Burden Of Health Care Costs Research Articles

Achieving Healthcare Value through Care Plan Accountability

U.S. medical costs continue to outpace the GDP despite the introduction of multiple accountable care efforts established to reduce unnecessary expenditures. These increasing costs have a negative impact on patients who are experiencing increased out-of-pocket expenses as well as employers who must shoulder a large part of the healthcare cost burden. While there are multiple societal factors contributing to the rising medical costs, our healthcare system can play a more effective role in addressing this problem. This role begins with fundamental changes to our reimbursement systems placing an emphasis on individual plans of care and adding greater accountability through free market controls. A comprehensive plan of care lays out the roles of care plan participants across medical, social, and behavioral services with a corresponding budget covering all the services provided as well as the expected outcomes from each service. An initial free market control is patient authority to accept or reject the plan of care with a corresponding financial responsibility for compliance in care plan execution. The elements of provider accountability include a public provider performance reporting system across quality, costs and patient satisfaction factors as well as a reimbursement system that incentivizes effective care planning and execution. This shift in focus from incremental care to care planning and execution combined with the institution of pro-competitive and financial accountability measures is expected to bring greater value to healthcare by improving patient outcomes while reducing medical costs.

Trends in syncope testing and admissions in the USA from 2006 through 2019.

Syncope is common, with bimodal distribution through life, peaking in adolescence and in the elderly, and overall increases in incidence with age among both men and women. In this context, syncope-related visits to emergency departments (ED), hospitalizations, and testing are a significant healthcare cost burden. Ultimately, understanding the volume of testing types and settings of syncope encounters may aid in more effective healthcare utilization and high value care for this patient population. Data for this study were collected from the Truven Health Analytics MarketScan Database from 2006 to 2019. This database contains both commercially insured patients and those with Medicare coverage. Patients with the diagnosis of syncope were identified using International Classification of Diseases (ICD)-9 and -10 codes. We assessed the incidence of various tests for syncope evaluation and ED disposition for the study period. The incidence of syncope among the study cohort rose from nine per 1000 patients to 13 per 1000 patients during the study period. The incidence of testing for syncope among multiple domains (neurologic, cardiac, blood testing) decreased in some categories, but routine testing remained prevalent. Women had a significantly lower incidence of testing in most testing domains. Discharge rate from the ED for patients presenting with syncope remained stable during the study period. However, admission rate to the hospital for those aged > 65 years increased during the study time. Testing and admissions for syncope remain prevalent and are drivers of healthcare-associated costs. There is a clear need for further work in developing a focused approach in the evaluation of syncope patients in order to mitigate healthcare costs and improve outcomes.

Economic Analysis of Catheter-Directed Thrombolysis for Intermediate-Risk Pulmonary Embolism.

Pulmonary embolism is associated with a significant burden of morbidity, mortality, and health care costs. Catheter-directed thrombolysis has emerged as a promising option for patients with intermediate-risk pulmonary embolism which aims to improve outcomes over standard anticoagulation. We constructed a decision-analytic model comparing the cost-effectiveness of catheter-directed thrombolysis to anticoagulation alone for the management of intermediate-risk pulmonary embolism. Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios (ICER). Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. The main outcome was ICER (US dollars/deaths averted). In the base case analysis, derived using systemic lysis data, the cost associated with catheter-directed thrombolysis was estimated at $22,353 with a probability of survival at 1 month of 0.984. For the anticoagulation alone strategy, the cost was $25,060, and the probability of survival at 1 month was 0.958. Overall, catheter-directed thrombolysis resulted in savings of $104,089 per death averted (ICER,-$104,089 per death averted). Sensitivity analysis revealed that catheter-directed thrombolysis would no longer be cost-effective when its associated mortality is greater than 0.042. In the probabilistic analysis, at a willingness-to-pay of $100,000, catheter-directed thrombolysis had a 63% chance of being cost-effective, and in cost-effectiveness acceptability curves, it was cost-effective in 63%-78% of simulations for a willingness to pay ranging from $0 to $100,000. If the assumptions made in our model are shown to be accurate then CDT would be cost-effective and may lead to considerable cost savings if used where clinically appropriate.

Recommendations for fast-track extubation in adult cardiac surgery patients: a consensus statement.

