Hospital Charges Research Articles

Variation in Commercial Prices for Thyroidectomy and Parathyroidectomy at US Hospitals

BackgroundThe 2021 Hospital Price Transparency Rule mandated hospitals to publicly disclose their service prices to improve competition and lower healthcare costs. Our aim was to characterize commercial price variation for thyroidectomy and parathyroidectomy. MethodsWe performed a national cross-sectional study of hospital price variation in 2022 and 2023 using the Turquoise Health dataset. Our main outcomes were within- and across-hospital 90th-to-10th percentile commercial price ratios and a high commercial-to-Medicare (1.5) price ratio. We performed logistic regressions to identify hospital factors associated with a high commercial-to-Medicare price ratio. ResultsFor 16,794 unique commercial rates across 564 facilities, within-hospital price ratios ranged from 2.0 to 2.4, and across-hospital price ratios ranged from 2.7 to 4.1. High market concentration and five-star hospital rating were associated with high commercial-to-Medicare price ratios compared to low market concentration and three-star hospital rating, respectively. ConclusionsNotable variation exists within and across hospitals signaling facilities have negotiated different payments from insurance companies for the same service. Quality may be a modifiable factor to increase hospital revenue and improve care for patients.

Commercial inpatient hospital price growth driven by system affiliation and nonprofit-status hospitals.

As policymakers continue to grapple with rising health care costs and prices, understanding trends and variations in inpatient prices among hospital characteristics is an important benchmark to allow policymakers to craft targeted policies. In this study, we provide descriptive trends on variation in inpatient prices paid by commercial health plans stratified by hospital characteristics using data from Health Care Cost Institute's employer-sponsored insured claims data. Our analyses found evidence of considerable variation among inpatient price levels and growth among system affiliation and profitability. Prices among system-affiliated hospitals grew from $14 281.74 in 2012 to $20 731.95 in 2021, corresponding to a 45.2% increase during this period. On the other hand, prices among independent hospitals grew more slowly, from $13 460.50 in 2012 to $18 196.90 in 2021, corresponding to a 35.2% increase. We did not observe a similar trend in growth rates among case mix index by hospital characteristics, implying that differential inpatient price growth is not driven by changes in case mix by hospital characteristics. Heterogeneity in hospital prices and price growth by type of hospital suggests that public and private policymakers aiming to rein in health spending should consider policies that address this variation.

Disparity in receiving destination treatment for heart failure patients according to HIV status

Abstract Background Patients living with HIV (PLWH) are well known to be at higher risk of developing cardiovascular diseases. However, PLWH with end-stage HF (ESHF) might not be considered for definitive treatments equally as their HIV-negative counterparts. Methods National Inpatient Sample (NIS) database was queried to identify ESHF patients hospitalized to receive left ventricular assist device (LVAD) or undergo heart transplantation (HTX). In-hospital outcomes of this population were stratified based on HIV status. Results Weighted data of a total of 16,700 ESHF patients was retrieved, out of which 65 patients (0.2%) had a positive HIV status. Out of 65 PLWH with ESHF, 35 patients (53.8%) received LVAD, and 30 patients (46.1%) received HTX, which were comparable to their HIV-negative counterparts (58.4% and 43.1%, respectively). Although PLWH had a longer length of stay (39.7±35.6 days vs. 49.5±, 42.3 days, p=0.3) and higher hospital charges ($1,458,527±$ 1,509,873 vs. $1,113,344±$953,830) than HIV negative counterparts, the difference was not statistically significant. Mortality rate did not differ between HF patients based on HIV positive status or the bridge/destination treatment they had received. Conclusions Although the proportion of PLWH with HF who received HTX has decreased over the last few years, the proportion of those who received LVAD has been on a compensatory rise. HIV positive status is not associated with a higher mortality rate but increases the length of stay and hospital charges.

Outcomes of ventricular tachycardia ablation with intracardiac echocardiography-a retrospective cohort study of the national inpatient sample

Abstract Background Intracardiac echocardiography (ICE) is being increasingly used in VT ablation. Sparse literature indicates that ICE reduces repeat VT ablation and VT-related admissions (1). Objective To determine if ICE reduced procedural complications, mortality, length of stay, and hospitalization costs in VT ablation. Methods Utilizing the National Inpatient Sample (NIS) of the years 2016 to 2020, we compared the differences between patients who had VT ablation with and without ICE. We used multivariable logistic and linear regression models as appropriate to determine if ICE was associated with improved outcomes as defined above. Results We included 15,480 hospitalizations (95% CI 14,513-16,446) with VT ablations. ICE was used in 1815 (11.7%) of the patients. The mortality rate was 2.2%(95% CI 1.1-4.3) in the ICE group and 3.2% (95% CI 2.6-3.9) in the non-ICE group, and composite complications rate was 18.4% (95% CI 14.7-22.7) in the ICE group and 19.2% (17.7-20.8) in the non-ICE group. On univariate and multivariate analysis, ICE was not associated with a decrease in mortality, composite complications, or hospitalization charges but with a reduction in length of stay (Tables 1 and 2). ICE was associated with sepsis on univariate analysis but not on multivariate analysis (aOR 0.51, 95% CI 0.26-1.00, P=0.051) Conclusion Our study demonstrates that ICE was not associated with a reduction in mortality or complications in VT ablation but was associated with a slightly shorter length of stay. Although our observational study did not demonstrate a major benefit with ICE, given the multiple advantages of ICE in VT ablations, such as real-time recognition of myocardial substrate, identification of anatomical structures to guide ablation, and prompt recognition of intra-procedural complications, we recommend randomized controlled studies to evaluate the efficacy of ICE(2). Our study is limited by its retrospective nature and reliance on ICD codes for data extraction.

