Hospital-related Costs Research Articles

Can the Choice of Cementless Implants and Bearings during Total Hip Arthroplasty Have an Impact on the Overall Costs within a Bundled Payment Model?

AbstractThe comprehensive care for joint replacement model from the Center for Medicare and Medicaid Services and similar programs from other payers make hospitals and health care systems more responsible for better clinical and economic outcomes of total hip arthroplasty (THA) patients. The objective of the study was to evaluate hospital-related clinical and economic outcomes of using the cementless R3 cup and Polarstem with an oxidized zirconium bearing compared with other cementless hip systems using a ceramic bearing in THA patients. We retrospectively reviewed primary THA patients from the premier perspective database between 2014 and 2018Q3. Patients with R3 cup and Polarstem with an oxidized zirconium bearing were identified using appropriate keywords from billing records and compared against cementless and ceramic-on-polyethylene (CoP) THA patients who did not meet the keywords' criteria. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision THA; bilateral THA in same discharge or different discharges. 1:3 propensity score matching was used to control patients' demographic, clinical, and hospital characteristics. Generalized estimating equation model with appropriate distribution and link function was used to estimate hospital-related cost while logistic regression models were used to estimate discharged status, transfusion, and 30-days readmission. The study matched 818 R3/Polarstem with oxidized zirconium bearing patients with 2,454 CoP cementless THA patients. Length of stay for the R3/Polarstem patients (mean = 1.61 days; confidence interval [CI] = 1.41–1.80) was significantly lower (p-value ≤ 0.0001) than CoP THA patients (mean = 2.06 days; CI = 1.95–2.17). R3/Polarstem hip patients were 36% (odds ratio [OR] = 1.36; CI = 1.07–1.72; p-value = 0.0112) more likely to be discharged to home/home health care, 18% (OR = 0.82; CI = 0.63–1.06; p-value = 0.1235) less likely to be discharged to a skilled nursing facility (SNF), 84% less likely to have transfusion (OR = 0.16; CI = 0.09–0.29; p-value ≤ 0.0001), and 44% (OR = 0.56; CI = 0.32–0.98; p-value = 0.0412) less likely to readmitted within 30 days than CoP THA patients. Mean total hospital costs was marginally higher for R3/Polarstem patients (mean = $15,611; vs. $15,002; p-value = 0.0041) than CoP THA patients. While the total hospital costs for the R3/Polarstem was higher than CoP, the reduced length of stay, reduced discharge to SNF, and lower readmission rates can help to save money in the bundled payment and make the use of certain cementless hip systems a potential cost saving solution.

Failure after proximal humeral fracture osteosynthesis: a one\xa0year analysis of hospital-related healthcare cost

PurposeThe issue of rising healthcare costs and limited resources is a topic of worldwide discussion over the last several decades. We hypothesized that failure of proximal humeral fracture osteosynthesis is presumed to be an important determinant in healthcare resources and related costs. The aim of this study was to calculate the total hospital-related healthcare cost of proximal humeral fracture osteosynthesis over one year focusing on failure.MethodsA total of 121 patients with a proximal humeral fracture treated by angular stable osteosynthesis were included in this retrospective study. All hospital-related healthcare costs were investigated. Five main hospital-related cost categories were defined: hospitalization cost, honoraria, day care admission, materials, and pharmaceuticals.ResultsA total healthcare cost of € 1,139,448 was calculated for the whole patient group. Twelve patients needed revision surgery due to complications or fixation-related failure. This failure rate alone costed € 190,809 of the healthcare resources. In other words, failure after proximal humeral fracture osteosynthesis costed 17% of the total healthcare expenditure inone year.ConclusionThis study demonstrates that a high amount of hospital-related healthcare resources is spent because of failure after proximal humeral fracture osteosynthesis. Further research is necessary and should investigate on how to prevent failure. This is not only in the patient’s interest, but it is also of great importance for maintaining a healthy healthcare system.

