Hospital Costs Research Articles

Independent Risk Factors and Economic Burden Associated With Delayed Extubation Following Pediatric Liver Transplantation.

Successful early extubation (EE) after liver transplant (LT) has been shown to reduce intensive care unit (ICU) and hospital length of stay and infectious, vascular, and sedation-related complications in adults. EE may not always be feasible in children, and many may require prolonged mechanical ventilation. Limited data exists regarding the candidacy of EE, risk factors, consequences, and hospital costs of delayed extubation (DE) in pediatric LT. We conducted a retrospective review to investigate predictive factors and associated costs of EE and DE in infants and children after orthotopic LT at our institution between 2011 and 2021. Of 338 LT (median age 39 months, 54% females), 246 (73%) had EE (within 24 h of LT), while 27% had DE. Age < 1 year (p = 0.0019), diagnosis of biliary atresia (0.02), abnormal pre-LT echocardiogram (0.02), and patients with ongoing hospital admission before LT (0.0001) were independently associated with DE. Hospital costs were significantly (∼3-fold) higher (p < 0.0001) in the DE group. In addition, factors associated with increased total hospital costs were age < 1 year and hospitalization before LT. EE post-LT is feasible and merits a trial. The prevalence of DE though modest is associated with increased resource utilization and hospital costs. Children who can be extubated early and those at risk for DE can be identified pre-operatively for optimal planning and allocation of resources.

Center Related Variation in Hospitalization Cost for Patients Undergoing Percutaneous Left Atrial Appendage Occlusion

BackgroundThe commercial use of percutaneous LAAO with the Watchman device is increasing in the United States. The purpose of this study was to evaluate center related variation in total hospital costs for Watchman device implantation and identify factors associated with high hospital costs at a national level. MethodsAll adults undergoing elective LAAO with Watchman were identified in the 2016 to 2018 National Inpatient Database. Mixed models were used to evaluate the impact of center on total hospital costs adjusting for patient and center characteristics, and length of stay. ResultsA total of 30,175 patients underwent Watchman device implantation at a median cost of $24,500 and demonstrated significant variability across admissions (inter-decile range, $13,900-37,000). Nearly 13% of the variability in patient-level costs was related to the center performing the procedure rather than patient factors. Higher volume centers had lower total costs and demonstrated lesser total cost variation. Centers with low procedural volume, occurrence of procedural complications, congestive heart failure, and length of stay were independent predictors of a high-cost hospitalization. Though complications were associated with increased expenditure, they did not explain the observed cost variation related to the center. ConclusionA significant proportion of variation in total hospital cost was attributable to the center performing the procedure. Addressing variability of Watchman-related costs is necessary to achieve high-quality value-based care.

Vein bypass first vs. best endovascular treatment first revascularisation strategy for chronic limb-threatening ischaemia due to infra-popliteal disease: the BASIL-2 RCT.