Impact of household income on acute decompensated heart failure outcomes: national representative sample

Abstract Background The clinical outcomes of ADHF have been extensively studied; however, the impact of household income still needs to be better understood. This study aimed to elucidate the relationship between household income and outcomes in patients with ADHF. Methods This national retrospective cohort study used data from the 2016-2020 National Inpatient Database, focusing on patients admitted with ADHF. We stratified the cohort into two groups based on the median household income: below $50k and above $86k. The selection criteria included patients aged ≥ 18 years diagnosed with ADHF, excluding those with incomplete income data. The primary outcome was all-cause inpatient mortality, with a length of stay (LOS) and total hospital charges as secondary outcomes. Statistical analysis employed logistic and linear regressions adjusted for confounders, with the significance level set at p<0.05. We accounted for missing data using multiple imputation analyses. Results 1,123,024 patients admitted with ADHF met the inclusion criteria. We divided the groups into two cohorts: low-income (64%, N=718,735) and high-income (36%, N=404,289). No increase in mortality was identified (adjusted aOR: 1.05; p = 0.212). The study revealed that high-income patients had marginally longer average LOS (5.62 days vs. 5.35 days, p < 0.0001) and higher hospital charges ($62,512.46 vs. $49,440.14, p < 0.0001) compared to their low-income counterparts. Low-income patients exhibited a higher prevalence of hypertension and obesity, whereas high-income individuals were more affected by atrial fibrillation and hyperlipidemia (hypertension and obesity, p < 0.0001; atrial fibrillation, p < 0.0001). Conclusion In this national retrospective cohort of patients admitted for ADHF over five years, income did not affect mortality. However, LOS and total charges were affected by the median household income.

In-hospital economic impact and mortality of bariatric surgery on congestive heart failure in the USA: a nationwide analysis

Abstract Background Congestive Heart Failure (CHF) remains a significant economic burden in the inpatient setting. There is a complex correlation between obesity and Congestive Heart Failure (CHF). Bariatric surgery has emerged as a critical intervention for patients with morbid obesity. However, there is limited data on how this intervention impacts hospital economic metrics and patient outcomes in the context of CHF post-bariatric surgery. Purpose The purpose of this study is to assess the in-hospital economic impact and mortality among patients with congestive heart failure who have undergone bariatric surgery. Methods We queried the National Inpatient Sample from 2016 to 2020; this retrospective observational cohort study identified CHF patients who had undergone bariatric surgery through ICD-10 codes. Univariate and multivariate logistic regression analyses were performed to determine Total Charges (TOTCH) and Length of Stay (LOS), adjusting for confounders including the Elixhauser comorbidity index, hospital region, quarterly income, and hospital location to identify the economic impact on CHF (Table 1). Results Out of 25,900,000 patients with congestive heart failure, 5,983,684 (23%) were obese, and 208,220 (0.8%) had undergone bariatric surgery. The demographic profile showed a mean age of 63 predominance of females (65%) and the White population (69.5%) (Table 1). The mean TOTCH for patients undergoing bariatric surgery was $66,235, compared to $76,046 for those who did not undergo the surgery, with a significant mean decrease in TOTCH of -$11,454 (p<0.001, 95% CI: -$12,472 to -$10,435). The mean LOS was 5 days for patients with bariatric surgery versus 6 days for those without, showing a mean decrease in LOS of 0.93 days (95% CI: -0.99 to -0.87). Additionally, there was a significant decrease in overall mortality risk among patients who had bariatric surgery (2.1%) compared to those who did not (5%), with an (OR 0.4 p<0.001, 95% CI: 0.38 to 0.43). Conclusion Our research demonstrates that bariatric surgery in obese individuals with congestive heart failure (CHF) markedly decreases in-hospital mortality, reduces hospital charges, and shortens the length of hospital stays. These findings underscore the potential of bariatric surgery as a cost-effective intervention for improving outcomes in patients with CHF and obesity, highlighting the importance of considering surgical weight loss options in the management of CHF.Table 1

