scholarly journals Do Sex-Related Differences of Comorbidity Burden and/or In-Hospital Mortality Exist in Cancer Patients? A Retrospective Study in an Internal Medicine Setting

Life ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 261
Author(s):  
Alfredo De Giorgi ◽  
Fabio Fabbian ◽  
Rosaria Cappadona ◽  
Ruana Tiseo ◽  
Christian Molino ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Metastatic Cancer ◽  
Diagnostic Procedures ◽  
International Classification Of Diseases ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Comorbidity Burden

Cancer represents important comorbidity, and data on outcomes are usually derived from selected oncologic units. Our aim was to evaluate possible sex-related differences and factors associated with in-hospital mortality (IHM) in a consecutive cohort of elderly patients with cancer admitted to internal medicine. We included all patients admitted to our department with a diagnosis of cancer during 2018. Based on the International Classification of Diseases, 9th Revision, Clinical Modification, demography, comorbidity burden, and diagnostic procedures were evaluated, with IHM as our outcome. We evaluated 955 subjects with cancer (23.9% of total hospital admissions), 42.9% were males, and the mean age was 76.4 ± 11.4 years. Metastatic cancer was diagnosed in 18.2%. The deceased group had a higher modified Elixhauser Index (17.6 ± 7.7 vs. 14 ± 7.3, p < 0.001), prevalence of cachexia (17.9% vs. 7.2%, p < 0.001), and presence of metastasis (27.8% vs. 16.3%, p = 0.001) than survivors. Females had a higher age (77.4 ± 11.4 vs. 75.5 ± 11.4, p = 0.013), and lower comorbidity (10.2 ± 5.9 vs. 12.0 ± 5.6, p < 0.001) than males. IHM was not significantly different among sex groups, but it was independently associated with cachexia and metastasis only in women. Comorbidities are highly prevalent in patients with cancer admitted to the internal medicine setting and are associated with an increased risk of all-cause mortality, especially in female elderly patients with advanced disease.

Impact of cancer on emergency department outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18618-e18618
Author(s):  
Alexander S. Qian ◽  
Edmund M. Qiao ◽  
Vinit Nalawade ◽  
Rohith S. Voora ◽  
Nikhil V. Kotha ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Cancer Patients ◽  
Metastatic Cancer ◽  
Inpatient Admission ◽  
Cancer Site ◽  
Patients With Cancer ◽  
Increased Risk

e18618 Background: Cancer patients frequently utilize the Emergency Department (ED) for a variety of diagnoses, both related and unrelated to their cancer. Patients with cancer have unique risks related to their cancer and treatment which could influence ED-related outcomes. A better understanding of these risks could help improve risk-stratification for these patients and help inform future interventions. This study sought to define the increased risks cancer patients face for inpatient admission and hospital mortality among cancer patients presenting to the ED. Methods: From the National Emergency Department Sample (NEDS) we identified patients with and without a diagnosis of cancer presenting to the ED between 2016 and 2018. We used International Classification of Diseases, version 10 (ICD10-CM) codes to identify patients with cancer, and to identify patient’s presenting diagnosis. Multivariable mixed-effects logistic regression models assessed the influence of cancer diagnoses on two endpoints: hospital admission from the ED, and inpatient hospital mortality. Results: There were 340 million weighted ED visits, of which 8.3 million (2.3%) occurred in patients with a cancer diagnosis. Compared to non-cancer patients, patients with cancer had an increased risk of inpatient admission (64.7% vs. 14.8%; p < 0.0001) and hospital mortality (4.6% vs. 0.5%; p < 0.0001). Factors associated with both an increased risk of hospitalization and death included older age, male gender, lower income level, discharge quarter, and receipt of care in a teaching hospital. We identified the top 15 most common presenting diagnoses among cancer patients, and among each of these diagnoses, cancer patients had increased risks of hospitalization (odds ratio [OR] range 2.0-13.2; all p < 0.05) and death (OR range 2.1-14.4; all p < 0.05) compared to non-cancer patients with the same diagnosis. Within the cancer patient cohort, cancer site was the most robust individual predictor associated with risk of hospitalization or death, with highest risk among patients with metastatic cancer, liver and lung cancers compared to the reference group of prostate cancer patients. Conclusions: Cancer patients presenting to the ED have high risks for hospital admission and death when compared to patients without cancer. Cancer patients represent a distinct population and may benefit from cancer-specific risk stratification or focused interventions tailored to improve outcomes in the ED setting.