Column-generation-based heuristic approaches to stochastic surgery scheduling with downstream capacity constraints

This paper addresses an advance surgery scheduling problem in an operating theater composed of multiple operating rooms (ORs) and a downstream surgical intensive care unit (SICU). Uncertainties in surgery durations and postoperative length-of-stays are taken into consideration. The decisions are made on a weekly basis and consist of three parts: determining the surgical blocks to open, selecting the surgeries to be performed from a waiting list, and assigning the selected surgeries to available surgical blocks. The objective is to minimize the patient-related cost as well as the hospital-related cost while respecting the SICU capacity constraints. We propose a two-stage stochastic programming model with recourse to address the studied problem. Sample average approximation is employed to translate the stochastic programming model into a deterministic integer linear programming (DILP) model, which is then solved by column-generation-based heuristic (CGBH) approaches. The CGBH approaches developed in this paper reformulate the DILP model in a column-oriented way and adopt multiple column-generation strategies and heuristic rules to improve computational efficiency. The experimental results illustrate that the proposed CGBH approaches require significantly less computation time than the conventional algorithm, and that the gaps between the resulting near-optimal solutions and the exact ones are below 1%. Moreover, numerical experiments carried out with large test problems validate the capability of the CGBH approaches in solving realistically sized cases.

Incidence and Cost of Deep Vein Thrombosis in Emergency General Surgery Over 15 Years

BackgroundDeep vein thromboses (DVTs) are a significant sequela of surgery and are associated with significant of morbidity and mortality in the United States. Operative emergency general surgery (EGS) cases have been demonstrated to have a greater burden of DVT than other types of surgery. Materials and methodsDVT in EGS cases were identified from the National Inpatient Sample–Healthcare Cost and Utilization Project database from 2001 to 2015 Q3 based on ICD-9 code specification. National incidence of DVT in EGS was calculated using the National Inpatient Sample–Healthcare Cost and Utilization Project sampling methodology, and propensity score matching was used to assess costs associated with DVT. ResultsAmong 15,148,352 sample-weighted hospitalizations, 0.623% (94,392) experienced DVT. Incidence of DVT was greatest in GI ulcer surgery (1.705%) and lowest in appendectomy (0.095%). Patients with a perioperative DVT incurred $22,301 more in hospital-related costs than their counterparts who did not have a DVT. Although rates of DVT remained stable over the period analyzed, DVT-associated costs increased at a 2.09% annual rate in excess of inflation during the period analyzed. This increase in costs was most significant for laparotomy, which increased at a rate of 8.09% annually. ConclusionsDVT continues to be a significant burden on resources in EGS in spite of efforts with DVT prophylaxis. Considering the increase in costs and little change in incidence, further research on cost-effective management of DVT in EGS is warranted.

Hospital-Based Resource Use and Costs Among Patients With Idiopathic Pulmonary Fibrosis Enrolled in the Idiopathic Pulmonary Fibrosis Prospective Outcomes (IPF-PRO) Registry

Idiopathic pulmonary fibrosis (IPF) is a rare and serious condition that is associated with high health-care resource use. The goal of this study was to estimate hospital-related resource use and costs by using a national, prospective registry of patients who were diagnosed with IPF or who had their diagnosis confirmed at the enrolling center in the past 6months in the United States. Participants enrolled between June 5, 2014, and April 12, 2016, in the ongoing Idiopathic Pulmonary Fibrosis Prospective Outcomes Registry were included (N= 300). Time to first hospitalization was analyzed by using Kaplan-Meier methods. Annualized costs were estimated for hospitalizations, ICU admissions, and ED visits. At enrollment, most participants were male (75%), white (95%), commercially insured (64%), smokers (68%), had an FVC between 50%and 80%predicted (66%), and received antifibrotic drugs (55%). During the first 12months of follow-up, participants averaged 0.11 ED visit, 0.42 hospitalization, 0.08 ICU admission, 2.18 hospital days, and 0.45 ICU day. Probability of hospitalization was 18%and 30%at 6 and 12months, respectively, and was highest for those with FVC< 50%predicted/diffusing lung capacity for carbon monoxide< 30%predicted. Mean annual costs (95%CI) for ICU admission and inpatient care were $10,098 ($4,732-$16,662) and $13,975 ($8,482-$20,918), respectively, per patient. IPF is associated with a substantial economic burden incurred by patients requiring hospital care. Future research in IPF should focus on improving clinical outcomes while reducing cost of care in hospitals. ClinicalTrials.gov; No.: NCT01915511; URL: www.clinicaltrials.gov.

Efficiency gains from a standardised approach to older people presenting to the emergency department after a fall.

