Higher Admission Costs Research Articles

The economic impact of a COVID-19 illness from the perspective of families seeking care in a private hospital in India.

The Covid-19 pandemic had a tremendous impact that caused significant morbidity, mortality, and financial stress for families. Our study aimed to determine the Out-of-pocket expenses and economic impact of a Covid-19 illness for households where patients were admitted to a private hospital in India. This was a cost-of-illness study from a tertiary care academic institute where adult patients diagnosed with COVID-19 from May 2020 to June 2021 were included. Patients with an admission of less than one day or who had any form of insurance were excluded. The clinical and financial details were obtained from the hospital information system and a cross-sectional survey. This was stratified across three clinical severity levels and two epidemiological waves. The final analysis included 4445 patients, with 73 % admitted in Wave 1 and 99 patients interviewed. For patients with severity levels 1, 2 and 3, the median admission days were 7, 8 and 13 days respectively. The total cost of illness (general category) was $934 (₹69,010), $1507 (₹111,403) and $3611 (₹266,930) and the direct medical cost constituted 66%, 77% and 91% of the total cost for each level respectively. Factors associated with higher admission costs were higher age groups, male gender, oxygen use, ICU care, private admission, increased duration of hospital stay and Wave 2. The median annual household income was $3247 (₹240,000) and 36% of families had to rely on more than one financial coping strategies, loans with interest being the commonest one. The lockdown period affected employment and reduced income for a considerable proportion of households. A Covid admission of higher severity was a significant financial burden on families. The study reaffirms the need for collaborative and sustainable health financing systems to protect populations from hardships.$-US Dollar; ₹- Indian Rupees.

Incidence and medical costs of chronic obstructive respiratory disease in Spanish hospitals: a retrospective database analysis

ObjectiveThis study aimed to assess the comorbidity profile, use of health care resources and medical costs of patients with chronic obstructive pulmonary disease (COPD) treated at the hospital level in Spain.MethodsAdmission records of patients with COPD and at least two admissions registered between January 2016 and December 2020 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study.Results95,140 patients met the inclusion criteria; 69.1% were males with a median age of 75 years. Mean Charlson comorbidity index (CCI) was 1.9 in the index admission, increasing to 2.1 during the follow-up period. An acute exacerbation of COPD was registered in 93.6% of patients in the index admission; other secondary diagnoses included respiratory failure (56.8%), essential hypertension (36.9%), hypercholesterolemia (26.7%) and diabetes (26.3%). The age-adjusted incidence rate of COPD was 22.6 per 10,000 persons over the study period, decreasing significantly in the year 2020. Mortality rate was 4.1% for COPD patients, increasing to 6.6% in the year 2020. The year 2020, 191 patients registered a COVID-19 infection, with a mortality rate of 23.0%. Length of hospital stay, and intensive care unit (ICU) stay increased in the follow-up period versus the index admission, similar to admission costs. Mean admission cost was €3212 in the index admission, with cost increases being associated with age, length of stay, ICU stay and CCI.ConclusionsPatients’ condition worsened significantly over the follow-up period, in terms of comorbidity and dependence on respirator, with an increased mortality rate and higher admission costs.

Effect of holiday admission on clinical outcome of patients with upper gastrointestinal bleeding: A real-world report from Thailand