scholarly journals Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry

2021 ◽  
Author(s):  
Salvatore Corrao ◽  
Alessandro Nobili ◽  
Giuseppe Natoli ◽  
Pier Mannuccio Mannucci ◽  
Francesco Perticone ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Barthel Index ◽  
Rating Scale ◽  
Depression Scale ◽  
Cognitive Status ◽  
Hospital Death ◽  
Glycemia Level ◽  
Male Sex

Abstract Aims The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years. Methods Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge. Results Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250 mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and < 250 mg/dL, respectively (p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250 mg/dL (OR 2.07; [95% CI 1.34–3.19]), Barthel Index ≤ 40 (3.28[2.44–4.42]), CIRS-SI (1.87[1.27–2.77]), and male sex (1.54[1.16–2.03]). Conclusions The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250 mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex.

scholarly journals Recanalisation theraphy for acute ischemic stroke in cancer patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giovanni Merlino ◽  
Carmelo Smeralda ◽  
Gian Luigi Gigli ◽  
Simone Lorenzut ◽  
Sara Pez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Metastatic Cancer ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
University Hospital ◽  
Bridging Therapy ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Active Cancer

AbstractTo date, very few studies focused their attention on efficacy and safety of recanalisation therapy in acute ischemic stroke (AIS) patients with cancer, reporting conflicting results. We retrospectively analysed data from our database of consecutive patients admitted to the Udine University Hospital with AIS that were treated with recanalisation therapy, i.e. intravenous thrombolysis (IVT), mechanical thrombectomy (MT), and bridging therapy, from January 2015 to December 2019. We compared 3-month dependency, 3-month mortality, and symptomatic intracranial haemorrhage (SICH) occurrence of patients with active cancer (AC) and remote cancer (RC) with that of patients without cancer (WC) undergoing recanalisation therapy for AIS. Patients were followed up for 3 months. Among the 613 AIS patients included in the study, 79 patients (12.9%) had either AC (n = 46; 7.5%) or RC (n = 33; 5.4%). Although AC patients, when treated with IVT, had a significantly increased risk of 3-month mortality [odds ratio (OR) 6.97, 95% confidence interval (CI) 2.42–20.07, p = 0.001] than WC patients, stroke-related deaths did not differ between AC and WC patients (30% vs. 28.8%, p = 0.939). There were no significant differences between AC and WC patients, when treated with MT ± IVT, regarding 3-month dependency, 3-month mortality and SICH. Functional independence, mortality, and SICH were similar between RC and WC patients. In conclusion, recanalisation therapy might be used in AIS patients with nonmetastatic AC and with RC. Further studies are needed to explore the outcome of AIS patients with metastatic cancer undergoing recanalisation therapy.

A Case Illustrating That Cancer Tips the Scale of Thrombosis.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4128-4128
Author(s):  
Emma C. Scott ◽  
Jeffrey Cohn ◽  
Stephen Heitner
Keyword(s):  
Tumor Cells ◽  
Ductal Carcinoma ◽  
Metastatic Cancer ◽  
Factor V Leiden ◽  
Cysteine Proteases ◽  
Factor V ◽  
Factor V Leiden Mutation ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Prothrombin Mutation

