost and LOS for HAIs caused by antibiotic-resistant GN pathogens were determined by comparison with the hospital costs and LOS for a control group with HAIs due to antibiotic-susceptible GN pathogens. Statistical analyses were conducted by using univariate and multivariate analyses. Twenty-nine percent of the HAIs were caused by resistant GN pathogens, and almost 16% involved a multidrug-resistant GN pathogen. The additional total hospital cost and LOS attributable to antibiotic-resistant HAIs caused by GN pathogens were 29.3% (P < 0.0001; 95% confidence interval, 16.23 to 42.35) and 23.8% (P = 0.0003; 95% confidence interval, 11.01 to 36.56) higher than those attributable to HAIs caused by antibiotic-susceptible GN pathogens, respectively. Significant covariates in the multivariate analysis were age ≥12 years, pneumonia, intensive care unit stay, and neutropenia. HAIs caused by antibiotic-resistant GN pathogens were associated with significantly higher total hospital costs and increased LOSs compared to those caused by their susceptible counterparts. This information should be used to assess the potential cost-efficacy of interventions aimed at the prevention of such infections.

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 &lt; .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 &lt; .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.

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.

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.

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.

Disparities in Mangement of Patients with Benign Colorectal Disease: Impact of Urbanization and Specialized Care

2016 ◽  
Vol 82 (11) ◽  
pp. 1046-1051 ◽  
Author(s):  
Viraj Pandit ◽  
Mazhar Khalil ◽  
Bellal Joseph ◽  
Jana Jandova ◽  
Tahereh Orouji Jokar ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Confidence Interval ◽  
Surgical Management ◽  
Surgical Intervention ◽  
Hospital Costs ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Specialized Care ◽  
Colorectal Surgeons ◽  
Colorectal Diseases

Disparities in the management of patients with various medical conditions are well established. Colorectal diseases continue to remain one of the most common causes for surgical intervention. The aim of this study was to assess disparities (rural versus urban) in the surgical management of patients with noncancerous benign colorectal diseases. We hypothesized that there is no difference among rural versus urban centers (UC) in the surgical management for noncancerous benign colorectal diseases. The national estimates of surgical procedures for benign colorectal diseases from the National Inpatient Sample database 2011 representing 20 per cent of all in-patient admissions were abstracted. Patients undergoing procedures (abscess drainage, hemmoroidectomy, fistulectomy, and bowel resections) were included. Patients with colon cancer and those who underwent emergency surgery were excluded. The population was divided into two groups: urban and rural, based on the location of treatment. Outcome measures were in-hospital complications, mortality, and hospital costs. Subanalysis of UC was preformed: centers with colorectal surgeons and centers without colorectal surgeons. Regression analysis was performed. A total of 20,617 patients who underwent surgical intervention for benign colorectal diseases across 496 (urban: 342, rural: 154) centers, were included. Of the UC, 38.3 per cent centers had colorectal surgeons. Patients managed in UC had lower complication rate (7.6% vs 10.2%, P < 0.001), shorter hospital length of stay (4.7 ± 3.1 vs 5.9 ± 3.6 days, P < 0.001), and higher hospital costs ($56,820 ± $27,691 vs $49,341 ± $2,598, P < 0.001) compared with rural centers. On subanalysis, patients managed in UC with colorectal surgeons had 11 per cent lower incidence of in-hospital complications [odds ratio: 0.89 (95% confidence interval: 0.76–0.94)] and a shorter hospital length of stay [Beta: -0.72 (95% confidence interval: —0.81 to —0.65)] when compared with patients managed in UC without colorectal specialization. Disparities exit in outcomes of the patients with noncancerous benign colorectal diseases managed surgically in urban versus rural centers. Specialized care with colorectal surgeons at UC helps reduce adverse patient outcomes. Steps to provide effective and safe surgical care in a cost-effective manner across rural as well as UC are warranted. Level of evidence: Level III, retrospective cohort analysis.

