Cost Database Research Articles

The authors provide an updated analysis of inpatient healthcare utilization, associated costs, and mortality trends for pediatric hydrocephalus in the US from 2006 to 2019. The goals were to describe patient, hospital, and hospitalization characteristics and determine factors associated with mortality. This cross-sectional study used 2006, 2009, 2012, 2016, and 2019 data from the Healthcare Cost and Utilization Project Kids' Inpatient Database, which collects nationally representative weighted data samples of pediatric hospital discharges. Admissions related to hydrocephalus were categorized as being associated with permanent cerebrospinal fluid (CSF) diversion (including CSF shunt management and endoscopic third ventriculostomy [ETV] with or without choroid plexus cauterization [CPC]) or unrelated to permanent CSF diversion. Each year, there were approximately 30,000-32,000 hydrocephalus-related admissions, resulting in 331,000-526,000 hospital days and US$3.4-5.0 billion charges, for pediatric patients. In 2019, hydrocephalus accounted for 0.5% of all pediatric hospital admissions, 1.4% of all pediatric hospital days, and 2.4% of all pediatric hospital charges in the US. The median (IQR) length of stay across all hydrocephalus-related admissions decreased from 4 (2-15) days in 2006 to 3 (2-9) days in 2019. CSF shunt-related admissions decreased from 11,111 in 2006 to 7959 in 2016; notably, admissions for CSF shunt malfunctions/revisions decreased over time (12,327 in 2006 to 5960 in 2019). In 2019, hospital stays were shorter (4.99 vs 6.69 days) and charges were lower (US$108 million vs US$128 million) in patients who underwent ETV or ETV+CPC compared to those who had initial shunt placement, respectively. However, these unadjusted differences likely reflect baseline patient selection rather than inherent procedural superiority. Patients admitted for periventricular-intraventricular hemorrhage of prematurity (pIVH) had longer hospital stays (p < 0.001) and higher mean costs than others. Compared with survivors, children who died were younger, had pIVH, had a birth-related admission, were self-paying, and were admitted to a nonchildren's hospital (p < 0.05). Pediatric hydrocephalus continues to pose a heavy burden in the US. Despite advancements in management, it remains associated with high costs, significant hospital utilization, and substantial morbidity and mortality. ETV admissions were associated with shorter hospital stays and lower costs, and pIVH was associated with particularly high resource utilization and markedly higher in-hospital mortality. Future efforts should focus on reducing mortality and improving care delivery for high-risk subgroups, particularly those with pIVH and birth-related etiologies.

Racial and/or Ethnic and Rural Disparities in Health Care Utilization Before Major Lower Extremity Amputation in Patients with Peripheral Artery Disease.

Retrospective cross-sectional study. We analyzed inpatient health care utilization, costs, and outcomes for pediatric neuromuscular scoliosis (NMS) in the US from 2003 to 2019. We describe hospitalization characteristics and identify predictors of perioperative complications. The Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) collects nationally representative weighted data samples of pediatric hospital discharges. We identified hospitalizations related to spinal fusion procedures for NMS in children from 2003, 2006, 2009, 2012, 2016, and 2019. Hospitalizations were categorized as surgical (initial spinal fusion, wound dehiscence, wound infection) and complication related (pneumonia, urinary tract infection, paralytic ileus, respiratory failure). Weighted national estimates of admissions, inflation-adjusted charges (2019 USD), length of stay (LOS), and hospital days were calculated. Survey-weighted logistic regression identified independent predictors of perioperative complications. Admissions for NMS rose >30-fold from 235 in 2006 to 7,242 in 2019. Total charges increased from $22 million to $1.31 billion, and the mean charge per hospitalization increased from $99,700 to $182,100. Hospital days increased from 1,942 to 58,528, and median LOS remained consistent at 8 days. In 2019, NMS accounted for 0.1% of pediatric admissions, 0.25% of hospital days, and 0.6% of hospital charges in the US. Surgical wound complications were <0.5% of encounters but incurred mean charges exceeding $456,000 and median LOS of 30 days. Among 15,821 weighted encounters, overall mortality was 0.7%. The likelihood of perioperative complications was higher among children transferred from another facility or covered by public or "other" insurance, whereas age ≥10 years and Black race were associated with lower odds of complications (P<0.05). Over the past two decades, pediatric NMS has become substantially more resource intensive, driven particularly by rising procedure costs, despite stable LOS and low mortality. Strategies for reducing perioperative complications may mitigate the economic burden of this vulnerable population. 4.

