scholarly journals Mortality rates, hospital length of stay, and the cost of treating subarachnoid hemorrhage in older patients: institutional and geographical differences

1997 ◽  
Vol 2 (2) ◽  
pp. E1
Author(s):  
Christopher L. Taylor ◽  
Zhong Yuan ◽  
Warren R. Selman ◽  
Robert A. Ratcheson ◽  
Alfred A. Rimm
Keyword(s):  
New York ◽  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Older Patients ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Hospital Length Of Stay ◽  
Annual Number ◽  
Geographical Differences ◽  
The Cost

The risk of disability and death and the cost of medical care are particularly high for patients with aneurysmal subarachnoid hemorrhage (SAH) who are 65 years of age or older. A retrospective analysis of 47,408 Medicare patients treated over an 8-year period was performed to determine whether a relationship exists between the mortality rate and surgical volume for older patients with SAH. The mortality rate, length of stay in the hospital, and cost of treatment for patients with SAH in California and New York were also compared. The mortality rate was 14.3% for patients with SAH who were 65 years old or older and who were treated surgically in hospitals in which an average of five or more craniotomies were performed per year; in hospitals averaging between one and five craniotomies annually the mortality rate was 18.4%; and in those averaging less than one such operation per year the rate was 20.5% (trend p = 0.01). There was no difference in the mortality rate for patients in California versus the rate for those in New York. Surgically and medically treated patients, respectively, left the hospital an average of 6.7 and 5.1 days sooner in California than in New York. The unadjusted average reimbursement from Medicare to hospitals for surgically treated patients averaged $1468 more in New York than in California (p < 0.0001), but was equivalent for medically treated patients in the two states. The mortality rate in older patients who are treated surgically for SAH may be inversely correlated with the annual number of craniotomies performed for SAH in patients 65 years of age or older at a given institution. Hospital stays for patients with SAH are significantly shorter in California than in New York.

Mortality rates, hospital length of stay, and the cost of treating subarachnoid hemorrhage in older patients: institutional and geographical differences

1997 ◽  
Vol 86 (4) ◽  
pp. 583-588 ◽  
Author(s):  
Christopher L. Taylor ◽  
Zhong Yuan ◽  
Warren R. Selman ◽  
Robert A. Ratcheson ◽  
Alfred A. Rimm
Keyword(s):  
New York ◽  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Older Patients ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
New York State ◽  
Hospital Length Of Stay ◽  
Annual Number ◽  
The Cost

✓ The risk of disability and death and the cost of medical care are particularly high for patients with aneurysmal subarachnoid hemorrhage (SAH) who are 65 years of age or older. A retrospective analysis of 47,408 Medicare patients treated over an 8-year period was performed to determine whether a relationship exists between the mortality rate and surgical volume for older patients with SAH. The mortality rate, length of stay in the hospital, and cost of treatment for patients with SAH in California and New York state were also compared. The mortality rate was 14.3% for patients with SAH who were 65 years old or older and who were treated surgically in hospitals in which an average of five or more craniotomies were performed per year; in hospitals averaging between one and five craniotomies annually the mortality rate was 18.4%; and in those averaging less than one such operation per year the rate was 20.5% (trend p = 0.01). There was no difference in the mortality rate for patients in California versus the rate for those in New York. Surgically and medically treated patients, respectively, left the hospital an average of 6.7 and 5.1 days sooner in California than in New York. The unadjusted average reimbursement from Medicare to hospitals for surgically treated patients averaged $1468 more in New York than in California (p < 0.0001), but was equivalent for medically treated patients in the two states. The mortality rate in older patients who are treated surgically for SAH may be inversely correlated with the annual number of craniotomies performed for SAH in patients 65 years of age or older at a given institution. Hospital stays for patients with SAH are significantly shorter in California than in New York.