Enhanced recovery after cardiac surgery in selected low-risk patients, has the potential to improve outcomes and reduce the burden of healthcare costs. Anesthesia-related challenges play a major role in the successful implementation of Enhanced Recovery After Surgery (ERAS) protocols, with particular emphasis placed on fast-track extubation. Acknowledging the importance of this practice, the Italian Association of Cardiac Anesthesiologists and Intensive Care (ITACTAIC) has advocated for an initiative to establish a consensus offering practical recommendations for fast-track extubation after adult cardiac surgery. After conducting a systematic review, all randomised control trials (RCTs) published between 2013 and 2023 were meticulously selected and analysed during a consensus meeting that involved statement voting. Out of the 2268 publications identified using the search string, 60 RCTs were selected and classified into six groups, each evaluating specific interventions associated with extubation within 6 hours post-surgery. The authors examined 20 RCTs pertaining to loco-regional anesthesia, 19 analysing elements of general anesthesia, 12 focused on surgery-related aspects and techniques, three examining ventilation, two exploring anesthesia depth monitoring, and four addressing miscellaneous aspects. The expert panel approved 16 statements with 15 achieving high agreement and one obtaining moderate agreement. Finally a total of eight interventions were considered associated with fast-track extubation: parasternal block, erector spinae plane block, alpha agonist in the operating room (OR), opioids in the OR, dexmedetomidine in the intensive care unit (ICU), minimal invasive surgical access, anesthesia depth monitoring, adaptative support ventilation. In the first consensus document ever published by a scientific society addressing practical recommendations for fast-track extubation post-cardiac surgery, the authors identified sixteen interventions commonly associated with fast-track extubation in selected adult cardiac surgery patients.

Healthcare Costs in the United States by Demographic Characteristics and Comorbidity Status

ObjectivesCurrent, real-world healthcare cost information is needed to project future expenditures and inform policy. We estimated the healthcare costs for adults in 2019 in the United States by age, sex, race/ethnicity, geographic region, and comorbidity. MethodsWe aggregated and summarized the healthcare costs in 2021 US dollars using claims data derived from Optum’s deidentified Clinformatics® Data Mart Database, which includes inpatient, outpatient, and prescription claims for commercial and Medicare Advantage beneficiaries nationwide. ResultsA total of 9 227 901 adults were included in the analysis. The largest group represented was 71 to 75 years old (13%), female (53%), White (68%), received care in the South (41%), and had commercial health insurance (56%). There was a positive relationship between healthcare cost and age. Females had a 1.3-fold multiplicative increase in costs than males (95% CI 1.33–1.34). There were 92.5% of individuals who had health claims in the Northeast, 89.6% in the Midwest, 88.9% in the South, 77.1% in the West, and 12.7% with unknown geographic region. Patients with severe renal failure, heart failure, or metastatic cancer incurred the highest mean yearly costs ($139 844, $113 031, and $85 299, respectively). Metastatic cancer and severe renal failure were associated with a 5.3-fold multiplicative increase in costs than not having these conditions, after adjusting for potential confounders (95% CI 5.26–5.41 and 4.98–5.16, respectively). ConclusionsWe identified patient characteristics and medical conditions that are associated with high healthcare cost burden and could benefit from tailored interventions. We provided detailed cost estimates to aid healthcare modeling, cost projection, and cost-minimizing interventions.

Increasing venture capital investment in spinal surgery: an analysis of investments from 2000 to 2023

BACKGROUND CONTEXTVenture capital (VC) plays a vital role in advancing spinal surgery technologies, driven by the growing burden of spinal disorders and high healthcare costs. Despite increasing interest, trends in VC funding for spinal surgery remain understudied. PURPOSEThis study aimed to examine temporal and thematic trends in VC investments in spinal surgery companies from 2000 to 2023. STUDY DESIGN/SETTINGA retrospective cross-sectional study analyzing VC investment trends in privately held US-based spinal surgery companies. METHODSUsing the PitchBook database, we analyzed 1001 VC investments in 227 spinal surgery companies between 2000 and 2023. Investments were categorized into surgical devices, noninvasive devices, biotechnology, surgical software, and clinical services. Total and annual investments were quantified in USD. RESULTSFrom 2000 to 2023, $5.37 billion was invested in spine surgery, with nonsurgical devices receiving the largest share (42.6%), followed by surgical devices (26.3%) and biotechnology (22.2%). Annual investment increased by 1782%, with a decline in 2023 likely due to macroeconomic factors. CONCLUSIONSVC funding in spinal surgery has grown significantly, especially in noninvasive technologies. Further research is needed to assess the long-term impact of these investments and explore alternative financing models.

