Healthcare Cost And Utilization Project Nationwide Inpatient Sample Research Articles

Nationwide Patterns of Pathologic Fractures Among Patients Hospitalized with Bone Metastases

Bone metastases can significantly affect quality-of-life, especially if they lead to pathologic fractures. However, it is unclear which patients are more likely to develop pathologic fractures when they have bone metastases. We aim to determine risk factors for pathologic fracture among those who are admitted with bone metastases and to evaluate the association of pathologic fracture with clinical and economic outcomes. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) was queried for all patients hospitalized with bone metastases and pathologic fractures in 2016. Baseline differences in demographic, clinical, socioeconomic, and hospital-related characteristics between patients with and without fractures were assessed by chi-square and ANOVA testing. Multivariable logistic regression was used to identify factors associated with fractures. Weighted frequencies were used to create national estimates for all data analysis. In 2016, 272,275 hospital admissions were associated with a diagnosis of bone metastases, of which 11.1% were found to have a pathologic fracture. Patients with fractures have a longer length-of-hospital-stay (mean 8.2 vs 6.3 days, p<0.001), and higher cost-of-hospital-stay (mean $23,526 vs $15,377, p<0.001) compared to patients without pathologic fractures. On multivariable analysis, primary cancers associated with increased risk of pathologic facture included multiple myeloma (odds ratio [OR] 2.91; 95% CI = 2.40-3.53), liver & intrahepatic bile duct (OR 1.72; 95% CI = 1.37-2.16), and kidney and renal pelvis cancer (OR 1.39; 95% CI = 1.21-1.60). Comorbidities significantly associated with fracture included osteoporosis (OR 1.68; 95% CI = 1.44-1.96), paralysis (OR 1.35; 95% CI = 1.18-1.55), and drug (OR 1.35; 95% CI = 1.09-1.66) and alcohol abuse (OR 1.33; 95% CI = 1.07-1.65). Approximately 11% of hospitalized patients with bone metastases presented with a concomitant pathologic fracture, which was associated with longer inpatient stay and higher cost. Multiple myeloma and osteoporosis were associated with higher risk of pathologic fracture. These groups may benefit from increased outpatient monitoring, prophylactic stabilization, or early irradiation.

Pregnancy outcomes after thyroid cancer.

Background Thyroid cancer is one of the most common cancers in women of reproductive age. Our purpose was to evaluate the association between thyroid cancer and maternal and neonatal outcomes of pregnancy. Methods We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database from the US. A cohort consisting of women who delivered between 1999 and 2014 was created. Multivariate logistic regression, controlling for baseline maternal characteristics, was used to compare pregnancy complications and neonatal outcomes of pregnant women with thyroid cancer [International Classification of Diseases, ninth edition (ICD-9) code 193] diagnosed before or during pregnancy with those of the obstetric population without thyroid cancer. Results The study included 14,513,587 pregnant women, of which 581 women had a diagnosis of thyroid cancer (4/100,000). During the observation period, there was an upward trend in the prevalence of thyroid cancer among pregnant women, though not statistically significant (P = 0.147). Women with thyroid cancer were more likely to be Caucasian, belong to a higher income quartile, have private insurance, to be discharged from an urban teaching hospital and to have pre-gestational hypertension. Women with thyroid cancer had a greater chance of delivering vaginally, requiring transfusion of blood and developing venous thromboembolism (VTE). Neonates of mothers with thyroid cancer were not found to be at increased risk for the adverse neonatal outcomes examined, specifically, congenital malformations, intrauterine growth restriction, fetal death and preterm labor. Conclusion Pregnancies complicated by thyroid cancer have higher incidences of VTE and need for transfusions, with comparable overall newborn outcomes.