Chronic limb-threatening ischaemia with ischaemic pain and/or tissue loss. To examine the clinical and cost-effectiveness of a vein bypass-first compared to a best endovascular treatment-first revascularisation strategy in preventing major amputation or death. Superiority, open, pragmatic, multicentre, phase III randomised trial. Thirty-nine vascular surgery units in the United Kingdom, and one each in Sweden and Denmark. Patients with chronic limb-threatening ischaemia due to atherosclerotic peripheral arterial disease who required an infra-popliteal revascularisation, with or without an additional more proximal infra-inguinal revascularisation procedure, to restore limb perfusion. A vein bypass-first or a best endovascular treatment-first infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation strategy. The primary outcome was amputation-free survival. Secondary outcomes included overall survival, major amputation, further revascularisation interventions, major adverse limb event, health-related quality of life and serious adverse events. Participants were randomised to a vein bypass-first or a best endovascular treatment-first revascularisation strategy. The original sample size of 600 participants (247 events) was based on a hazard ratio of 0.66 with amputation-free survival rates of 0.72, 0.62, 0.53, 0.47 and 0.35 in years 1-5 in the best endovascular treatment-first group with 90% power and alpha at p = 0.05. The sample size was revised to an event-based approach as a result of increased follow-up time due to slower than anticipated recruitment rates. Participants were followed up for a minimum of 2 years. A cost-effectiveness analysis was employed to estimate differences in total hospital costs and amputation-free survival between the groups. Additionally, a cost-utility analysis was carried out and the total cost and quality-adjusted life-years, 2 and 3 years after randomisation were used. Between 22 July 2014 and 30 November 2020, 345 participants were randomised, 172 to vein bypass-first and 173 to best endovascular treatment-first. Non-amputation-free survival occurred in 108 (63%) of 172 patients in the vein bypass-first group and 92 (53%) of 173 patients in the best endovascular treatment-first group [adjusted hazard ratio 1.35 (95% confidence interval 1.02 to 1.80); p = 0.037]. Ninety-one (53%) of 172 patients in the vein bypass-first group and 77 (45%) of 173 patients in the best endovascular treatment-first group died [adjusted hazard ratio 1.37 (95% confidence interval 1.00 to 1.87)]. Over follow-up, the economic evaluation discounted results showed that best endovascular treatment-first was associated with £1690 less hospital costs compared to vein bypass-first. The cost utility analysis showed that compared to vein bypass-first, best endovascular treatment-first was associated with £224 and £2233 less discounted hospital costs and 0.016 and 0.085 discounted quality-adjusted life-year gain after 2 and 3 years from randomisation. Recruiting patients to the Bypass versus Angioplasty in Severe Ischaemia of the Leg Trial-2 trial was difficult and the target number of events was not achieved. A best endovascular treatment-first revascularisation strategy was associated with better amputation-free survival, which was largely driven by fewer deaths. Overall, the economic evaluation results suggest that best endovascular treatment-first dominates vein bypass-first in the cost-effectiveness analysis and cost-utility analysis as it was less costly and more effective than a vein bypass-first strategy. The Bypass versus Angioplasty in Severe Ischaemia of the Leg Trial-2 investigators have a data sharing agreement with the BEst Surgical Therapy in patients with Chronic Limb threatening Ischaemia investigators. One output of this collaboration will be an individual patient data meta-analysis. Current Controlled Trials ISRCTN27728689. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/35/45) and is published in full in Health Technology Assessment; Vol. 28, No. 65. See the NIHR Funding and Awards website for further award information.

Estimation of two-year hospital costs of hip and knee periprosthetic joint infection treatments using activity-based costing.

Our aim was to estimate the total costs of all hospitalizations for treating periprosthetic joint infection (PJI) by main management strategy within 24 months post-diagnosis using activity-based costing. Additionally, we investigated the influence of individual PJI treatment pathways on hospital costs within the first 24 months. Using admission and procedure data from a prospective observational cohort in Australia and New Zealand, Australian Refined Diagnosis Related Groups were assigned to each admitted patient episode of care for activity-based costing estimates of 273 hip PJI patients and 377 knee PJI patients. Costs were aggregated at 24 months post-diagnosis, and are presented in Australian dollars. The mean cost per hip and knee PJI patient was $64,585 (SD $53,550). Single-stage revision mean costs were $67,029 (SD $47,116) and $80,063 (SD $42,438) for hip and knee, respectively. Two-stage revision costs were $113,226 (SD $66,724) and $122,425 (SD $60,874) for hip and knee, respectively. Debridement, antibiotics, and implant retention in hips and knees mean costs were $53,537 (SD$ 39,342) and $48,463 (SD $33,179), respectively. Suppressive antibiotic therapy without surgical management mean costs were $20,296 (SD $8,875) for hip patients and $16,481 (SD $6,712) for knee patients. Hip patients had 16 different treatment pathways and knee patients had 18 treatment pathways. Additional treatment, episodes of care, and length of stay contributed to substantially increased costs up to a maximum of $369,948. Treating PJI incurs a substantial cost burden, which is substantially influenced by management strategy. With an annual PJI incidence of 3,900, the cost burden would be in excess of $250 million to the Australian healthcare system. Treatment pathways with additional surgery, more episodes of care, and a longer length of stay substantially increase the associated hospital costs. Prospectively monitoring individual patient treatment pathways beyond initial management is important when quantifying PJI treatment cost. Our study highlights the importance of optimizing initial surgical treatment, and informs treating hospitals of the resources required to provide care for PJI patients.

