Higher Hospital Costs Research Articles

Neonatal inpatient stays longer than one year: Who was admitted, what happened, and how much did it cost?

Background Anecdotal evidence suggests that some preterm infants remain hospitalized for more than a year, but little is known about this population. We aimed to describe the characteristics, the hospital course, and the hospital costs for preterm hospitalizations with length of stay (LOS) ≥365 days. Methods This was a retrospective, descriptive cohort study of the 2016 and 2019 Kids Inpatient Database. ICD-10 codes were used to identify preterm infants, their comorbidities, and surgical interventions. The study population was dichotomized into LOS ≤364 days (PT364) and LOS ≥365 days (PT365) and compared using Chi-square or Mann-Whitney U test as appropriate. The exposure was PT365, and the outcomes were the characteristics, comorbidities, discharge disposition, and inflation-adjusted hospital costs. Results Among 688,995 preterm infants, 111 had LOS ≥365 days (0.016%). Compared to PT364, PT365 were more likely to be males (74.6% vs 53.2%), of gestational age ≤27 weeks (71.5% vs 4.7%), and <1000 gm birthweight (64.2% vs 4.0%). PT365 were more likely to have a higher prevalence of comorbidities in each organ system, surgical and procedural interventions, and neonatal chronic complex conditions (872% vs 13.3%). PT365 were less likely to be discharged home (45.7% vs 93.4%) and more likely to be discharged to home healthcare (28.0% vs 5.7%) or to a skilled nursing facility (16.0% vs 0.8). The median hospital cost per surviving PT365 was $1,616,336. Conclusion PT365 was rare but was associated with complex chronic conditions, increased morbidity and surgical burden, and high inflation-adjusted hospital costs.

Directional Freeze-Casting Cryogel Loaded with Quaternized Chitosan Modified Gallium Metal-Organic Frameworks to Capture and Eradicate the Resistant Bacteria for Guided Regeneration in Infected Bone Defects.

Antimicrobial resistance and impaired bone regeneration are the great challenges in treating infected bone defects. Its recurrent and resistant nature, high incidence rate, long-term hospitalization, and high medical costs have driven the efforts of the scientific community to develop new therapies to improve the situation. Considering the complex microenvironment and persistent mechanisms mediated by resistant bacteria, it is crucial to develop an implant with enhanced osseointegration and sustained and effective infection clearance effects. Here, a positively charged quaternized chitosan (QCS) coated gallium-based metal-organic framework (GaMOF) is designed, to capture the antibiotic-resistant bacteria (Methicillin-resistant Staphylococcus aureus, MRSA) as a "captor", and rejuvenate Methicillin (Me) via disturbing the tricarboxylic acid (TCA) cycle. Then, a radially oriented porous cryogel loaded with the Me and QCSGaMOF is fabricated by the directional freeze-casting method. The oriented porous structure has an enhanced osseointegration effect by guiding the ingrowth of osteogenic cells. In vitro and in vivo experiments prove the advantages of as-prepared Me/QCSGa-MOF@Cryogel in combating resistant bacteria and guiding bone regeneration in infected bone defects.

Evaluation of disparities in hospitalisation outcomes for deaf and hard of hearing patients with COVID-19: a multistate analysis of statewide inpatient databases from Florida, Maryland, New York and Washington

ObjectiveInvestigate whether deaf or hard of hearing (D/HH) patients with COVID-19 exhibited different hospitalisation outcomes compared with hearing patients with COVID-19.DesignCohort studySettingStatewide Inpatient Databases for Florida, Maryland, New York and...

Reducing Surgical Site Infections With Silver Impregnated Dressings in Lower Extremity Bypass Patients.