Inpatient burden of cervical and uterine cancer in the United States.

e17009 Background: Limited data on the inpatient burden of cervical and uterine cancer exist. Therefore, this study assessed inpatient mortality, length of stay (LOS), and costs among hospitalized cervical and uterine cancer patients. Methods: This was a retrospective analysis of the 2006–2015 Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS). Cervical and uterine cancer cases were identified using ICD-9 codes of 180.9 and 182.0 respectively. Patient demographics, hospital characteristics, and hospital outcomes (hospitalization rates, inpatient mortality, LOS, and costs) were examined. Multivariate logistic regression models were used to determine predictors of inpatient mortality. Generalized linear models were used to determine predictors of LOS and costs. Results: The analytic cohort included 67,429 cervical cancer and 74,394 uterine cancer cases resulting in 55.92 (±1.51) and 61.69 (±1.78) annual hospitalizations (per 100,000 women), respectively. The highest proportion of hospitalizations related to cervical and uterine cancer were among patients aged 45-65 years (38.9%, 45.7%), Caucasians (70.3%, 78.1%), having public insurance (59.6%, 67.4%), and admitted at large (63.3%, 63.1%), urban teaching (54.8%, 56.5%) hospitals. The mean LOS, proportion of patients who died during hospitalization, and hospital charges per stay were 4.22 (±0.02) days, 1.02%, and $9,646 (±$63.06) for cervical cancer and 4.39 (±0.02) days, 1.43%, and $10,790 (±65.47) for uterine cancer related hospitalizations. Age &gt; 65 years (vs 18-45 years) (OR: 3.656; 95% CI: 2.99 – 4.47), and higher Elixhauser mortality score (OR: 1.097; 95% CI: 1.09 – 1.10) were associated with higher inpatient mortality among cervical cancer patients. Predictors of inpatient mortality for uterine cancer were similar. Patient age, insurance, race, hospital size, urban (vs rural) location, region of the country, and Elixhauser mortality score emerged as significant predictors of LOS and cost per hospital discharge across both cancers. Conclusions: Cervical and uterine cancer are associated with considerable inpatient burden. There was considerable variation in inpatient mortality, LOS, and costs based on patient, hospital, and discharge level characteristics.

Neonatal outcomes of pregnancy‐associated breast cancer: Population‐based study on 11 million births

As the age at first pregnancy continues to rise in the United States so does the incidence of breast cancer diagnosed during pregnancy. Our objective was to evaluate temporal trends in the incidence of pregnancy-associated breast cancer (PABC) and to measure neonatal outcomes associated with PABC. We conducted a population-based cohort study using the 1999-2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from the United States. Logistic regression models, adjusted for maternal baseline characteristics, examined the effect of PABC on neonatal outcomes. There were 11846300 deliveries between 1999 and 2012, of which 772 cases of PABC were identified, resulting in an overall incidence of 6.5 cases/100000 pregnancies. There was a significant increase in the incidence of PABC during the study period (P<0.05). Women with PABC tended to be older, of white ethnicity, belong to a higher income quartile and to be treated in an urban teaching hospital. In pregnancies complicated by breast cancer, there was a greater risk of preterm delivery (OR 4.84, 95% CI 4.05-5.79) and preterm premature rupture of membranes (OR 1.79, 95% CI 1.06-3.05). No associations were observed between PABC and intrauterine growth restriction, congenital anomalies or intrauterine fetal demise. There is an uptrend in the incidence of PABC and therefore, the need for counseling these patients is also increasing. Although pregnancies with the diagnosis of maternal breast cancer are more prone to premature births, it is encouraging that these babies do not appear to be at increased risk for congenital anomalies, growth restriction, or fetal demise.

National trends in hospitalizations and outcomes in patients with alcoholic cardiomyopathy.