Importance Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure affecting women during late pregnancy or early postpartum. Its impact on maternal, delivery, and neonatal outcomes remains understudied, highlighting the need for comprehensive research. Objective To determine the effects of PPCM during pregnancy on maternal, delivery, and neonatal outcomes using a large, contemporary nationwide database. Design Retrospective analysis of a population-based cohort using the Healthcare Cost and Utilisation Project Nationwide Inpatient Sample (HCUP-NIS) database from 2004 to 2014. Setting Hospital inpatient stays across 48 states and the District of Columbia in the United States. Participants 9,096,788 pregnant women who delivered or had a maternal death, including 2127 diagnosed with PPCM. Exposures Diagnosis of peripartum cardiomyopathy during or after pregnancy, identified using ICD-9 diagnosis code 674.5x. Main outcomes and measures Women with PPCM had significantly higher rates of pregnancy-induced hypertension, preeclampsia, eclampsia, caesarean delivery, postpartum haemorrhage, and maternal death compared to those without PPCM. Delivery outcomes showed increased rates of preterm delivery, chorioamnionitis, and wound complications among PPCM patients. Neonatal outcomes revealed higher incidences of intrauterine foetal death and congenital anomalies in offspring of women with PPCM. Demographic and clinical characteristics associated with PPCM included advanced maternal age, African American race, obesity, chronic hypertension, previous caesarean section, smoking during pregnancy, and pregestational diabetes.

Quick Cuts: Surgeon Tendency to Operate in Emergency General Surgery.

Accurately estimating total accident costs is essential for managing construction safety budgets. While direct costs are well-documented, indirect costs—such as productivity loss, material damage, and legal expenses—are difficult to predict and often overlooked. Traditional ratio-based methods lack accuracy due to variability across projects and accident types. This study introduces a two-tiered machine learning framework for real-time indirect cost estimation. In the first tier, classification models (decision tree, random forest, k-nearest neighbor, and XGBoost) predict total cost categories; in the second, regression models (decision tree, random forest, gradient boosting, and light-gradient boosting machine) estimate indirect costs. Using a dataset of 1036 construction accidents collected over two years, the model achieved accuracies above 87% in classification and an R2 of 0.95 with a training MSE of 0.21 in regression. Compared to conventional statistical and single-step models, it demonstrated superior predictive performance, reducing average deviations to $362.63 and sometimes achieving zero deviation. This framework enables more precise, real-time estimation of hidden costs, promoting better safety investment, reduced financial risk, and adaptive learning through retraining. When integrated with a national accident cost database, it supports ongoing improvement and informed risk management for construction stakeholders.

BackgroundWe sought to examine socioeconomic disparities in 30-day hospital readmissions and in-hospital mortality among admissions of people with eating disorders in a U.S. national sample.MethodsUsing the 2019 Healthcare Cost and Utilization Project Nationwide Readmissions Database (HCUP-NRD), we analyzed data from 13,986 admissions with a primary or secondary diagnosis of eating disorders. Multivariable logistic regression assessed associations between socioeconomic status (SES), insurance status, and 30-day readmission, as well as in-hospital mortality. SES was categorized into quartiles based on neighborhood median income from patients’ postal codes. Insurance status included Medicare, Medicaid, private insurance, and other. Generalized Estimating Equations (GEE) accounted for facility clustering.ResultsOf 13,986 admissions, 693 were readmissions. Admissions of people with eating disorders in the highest income quartile had significantly higher odds of readmission (OR = 1.60, 95% CI = 1.23–2.10) compared to those in the lowest quartile. Admissions covered by Medicaid (OR = 0.71, 95% CI = 0.57–0.89) or private insurance (OR = 0.66, 95% CI = 0.53–0.83) had lower odds of readmission compared to admissions covered by Medicare. No significant differences in readmission rates were observed across hospitals located in different geographic areas nor across hospitals with differing ownership. In-hospital mortality was highest among admissions of people with eating disorders insured by Medicare (1.35%) and lowest among those with private insurance (0.39%) (OR = 0.48, 95% CI = 0.27–0.84).ConclusionPeople with eating disorders from higher SES backgrounds had higher readmission rates but lower in-hospital mortality, potentially indicating that these people may be receiving a more intensive level of outpatient care. Higher readmission rates may paradoxically indicate continued engagement in follow-up care. However, this interpretation remains speculative and further research is needed to explore the mechanisms behind these disparities, particularly focusing on access to care for people with eating disorders from lower-income backgrounds.