BackgroundHoliday admissions are associated with poorer clinical outcomes compared with non-holiday admissions. However, data remain inconsistent concerning the “holiday effect” for patients with upper gastrointestinal bleeding. This study compared the differences between clinical courses of patients with upper gastrointestinal bleeding who were admitted on holidays and non-holidays in Thailand. MethodsWe retrospectively reviewed the medical records of patients with upper gastrointestinal bleeding confirmed by endoscopy who were admitted on holidays and non-holidays between January 2016 and December 2017. Mortality, medical resource usage, time to endoscopy, and clinical outcomes were compared between the groups. ResultsIn total, 132 and 190 patients with upper gastrointestinal bleeding were admitted on holidays and non-holidays, respectively. Baseline characteristics, diagnosis of variceal bleeding, and pre-and post-endoscopic scores were not different between the two groups. Patients admitted on non-holidays were more likely to undergo early endoscopy, within 24 h of hospitalization (78.9% vs. 37.9%, p < 0.001), and had a shorter median time to endoscopy (median [interquartile range]: 17 [12–23] vs. 34 [17–56] h, p < 0.001) than those admitted on holidays. No significant differences in in-hospital mortality rate, number of blood transfusions, endoscopic interventions, additional interventions (including angioembolization and surgery), and length of stay were observed. Patients admitted on holidays had increased admission costs than those admitted on non-holidays (751 [495–1203] vs. 660 [432–1028] US dollars, p= 0.033). After adjusting for confounding factors, holiday admission was a predictor of early endoscopy (adjusted odds ratio 0.159; 95% confidence interval, 0096–0.264, p < 0.001), but was not associated with in-hospital mortality or other clinical outcomes. ConclusionsPatients with upper gastrointestinal bleeding who were admitted on holidays had a lower rate of early endoscopy, longer time to endoscopy, and higher admission cost than those admitted on non-holidays. Holiday admission was not associated with in-hospital mortality or other clinical outcomes.

Does Hospital Teaching Status Affect the Outcomes of Patients Undergoing Anterior Cervical Discectomy and Fusion?

Teaching hospitals are responsible for the training and education of residents and have been centers of research and advancement in an era of evidence-based medicine. Several studies have reported conflicting findings regarding the effects of teaching status on the outcomes of patients. In the present study, we aimed to identify the differences in surgical outcomes among patients who had undergone anterior cervical discectomy and fusion (ACDF) between teaching and nonteaching hospitals. We queried the National Inpatient Sample for 2012-2015. We identified patients with cervical degenerative disease who had undergone single-level ACDF using the International Classification of Disease, 9th revision, diagnosis and procedure codes. One-to-one propensity score matching was conducted, using appropriate and clinically relevant variables. Stepwise multivariable logistic regression was performed to assess the effect of teaching status on the outcomes of interest. Finally, a marginal effect analysis was conducted to compare the differences in admission costs stratified by teaching status within each insurance type. A total of 52,212 patients who had undergone elective ACDF from 2012 to 2015 were identified and matched, with 26,106 patients in each group. On multivariable regression, after adjusting for demographics and hospital characteristics, teaching hospitals were associated with greater odds of nonroutine discharge (odds ratio, 1.25; P < 0.001) and higher admission cost (coefficient, 414.31; P= 0.002). However, teaching status was not associated with inpatient mortality or morbidity. The marginal effect analysis results indicated that privately insured patients incurred greater costs in nonteaching hospitals. Our results have shown that patients undergoing ACDF at nonteaching hospitals had a greater odds of routine discharge and higher admission costs compared with those at teaching hospitals but similar outcomes in terms of inpatient mortality and morbidity.

Predictors of adverse outcomes and cost after surgical management for idiopathic normal pressure hydrocephalus: Analyses from a national database