Use of coagulation factor concentrates and blood transfusion in cardiac surgery: a retrospective cohort study of adults with hereditary and acquired bleeding disorders

BackgroundCardiac surgery poses a significant risk of perioperative bleeding and allogeneic blood transfusions, particularly in patients with bleeding disorders. Increasingly frequent use of coagulation factor concentrates could impact haemorrhagic risks, thromboembolic events, and costs. We describe the use of coagulation factor concentrates and allogeneic blood products in cardiac surgical patients with hereditary and acquired bleeding disorders to assess pertinent outcomes, including perioperative haemorrhage, thromboembolism, and hospital costs. MethodsWe conducted a retrospective cohort study using the Premier Health Database, including adult cardiac surgical patients diagnosed with hereditary or acquired bleeding disorders compared with those without bleeding disorders. ResultsPatients with acquired bleeding disorders required more extensive use of coagulation factor concentrates and blood products compared with those with hereditary bleeding disorders or without bleeding disorders. The highest exposures to coagulation factor concentrates were found in the acquired bleeding disorders group, with 24% receiving factor VIIa and 11.7% receiving prothrombin complex concentrate. This group also experienced significantly higher rates of complications, including a 15.8% rate of haemorrhage and a 19.2% rate of thromboembolic events. The acquired bleeding disorders group had longer intensive care and hospital stays, and the highest mortality rate (19.2%). The increased use of perioperative replacement of factor VIII and factor IX in the hereditary bleeding disorders group led to increased pharmacy costs but did not significantly impact blood bank charges. ConclusionsAcquired bleeding disorders in cardiac surgery patients are associated with increased use of haemostatic interventions, postoperative complications, and increased healthcare costs. Improved management of perioperative haemostasis and thromboprophylaxis strategies are essential for optimising patient outcomes and reducing expenses.

The CLIPS Protocol: Cast re-aLignment In Paediatric patients using Stationery

Paediatric tibial shaft fractures are commonly treated nonoperatively and followed-up in the clinic setting. Loss of position has traditionally been managed with wedging of the cast or admission and manipulation in the operaing theatre. The authors present a technique to aid in the wedging of plasters for paediatric tibia and forearm fractures that reduces time requirement, hospital costs and emotional distress on the part of the patient and family.

Comparative Study on the Effectiveness, Safety, and Economic Costs of Endoscopic Submucosal Dissection for Colorectal Tumors Under Conscious Sedation and General Anesthesia.

Endoscopic submucosal dissection (ESD) is a minimally invasive surgical procedure used for en bloc removal of colorectal tumors. Although colorectal ESD is ideally conducted under conscious sedation, it is often performed under general anesthesia because of its complexity and lengthy duration. Currently, there is limited research on colorectal ESD performed under conscious sedation. The purpose of this study was to evaluate the effectiveness, safety, and economic cost of colorectal ESD under conscious sedation compared to general anesthesia. Retrospective analysis of 301 patients who underwent ESD treatment for colorectal tumors at the Endoscopy Center of Peking University Cancer Hospital from January 2018 to November 2020. Patients were divided into the sedation group (group S, n=88) and the general anesthesia group (group A, n=213) based on the anesthetic method. To balance the confounding factors between the 2 groups, 75 matched pairs were obtained after using propensity score matching (PSM). Intraoperative and postoperative parameters were then compared between the matched groups. After PSM, there was no statistically significant difference between group S and group A in terms of the surgical time, en bloc resection rate, and complete resection rate. There was also no statistically significant difference in the occurrence rates of bleeding, perforation, and post-ESD electrocoagulation syndrome (PEECS) between the 2 groups. However, the length of hospital stay was significantly shorter in group S (1.23±0.89d) than in group A (5.92±3.05d) ( P <0.05). The hospitalization costs were also significantly lower in group S (16482.34±13154.32 yuan) compared with group A (34743.74±13779.40 yuan) (P < 0.05 ). Compared to general anesthesia, performing ESD for colorectal tumors under conscious sedation has equivalent effectiveness and safety while shortening the hospital stay and reducing the economic costs.