Numerous studies have shown conflicting results regarding the natural history and outcomes with alcoholic cardiomyopathy (AC). Determining the trends in hospitalization among patients with AC and associated outcomes will facilitate a better understanding of this disease. We conducted our analysis on discharge data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2002 through 2014. We obtained data from patients aged ≥18 years with diagnosis of "Alcoholic Cardiomyopathy." Death was defined within the NIS as in-hospital mortality. By using International Classification of Disease-9th edition-Clinical Modification (ICD-9CM) diagnoses and diagnosis-related groups different comorbidities were identified. We studied a total of 45 365 admissions among patients with AC. The absolute number of admissions decreased from 2002 to 2014 (3866-2834 admissions). In-hospital mortality was variable throughout study duration without a clinically relevant trend (Mean 4.5%, range 3.6%-5.6%). The patients were mostly male (87%) and Caucasian (50.5%). Commonest age groups involved were 45-59 years (46.7%) followed by 60-74 years (29.2%). Trends in associated comorbidities such as smoking, drug abuse, depression, and hypertension increased over the same time period. Among all admissions, almost half were for cardiovascular etiologies (48.9%) and heart failure (≈24%) was the commonest reason for hospital admission. While the overall admissions among patients with AC decreased over time, the proportion of patients with high-risk characteristics such as smoking, depression, and drug abuse increased. Patients aged 45 and older were largely affected and cardiovascular etiologies predominated among causes for admission.

Gastroparesis in Non-Diabetics: Associated Conditions and Possible Risk Factors

BackgroundGastroparesis is a syndrome characterized by delayed gastric emptying in the absence of any mechanical cause. While often associated with diabetes mellitus, most cases of gastroparesis are idiopathic. The purpose of the present paper is to review the co-morbid conditions that most likely associate with non-diabetic gastroparesis.MethodsThe Healthcare Cost and Utilization Project: Nationwide Inpatient Sample (HCUP-NIS) data were used from the year 2013 - 2014 and the Apriori algorithm was run on this subset of patients to identify what co-morbid conditions are most likely associated with gastroparesis.ResultsNotable conditions that were found to be most closely linked with gastroparesis were: chronic pancreatitis, end stage renal disease, irritable bowel syndrome, systemic lupus erythematosus, fibromyalgia, and venous thromboembolism. Some of the implications of these findings are briefly discussed.ConclusionsGastroparesis is strongly associated with multiple medical conditions which may be potential targets for treatment.

Pregnancy outcomes among women with asthma

Purpose: The purpose of this study is to examine the association between maternal asthma and pregnancy, delivery and neonatal outcomes.Materials and methods:We carried out a retrospective cohort study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database from 2003 to 2011. Among women who delivered during this time period, we compared pregnancy, delivery, and neonatal outcomes in asthmatics versus non-asthmatics. Multivariate logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals.Results: In a cohort of 7,772,999 pregnant women, 223,236 (2.9%) had asthma. The prevalence of asthma-complicated pregnancies rose over the study period from 1.9% in 2003 to 3.7% in 2011 (p < .001). Pregnant asthmatics had more pre-existing health conditions, such as diabetes, chronic hypertension, obesity, and thyroid disease, and were more likely to smoke. Even after adjustment for these comorbidities, and other covariates, within statistical models, asthma was found to be associated with greater risk of several pregnancy complications: gestational hypertension, preeclampsia, gestational diabetes, placenta previa, preterm premature rupture of membranes, placental abruption, chorioamnionitis, preterm delivery, postpartum hemorrhage, venous thromboembolism, caesarean section delivery, and maternal mortality. Neonates born to asthmatics had greater risk of being small for gestational age and for having congenital anomalies, and lower risk of intrauterine fetal death.Conclusions: Asthma is associated with an increase in adverse pregnancy, labor, and neonatal outcomes. Close surveillance of asthmatic patients during the prenatal period is warranted and care in a tertiary hospital is advised.