Surgical site infection (SSI) after lower extremity (LE) bypass surgery is associated with longer length of stay, higher hospital cost, increased morbidity, and even graft loss. Silver impregnated dressings have been used by other surgical subspecialties to decrease SSI with reported success. The National Surgical Quality Improvement Program (NSQIP) published a national expected rate of 7.9% for SSI after open LE bypass surgery in 2018. Our institutional SSI rate in 2018 was 12.8%. In order to reduce this rate, we transitioned to silver impregnated dressings for all LE bypass procedures and studied any subsequent changes in rates of SSI. We used NSQIP data to retrospectively study two consecutive cohorts of vascular surgery patients at a single institution who underwent LE bypasses. Inclusion criteria were open infrainguinal LE bypass patients who were selected via Current Procedural Terminology codes. Patients in 2019 who underwent LE bypass received dry sterile dressing (DSD) postoperatively. Patients in 2020 who underwent LE bypass were treated with silver impregnated dressings postoperatively. NSQIP criteria were used to determine if patients in both cohorts developed SSIs within 30d of surgery. Fischer's exact and Χ2 test were used to compare groups before and after the intervention. Placement of silver dressings in the intervention cohort was confirmed using review of the medical chart and operative billing reports. A total of 282 patients who underwent LE bypass in 2019 and 2020 met inclusion criteria. The standard of care cohort had 168 patients with DSD, while the cohort after intervention had 114 patients with silver impregnated dressings. The groups were similar in terms of demographics and comorbidities (Table1). There was a statistically significant reduction in superficial SSI in the silver dressing group compared to the DSD group (9.6% versus 20.8%, P=0.014, Table2). There was a 63% compliance with silver dressing placement in the intervention group. This subset of patients with confirmed dressing placement was similar in terms of demographics and comorbidities (Table3). Superficial SSI in this patient cohort was decreased from 20.8 to 12.5% (P=0.15, Table4). There was no observed difference in deep or organ space infections, wound dehiscence, readmission, and return to operating room between both groups. This study demonstrated a statistically significant reduction in the rate of superficial SSI in patients undergoing open LE bypass with the use of a silver impregnated dressing when compared to a sterile gauze dressing. Although our study does not demonstrate a causal relationship, this relatively inexpensive and low-risk intervention's association with a significant decrease in an otherwise very serious postoperative complication argues for a change in clinical practice or prospective confirmatory studies to optimize patient outcomes after LE bypass.

Clinical comparative study of robot-assisted and traditional laparoscopic surgery in patients with cervical cancer: a retrospective cohort study

BackgroundA new era in minimally invasive surgery has been ushered in by Leonardo’s robot surgical system, but the safety and effectiveness in cervical cancer is lake of evidence. This study aimed to compare the safety, effectiveness, and cost-effectiveness of robot-assisted laparoscopic radical hysterectomy (RRH) and conventional laparoscopic radical hysterectomy (LRH) in patients with cervical cancer.MethodsPatients with cervical cancer who had radical surgery at the first affiliated Hospital of Chongqing Medical University between January 2017 and June 2022 were enrolled. Patients in the LRH and RRH groups were matched 1:1 using propensity score matching (PSM), all patients were followed up to September 2023, cancer recurrence occurred or death, whichever came first.Results522 cervical cancer patients were enrolled in this study, 261 of whom were in the LRH group and 261 of whom were in the RRH group. Univariate analysis showed that the RRH group had less intraoperative blood loss, shorter operation time and hospital stay, lower incidence of composite complications and urinary retention, but had higher hospitalization costs. Multivariate Logistic regression analysis showed that LRH was an independent protective factor for composite complications (OR 1.531; 95%CI,1.022 to 2.295; P = .039). Cox regression analysis with cancer recurrence as the endpoint showed that LRH (HR 0.320; 95%CI,0.255 to 0.401; P < .001) and longer operation time (HR 0.995; 95%CI,0.993 to 0.997; P < .001) reduced 68% and 5% risk of cancer recurrence ; results also indicated that the older age (HR 1.017; 95%CI,1.007 to 1.027; P = .001) and postoperative complications (HR 22.410; 95%CI,16.019 to 31.350; P < .001) would increase 224% recurrence risk of cancer recurrence.ConclusionsBoth LRH and RRH demonstrated good short-term efficacy, with RRH outperforming LRH in terms of reduced intraoperative bleeding, shorter hospital stays and operation times, and fewer composite complications. However, the RRH group faces a higher risk of early cancer recurrence and incurs greater expenses. In summary, comprehensive long-term prospective studies are needed to thoroughly explore the effectiveness and safety of both LRH and RRH.

End-of-life care costs and place of death across health and social care sectors

ObjectivesThis study explores the relationship between end-of-life care costs and place of death across different health and social care sectors.MethodsWe used a linked local government and health data of East...

Clinical Outcomes Following Treatment of Cervical Spondylotic Radiculopathy With Cervical Posterior Decompression Using Unilateral Biportal Endoscopic Technique: A Single Center Retrospective Series of 20 Patients.