Length of hospital stay in aneurysmal subarachnoid hemorrhage patients without vasospasm on angiography: potential for a fast-track discharge cohort

2021 ◽  
pp. neurintsurg-2021-017424
Author(s):  
Joshua S Catapano ◽  
Visish M Srinivasan ◽  
Kavelin Rumalla ◽  
Mohamed A Labib ◽  
Candice L Nguyen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Length Of Hospital Stay ◽  
Hospital Length Of Stay ◽  
Neurologic Outcome ◽  
Angiographic Vasospasm ◽  
Fisher Grade ◽  
Tertiary Center

BackgroundPatients with aneurysmal subarachnoid hemorrhage (aSAH) frequently suffer from vasospasm. We analyzed the association between absence of early angiographic vasospasm and early discharge.MethodsAll aSAH patients treated from August 1, 2007, to July 31, 2019, at a single tertiary center were reviewed. Patients undergoing diagnostic digital subtraction angiography (DSA) on post-aSAH days 5 to 7 were analyzed; cohorts with and without angiographic vasospasm (angiographic reports by attending neurovascular surgeons) were compared. Primary outcome was hospital length of stay; secondary outcomes were intensive care unit length of stay, 30 day return to the emergency department (ED), and poor neurologic outcome, defined as a modified Rankin Scale (mRS) score >2.ResultsA total of 298 patients underwent DSA on post-aSAH day 5, 6, or 7. Most patients (n=188, 63%) had angiographic vasospasm; 110 patients (37%) did not. Patients without vasospasm had a significantly lower mean length of hospital stay than vasospasm patients (18.0±7.1 days vs 22.4±8.6 days; p<0.001). The two cohorts did not differ significantly in the proportion of patients with mRS scores >2 at last follow-up or those returning to the ED before 30 days. After adjustment for Hunt and Hess scores, Fisher grade, admission Glasgow Coma Scale score, and age, logistic regression analysis showed that the absence of vasospasm on post-aSAH days 5–7 predicted discharge on or before hospital day 14 (OR 3.4, 95% CI 1.8 to 6.4, p<0.001).ConclusionLack of angiographic vasospasm 5 to 7 days after aSAH is associated with shorter hospitalization, with no increase in 30 day ED visits or poor neurologic outcome.

Risk Factors, Incidence, and Effect of Cardiac Failure and Myocardial Infarction in Aneurysmal Subarachnoid Hemorrhage Patients

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 450-457 ◽  
Author(s):  
Young Woo Kim ◽  
Dan Neal ◽  
Brian L. Hoh
Keyword(s):  
Myocardial Infarction ◽  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Cardiac Failure ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Hospital Length Of Stay ◽  
Cardiac Complications ◽  
Hospitalization Costs ◽  
Primary Payer ◽  
Generalized Estimating

Abstract BACKGROUND: Cardiac dysfunction is a well-known complication of aneurysmal subarachnoid hemorrhage (aSAH). However, the clinical significance of cardiac complications is largely unknown. OBJECTIVE: To determine whether cardiac complications are independently related to outcomes and to identify potential predictors associated with these complications. METHODS: We extracted all hospitalizations for aSAH from the National Inpatient Sample database for years 2002 to 2009. We used generalized estimating equations to determine whether cardiac complications were associated with the patient outcomes and to evaluate potential predictors of cardiac complications. RESULTS: Among 53 713 cases of aSAH, there were 3609 (6.72%) and 151 (0.28%) incidences of cardiac failure (CF) and myocardial infarction (MI), respectively. The overall in-hospital mortality rate was 24.8%, whereas the mortality rate for patients with CF was 34.4% and the mortality rate for patients with MI was 29.8%. Patients who experienced CF were significantly more likely than other patients to die in the hospital (odds ratio: 1.6, 95% confidence interval: 1.47-1.68; P &lt; .001). The difference in mortality rates between MI patients and other patients, however, was not statistically significant. The generalized estimating equation model identified 7 factors that were predictive of CF: age, sex, race, primary payer, diabetes, smoker, and cardiac disease. For MI, the model identified age, race, and primary payer as significant predictors of MI. CONCLUSION: Our results suggest that an important association exists between cardiac complications and mortality/morbidity in aSAH patients. aSAH patients with CF appear to have a higher mortality rate, longer hospital length of stay, and higher hospitalization costs compared with those without CF.