Abstract Background: There are many causes of thrombosis in cancer, including cancer itself, the release of TNF, IL-1 &IL-6 causing endothelial damage, the interaction between tumor cells and macrophages activates platelets, factors X11 &X. Cysteine proteases &tissue factor, in the tumor cells have pro-coagulant activity (Bick, R. New Engl J of Med. Volume 349. July 2003). Chemotherapy, hormonal therapy and indwelling central venous catheters also increase the risk of thrombosis. There is a RR of 4.1 for patients with cancer who did not have chemotherapy and 6.5 for patients with cancer who had chemotherapy (Heit et al. Arch Intern Med. 2000; 160: 809–815). Factor V Leiden mutation causes partial resistance to the inactivating effects of activated protein C. 5% of the population carries this mutation and it is present in 20% of patients with a 1st venous thrombotic episode. The risk of venous thrombosis is 3–8 fold. The prothrombin mutation is less common and the relative risk of thrombosis is about 2.0. In a large case control study it was found that carriers of the Factor V Leiden or the prothrombin mutation who also had cancer had an approximately 12–17 times increased risk of thrombosis; compared to an overall 7 times risk in patients with malignancy alone (Blom et al. JAMA. Feb 9, 2005. Vol 293, No 6). Case history: A 54 year old caucasion female was diagnosed with stage 1 infiltrating ductal carcinoma after palpating a lump in her left breast. The tumor was 1.6 cm, ER negative, PR negative and HER-2 negative. Lumpectomy and axillary node dissection revealed no residual carcinoma in the breast and no involvement of eleven lymph nodes. She completed 4 cycles of Cytoxan and Adriamycin successfully and was to start radiation therapy. 1 week after completing chemotherapy she had a focal seizure with tonicclonic movements of her right arm and no loss of consciousness. An MRI showed cortical infarcts, which were originally thought to be metastatic hemorrhages, in the left parietal and frontal areas and right parietal area. A follow up MRI showed considerable improvement of the cortical lesions, with no evidence of any metastatic cancer. Subsequently, she developed bilateral DVTs for which an IVC filter was placed as it was felt that she was not a candidate for anticoagulation given her recent CNS hemorrhage. She was also found to have bilateral pulmonary emboli on CT scan of the chest. Two other underlying disorders predisposing to thrombosis were found- Factor V Leiden mutation and the prothrombin gene mutation. Further imaging confirmed a thrombotic etiology for her CNS event, and coumadin was started. Conclusion: This case demonstrates the magnitude of the effect of cancer on thrombosis. This patient had 2 prothrombotic mutations, was a smoker, who had been on the OCP for 10 years prior to menopause, yet had no thrombotic episodes until she developed cancer. Also of interest is that the thrombotic episodes occurred shortly after completion of chemotherapy- another prothrombotic factor.

Clinician assessment of potentially avoidable hospitalization in patients with cancer.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 4-4
Author(s):  
Gabriel Brooks ◽  
Hajime Uno ◽  
Joseph O. Jacobson ◽  
Deborah Schrag
Keyword(s):  
Patient Care ◽  
Primary Outcome ◽  
Hospital Admissions ◽  
Physician Assistant ◽  
Metastatic Cancer ◽  
Patients With Cancer ◽  
Avoidable Hospitalizations ◽  
Medical Spending ◽  
Common Cancer ◽  
Clinician Assessment

4 Background: In patients with advanced cancer, acute hospitalization accounts for nearly half of all medical spending. Prior research has suggested that many hospitalizations in cancer patients are potentially avoidable, however the perspectives of clinicians directly involved in patient care are not known. Methods: We studied hospital admissions to an inpatient medical oncology service among patients with solid tumor malignancies. For each hospitalization, we interviewed three clinicians from the medical team: the outpatient medical oncologist, the inpatient attending oncologist, and the inpatient resident physician or physician assistant. Respondents were asked to identify whether or not each hospitalization was potentially avoidable (‘probably’ or ‘definitely’ avoidable vs. ‘definitely not’ or ‘probably not’ avoidable). The primary outcome was the proportion of hospitalizations identified as potentially avoidable by two or more of the three clinicians. Results: Complete clinician interview data were collected for 103 of 132 eligible hospitalizations (78%). The median age at hospitalization was 64 years, and 79% of hospitalized patients had metastatic cancer. The most common cancer sites were the lung, breast, and colorectum. 18% of hospitalizations were rated as potentially avoidable by the outpatient oncologist, 28% by the inpatient oncologist, and 30% by the inpatient resident or physician assistant. 24 hospitalizations (23%) were identified as potentially avoidable by two or more clinicians, but only 2% were identified as potentially avoidable by all three clinicians. Hospitalizations were more likely to be perceived as potentially avoidable when psychosocial factors contributed to the reason for hospital admission (OR 2.9, 95% CI 1.2-7.3). Median length of stay was shorter for potentially avoidable hospitalizations (2 vs. 4 days), but rates of death and readmission within 90 days did not significantly differ following potentially avoidable vs. other hospitalizations. Conclusions: A substantial proportion of hospitalizations in patients with cancer are perceived as potentially avoidable by clinicians who are directly involved in patient care.

scholarly journals Impact of Comorbidities on Length of Stay and Mortality in Hospitalized Patients with Cancer and Febrile Neutropenia

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2601-2601 ◽  
Author(s):  
Eva Culakova ◽  
Marek S. Poniewierski ◽  
Jeffrey Crawford ◽  
David C. Dale ◽  
Gary H. Lyman
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Research Funding ◽  
Infectious Complications ◽  
Hospitalized Patients ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Time Period ◽  
Increased Risk ◽  
The Impact