Role of FIRE-MADE FI for diagnosing frailty in central rural India and its comparison with LASA FI.

An aging population ultimately has deprived physiological stores making them vulnerable for development of a syndrome called frailty, which presents with a cumulative decrease in tolerance, immunity, vision, balance, organ functions, health, and independent living. All these result in rising prevalence of frailty and its components, along with burden of disease, dependence, and health care cost. Thus, early estimation and assessment and interventions to correct it mark the mile stone in geriatric medicine. The present study was conducted with an aim to compare and correlate FIRE-MADE (Frailty Index in Rural Elderly - Mental status, Activities of daily living, Depression, and Events) FI (frailty index) with LASA (Longitudinal Aging Study Amsterdam) FI in central rural India's geriatric population. A cross-sectional study for assessment of frailty in the geriatric population of central rural India, reporting to the medicine department of a tertiary hospital, situated at Wardha district, by using FIRE-MADE and LASA FI was undertaken. Their scores were compared. The efficiency of FIRE-MADE FI in comparison with LASA FI was calculated. A frailty threshold of ≥ 0.25 is considered for diagnosing frailty. Standard descriptive and inferential statistics were used to evaluate all parametric and non-parametric data. Out of 250 geriatric people, 224 (89.6%) were frail according to LASA FI and 204 (81.6%) were frail according to FIRE-MADE FI. As compared to LASA FI, FIRE-MADE FI was 91.07% sensitive and 73.08% specific, with a positive predictive value of 96.68% and a diagnostic accuracy of 89.20%. The Indian rural population of central India has high prevalence of frailty. FIRE-MADE FI can be used as a potential, effective, and validated tool for early diagnosing and management of frailty. Among the parameters of FIRE-MADE FI, IHD was the most important contributing factor for development of frailty, followed by cognitive impairment, polypharmacy, and remaining factors mentioned in FIRE-MADE FI.

Healthcare resource use and costs associated with the misdiagnosis of migraine.

To compare healthcare resource utilization and healthcare costs in patients with migraine with or without a history of misdiagnosis. Despite the high prevalence of migraine, migraine is commonly misdiagnosed. The healthcare resource use and cost burden of a misdiagnosis is unknown. This retrospective cohort study identified adults with an incident migraine diagnosis from the Merative™ Marketscan® Commercial and Medicare Supplemental Databases between June 2018 and 2019. Patients with a diagnosis of commonly considered misdiagnoses (headache, sinusitis, or cervical pain) before their migraine diagnosis were classified as the "misdiagnosed cohort." Patients in the misdiagnosed cohort were potentially misdiagnosed, then eventually received a correct diagnosis. Patients without a history of commonly considered misdiagnoses prior to their migraine diagnosis were classified as the "correctly diagnosed cohort." Healthcare resource utilization and healthcare costs were assessed in the period before migraine diagnosis and compared between the cohorts. Outcomes were reported as per patient per month and compared with incidence rate ratios. A total of 29,147 patients comprised the correctly diagnosed cohort and 3841 patients comprised the misdiagnosed cohort and met the inclusion criteria. Patients in the misdiagnosed cohort had statistically significantly higher rates of inpatient admissions (0.02 vs. 0.01, incidence rate ratio [IRR] 1.61, 95% confidence interval [CI] 1.47-1.74), emergency department visits (0.10 vs. 0.05; IRR 1.89, 95% CI 1.79-1.99), neurologist visits (0.12 vs. 0.02; IRR 5.95, 95% CI 5.40-6.57), non-neurologist outpatient visits (2.64 vs. 1.58; IRR 1.67, 95% CI 1.62-1.72) and prescription fills (2.82 vs. 1.84; IRR 1.53, 95% CI 1.48-1.58) compared to correctly diagnosed patients. Misdiagnosed patients had statistically significantly higher rates of healthcare cost accrual for inpatient admissions ($1362 vs. $518; IRR 2.62, 95% CI 2.50-2.75), emergency department visits ($222 vs. $98; IRR 2.27, 95% CI 2.18-2.36), neurologist visits ($42 vs. $9; IRR 4.39, 95% CI 4.00-4.79), non-neurologist outpatient visits ($1327 vs. $641; IRR 2.07, 95% CI 1.91-2.24), and prescription fills ($305 vs. $215; IRR 1.41, 95% CI 1.18-1.70) compared to correctly diagnosed patients. Patients with migraine who have a history of misdiagnoses have higher rates of healthcare resource utilization and cost accrual versus those without such history.