A Comparison of Childbirth Costs for Adolescents and Adults From 2001 to 2010

PurposeAlthough teenage birth rates in America have fallen to a historic low of 26.2 births per 1,000 teenagers, the U.S. remains behind the rest of the industrialized world. Adolescent pregnancy is relatively well discussed in today's literature, with ever more detailed estimates constantly emerging to quantify the cost of children born to America's teenagers. This study, however, describes the financial cost of childbirth in the U.S. with a specific focus on understanding the impact of adolescent childbirth in comparison to that of adult women and of annual childbirth as a whole. MethodsThis retrospective cohort study used data from the 2001–2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS), a uniform, multistate database containing information regarding approximately 8 million hospital inpatient stays per year of data. Data were analyzed involving payment type, length of stay, and aggregate cost of all childbirths to adolescent girls (under 18 years of age) and to adult women. ResultsThis study found that Medicaid pays for the majority (70%) of births to adolescent girls, whereas private insurance pays for the majority (53%) of births to adult women. This was in contrast to the Medicaid coverage of 41% of all childbirths within the study time frame. Furthermore, the aggregate cost of childbirths to adolescent girls paid for by Medicaid was $670 million. ConclusionsBeyond their social impact, births to adolescent mothers place a financial burden on the national economy. Stronger efforts must be made to decrease adolescent childbirth.

In-Hospital Mortality and Post-Surgical Complications Among Cancer Patients with Metabolic Syndrome.

Metabolic syndrome (MetS) is an important etiologic and prognostic factor for cancer, but few studies have assessed hospitalization outcomes among patients with both conditions. Data was obtained from the Healthcare Cost and Utilization project Nationwide Inpatient Sample (HCUP-NIS). Study variables were assessed using ICD-9 codes on adults aged 40years and over admitted to a US hospital between 2007 and 2011 with primary diagnosis of either breast, colorectal, or prostate cancer. We examined in-hospital mortality, post-surgical complications, and discharge disposition among cancer patients with MetS and compared with non-MetS patients. Hospitalized breast (OR: 0.31, 95% CI: 0.20-0.46), colorectal (OR: 0.41, 95% CI: 0.35-0.49), and prostate (OR: 0.28, 95% CI: 0.16-0.49) cancer patients with MetS had significantly reduced odds of in-hospital mortality. The odds of post-surgical complications among breast (OR: 1.20, 95% CI: 1.03-1.39) and prostate (OR: 1.22, 95% CI: 1.09-1.37) cancer patients with MetS were higher, but lower by 7% among colorectal cancer patients with MetS. Additionally, breast (OR: 1.21, 95% CI: 1.11-1.32) and colorectal (OR: 1.06, 95% CI: 1.01-1.11) cancer patients with MetS had significantly higher odds for discharge to a skilled nursing facility compared with those without MetS, but this was not statistically significant among prostate cancer patients. Adverse health outcomes were significantly higher among hospitalized patients with a primary diagnosis of cancer and MetS. Future studies are needed to identify clinical strategies for detecting and managing patients with MetS to reduce the likelihood of poor inpatient outcomes.

Sequential matched analysis of racial disparities in breast cancer hospitalization outcomes among African American and White patients

BackgroundThe purpose of this study is to determine if racial disparities in inpatient outcomes persist among hospitalized patients comparing African American and White breast cancer patients matched on demographics, presentation and treatment. MethodsA total of 136,211 African American and White breast cancer patients from the Healthcare Cost and Utilization Project − Nationwide Inpatient Sample (HCUP-NIS) database, matched on demographics alone, demographics and presentation or demographics, presentation and treatment were studied. Conditional logistic regression was conducted to evaluate post-surgical complications, length of stay and in-hospital mortality outcomes. Analysis was further stratified by age (≤65 years and >65years) to evaluate whether disparities were larger in younger or older patients. All analysis was conducted using SAS 9.3. ResultsWhite women had significantly shorter hospital length of stay when matched on demographics (β=−0.87, p-value=<0.0001), demographics and presentation (β=−0.63, p-value=<0.0001), and demographics, presentation and treatment (β=−0.51, p-value=<0.0001) compared with African Americans. White women also had lower odds of mortality compared with African American women when matched on demographics (OR: 0.72, 95% CI: 0.65-0.79), demographics and presentation (OR: 0.77, 95% CI: 0.71-0.85), or matched on demographics, presentation and treatment (OR: 0.80, 95% CI: 0.73-0.88). The racial difference observed in length of stay and mortality was larger in the age group ≤65 years compared with >65years ConclusionAfrican American women experienced higher odds of inpatient mortality and longer length of stay compared with White women even after accounting for differences in demographics, presentation and treatment characteristics.

