The impact of comorbidities, regional trends, and hospital factors on discharge dispositions and hospital costs after acoustic neuroma microsurgery: a United States nationwide inpatient data sample study (2005–2009)

Object Hospitalization cost and patient outcome after acoustic neuroma surgery depend on several factors. There is a paucity of data regarding the relationship between demographic features such as age, sex, race, insurance status, and patient outcome. Apart from demographic factors, there are several hospital-related factors and regional issues that can affect outcomes and hospital costs. To the authors' knowledge, no study has investigated the issue of regional disparity across the country in terms of cost of hospitalization and discharge disposition. Methods The authors analyzed the Nationwide Inpatient Sample (NIS) database over the years 2005–2009. Several variables were analyzed from the database, including patient demographics, comorbidities, and surgical complications. Hospital variables, such as bedsize, rural/urban location, teaching status, federal or private ownership, and the region, were also examined. Patient outcome and increased hospitalization costs were the dependent variables studied. Results A total of 2589 admissions from 242 hospitals were analyzed from the NIS data over the years 2005–2009. The mean age was 48.99 ± 13.861 years (± SD), and 304 (11.7%) of the patients were older than 65 years. The cumulative cost incurred by the hospitals from 2005 to 2009 was $948.77 million. The mean expenditure per admission was $76,365.09 ± $58,039.93. The mean total charges per admission rose from $59,633.00 in 2005 to $97,370.00 in 2009. The factors that predicted most significantly with other than routine (OTR) disposition outcome were age older than 65 years (OR 2.22, 95% CI 1.411–3.518; p < 0.001), aspiration pneumonia (OR 16.085, 95% CI 4.974–52.016; p < 0.001), and meningitis (OR 11.299, 95% CI 3.126–40.840; p < 0.001). When compared with patients with Medicare and Medicaid, patients with private insurance had a protective effect against OTR disposition outcome. Higher comorbidities predicted independently for OTR disposition outcome (OR 1.409, 95% CI 1.072–1.852; p = 0.014). The West region predicted negatively for OTR disposition outcome. Large hospitals were independently associated with higher hospital charges (OR 4.269, 95% CI 3.106–5.867; p < 0.001). The West region had significantly higher (p < 0.001) mean hospital charges than the other regions. Patient factors such as meningitis and aspiration pneumonia were strong independent predictors of increased hospital charges (p < 0.001). Higher comorbidities (OR 1.297, 95% CI 1.036–1.624; p = 0.023) and presence of neurofibromatosis Type 2 (OR 2.341, 95% CI 1.479–3.707; p < 0.001) were associated with higher hospital charges. Conclusions The authors' study shows that several factors can affect patient outcome and hospital charges for patients who have undergone acoustic neuroma surgery. Factors such as younger age, higher ZIP code income, less comorbidity, private insurance, elective surgery, and the West region predicted for better disposition outcome. However, the West region, higher comorbidities, and weekend admissions were associated with higher hospitalization costs.

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Seismic Anisotropy at the Hikurangi Subduction Margin

10.26686/wgtn.17019233.v1 ◽

2021 ◽

Author(s):

◽

Thomas Wilson

Keyword(s):

Stress Field ◽

Delay Time ◽

Seismic Anisotropy ◽

The West ◽

Study Region ◽

East Region ◽

West Region ◽

Gravitational Stress ◽

Significant Difference ◽

The Mean

<p>To determine the stress state in the southern North Island of New Zealand, we use shear wave splitting analysis to measure seismic anisotropy and infer the orientation of the maximum horizontal stress directions (Shmax) in the crust. We use data recorded by 44 temporary seismometers deployed as part of the Seismic Array Hikurangi Experiment, and from six permanent stations from the national GeoNet network. Using 425 local earthquake events recorded across the 50 stations we made 13,807 measurements of the two splitting parameters, φ (fast direction) and δt (delay time). These measurements are compared to SHmax directions obtained from previous focal mechanism studies (SfocalHmax), and stresses due to the weight of topography (SgravHmax). Generally there is good agreement between the alignment of SfocalHmax, SgravHmax, and the mean φ measured at each station. We also ﬁnd a∼ 90◦ change in the trend of φ in the Wairarapa region for stations across the Wairarapa Fault trace. Based on the variation of φ, we divide the study region into three regions (West, Basin, and East), whose bounds approximately coincide with the Wairarapa and Dry Creek faults. We ﬁnd the average φ of the West region average agrees with previous anisotropy studies, which were undertaken within the bounds of the West region on the Tararua array. Also, we use our delay time measurements to estimate a 3.7±1.2% strength of anisotropy in the overriding Australian Plate, which agrees with the 4% crustal anisotropy measured previously. There is close alignment of the region average φ of the West and East regions, which also agrees with the deep splitting measurements previously obtained. There is no signiﬁcant diﬀerence between the mean φ and Sgravhmax for the West and Basin regions; however, we ﬁnd a diﬀerence of 31± 19.5◦ for the East region. We argue that this diﬀerence is due to tectonic loading stresses being suﬃciently large in the East region to cause the total stress ﬁeld to deviate from the gravitational stress ﬁeld.</p>