Objective Falls are a major cause of hospital-related costs in people aged ≥65 years. Despite this, falls are often seen as trivial and given low priority in an emergency department (ED), especially in the absence of overt major injury. ED systems that care for falls patients are often inefficient. The aims of this study were to: (1) design and implement a standardised and systematic approach to patients presenting to an ED after a fall; and (2) achieve hospital efficiency gains, such as reduced hospital length of stay, through implementation of this approach. Methods A prospective study was conducted with pre- and postintervention measurement of outcomes. The key features of the intervention were direct admission to an ED short stay unit, standardised assessment of cognition, medications, mobility and discharge risk, and access in the ED to a geriatric consultation service for complex patients. Results In the 12 months of the intervention, 1435 male and female patients aged ≥65 years were enrolled in the study. At the end of 12 months, these patients had significantly higher ED discharge (66% vs 46%; P<0.001) and, if admitted, shorter median hospital stays (6 vs 2 days; P<0.001) compared with the baseline pre-intervention phase. Analysis 1 year later revealed that these outcomes were sustained or further improved. Conclusion A systematic approach to falls in older patients attending the ED is feasible and beneficial. Decreased hospital stay and improved rates of effective discharge from ED back to the community are achievable and sustainable. What is known about the topic? Falls are common, serious and costly. Not identifying and managing falls risk factors is a common feature of ED practice. As a result, admission rates to hospital for patients who fall are high. What does this paper add? In this large study we have shown that a systematic approach to falls assessment is feasible, sustainable and results in higher discharge rates from the ED. What are the implications for practitioners? EDs are the gateway to a hospital bed. It is possible to redesign ED flow and bring front-loaded multidisciplinary geriatric care into an ED short stay environment, to the benefit of patients and health systems.

Rotavirus symptomatic infection among unvaccinated and vaccinated children in Valencia, Spain

BackgroundHuman group A rotavirus is the leading cause of severe acute gastroenteritis in young children worldwide. Immunization programs have reduced the disease burden in many countries. Vaccination coverage in the Autonomous Region of Valencia, Spain, is around 40%, as the rotavirus vaccine is not funded by the National Health System. Despite this low-medium vaccine coverage, rotavirus vaccination has substantially reduced hospitalizations due to rotavirus infection and hospital-related costs. However, there are very few studies evaluating symptomatic rotavirus infections not requiring hospitalization in vaccinated children. The objective of this study was to investigate symptomatic rotavirus infections among vaccinated children in the health area served by the Hospital Clínico Universitario of Valencia, Spain, from 2013 to 2015.MethodsA total of 133 children younger than 5 years of age with rotavirus infection were studied. Demographic and epidemiological data were collected and informed consent from their caretakers obtained. Rotavirus infection was detected by immunological methods and G/P rotavirus genotypes were determined by RT-PCR, following standard procedures from the EuroRotaNet network.ResultsForty infants (30.1%; 95% CI: 22.3–37.9) out of 133 were diagnosed with symptomatic rotavirus infection despite having been previously vaccinated, either with RotaTeq (85%) or with Rotarix (15%). Children fully vaccinated against rotavirus (24.8%), partially vaccinated (5.3%) and unvaccinated (69.9%) were found. The infecting genotypes showed high G-type diversity, although no significant differences were found between the G/P genotypes infecting vaccinated and unvaccinated children during the same time period. G9P[8], G12P[8] and G1P[8] were the most prevalent genotypes. Severity of gastroenteritis symptoms required 28 (66.6%) vaccinated and 67 (73.6%) unvaccinated children to be attended at the Emergency Room.ConclusionRotavirus vaccine efficacy in reducing the incidence of severe rotavirus infection has been well documented, but symptomatic rotavirus infection can sometimes occur in vaccinees.