IntroductionWe utilized a national administrative database to investigate drivers of immediate adverse economic and hospital outcomes, including non-routine discharge, prolonged length of stay (LOS), and admission costs among patients undergoing surgery for idiopathic normal pressure hydrocephalus (iNPH). MethodsThe National Inpatient Sample (NIS) was queried from 2007 to 2017 for patients aged ≥60 with a diagnosis code for iNPH undergoing surgery. Multivariable logistic-regression models and Wald χ2 were used to identify drivers of non-routine discharge, prolonged length of stay (LOS) (>75th percentile) and higher admission costs (>90th percentile). ResultsA total of 13,363 patients with iNPH undergoing surgical management were identified. The most common comorbidity reported in the cohort was a cardiovascular pathology (56.9 %, n = 7,787), followed by urinary pathology (37.2 %, n = 5,084), osteoarthritis (7.8 %, n = 1,071), Alzheimer’s disease (4.6 %, n = 626) and cerebrovascular pathology (4.2 %, n = 569). The most frequently employed procedure was ventriculo-peritoneal (VP) shunt placement (65.6 %, n = 8,942) of which 89.8 % (n = 8,027) were performed open and 10.2 % (n = 915) laparoscopically. This was followed by lumbo-peritoneal (LP) shunting (15.5 %, n = 2,115), lumbar puncture alone (screened, serial CSF removal) (14.8 %, n = 2,013), endoscopic third ventriculostomy (ETV) (2%, n = 274), ventriculo-atrial (VA) shunt (0.95 %, n = 130) and ventriculo-pleural (Vpleural) shunt (0.46 %, n = 64). The median (IQR) LOS was 3 days (2–5), the rate of non-routine discharge was 37.3 % and median (IQR) cost was $11,230 ($7,735–15,590).On multivariable-analysis, emergent-admission (OR 2.91), older age (76–90: OR 1.55; 90+: OR 2.66), VP shunt (open: OR 3.09; laparoscopic: OR 2.32), ETV (OR 3.16), VA/VPleural shunt (OR 2.73) and hospital admission in Northeast-region compared to Midwest (OR 1.27) were found to be associated with increased risk of non-routine discharge. Some of the highly significant associated factors for prolonged LOS included emergent-admission (OR 11.34), ETV (OR 10.92), VA/VPleural shunt (OR 7.79) and open VP shunt (OR 8.24). For increased admission costs, some of the highly associated factors included VA/VPleural shunt (OR 18.48), laparoscopic VP shunt (OR 9.92), open VP shunt (OR 12.72) and ETV (OR 9.34). Predictor importance analysis revealed emergent admission, number of diagnosis codes (comorbidities) open VP shunt, hospital region, age] and revision or removal of shunt to be the most important drivers of these outcomes. ConclusionAnalyses from a national database indicate that among patients with iNPH, an emergent-admission may be the most significant risk-factor of adverse economic outcomes and higher costs.

Clinical predictors of adverse events during continuous video-EEG monitoring in an epilepsy unit.

Patients admitted to epilepsy monitoring units (EMUs) for diagnostic and presurgical evaluation have an increased risk of seizure-related injury, particularly in the many cases in which medication is withdrawn. The purpose of this study was to assess the prevalence of adverse events (AEs) in this setting and to analyse associated clinical factors and costs. We evaluated consecutive patients admitted to an EMU at a tertiary care hospital over a 10-year period based on a descriptive, longitudinal study. We analysed the occurrence of AEs (traumatic injury, psychiatric complications, status epilepticus, cardiorespiratory disturbances, and death), investigated potential risk factors using univariate and multivariate logistic regression analysis, and compared admission costs between patients with and without AEs. In total, 411 EMU admissions were studied corresponding to 352 patients (55% women; mean [SD] age: 41.7 [12.1] years). Twenty-five patients (6%) experienced an AE. The most common event was traumatic injury (n=9), followed by status epilepticus (n=8), psychiatric complications (n=7), and cardiorespiratory disturbances (n=1). On comparing patients with and without AEs, we observed that the former were more likely to experience generalized seizures (OR: 7.81; 95%CI: 3.51-12.23; p<0.001) or have more seizures overall during admission (OR: 3.2; 95%CI: 1.42-6.8; p=0.002). Patients with AEs also had longer EMU stays (6.91 [2.64] vs 5.08 [1.1]; p=0.004), longer hospital stays (8.45 [3.6] vs 5.18 [1.2]; p<0.001), and higher costs (€7277.71 [€2743.9] vs €5175.7 [€1182.5]; p<0.001). Patients with generalized seizures and more seizures during admission were at greater risk of AEs, which were associated with higher admission costs.

Trends and Outcomes of Gastrointestinal Bleeding Among Septic Shock Patients of the United States: A 10-Year Analysis of a Nationwide Inpatient Sample.