Unilateral biportal endoscopy (UBE) is a minimally invasive approach to treat cervical spondylotic radiculopathy (CSR), which is a common condition caused secondary to disc herniation, disc degeneration, uncal osteophytes, and other conditions manifesting as neuropathic radicular pain. Anterior cervical discectomy and fusion (ACDF) is the gold standard surgical technique for treating CSR. However, it has several disadvantages, including loss of mobile segment, adjacent segment degeneration (ASD), implant- and approach-related complications, and high hospitalization costs. The current study aimed to evaluate the safety and efficacy of UBE decompression for CSR. After obtaining IRB approval, a single-center retrospective study was undertaken. Included patients underwent UBE decompression for CSR with a minimum of 6 months of follow-up. Patient demographics, perioperative data, and length of hospital stay were reviewed. Clinical outcomes were assessed using VAS scores for neck and arm pain, and NDI scores were measure preoperatively and at 1 and 6 months after UBE decompression. A repeated analysis of variance test was performed to measure the difference between VAS and NDI scores. Twenty patients (M: 15, F: 5) with a mean age of 56.7 ± 10.2 years were included. The mean follow-up period was 8.4 ± 1.8 months. The mean surgical time was 64.3±10.6 minutes. The average length of hospital stay was 1 day. At the final follow-up, the mean VAS for arm pain improved from 6.4 ± 0.7 to 0.6 ± 0.5 (92% improvement) and the mean VAS for neck pain improved from 3.3 ± 0.4 to 2.0 ± 0.2 (40% improvement). NDI score improved from 23.2 ± 1.95 to 5.7 ± 0.6 at the final follow-up (75% improvement). There were no complications. UBE is a safe and effective surgical treatment option for patients with CSR with excellent clinical outcomes. Clinical relevance of this case series study is to demonstrate the safety and efficacy of the novel unilateral biportal endoscopic decompression of cervical spondylotic radiculopathy and its short term clinical outcomes.

PERFIL MICROBIOLÓGICO DAS INFECÇÕES RELACIONADAS À ASSISTÊNCIA À SAÚDE EM HOSPITAIS UNIVERSITÁRIOS: REVISÃO DE LITERATURA

Considering that healthcare-associated hospital infections (HAIs) are acquired 48 hours after hospital admission, or manifest within 3 days after hospital discharge, they may be associated with healthcare prophylaxis, causing an impact on the health of the patient. patient, family, hospital institutions and even society as a whole. The main objective of this work was to evaluate the bacterial incidence of surfaces and equipment in emergency rooms, medication rooms, intermediate care rooms and surgical blocks at a university hospital. Hospital infections represent a challenge when it comes to clinical practice regarding hospitalized patients. Its parameter determines a considerable increase in the hospitalization period, in lethality and, at the same time, contributes to high hospital costs. Hospitalized patients, specifically in the Intensive Care Unit, are particularly more exposed to hospital infections, given their clinical conditions, which require invasive procedures and antimicrobial therapy. This study aimed to observe and determine the prevalence of nosocomial infection (HI) distributed across sectors of a tertiary hospital in Pernambuco, specialized as a day hospital, which offers consultations in different specialties such as Anesthesiology, Cardiology, General Surgery, Vascular Surgery, Internal Medicine, Urology among the different specialties. Data collection was carried out, with a retrospective of these exams on hospitalized patients from 2019 to 2023.

Perioperative outcomes and hospitalization costs of radical vs. conservative surgery for hepatic cystic echinococcosis: A retrospective study.

Surgical intervention is a crucial treatment for hepatic cystic echinococcosis. However, the choice between radical and conservative surgery remains controversial. This study aimed to compare the perioperative outcomes and hospitalization costs between radical and conservative surgery for hepatic cystic echinococcosis. A retrospective cohort study was conducted on patients undergoing surgical treatment at the First People's Hospital of Kashi Prefecture from July 1, 2012, to October 1, 2023. Propensity score-matching analysis was utilized to mitigate patient selection bias between the two surgical groups. Of the 434 patients included, 324 underwent conservative surgery and 110 underwent radical surgery. After propensity score-matching, 182 conservative surgery and 102 radical surgery patients were compared. Radical surgery patients experienced longer operative time, higher intraoperative blood loss, increased blood transfusion, and higher costs compared to conservative surgery patients. However, no differences were observed in short-term outcomes, including overall morbidity, death, bile leak, effusion, pulmonary infection, incision infection, intestinal obstruction, ICU stay, abdominal drainage time, and postoperative hospital stays. This study suggests that radical surgery is associated with greater surgical complexity and higher hospitalization costs, while it doesn't offer a significant short-term advantage. Conservative surgery may be a viable option in resource-limited settings or for patients unsuitable for complex procedures. Further research with long-term follow-up is needed to determine the optimal approach.

