Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups

The demand for revision total joint arthroplasties (rTJAs) is expected to increase as the age of the population continues to rise. Accurate cost data regarding hospital expenses for differing age groups are needed to deliver optimal care within value-based healthcare (VBHC) models. The aim of this study was to compare the total in-hospital costs by decadal groups following rTJA and to determine the primary drivers of the costs for these procedures. Time-driven activity-based costing (TDABC) was used to capture granular hospital costs. A total of 551 rTJAs were included in the study, with 294 sexagenarians, 198 septuagenarians, and 59 octogenarians and older. Sexagenarians had a lower ASA classification (2.3 vs. 2.4 and 2.7; p < 0.0001) and were more often privately insured (66.7% vs. 24.2% and 33.9%; p < 0.0001) as compared to septuagenarians and octogenarians and older, respectively. Sexagenarians were discharged to home at a higher rate (85.3% vs. 68.3% and 34.3%; p < 0.0001), experienced a longer operating room (OR) time (199.8 min vs. 189.7 min and 172.3 min; p = 0.0195), and had a differing overall hospital length of stay (2.8 days vs. 2.7 days and 3.6 days; p = 0.0086) compared to septuagenarians and octogenarians and older, respectively. Sexagenarians had 7% and 23% less expensive personnel costs from post-anesthesia care unit (PACU) to discharge (p < 0.0001), and 1% and 24% more expensive implant costs (p = 0.077) compared to septuagenarians and octogenarians and older, respectively. Sexagenarians had a lower total in-hospital cost for rTJAs by 0.9% compared to septuagenarians but 12% more expensive total in-hospital costs compared to octogenarians and older (p = 0.185). Multivariate linear regression showed that the implant cost (0.88389; p < 0.0001), OR time (0.12140; p < 0.0001), personnel cost from PACU through to discharge (0.11472; p = 0.0007), and rTHAs (−0.03058; p < 0.0001) to be the strongest associations with overall costs. Focusing on the implant costs and OR times to reduce costs for all age groups for rTJAs is important to provide cost-effective VBHC.

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Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

Geriatrics ◽

10.3390/geriatrics6010026 ◽

2021 ◽

Vol 6 (1) ◽

pp. 26

Author(s):

Christopher Fang ◽

Andrew Hagar ◽

Matthew Gordon ◽

Carl T. Talmo ◽

David A. Mattingly ◽

...

Keyword(s):

Length Of Stay ◽

Total Joint Arthroplasty ◽

Hospital Costs ◽

Cost Effective ◽

Joint Arthroplasty ◽

Nursing Facilities ◽

Activity Based Costing ◽

Skilled Nursing ◽

Value Based Care ◽

Hospital Expenses

The proportion of patients over the age of 90 years continues to grow, and the anticipated demand for total joint arthroplasty (TJA) in this population is expected to rise concomitantly. As the country shifts to alternative reimbursement models, data regarding hospital expenses is needed for accurate risk-adjusted stratification. The aim of this study was to compare total in-hospital costs following primary TJA in octogenarians and nonagenarians, and to determine the primary drivers of cost. This was a retrospective analysis from a single institution in the U.S. We used time-drive activity-based costing (TDABC) to capture granular total hospital costs for each patient. 889 TJA’s were included in the study, with 841 octogenarians and 48 nonagenarians. Nonagenarians were more likely to undergo total hip arthroplasty (THA) (70.8% vs. 42.4%; p < 0.0001), had higher ASA classification (2.6 vs. 2.4; p = 0.049), and were more often privately insured (35.4% vs. 27.8%; p = 0.0001) as compared to octogenarians. Nonagenarians were more often discharged to skilled nursing facilities (56.2% vs. 37.5%; p = 0.0011), experienced longer operating room (OR) time (142 vs. 133; p = 0.0201) and length of stay (3.7 vs. 3.1; p = 0.0003), and had higher implant and total in-hospital costs (p < 0.0001 and 0.0001). Multivariate linear regression showed implant cost (0.700; p < 0.0001), length of stay (0.546; p < 0.0001), and OR time (0.288; p < 0.0001) to be the strongest associations with overall costs. Primary TJA for nonagenarians was more expensive than octogenarians. Targeting implant costs, length of stay, and OR time can reduce costs for nonagenarians in order to provide cost-effective value-based care.