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

Carotid Endarterectomy: Update on the Gold Standard Treatment for Carotid Stenosis

2005 ◽  
Vol 71 (8) ◽  
pp. 647-652 ◽  
Author(s):  
Nancy L. Harthun ◽  
A.J. Baglioni ◽  
Gail L. Kongable ◽  
Timothy D. Meakem ◽  
Kenneth J. Cherry
Keyword(s):  
Clinical Trials ◽  
Length Of Stay ◽  
Carotid Endarterectomy ◽  
Randomized Clinical Trials ◽  
Hospital Costs ◽  
Carotid Stenting ◽  
Veterans Administration ◽  
Lengths Of Stay ◽  
Related Group ◽  
Median Hospital

Many prospective, randomized clinical trials evaluating the safety and efficacy of carotid endarterectomy (CEA) versus medical management in the prevention of ischemic stroke were performed in the 1990s. Clinical trials are underway that will compare CEA outcomes to carotid stenting; however, relatively few studies have examined the outcomes of modern CEA. The purpose of this report is to examine current outcomes of CEA and evaluate hospital costs and length of stay. Statewide results were collected for all hospitals, except Veterans Administration hospitals, by Virginia Health Information (VHI). Data for the years 1997–2001 were evaluated, and data were based on the All Patient Refined Diagnostic Related Group (APR-DRG; 3M Company). A total of 14,095 CEAs were performed in a 5-year period. The mortality of patients undergoing CEA was 0.5 per cent. The stroke rate was 1 per cent overall and decreased each year of the study. Mean and median lengths of hospital stay were 3 and 2 days, respectively. Length of stay decreased over the course of this study. Mean and median hospital costs were $14,331 and $11,268. Higher rates of mortality and stroke and higher costs were observed at low-volume hospitals. The need for CEA is substantial. CEA is safe and inexpensive. The data presented here demonstrates continued refinement in CEA, leading to a very low rate of perioperative adverse events, declining lengths of stay, and low hospital costs.

scholarly journals Early esophagogastroduodenoscopy is associated with better Outcomes in upper gastrointestinal bleeding: a nationwide study

2017 ◽  
Vol 05 (05) ◽  
pp. E376-E386 ◽  
Author(s):  
Sushil Garg ◽  
Chimaobi Anugwom ◽  
James Campbell ◽  
Vaibhav Wadhwa ◽  
Nancy Gupta ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Multivariable Analysis ◽  
Hospital Costs ◽  
Upper Gastrointestinal Hemorrhage ◽  
National Inpatient Sample ◽  
Total Hospital ◽  
Diagnostic Codes ◽  
Upper Gastrointestinal

Abstract Background and study aims We analyzed NIS (National Inpatient Sample) database from 2007 – 2013 to determine if early esophagogastroduodenoscopy (EGD) (24 hours) for upper gastrointestinal bleeding improved the outcomes in terms of mortality, length of stay and costs. Patients and methods Patients were classified as having upper gastrointestinal hemorrhage by querying all diagnostic codes for the ICD-9-CM codes corresponding to upper gastrointestinal bleeding. For these patients, performance of EGD during admission was determined by querying all procedural codes for the ICD-9-CM codes corresponding to EGD; early EGD was defined as having EGD performed within 24 hours of admission and late EGD was defined as having EGD performed after 24 hours of admission. Results A total of 1,789,532 subjects with UGIH were identified. Subjects who had an early EGD were less likely to have hypovolemia, acute renal failure and acute respiratory failure. On multivariable analysis, we found that subjects without EGD were 3 times more likely to die during the admission than those with early EGD. In addition, those with late EGD had 50 % higher odds of dying than those with an early EGD. Also, after adjusting for all factors in the model, hospital stay was on average 3 and 3.7 days longer for subjects with no or late EGD, respectively, then for subjects with early EGD. Conclusion Early EGD (within 24 hours) is associated with lower in-hospital mortality, morbidity, shorter length of stay and lower total hospital costs.

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