Steel structures that support machines and industrial process installations should ideally be flexible, adaptable, and easily reconfigurable. However, in current practice, new profiles are frequently used and discarded whenever layout modifications are required, leading to considerable material waste, increased costs, and environmental burdens. Such practices conflict with the principles of the circular economy, in which reusability is preferable to recycling. This paper presents a life cycle sustainability assessment (life cycle cost, LCC, and life cycle assessment, LCA) applied to six structural typologies: (a) welded IPE profiles, (b) bolted IPE profiles, (c) welded tubular profiles, (d) bolted tubular profiles, (e) clamped IPE profiles with demountable joints, and (f) flanged tubular profiles with demountable joints. The assessment integrates structural calculations with an updatable database of costs, operation times, and service lives, providing a systematic framework for evaluating both economic and environmental performance in medium-load industrial structures (0.5–9.8 kN/m2). Application to nine representative case studies demonstrated that demountable clamped and flanged joints become economically competitive after three life cycles, and after only two life cycles under high-load conditions (9.8 kN/m2). The findings indicate relative cost savings of up to 75% in optimized configurations and carbon-footprint reductions of approximately 50% after three cycles. These results provide quantitative evidence of the long-term advantages of demountable and reconfigurable steel structures. Their capacity for repeated reuse without loss of performance supports sustainable design strategies, reduces environmental impacts, and advances circular economy principles, making them an attractive option for modern industrial facilities subject to frequent modifications.

IntroductionCesarean sections are commonly performed in the United States, including among patients for whom vaginal delivery may be clinically feasible. This study aimed to evaluate rates and factors associated with cesarean section use and inpatient cost among low-risk deliveries in selected U.S. states.MethodsThis was a retrospective, cross-sectional analysis using Healthcare Cost and Utilization Project (HCUP) State Inpatient database for Maryland, Florida, and Wisconsin between January 1, 2017, and December 31, 2020. American Hospital Association (AHA) data and median household income quartiles based on the Agency for Healthcare Research and Quality’s (AHRQ) 2018 estimates were included in this study to assess hospital and patient neighborhood characteristics. AHA data was linked to HCUP data using the hospital identifier number. Median household income quartiles were linked to HCUP using ZIP codes. A multivariable generalized estimating equations regression model including a random intercept for hospitals was used to identify patient- and hospital-level characteristics associated with the use of cesarean section.Results245,383 women who underwent a delivery between 2017 and 2020 were included in the analysis. Of these women, 8.1% had cesarean section and 91.9% had vaginal delivery. Mean age was 26.9 (SD ± 4.41) years for cesarean section and 26.9 (SD± 4.37) years for vaginal delivery. An increasing rate of cesarean section was detected during the study period. Higher rates of cesarean section were found among Black and Hispanic women compared to White and Asian, and among women with lower income. Hospitals in Florida had the highest cesarean section rate of 9.4% among low-risk women while Maryland and Wisconsin had rates of 6.3% and 5.3%, respectively. Being Hispanic or Black, having private insurance, and giving birth in a for-profit hospital were associated with higher cesarean section utilization after controlling patient- and hospital-level factors. DiscussionA range of clinical and policy interventions have been implemented over the past decade to reduce cesarean sections among low-risk deliveries; however, we still identified an increasing rate of cesarean section among low-risk women between 2017 and 2020 in select U.S. states. There is an emergent need to revisit policies and interventions that impact cesarean section in these states. Women with low socioeconomic status were more vulnerable to have cesarean sections. Identifying variation in cesarean delivery rates among low-risk populations may inform future efforts to improve maternal care quality.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-025-08148-0.