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High incidence of asymptomatic SARS-CoV-2 infection, Chongqing, China

10.1101/2020.03.16.20037259 ◽

2020 ◽

Cited By ~ 4

Author(s):

Yang Tao ◽

Panke Cheng ◽

Wen Chen ◽

Peng Wan ◽

Yaokai Chen ◽

...

Keyword(s):

Asymptomatic Patient ◽

Medical Center ◽

Age Groups ◽

The Elderly ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Asymptomatic Patients ◽

Imported Cases ◽

History Of ◽

Epidemiological Characteristics

SummaryBackgroundSARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection.MethodsIn this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiological characteristics and variable of these patients were collected and analyzed.Findings82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe Covid-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who was returnees from Wuhan, 18.1% was asymptomatic patients. In different infection periods, compared with the proportion after 1/31/2020, the proportion of asymptomatic patient among SARS-CoV-2 infected patient was higher(19% VS 1.5%). In different age groups, the proportion of asymptomatic patient was the highest(28.6%) in children group under 14, next in elder group over 70 (27.3%). Compared with mild and common Covid-19 patients, the mean latency of asymptomatic was longer (11.25 days VS 8.86 days), but the hospital length of stay was shorter (14.3 days VS 16.96 days).ConclusionThe SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population.

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227. Prevalence, Comorbidities and Expenditures of S. aureus Bacteremia in Liver Transplant Recipients: A 2012–2016 Nationwide Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.302 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S131-S132

Author(s):

Jahanavi M Ramakrishna ◽

Paul Kroner ◽

Haytham Helmi ◽

Claudia R Libertin

Keyword(s):

Resource Utilization ◽

Hospital Costs ◽

Organ Transplant ◽

The United States ◽

Mortality Rates ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Solid Organ ◽

Inpatient Mortality ◽

Mrsa Infection

Abstract Background Bacteremia due to Staphylococcus aureus is a known complication of liver transplantation (LT). Studies have shown that LT recipients are more predisposed to S. aureus infections than other solid-organ transplant patients; however, these studies have been limited in scope and mostly based out of single centers. Methods This is a retrospective cohort study using 2012–2016 NIS, the largest public inpatient database in the United States. All patients with ICD9-10CM procedural codes for LT were included. The cohort was stratified into two groups depending on whether they had MSSA or MRSA infection. The odds of inpatient mortality in both groups of patients undergoing LT were determined. The inpatient mortality odds were then compared with those of patients undergoing LT without associated S. aureus infection. Other outcomes included inpatient morbidity, resource utilization, hospital length of stay (LOS), and inflation-adjusted total hospital costs and charges. Multivariate regression analyses were used to adjust for demographic variables and Charlson Comorbidity Index. Results A total of 26,415 patients underwent LT in the study period, of which 180 had MSSA and 160 had MRSA infection reported. The mean age was 51.5 years and 35.6% were female. Patients with MSSA and MRSA displayed significantly higher inpatient mortality rates (11.1% and 9.4%, respectively) compared with non-MSSA/MRSA patients (3.4%) who underwent LT (P < 0.01). After adjusting for confounders, patients with MSSA infection displayed higher mortality odds (aOR: 4.45, P < 0.01), while patients with MRSA infection had non-statistically significant higher inpatient mortality odds (aOR: 3.10, P = 0.12) compared with patients without MSSA/MRSA infection. Both MSSA and MRSA cohorts displayed higher mortality odds if the infection resulted in sepsis (aOR: 9.92 and 5.70, respectively; P < 0.01). Conclusion There is a direct correlation between S. aureus bacteremia and increased mortality rates and incidence of sepsis and shock in LT recipients. Patients with S. aureus bacteremia spent more days in hospital and had higher cost of healthcare. Preventing and aggressively treating S. aureus infections in the immediate post-LT setting is key to reducing mortality, morbidity and resource utilization in patients undergoing LT. Disclosures All authors: No reported disclosures.