Background: Hematologic toxicities are common side effects of cancer chemotherapy. Despite advances in supportive care, febrile neutropenia (FN) continues to represent a serious adverse event often requiring hospitalization and is associated with an increased risk of mortality. The purpose of this analysis was to investigate the impact of comorbidities and infectious complications on in-patient length of stay (LOS) and mortality in hospitalized patients with cancer and neutropenia over the past decade. Methods: Hospitalization data from the University Health Consortium database inclusive of the years 2004-2012 from 239 US medical centers were analyzed. Cancer type, presence of neutropenia, comorbidities, and infection type were based on ICD-9-CM codes recorded during hospitalization. This analysis includes adult patients with malignant disease and neutropenia. Patients undergoing bone marrow or stem cell transplantation were excluded. For patients with multiple hospitalizations, the first admission during the time period studied was utilized. Primary study outcomes included hospital length of stay (LOS≥10 days) and in-hospital mortality. Multivariate logistic regression analysis was utilized to study the impact of major comorbidities on the primary outcomes. Major comorbidities under consideration included heart, liver, lung, renal, cerebrovascular, peripheral-vascular disease, diabetes and venous thromboembolism. Results: Among 135,309 patients with cancer hospitalized with neutropenic events, one-third were age 65 years or older and 51% were male. Approximately one-quarter (24.5%) of patients experienced more than one admission with FN. The mean (median) length of stay increased progressively from 11.1 (6) days in 2004 to 12.8 (7) days in 2012. Patients with leukemia, lymphoma and central nervous system (CNS) malignancies experienced the longest mean LOS (21.4, 10.5, 10.2 days, respectively). Overall, 50,846 (37.6%) had a LOS≥10 days and 10,261 (7.6%) patients died during the hospitalization with no difference seen over the time period of observation. (P=.30). Greater rates of mortality were observed in patients with lung (11.2%) or CNS (9.3%) malignancies, and leukemia (9.3%). Infectious complications were documented in 59.5% of patients and their presence was associated with greater LOS≥10 days (48.2% vs. 22.0%) and higher mortality (11.2% vs. 2.3%). Greater LOS≥10 days (51.6% vs. 37.1%) and increased mortality (9.8% vs. 7.5%) were also observed among obese patients with cancer. Likewise, patients with multiple comorbid conditions had more prolonged hospitalizations and a greater risk of in-hospital mortality. (Table) Abstract 2601. Table Solid tumors Lymphoma LeukemiaNo. of comorbiditiesNo. of patients% died% with LOS≥10 daysNo. of patients% died% with LOS≥10 daysNo. of patients% died% with LOS≥10 days017,8580.911.28,1890.617.010,3950.853.5118,1723.417.97,7512.626.611,3803.463.2214,2508.927.25,3868.141.08,6039.769.937,49918.038.42,86118.455.25,04022.877.742,70525.151.41,06033.670.52,00438.183.1≥ 560235.262.327839.980.657749.087.0All patients*61,0867.022.625,5256.632.237,9999.265.4 LOS – length of stay; * 10,699 patients with other type or multiple tumors not included in the table The trend toward longer LOS and greater mortality with increased number of comorbidities persisted in multivariate analyses after adjusting for cancer type, age, gender, ethnicity and type of infection (odds ratio (OR) per +1 comorbidity increase: [mortality: OR =1.89; 95% CI: 1.85-1.92; P<.0001], [LOS: OR=1.56; 95% CI: 1.54-1.58; P<.0001]). Conclusions: Major medical comorbidities are common among hospitalized patients with cancer and neutropenia. Importantly, such comorbidities are associated with prolonged hospitalization and increased risk of in-hospital mortality with significantly worse outcomes in patients with lymphoma or leukemia. Greater awareness of risk factors associated with poor prognosis in cancer patients hospitalized with neutropenic complications as well as validated risk tools to better identify low risk as well high risk patients may guide more personalized cancer care, potentially improving clinical outcomes and lowering the cost of care. Disclosures Crawford: Amgen: Consultancy. Dale:Amgen: Consultancy, Honoraria, Research Funding. Lyman:Amgen: Research Funding.

scholarly journals Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer

2021 ◽  
pp. 1-8
Author(s):  
Chetna Malhotra ◽  
Rahul Malhotra ◽  
Filipinas Bundoc ◽  
Irene Teo ◽  
Semra Ozdemir ◽  
...  
Keyword(s):  
End Of Life ◽  
Odds Ratio ◽  
Healthcare Costs ◽  
Hospital Admissions ◽  
Metastatic Cancer ◽  
Comprehensive Understanding ◽  
Patients With Cancer ◽  
Multivariable Models ◽  
Hospital Days ◽  
Death Data