Abstract 4113371: Impact of Protein-Energy Malnutrition on Atrial Fibrillation Outcomes: Insights from National Inpatient Sample (NIS) Study

Background: Atrial fibrillation (AF) is the most prevalent arrhythmia. Protein-energy malnutrition (PEM) has been implicated in various cardiovascular conditions, but the studies on its impact on AF outcomes are limited. This study aims to investigate the relationship between PEM and AF outcomes, since malnutrition could be a modifiable risk factor. Methods: Utilizing data from NIS (2017–2020), patients of age more than 18 years with a primary diagnosis of AF and a secondary diagnosis of PEM were identified. Data analysis was performed using STATA, employing the Student's t-test and Fischer's exact test to compare continuous variables and proportions, respectively. Adjusted odds ratios were calculated through multivariate regression analysis. The primary outcome was mortality, with secondary outcomes being mean length of stay (LOS), total hospitalization cost, major adverse cardiovascular events (MACE) and various in-hospital complications. Trends in mortality, LOS, and total cost of hospitalization were also assessed. Results: A total of 17,652,695 patients with AF were identified, of whom 1,452,695 (8.22%) had PEM. Patients with PEM had increased mortality (10.8% vs 4.52%, p&lt;0.001), increased mean LOS (10.14 days vs 5.52 days, p&lt;0.001) and a higher hospitalization cost ($121,721 vs 69,348, p&lt;0.001). In AF patients with PEM compared to those without PEM, there were significantly increased rates of ACS (adjusted odds ratio, or aOR=1.21, 2.48 vs 1.85, p&lt;0.001), pulmonary edema (aOR=1.37, 0.61 vs 0.44, p&lt;0.001), CVA (aOR=1.45, 1.7 vs 1.04, p&lt;0.001) acute respiratory failure (aOR=1.78, 20.27 vs 11.75, p&lt;0.001), need of mechanical ventilation (aOR= 2.46, 9.36 vs 3.96, p&lt;0.001), ARDS (aOR= 2.8, 0.55 vs 0.21, p&lt;0.001), AKI (aOR=1.57, 35.45 vs 24.12, p&lt;0.001), and septic shock (aOR= 3.32, 10.3 vs 3.24, p&lt;0.001). There is an increased trend of mortality (10.77 in 2017 vs 11.87 in 2020, p&lt;0.001), LOS (10.49 in 2017 vs 10.8 in 2020, p=0.04) and total hospitalization cost ($121,233 in 2017 vs $140,869 in 2020, p&lt;0.001) in patients with AF and PEM. Conclusion: Our study highlights the association between PEM and adverse AF outcomes, revealing PEM as a significant predictor of increased mortality, morbidity, length of stay, and hospitalization costs. These results emphasize the necessity for targeted nutritional interventions in AF management. Further research and clinical strategies addressing nutritional deficits in AF populations are essential for improving outcomes.

Abstract 4128352: Association Between G6PD Deficiency and Congenital Heart Disease Incidence and Hospital Outcomes

Background: G6PD deficiency classically presents with hemolytic anemia, but associations have been described with atherogenesis and coronary artery disease. There are limited data that also suggest a link between G6PD deficiency and the development of congenital heart disease (CHD). Hypothesis: We hypothesize a higher incidence of CHD among individuals with G6PD deficiency as well as worse hospital outcomes for those with CHD and G6PD deficiency. Methods: We reviewed the Vizient® Clinical Data Base (a national, administrative database) from 10/2019-3/2024 for admissions of individuals aged 0-25 years with ICD-10 codes for moderate to severe CHD with and without and G6PD deficiency (D55.0, D75.A) to calculate and compare CHD incidence. Additional data included: demographics, hospital outcomes and costs. Hospital outcomes were compared using t-tests for normally distributed data, Mann-Whitney U test for non-normally distributed data and χ 2 for categorical data. Results: There were 213,708 admissions of individuals with CHD and &lt;1% had G6PD deficiency; findings in Table 1. Of the 6,363 admissions with G6PD, 289 (4.5%) had CHD and of 11,179,670 without G6PD, 213,419 (1.9%) had CHD ( p &lt;0.001). Patients with CHD and G6PD deficiency had male predominance and more Blacks (consistent with known G6PD deficiency epidemiology), longer length of stay and higher hospital costs than those without G6PD deficiency (Table 1). Conclusions: This review of a national database shows a higher incidence of CHD in admissions with G6PD deficiency as well as worse hospital outcomes (longer length of stay, higher costs) for those with CHD and comorbid G6PD deficiency. There were demographic differences, but these reflect the typical inheritance of G6PD deficiency. While there may be potential interplay between race/ethnicity and these outcomes as well, further investigation is needed.