Pregnancy Outcomes in Women With Neuromuscular Dystrophies: A Retrospective Study [34F

INTRODUCTION: Neuromuscular dystrophies (NMD) are a group of rare genetic diseases characterized by weakness and muscular wasting. Data on NMD in pregnancy is limited. Our aim is to determine the prevalence of muscular dystrophies at delivery, and related maternal and newborn outcomes. METHODS: Using the United States Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 1999 to 2013, we conducted a population-based retrospective cohort study to compare women with and without any form of NMD at delivery. We used multivariate logistic regression analyses to estimate the associated risks of maternal and neonatal outcomes. RESULTS: Of the 12,592,178 births in our cohort, 914 deliveries were to women carrying a NMD. Over the 15-year period, there was an increased prevalence rate from 3 to 10 cases per 100 000 deliveries per year (p &lt; 0.001). Births to women with NMD were more likely to be premature (OR 1.60, 95% CI 1.26-2.02), have intrauterine growth restriction (OR 2.08,95% CI 1.50-2.90) and congenital malformation (OR 4.93, 95% CI 3.30-7.38). Compared with controls, women with muscular dystrophies were more likely to deliver by cesarean section (OR 1.87,95% CI 1.62-2.17), have forceps assisted deliveries (OR 1.76, 95% CI 1.01-3.04), were at higher risk of major morbidities including cardiac dysrhythmia (OR 4.97,95% CI 3.02-8.20) and increased requirements for blood transfusion (OR 2.44,95% CI 1.56-3.83). CONCLUSION: Pregnancies in NMD patients are associated with an increased risk of maternal and fetal morbidities and, as such, they should be cared for in a tertiary care center.

Cost of bariatric surgery and factors associated with increased cost: an analysis of national inpatient sample

BackgroundIn the current healthcare environment, bariatric surgery centers need to be cost-effective while maintaining quality. ObjectiveThe aim of this study was to evaluate national cost of bariatric surgery to identify the factors associated with a higher cost. SettingA retrospective analysis of 2012–2013 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS). MethodWe included all patients with a diagnosis of morbid obesity (ICD9 278.01) and a Diagnosis Related Group code related to procedures for obesity, who underwent Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB) as their primary procedure. We converted “hospital charges” to “cost,” using hospital specific cost-to-charge ratio. Inflation was adjusted using the annual consumer price index. Increased cost was defined as the top 20th percentile of the expenditure and its associated factors were analyzed using the logistic regression multivariate analysis. ResultsA total of 45,219 patients (20,966 RYGBs, 22,380 SGs, and 1,873 AGBs) were included. The median (interquartile range) calculated costs for RYGB, SG, and AGB were $12,543 ($9,970–$15,857), $10,531 ($8,248–$13,527), and $9,219 ($7,545–$12,106), respectively (P<.001). Robotic-assisted procedures had the highest impact on the cost (odds ratio 3.6, 95% confidence interval 3.2–4). Hospital cost of RYGB and SG increased linearly with the length of hospital stay and almost doubled after 7 days. Furthermore, multivariate analysis showed that certain co-morbidities and concurrent procedures were associated with an increased cost. ConclusionFactors contributing to the cost variation of bariatric procedures include co-morbidities, robotic platform, complexity of surgery, and hospital length of stay.

Gastrointestinal manifestations associated with systemic sclerosis: results from the nationwide inpatient sample.

