Total Hospital Costs Research Articles

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<0.001), increased mean LOS (10.14 days vs 5.52 days, p<0.001) and a higher hospitalization cost ($121,721 vs 69,348, p<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<0.001), pulmonary edema (aOR=1.37, 0.61 vs 0.44, p<0.001), CVA (aOR=1.45, 1.7 vs 1.04, p<0.001) acute respiratory failure (aOR=1.78, 20.27 vs 11.75, p<0.001), need of mechanical ventilation (aOR= 2.46, 9.36 vs 3.96, p<0.001), ARDS (aOR= 2.8, 0.55 vs 0.21, p<0.001), AKI (aOR=1.57, 35.45 vs 24.12, p<0.001), and septic shock (aOR= 3.32, 10.3 vs 3.24, p<0.001). There is an increased trend of mortality (10.77 in 2017 vs 11.87 in 2020, p<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<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 4138570: The Hidden Killer in Patients with Sepsis Spectra Disorders: Systolic Heart Failure

Introduction: Sepsis and systolic heart failure (sHF) often prompt hospitalization and require near diametrically opposite treatment strategies. We, therefore, studied whether sHF would impact outcomes in patients with sepsis spectra. Methods: We examined the National Inpatient Sample 2021 for adults admitted with sepsis spectra (sepsis, severe sepsis, and septic shock). We compared patients with sHF vs those without. STATA 18 th edition was used for analyses. Age, gender, race, hypertension, diabetes, obesity, dyslipidemia, and Elixhauser comorbidity index were identified as confounders by univariate analyses and tested further with multivariate logistic regression models. The primary outcome was mortality. Secondary outcomes were the need for intubation, cardiac arrest, length of stay (LOS), and total hospital charges. Results: In 2021, nationwide, 3,030,351 adults were admitted for sepsis spectra, and 209,134 (6.9%) had concomitant sHF. Patients with sHF and sepsis spectra (as compared to those without sHF) were less likely female (35.5% vs. 48%), had a substantially higher likelihood of a prior MI, and nearly 50% were diabetic and hyperlipidemic with a higher comorbidity index. Baseline characteristics are in the Table. Sepsis and sHF resulted in substantially higher mortality (22.7%) as compared to patients with sepsis alone (14.9%) adjusted odds ratio (aOR) of 1.11 (CI 1.08-1.14; p-value < 0.001). Patients with sepsis and sHF were more likely to require intubation 22.2% vs. 14.0% aOR 1.21 (CI 1.18-1.25; p-value < 0.001), had more cardiac arrest 7.7% vs. 4.0% aOR 1.38 (CI 1.32-1.44; p-value < 0.001), and a longer LOS (11.9 vs 9.4 days adjusted incidence rate ratio (aIRR) 1.06; CI 1.05 – 1.08; p-value < 0.001). Consequently, total hospital charges were also higher, $189,415 vs $133,720, aIRR 1.15 (CI 1.13-1.18; p-value < 0.001). Conclusion: In 2021, nationwide, sepsis spectra remain a major cause of in-patient mortality. We demonstrate that the coexistence of systolic heart failure and sepsis dramatically worsens complications, mortality, and total hospital costs. This study is a call to action for the in-depth analyses of this very high-risk group of patients.

Abstract 4145880: Incidence and Outcomes of Acute Myocardial Infarction (AMI) in Hematological Malignancy Patients: Systematic review and Meta-analysis

Background: Patients with hematological malignancies may face increased cardiovascular risks, including acute myocardial infarction (AMI). This systematic review and meta-analysis aims to evaluate the incidence and outcomes of AMI in patients with hematological malignancies compared with the general population. Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Random effect models were utilized to calculate Mantel-Haenszel odds ratios (ORs) with 95% confidence intervals (CIs). The inverse variance method with DerSimonian–Laird (DL) of Tau2 was used to calculate standardized mean differences (SMDs) with CIs. Statistical significance was set at p < 0.05. The primary endpoint was the incidence of AMI, while secondary outcomes included in-hospital mortality, length of hospital stay, likelihood of undergoing invasive procedures, total hospital costs, bleeding events, and stroke outcomes. Results: Twenty-six articles, including approximately 6.33 million patients with hematological malignancies, were included in the meta-analysis. Hematological malignancies were not associated with an increased incidence of AMI compared with the general population (OR = 0.91; 95% CI 0.80 to 1.03; p<0.001). AMI in hematological malignancies was associated with an increased risk of in-hospital mortality (OR = 1.71; 95% CI 1.57 to 1.86; p<0.001), bleeding event (OR = 1.30; 95% CI 1.12 to 1.60; p<0.001), and stroke (OR = 1.24; 95% CI 1.09 to 1.42) compared with AMI in the general population. Patients admitted due to AMI in hematologic malignancies also experienced an increased length of stay (SMD = 0.25; 95% CI 0.20 to 0.28; p<0.001) compared with AMI in the general population. There was no significant difference between the two groups in terms of the likelihood of undergoing invasive procedures (OR = 0.62; 95% CI 0.56 to 0.69) or total hospital expenditure (SMD = 0.09; 95% CI -0.01 to 0.19). Conclusion: While hematological malignancies do not appear to increase the incidence of acute myocardial infarction (AMI), patients who experience AMI episodes are at higher odds of in-hospital complications.