The Burden of Health Care Utilization, Cost, and Mortality Associated with Select Surgical Site Infections

ObjectiveThis study assessed the additional healthcare utilization, cost, and mortality resulting from three surgical site infections (SSIs): mediastinitis/SSI after coronary artery bypass graft, SSI after bariatric surgery for obesity, and SSI after certain orthopedic procedures. MethodsThis retrospective observational cohort study used commercial and Medicare Advantage claims from 2016 to 2021. Patients with one of three SSIs were compared to a 1:1 propensity score-matched group of patients with the same surgeries but without SSI on outcomes up to one year post-discharge. ResultsThe total sample size was 4,620. Compared to their matched cohorts, the three SSI cohorts had longer mean index inpatient length of stay (LOS; adjusted days difference ranged from 1.73 to 6.27 days; all p < 0.001) and higher 30-day readmission rates (adjusted odds ratio ranged from 2.8 to 25.1; all p ≤ 0.001). The SSI cohort for orthopedic procedures had higher 12-month mortality (hazard ratio of 1.6; p = 0.01), though other cohorts did not have significant differences. Total medical costs were higher in all three SSI versus matched comparison cohorts for the index episode and six months and one year post-discharge. Average adjusted one-year total medical cost differences ranged from $40,606 to $68,101 per person, depending on the cohort (p < 0.001), with out-of-pocket cost differences ranging from $330 to $860 (p < 0.05). ConclusionPatients with SSIs experienced higher LOS, readmission rates, total medical costs, and higher mortality for some populations compared to their matched comparison cohorts during the first year post-discharge. Identifying strategies to reduce SSIs is important both for patient outcomes and affordability of care.

An interdisciplinary examination of a gunshot detection system: The public health context of a policing technology

Gun violence is a unique, preventable problem that contributes to a significant burden of healthcare and social costs, disability, and death in the United States. To address gun violence, several surveillance technologies have been implemented in municipalities across the US which are facilitating the collection of large amounts of data with the aim of reducing the occurrence of gun violence and responding to such incidences more quickly. One tool is ShotSpotter®, a popular acoustic gunshot detection system deployed by police departments. There are, however, research gaps about the concerns of using this technology and, to our knowledge, very little discussion about the implications and its effect on vulnerable groups exists. Accordingly, in this article, we argue against the use of technologies such as ShotSpotter as current data show inconsistent results in reducing violence. We also suggest the potential for harm from such surveillance technology should be cautiously weighed, as it could exceed the benefits of using such technology, thereby warranting further examination and research.

Renoprotective Effect of Febuxostat on Contrast Induced Acute Kidney Injury in Chronic Kidney Disease Patients Stage 3. Randomized Controlled Trial

Abstract Introduction Contrast induced acute kidney injury (CI-AKI) is known to be a complication of using intravascular contrast injection. Unfortunately, It is associated with adverse outcomes as prolonged length of hospitalization and increased burden of health care costs. So, we aimed to determine the efficacy of febuxostat in prevention of contrast induced acute kidney injury among patients with chronic kidney disease Stage 3 performing percutaneous coronary intervention (PCI). Methods In a randomized controlled trial we enrolled 120 CKD stage 3 Patients with acute coronary syndrome referred to the cardiology department Ain-Shams University hospital for performing PCI and stenting. Patients were randomly assigned to two arms: Group I (study group): Included 60 patients who received Febuxostat added to the traditional treatment (IV hydration and N-acetylcysteine). The patients received Feburic 80 mg within 6- 18 hours before and within 6-18 hours after the coronary intervention (a time gap of 24 hours between two doses).Group II (control group): included 60 patients who received only traditional treatment. Results The incidence of AKI was higher in the control group with a statistically significant difference. We found that Independent Significant risk factors that led to AKI were febuxostate avoidance, DM, high urea level, high creatinine level, CKD stage 3B, high Mehran score and high AKI risk. Conclusion We demonstrated that febuxostat has a renoprotective effect and it can help to reduce the incidence CI-AKI in CKD patients stage 3 performing PCI.