scholarly journals P079: A retrospective cohort study of the impact of age and post-intubation hypotension threshold on mortality

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S92
Author(s):  
D. Lachance-Perreault ◽  
J. Turgeon ◽  
V. Boucher ◽  
M. Émond
Keyword(s):  
Blood Pressure ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Systolic Blood Pressure ◽  
Older Patients ◽  
Hospital Length Of Stay ◽  
Older Patient ◽  
Historical Cohort ◽  
Post Intubation ◽  
The Impact

Introduction: Endotracheal intubation (EI) is frequently performed in the emergency department (ED). Although this procedure is generally life-saving, EI is also known to cause adverse effects, such as hemodynamic alterations. A systolic blood pressure &lt;90 mmHg is the most commonly accepted definition of hypotension; however systolic blood pressure naturally increases with age. The National Trauma Triage Protocol now states that this threshold could be raised to 110 mmHg in older patients. Objective: to determine the impact of increasing the post-intubation hypotension (PIH) threshold to 110 mmHg on hospital length of stay and mortality in older patients. Methods: Design: A historical cohort of patients admitted in a level-1 trauma center ED between 06/2011 and 05/2016 was constituted. Population: Patients were included if pre-EI vital signs were available, their intubation was performed in the resuscitation room, were aged ≥65, if no surgical access was needed and if EI was performed in ≤3 attempts. Measures: All clinical data including vitals were prospectively recorded using the software ReaScribe. Main outcome was in-hospital mortality. Analyses: Univariate and multivariate analyses assessed the relation between PHI and outcomes. Results: A total of 181 patients were included. When using the 90-mmHg threshold, 92 patients suffered from PIH. Mean length of stay for these PIH patients was 18.9 days, compared to 12.0 days for non-hypotensive patients (P = 0.06). Mortality rate at 24 hours was 9.78% and 15.83% for PIH and non PIH patients, respectively (p = 0.2). The 110-mmHg threshold identified 33 additional PIH patients (n = 125) and their mean length of stay was 17.8 compared to 10.2 days for non PIH patients (P = 0.02). Mortality rate at 24 hours was 9.90% for PIH patients and 21.43% for non PIH patients (p = 0.02). Conclusion: PIH was associated with a significant increase in LOS when the PIH threshold is set at 110. Mortality rate is high in the intubated ED older patient and that increasing hypotension threshold for older patient seem to have no impact on patient mortality at 24 hours. Since our sample is limited, more research is needed to confirm these results.

Economic Analysis of Tirilazad Mesylate for Aneurysmal Subarachnoid Hemorrhage: Economic Evaluation of a Phase III Clinical Trial in Europe and Australia

1998 ◽  
Vol 14 (1) ◽  
pp. 145-160 ◽  
Author(s):  
Henry Glick ◽  
Richard Willke ◽  
Daniel Polsky ◽  
Ted Llana ◽  
Wayne M. Alves ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cost Effectiveness ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Controlled Trial ◽  
Cost Of Care ◽  
Phase Iii ◽  
Double Blind ◽  
Additional Information ◽  
Tirilazad Mesylate ◽  
The Cost

AbstractThis study used data from a multinational phase III randomized, double-blind, vehicle-controlled trial to evaluate the cost-effectiveness of tirilazad mesylate (Freedox®) in the treatment of aneurysmal subarachnoid hemorrhage. In men, therapy with 6 mg/kg per day of tirilazad mesylate was associated with significantly increased survival, increased cost of care, and ratios of cost per death averted that compare favorably with the ratios of other life and death interventions. In women, it appeared to have no effects on costs or survival. Further clinical studies may provide additional information about the cost-effectiveness of this intervention.

scholarly journals Subarachnoid Hemorrhage in Hospitalized Renal Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease: A Nationwide Analysis

2019 ◽  
Vol 8 (4) ◽  
pp. 524 ◽  
Author(s):  
Wisit Cheungpasitporn ◽  
Charat Thongprayoon ◽  
Patompong Ungprasert ◽  
Karn Wijarnpreecha ◽  
Wisit Kaewput ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Renal Transplant ◽  
Kidney Disease ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Polycystic Kidney ◽  
Aneurysm Clipping ◽  
Transplant Patients ◽  
Renal Transplant Patients