Robotic surgery versus laparoscopic surgery for rectal cancer: a comparative study on surgical safety and functional outcomes.

This study aims to evaluate the clinical efficacy and functional outcomes of DA Vinci (Xi)-assisted surgery compared to conventional laparoscopic surgery for middle and low rectal cancer, focusing on oncologic cure and functional preservation. Between December 2020 and June 2021, 102 patients with middle and low rectal cancer (tumour lower margin ≤10 cm) were enrolled at the affiliated Hospital of Xuzhou Medical University. Participants were divided into two groups: robot-assisted (n = 51) and laparoscopy-assisted (n = 51). Each group underwent a radical resection using their assigned method. Clinical and functional outcomes were analysed post-surgery. Preoperative data did not differ significantly between groups (P > 0.05). All surgeries were successfully completed without conversion to open surgery. The robotic group experienced significantly less intraoperative blood loss (55.2 ± 29.8 mL vs. 109.5 ± 58.5 mL) and faster recovery in gastrointestinal function (35.1 ± 9.4 h vs. 40.7 ± 1.9 h), diet recovery (2.1 ± 0.8 days vs. 2.9 ± 0.4 days), and catheter removal (2.9 ± 2.7 days vs. 5.3 ± 2.1 days). The robotic group also dissected more lymph nodes (23 ± 6 vs. 15 ± 4). However, they had longer operative times (239.8 ± 29.6 min vs. 141.1 ± 18.5 min) and higher hospital costs. Satisfaction levels regarding defecation, voiding, and sexual functions were notably higher in the robotic group. No significant differences in surgical safety or immediate postoperative outcomes were observed between robotic and laparoscopic approaches. However, robotic surgery demonstrated superior lymph node dissection, anal function preservation, and gastrointestinal recovery, enhancing overall functional outcomes.

Real-World Assessment of Economic and Clinical Outcomes in Thai Patients With Respiratory Syncytial Virus Infection Across Age Groups: A Retrospective Cohort Analysis.

Respiratory syncytial virus (RSV) is an important cause of acute lower respiratory infections worldwide, including Thailand. This study aimed to assess clinical and economic burdens of RSV infections across different age groups in Thailand. A retrospective cohort study was conducted using data from a tertiary care hospital from 2014 to 2021. Patients who tested at least one positive RSV were included and stratified into five age groups (< 2, 2-5, 5-18, 18-65, and > 65 years). Healthcare resource utilization, direct medical costs, and clinical outcomes were analyzed with descriptive statistics. Generalized linear models with gamma distributions and log link were used to model cost outcomes. Costs were reported in 2021 US dollars (USD), with 1 USD = 31.98 Thai Baht. A total of 2122 RSV-positive patients were identified, half of which (1097) were hospitalized. The median (interquartile range [IQR]) total hospitalization costs ranged from USD780 (IQR: USD488-USD1185) in those < 2 years to USD2231 (IQR: USD1250-USD4989) in those aged 65+ years. Case fatality rates among hospitalized patients also varied from 2.5% to 28.4% depending on age. Increased age, presence of comorbidities, and need for critical care were associated with higher hospitalization costs. Among RSV-positive patients, younger children experienced the greatest burden, but poorer outcomes were observed in older adults. Higher costs were associated with older age, comorbidities and critical care needs. Understanding RSV economic burdens is crucial for assessing the cost-effectiveness and public health value of vaccination programs that prioritize at-risk groups to mitigate the public health impact.

Higher Hospitalization Costs and Fewer Routine Discharges in the Medicaid Expansion Era for Lung Transplant Recipients.