BackgroundSystemic sclerosis (SSc) is a multisystem disease associated with significant morbidity and increased mortality. The prevalence of different gastrointestinal (GI) manifestations has been investigated in multiple, but mainly small, retrospective studies. In this study, we investigated the prevalence and risk for a broad spectrum of GI disorders and malignancies in a large sample of inpatients with SSc in the United States.MethodsWe conducted a retrospective analysis using the 2010-2011 Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS). SSc patients were identified by ICD-9-CM code 710.1. Non-SSc patients (“controls”) were matched to cases 4:1 by age and sex. We examined demographics, clinical characteristics, and a range of GI conditions.ResultsFrom 15,824,031 total patients, 13,633 cases of SSc were matched to 54,532 controls. The prevalence of GI manifestations among SSc patients was 59.24% compared to 29.96% for controls (P<0.0001). Significantly elevated GI manifestations in SSc patients included dysphagia (4.3% vs. 1.9%, P<0.0001), esophageal reflux (34.8% vs. 15.4%, P<0.0001), Barrett’s esophagus (1.7% vs. 0.3%, P<0.0001), constipation (6% vs. 4.6%, P<0.0001), diarrhea (4.5% vs. 2.4%, P<0.0001), fecal incontinence (0.4% vs. 0.2%, P<0.0001), and celiac disease (0.2% vs. 0%, P<0.0001). Some GI disorders were significantly lower in SSc patients, including cholelithiasis (1.6% vs. 2.1%, P<0.0001) and GI malignancies (1% vs. 2.2%, P<0.0001).ConclusionsOur results emphasize the established association between SSc and esophageal disorders, such as dysphagia and reflux disease. Our analysis indicated a significant positive association between SSc and celiac disease, and a negative association between SSC and cholelithiasis.

The In-hospital Mortality Rate in Gastrointestinal Hemorrhage with Shock: A Nationwide Analysis

Introduction: Gastrointestinal bleeding that requires hospitalization leads to significant morbidity and mortality in the United States. Although incidence of hospital admissions due to upper GI bleeding is four to five times higher than lower GI bleeding yet mortality rate for both have been reported about the same ranging between 10 - 24% in both groups. However, only limited mortality data is available in such patients who have shock. We wanted to study mortality in both upper and lower GI bleed especially in patients especially those who had shock Methods: We conducted a retrospective analysis using the 2009-2013 Healthcare Cost and Utilization Project -Nationwide Inpatient Sample (HCUP-NIS). GI bleeding patients were identified by CCS diagnosis code 153. Upper GI bleed, lower GI bleed and patients in shock in each category were identified using ICD-9 diagnostic codes. We used SAS survey frequency procedure with discwt HCUP variable as weight to get national estimates. Chi-square test was used for comparison of categorical data.Figure 1Results: Our analysis consisted of about 1.82 million (1829295) cases with primary admission diagnosis of GI bleeding over five years. Overall, all-cause mortality rate in patients with shock was 17% compared to 2.2% in those without shock. Subgroup analysis by type of GI bleeding showed that mortality in cases of Upper GI bleeding (UGIB) with shock was 13.8 % compared to 1.88% in those without shock. Lower GI bleeding (LGIB) was noted to have all-cause mortality of 24.3 % in shock versus 2.67 % in those without shock. p- value for all observation was less than 0.0001. Conclusion: Our analysis showed that overall mortality rate in lower GI bleeding is higher than upper GI bleeding but mortality rate is much higher in patients with shock in both groups and early goal directed therapy might lead to improvement in mortality in this patient population.