Influence of hospital ownership on patient outcomes in STEMI-induced cardiogenic shock undergoing revascularization: a retrospective cohort study

Abstract Background Investor-owned hospitals constitute an expanding segment of healthcare enterprises that frequently eschew the provision of non-profitable services. The implications of this disparity in costs on the mortality rates of patients experiencing cardiogenic shock (CS) subsequent to ST-Elevation Myocardial Infarction (STEMI) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) or bare-metal stents (BMS) remain unknown. Methods In this retrospective analysis, data from the National Inpatient Sample (NIS) were examined, including acute care admissions for patients aged 18 years and above admitted due to cardiogenic shock secondary to ST-Elevation Myocardial Infarction (STEMI) who underwent percutaneous coronary intervention (PCI) with the placement of either drug-eluting stents (DES) or bare-metal stents (BMS) between 2016 and 2020. Multivariable logistic regression, multilinear regression, chi-square tests, and t-tests were used to compare mortality rates, length of stay (LOS), and healthcare costs, adjusting for potential confounders. The total charges were adjusted for inflation using the Consumer Price Index (CPI) from the Bureau of Labor Statistics to ensure consistency in financial evaluations. Results We analyzed 66,180 patients and divided them into two cohorts: admitted to investor-owned vs nonprofit institutions. The findings revealed no significant difference in mortality rates, with an adjusted odds ratio (aOR) of 1.03 (P=0.60; 95% CI: 0.91-1.16). However, treatment in investor-owned hospitals was associated with significantly higher healthcare costs, with a coefficient of 120,921 (P<0.001; 95% CI: 106,658.6–135,184.7), but without a significant difference in length of stay (LOS) (coefficient 0.04; P=0.81; 95% CI: -0.33 to 0.41). Key predictors of mortality included age, with each additional year increasing the odds of mortality by 3% (P<0.001; 95% CI: 1.02-1.03), and uninsured status, which was linked to a higher mortality risk (aOR 1.40; P<0.001; 95% CI: 1.16-1.70). Disparities in healthcare costs were observed across different races and insurance types, notably affecting Hispanic patients and those covered by Medicaid. A significant difference was noted in the average adjusted hospital charges between non-profit and investor-owned hospitals; the average charge at investor-owned hospitals was $314,633, compared to $220,227 at non-profit hospitals (P<0.01), marking a net difference of $94,406. Conclusion This retrospective cohort analysis demonstrated that investor-owned hospitals incurred, on average, over $94,406 more in healthcare costs than nonprofit hospitals, with no significant difference in mortality rates and only a marginal difference in length of stay (LOS). Higher expenses at investor-owned hospitals did not translate into improved patient outcomes, challenging the notion that increased healthcare spending necessarily results in better healthcare delivery.

Impact of coronary CT angiography on the hospital outcome among patients admitted with AMI undergoing revascularization procedures in theUS

Abstract Background Coronary CT angiography (CCTA) is gaining popularity as a diagnostic modality for risk stratification among patients hospitalized with acute myocardial infarction (AMI). However, its impact on the hospital outcomes among this population of patients remains to be determined. Methods Using national inpatient sample database, admission cases with a diagnosis of AMI who underwent revascularization procedures were identified from 2016-2020. The prevalence of CCTA was determined among the patient population and stratified based on the type of AMI (STEMI vs. NSTEMI) and revascularization procedure (PCI vs. CABG). Hospital outcomes were compared among the study strata. Results A total of 862,064 admission cases for STEMI and 3,586,944 admission cases for NSTEMI were identified out of which 661,958 cases underwent revascularization procedures. The utilization of CCTA was roughly 10 times higher among AMI cases undergoing PCI than those undergoing CABG (0.5% vs. 0.06%, p<0.0001). Prior CCTA increased the odds of receiving PCI by 79.3 times and the odds of undergoing CABG by 2.8 times. Among STEMI patients undergoing PCI, prior CCTA was associated with a lower mortality rate and non-home disposition (13.8% vs. 21.2%, p<0.0001) compared to no CCTA (3% vs. 5.5%, p=0.01). For NSTEMI patients undergoing PCI, CCTA was associated with a lower non-home disposition (16.5% vs. 20.6%, p=0.003) but not a significantly lower mortality rate. CCTA did not demonstrate any statistically significant differences for AMI patients undergoing CABG. On the other hand, CCTA increased the cost of hospitalization by $15,130.7 for STEMI patients undergoing PCI, length of stay (9 days) and hospital cost for STEMI patients undergoing CABG ($302,802), and total hospital cost for NSTEMI patients undergoing PCI by $8,705. Conclusions Using CCTA helps in risk stratifying AMI patients for revascularization procedures, allocating PCI to those admitted with STEMI and CABG to those with NSTEMI. Although CCTA reduces the risk of death and non-home disposition among STEMI patients undergoing PCI, it also increases hospital charges for patients receiving revascularization procedures.