In January 2014, states expanded Medicaid access under the Affordable Care Act. We studied the financial implications of this policy on lung transplantation, a costly procedure. Lung transplant (LT) hospitalizations were identified within the National Inpatient Sample (2005-2020). Recipients were categorized as "pre-expansion" (1/2005-12/2013) versus "post-expansion" (1/2014-12/2020) of Medicaid and as being in "expander" versus "non-expander" regions. We calculated difference-in-differences estimates comparing pre- and post-expansion eras in expander versus non-expander regions for inflation-adjusted hospitalization costs and for discharge disposition. We evaluated total hospitalization costs using multivariable generalized linear regression, adjusting for recipient demographics, Charlson Comorbidity Index, single versus double-lung transplant, and extracorporeal membrane oxygenation (ECMO), ex-vivo lung perfusion (EVLP), and mechanical ventilation usage. Of the 29225 LT recipients identified, 14085 were pre-expansion and 15140 were post-expansion. More recipients were insured by Medicaid in expander n=735 (9%) versus non-expander n=220, (3%) regions (p=0.01) post-expansion. Hospitalization costs increased post- versus pre-expansion by $20948 (95% CI=$8713-$33183, p<0.001) more in expander versus non-expander regions even after adjustment for risk factors associated with increased costs. Within expander regions, recipients post- versus pre-expansion were less likely to be discharged routinely (n=2625, 28%vs. n=3959, 44%) and more likely to be discharged to care facilities (n=2045, 22%vs. n=1045, 12%, p<0.001). Although Medicaid expansion resulted in greater access to care, it was associated with increased hospitalization costs and fewer routine discharges for LT recipients. Further research is warranted to identify the reasons that underpin the financial sequelae of Medicaid expansion, including changes in access to care for sicker patients.

The Extra Length of Stay, Costs, and Mortality Associated With Healthcare-Associated Infections: A Case-Control Study.

This study aims to compare the mortality rate, length of stay (LOS), and hospitalization cost in patients with and without healthcare-associated infections (HCAIs). This prospective cohort study is conducted on 396 matched patients admitted to a tertiary teaching hospital with 800 beds in the southwest of Iran from July 2021 to January 2022. The cases were patients admitted during the study period who had, at minimum, one type of HCAI. For a comparison group, we considered all patients without HCAIs who hospitalized in the same ward and at the same time with the same age and gender in a ratio of one case to three controls. Descriptive analyses were done based on direct medical costs, LOS, and mortality rate in patients. The magnitude of the relationship between potential risk factors and HCAI was quantified using logistic regression. The most common HCAI and microorganisms were urinary tract infection (UTI) and Escherichia coli, respectively. The mean LOS for infected patients was 20.3 (±16) days, compared to 8.7 (±8.6) days for noninfected patients (p value ≤ 0.05). Lengths of stay (odds ratio [OR] = 1.09; 95% CI = 1.06-1.19; p value = 0.000), ICU lengths of stay (OR = 1.08; 95% CI = 1.02-1.15; p value = 0.003), presence of central Catheter (OR = 0.127; 95% CI = 0.51-0.319; p value = 0.000), and urinary catheter (OR = 0.225; 95% CI = 0.122-0.415; p value = 0.000), mechanical ventilation (OR = 0.136; 95% CI = 0.57-0.325; p value = 0.000), receipt of immunosuppressors (OR = 1.99; 95% CI = 11.12-3.56; p value = 0.01), were Significantly associated with HCAI. Patients with infections had a more costly hospital stay than noninfected patients (mean diff: $2037.46 ([SD]: 482.25$) (p value = 0.000). The highest cost component was the cost of medication expenditure (mean: $1612.66 ([SD]: $2542.27). UTI was the most common HCAI in our study. An infection acquired during a hospital stay may be associated with higher hospitalization costs, prolonged hospitalization, and an increase in the rate of mortality. Longer lengths of stay, presence of central and urinary Catheters, receipt of immunosuppressors, use of mechanical ventilator were common risk factors for HCAI. This study reveals that the median reimbursement cost per hospitalization of patients with HCAIs was higher than patients without HCAIs. This highlights the necessity for implementation of HCAI prevention and control measures.

Clinical characteristics of megaloblastic anemia with pancytopenia

ABSTRACT Objectives In this study, we aimed to explore the clinical characteristics of patients with megaloblastic anemia and pancytopenia. Methods Data on patient characteristics, laboratory examinations, clinical manifestations, and associated diseases were collected from Changzhou Hospital of Traditional Chinese Medicine. The participants were divided into two groups according to routine blood test results: megaloblastic anemia patients with pancytopenia (Group A) and megaloblastic anemia patients with simple anemia (Group B). Results The number of patients with fever and bleeding in Group A was much higher than that in Group B. Inpatient days and hospitalization costs in Group A were higher than those in Group B. White blood cell count, red blood cell count, haemoglobin level, and platelet count in Group A were lower than those in Group B. There were no significant differences in mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and serum levels of lactate dehydrogenase (LDH), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), albumin (ALB), vitamin B12, folic acid, and ferritin between the two groups. The incidence of associated diseases, particularly pulmonary infections, was significantly higher in Group A than in Group B. There was no significant difference in the degree of bone marrow hyperplasia between the two groups. Conclusion Patients with pancytopenia and megaloblastic anemia often developed infection and bleeding, which caused more severe anemia, higher hospitalization costs, and longer inpatient days. Early diagnosis and active treatment are required to reduce patient complications and costs.