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An Evaluation of the Therapeutic Nutrition Knowledge of Belizean Nurses

New Medical Innovations and Research ◽

10.31579/jnmir.2021/004 ◽

2021 ◽

Vol 2 (1) ◽

pp. 01-07

Author(s):

Marcia Magnus

Keyword(s):

Response Rate ◽

Nutritional Knowledge ◽

The West ◽

Nutrition And Diabetes ◽

West Region ◽

Nutritional Guidance ◽

The Mean ◽

The Caribbean ◽

Low Levels ◽

Correct Response Rate

In Belize, patients rely on nurses for nutritional guidance on non-communicable diseases in the Caribbean. The objectives of this study were to quantify the therapeutic nutritional knowledge of 198 Belizean nurses using the Al-Shwaiyat questionnaire. The mean correct response rate for the therapeutic nutritional knowledge was suboptimal (53.30%±17.20). Nurses in the West region of the country had the highest mean knowledge scores on nutrition and diabetes 75.41±20.10, p=0.003; on nutrition and cardiovascular diseases 57.23±10.90, p=0.000; and in overall knowledge 62.34±9.76 p=0.000. Nurses without a diagnosis of diabetes had higher mean knowledge scores on a) nutrition and diabetes 63.86±26.07, p=0.001; b) nutrition and obesity questions 49.55±20.80, p=0.004; c) nutrition and cardiovascular disease 53.30±15.70, p=0.007 and d), overall mean 55.24±16.67, p=0.000. There is a need to address the low levels of knowledge of Belizean nurses.

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Same-day Discharge after Appendectomy Results in Cost Savings and Improved Efficiency

The American Surgeon ◽

10.1177/000313481408000829 ◽

2014 ◽

Vol 80 (8) ◽

pp. 787-791 ◽

Cited By ~ 23

Author(s):

Sandra M. Farach ◽

Paul D. Danielson ◽

N. Elizabeth Walford ◽

Richard P. Harmel ◽

Nicole M. Chandler

Keyword(s):

Hospital Costs ◽

Cost Savings ◽

Day Surgery ◽

Hospital Charges ◽

Patient Transfers ◽

Same Day Discharge ◽

Hospital Resources ◽

The Mean ◽

Clinical Measures ◽

Cent Patient

Appendectomy incurs significant costs for the healthcare system. There is evidence that patients can be safely discharged the same day after appendectomy. The purpose of this study was to develop an evidence-based protocol for same-day discharge after appendectomy. A fast-track surgery protocol was developed for same-day discharge after appendectomy. This was prospectively applied to all patients presenting for appendectomy from July 2012 to June 2013. Demographics, clinical measures, and outcomes were measured. Of 206 patients eligible for same-day discharge, 185 (90%) were successfully discharged according to the protocol. The mean length of stay after appendectomy was 3.1 ± 1.4 hours. Protocol implementation reduced inpatient use from 99 to 53 per cent. Patient transfers were reduced, resulting in 40 per cent fewer handoffs. The decreased use of hospital resources resulted in a median reduction of hospital charges of $4111 per patient. The complication rate for patients discharged the same day was 2.7 per cent. Appendectomy for acute appendicitis or interval appendectomy can be performed safely as same-day surgery. Implementation of this protocol resulted in optimization of resource use by reducing inpatient admissions, decreasing handoffs, and reducing hospital costs.

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Seismic Anisotropy at the Hikurangi Subduction Margin

10.26686/wgtn.17019233 ◽

2021 ◽

Author(s):

◽

Thomas Wilson

Keyword(s):

Stress Field ◽

Delay Time ◽

Seismic Anisotropy ◽

The West ◽

Study Region ◽

East Region ◽

West Region ◽

Gravitational Stress ◽

Significant Difference ◽

The Mean

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Pediatric hospitalizations and in-patient mortality from all-terrain vehicle crashes, 2006–2016

Trauma ◽

10.1177/1460408619830858 ◽

2019 ◽

Vol 22 (1) ◽

pp. 56-63

Author(s):

Sarah B Cairo ◽

Joshua K Burk ◽

David H Rothstein

Keyword(s):