O18 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE STUDY)

Abstract Aim The aim of this study is to investigate which factors contribute to anastomotic leakage severity and to compose an evidence based anastomotic leakage severity score. Secondly, we aim to investigate which anastomotic leakage characteristics are associated with success of different anastomotic leakage treatments and to compare the effectiveness of different initial anastomotic leakage treatments for anastomotic leakage classified according to severity and leakage characteristics. Background Anastomotic leakage occurs in 0%-30% after esophagectomy for cancer. It is a severe complication with mortality rates approximately ranging from 2%-12%. In addition, it is associated with a prolonged ICU treatment and hospital stay. Anastomotic leakage severity is currently graded according to how it is treated (grade I: conservative treatment, grade II: endoscopic/radiologic intervention and grade III: surgical intervention). However, this scoring system cannot be used to guide decision making when anastomotic leakage is diagnosed in a clinical setting. Factors that may influence the severity of the anastomotic leakage are (amongst others) location of the anastomosis, estimated surface of the defect, estimated circumference of the defect, extent of contamination, degree of sepsis and time from diagnosis until therapy. However, little is known about to what extent these and other factors contribute to anastomotic leakage severity. In addition, there is a paucity of data on what leakage characteristics dictate the success of a specific treatment. Methods We will perform an international multicenter retrospective cohort study. All adult patients with anastomotic leakage according to the ECCG definition after esophagectomy and gastric conduit reconstruction for esophageal cancer are suitable for inclusion. We aim to include at least 1000 patients. The primary outcome parameter is 90-day mortality. Secondary outcome parameters are in-hospital mortality, 30-day mortality, 180-day mortality, comprehensive complications index, total number of reinterventions, hospital and ICU length of stay and hospital related costs. Results Data collection will take place from April 2019 until December 2019. Study results are expected in June 2020. Conclusion We hypothesize that we will be able to identify factors that influence the severity of the anastomotic leakage and to compose a leakage severity score. Furthermore, we expect to identify leakage characteristics dictating the success of a specific treatment.

PMD57 TOTAL HOSPITAL COSTS AND READMISSION RATE OF PATIENT-SPECIFIC CUTTING GUIDE IN TOTAL KNEE ARTHROPLASTY (TKA) PATIENTS

Despite advancements in surgical technique and component design, implant loosening, stiffness, and instability remain leading causes of TKA failure. Patient Specific Instruments (PSI) aid in surgical precision and in implant positioning and ultimately reduce readmission and revisions in TKA. The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, 365 days in PSI guided TKA patients We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were <21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate 30, 60, 90 days and 1-year readmission rate The study matched 3,358 TKA with PSI with TKA and without PSI patients. Mean total hospital costs was statistically significant (<.0001) lower for TKA with PSI ($14,910; CI: $14,735 - $15,087) than TKA without PSI patients ($16,018; CI: $15,826 - $16,212). TKA with PSI patients were 31% (OR=0.69; CI=0.51-0.95; p-value=0.0218) less likely to be readmitted at 30 days; 35% (OR=0.65; CI=0.50-0.86; p-value=0.0022) less likely to be readmitted at 60 days; 32% (OR=0.68; CI=0.53-0.88; p-value=0.0031) less likely to be readmitted at 90 days; 28% (OR=0.72; CI=0.60-0.86; p-value=0.0004) less likely to be readmitted at 365 days than TKA without PSI patients Hospitals and healthcare professionals can use retrospective real-world data to make informed decisions on using PSI to reduce hospital cost and readmission rate, and improve outcomes in TKA patients

Medico-economic impact of robot-assisted lung segmentectomy: what is the cost of the learning curve?

The objective of this study was to assess the learning curve (LC) of robot-assisted lung segmentectomy and to evaluate hospital-related costs. We conducted a retrospective study of Robot-assisted thoracic surgery (RATS) segmentectomies performed by 1 surgeon during 5 years. Perioperative and medical device data were collected. The LC, based on operating time, was assessed by Cumulative SUM analysis and an exponential model. Cost of care was estimated using the French National Cost Study method. One hundred and two RATS segmentectomies were included. The LC was completed at ∼30 procedures according to both models without significant difference in patients' characteristics before or after the LC. Mean operative time decreased from 136 min [95% confidence intervals (CI) 124-149] for the first 30 procedures to 97 min (95% CI 88-107) for the last 30 procedures. Mean length of stay decreased non-significantly (P = 0.10 for linear trend) from 8.1 days (95% CI 6.1-11.0) to 6.2 days (95% CI 4.9-7.9). The overall costs for the last 30 procedures as compared with the first 30 did not significantly decrease in the primary economic analysis but significantly decreased (P = 0.02) by €1271 (95% CI -2688 to +108, P = 0.02 for linear trend) after exclusion of 1 outlier (hospitalization-related costs > €10000). After exclusion of this outlier, costs related to EndoWrist® instruments significantly decreased by €-135 (95% CI -220 to -35, P = 0.004), whereas costs related to clips decreased non-significantly (P = 0.28). The LC was completed at ∼30 procedures. Inexperienced surgeons may have higher procedure costs, related to consumable medical devices and operating time.