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Characterizing the Financial Value of In-Home Palliative Care for Patients, Payers, and Hospitals

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119872486 ◽

2019 ◽

Vol 37 (3) ◽

pp. 196-200

Author(s):

Saad Akhtar ◽

Vamshek Srinivasan ◽

Carol Weisse ◽

Phil DiSorbo

Keyword(s):

Palliative Care ◽

Chronic Conditions ◽

Health Care Services ◽

Cost Effective ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Multiple Chronic Conditions ◽

Care Services ◽

Financial Benefits ◽

Inpatient Hospitalizations

Background: The holistic and multidisciplinary approach of in-home palliative care (IHPC) is known to offer high-quality and cost-effective care for patients at the end of life. However, the financial benefits of upstream IHPC programs to hospitals, patients, and payers have not been fully characterized for patients with comorbid chronic conditions. Aim: To characterize the financial benefits that upstream IHPC offers to patients with multiple chronic conditions. Methods: A structured retrospective patient record review was conducted on the number of emergency department (ED) visits, number of inpatient hospitalizations, hospital length of stay (LOS), and payments made to the hospital for all patients (N = 71) enrolled in an IHPC program between January 1, 2016, and June 30, 2016. Discharge history from each patient’s medical record was also assessed. Comparisons were drawn between patients’ LOS on IHPC and an equivalent time period prior to enrollment in IHPC. Results: After patients enrolled in IHPC, average ED and inpatient utilization declined significantly by 41% ( P = .01) and 71% ( P < .001), respectively. The payers for health-care services realized a significant decline of US$2,201 ( P < .001) in hospital payments per patient per month. Inpatient LOS was also significantly lower than expected once patients enrolled in the program ( P = .01). Conclusions: As the need for chronic disease management continues to grow, managers of health systems, managed care organizations, and home health agencies should be cognizant of the financial value that IHPC has to offer.

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Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures

Anesthesiology ◽

10.1097/aln.0000000000002136 ◽

2018 ◽

Vol 128 (5) ◽

pp. 880-890 ◽

Cited By ~ 41

Author(s):

Atul Gupta ◽

Junaid Nizamuddin ◽

Dalia Elmofty ◽

Sarah L. Nizamuddin ◽

Avery Tung ◽

...

Keyword(s):

Length Of Stay ◽

Operating Room ◽

Healthcare Utilization ◽

Cohort Analysis ◽

Hospital Costs ◽

Hospital Length ◽

Opioid Abuse ◽

Hospital Length Of Stay ◽

Opioid Overdose ◽

Readmission Rates

Abstract Background Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. Methods A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Results Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Conclusions Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.

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Surgical Site Infection After Pediatric Cardiothoracic Surgery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116674467 ◽

2016 ◽

Vol 8 (1) ◽

pp. 7-12 ◽

Cited By ~ 13

Author(s):

Anthony A. Sochet ◽

Alexander M. Cartron ◽

Aoibhinn Nyhan ◽

Michael C. Spaeder ◽

Xiaoyan Song ◽

...

Keyword(s):