Reassess Hospital Costs and Mortality Between Myocardial Infarction With and Without ST-Segment Elevation in a Modern Context.

Patients with ST-segment elevation myocardial infarction (STEMI) may have higher hospitalization costs and poorer prognosis than non-ST-segment elevation myocardial infarction (NSTEMI). A single-center retrospective study was conducted on 758 STEMI patients and 386 NSTEMI patients from January 1, 2020 to May 30, 2023 aimed to investigate the differences in cost and mortality. STEMI patients had higher maximal troponin I (15,222.5 (27.18, 40,000.00) vs. 2731.5 (10.73, 27,857.25), p < 0.001) and lower left ventricular ejection fraction (LVEF) (56% (53%, 59%) vs. 57% (55%, 59%), p < 0.001) compared to NSTEMI patients. The clinical symptoms were mainly persistent or interrupted chest pain/distress in either STEMI or NSTEMI patients. STEMI patients had a significantly higher risk of combined hypotension than NSTEMI patients (8.97% vs. 3.89%, p = 0.002), and IABP was much more frequently used in the STEMI group with a statistical difference (2.90% vs. 0.52%, p = 0.015). STEMI patients have statistically higher hospitalization costs (RMB, ¥) (31,667 (25,337.79, 39,790) vs. 30,506.91 (21,405.96, 40,233.75), p = 0.006) and longer hospitalization days (10 (8, 11) vs. 9 (8, 11), p = 0.001) compared to NSTEMI patients. Although in-hospital mortality was higher in STEMI patients, the difference was not statistically significant (3.56% vs. 2.07%, p = 0.167). Multivariable logistic regression was performed and found that systolic blood pressure and NT-proBNP were risk factors for patient death (OR ≥ 1). STEMI patients are more likely comorbid cardiogenic shock, heart failure complications with higher hospitalization costs and longer hospitalization days. And relatively more use of acute mechanical circulatory support devices such as IABP. ChiCTR2300077885.

Surgical treatment of cesarean scar pregnancy based on the three-category system: a retrospective analysis

BackgroundCesarean scar pregnancy (CSP), a distinct form of ectopic pregnancy, presents challenges in effective management. It is categorized into three subtypes according to the location of placental implantation and the thickness of the myometrium at the uterine scar. Nevertheless, the optimal choice of treatment modalities for these subtypes remains largely unexamined.MethodsIn this retrospective analysis, we investigated the cases of 130 patients diagnosed with CSP who underwent diverse treatment approaches, namely ultrasound-guided dilation and curettage (D&C), hysteroscopic surgery alone or in combination with laparoscopic surgery (HCoLC), or uterine artery embolization (UAE) followed by curettage. Clinical data were meticulously retrieved from medical records and follow-up data, and a comparative analysis of relevant indicators was carried out across the different CSP subtypes.ResultsFrom January 2017 to December 2021, 35 patients underwent D&C, 85 underwent HCoLC, and 10 received UAE as a pretreatment. In the D&C group, the success rates for Type I and Type II CSP were 64.29% (18/28) and 14.28% (1/7), respectively. Significant differences were observed between the success and failure groups in terms of gestational sac size and clinical classification. Compared to Type I CSP, Type II CSP exhibited significantly longer surgical durations and higher hospitalization costs (P < 0.05). Three patients classified as Type III underwent simultaneous hysteroscopic evacuation of cesarean scar pregnancy and laparoscopic repair of the cesarean scar defect, achieving a 100% success rate in their initial treatment. HCoLC showed no significant differences in surgical duration and hospitalization costs but had higher success rates and shorter hospital stays compared to the D&C and UAE groups (P < 0.05). The UAE group had significantly longer surgical durations, higher hospitalization costs, and a higher incidence of postoperative complications (P < 0.05). However, these factors did not result in improved surgical success rates.ConclusionThe classification of CSP and the measurement of gestational sac are of crucial importance in determining the most appropriate surgical intervention strategy. For patients diagnosed with Type I CSP, D&C and hysteroscopy are reliable treatment choices. In cases with larger gestational sacs or Type II CSP, hysteroscopy, either alone or in combination with laparoscopy, is regarded as a reliable and effective treatment approach. In patients with type III CSP, lesion excision with uterine repair is the recommended treatment.