Racial and socio-economic disparities in breast cancer hospitalization outcomes by insurance status

BackgroundBreast cancer remains a major cause of morbidity and mortality among women in the US, and despite numerous studies documenting racial disparities in outcomes, the survival difference between Black and White women diagnosed with breast cancer continues to widen. Few studies have assessed whether observed racial disparities in outcomes vary by insurance type e.g. Medicare/Medicaid versus private insurance. Differences in coverage, availability of networked physicians, or cost-sharing policies may influence choice of treatment and treatment outcomes, even after patients have been hospitalized, effects of which may be differential by race. PurposeThe aim of this analysis was to examine hospitalization outcomes among patients with a primary diagnosis of breast cancer and assess whether differences in outcome exist by insurance status after adjusting for age, race/ethnicity and socio-economic status. MethodsWe obtained data on over 67,000 breast cancer patients with a primary diagnosis of breast cancer for this cross-sectional study from the 2007–2011 Healthcare Cost and Utilization project Nationwide Inpatient Sample (HCUP-NIS), and examined breast cancer surgery type (mastectomy vs. breast conserving surgery or BCS), post-surgical complications and in-hospital mortality. Multivariable regression models were used to compute estimates, odds ratios and 95% confidence intervals. ResultsBlack patients were less likely to receive mastectomies compared with White women (OR: 0.80, 95% CI: 0.71–0.90), regardless of whether they had Medicare/Medicaid or Private insurance. Black patients were also more likely to experience post-surgical complications (OR: 1.41, 95% CI: 1.12–1.78) and higher in-hospital mortality (OR: 1.57, 95%: 1.21–2.03) compared with White patients, associations that were strongest among women with Private insurance. Women residing outside of large metropolitan areas were significantly more likely to receive mastectomies (OR: 1.89, 95% CI: 1.54–2.31) and experience higher in-hospital mortality (OR: 1.74, 95% CI: 1.40–2.16) compared with those in metropolitan areas, regardless of insurance type. ConclusionAmong hospitalized patients with breast cancer, racial differences in hospitalization outcomes existed and worse outcomes were observed among Black women with private insurance. Future studies are needed to determine factors associated with poor outcomes in this group of women, as well as to examine contributors to low BCS adoption in non-metropolitan areas.

National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis With Policy Implications

To determine which factors are associated with higher costs of urethroplasty procedure and whether these factors have been increasing over time. Identification of determinants of extreme costs may help reduce cost while maintaining quality. We conducted a retrospective analysis using the 2001-2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). The HCUP-NIS captures hospital charges which we converted to cost using the HCUP cost-to-charge ratio. Log cost linear regression with sensitivity analysis was used to determine variables associated with increased costs. Extreme cost was defined as the top 20th percentile of expenditure, analyzed with logistic regression, and expressed as odds ratios (OR). A total of 2298 urethroplasties were recorded in NIS over the study period. The median (interquartile range) calculated cost was $7321 ($5677-$10,000). Patients with multiple comorbid conditions were associated with extreme costs [OR 1.56, 95% confidence interval (CI) 1.19-2.04, P = .02] compared with patients with no comorbid disease. Inpatient complications raised the odds of extreme costs (OR 3.2, CI 2.14-4.75, P <.001). Graft urethroplasties were associated with extreme costs (OR 1.78, 95% CI 1.2-2.64, P = .005). Variations in patient age, race, hospital region, bed size, teaching status, payor type, and volume of urethroplasty cases were not associated with extremes of cost. Cost variation for perioperative inpatient urethroplasty procedures is dependent on preoperative patient comorbidities, postoperative complications, and surgical complexity related to graft usage. Procedural cost and cost variation are critical for understanding which aspects of care have the greatest impact on cost.

Trends of hospitalization for schizoaffective disorder (SD) in USA: A nationwide analysis

ObjectivesSchizoaffective disorder (SD) is an important cause of morbidity and mortality in hospitalized patients. While SD has been extensively studied in the past, the contemporary data for impact of SD on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 4,66,800 patients were analyzed; 50.90% were female and 49.10% male (P &lt; 0.0001); 61.15% were white, 25.97% black and 12.88% of other race (P &lt; 0.0001). Rate of hospitalization increased from 13,035.05/million to 26,703.21/million from 1998–2011. Overall mortality was 0.50% and mean cost of hospitalization was 20,995.19$. The in-hospital mortality increased from 0.46% to 0.50% (P &lt; 0.0001) and mean cost of hospitalization increased from 11,504.94$ to 31,460.67$. Total spending on SD related admissions increased from $1.2 billion/year to $6.6 billion/year.ConclusionsWhile mortality has slightly increased from 1998 to 2011, the cost has significantly increased from $1.2 billion/year to $6.6 billion/year which leads to an estimated $5.4 billion/year additional burden to US health care system. In the era of cost conscious care, preventing SD related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for SD related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Trends of hospitalization for anorexia nervosa in USA: A nationwide analysis