Health technology assessment implementation in WHO South-East Asia Region: a realist review protocol.

A robust Health Technology Assessment (HTA) framework is crucial to address the rising burden of healthcare costs and to inform decision-making to promote high-quality health systems. This research aims to describe the HTA methods and mechanisms for the successful implementation of HTA in the WHO South-East Asia region, and contextualize the synthesized evidence relevant to Indian settings. Realist review involves developing a program theory by conducting a systematic search strategy, screening, study selection, data extraction, and data synthesis. A systematic search for literature will be conducted on PubMed (NCBI), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate), and ProQuest Central for identifying the methods used for HTA of health technology interventions. Stakeholder consultations will be conducted to develop a program theory following the Context-Mechanism-Outcome configurations (CMOcs) framework. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. The proposed realist review will be reported as per the Realist and MEta-narrative Evidence Syntheses: Evolving Standards [RAMESES II] guidelines. To our knowledge, there has been no comprehensive review conducted to understand the mechanisms of HTA methods in the WHO South-East Asia region. The findings from the realist review will help us understand the mechanisms through which the HTA could work in WHO South-East Asian countries. We will then contextualize the findings obtained from evidence to Indian settings, based on program theory development through stakeholder consultation. A framework will be developed that can be used by policymakers/HTA experts in India for effective implementation of the same.

Volatile vs Total intravenous Anaesthesia for major non-cardiac surgery: a pragmatic randomised triaL (VITAL)

BackgroundImproving outcomes after surgery is a major public health research priority for patients, clinicians and the NHS. The greatest burden of perioperative complications, mortality and healthcare costs lies amongst the population of patients aged over 50 years who undergo major non-cardiac surgery. The Volatile vs Total Intravenous Anaesthesia for major non-cardiac surgery (VITAL) trial specifically examines the effect of anaesthetic technique on key patient outcomes: quality of recovery after surgery (quality of recovery after anaesthesia, patient satisfaction and major post-operative complications), survival and patient safety.MethodsA multi-centre pragmatic efficient randomised trial with health economic evaluation comparing total intravenous anaesthesia with volatile-based anaesthesia in adults (aged 50 and over) undergoing elective major non-cardiac surgery under general anaesthesia.DiscussionGiven the very large number of patients exposed to general anaesthesia every year, even small differences in outcome between the two techniques could result in substantial excess harm. Results from the VITAL trial will ensure patients can benefit from the very safest anaesthesia care, promoting an early return home, reducing healthcare costs and maximising the health benefits of surgical treatments.Trial registrationISRCTN62903453. September 09, 2021.

“A great feeling to know that there’s somebody interested in improving your life”: Experiences of a blended falls prevention programme

BACKGROUND: Falls have a detrimental effect on Ireland’s ageing population and result in a significant personal and healthcare cost burden. Evidence-based falls prevention programmes reduce the harmful effects of falls. The Covid-19 pandemic disrupted in-person programme delivery and necessitated a shift to telerehabilitation. The feasibility and acceptability of falls prevention telerehabilitation needs further investigation. OBJECTIVE: The objective of this study was to explore the opinions of participants and physiotherapists about a falls prevention telerehabilitation programme, and identify key barriers and facilitators to improve the quality of future similar programmes. METHODS: A qualitative study design was used, 13 semi-structured one-to-one telephone interviews (n = 11 participants, n = 2 physiotherapists) were performed. Data were coded and thematic analysed. RESULTS: Four inter-related themes were identified: technical considerations for change in mode of programme delivery to online and blended; facilitators and barriers for effective delivery of the online and blended programmes; factors promoting programme engagement and progress; significance of supportive interpersonal relationships. CONCLUSIONS: Participants and physiotherapists reported improvements in strength, balance and confidence, and willingness to continue the exercises long-term. Telerehabilitation had some advantages over in-person including flexibility and convenience; however, these gains must be considered against the drawbacks of less social interaction and group cohesion. Key insights identified regarding satisfaction with the technology, format and delivery can be used to improve the quality of future online and blended programmes.

EE502 Healthcare Resource Utilization and Cost Burden in Patients with Primary Biliary Cholangitis

EE502 Healthcare Resource Utilization and Cost Burden in Patients with Primary Biliary Cholangitis

Characteristics of late preterm infant readmissions: A systematic review.