IntroductionGastrointestinal bleeding (GIB) complicating septic shock (SS) presents a therapeutic challenge in intensive care units. Large-scale data regarding utilization, length of stay, and cost outcomes of this association are lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample from 2003 to 2012, and identified all adult patients aged ≥18 years hospitalized for SS by the International Classification of Diseases, Ninth Revision (ICD-9) diagnostic code for SS and GIB. We compared the baseline characteristics and outcomes among patients with SS plus GIB to patients with SS without GIB.ResultsThe weighted sample size from 2003 to 2012 was 119,684 admissions for SS. Among them, 6,571 (5.4%) patients were found to have a GIB. The mean age of the SS population with and without GIB was (mean/standard error of mean) [70.85 (0.43) vs. 67.43 (0.13) P < 0.001, respectively]. The incidence of GIB over the course of 10 years has remained stable; however, the mortality associated with GIB among SS patients is found to be declining especially from 2008 (59.2%) to 2012 (45.1%) (P < 0.01). Patients with SS and GIB compared to patients with SS and no GIB were found to have a longer length of stay [20.56 (0.61) vs. 15.76 (0.13) P < 0.001], higher mortality [54% vs. 45% P < 0.001], and higher admission costs in United States dollar ($) (mean/SEM) [$192,524.89 (7,378.20) vs. $142,688.55 (1,336.65) P < 0.001]. Univariate analysis demonstrated that comorbid conditions like peptic ulcer disease and cirrhosis had significant odds ratios {1.56 and 1.709, P = 0.016 and 0.046 respectively} for the occurrence of GIB with SS. Gastroesophageal reflux disease was found to be associated with a lower incidence of GIB [odds ratio: 0.57, P = 0.0008]. The cause of sepsis (pneumonia, urinary tract infection, or abdominal infections) was not a significant distinguishing factor for the incidence of GIB in SS.ConclusionGIB continues to affect the patients with SS admitted in intensive care units in the United States. We found an incidence of 5.4% of GIB in patients with SS, and it was associated with worse outcomes.

Incidence and Predictors of GI Bleeding Among Septic Shock Patients of United States: A 10-Year Analysis of Nationwide Inpatient Population

SESSION TITLE: Sepsis & Septic Shock SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 29, 2017 at 01:30 PM - 03:00 PM PURPOSE: Gastrointestinal bleeding (GIB) complicating septic shock(SS) presents a therapeutic challenge in the intensive care units. Contemporary large-scale data regarding utilization, length of stay, and cost outcomes of this association are lacking. The purpose of this study is to analyze trends, outcomes and risk factors associated with GIB in patients with SS. METHODS: We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample from 2003 to 2012 we identified all adult patients aged ≥18 years hospitalized for septic shock by the following criteria previously validated by recently presented data of the same database (BMC Infectious diseases 2016 10.1186): 1) primary ICD-9 diagnosis of infection associated with sepsis plus vasopressor use, or 2) primary ICD-9 diagnosis of infection associated with sepsis plus a non-primary diagnosis of septic shock, or 3) primary ICD-9 diagnosis of septic shock. We compared the baseline characteristics and outcomes among patients with SS plus GIB to patients with SS without GIB. Measured outcomes included length-of-stay, mortality and cost of hospitalization. Comorbidities were assessed with a univariate logistic regression to determine associated risk factors for GIB among SS patients. A multivariate analysis was also performed to address any confounders. RESULTS: The weighted sample size from 2003 to 2012 was 119684 admissions for SS. Among them, 6571(5.4%) patients were found to have a GIB. Mean age of the SS population with and without GIB was Age (mean/SEM) {70.85 (0.43) vs. 67.43 (0.13) P<0.001} respectively. The incidence of GIB among black (6.8%) septic patients was higher compared to white (5.3%) or Hispanic (5.9%) P<0.001. No significant difference in the occurrence of GIB between males and females respectively {5.6% vs. 5.7% P=0.653}. Patients with SS and GIB compared to patients with SS and no GIB were found to have longer length of stay {20.56 (0.61) vs. 15.76 (0.13) P<0.001}, higher mortality {54% vs. 45% P<0.001} and higher admission costs (mean/SEM) {192524.89 (7378.20) vs. 142688.55 (1336.65) P<0.001}. Univariate analysis demonstrated that major comorbid conditions associated with an increased incidence of GIB in septic patients included peptic ulcer disease and cirrhosis which both had significant odds ratios {1.56 and 1.709, P=0.016 and 0.046 respectively}. Gastroesophageal reflux disease was found to be associated with a lower incidence of GIB {OR: 0.57, P=0.0008}. The cause of sepsis (pneumonia, urinary tract infection or abdominal infections) was not a significant distinguishing factor for the incidence of GIB in SS. CONCLUSIONS: GIB among SS patients is associated with 9% increase in mortality compared to no GIB, with increased length of stay and cost burden. The risk of GIB in Septic Shock patients is perhaps more related to the baseline patient characteristics and comorbid illness than to the etiology of sepsis. CLINICAL IMPLICATIONS: To the author's knowledge this is the first nationwide extensive study analyzing the association of GIB and SS in US inpatient population. Awareness of the risk factors and association of GIB among SS patients may help to improve the outcomes by institution of agressive prophylactic measures among high risk patients. DISCLOSURE: The following authors have nothing to disclose: Abdul Siddiqui, Faraz Siddiqui, Saqib Abbasi, Tahir Khan, Moiz Ahmed, Sana Alhajri, Shimshon Wiesel, Naureen Narula, Asma Memon, Michel Chalhoub No Product/Research Disclosure Information

