scholarly journals Length of Stay, Hospital Costs and Mortality Associated With Comorbidity According to the Charlson Comorbidity Index in Immobile Patients After Ischemic Stroke in China: A National Study

2021 ◽  
Author(s):  
Hongpeng Liu ◽  
Baoyun Song ◽  
Jingfen Jin ◽  
Yilan Liu ◽  
Xianxiu Wen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Charlson Comorbidity Index ◽  
Hospital Costs ◽  
National Study ◽  
Comorbidity Index ◽  
Stay Hospital

Hospital Costs and Severity of Illness in Three Types of Elective Surgery

1997 ◽  
Vol 86 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Alex Macario ◽  
Terry S. Vitez ◽  
Brian Dunn ◽  
Tom McDonald ◽  
Byron Brown
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Operating Room ◽  
Knee Replacement ◽  
Charlson Comorbidity Index ◽  
Elective Surgery ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Total Hospital ◽  
Comorbidity Index

Background If patients who are more severely ill have greater hospital costs for surgery, then health-care reimbursements need to be adjusted appropriately so that providers caring for more seriously ill patients are not penalized for incurring higher costs. The authors' goal for this study was to determine if severity of illness, as measured by either the American Society of Anesthesiologists Physical Status (ASA PS) or the comorbidity index developed by Charlson, can predict anesthesia costs, operating room costs, total hospital costs, or length of stay for elective surgery. Methods The authors randomly selected 224 inpatients (60% sampling fraction) having either colectomy (n = 30), total knee replacement (n = 100), or laparoscopic cholecystectomy (n = 94) from September 1993 to September 1994. For each surgical procedure, backward-elimination multiple regression was used to build models to predict (1) total hospital costs, (2) operating room costs, (3) anesthesia costs, and (4) length of stay. Explanatory candidate variables included patient age (years), sex, ASA PS, Charlson comorbidity index (which weighs the number and seriousness of coexisting diseases), and type of insurance (Medicare/Medicaid, managed care, or indemnity). These analyses were repeated for the pooled data of all 224 patients. Costs (not patient charges) were obtained from the hospital cost accounting software. Results Mean total hospital costs were $3,778 (95% confidence interval +/- 299) for laparoscopic cholecystectomy, $13,614 (95% CI +/- 3,019) for colectomy, and $18,788 (95% CI +/- 573) for knee replacement. The correlation (r) between ASA PS and Charlson comorbidity scores equaled 0.34 (P < .001). No consistent relation was found between hospital costs and either of the two severity-of-illness indices. The Charlson comorbidity index (but not the ASA PS) predicted hospital costs only for knee replacement (P = .003). The ASA PS, but not the Charlson index, predicted operating room and anesthesia costs only for colectomy (P < .03). Conclusions Severity of illness, as categorized by ASA PS categories 1-3 or by the Charlson comorbidity index, was not a consistent predictor of hospital costs and lengths of stay for three types of elective surgery. Hospital resources for these lower-risk elective procedures may be expended primarily to manage the consequences of the surgical disease, rather than to manage the patient's coexisting diseases.

scholarly journals Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay, Costs and Mortality among Older Adults Hospitalised for Acute Stroke

2018 ◽  
Vol 15 (11) ◽  
pp. 2532 ◽  
Author(s):  
Richard Ofori-Asenso ◽  
Ella Zomer ◽  
Ken Chin ◽  
Si Si ◽  
Peter Markey ◽  
...  
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Acute Stroke ◽  
Charlson Comorbidity Index ◽  
Negative Binomial ◽  
Cox Regression ◽  
Negative Binomial Regression ◽  
Tertiary Hospital ◽  
Hospital Death ◽  
Comorbidity Index