The association of obesity and in-hospital outcomes among patients undergoing ablation for atrial fibrillation: a propensity-score matched analysis

Abstract Background Obesity is a strong risk factor for atrial fibrillation (AF), and it can affect the prognosis of AF. However, the impact of obesity (BMI≥30 kg/m²) on postoperative complications after AF ablation has not been extensively studied. We aimed to evaluate the association of obesity with in-hospital outcomes among patients with AF who ablation procedures. Methods The study utilized the National Inpatient Sample (NIS) database 2016-2020. Patients were divided into obese and non-obese groups and matched with propensity score matching (1:1). This matching involved adjusting for baseline variables (including age, gender, primary expected payer, race, and median household income) and comorbidities (including diabetes, hypertension, hyperlipidemia, history of coronary artery bypass grafting (CABG), chronic kidney disease, hyperthyroidism, cardiomyopathy, prior stroke or transient ischemic attack, heart failure with preserved ejection fraction (HFpEF), heart failure with reduced ejection fraction (HFrEF), heart valve disease, coronary artery disease, chronic obstructive pulmonary disease (COPD), alcohol misuse, anemia, and smoking). Furthermore, a weighted analysis was conducted utilizing weights provided by the NIS, and multivariate logistic regression was used to calculate the odds ratio. Results A total of 29,440 patient with AF who underwent ablation were included. After propensity matching, (8,110 in obese and 8,110 in non-obese group) the baseline characteristics were not significantly different between the two groups. Obesity was independently associated with higher risk of pseudoaneurysm, hematoma, postoperative anemia, acute kidney injury, vasopressor need, mechanical ventilation, pulmonary embolism, and ischemic stroke in patients who underwent ablation for AF (Figure 1). In addition, obese group had significantly higher length of stay (median and IQR 2 [1-3] vs 2 [1-4]) and total charges (median and IQR: 131,248$ [95,303-197,784] vs 143,693$ [102,720-206728]) compared to non-obese group (p<0.001). However, in-hospital mortality was not significantly different between the two groups. Conclusion In patients who underwent AF ablation, obesity is associated with significantly higher risk of post-operative complications, as well as increased LOS and total hospital charges.

The effect of HIV seropositivity on inpatient outcomes in atrial tachyarrhythmias: a US population analysis

Abstract Background With the advent of antiretroviral therapy, the life expectancy of persons living with HIV(PLHIV) has been significantly prolonged and we are now seeing this group increasingly affected by chronic conditions. Atrial fibrillation is the most common sustained tachyarrhythmias in adults and commonly coexists with atrial flutter. HIV-1 especially has been shown to possess a specific cardiac tropism in which chronic immune activation and inflammation may lead to cytotoxicity and death of cardiac myocytes. It has also been associated with left atrial enlargement, which may increase arrhythmia generation and propagation. The effect of HIV on outcomes in atrial tachyarrhythmias have been poorly studied, so we therefore wanted to explore this influence on in-patient outcomes. Purpose To assess the effect of HIV seropositivity on inhospital outcomes of patients admitted with atrial fibrillation/flutter (AF) Method The study uses data from the HCUP-NIS database, which includes billing information from hospitals across the US. The study population included patients admitted with a principal diagnosis of atrial fibrillation or atrial flutter in 2020. Patients with HIV positivity were identified using ICD-10 codes. Multivariate regression was used to analyze outcomes while adjusting for confounders. They were classified into two groups: AF-only (AF-O) and AF with HIV (AF-H). Results A total of 400,715 patients were admitted with a primary diagnosis of atrial fibrillation/flutter in 2020, 1175 were PLHIV. Patients in the AF-H group were more likely to be younger, non-Caucasian, tobacco smokers, have lower median income, be uninsured, have HFrEF and CKD. They however had lower rates of HFpEF than persons in the AF-O group. After adjusting for hospital level confounders, the in-hospital mortality rate was similar between the two groups (aOR 0.46 95% CI 0.05-3.98, p=0.48). The rates of ischemic stroke/systemic embolization, major bleeding, in hospital respiratory failure, length of stay and total hospital charges were also not significantly different Conclusion The study suggests that AF patients with HIV have similar in-hospital mortality rates as patients without. There are significant differences in the economic and ethnic makeup of the two groups but these did not significantly influence the outcomes of interest. Larger cohorts will be needed to confirm these findings definitively, especially as more persons with HIV continue surviving past the sixth decade of life.

Using Quality Improvement to Optimize Blood Product Utilization in a Pediatric Cardiac Catheterization Laboratory.