ObjectivesAnorexia Nervosa (AN) is an important cause of morbidity and mortality in hospitalized patients. While AN has been extensively studied in the past, the contemporary data for impact of AN on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998-2011 using the ICD-9 codes for AN. Severity of co-morbid conditions was defined by Deyo modification of Charlson co-morbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, chi-square test, t-test and Cochran-Armitage test were used to test significance.Results28,150 patients were analyzed. 93.94% were female and 6.06% were male (P &lt; 0.0001). 88.67% were white, 2.93% were black and 8.4% were of other race (P &lt; 0.0001). Rate of hospitalization decreased from 1530/million to 1349.5/million from 1998-2011. Overall mortality was 0.78% and mean cost of hospitalization was 25,829.82$. The in-hospital mortality reduced from 0.95% to 0.44% (P &lt; 0.0001) and mean cost of hospitalization increased from 11,956.55$ to 39,831.51$. Total yearly spending on AN related admissions increased from $145.33 million/year to $420.61 million/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $145.33 million/year to $420.61 million/year, which leads to an estimated $275.28 million additional burden to the US health care system. In the era of cost conscious care, preventing AN related Hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for AN related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Trends of hospitalization for schizophreniform disorder in USA: A nationwide analysis

ObjectivesSchizophreniform disorder (SD) is an important cause of morbidity and mortality in hospitalized patients. While SD has been extensively studied in the past, the contemporary data for impact of SD on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 8645 patients were analyzed; 36.21% were female and 63.79% were male (P &lt; 0.0001); 49.04% were white, 39.06% black and 19.9% of other race (P &lt; 0.0001). Rate of hospitalization decreased from 599.22/million to 394.47/million from 1998–2011. Overall mortality was 0.23% and mean cost of hospitalization was 17930.23. The in-hospital mortality reduced from 0.21% to 0.15% (P &lt; 0.0001) and mean cost of hospitalization increased from 9662.88$ to 27,749.68$ from 1998–2011. Total spending on SD related admissions have increased from $47.59 million/year to $853.83 million/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $47.59 million/year to $853.83 million/year, which leads to an estimated $806.24 million/year additional burden to US health care system from 1998 to 2011. In the era of cost conscious care, preventing SD related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for SD related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Trends of hospitalization for bipolar I in USA: A nationwide analysis

ObjectivesBipolar I (B-I) is an important cause of morbidity and mortality in hospitalized patients. While B-I has been extensively studied in the past, the contemporary data for impact of B-I on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 1,80,681 were analyzed; 56.29% were female and 43.71% were male (P &lt; 0.0001); 70.63% were white, 17.14% black and 12.23% of other race (P &lt; 0.0001). Rate of hospitalization increased from 7469.65/million to 9375.27/million from 1998–2011. Overall mortality was 0.12% and mean cost of hospitalization was 19,821.50$. The in-hospital mortality increased from 0.13% to 0.16% (P &lt; 0.0001) and mean cost of hospitalization increased from 12,091.31$ to 29,292.97$. Total yearly spending on B-I related admissions increased from $0.72 million/year to $2.16 billion/year.ConclusionsWhile mortality has slightly increased from 1998 to 2011, the cost has significantly increased from $0.72 million/year to $2.16 billion/year, which leads to an estimated $1.46 billion/year additional burden to US health care system. In the era of cost conscious care, preventing B-I related Hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for B-I related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.