Many surgeons have adopted minimally invasive esophagectomy (MIE) as an alternative to open esophagectomy (OE). However, limited population-level data exist comparing clinical outcomes and costs by surgical approach. This study evaluated contemporary utilization trends, outcomes, and costs between MIE and OE using real-world data. We conducted a retrospective cohort study of patients who underwent MIE or OE using data from the Healthcare Cost and Utilization Project Florida State Inpatient Database from2016 to 2021. Utilization trends were analyzed using Cochran-Armitage tests. Multivariable regression models were utilized toevaluate the association of surgical approach with postoperative outcomes and hospitalization costs. Of 2550 total patients, 1218 (47.8%) and 1332 (52.2%) underwent MIE and OE, respectively. Utilization of MIE increased significantly over time, as MIE grew from 43.4% of annual esophagectomy volume in 2016 to 57.7% by 2021 (trendP < 0.001). MIE patients had a higher prevalence of esophageal or esophagogastric junction cancer compared to OE patients (75.7% vs. 60.1%; P < 0.001), but exhibited a comparable overall comorbidity burden (e.g., 2-3 comorbidities: 44.1% vs. 43.5%; P = 0.061). MIE patients had significantly shorter hospital stays (median: 8 vs. 10days, P < 0.001). MIE was associated with reduced risk-adjusted odds of postoperative complications (adjusted odds ratio 0.560, confidence interval 0.474-0.661, P < 0.001). Operating room costs were significantlyhigher with MIE compared to OE (median:$13,964 vs. $10,618, P < 0.001), whereas intensive care unit costs were lower (median:$2325 vs. $5706, P < 0.001). Index hospitalization (median:$41,795 vs. $40,289, P = 0.340) and 90-day costs (median:$46,509 vs. $45,408, P = 0.550) were comparable between groups. In subgroup analyses, in-hospital mortality was significantly lower with MIE at low-volume(<20 esophagectomiesannually) hospitals (2.5% vs. 5.3%, P = 0.010). However, this difference was not statistically significant at high-volume(≥20 esophagectomiesannually) hospitals (2.9% vs. 5.0%, P = 0.072). MIE has had rapid growth in utilization. MIE appears to provide a viable, cost-effective alternative to OE, with fewer postoperative complications, shorter hospital stays, and comparable overall costs.

Cancer is currently among the most prevalent and fatal diseases, so new, costly drugs for its treatment will be available in the coming years. Budget impact analyses (BIAs) are an essential component of the economic evaluation of new oncological and haematological drugs, and are increasingly required by health authorities in many countries as part of the pricing and reimbursement process. This article aims to provide updated guidance on the methodology for performing such analyses. In a BIA, the resource consumption in the reference scenario (before the new drug is introduced) is always compared with the resource consumption in the future scenario (after the new treatment is commercialized). The most important parts of a BIA include calculating the number of the existing patient population, the current mix of treatments and the expected mix after the coming of the new drug, the cost of the treatment mixes and other changes in cancer-related costs. The BIA's data sources should be drawn from the best available published evidence, such as clinical trials, observational studies, local epidemiological information, cost databases and expert opinion. Where possible, the decision maker's population and calculations for other parameter estimations should also be included. A deterministic analysis and a scenario sensitivity analysis should be carried out in every BIA. The BIA report must provide details of resource consumption and associated costs in the reference scenario and the future scenario. The difference between the 2 scenarios will represent the budget impact of introducing a new drug to the market.