Abstract 4138583: Incidence and Outcomes of Heparin-Induced Thrombocytopenia Among Patients Undergoing Left Ventricular Assist Device Implantation

Background: Left Ventricular Assist Devices (LVAD) are being increasingly used as a bridge to transplant and destination therapy for advanced (stage D) heart failure. Heparin-induced thrombocytopenia (HIT) increases the risk of thromboembolic and bleeding events. HIT is also a well-known complication in patients undergoing LVAD implantation. This study examines the incidence and impact of HIT on outcomes in LVAD implants using a nationwide database from 2016 to 2020. Methods: We queried the National Inpatient Sample database for 2016-2020 to identify all adults ≥ 18 who underwent LVAD insertion using ICD 10 codes. LVAD recipients were dichotomized into two cohorts by the presence of HIT. Our primary outcome was in-hospital mortality. Secondary outcomes included vascular complications, acute kidney injury (AKI), length of stay, and total cost. Outcomes were adjusted for demographic variables, hospital-level characteristics, and comorbidities using regression analysis. Results: A total of 19975 (95% CI: 18328 - 21622) hospitalization records for LVAD insertion were identified, out of which HIT occurred in 1.8%. There were significant differences in AKI requiring dialysis, (p < 0.03) cardiogenic shock, (p<0.01), mechanical ventilation (p<0.01), pulmonary embolism (PE) (p< 0.001) and acute deep vein thrombosis (DVT) (p< 0.001) which occurred more in HIT. In-hospital mortality was not significantly associated with HIT (adjusted odds ratio [aOR] 1.49, 95% CI :0.73-3.04, p value 0.28). Older age (aOR 1.02; 95% CI: 1.01-1.02) was associated with mortality after LVAD insertion. AKI, ischemic stroke, hemorrhagic stroke, acute coronary syndrome, arterial dissection, cardiogenic shock, and mechanical ventilation were significantly associated with in-hospital mortality. Our analysis did not show any differences in the incidence of vascular complications, stroke, intraoperative bleeding, blood transfusions and AKI between the HIT and non-HIT group. The HIT group stayed longer in the hospital 39 days (95% CI: 36- 38) vs 37 days (95% CI: 35- 44) and incurred higher total hospital cost of $1,101,638 vs. $1,245,616) although this was not statistically significant. Conclusion: Among US hospitalized patients undergoing LVAD implants, HIT was significantly associated with a higher risk of AKI requiring dialysis, PE, acute DVT, cardiogenic shock and need for mechanical ventilation. It was however not associated with a higher risk of in-hospital mortality.

Short-Term Efficacy of LCBDE+LC Versus ERCP/EST+LC in the Treatment of Cholelithiasis Combined with Common Bile Duct Stones: A Retrospective Cohort Study.

Background: Minimally invasive treatments for cholelithiasis have gained popularity. The complexity of diagnosing and treating choledocholithiasis offers multiple surgical options, including laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+LC) and endoscopic retrograde cholangiopancreatography and/or endoscopic sphincterotomy plus laparoscopic cholecystectomy (ERCP/EST+LC). Objective: To compare outcomes in patients with typical signs, symptoms, laboratory, and imaging features of cholelithiasis combined with common bile duct stones, we retrospectively analyzed the short-term outcomes of LCBDE+LC and ERCP/EST+LC. Methods: We analyzed 318 patients with gallbladder stones treated between January 2022 and May 2024. Of these, 152 underwent LCBDE+LC, and 166 underwent ERCP/EST+LC. We compared patients' baseline characteristics, perioperative outcomes, and short-term complications between the two groups. The primary outcome was the effectiveness of choledochal stone removal, while secondary outcomes included length of stay, hospitalization costs, and patient satisfaction. Results: Patients' baseline characteristics were similar between the LCBDE+LC and ERCP/EST+LC groups. Stone clearance rates were comparable (97.37% versus 95.18%, P = .306), with a slight advantage in the LCBDE+LC group. The length of hospitalization was significantly shorter in the LCBDE+LC group (6.49 ± 1.18 days versus 6.77 ± 1.11 days, P < .05). The LCBDE+LC group also had lower total hospitalization costs ($5188.78 ± 861.26 versus $6498.76 ± 1190.58 P < .01). Additionally, the incidence of pancreatitis was lower in the LCBDE+LC group (0.66% versus 6.02%, P < .01). There were no significant differences between the groups in other short-term complications such as abdominal infection, cholangitis, biliary bleeding, or bile leakage. Postoperative follow-up indicated higher patient satisfaction and acceptance in the LCBDE+LC group (SSQ-8, 85.84 ± 4.31 points versus 81.20 ± 4.54 points, P < .01). Conclusion: Our findings suggest that the LCBDE+LC holds promise as a safe and efficacious approach for the management of cholelithiasis combined with common bile duct stones. However, further prospective clinical trials are essential to corroborate these results and confirm their broader applicability.