Short-term surgical outcomes of open, laparoscopic, and robot-assisted pancreatoduodenectomy: A comparative, single-center, retrospective study.

Although laparoscopic pancreaticoduodenectomy (LPD) and robot-assisted pancreaticoduodenectomy (RPD) are gradually gaining popularity, their advantages over open pancreaticoduodenectomy (OPD) remain controversial. This study aimed to compare the short-term outcomes of OPD, LPD, and RPD to elucidate the advantages and disadvantages of each procedure. We retrospectively analyzed 16 LPD, 43 RPD, and 36 OPD procedures performed at a single center between April 2020 and May 2024. Clinical data, including operative time, estimated blood loss, postoperative complications, length of hospital stay, and hospitalization costs, were retrospectively collected and analyzed. RPD demonstrated a significantly longer operative time (553 min) than OPD (446 min) and LPD (453 min) but a significantly lower estimated blood loss than OPD (150 mL vs. 400 mL, p < .001). Postoperative complication rates (Clavien-Dindo grade ≥3) were lower for RPD (24.4%) than those for OPD (50.0%) and LPD (68.8%). RPD also showed a significantly lower rate of clinically relevant postoperative pancreatic fistula (14.6% vs. 38.9% for OPD and 43.8% for LPD) and a shorter duration of hospitalization (11 vs. 28 days for OPD and 21 days for LPD, p < .001). Hospitalization costs were higher for RPD (20 109 USD) than for OPD (18 487 USD, p < .001), with LPD (20 496 USD) and RPD costs being similar. RPD appears to offer advantages in terms of reduced blood loss and postoperative complications and shortened hospital stay despite longer operative times and higher hospitalization costs. Therefore, RPD may be a more beneficial approach than OPD or LPD in pancreatic surgery.

Prognostic value of the fat-free mass index-based cachexia index in patients with colorectal cancer

Studies have shown that the cachexia index (CXI) is a useful predictor of cachexia in patients with colorectal cancer. However, the application of the CXI is limited stemming from the intricacy and additional cost of radiographic examinations. This study aimed to develop an easy-to-use and practical CXI based on fat-free mass index (FFMI-CXI) to evaluate the prognostic value of FFMI-CXI in CRC. A total of 656 patients with CRC were enrolled in the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) study. The FFMI-CXI was calculated as [FFMI (kg)/height (m)2 × serum albumin (g/L)]/neutrophil-lymphocyte ratio. The cutoff value for FFMI-CXI was determined through the analysis of ROC curves and Youden’s index for both male and female cohorts. Kaplan–Meier survival curves with log-rank tests were conducted to compare time–event relationships between different groups. Cox proportional hazards regression models incorporating both univariate and multivariate variables were employed to explore the independent prognostic factors associated with OS. Logistic regression analysis was performed to assess the association of the FFMI-CXI with secondary outcomes. The major outcome was 5-year overall survival (OS). Based on the cutoff values, 331 patients had low FFMI-CXI, and 325 patients had high FFMI-CXI. Patients in the low FFMI-CXI subgroup were significantly older and had advanced TNM stage, malnutrition, high systemic inflammation, long hospitalizations, high hospitalization costs, adverse short-term outcomes, and all-cause mortality. Multivariate Cox regression analyses revealed that FFMI-CXI (HR 0.47, 95% CI 0.33–0.66; p < 0.001) and TNM stage (HR 3.38, 95% CI 2.63–4.35; p < 0.001) were independently associated with OS in CRC patients. K-M survival curves revealed that the CRC patients with a high FFMI-CXI had significantly more favorable OS than those with low FFMI-CXI (62.84% vs. 84.31%; log-rank p < 0.001). Furthermore, the FFMI-CXI was valuable for predicting 90-day outcomes, malnutrition, cancer cachexia, length of hospitalization, and hospitalization expenses. This study revealed that the FFMI-CXI can be used as a prognostic indicator in patients with CRC. Patients with low FFMI-CXI should receive more attention.