Delabeling of allergy to beta-lactam antibiotics in hospitalized patients: a prospective study evaluating cost savings.

Patients with a penicillin allergy label are at risk of an associated increase in adverse antibiotic events and hospitalization costs. We aimed to study the economic savings derived from the correct diagnosis and delabeling inpatients with suspected beta-lactam allergy, considering the acquisition cost of antimicrobials prescribed during a patient's hospital stay. We prospectively evaluated patients admitted to the University Hospital of Salamanca who had been labeled as allergic to beta-lactams and performed a delabeling study. Subsequently, cost differences between antibiotics administered before and after the allergy study and those derived from those patients who received alternative antibiotics during admission and those who switched to beta-lactams after the allergy study were calculated. One hundred seventy-seven inpatients labeled as allergic to beta-lactams underwent a delabeling study; 34 (19.2%) were confirmed to have allergy to beta-lactams. Of the total number of patients, 136 (76.8%) received antibiotics during their hospitalization, involving a mean (SD) cost of €203.07 (318.42) and a median (IQR) cost of €88.97 (48.86-233.56). After delabeling in 85 (62.5%) patients, the antibiotic treatment was changed to beta-lactams. In this group of patients, the mean cost (SD) decreased from €188.91 (351.09) before the change to 91.31 (136.07) afterward, and the median cost (IQR) decreased from €72.92 (45.82-211.99) to €19.24 (11.66-168). The reduction was significant compared to the median cost of patients whose treatment was not changed to beta-lactams (p<0.001). Delabeling hospitalized patients represents a cost-saving measure for treating patients labeled as allergic to beta-lactams.

Implementing a Streamlined Hypoglossal Nerve Stimulator Pathway: Cost, Time to Surgery, and Outcomes.

To evaluate the costs, time to surgery, and clinical outcomes associated with implementing a streamlined hypoglossal nerve stimulator (HGNS) implantation pathway. Retrospective cohort study. Single tertiary care center in the United States from 2016 to 2023. Patients with a lack of complete concentric collapse of the velum during volitional snore on in-office laryngoscopy qualified for the streamlined HGNS pathway. This pathway consisted of confirmatory drug-induced sleep endoscopy (DISE) followed immediately by HGNS implantation during the same surgical encounter. Outcomes were compared to patients in the traditional pathway (standalone DISE followed by HGNS implantation on a later date). A total of 68 patients (13 streamlined, 55 traditional) with obstructive sleep apnea who underwent HGNS implantation were included. Patients were predominately male (70.6%) and White (95.6%) and had a mean (SD) age of 63.5 (10.0) years. The streamlined pathway was associated with a significant reduction in both hospital costs (mean difference $9258, 95% confidence interval [CI]: 3690-14,825; P = .002) and time to surgery (mean decrease of 3.82 months, 95% CI: 0.83-6.80 months; P = .013) compared to the traditional pathway. Patients in both groups had reduction in apnea-hypopnea index and Epworth Sleepiness Scale score, with no significant differences in comparisons between groups. In select patients, the streamlined HGNS pathway may expedite time to surgery and reduce hospital costs with comparable clinical outcomes to a traditional 2-stage pathway. Further research is warranted to validate patient selection and better understand longitudinal outcomes.