Background: This study aimed to evaluate the hospitalization rates for subarachnoid hemorrhage (SAH) among renal transplant patients with adult polycystic kidney disease (ADPKD) and its outcomes, when compared to non-ADPKD renal transplant patients. Methods: The 2005–2014 National Inpatient Sample databases were used to identify all hospitalized renal transplant patients. The inpatient prevalence of SAH as a discharge diagnosis between ADPKD and non-ADPKD renal transplant patients was compared. Among SAH patients, the in-hospital mortality, use of aneurysm clipping, hospital length of stay, total hospitalization cost and charges between ADPKD and non-ADPKD patients were compared, adjusting for potential confounders. Results: The inpatient prevalence of SAH in ADPKD was 3.8/1000 admissions, compared to 0.9/1000 admissions in non-ADPKD patients (p < 0.01). Of 833 renal transplant patients with a diagnosis of SAH, 30 had ADPKD. Five (17%) ADPKD renal patients with SAH died in hospitals compared to 188 (23.4%) non-ADPKD renal patients (p = 0.70). In adjusted analysis, there was no statistically significant difference in mortality, use of aneurysm clipping, hospital length of stay, or total hospitalization costs and charges between ADPKD and non-ADPKD patients with SAH. Conclusion: Renal transplant patients with ADPKD had a 4-fold higher inpatient prevalence of SAH than those without ADPKD. Further studies are needed to compare the incidence of overall admissions in ADPKD and non-ADPKD patients. When renal transplant patients developed SAH, inpatient mortality rates were high regardless of ADPKD status. The outcomes, as well as resource utilization, were comparable between the two groups.

scholarly journals The costs of traumatic head injury and associated factors at University of Gondar Specialized Referral Hospital, Northwest Ethiopia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yilak Asmamaw ◽  
Mezgebu Yitayal ◽  
Ayal Debie ◽  
Simegnew Handebo
Keyword(s):  
Head Injury ◽  
Length Of Stay ◽  
Medical Cost ◽  
Low Income ◽  
Associated Factors ◽  
Referral Hospital ◽  
Hospital Length Of Stay ◽  
Traumatic Head Injury ◽  
Traumatic Head ◽  
The Cost

Abstract Background Head injuries account for 650,000 annual deaths worldwide. The cost for treating head injury was estimated at US $200 million annually. This contributes to economic impoverishment in low income countries like Ethiopia. Hence, this study was aimed to assess the cost of Traumatic Head Injury (THI) and associated factors in the University of Gondar Specialized Referral Hospital. Method An institution-based cross-sectional study was conducted from March 01 to May 30, 2017. A total of 387 THI patients were included in the study. An interviewer-administered questionnaire was used for data collection. Direct costs and indirect costs were measured by using the bottom-up approach. Data were entered into Epi-Info version 7 and imported to SPSS version 20 for analysis. Simple and multiple linear regression analysis were done to identify factors associated with cost of THI. Results The mean cost of THI per patient was 4673.43 Ethiopian Birr (ETB), 95% CI (4523.6-4823.3), and length of hospital stay averaged 1.73, 95% CI (1.63–1.82). Direct non-medical cost, like transportation fee 1896.19 ETB (±762.56 SD) and medical costs 1101.66 ETB (±534.13 SD) were account for 40.57 and 23.58% of total costs respectively. The indirect cost, loss of income by patient and their attendant due to injury, was 1675.58 ETB (+ 459.26 SD). Patients with moderate and severe levels of injury have 635.167 ETB (Standardized coefficient = 0.173, p < 0.001) and 773.621 ETB (Standardized coefficient = 0. 132, p < 0.001) increased costs, respectively, compared to mild level THI patients. Costs for patients ages 31–45 years were 252.504 ETB (Standardized coefficient = − 0.066, p = 0.046) lower than costs for those 5–14 years old. The cost of THI patients increased by 1022.853 ETB for each additional day of hospital length of stay (Standardized coefficient = 0.648, p < 0.001). Conclusion Most expenses of the THI were from direct non-medical cost. Prior health service use, length of stay, level of injury, and age were significant predictors of cost of THI.