Packed red blood cells (PRBC) are frequently ordered for cardiac catheterization procedures, which increases resource utilization and patient charges. We applied the Plan-Do-Study-Act (PDSA) principle in order to optimize the ordering of PRBC for pediatric cardiac procedures and reducing charges. Our primary aim was to increase adherence to ordering guidelines to greater than 97%, with a global aim to reduce resource utilization. The existing PRBC ordering guidelines were revised and procedure reports were updated to include administration of PRBC. The rate of pre-procedure PRBC orders, adherence to the new protocol guidelines, presence of documentation and rate of blood transfusion within 24h post-procedure, frequency of emergency release blood during a procedure were monitored. During our study period, there was an increased adherence from 86 to 100% adherence following implementation of the updated guidelines. With improved adherence, we decreased PRBC ordering and hospital charges to the patient in low-risk cardiac catheterization procedures, without an increase in blood transfusions.

Preoperative Depression is Associated With a Higher Risk of Bleeding in Type a Aortic Dissection Repair: A Population Study of National Inpatient Sample From 2015-2020.

Depression is highly prevalent in patients with aortic diseases. While depression has been shown to predispose patients to adverse outcomes after surgery, its impact on postoperative outcomes in Stanford Type A Aortic Dissection (TAAD) has not been established. This study aimed to conduct a population-based examination of the effect of preoperative depression on in-hospital outcomes after TAAD using the National/Nationwide Inpatient Sample (NIS) database, the largest all-layer database in the US. Patients undergoing TAAD repair were identified in NIS from the last quarter of 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients with and without preoperative depression, adjusted for demographics, comorbidities, hospital characteristics, primary payer status, and transfer status. There were 321 (7.50%) patients with depression and 3961 (92.50%) non-depressive patients who underwent TAAD repair. Patients with and without depression had comparable in-hospital mortality (11.84% vs 15.37%, P = 0.35). However, Patients with depression had a higher risk of hemorrhage/hematoma (83.49% vs 76.6%, aOR 1.593, 95 CI 1.161-2.184, P < 0.01) and a higher rate of transfer out (40.81% vs 32.62%, aOR 1.396, 95 CI 1.077-1.81, P = 0.01). All other in-hospital complications, hospital length of stay (LOS), and total hospital charge were comparable between patients with and without depression. Preoperative depression is associated with a higher risk of bleeding after TAAD repair. This may be due to anti-depression treatment, such as Selective Serotonin Reuptake Inhibitors (SSRIs), that can disrupt platelet function and lead to abnormal bleeding. While depression is not associated with other major outcomes, preoperative depression screening, as well as hemostatic monitoring and appropriate blood management in patients with depression may be crucial in preventing bleeding complications in TAAD repair.

Impact of Frailty on Early Readmissions of Endoscopic Retrograde Cholangiopancreatography in the United States: Where Do We Stand?

Background/Objectives: We assessed the impact of frailty on outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Methods: The National Readmission Database (2016-2020) was used to identify index and 30-day ERCP readmissions, which were categorized into low-frailty, intermediate-frailty, and high-frailty groups based on the Hospital Frailty Risk Score (HFRS). Outcomes were then compared. Results: Of 885,416 index admissions, 9.9% were readmitted within 30 days of ERCP. The odds of 30-day readmission were higher in the intermediate-frailty group (12.59% vs. 8.2%, odds ratio [OR] 1.67, 95% confidence interval [CI] 1.64-1.71, p < 0.001) and the high-frailty group (10.57% vs. 8.2%, OR 1.62, 95% CI 1.52-1.73, p < 0.001) compared to the low-frailty group. On readmission, a higher HFRS also increased mean length of stay (intermediate-frailty vs. low-frailty: 8.49 vs. 4.22 days, mean difference (MD) 4.26, 95% CI 4.19-4.34, p < 0.001; high-frailty vs. low-frailty: 10.9 vs. 4.22 days, MD 10.9 days, 95% CI 10.52-11.28, p < 0.001) and mean total hospitalization charges (intermediate-frailty vs. low-frailty: $118,996 vs. $68,034, MD $50,962, 95% CI 48, 854-53,069, p < 0.001; high-frailty vs. low-frailty: $195,584 vs. $68,034, MD $127,550, 95% CI 120,581-134,519, p < 0.001). The odds of inpatient mortality were also higher for the intermediate-frailty and high-frailty compared to the low-frailty subgroup. Conclusions: Frailty was associated with worse clinical outcomes after ERCP.

Racial/Ethnic Disparities in Hospitalization Outcomes by Palliative Care Utilization and Trends Among Women With Metastatic Breast Cancer in the United States.