654 Improving Inflammatory Bowel Disease Care: A Quality Improvement Project for Venous Thromboembolism Prophylaxis

INTRODUCTION: Inflammatory Bowel Disease (IBD) patients admitted with a flare are 5-6x more likely to have a complication with venous thromboembolism (VTE). As a result, more emphasis is being placed on administering chemical prophylaxis to these patients. A 6-month retrospective chart review of patients hospitalized at our institution with an IBD flare without severe GI bleeding revealed that only 39% received chemical VTE prophylaxis. Herein, we designed a quality improvement project with an aim to improve this rate to over 75%. METHODS: Our initial Ishikawa diagram was used to map out the entire process from which a patient enters the emergency room until they are admitted to their hospital bed to analyze reasons DVT chemoprophylaxis was withheld. “Bleeding” was the most commonly documented reason. We then decided to target the patient population to hospitalized IBD flares without severe GI bleeding. The parameters we set for this included Hemoglobin &lt;7 g/dL, tachycardia, and/or hypotension. Our main intervention was placing reminder sheets in each Internal Medicine team room with the aforementioned parameters for appropriate use of chemical prophylaxis. Further, a department-wide e-mail was sent to all of Internal Medicine with the reminder sheet attached and educational text. RESULTS: Over the 4 months post-intervention, VTE prophylaxis rates for hospitalized IBD flares without severe bleeding (n = 14) improved to 100%. Hospitalization related costs for a diagnosis of “DVT” or “PE” are reportedly ∼$10,000 &amp; $20,000, respectively. The cost of Lovenox for a 5 day length of stay for an 80 kg man is $420. There is an estimated 7.6 to 41% risk of VTE amongst patients hospitalized for flares. At University Hospital, we averaged about 4 flares without severe bleeding/month. Using 25% risk for 48 patients per year, this could potentially lead to 12 VTE prevented/year. Taking all of this into account there is a potential 900% return on investment with savings of about $160,000/year. CONCLUSION: It does appear that our interventions helped us reach our goal to improve VTE prophylaxis rates in IBD flares. A weakness, however, is the low sample size of patients, but we do plan to continue collecting data over the next year. Further, education has been proven to be a weak intervention with poor sustainability in the world of QI. The main plan for sustainability remains to work with IT to implement “IBD flare without severe bleeding” as a check-mark for high-risk of VTE on the admission order set.

Global hospital and operative costs associated with various ventral cavity procedures: a comprehensive literature review and analysis across regions

Objectives: The aim of this literature review was to provide a comprehensive report on hospital costs, and cost components, for a range of ventral cavity surgical procedures across three regions of focus: (1) Americas, (2) Europe, Middle East and Africa (EMEA), and (3) Asia-Pacific.Methods: A structured search was performed and utilized a combination of controlled vocabulary (e.g., “Hepatectomy”, “Colectomy”, “Costs and Cost Analysis”) and keywords (e.g. “liver resection”, “bowel removal”, “economics”). Studies were considered eligible for inclusion if they reported hospital-related costs associated with the procedures of interest. Cost outcomes included operating room (OR) time costs, total OR costs, ward stay costs, total admission costs, OR cost per minute and ward cost per day. All costs were converted to 2018 USD.Results: Total admission costs were observed to be highest in the Americas, with an average cost of $15,791. The average OR time cost per minute was found to vary by region: $24.83 (Americas), $14.29 (Asia-Pacific), and $13.90 (EMEA). A cost-breakdown demonstrated that OR costs typically comprised close to 50%, or more, of hospital admission costs. This review also demonstrates that decreasing OR time by 30 min provides cost savings approximately equivalent to a 1-day reduction in ward time.Conclusion: This literature review provided a comprehensive assessment of hospital costs across various surgical procedures, approaches, and geographical regions. Our findings indicate that novel processes and healthcare technologies that aim to reduce resources such as operating time and hospital stay, can potentially provide resource savings for hospital payers.