Comparison of Health Care Costs Between Claimants and Nonclaimants in the No-Fault Compensation System of Finland.

ObjectivesIf patients experience health care–related adverse events, they may claim for compensation. Adverse events of claimants are generally more severe and presumably involve higher health care costs than those of nonclaimants. The aim of this study was to estimate the cost differential between claimants and nonclaimants in the no-fault system in Finland.MethodsWe compiled register data on patients having had coronary artery bypass grafting (CABG, n = 20,500), total hip arthroplasty (n = 17,506), or knee arthroplasty (TKA, n = 18,512) and calculated risk-adjusted cost differentials by using a gamma distributed, log-linked generalized linear model. The explained variable comprised costs, whereas the main explanatory variables were whether the patient filed a claim and whether he or she received compensation.ResultsUncompensated claimants had higher admission costs (CABG, €3660, 29%; total hip arthroplasty, €418, 5%; TKA, €359, 4%) compared with nonclaimants, whereas the differential between compensated claimants and uncompensated claimants was statistically insignificant. Significant associations emerged concerning CABG 1-year costs: uncompensated claimants had €12,990 (71%) higher costs than nonclaimants, whereas compensated claimants had €6388 (20%) higher costs than uncompensated claimants.ConclusionsAlthough the precise cost differentials may be specific to Finland, the implications may apply also to other countries. (1) Excess costs of claimants should motivate efforts to reduce adverse events. (2) Analyses of claims to improve patient safety should not be restricted to compensated claims only but should equally concern uncompensated claims. A further implication regarding Finland is that additional approaches to identify and report adverse events are necessary.

Initial blood pressure is associated with stroke severity and is predictive of admission cost and one-year outcome in different stroke subtypes: a SRICHS registry study.