Prematurity represents a critical health disparity. It is important to note that late preterm (LPT) infants comprise the majority of preterm births, yet they are the least studied within the premature population. Evidence-based practice guidelines are now a decade old, indicating the potential need for review and revision. This systematic review proposed the assessment of sociodemographic characteristics of LPT infants, clinical practice standards, and associated hospital readmission rates, mortality, and morbidity to determine the need for revision of evidence-based practice guidelines for these infants. The Preferred Reporting System Items for Systematic Reviews and Meta Analysis methodology provided the framework for the completion of this review. Literature searches of PubMed/Medline (Ovid), Web of Science, Cumulative Index of Nursing, and Allied Health Literature Plus databases and citation searches included articles published after 2012 using the search terms "late preterm infants," "readmissions," and "readmission rates." The literature search identified 11 studies meeting search criteria. These studies included quasi experimental, retrospective, and prospective cohort studies. These studies highlighted the characteristics of LPT infants that potentially contribute to increased readmission rates, morbidity and mortality rates, health care costs, and long-term health inequities. Overall findings indicate the need for review and revision of evidence-based practice guidelines for these infants. This systematic review manifests the vulnerability of LPT infants and the accompanying need for up-to-date clinical practice guidelines to effectively reduce their morbidity and mortality rates, hospital readmissions rates, and burden of health care costs.

A two-decade trend analysis of in-hospital outcomes and racial/ethnic disparities among hospitalized patients with lung cancer in the United States.

11035 Background: Previous research has focused largely on the disease and healthcare cost burden of lung cancer (LC),however, long-term trends of hospitalizations among LC patients (pts) in the US are limited. We aimed to describe longitudinal trends in in-hospital outcomes among hospitalized LC pts, overall and by race/ethnicity. Methods: We analyzed data from the National Inpatient Sample database, spanning 1998 to 2020. The study cohort included pts aged ≥18 years with a principal LC diagnosis. We assessed four in-hospital outcomes: 1) hospitalization, 2) mortality, 3) length of stay (LOS), and 4) total hospitalization charges (THCs). THCs were adjusted for inflation using the Medicare Hospital Care Consumer Price Index.To quantify trends, we performed weighted analyses (weighted means or proportions) and calculated P-trend using Cochran-Armitage or Jonckheere-Terpstra tests. Results: Of 791,100 pts (mean age 68.2 years), 80.4% were White, followed by 11.9% Black, 4.7% Hispanic, and 3.0% Asian or Pacific Islander (API). Among US hospitalized pts in 1998, 0.54% had a principal LC diagnosis, with hospitalization rates having decreased to 0.37% in 2020 ( P-trend&lt;.001). By race/ethnicity, the LC hospitalization rate for White pts declined from 0.53% in 1998 to 0.39% in 2020; for Black pts, it declined from 0.35% to 0.26%; and for Hispanic pts, it declined from 0.18% to 0.12% (all P-trend&lt;.001). In contrast, the hospitalization rate for API pts increased from 0.30% in 1998 to 0.38% in 2020 ( P-trend&lt;.001). The overall LC-specific in-hospital mortality rate declined drastically from 15.9% in 1998 to 6.2% in 2020 ( P-trend&lt;.001); a similar pattern was observed across racial/ethnic groups. The LOS reduced from an average of 7.9 days in 1998 to 5.9 days in 2020 ( P-trend&lt;.001). By race/ethnicity, the LOS for White pts decreased from 7.8 days in 1998 to 5.2 days in 2020; for Black pts, it decreased from 9.0 to 7.0 days; for Hispanic pts, it decreased from 8.8 to 6.7 days; and it declined from 8.7 to 5.9 days in API pts (all P-trend&lt;.001). THCs rose significantly from $39,706 in 1998 to $92,734 in 2020 ( P-trend&lt;.001). In White pts, THCs rose from $39782 to $89,681; from $41,235 to $91,792 in Black pts; from $49,444 to $119,386 in Hispanic pts; and from $52,779 to $112,365 in API pts (all P-trend&lt;.001). Moreover, the odds of female pts hospitalized with LC was higher (AOR=1.47, 95% CI=1.40-1.54, P&lt;.001) in 2020 compared to 1998. Conclusions: In this racially diverse hospitalized LC cohort, LOS, rates of hospitalizations, and mortality rates have declined, while THCs have risen significantly, over the last 20 years. API and female pts bore a heavier burden of hospitalizations. Our findings suggest the need for targeted healthcare interventions or policies to reduce THCs and hospitalization disparities in LC pts.