Study Of Incidence And Risk Factors In Surgical Site Infections Post LSCS At Tertiary Care Centre In Western Rajasthan

Background: Surgical site infection post LSCS leads to increasing patient morbidity and increase the duration of patient hospitalization, hospital costs and raise the burden on our healthcare system. The incidence of SSI after caesarean section ranges from 3% to 5%. Objective of current investigation was to study the incidence&amp;risk factors responsible for SSI in LSCS. Methods: This prospective study was done among pregnant women undergoing LSCS who developed SSI at department of Obstetrics and Gynaecology in Umaid Hospital, Jodhpur during June 2023 to August 2023. All patients were following up to 7thpostoperative day.SSI was defined by CDC criteria. Results: The incidence of SSI noted in present study was 2.5%. Almost 30.8% cases had BMI ≥25 kg/m2 , 55% multipara, 67.3% resided in rural area. Anemia, PROM, LSCS in emergency, multiple vaginal examination (&gt;5), prolonged labornoted in participants of SSI was 51.9%, 26.9%, 75, 34.6%, 38.4% respectively. Silk suture material was used in 71% of cases who developed SSI. Conclusions: Incidence of SSI in present is 2.5%. BMI, Anemia, PROM, LSCS in emergency, multiple vaginal examination (&gt;5), prolonged labor, silk suture material were noted higher among the participants who developed SSI. Keywords: Cesarean delivery, Incidence of SSI, Risk factor, Surgical site infection

National Costs for Cardiovascular-related Hospitalizations and Inpatient Procedures in the United States, 2016-2021

The current economic burden of cardiovascular-related hospitalizations grouped by diagnoses and procedures in the U.S. has not been well characterized. The objective was to identify current trends in cardiovascular-related hospitalizations, procedural utilization, and health care costs, using the most recent 6 years of hospitalization data. A retrospective analysis of discharge data from the National Inpatient Sample (NIS) database was conducted to determine trends in cardiovascular-related hospitalizations, costs, and procedures for each year from 2016 to the most recent available dataset, 2021. Total cardiovascular-related costs were adjusted to and reported in 2023 dollars. In 2021, there were 4,687,370 cardiovascular-related hospitalizations at a cost of $108 billion. Heart failure hospitalizations accounted for the highest costs at $18.5 billion, followed by Non-ST-Elevation Myocardial Infarction at $11.2 billion, and stroke at $10.9 billion. Significant upward trends in costs from 2016 to 2021 were observed for heart failure, stroke, atrial fibrillation, ST-elevation myocardial infarction, chest pain, hypertensive emergency, ventricular tachycardia, aortic dissection, sudden cardiac death, pericarditis, supraventricular tachycardia, and pulmonary heart disease. Over the 6 observational years, total costs increased by over $10 billion, representing a 10 percent increase. However, the increases were not linear, as there was a significant increase of 6.5% from 2018 to 2019, then a dip of over 7% from 2019 to 2020, followed by a rise of about 6% from 2020 to 2021. By 2030, total CV-related costs are projected to reach $131.3 billion. For all years, coronary procedures were the most performed, followed by ECMO, non-bypass peripheral vascular surgery, pacemaker placement, and CABG. Both TAVR and MitraClip procedures demonstrated significant upward trends from 2016 to 2021. Overall, from the years 2016 to 2021, cardiovascular-related hospitalizations, costs, and procedures demonstrated upward trends. In conclusion, cardiovascular disease remains a high burden in the hospital setting with tremendous health care costs.

Skeletal muscle density as a new predictor of abdominal infection in abdominal trauma patients

Background and aimsSkeletal muscle density (SMD) is a valuable prognostic indicator in various conditions such as cancer, liver cirrhosis. Yet, the connection between SMD and intra-abdominal infection in individuals who have suffered abdominal injuries is still unclear. The purpose of this research is to examine how well SMD can predict intra-abdominal infection in patients who have suffered abdominal trauma. MethodsParticipants with abdominal injuries were included in this research from January 2015 to April 2023. Based on the sex-specific cut off values of SMD, the entire population was split into two categories. Prognostic factors were identified through logistic regression analysis. ROC was used to assess the predictive accuracy of SMD and its combinations with other biomarkers for clinical outcomes. ResultsA total of 220 patients were ultimately included in the study. Patients in the group with low SMD exhibited a higher incidence of intra-abdominal infection, longer hospital stays, and increased hospital costs. In patients with abdominal trauma, low SMD was identified as a significant independent predictor of intra-abdominal infection (OR 2.397; 95% CI 1.117- 5.141, p = 0.025). Low SMD had a higher area under the curve (AUC) in ROC analysis compared to TRF, NRS2002 score, and APACHEII score for predicting intra-abdominal infection (AUC 0.70, 95% CI 0.61-0.78, p = 0.002). Moreover, low SMD showed associations with clinical outcomes such as hospital stay length and costs (p < 0.01). ConclusionsLow SMD is recognized as an independent risk factor for predicting intra-abdominal infections in this patient population. Notably, SMD is emerging as a novel predictor of abdominal infections in patients with abdominal trauma.