BackgroundTo investigate if initial blood pressure (BP) on admission is associated with stroke severity and predictive of admission costs and one-year-outcome in acute ischemic (IS) and hemorrhagic stroke (HS).MethodsThis is a single-center retrospective cohort study. Stroke patients admitted within 3 days after onset between January 1st and December 31st in 2009 were recruited. The initial BP on admission was subdivided into high (systolic BP ≥ 211 mmHg or diastolic BP ≥ 111 mmHg), medium (systolic BP 111–210 mmHg or diastolic BP 71–110 mmHg), and low (systolic BP ≤ 110 mmHg or diastolic BP ≤ 70 mmHg) groups and further subgrouped with 25 mmHg difference in systole and 10 mmHg difference in diastole for the correlation analysis with demographics, admission cost and one-year modified Rankin scale (mRS).ResultsIn 1173 IS patients (mean age: 67.8 ± 12.8 years old, 61.4 % male), low diastolic BP group had higher frequency of heart disease (p =0.001), dehydration (p =0.03) and lower hemoglobin level (p <0.001). The extremely high and low systolic BP subgroups had worse National Institutes of Health Stroke Scale (NIHSS) score (p =0.03), higher admission cost (p <0.001), and worse one-year mRS (p =0.03), while extremely high and low diastolic BP subgroups had higher admission cost (p <0.01). In 282 HS patients (mean age: 62.4 ± 15.4 years old, 60.6 % male), both low systolic and diastolic BP groups had lower hemoglobin level (systole: p =0.05; diastole: p <0.001). The extremely high and low BP subgroups had worse NIHSS score (p =0.01 and p <0.001, respectively), worse one-year mRS (p =0.002 and p =0.001, respectively), and higher admission cost (diastole: p <0.002).ConclusionsStroke patients with extremely high and low BP on admission have not only worse stroke severity but also higher admission cost and/or worse one-year outcome. In those patients with low BP, low admission hemoglobin might be a contributing factor.

Aortic Valve Replacement in Heart Failure Patients: Full Sternotomy or Minimally Invasive Access?

predicts length of stay, 14.6% of the variability in LOS was attributed to preoperative nutrition and inotropes, (R50.14; p!.001) The nutritional coefficient was -0.288 (p-value 5 0.001) and inotrope use coefficient was 0.246 (p-value 5 0.013) (Fig. A). There was a trend towards higher costs for patients with a serum albumin !3g/dL (HR .85; p!.07). Patients on inotropes had a 38% higher admission cost (HR 1.38; p!.001). Patients on inotropes with a serum albumin greater than 3g/dL had 22% (HR .78; p!.024) lower admission costs than those who were malnourished. The addition of inotropes to a malnourished patient had 54% higher admission costs (HR 1.54; p!.001). In contrast, patient’s receiving MCS with normal serum albumin and the addition of inotropes did not significantly add to costs (HR 1.25; p!.068). Conclusion: We identified a novel finding in patients undergoing durable MCS. Cardiac cachexia compounded the length of stay in the heart failure population receiving mechanical circulatory support. We suggest a thorough nutritional assessment prior to MCS placement. Nutritional status may assist surgeons and cardiologist in choosing the optimal timing of intervention to shorten LOS and resource utilization.

Dehydration is an independent predictor of discharge outcome and admission cost in acute ischaemic stroke.

Our aim was to investigate the influence of admission dehydration on the discharge outcome in acute ischaemic and hemorrhagic stroke. Between January 2009 and December 2011, 4311 ischaemic and 1371 hemorrhagic stroke patients from the stroke registry of Chang Gung healthcare system were analyzed. The eligible patients were identified according to inclusion/exclusion criteria. In total, 2570 acute ischaemic and 573 acute hemorrhagic stroke patients were finally recruited. According to the blood urea nitrogen (BUN) to creatinine (Cr) ratio (BUN/Cr), these patients were divided into dehydrated (BUN/Cr ≥ 15) and non-dehydrated (BUN/Cr < 15) groups. Demographics, admission costs and discharge outcomes including modified Rankin scale (mRS) and Barthel index (BI) were examined. Data were analyzed using multivariate analysis of two-stage least squares including logistic and linear regression. Acute ischaemic stroke with admission dehydration had higher infection rates (P = 0.006), worse discharge BI (62.8 ± 37.4 vs. 73.4 ± 32.4, P < 0.001, adjusted P < 0.001), worse mRS (2.7 ± 1.6 vs. 2.3 ± 1.5, P < 0.001, adjusted P = 0.009) and higher admission costs (2470.8 ± 3160.8 vs. 1901.2 ± 2046.8 US dollars, P < 0.001, adjusted P = 0.013) than those without dehydration. However, acute hemorrhagic stroke with or without admission dehydration showd no difference in admission costs (P = 0.618) and discharge outcomes (BI, P = 0.058; mRS, P = 0.058). Admission dehydration is associated with worse discharge outcomes and higher admission costs in acute ischaemic stroke but not in hemorrhagic stroke.