scholarly journals Hyperglycemia: A Predictor of Death in Severe Head Injury Patients

2016 ◽  
Vol 9 ◽  
pp. CMED.S40330 ◽  
Author(s):  
Simin Babaie Kafaki ◽  
Kamaledin Alaedini ◽  
Ashkan Qorbani ◽  
Leila Asadian ◽  
Kaveh Haddadi
Keyword(s):  
Blood Glucose ◽  
Head Injury ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Blood Glucose Level ◽  
Prospective Study ◽  
Glucose Level ◽  
Severe Head Injury ◽  
Hospital Length Of Stay ◽  
Comprehensive Treatment

Objectives Management of hyperglycemia during an acute sickness in adults is accompanied by improved outcomes. We have designed a prospective study with meticulous attention to exclude all diabetes patients by checking hemoglobin A1c (HbA1c or glycated hemoglobin) to avoid the ill-effects of hyperglycemia in patients with traumatic head injury admitted to the intensive care unit (ICU). Methods This prospective study included adults with traumatic primary brain injury with a Glasgow coma score of ≥8 necessitating mechanical ventilation treated in the period 2012–2015. After screening 311 patients, 220 were included in the study. Both blood glucose and HbA1c levels of all the patients at admission, as well as blood glucose level after 72 hours, were obtained from the records. The patients were later grouped based on their admission blood glucose levels (<200 mg/dL or ≤200 mg/dL). Injury severity score (ISS) was documented for every patient. As a final point, the outcomes were determined based on the hospital length of stay (HLS) and ICU length of stay (ILS), plusmortality rates. Results About 39% ( n = 85) of patients were admitted with hyperglycemia during the study period. The mortality rate in patients with glucose ≤200 mg/dL was 65.8% ( N = 56), against 23.7% ( N = 32) in the group with glucose <200 mg/dL, with mortality rising as the blood glucose level increased ( P = 0.014). Conclusions We conclude that admission hyperglycemia is related with increased mortality rate in head injury patients, and comprehensive treatment of hyperglycemia can improve the outcome of severe head injury patients.

scholarly journals Similar Efficacy of Arthroscopy and Arthrotomy in Infection Eradication in the Treatment of Septic Knee: A Systematic Review and Meta-Analysis

2022 ◽  
Vol 8 ◽  
Author(s):  
Zhimin Liang ◽  
Xiaofan Deng ◽  
Lingli Li ◽  
Jing Wang
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Septic Arthritis ◽  
Operative Time ◽  
Similar Efficacy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Infection Eradication

Aim: To compare the arthroscopy vs. arthrotomy for the treatment of native knee septic arthritis.Methods: Electronic databases of PubMed, Embase and Cochrane Library were searched for eligible studies. Retrospective comparative studies comparing arthroscopy or arthrotomy for patients with septic arthritis of the native knee were eligible for this review. The primary outcome was recurrence of infection after first procedure. The secondary outcomes included hospital length of stay, operative time, range of motion of the involved knee after surgery, overall complications and mortality rate,Results: Thirteen trials were included in this study. There were a total of 2,162 septic arthritis knees treated with arthroscopic debridement and irrigation, and 1,889 septic arthritis knees treated with open debridement and irrigation. Arthroscopy and arthrotomy management of the knee septic arthritis showed comparable rate of reinfection (OR = 0.85; 95% CI, 0.57–1.27; P = 0.44). No significant difference was observed in hospital length of stay, operative time and mortality rate between arthroscopy and arthrotomy management group, while arthroscopy treatment was associated with significantly higher knee range of motion and lower complication rate when compared with arthrotomy treatment.Conclusion: Arthroscopy and arthrotomy showed similar efficacy in infection eradication in the treatment of native septic knee. However, arthroscopy treatment was associated with better postoperative functional recovery and lower complication rate.

Sign in / Sign up

Export Citation Format

Share Document