Antibiotic resistance and plasmid profile of bacteria associated with nosocomial infections: A case study of Ekiti -State Teaching Hospital

Many serious health problems resulting in an enormous burden of morbidity and high health care costs are traceable to infections caused by the nosocomial pathogens; major victims are relatives of patients, the care givers who are doing their legal duties and at times the patients whose conditions could be complicated. The causative organisms of these infections and their sensitivity to antibiotics need to be ascertained. This study investigated the antibiotic sensitivity and plasmid profile of bacteria associated with nosocomial infections. A total of 45 samples were collected from children, male and female surgical wards in Ekiti State Teaching Hospital, Ado-Ekiti by using swab sticks and settling plates method. Isolation of bacteria, antibiotic sensitivity and plasmid profiling of the isolates were carried out using standard microbiological methods. The results showed that a total of 56 bacterial isolates were obtained from the 3 different wards, this includes Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Lactobacillus fermenti, Bacillus subtilis, Bacillus cereus and Micrococcus luteus. Staphylococcus aureus had the highest frequency of occurrence with 30(53.6%), followed by Staphylococcus epidermidis 10(17.7%), Escherichia coli 7(12.5%), Lactobacillus fermentii and Micrococcus luteus 3(5.4%) and Bacillus subtilis 2(3.6%) respectively, while Bacillus cereus 1(1.8%) had the least frequency of occurrence. The gram positive isolates were more resistant to the antibiotics compare to the gram negative isolates, Staphylococcus aureus was the most resistant of all the isolates followed by Staphylococcus epidermidis, the five representative resistant isolates harbored plasmid of different sizes. The findings of this study suggests that patients, care givers and visitors to the hospital should maintain good personal hygiene and proper sanitary measures to avoid nosocomial infections, therefore, surveillance of nosocomial pathogens is important to reduce hospital stay, cost, morbidity and mortality rate.

Advanced chronic kidney disease increases complications in anterior cervical discectomies with fusions: An analysis of 75,508 patients

BackgroundAlthough anterior cervical discectomy and fusion (ACDF) procedures for cervical spine disease have been increasing amid a growing population of patients with kidney dysfunction, there is a scarcity of literature focusing on kidney dysfunction as a risk-factor for post-operative ACDF complications. The purpose is to evaluate the differential impact of kidney dysfunction on perioperative outcomes including surgical and medical complications, extended length of hospital stay (LOS), and death within 30 days following ACDF. Patient SampleThis was a retrospective cohort study of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program database to identify patients who had undergone an elective ACDF procedure between 2011-2021 using Current Procedural Terminology code 22551. Patients were categorized into five cohorts based on eGFR according to the “Kidney Disease: Improving Global Outcomes” Classification: values of: ≥ 90(reference cohort), 60-89 (G2), 30-59 (G3), 15-29 (G4), and <15 (G5). One-way ANOVA for continuous variables and chi-square tests for categorical variables were used to identify differences in perioperative variables between the five groups. Multivariable logistic regression analysis assessed the effect of kidney dysfunction on post-operative surgical outcomes. Significance was defined as p <0.05. Results75,508 ACDF patients were included, of who 57,480 were G1, 15,186 were G2, 2,192 were G3, 312 were G4, and 338 were G5. G4 and G5 independently increased the risk of medical complications (OR: 1.893, 95% CI [1.296-2.705]; OR: 2.241, 95% CI [1.222-3.964]) and blood transfusion. Only G5 independently increased the risk for extended LOS (OR: 2.410, 95% CI [1.281-4.371], p= 0.005). ConclusionHigh grade CKD is an independent risk factor for medical complications, extended hospital LOS, and blood transfusions following ACDF, underscoring the importance of risk stratification to optimize perioperative management and reduce the burden of complications and healthcare costs. Conversely, low grade CKD does not increase the risk of complications in ACDF.

BPI24-019: Estimation of Impact of Care Gap on Patient Outcome and Health Care Cost Burden Using Real World Data in Early-Stage NSCLC-An Empirical Study for Delay in Surgery.

BPI24-019: Estimation of Impact of Care Gap on Patient Outcome and Health Care Cost Burden Using Real World Data in Early-Stage NSCLC-An Empirical Study for Delay in Surgery.