Effect of procedural refinement of transfemoral transcatheter aortic valve implantation on outcomes and costs: a single-centre retrospective study

ObjectivesTo determine the effect of introducing several procedural refinements of transfemoral transcatheter aortic valve implantation (TAVI) on clinical outcomes and costs.DesignRetrospective analysis comparing two consecutive 1-year periods, before and after...

Predicting Short-term Outcomes After Radical Cystectomy Based on Frailty

ObjectiveTo evaluate the impact of frailty on adverse perioperative outcomes in patients treated with radical cystectomy for bladder cancer. Material and MethodsWe identified 9459 adults (age ≥18) in the Nationwide Readmission Database who underwent radical cystectomy in 2014 for bladder cancer. We defined patients’ frailty status using Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator and compared in-hospital mortality, ICU-level complications, 30-day readmissions, nonhome discharge, length of hospitalization, and hospital-related costs between frail and nonfrail patients using χ2 tests. We used multivariate logistic regression to identify predictors of the primary outcomes of interest. ResultsOf 9459 patients undergoing radical cystectomy, 7.1% (n = 673) met criteria. Frail patients were more likely than nonfrail patients to have comorbid conditions (68.2% vs 59.7%; P= .005), in-hospital mortality (4.2% vs 1.5%; P= .04), ICU-level complications (52.9% vs 18.6%; P<.001), nonhome discharge (33.9% vs 11.6%; P <.001), longer length of stay (median 15 vs 7 days; P<.001), and higher median cost of the index admission ($39,665 vs $27,307). Frailty was the strongest independent predictor of ICU-level complications, nonhome discharge, increased length of stay, and hospital-related costs of any covariate. ConclusionFrail patients receiving radical cystectomy were more likely than nonfrail patients to have adverse perioperative outcomes and higher odds of in-hospital mortality, ICU-level complications, nonhome discharge, increased length of stay, and hospital-related costs. Preoperative consideration of frailty may be useful in clinical guidance and shared decision-making.

Post-hospital syndrome predicts poor postoperative outcomes and increased cost following transvaginal midurethral sling placement.

Post-hospital syndrome (PHS), a 90-day period of health vulnerability related to physiologic stressors following recent inpatient admission, has been observed in surgical and non-surgical patients. We aim to explore its effects on readmission and complication rates in patients undergoing elective female mid-urethral sling placement for the treatment of stress urinary incontinence. The Healthcare Cost and Utilization Project State Inpatient Database, State Emergency Department Database, and State Ambulatory Surgery Database for Florida between 2009 and 2014 were linked and utilized. Patients were identified as having undergone an outpatient mid-urethral sling placement with or without cystoscopy by CPT code. The primary exposure was PHS, defined as any inpatient admission within 90days of mid-urethral sling placement. Patients with inpatient hospitalizations within 1year of sling procedure were categorized based on timing of prior admission and analyzed. The primary outcomes were 30-day hospital readmission, rates of postoperative ED visits, minor/major complications rates, and overall 30-day cost. A multivariable logistic regression model was fit to assess independent predictors of adverse surgical outcomes. A total of 17,081 female patients who underwent mid-urethral sling procedures were identified. Patients with PHS were at higher risk for 30-day readmission [OR: 5.36 (IQR: 3.61-7.93); p < 0.005], 30-day ED visits [OR: 2.38 (IQR: 1.75-3.25); p < 0.005], major complications [OR: 6.22 (IQR: 4.67-8.29); p < 0.005], and minor complications [OR: 4.62 (IQR: 3.77-5.67); p < 0.005]. This risk was time dependent in nature with a decreasing risk profile the further surgery was from index hospitalization. Furthermore, PHS patients were more likely to incur an increased cost burden with an average 30-day increased cost of $705.80. Hospitalization within 90days prior to mid-urethral sling placement is a risk-adjusted, independent predictor of increased rates of 30-day readmission rates, 30-day ED visits, 30-day minor/major complications, and increased hospital-related cost. Clinical and surgical outcomes may be improved with consideration of prior hospitalizations in determining the timing of mid-urethral sling placement for stress urinary incontinence.