Persons living with dementia (PLWD) have longer lengths of stay (LOS) in the Emergency Department (ED), which increases risk of delirium, falls and medication errors. Care of PLWD in the ED is complex and presence of dementia care specialists (geriatrics, neurology, psychiatry) may streamline care. We sought to understand the contribution of health system factors, including presence of dementia care specialists, to LOS among PLWD. We linked statewide ED visit data on patients discharged from the ED for Arkansas, Arizona, Florida and Massachusetts from the 2018 Healthcare Cost and Utilization Project State Emergency Department Database to the American Hospital Association Annual Survey and Healthcare Information Technology supplement. We included ED visit records for persons ≥ 65 years with ICD-10 dementia diagnoses. Median LOS was estimated at the hospital level and then used as a dependent measure in hospital-level Poisson multivariable models that conditioned on system characteristics. We included 72,083 ED visits resulting in discharge at 225 health systems. Most EDs were in non-governmental, not-for-profit community hospitals (n = 159, 71%). Median patient age was 83 years (IQR 67, 92), females comprised a mean of 64% of visits. Median LOS was 4h (IQR 3-7), mean LOS was 9.3h (SD 16.3). Neurology was the most commonly available dementia care service (n = 180, 80%), followed by psychiatric services (n = 139 EDs, 62%) and geriatric services (n = 132, 59%). In Poisson models adjusting for a parsimonious set of co-variates, the presence of geriatric services was associated with a 16% lower mean LOS (IRR 0.84, 95% CI 0.73-0.97), however, this association lost significance in fully adjusted models (IRR 0.87, 95% CI 0.76-1.01). Availability of geriatric specialty services may offer hospitals an advantage in streamlining ED care for PLWD and in reducing visit length for this complex patient group. These findings reinforce the potential value of the Geriatrics Emergency Department Accreditation programs.

Postmastectomy autologous reconstruction (PMAR) is an important component of comprehensive breast cancer care. Previous research has suggested the existence of sociodemographic disparities in complications after immediate PMAR. The objective of this study was to examine the impact of sociodemographic and clinical factors on immediate PMAR postoperative outcomes. We performed a retrospective cohort study of adult patients undergoing PMAR in the Healthcare Cost and Utilization Project Florida State Inpatient Database (2016-2021). Postmastectomy autologous reconstruction included deep inferior epigastric perforator (DIEP), transverse rectus abdominis myocutaneous (TRAM), and latissimus dorsi (LD) flaps. Primary outcomes were inpatient postoperative complications and readmissions within 30 and 90 days. Data elements were abstracted by using ICD-10 codes and comorbidities defined by using the Elixhauser classification. Univariate and multivariate analyses were performed. We identified 3537 women admitted for PMAR. 483 (13.7%) patients experienced complications 30 days postsurgery. An additional 46 patients (15%) experienced complications within 90 days. A total of 224 patients (6.3%) were readmitted within 30 days, and 368 (10.4%) were readmitted within 90 days. Patients living in smaller metropolitan areas or with four or more comorbidities had significantly increased odds of complications. Patients with Medicaid, Medicare, or two or more comorbidities were significantly more likely to experience hospital length of stay ≥7 days. Residing in smaller metropolitan areas, having two or more comorbidities, or having Medicare were associated with increased odds of 30-day and 90-day readmission. Disparities exist in outcomes after PMAR in patients with public insurance, residing in smaller metropolitan areas, and with multiple comorbidities. These findings should be further evaluated to assess validity and determine generalizability.

Lower survival rates among Black adults relative to White adults after in-hospital cardiac arrest are well-described, but these findings have not been consistently replicated in pediatric studies. To use a large, national, population-based inpatient database to evaluate the associations between in-hospital mortality in children receiving cardiopulmonary resuscitation (CPR) and patient race or ethnicity, patient insurance status, and the treating hospital's proportion of Black and publicly insured patients. This retrospective population-based cohort study used the Healthcare Cost and Utilization Project Kids' Inpatient Database (1997-2019 triennial versions). Participants included pediatric inpatients (aged <18 years) who received in-hospital CPR. Initial data analysis occurred January 20 to July 31, 2023. Revision analyses were completed December 1, 2024, to March 3, 2025. The exposures for the primary analyses were race or ethnicity and insurance payer. The secondary analyses exposures were the proportion of the treating hospital's admissions (not limited to those receiving CPR) of Black patients and of publicly insured patients. The primary outcome for all analyses was in-hospital mortality. The final cohort included 27 332 children (6366 neonates aged 5-28 days [23.3%], 9665 infants aged 29 days to <1 year [35.4%], 4867 aged 1 year to <8 years [17.8%], and 6434 aged ≥8 years [23.5%]; 15 356 male [56.2%]; 6081 (22.2%) Black; 5123 (18.7%) Hispanic; 13 062 (47.8%) White; and 3066 (11.2%) other race or ethnicity) who received in-hospital CPR at sites with 3899 unique hospital identification numbers. Relative to White children, higher odds of in-hospital mortality were observed for Black (adjusted odds ratio [AOR], 1.20; 95% CI, 1.08-1.34; P < .001) and Hispanic (AOR, 1.16; 95% CI, 1.04-1.30; P = .006) children and those of other race or ethnicity (AOR, 1.37; 95% CI 1.20-1.58; P < .001). Public insurance was not associated with in-hospital mortality compared with private insurance (AOR, 1.00; 95% CI, 0.91-1.11; P = .93). On multivariable analysis of the 2003-2019 datasets, children receiving CPR at hospitals with the highest proportion of Black patients (>30.1%) had higher odds of in-hospital mortality than children receiving CPR at hospitals with the lowest proportion of Black patients (AOR, 1.50; 95% CI, 1.17-1.92; P = .001). In this retrospective cohort study of pediatric in-hospital cardiac arrest in a large, national, administrative dataset, children of racial and ethnic minority groups receiving CPR had higher odds of in-hospital mortality. In addition, the odds of in-hospital mortality among children receiving CPR were higher at hospitals with the highest proportion of Black patients.