We examined the trends in palliative care utilization, racial/ethnic disparities in hospitalization outcomes among adult women with a diagnosis of metastatic breast cancer (MBC), and effect modification by palliative care utilization. Retrospective cohort analyses were conducted using the Agency for Healthcare Research and Quality sponsored Healthcare Cost and Utilization Project-National Inpatient Sample database from 2016 to 2020. Regression analyses were used to evaluate palliative care trends, and the association between race/ethnicity and in-hospital mortality, length of stay, total hospital charges, and discharge disposition. Stratified analyses were conducted by palliative care use. Palliative care consultations in the study population increased from 16.4% in 2016 to 20.3% in 2020. Black (adjusted odds ratio [AOR], 1.25 [95% CI, 1.16 to 1.34]) and Hispanic (AOR, 1.12 [95% CI, 1.01 to 1.23]) female patients with MBC had higher in-hospital mortality compared with the White patients. Among those who received palliative care, Blacks had similar odds (AOR, 1.08 [95% CI, 0.97 to 1.20]) of in-hospital mortality when compared with Whites. Black women were more likely to have longer hospital stays relative to White women. Although Black women had similar odds (AOR, 0.98 [95% CI, 0.92 to 1.04]) of discharge to a short-term/skilled nursing facility versus routine discharge compared with White women, Blacks who received palliative care had 19% (95% CI, 0.70 to 0.95) lower odds of discharge to a facility. Our findings emphasize the importance of palliative care use among patients with MBC and highlight the need to raise awareness of its benefits, especially in minority populations. Further studies are needed to explore ways to narrow the gap in existing disparities and to test these interventions on care metrics and patient outcomes.

Firearm-related Hospitalizations and Newly Acquired Morbidities in Children and Adolescents: A Nationally Representative Study

BackgroundFirearm injury is the leading cause of pediatric death in the United States (US), but few investigations have focused on the healthcare cost and burden of hospitalized survivors. We aimed to delineate the landscape of pediatric firearm hospitalizations, with a focus on sociodemographic characteristics and on acquired morbidity among survivors. MethodsWe performed a retrospective cohort study of hospitalized children (<21 years old) with firearm injuries using the 2019 Kids’ Inpatient Database, representing 80% of pediatric hospitalizations nationally. ResultsThere were 5998 hospitalizations with 5592 hospital survivors, giving a US population-adjusted hospitalization rate of 9.7 per 100,000 subjects <21 years. Black subjects (37.9 per 100,000) were admitted at higher rates than other races and ethnicities (3.8–6.2 per 100,000). Non-survivors were overrepresented in White subjects who were disproportionately victims of suicide. There were 199 new invasive medical devices placed (3.3% of hospitalized subjects), including 194 in 5592 survivors (3.5% of survivors): 87 tracheostomies, 30 feeding tubes, and 77 both. Suicide attempt was overrepresented as a cause of injury in subjects needing new devices. Charges and length of stay were longer for subjects needing new devices. Total charges for all hospitalized subjects exceeded $1.05 billion for 2019, $136 million (13%) of which represented the 3.3% of admissions needing new devices. ConclusionsAmong pediatric firearm hospitalizations in 2019, Black children were overrepresented among assaults, and White children for suicide attempts. Suicide attempts were overrepresented among non-survivors, those requiring new devices, and contributed disproportionately to total hospital charges. Level of EvidenceLevel 3.

Implant Cost Awareness Among Orthopaedic Surgeons at a Single Academic Institution

Introduction Despite the increasing costs of implants, surgeons’ awareness of these costs varies widely. The purpose of this study is to determine baseline awareness of sports-medicine-related implant cost among orthopaedic surgeons. Methods A survey including images of 10 different orthopaedic implants related to sports medicine was sent to 18 surgeons. All included surgeons practice in a single ambulatory surgery center and routinely perform sports-medicine-related procedures. Surgeons were asked to estimate the cost of each implant and answer questions about surgeon characteristics. Cost estimates were compared with implant cost found in the institutional charge master database. Results Cost estimates varied widely among providers regardless of fellowship training. The average percent error among all providers was 54.3%. Surgeons that rated knowledge of implant cost to be important most or all of the time had an average cost estimate error of 60.7% versus 48.0% error in their counterparts that stated that knowledge of cost was important to them only some of the time, though this did not reach statistical significance. Low-cost implants were more likely to be overestimated while high-cost implants were more often underestimated. Years of experience, sports medicine fellowship training, and involvement in contract negotiations had no effect on implant cost accuracy. Conclusion Implant cost awareness is dishearteningly low sports medicine orthopaedists despite the large economic impact of these devices. There is considerable room for improving cost awareness in sports medicine.