Opioid use disorder's impact on asthma hospitalizations: A propensity-matched nationwide study

BackgroundPatients with asthma and opioid use disorder (OUD) experience higher rates of acute exacerbation, but the effects of OUD on asthma hospitalizations have been poorly described. ObjectiveTo explore how concurrent OUD may affect the clinical outcomes of adult patients hospitalized for asthma. MethodsUsing the National Inpatient Sample, adult patients admitted for asthma with concomitant OUD were identified and compared with those without OUD. Cohorts were matched in a 1:1 ratio using propensity score matching, with mortality as primary outcome of interest. ResultsA total of 491,990 patients were hospitalized for asthma, and 3.49% had a concomitant diagnosis of OUD. Patients with asthma and OUD were younger, with a mean age of 41 years (SD ± 12.2) vs 51 years (SD ± 17.2) in those without OUD. After matching, both cohorts had 17,125 patients. There was no significant difference regarding in-hospital mortality (odds ratio [OR] 0.92, 95% CI 0.51-1.63, P = .77) between the cohorts. Patients with asthma with OUD had significantly higher rates of mechanical ventilation (OR 1.52, 95% CI 1.23-1.87, P < .001), noninvasive mechanical ventilation (OR 1.37, 95% CI 1.15-1.62, P < .001), and mean length of stay (3.18 vs 2.92 days, P < .001) compared with patients with asthma without OUD. Patients with OUD had no difference in mean total hospitalization costs ($33,514 vs $31,529, P = .054) compared with patients without OUD. Compared with a routine hospital discharge, patients with OUD were more likely to leave against medical advice (relative risk [RR] 2.67, 95% CI 2.28-3.13, P < .001), be discharged to a long-term facility (RR 1.40, 95% CI 1.01-1.95, P = .045), and be discharged with home health care (RR 1.56, 95% CI 1.22-1.99, P < .001) than patients without OUD. ConclusionConcomitant OUD has no impact on mortality in asthma hospitalizations, but patients with asthma with OUD have worse secondary outcomes compared with those without OUD.

The impact of oral nutritional therapy on reducing hospital costs

The impact of oral nutritional therapy on reducing hospital costs

Association between average hospitalization cost and nutritional status of patients at nutritional risk upon hospital admission

Association between average hospitalization cost and nutritional status of patients at nutritional risk upon hospital admission

Managing Cerebrospinal Fluid Leak After Lumbar Spinal Fusion: When Conservative Treatment is Not the Answer?