Rural Areas ◽

Demographic Data ◽

Private Insurance ◽

Hospital Costs ◽

The United States ◽

Vehicle Crashes ◽

Targeted Interventions ◽

The Past ◽

West Region ◽

National Frequency

PurposeTo evaluate trends in national frequency of hospitalizations and in-patient mortality in the United States for children injured in all-terrain vehicle crashes during the past decade.MethodsRetrospective review of the 2006, 2009, 2012, and 2016 Kids' Inpatient Databases to identify hospitalizations of patients <19 years of age for all-terrain vehicle-related injuries. External-cause-of-injury codes were used to identify patients hospitalized for injuries sustained in all-terrain vehicle crashes. Odds ratios for in-patient mortality were calculated by logistic regression incorporating multiple individual demographic and hospital variables.ResultsEstimated all-terrain vehicle-related hospitalizations ranged from 3666 in 2006 (5.2/100,000 persons <19 years of age) to 2558 in 2012 (3.3/100,000). Crude in-patient mortality was low, and varied slightly from year to year (range, 0.55–1.04%). Patients hospitalized for all-terrain vehicle-related injuries were 76.8–78.4% White and 72.1–77.2% male. Totally 61.0–64.3% had private insurance, 35.3–39.3% were from rural areas, 37.4–38.3% were in the 10–14-year age group, and patients from the West region accounted for 40.4–43.6% of patients. There were no risk factors identified as being consistently associated with mortality in this cohort. Average total charges increased from $26,996 to $67,370 over the course of the study ( p < 0.001).ConclusionsHospitalizations for all-terrain vehicle-related injuries in children have fallen in the past decade although the reasons for this change are unknown. In-patient mortality rates have stayed relatively constant and while no factors were predictive of in-patient mortality, demographic data may provide an opportunity for targeted interventions to further reduce injuries and associated hospital costs.

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Acute Myeloid Leukemia in the Elderly: Longitudinal Outcomes and Hospital Charges in Chemotherapy and Non-Chemotherapy Patients.

Blood ◽

10.1182/blood.v104.11.3154.3154 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3154-3154

Author(s):

Laura M. Katz ◽

Lee S. Stern ◽

John M. Fastenau ◽

Catherine T. Piech ◽

John J. Doyle

Keyword(s):

Acute Myeloid Leukemia ◽

Elderly Patients ◽

Myeloid Leukemia ◽

Hospital Charges ◽

Total Charge ◽

Hospitalization Costs ◽

The Mean ◽

Chemotherapy Patients ◽

Acute Myeloid ◽

First Admission

Abstract Background: Patients with acute myeloid leukemia (AML) have an estimated median age of 65 to 70 years (J Clin Oncol1999;17:3569–76). The overall incidence of the disease increases with increasing age. The five-year survival rate for AML is 2% among elderly patients (Arch Intern Med2002;162:1597–1603). Treatment includes cytotoxic chemotherapy [e.g., the “7+3” regimen consisting of cytarabine and daunorubicin or idarubicin (Leukemia1996;10:389–95)], which can be associated with serious morbidity and is often not tolerated by older patients. Over 80% of Medicare payments for treating AML are attributable to hospitalization costs (Arch Intern Med2002;162:1597–1603). Methods: A longitudinal cohort design was employed using an inpatient database containing information on over three million individuals from 28 hospitals in the US. The study population included patients aged 60 years and older with initial AML diagnosis between January 2000 and June 2003. Patients were followed across multiple admissions, from first inpatient encounter through last discharge from hospital. Descriptive statistics (demographics and hospital characteristics), comorbidities, chemotherapies, outcomes, resource utilization, and charges were examined; multivariate linear regressions were performed. Results: 275 patients were identified and included in these analyses. The mean age upon first AML admission was 74.3 years (SD=8.1) and 46.6% of patients were female. On first admission, the mean length of stay (LOS) was 14.7 days (SD=14.3), 37.8% of patients received chemotherapy, and one quarter of all patients (25.3%) died. Patients incurred a mean total charge of $70,305 on first admission, while the median was $17,640; patients on chemotherapy had mean and median total charges of $113,118 and $74,689, respectively, versus $43,999 and $9,784, respectively, for non-chemotherapy patients. Chemotherapy patients also had a higher mean LOS than non-chemotherapy patients (23.0 vs. 6.7 days, respectively). 44.4% of patients had a least one re-admission with a mean of 36.4 days (SD=62.1) between the first and second admissions. For re-admissions, the mean LOS and charges were 8.9 days (SD=15.3) and $38,785 (median $13,936), respectively. Across all admissions, 41.4% of patients received chemotherapy and 40.7% of patients died in-hospital. Over the entire study period, patients incurred a mean total charge of $115,471 with a median charge of $49,168. In multivariate analyses, after adjustment for covariates, chemotherapy was found to be a significant predictor (p<0.0001) of admission charges, LOS, and total days of stay. Conclusion: Elderly patients with AML incurred substantial charges and inpatient mortality. The highest charges and the majority of deaths occurred during first admission. Current chemotherapy regimens in these patients were associated with substantially increased charges.

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