Background: Reducing suffering at the end of life is important. Doing so requires a comprehensive understanding of the course of suffering for patients with cancer during their last year of life. This study describes trajectories of psychological, spiritual, physical, and functional suffering in the last year of life among patients with a solid metastatic cancer. Patients and Methods: We conducted a prospective cohort study of 600 patients with a solid metastatic cancer between July 2016 and December 2019 in Singapore. We assessed patients’ psychological, spiritual, physical, and functional suffering every 3 months until death. Data from the last year of life of 345 decedents were analyzed. We used group-based multitrajectory modeling to delineate trajectories of suffering during the last year of a patient’s life. Results: We identified 5 trajectories representing suffering: (1) persistently low (47% of the sample); (2) slowly increasing (14%); (3) predominantly spiritual (21%); (4) rapidly increasing (12%); and (5) persistently high (6%). Compared with patients with primary or less education, those with secondary (high school) (odds ratio [OR], 3.49; 95% CI, 1.05–11.59) education were more likely to have rapidly increasing versus persistently low suffering. In multivariable models adjusting for potential confounders, compared with patients with persistently low suffering, those with rapidly increasing suffering had more hospital admissions (β=0.24; 95% CI, 0.00–0.47) and hospital days (β=0.40; 95% CI, 0.04–0.75) during the last year of life. Those with persistently high suffering had more hospital days (β=0.70; 95% CI, 0.23–1.17). Conclusions: The course of suffering during the last year of life among patients with cancer is variable and related to patients’ hospitalizations. Understanding this variation can facilitate clinical decisions to minimize suffering and reduce healthcare costs at the end of life.

scholarly journals The Difficult Task of Diagnosing Depression in Elderly People with Cancer: A Systematic Review

2021 ◽  
Vol 17 (1) ◽  
pp. 295-306
Author(s):  
Elena Massa ◽  
Clelia Donisi ◽  
Nicole Liscia ◽  
Clelia Madeddu ◽  
Valentino Impera ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Elderly Patients ◽  
Elderly People ◽  
Diagnosis Delay ◽  
Keywords Depression ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Anticancer Treatment

Background: Depression is a common psychiatric problem in the elderly and oncology patients. In elderly people with cancer, depression has a peculiar phenomenology. It has a significant impact on the quality of life. Moreover, it is associated with poor adherence to treatments, increased risk of suicide, and mortality. Nevertheless, the topic of depression in elderly people with cancer remains unexplored. Objective: The main goal of this article is to review the literature from the past 20 years on the relationships between depression, cancer, and aging. Methods: The methods followed the Prisma model for eligibility of studies. The articles in which the keywords “depression”, “cancer”, “ elderly, aging, or geriatric” were present, either in the text or in the abstract, were selected. 8.056 articles, by matching the keywords “depression and elderly and cancer,” were identified. Only 532 papers met the eligibility criteria of search limits and selection process. Out of 532 papers, 467 were considered irrelevant, leaving 65 relevant studies. Out of 65 suitable studies, 39 (60.0%) met our quality criteria and were included. Results: The risk factors associated with depression in elderly people with cancer can be divided into 4 groups: 1) tumor-related; 2) anticancer treatment-related; 3) patients-related; 4) number and type of comorbidity. The main obstacles in diagnosing depression in elderly patients with cancer are the overlap of the symptoms of cancer and side effects of treatment with the symptoms of depression but also the different ways of reporting depressive symptoms of elderly people and the different clinical types of depression. There is a lack of data regarding validated scales to assess depression in geriatric patients with cancer. Any mental illness, specifically co-occurring anxiety and depression, increases the risk of diagnosis delay and anticancer treatment adherence. Cancer and the diagnosis of mental disorders prior to cancer diagnosis correlate with an increased risk for suicide. A non-pharmacological therapeutic approach, pharmacological treatment and/or a combination of both can be used to treat elderly patients with cancer, but a detailed analysis of comorbidities and the assessment of polypharmacy is mandatory in order to avoid potential side-effects and interactions between antidepressants and the other drugs taken by the patients. Conclusion: Future research should be conducted with the aim of developing a modified and adapted assessment method for the diagnosis and treatment of depression in elderly people with cancer in order to improve their clinical outcomes and quality of life.