Length Of Stay ◽

Surgical Site Infection ◽

Heart Surgery ◽

Hospital Costs ◽

Congenital Heart Surgery ◽

Hospital Length ◽

Cardiothoracic Surgery ◽

Hospital Length Of Stay ◽

Published Data ◽

Site Infection

Background: Surgical site infection (SSI) occurs in 0.25% to 6% of children after cardiothoracic surgery (CTS). There are no published data regarding the financial impact of SSI after pediatric CTS. We sought to determine the attributable hospital cost and length of stay associated with SSI in children after CTS. Methods: We performed a retrospective, matched cohort study in a 26-bed cardiac intensive care unit (CICU) from January 2010 through December 2013. Cases with SSI were identified retrospectively and individually matched to controls 2:1 by age, gender, Risk Adjustment for Congenital Heart Surgery score, Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery category, and primary cardiac diagnosis and procedure. Results: Of the 981 cases performed during the study period, 12 with SSI were identified. There were no differences in demographics, clinical characteristics, or intraoperative data. Median total hospital costs were higher in participants with SSI as compared to controls (US$219,573 vs US$82,623, P < .01). Children with SSI had longer median CICU length of stay (9 vs 3 days, P < .01), hospital length of stay (18 vs 8.5 days, P < .01), and duration of mechanical ventilation (2 vs 1 day, P < .01) and vasoactive administration (4.5 vs 1 day, P < .01). Conclusions: Children with SSI after CTS have an associated increase in hospital costs of US$136,950/case and hospital length of stay of 9.5 days/case. The economic burden posed by SSI stress the importance of infection control surveillance, exhaustive preventative measures, and identification of modifiable risk factors.

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Time between Symptom Onset, Hospitalisation and Recovery or Death: a Statistical Analysis of Different Time-Delay Distributions in Belgian COVID-19 Patients

10.1101/2020.07.18.20156307 ◽

2020 ◽

Cited By ~ 4

Author(s):

Christel Faes ◽

Steven Abrams ◽

Dominique Van Beckhoven ◽

Geert Meyfroidt ◽

Erika Vlieghe ◽

...

Keyword(s):

Nursing Home ◽

Length Of Stay ◽

Symptom Onset ◽

Age Groups ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Age Group ◽

Median Length ◽

Nursing Home Patients ◽

Interval Censored

Background There are different patterns in the COVID-19 outbreak in the general population and amongst nursing home patients. Different age-groups are also impacted differently. However, it remains unclear whether the time from symptom onset to diagnosis and hospitalization or the length of stay in the hospital is different for different age groups, gender, residence place or whether it is time dependent. Methods Sciensano, the Belgian Scientific Institute of Public Health, collected information on hospitalized patients with COVID-19 hospital admissions from 114 participating hospitals in Belgium. Between March 14, 2020 and June 12, 2020, a total of 14,618 COVID-19 patients were registered. The time of symptom onset, time of COVID-19 diagnosis, time of hospitalization, time of recovery or death, and length of stay in intensive care are recorded. The distributions of these different event times for different age groups are estimated accounting for interval censoring and right truncation in the observed data. Results The truncated and interval-censored Weibull regression model is the best model for the time between symptom onset and diagnosis/hospitalization best, whereas the length of stay in hospital is best described by a truncated and interval-censored lognormal regression model. Conclusions The time between symptom onset and hospitalization and between symptom onset and diagnosis are very similar, with median length between symptom onset and hospitalization ranging between 3 and 10.4 days, depending on the age of the patient and whether or not the patient lives in a nursing home. Patients coming from a nursing home facility have a slightly prolonged time between symptom onset and hospitalization (i.e., 2 days). The longest delay time is observed in the age group 20-60 years old. The time from symptom onset to diagnosis follows the same trend, but on average is one day longer as compared to the time to hospitalization. The median length of stay in hospital varies between 3 and 10.4 days, with the length of stay increasing with age. However, a difference is observed between patients that recover and patients that die. While the hospital length of stay for patients that recover increases with age, we observe the longest time between hospitalization and death in the age group 20-60. And, while the hospital length of stay for patients that recover is shorter for patients living in a nursing home, the time from hospitalization to death is longer for these patients. But, over the course of the first wave, the length of stay has decreased, with a decrease in median length of stay of around 2 days.