IntroductionCSF leaks are a known complication of lumbar fusion surgery. There is a scarcity of literature describing the management of this complication. The aim of this study was to identify patients who are at risk of requiring further intervention for managing CSF leaks. MethodsThe Nationwide Inpatient Sample (NIS) database was used to identify patients who had lumbar fusion in the United States from 2002 to 2014. Inpatient outcomes including the incidence and risk factors for requiring an intervention were calculated. Secondary outcomes including average length of stay (LOS), mean cost, and mortality rates were calculated. All statistical analyses were conducted based on multivariate regression models using the SPSS software. ResultsA total of 11,636 patients with post-operative CSF leak after elective lumbar fusion were identified in the NIS database from 2002 to 2014. Of these patients, 79.9% (9,294/11,636) required an advanced intervention including epidural blood patch, simple repair, or operative management. There was an increase of 13% per year in the use of an intervention in managing CSF leaks. After controlling for several confounding factors, independent risk factors for requiring an intervention included: older age (OR: 1.01; 95% CI: 1.005-1.013; p<0.0001), lateral approach (OR: 1.52; 95% CI: 1.26-1.81; p<0.0001) and posterior approach (OR: 1.60; 95% CI: 1.34-1.91; p<0.0001) compared to anterior approach.Nonsurgical treatment was associated with increased length of stay (5.93±4.61 vs. 5.25±3.63;p<0.0001) with similar hospitalization costs (119,537.2±89,045.6 vs. 120,277.9±87,894.1; p=0.72) and mortality (0.3% vs. 0.3%; p>0.05). ConclusionSpine surgeons should be aware of certain patient and procedure-specific characteristics that increase the risk of requiring an intervention for CSF leak management after lumbar fusion to improve patient outcomes.

Outpatient management of pediatric epistaxis: A cost analysis and clinical model.

Pediatric epistaxis is a common, often non-operative condition encountered by Otolaryngologists. The present study seeks to (1) describe our outcomes of epistaxis management, (2) estimate the associated healthcare burden, and (3) propose a clinical model to optimize care coordination with primary care and advanced practice providers. Retrospective case series of pediatric patients treated outpatient for epistaxis by a single otolaryngologist from 2021 to 2022. The primary outcome after treatment with nasal lubricants was defined as (1) refractory epistaxis, (2) improvement, or (3) complete resolution. Cost data for office versus operative nasal cautery were analyzed. In total, 122 patients were included for analysis. Over a follow-up duration of 20.5 months (IQR 8-36), 24.6% of patients experienced refractory epistaxis, 41.8% of patients found improvement, and 33.6% had complete resolution (n = 122). Refractory epistaxis was associated with a family history of coagulopathy (p = .007), daily epistaxis episodes (p = .043), and anemia (p <.001). Average direct hospital costs associated with nasal cautery were $187 for in-office cauterization and $2179 for intraoperative cauterization. Estimated patient/third party payors savings were $1617 and $15,412 for in-office and intraoperative procedures, respectively, and $541.59 for specialty office visits alone. The average charge for laboratory work-up was $576. Approximately 75% of patients with epistaxis experienced improvement or resolution of symptoms with nasal lubrication alone. Refractory epistaxis was associated with a family history of coagulopathy, daily epistaxis episodes, and anemia. Otolaryngology visits for epistaxis were associated with a direct healthcare expense burden. Adaptation of our clinical model may mitigate these costs while improving patient care. Level of Evidence: 4.

Effect of Cryotherapy on Pain Intensity for Patients Undergoing Arterial Sheath Removal After Percutaneous Coronary Intervention: A Randomized Controlled Trial

Introduction: Coronary artery disease is the main cause of mortality globally, making up approximately 33% of all deaths Patients with coronary artery disease experience pain and discomfort post-percutaneous coronary intervention after the femoral catheter is removed, which might raise the patient's duration of hospitalisation and the hospital's costs. Aims: The purpose of the study is to evaluate the effect of cryotherapy on the degree of pain that patients who have had their arterial sheath removed after percutaneous coronary intervention felt. Methods: A test-and-retest design in a randomised controlled trial was conducted from January 7, 2024, to February 19, 2024, at Babylon Centre/Imam Al-Sadiq Hospital. A probability (simple random) sampling method was used in a two-group design, with 50 patients in each group as a control and cryotherapy group, and evaluating pain levels utilizing the visual analogue scale. Descriptive and inferential statistics were used in data analysis frequency, percentage, mean, paired sample t-test, standard deviation, and ANOVA. Results: This stated the mean pain level was similar before cryotherapy. However, after cryotherapy, the level of pain in the cryotherapy group was significantly less than that of the control group (2.38± 5.1 vs. 23.34± 11.5), respectively. P = 0.000 (&lt;0.05) demonstrating a statistically significant variation. Conclusions: According to the study, cryotherapy applied to the femoral sheath region assisted the percutaneous coronary intervention patients feel less pain when their femoral catheter was removed. In these situations, a local cold gel bag may be advised as a nursing intervention for pain management.