Efficacy of a stepped collaborative care intervention for comorbid cancer and depression: Health care utilization and costs.

e18348 Background: The aims of this study were to test the efficacy of a stepped collaborative care intervention for comorbid cancer and depression on outcomes including complication rates, health care utilization and costs. Methods: Patients diagnosed with cancer were enrolled in a randomized controlled trial testing the efficacy of a stepped collaborative care intervention. Patients were administered a battery of questionnaires prior to randomization. Rates and severity of surgical complications, health care utilization and costs were collected for a one-year period after randomization. Descriptive statistics, Chi-square analyses, and Ordered Restricted Inference analyses were performed. Results: Of the 100 patients, the mean age was 64.0 (SD = 10.3), the majority of the patients were male (51%), Caucasian (89%), diagnosed with hepatocellular or cholangiocarcinoma (47%) and stage III and IV (60%). For patients less than 75 years, patients randomized to the collaborative care intervention had lower rates of complications after surgery [Χ2= 5.45, P = 0.02]. We observed that 16% of patients randomized to the collaborative care intervention had complications versus 66.7% of the patients in the screening and referral arm. For patients who survived 6 months or less, those who were randomized to the collaborative care intervention had lower rates of 90-day readmissions than patients randomized to the screening and referral arm [Χ2= 4.0, P = 0.046]. The patients randomized to the collaborative care intervention did not have any readmissions while 2 patients in the screening and referral arm were readmitted. Patients randomized to the collaborative care intervention arm had lower median costs associated with the loss of workforce productivity ($2340 versus $3001; P = 0.07), hospital costs ($13,008 versus $21,109, P = 0.09), and cost per hospital registration ($1158 versus $2219, P = 0.07) when compared to the screening and referral arm. Conclusions: The stepped collaborative care intervention not only reduced depressive symptoms, but patients randomized to this intervention had lower complication rates, health care utilization, loss of work productivity, and hospital related costs. Clinical trial information: NCT02939755.

PMD29 HOSPITAL RELATED CLINICAL AND ECONOMICAL OUTCOMES OF A OXIDIZED ZIRCONIUM HIP SYSTEM IN TOTAL HIP ARTHROPLASTY PATIENTS

The Comprehensive Care for Joint Replacement Model (CJR) from the Center for Medicare and Medicaid services (CMS) and similar programs from other payers makes hospitals and healthcare systems more responsible for better clinical and economic outcomes of total hip arthroplasty (THA) patients. The objective of the study was to evaluate hospital-related clinical and economic outcomes of oxidized zirconium hip System in THA patients. We retrospectively reviewed primary THA patients from the Premier Perspective Database between 2014 and 2017. Patients with oxidized zirconium hip System were identified using appropriate keywords from billing records and compared against other THA patients who did not meet the keywords’ criteria. Patients were excluded if they were <21 years of age; outpatient hospital discharges; evidence of revision THA; bilateral THA in same discharge or different discharges. 1:1 Propensity Score Matching was used to control patients, hospital and clinical characteristics. Generalized Estimating Equation (GEE) model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate discharged status and 30-days readmission. The study matched 333 Oxidized Zirconium hip system patients with other THA patients. Length of stay for POLAR3 patients (mean=1.61days; CI=1.47-1.74) were significantly lower than other THA patients (mean=2.23days; CI=2.10-2.37). Oxidized Zirconium hip patients were 82% (OR=1.82; CI=1.19-2.78; p-value=0.0058) more likely to be discharged to home/home health care, 44% (OR=0.56; CI=0.35-0.90; p-value=0.0168) less likely to be discharged to a skilled nursing facility, and 65% (OR=0.35; CI=0.12-0.98; p-value=0.0447) less likely to readmitted within 30 days than other THA patients. Mean total hospital costs lower for Oxidized Zirconium hip patients (mean=$15,023; vs $15,451; p-value=0.1803) than other THA patients. Hospitals and healthcare professionals can use retrospective real-world data to make informed decisions on hip system choice to reduce hospital cost and improve outcomes in THA patients.