7313 Impact of Day of Admission on Hyperosmolar Hyperglycemic State Outcomes- a National Inpatient Sample Study

Abstract Disclosure: B. Neupane: None. S. Karki: None. A. Bhandari: None. K. Rajamani: None. Introduction: Hospital mortality and results are significantly influenced by the day of admission (weekend vs. weekday). Studies have shown there is an increase in rates of adjusted hospital mortality in various diseases. Hyperosmolar hyperglycemic state (HHS), or Hyperosmotic hyperglycemic nonketotic state (HHNK), is a serious complication associated with type 2 diabetes mellitus. There have been limited studies on how the day of admission impacts outcomes in HHS. Objective:To investigate if there are differences in weekend vs. weekday admission with the diagnosis of HHS on hospital outcomes. Methods: Retrospective data on adult patients (age &amp;gt;18) with a primary diagnosis of HHS was taken between 2017 and 2020 using the National Inpatient Sample (NIS). The data analysis tool utilized was STATA. Diseases and outcome codes were selected using the International Classification of Diseases (ICD-10). Multivariate regression analysis was used to adjust for potential variables and determine the adjusted odds ratio (aOR). The Fisher exact test was used to compare proportions, while the student t-test was used to compare continuous variables. The study's primary outcome was mortality; additional secondary outcomes included length of stay (LOS), total hospitalization costs, acute coronary syndrome (ACS), septic shock, pulmonary edema, acute respiratory failure (ARF), mechanical ventilation, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and cerebrovascular accidents (CVA). Between 2017 and 2020, the mortality rates, LOS, and total hospitalization charges of weekend and weekday admissions were analyzed. Results:181,720 patients were diagnosed with HHS; 46,100(25.36%) were admitted on the weekend. Weekend admission had increased rates of ARF (aOR =1.2, 11.15% vs. 9.57%, p&amp;lt;0.01) and mechanical ventilation (aOR =1.24, 7.04% vs. 5.79%, p&amp;lt;0.01) compared to the weekday admission. There was no difference in the outcomes of the two groups in the mortality rate, mean LOS, total hospital charges, ACS, septic shock, pulmonary edema, AKI, CVA, and ARDS. In weekend admission, there was an increase in trends of LOS and total hospitalization charges, but there were no significant outcomes in the mortality rates over the years. In weekday admission, there was an increase in mortality rate trends, LOS, and total hospitalization charges. Conclusion: There was an increase in ARF and mechanical ventilation rates on weekends compared to weekday admission. When the two groups were compared, there were no significant outcomes in mortality rate, LOS, hospital charges, and other hospital outcomes. In both weekend and weekday admissions, there was an increase in trends of LOS and total hospitalization charges; however, only admissions during the weekday showed a significant increase in mortality rate trends. Presentation: 6/1/2024

7695 Impact Of Day Of Admission On Outcomes Of Adrenal Insufficiency- A National Inpatient Sample Study

Abstract Disclosure: S. Karki: None. B. Neupane: None. S. Neupane: None. A. Bhandari: None. U. Farooq: None. K. Rajamani: None. Introduction: Admission day (weekend vs. weekday) significantly influences hospital outcomes and mortality in various diseases, with evidence suggesting higher mortality rates associated with weekend admissions. However, the “weekend effect” on adrenal insufficiency remains underexplored in national inpatient samples. Objective of the study:To assess the impact of admission day on mortality rates, hospital stays, costs, and overall outcomes in adrenal insufficiency patients. Methods: A retrospective cohort study encompassing adult patients (age&amp;gt;18 years) was conducted using the National Inpatient Sample (NIS) data spanning from 2017 to 2020. The International Classification of Disease (ICD-10) was used to select codes for diseases and outcomes. STATA was employed for statistical analysis, using multivariate regression analysis to calculate adjusted odds ratios and account for potential confounding variables. Continuous variables were compared using the student t-test, while proportions were compared using the Fisher exact test. The primary outcome was mortality, with secondary outcomes encompassing length of stay (LOS), total hospitalization charges, acute coronary syndrome (ACS), septic shock, pulmonary edema, acute respiratory failure (ARF), mechanical ventilation, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and cerebrovascular accidents (CVA). Results: A total of 150,005 patients diagnosed with adrenal insufficiency were included in the analysis. Patients with adrenal insufficiency were categorized into two groups based on the day of admission: weekend and weekday. Weekend admissions constituted 23.5% of the total cases of adrenal insufficiency, with 35,330 patients. Significant differences in outcomes were observed in septic shock (aOR=1.16, 7.24 % vs. 6.30 %, p=0.007), ARF (aOR=1.23, 11.82% vs. 9.87%, p&amp;lt;0.001), mechanical ventilation (aOR=1.35, 6.29% vs. 4.76%, p&amp;lt;0.001), ARDS (aOR=1.83, 0.57% vs. 0.33%, p=0.003), and AKI (aOR=1.15, 24.74% vs. 22.58%, p&amp;lt;0.001) in weekend vs weekday admissions. However, no significant differences were observed in mortality rates, mean length of hospital stay, total hospital costs, ACS, pulmonary edema, and CVA. Conclusion: Weekend admissions for adrenal insufficiency showed poorer outcomes which prompts further investigation into underlying factors. Insights gained might be helpful for strategic planning at state and national levels, aiding in outcome improvement. Presentation: 6/1/2024

8189 Demographics and Healthcare Utilization of Diabetic Versus Non-Diabetic Gastroparesis hospitalization in the United States Using the National Inpatient Sample database