Ten-year survival outcomes of video-assisted thoracic surgery vs. open major lung resection for stage I-III non-small cell lung cancer: a large cohort study in China.

Despite the widespread adoption of video-assisted thoracoscopic surgery (VATS) for major lung resection, the 10-year long-term survival outcomes of non-small cell lung cancer (NSCLC) treated with VATS compared with open major lung resection is lacking. The purpose of this study was to analyze the short- and long-term outcomes of VATS vs. open major lung resection for NSCLC. The perioperative outcomes and long-term survival of p-stage I-III NSCLC patients who underwent major lung resection via VATS vs. open major lung resection in the Western China Lung Cancer Database (WCLCD) between May 2006 and June 2018 were studied using propensity score matching (PSM). Of the 10,167 patients who underwent surgery for lung malignancies, 6,405 patients with stage I-III NSCLC were included in the study, including 4,224 in the VATS group and 2,181 in the open group. PSM resulted in 1,487 patients in both the VATS and open groups. The patients were matched by patient demographics, Charlson comorbidity index (CCI), tumor histology and TNM stage. Compared with open surgery, major lung resection via VATS resulted in less blood loss (median: 50 vs. 100 mL, P<0.001) and a shorter postoperative hospital stay (7.6±6.0 vs. 8.6±4.9 days, P<0.001) but higher total hospital costs (52.5±21.2 vs. 45.0±16.4 kRMB, P<0.001). The matched cohort showed that patients who underwent major lung resection via VATS had better overall survival (OS) and recurrence-free survival (RFS) than did patients who underwent major lung resection via open surgery (5-year survival: 64.9% vs. 57.7%, P<0.001; 5-year RFS: 50.3% vs. 45.3%, P=0.003). Patients who underwent VATS had a better 10-year OS rate (47.8% vs. 42.6%). According to the subgroup analysis, patients with stage II NSCLC who underwent major lung resection via VATS had better OS and RFS (OS: P<0.001; RFS: P=0.004), while there were no significant differences in OS or RFS between stage I and III NSCLC patients. Major lung resection via the VATS should be the preferred surgical option for stage I-III NSCLC patients due to its superior long-term survival outcome and advantages of less blood loss and shorter postoperative hospital stays.

Teiripe sa Bhaile: ICPOP Early Supported Discharge for Frailty

Abstract Background Older adults and particularly older adults with frailty are high users of acute hospital care which results in overall higher hospital costs and reduced functional independence. Early supported discharge (ESD) was found to have a statistically significant impact in reducing length of stay in older adults admitted for medical reasons. This poster outlines the rehabilitation pathway developed by an ICPOP team to provide early supported discharge for frail older inpatients with SMART rehab goals. Methods Suitable patients are identified and assessed prior to discharge from the acute ward. Each patient receives a comprehensive geriatric assessment in their own home. All patients receive at least 2 hours of therapy per week until they have reached their goals. Standardised outcome measures including Functional Assessment Measure (FIM/FAM) and EQ5D5L are captured for each patient. Clients are discharged once they have reached their goals or are at their new functional baseline. Results 52 patients have been seen on this pathway since 2023. Hip fracture was the most common reason for referral, followed by Falls. Average length of stay on service was 40 days. Average wait time to first assessment was 1.7 days, highlighting the responsiveness of the service. 4 patients seen in 2024 live alone, indicating this service is also appropriate for patients who don’t have supports readily available in the home. FIM/FAM scores increased from 148 to 160 on average- Indicating more functional independence. Conclusion This ICPOP Rehabilitation pathway offers a safe, person-centred alternative to traditional inpatient rehabilitation. Readmission rates post discharge were low indicating the programme's safety. Given the large number of hospital bed saved without compromising functional outcomes for the patients, the ICPOP team is working on expanding this pathway.