The burden of comorbidity among stroke patients is high. The aim of this study was to examine the effect of comorbidity on the length of stay (LOS), costs, and mortality among older adults hospitalised for acute stroke. Among 776 older adults (mean age 80.1 ± 8.3 years; 46.7% female) hospitalised for acute stroke during July 2013 to December 2015 at a tertiary hospital in Melbourne, Australia, we collected data on LOS, costs, and discharge outcomes. Comorbidity was assessed via the Charlson Comorbidity Index (CCI), where a CCI score of 0–1 was considered low and a CCI ≥ 2 was high. Negative binomial regression and quantile regression were applied to examine the association between CCI and LOS and cost, respectively. Survival was evaluated with the Kaplan–Meier and Cox regression analyses. The median LOS was 1.1 days longer for patients with high CCI than for those with low CCI. In-hospital mortality rate was 18.2% (22.1% for high CCI versus 11.8% for low CCI, p < 0.0001). After controlling for confounders, high CCI was associated with longer LOS (incidence rate ratio [IRR]; 1.35, p < 0.0001) and increased likelihood of in-hospital death (hazard ratio [HR]; 1.91, p = 0.003). The adjusted median, 25th, and 75th percentile costs were AUD$2483 (26.1%), AUD$1446 (28.1%), and AUD$3140 (27.9%) higher for patients with high CCI than for those with low CCI. Among older adults hospitalised for acute stroke, higher global comorbidity (CCI ≥ 2) was associated adverse clinical outcomes. Measures to better manage comorbidities should be considered as part of wider strategies towards mitigating the social and economic impacts of stroke.

Abstract 246: Length of Stay and Its Association With Get With the Guidelines-stroke Award Recognition

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Theresa Hamm ◽  
Angela Overton ◽  
Kathie Thomas ◽  
Renee Sednew
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Average Length ◽  
Hospital Costs ◽  
Stroke Patients ◽  
Improvement Program ◽  
Recommended Care ◽  
Award Winning ◽  
Significant Difference ◽  
Get With The Guidelines

Background and Objectives: The average length of stay (ALOS) provides important information regarding care efficiency and the financing of hospitals. A shorter ALOS helps to reduce hospital costs, increase capacity optimization, and improve hospital efficiency. A longer ALOS can be associated with reduced readmission rates and mortality rates. The objective of this study was to analyze the ALOS for stroke patients based on etiology subtype and Get With The Guidelines (GWTG)-Stroke award recognition. Methods: A retrospective review of the ALOS for hemorrhagic and ischemic stroke patients was conducted for the states of Illinois, Iowa, and Michigan from 99 hospitals using GWTG-Stroke from July 2014 through December 2015. Stroke subsets, GWTG award status, and ALOS were examined. Results: The national ALOS is 5.22 days for ischemic stroke, 12.75 days for subarachnoid hemorrhage (SAH), and 8.5 days for intracerebral hemorrhage (ICH). The ALOS for ischemic stroke was 4.36 days for non-award winning hospitals and 4.52 days for award winning hospitals. The ALOS for SAH was 7.51 days for non-award winning hospitals and 10.77 days for award winning hospitals. The ALOS for ICH was 18.63 days for non-award winning hospitals and 6.80 days for award winning hospitals. Further broken down, hospitals with a higher award (gold vs silver), had longer ALOS for both SAH and ICH (11.11 vs 8.72 and 7.07 vs 5.84 respectively), while there was no significant difference in ALOS for ischemic stroke. Conclusions: This study demonstrated that GWTG-Stroke award winning hospitals have a shorter ALOS for ICH and a higher ALOS for SAH than non-award winning hospitals. Those hospitals that have attained gold award status more closely align with national ALOS. Thus, hospitals that are more adherent to guideline recommended care via a quality improvement program may be more efficient when providing care, which impacts hospitals costs.

Abstract TP19: Charlson Comorbidity Index Predicts Mortality and Functional Outcome in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Daniela Samaniego ◽  
Maria Hernandez-Perez ◽  
Anna Planas ◽  
Lorena Martin ◽  
Laura Dorado ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Charlson Comorbidity Index ◽  
Mechanical Thrombectomy ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Arterial Revascularization ◽  
Comorbidity Index ◽  
High Comorbidity