The demand for surgical facial rejuvenation procedures, such as facelifts, has risen in recent decades. However, limited research has addressed the epidemiological and economic aspects of these procedures. This study examines trends in facelift surgeries using data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database. The HCUP-NIS database, which includes all-payer inpatient cases in the USA, was analyzed for facelift procedures identified through ICD-10 codes from 2016 to 2020. A total of 723 patients met the inclusion criteria. Patient demographics, hospitalization details, and procedural characteristics were evaluated using descriptive statistics. Exploratory comparisons were made across the three surgical technique subgroups, as allocated in ICD-10 procedural coding: open, percutaneous, and percutaneous endoscopic. The cohort included 723 patients, with a mean age of 56.7 ± 16.2 years, predominantly female (79.4%) and White (81%). Most patients were self-paying (63.2%) and of high-income status (50.8%). Higher-income individuals were more likely to undergo minimally invasive procedures. The average hospital stay was 1.7 ± 1.6 days, with total costs averaging $85,259.60 ± $63,152.80. The most common indication was plastic surgery due to cosmetic reasons. Facelift was also performed for gender dysphoria indications in 12.3% of the cases. Hypertension (18.8%) and nicotine abuse (13.7%) were the most frequent comorbidities. The results highlight the complex epidemiological and economic environment of inpatient facelift surgery. Procedures are subject to significant regional and socioeconomic disparities. The growing role of facial feminization and heterogenous surgical access warrants further research on emerging trends in esthetic facial surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Tick-borne diseases (TBDs) are a growing public health concern in the United States. This study analyzed 261,630 weighted hospitalizations from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database between 2002 and 2021 to evaluate trends, coinfections, demographic disparities, and financial impacts. Lyme disease was the most common cause, accounting for 65% of hospitalizations (171,328 admissions), followed by ehrlichiosis/anaplasmosis (46,446), babesiosis (18,057), rickettsial diseases (16,412), tularemia (2428), and other TBDs (19,435). Hospitalizations increased 2.5-fold over the study period, with the Northeast region bearing 52.9% of the burden and peaking in July. Males (53.9%), Caucasians (81.4%), and residents of higher-income zip codes were predominant, though rickettsial diseases showed elevated Hispanic representation (18.4%). Coinfections were common, with 35.8% of babesiosis and 15.6% of ehrlichiosis/anaplasmosis cases involving another TBD, suggesting that routine testing may be warranted. Median hospital charges rose from USD 9433 in 2002 to USD 35,161 in 2021, totaling USD 1.265 billion in 2021. In-hospital mortality was 1.1%, with the highest cause of mortality being babesiosis (2.06%). Future areas for research include characterizing the burden of disease in an outpatient setting, understanding the causes of racial disparities in hospitalizations, and testing strategies to identify coinfection.