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The Changing Landscape of Uncomplicated Gram-Negative Bacteremia: A Narrative Review to Guide Inpatient Management

Journal of Hospital Medicine ◽

10.12788/jhm.3414 ◽

2020 ◽

Vol 15 (12) ◽

pp. 746-753 ◽

Cited By ~ 1

Author(s):

Jeannie D Chan ◽

Chloe Bryson-Cahn ◽

Zahra Kassamali-Escobar ◽

John B Lynch ◽

Anneliese M Schleyer

Keyword(s):

Cost Effective ◽

Hospital Length ◽

Antimicrobial Treatment ◽

Blood Cultures ◽

Hospital Length Of Stay ◽

Source Control ◽

Gram Negative ◽

Oral Agents ◽

Gram Negative Bacteremia

Gram-negative bacteremia secondary to focal infection such as skin and soft-tissue infection, pneumonia, pyelonephritis, or urinary tract infection is commonly encountered in hospital care. Current practice guidelines lack sufficient detail to inform evidence-based practices. Specifically, antimicrobial duration, criteria to transition from intravenous to oral step-down therapy, choice of oral antimicrobials, and reassessment of follow-up blood cultures are not addressed. The presence of bacteremia is often used as a justification for a prolonged course of antimicrobial therapy regardless of infection source or clinical response. Antimicrobials are lifesaving but not benign. Prolonged antimicrobial exposure is associated with adverse effects, increased rates of Clostridioides difficile infection, antimicrobial resistance, and longer hospital length of stay. Emerging evidence supports shorter overall duration of antimicrobial treatment and earlier transition to oral agents among patients with uncomplicated Enterobacteriaceae bacteremia who have achieved adequate source control and demonstrated clinical stability and improvement. After appropriate initial treatment with an intravenous antimicrobial, transition to highly bioavailable oral agents should be considered for total treatment duration of 7 days. Routine follow-up blood cultures are not cost-effective and may result in unnecessary healthcare resource utilization and inappropriate use of antimicrobials. Clinicians should incorporate these principles into the management of gram-negative bacteremia in the hospital.

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High incidence of asymptomatic SARS-CoV-2 infection, Chongqing, China

10.21203/rs.3.rs-25603/v1 ◽

2020 ◽

Cited By ~ 2

Author(s):

Yang Tao ◽

Panke Cheng ◽

Wen Chen ◽

Peng Wan ◽

Yaokai Chen ◽

...

Keyword(s):

Asymptomatic Patient ◽

Medical Center ◽

Age Groups ◽

The Elderly ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Asymptomatic Patients ◽

Imported Cases ◽

History Of ◽

Epidemiological Characteristics

Abstract Background SARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection. Methods In this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiological characteristics and variable of these patients were collected and analyzed. Findings 82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe Covid-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who was returnees from Wuhan, 18.1% was asymptomatic patients. In different infection periods, compared with the proportion after 1/31/2020, the proportion of asymptomatic patient among SARS-CoV-2 infected patient was higher(19% VS 1.5%). In different age groups, the proportion of asymptomatic patient was the highest(28.6%) in children group under 14, next in elder group over 70 (27.3%). Compared with mild and common Covid-19 patients, the mean latency of asymptomatic was longer (11.25 days VS 8.86 days), but the hospital length of stay was shorter (14.3 days VS 16.96 days). Conclusion The SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population.

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Modeling Resource Use with Time Equations: Empirical Evidence

Journal of Management Accounting Research ◽

10.2308/jmar-51444 ◽

2016 ◽

Vol 29 (1) ◽

pp. 1-12 ◽

Cited By ~ 4

Author(s):

Ramji Balakrishnan ◽

Andrew J. Pugely ◽

Apurva S. Shah

Keyword(s):

Resource Use ◽

Operating Time ◽

Strong Support ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Activity Based Costing ◽

Race And Gender ◽

Use Of Time ◽

And Gender ◽

Using Data

ABSTRACT We test whether cost-object-level characteristics significantly and predictably affect resource use within a single standardized activity. Using data on operating time for joint replacements, we find reliable effects for age, race, and gender after controlling for body mass index and other comorbidities. Modeling such granular variation is practically not possible in a classic two-stage system. Thus, this finding provides strong support for the use of time equations, as in time-driven activity-based costing, to model resource use. Supplementary analyses of hospital length of stay and gross charges show that, in addition to the expected direct effects, hospital-level characteristics moderate how patient-level attributes affect resource use.

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