scholarly journals High-Cost Hospitalizations Among Elderly Patients With Cancer

2019 ◽  
Vol 15 (5) ◽  
pp. e447-e457 ◽  
Author(s):  
Jaqueline Avila ◽  
Daniel Jupiter ◽  
Mariana Chavez-MacGregor ◽  
Claire de Oliveira ◽  
Sapna Kaul
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Odds Ratio ◽  
Lower Cost ◽  
Metastatic Cancer ◽  
The United States ◽  
National Sample ◽  
Interquartile Range ◽  
Care Needs ◽  
Patients With Cancer

PURPOSE: Health care costs are driven by a small proportion of patients, and it is important to identify their characteristics to effectively manage their health care needs. We examined characteristics associated with high-cost inpatient visits of elderly patients with cancer using a national sample. METHODS: We identified 574,367 inpatient visits of individuals age 65 years or older with a cancer diagnosis using the 2014 National Inpatient Sample data, an all-payer sample of inpatient stays in the United States. High-cost visits were defined as those with a total cost at or above the 90th percentile. The remaining visits were defined as the lower-cost group. We examined patients’ clinical characteristics and hospital characteristics for both groups. Logistic regression was used to identify characteristics associated with being in the high-cost group. RESULTS: The median visit cost in the high-cost group was $38,194 (interquartile range, $31,405 to $51,802), which was nearly five times the cost of the lower-cost group (median, $8,257; interquartile range, $5,032 to $13,335). Hematologic malignancies were the most common cancer in the high-cost group. Those in the high-cost group were more likely to have metastatic cancer. Compared with patients with no comorbidities, those with five or more comorbidities were four times more likely to be in the high-cost group (odds ratio, 4.08; 95% CI, 3.74 to 4.46). Patients with a greater number of procedures were also more likely to be in the high-cost group (odds ratio, 1.57; 95% CI, 1.52 to 1.61). CONCLUSION: High-cost cancer visits were five times more expensive than the remaining visits. Identification of high-cost visits and the associated factors may help provide tailored strategies to effectively manage costly inpatient admissions.

Association of dyspnea, mortality, and resource use in hospitalised patients

2021 ◽  
pp. 1902107
Author(s):  
Jennifer P. Stevens ◽  
Tenzin Dechen ◽  
Richard M. Schwartzstein ◽  
Carl O'Donnell ◽  
Kathy Baker ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admissions ◽  
Medical Center ◽  
Intensive Care Unit Discharge ◽  
Academic Medical Center ◽  
Severity Of Illness ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk

As many as 1 in 10 patients experience dyspnea at hospital admission but the relationship between dyspnea and patient outcomes is unknown. We sought to determine whether dyspnea on admission predicts outcomes.We conducted a retrospective cohort study in a single, academic medical center. We analysed 67 362 consecutive hospital admissions with available data on dyspnea, pain, and outcomes. As part of the Initial Patient Assessment by nurses, patients rated “breathing discomfort” using a 0 to 10 scale, (10=“unbearable”). Patients reported dyspnea at the time of admission and recalled dyspnea experienced in the 24 h prior to admission. Outcomes included in-hospital mortality, 2-year mortality, length of stay, need for rapid response system activation, transfer to the intensive care unit, discharge to extended care, and 7- and 30-day all cause readmission to the same institution.Patients who reported any dyspnea were at an increased risk of death during that hospital stay; the greater the dyspnea, the greater the risk of death (dyspnea=0, 0.8% in-hospital mortality; dyspnea=1–3, 2.5% mortality; dyspnea ≥4, 3.7% mortality, p<0.001). After adjustment for patient comorbidities, demographics, and severity of illness, increasing dyspnea remained associated with inpatient mortality (dyspnea 1–3, aOR 2.1, 95% CI 1.7–2.6; dyspnea ≥4, aOR 3.1, 95% CI 2.4–3.9). Pain did not predict increased mortality. Patients reporting dyspnea also used more hospital resources, were more likely to be readmitted, and were at increased risk of death within 2 years (dyspnea=1–3 adjusted HR 1.5, 95% CI 1.3–1.6; dyspnea ≥4 adjusted HR 1.7, 95% CI 1.5–1.8).We found that dyspnea of any rating was associated with an increased risk of death. Dyspnea can be rapidly collected by nursing staff, which may allow for better monitoring or interventions that could reduce mortality and morbidity.

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