Introduction: Despite mechanical thrombectomy has achieved a dramatic improvement on ischemic stroke prognosis, up to 50% of patients treated with this approach do not have good functional outcome. Besides age and baseline infarct core, comorbidity might play a role in stroke prognosis. We aim to study the capacity of Charlson comorbidity index (CCI) in predicting mortality and functional outcome in acute ischemic stroke patients who underwent mechanical thrombectomy. Methods: We studied 228 consecutive patients (59% male, mean age 65y) with acute anterior circulation arterial occlusion treated with stent retrievers between May 2009 and March 2015. Demographical data, stroke severity, ASPECTS score at baseline and medical conditions included in the CCI were collected and CCI score was calculated retrospectively. We considered low comorbidity if CCI score was <2 and high comorbidity if CCI score was ≥2. Complete arterial revascularization was defined as a TICI ≥2b on final angiographic run. Good functional outcome was defined as a modified Rankin score ≤2 at 90 days. Results: The CCI was 0 in 47% of patients, 1 in 23%, 2 in 15%, 3 in 10% and ≥4 in 5%. CCI of 2 or more was associated with poor functional outcome (70.6% vs 50%, p = 0.004) and mortality (33.8% vs. 11.7%, p <0.001) compared to patients with low CCI. In a logistic regression adjusted by stroke severity, age, ASPECTS score at baseline and arterial revascularization, high comorbidity remained as an independent predictor of poor outcome (OR 2.9; 95% CI 1.4-5.8) and mortality (OR 4.6, 95% CI 2.0-10.3). Conclusions: High comorbidity assessed by Charlson Comorbidity Index is associated with poor functional outcome and mortality in acute stroke patients treated with mechanical thrombectomy.

scholarly journals Developing an adapted Charlson comorbidity index for ischemic stroke outcome studies

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ruth E. Hall ◽  
Joan Porter ◽  
Hude Quan ◽  
Mathew J. Reeves
Keyword(s):  
Ischemic Stroke ◽  
Charlson Comorbidity Index ◽  
Cox Model ◽  
Comorbid Conditions ◽  
Stroke Registry ◽  
C Statistic ◽  
Hazard Ratios ◽  
Comorbidity Index ◽  
Cci Model ◽  
One Year

Abstract Background The Charlson comorbidity index (CCI) is commonly used to adjust for patient casemix. We reevaluated the CCI in an ischemic stroke (IS) cohort to determine whether the original seventeen comorbidities and their weights are relevant. Methods We identified an IS cohort (N = 6988) from the Ontario Stroke Registry (OSR) who were discharged from acute hospitals (N = 100) between April 1, 2012 and March 31, 2013. We used hospital discharge ICD-10-CA data to identify Charlson comorbidities. We developed a multivariable Cox model to predict one-year mortality retaining statistically significant (P < 0.05) comorbidities with hazard ratios ≥1.2. Hazard ratios were used to generate revised weights (1–6) for the comorbid conditions. The performance of the IS adapted Charlson comorbidity index (ISCCI) mortality model was compared to the original CCI using the c-statistic and continuous Net Reclassification Index (cNRI). Results Ten of the 17 Charlson comorbid conditions were retained in the ISCCI model and 7 had reassigned weights when compared to the original CCI model . The ISCCI model showed a small but significant increase in the c-statistic compared to the CCI for 30-day mortality (c-statistic 0.746 vs. 0.732, p = 0.009), but no significant increase in c-statistic for in-hospital or one-year mortality. There was also no improvement in the cNRI when the ISCCI model was compared to the CCI. Conclusions The ISCCI model had similar performance to the original CCI model. The key advantage of the ISCCI model is it includes seven fewer comorbidities and therefore easier to implement in situations where coded data is unavailable.

scholarly journals A systematic review and meta-analysis of the effects of clinical pathways on length of stay, hospital costs and patient outcomes

2008 ◽  
Vol 8 (1) ◽  
Author(s):  
Thomas Rotter ◽  
Joachim Kugler ◽  
Rainer Koch ◽  
Holger Gothe ◽  
Sabine Twork ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Clinical Pathways ◽  
Meta Analysis ◽  
Hospital Costs ◽  
Stay Hospital

Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

2015 ◽  
Vol 35 (1) ◽  
pp. 39-49 ◽  
Author(s):  
Ryan M. Rivosecchi ◽  
Pamela L. Smithburger ◽  
Susan Svec ◽  
Shauna Campbell ◽  
Sandra L. Kane-Gill
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Length Of Stay ◽  
Adverse Effects ◽  
Hospital Costs ◽  
Evidence Based ◽  
Inpatient Settings ◽  
Stay Hospital ◽  
Critical Care Patients

Development of delirium in critical care patients is associated with increased length of stay, hospital costs, and mortality. Delirium occurs across all inpatient settings, although critically ill patients who require mechanical ventilation are at the highest risk. Overall, evidence to support the use of antipsychotics to either prevent or treat delirium is lacking, and these medications can have adverse effects. The pain, agitation, and delirium guidelines of the American College of Critical Care Medicine provide the strongest level of recommendation for the use of nonpharmacological approaches to prevent delirium, but questions remain about which nonpharmacological interventions are beneficial.

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