The main objective of this research is to examine the application of cost tables in flexible production systems within intelligent and resilient supply chains. This application aims to find out, promptly, how changes in customer preferences lead to changes in the technical industrial process, the costs of the new product, and the other changes required. The current work has tried to investigate all previous changes that led to the existence of a flexible production system, within the context of the resilient intelligent supply chain. The existence of the intelligent supply chain has created states of cooperative games, a matter which indicates the existence of some sorts of debates and negotiations between the different partners of the chain, and the existence of continuous games. To put an end to the supposed game between the previous partners, the search theory was put to work as a rational tool to stop the game at the optimal level of variation and the acceptable iteration numbers. Flexible systems are designed to handle a wide variety of customer demands and rapid changes in requirements, driven by evolving product designs and preferences. This variability has increased the need for early cost prediction, raising issues of cost accuracy and product suitability. The Japanese concept of multivariate cost tables emerged to address this need, particularly in industrial settings. These models account for dynamic product technology changes to satisfy diverse demands from both customers and competitors. Considering flexible, resilient, and intelligent supply chains expands the model’s variables to adapt to continuous customer changes, necessitating cooperative mechanisms—such as collations and game theory applications—rather than purely competitive approaches. The model supports flexible manufacturing, delivery, and after-sales service within a closed-loop supply chain. Suggested examples validate the model’s credibility and adaptability to other issues. Flexibility reflects competitive interactions among supply chain partners, where external influences and intersecting utilities prompt bargaining and conflict. Search theory is proposed to resolve extended debates and disruptions, aiming to enhance customer value.

The high economic cost of biological invasions in China.

There is a lack of consensus on the effects of prior colectomy on health outcomes, particularly those that involve orthopedic procedures. We sought to characterize the association between prior colectomy and outcomes following primary total knee arthroplasty (TKA). We hypothesized that compared with patients without, those with prior colectomy who undergo primary TKA have higher odds of same-admission postoperative complication and reoperation. We performed a retrospective cohort study using the Healthcare Cost and Utilization Project (HCUP) National (Nationwide) Inpatient Sample (NIS) database to identify patients who underwent primary TKA. Patients with prior colectomy were propensity-score matched to patients without prior colectomy at a ratio of 1:50 by age, gender, race/ethnicity, Charlson-Deyo Comorbidity index, history of osteoporosis, history of smoking, insurance status, hospital size, hospital location and teaching status, and hospital ownership. Adjusted logistic regression analyses were used to determine the relationship between colectomy and the same-admission outcomes, postoperative complication, and reoperation. Overall, 894,911 patients underwent primary TKA during the study period. After propensity score matching (PSM), 2,625 (1.96%) patients were assigned to the cohort with prior colectomy, while 131,250 (98.04%) patients were assigned to the cohort without prior colectomy. Compared with patients without prior colectomy, those with prior colectomy who underwent primary TKA had no significantly higher odds of same-admission postoperative complication; however, they had 2.12 times higher odds (95% confidence interval: 1.04-4.31; p = 0.038) of same-admission reoperation. Compared with patients with no prior colectomy, those with prior colectomy who underwent primary TKA had no higher odds of postoperative complication but had over twice the odds of reoperation during the same admission for surgery. Further studies examining the role of the colon and microbiota may help to better understand outcomes associated with the history of prior colectomy in the setting of primary TKA. This study is a level III retrospective cohort study.

This paper systematically explores the development and application of engineering cost databases driven by technology. Confronting persistent challenges in traditional cost management, such as data fragmentation, over-reliance on standardized quotas, and inefficiency. The integration of technologies: big data, artificial intelligence (AI), cloud computing, blockchain, the Internet of Things (IoT), and Building Information Modeling (BIM) provides robust momentum for database construction. Specifically, it elaborates on key technological pathways for building such databases, encompassing: the integration and standardization of multi-source heterogeneous data; the utilization of data lakes, Natural Language Processing (NLP), knowledge graphs, and intelligent analytical prediction models based on algorithms like Random Forest and Long Short-Term Memory (LSTM); dynamic update mechanisms; and integration with cloud platforms and real-time data acquisition. Practical case studies, including Shandong Province's initiatives, the "Smart Cost" system in Chancheng District, Guangzhou, the material price database of Rizhao Municipal Housing and Urban-Rural Development Bureau, and Yema Technology's AI database, demonstrate the efficacy of these technological applications. Finally, the paper anticipates the future trajectory of engineering cost databases towards increasing intelligence, emphasizing their pivotal role in supporting intelligent construction within international projects and achieving objectives related to engineering intelligence and cost datafication. It posits that such databases will become the core engine driving the construction industry's transformation towards greater refinement, intelligence, and high-quality development.