Abstract Disclosure: S. Khan: None. L. Zia: None. M. Khan: None. M. Amin: None. M. Khan: None. F. Sattar: None. Background: Gastroparesis is commonly associated with neuropathy secondary to Diabetes and Non-Diabetic causes such as Idiopathic, Post-Viral and Surgical with a wide spectrum of clinical manifestations impairing quality of life, worsening morbidity, and mortality. The purpose of this study is to assess Demographic disparities and utilization of healthcare services between Diabetic (DG) Versus Non-Diabetic Gastroparesis (NDG) admissions. Methods: Data were extracted from the National Inpatient Sample Database for the year 2020. It comprises discharge data obtained from a 20% stratified sample of community hospitals across the country. We conducted a retrospective cohort study focusing on admissions of patients aged 18 years and above with diagnosis of DG and NDG were identified using ICD-10 codes. Multivariate regression analysis was used to estimate the Mean difference of the Average length of hospital stay (LOS), and total hospital charges (THC). Multivariate logistic and linear regression was used accordingly to adjust for confounders. Analysis was performed using STATA 18. Results: Our study identified 10330 patients hospitalized due to gastroparesis, among them 1446 (14%) had DG. Hospitalizations with DG in comparison with NDG had lower number of women (65% Vs 80.7%, P≤0.05), a higher proportion of black adults (36.5% Vs 17%), a lower proportion of white adults (46.4% Vs 70%), and a higher Charlson Comorbidity Index. In DG, 104(7.19%) patients had EGD and non-diabetic gastroparesis, 977 (11%) had EGD during admission. The mean LOS in hospital was 4.72 days and mean total hospital charges were 51327 USD. Comparing both cohorts, there was statistically significant decrease in the mean LOS in DG, Adjusted Mean difference of 1.27 days (P = 0.006). In addition, there was significant decrease in the total cost of hospitalization with an adjusted Mean difference of 13832 (P=0.001). Thirty patients with NDG died during hospital course and none with Diabetic gastroparesis. Conclusion: According to our findings, majority of admissions with gastroparesis are related with non-diabetic causes with higher healthcare utilization and mortality rate. Gastroparesis is a relatively frequent and poorly understood condition which needs considerate effort to have a better understanding of disease. Presentation: 6/2/2024

8171 Analysis of Inflammatory Bowel Disease and Hashimoto's Disease: A Nationwide Study

Abstract Disclosure: C. Yang: None. L. Joo: None. B. Blair: None. Analysis of Inflammatory Bowel Disease and Hashimoto’s Disease: A Nationwide Study Introduction: The U.S. population is aging rapidly. There is limited data specifically for patients with Hashimoto’s disease who are older than or equal to 80 years old. We sought to examine the national inpatient sample database to describe in-hospital outcomes among these older patients. Methods: Data were extracted from the National Inpatient Sample (NIS) Database for the years 2019 and 2020. The NIS was searched for hospitalizations of adult patients with Hashimoto's disease using international classification of diseases 10th revision codes. We then examined the outcomes in patients who were older than or equal to 80 years old (YO) vs. younger than 80 years old. Linear regression and multivariate logistic was used accordingly to adjust for confounders. The primary outcome was inpatient mortality. Secondary outcomes were hospital length of stay (LOS), and total hospital charges (TOTHCG). SPSS software was used for statistical analysis. Results: This study included 48,649 patients with Hashimoto’s disease, of which 3,038(6.2%) patients were over or equal to the age of 80. Admissions with Hashimoto’s and old age had higher prevalence of hypertension (12.3% Vs 11.3 %, p&amp;lt;0.001), diabetes mellitus (14.8% VS 11.4% p &amp;lt;0.001), and obesity (6.9% Vs 3.1%, p&amp;lt;0.001). In-hospital mortality was higher among the older cohort (2.6% Vs 0.87, p&amp;lt; 0.001). On linear regression analysis, increased age was associated with increased in-hospital mortality (p&amp;lt;0.001). On multivariable regression, age &amp;gt;80 years was associated with higher odds of inpatient mortality (OR1.229, CI 1.174-1.286, p&amp;lt;0.001)). It was also shown that older Hashimoto’s patients pay significantly more total hospital charges ($82,361vs $70,231) with higher length of stay (7.4 days vs 5.6 days, p&amp;lt;0.001). On secondary analysis, it has shown that Hashimoto’s patients aged more than or equal to 80 years old had higher odds of having Crohn’s Disease (OR 1.032, CI 1.014-1.049, p&amp;lt;0.001) and Ulcerative Colitis (OR 1.025, CI 0.991-1.061, p&amp;lt;0.001). Conclusion: In this nationally representative population-based retrospective cohort study, aging was associated with higher mortality and worse outcomes among patients with Hashimoto’s disease. These results were distinguished in patients with inflammatory bowel disease. Presentation: 6/2/2024