PMD30 HOSPITAL RELATED CLINICAL AND ECONOMICAL OUTCOMES OF TWO PREMIUM KNEE SYSTEM IN TOTAL KNEE ARTHROPLASTY PATIENTS

The Comprehensive Care for Joint Replacement Model (CJR) from CMS and similar programs from other payers makes hospitals and healthcare systems more responsible for better clinical and economic outcomes of total knee arthroplasty (TKA) patients. The objective of the study was to evaluate hospital-related clinical and economic outcomes of a two premium knee system in TKA patients We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017. Patients with journey II knee system and triathlon knee system identified using appropriate keywords from billing records were included in the study. Patients were excluded if they were <21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate discharged status and 1-year readmission rate. The study matched 2,247 journey II knee system patients with triathlon knee system patients. Length of stay for journey II knee system patients (mean=2.26days; CI=2.21-2.31) were significantly lower than triathlon knee system patients (mean=2.49days; CI=2.44-2.54). Journey II knee system patients were 26% (OR=1.26; CI=1.08-1.47; p-value=0.0030) more likely to be discharged to home/home health care, 28% (OR=0.72; CI=0.60-0.86; p-value=0.0003) less likely to be discharged to skilled nursing facility, and 27% (OR=0.73; CI=0.56-0.96; p-value=0.0264) less likely to be readmitted within 1-year than triathlon knee system patients. Mean total hospital costs were significantly lower for journey II knee system patients (mean=$15,165; CI=$14,922-$15,411) than triathlon knee system patients (mean=$15,594; CI=$15,344-$15,848). Hospitals and healthcare professionals can use retrospective real-world data to make informed decisions on knee system choice to reduce hospital cost and improve outcomes in TKA.

Extracorporeal Photopheresis Improves Survival Probability and Lowers Hospital-Related Expenses In Lung Transplant Recipients With Bronchiolitis Obliterans Syndrome

Purpose Extracorporeal photopheresis (ECP) is used at the Medical University of Vienna as an empiric treatment option for lung transplant recipients suffering from bronchiolitis obliterans syndrome (BOS). The objective of the present retrospective investigation was to evaluate hospital-related costs and the clinical value of ECP when applied as an adjunct to the local standard therapy of BOS compared to standard treatment alone. Methods The patient population consisted of 32 double-lung transplant recipients who had been diagnosed with BOS. Sixteen matched pairs, each pair comprising of one ECP-treated patient and one control patient was built (matched population). Preselect pair-match criteria were weighted. The primary matching criterion was the BOS grade at diagnosis. Secondary matching factors were the year of transplantation, age at transplantation, and gender. Results Study groups were identical in demographic characteristics and clinical parameters at baseline. Over the observation period of up to 15.5 years, survival probability was improved by approximately 30% in the ECP treated patients as compared to matched controls (see Figure A; p Conclusion Compared to standard BOS-directed therapies, ECP improves significantly survival probability in double-lung transplant patients diagnosed with BOS. ECP exerts a significant impact on the number of total re-admissions to the hospital, the total days of care, and the total patient days. Thus, ECP has proved highly effective and cost saving in the treatment of lung transplant patients presenting with BOS.

Hospitalization cost reduction with sacubitril-valsartan implementation in a cohort of patients from the Daunia Heart Failure Registry

IntroductionAim of this study was to assess the impact of the introduction of new class of drugs (ARNI: angiotensin receptor-neprilysin inhibitor) on hospital related costs in a real world cohort of patients with chronic heart failure (CHF). MethodsSeventy-three consecutive patients with CHF and systolic dysfunction eligible for the treatment with ARNIs from the Daunia Heart Failure Registry were enrolled. Incidence of hospitalizations before and after treatment with ARNI, costs for drug and hospitalization for HF were recorded, indexed per year and compared. ResultsIndexed mean number of hospitalizations per year was 0.93 ± 1.70 before and 0.19 ± 0.70 after introduction of ARNI (p < 0.001, −80%), 2.26 ± 1.95 before and 0.38 ± 1.2 after ARNI in the subgroup of patients with at least one hospitalization for HF in the year before treatment with ARNI (p < 0.001, −83%).Mean indexed cost for hospitalization was 2067 ± 3715 euros before and 1847 ± 1549 after ARNI (p n.s., −11%); in the subgroup with at least one hospitalization for HF 5175 ± 4345 before and 2311 ± 2308 after ARNI (p < 0.001, −55%). Cost reduction increased with the number of indexed hospitalization per year before ARNI from 11% to 66%. ConclusionIn a real world scenario, treatment with ARNI is associated with lower indexed rates of hospitalizations and hospitalization related costs. Cost reduction increases with at least one indexed hospitalization for heart failure before treatment with ARNI.