Identification and Categorization of Technical Errors and Hazard-zones of Robotic versus Laparoscopic total Gastrectomy for Gastric Cancer: A Single Center Prospective Randomized Controlled Study.

The current research aimed to conduct a detailed analysis of intraoperative surgical performance, short-term outcomes, identify and categorize technical errors, and hazard-zones enacted during total gastrectomy performed robotically and laparoscopically by surgeons. Prospective research is needed to determine whether the technical advantages of robotic surgery translate to patient outcomes. Identify and process risk areas in robot-assisted total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) to get the best patient results. Patients undergoing RTG and LTG were recruited and randomized into the study. Six consultant/attending surgeons participated in this study and all surgical procedures were recorded. The unedited surgical video-recordings were handed over to third-party experts for granular analysis of the procedures using objective clinical human reliability analysis (OC-HRA) for the quality of intraoperative performance, technical errors, intraoperative complications. This study is a single center prospective randomized controlled trial. 82 patients were recruited and participated in this study with 40 cases undergoing RTG and 42 cases for LTG. RTG vs LTG. Determine whether RTG or LTG can provide the better intraoperative technical performance and identify the most hazardous zone (area) during total gastrectomy (TG). The technical errors enacted and identified in the RTG and the LTG were (46.11±5.63 VS 58.79±8.45, P＜0.001) respectively. The highest number of technical errors was identified during the dissection of the supra-pancreatic lymph nodes (Task Zones3, TZ3), including No.5, 7, 8a, 9, 11p, and 12a to complete the nodal clearance around the celiac artery and its trifurcation (7.29±1.88 VS 9.43±2.24, P <0.001) in both RTG and LTG. The number of lymph nodes harvested with RTG was higher than LTG (35.36±7.51 VS 30.54±6.95, P=0.016), especially in the upper margin of the pancreas (13.32±4.17 VS 9.36±3.81, P＜0.001). The total cost of hospitalization in the RTG group cost 3% more than LTG group ($15953.41±3533.91 VS $12198.26±2761.27, P＜0.001). This study offers compelling OC-HRA evidence demonstrating that RTG facilitates significantly superior technical performance compared to LTG. Whether examining short-term clinical outcomes or intraoperative operations, the robotic surgery system consistently outperforms laparoscopic surgery. Lymph node dissection in the supra-pancreatic region emerged as a major hazard zone in both procedures. chictr.org.cn: ChiCTR2000039193.

Effectiveness, safety, and cost-effectiveness of norvancomycin in the management of acute hematogenous osteomyelitis in pediatric patients: A retrospective case study.

This study was designed to investigate the effectiveness, safety, and cost-effectiveness of norvancomycin in the management of acute hematogenous osteomyelitis in pediatric patients. We conducted a retrospective study on cases of osteomyelitis in pediatric patients treated with norvancomycin or vancomycin at Hebei Children's Hospital from January 2015 to February 2023. The patients were categorized into the norvancomycin group and the vancomycin group. Clinical data regarding efficacy, safety, and cost-effectiveness before and after drug treatment were collected for comparative analysis. Each group contained 104 children. After 14 days of treatment, there were no statistically significant differences in the incidence of adverse events and efficacy indexes between the 2 groups. However, the total hospitalization cost of the norvancomycin group (¥28765.35 ± ¥11835.98) was significantly lower than that of the vancomycin group (¥43776.06 ± ¥33365.30) (P = .000). Additionally, compared to the vancomycin group, both the clinical efficacy cost ratio (290.44 vs 437.76) and bacteriological clearance cost ratio (356.14 vs 576.30) were lower in the norvancomycin group. Norvancomycin demonstrates comparable efficacy to the first-line drug vancomycin in treating acute hematogenous osteomyelitis in pediatric patients. Moreover, norvancomycin can significantly mitigate treatment expenses and exhibit favorable cost-effectiveness.

Retrospective Analysis of RSV Infection in Pediatric Patients: Epidemiology, Comorbidities, Treatment, and Costs in Dubai (2014-2023)

Background: Infections attributable to respiratory syncytial virus (RSV) are a major cause of hospitalization among young children worldwide. Despite substantial clinical and economic burden, real-world data associated with RSV infections in the United Arab Emirates (UAE) are limited. Objectives: This study aimed to assess among children (&lt;18 years) diagnosed with RSV the epidemiology, seasonality, comorbidities, treatment patterns, length of hospital stay, healthcare resource utilization (HCRU), and costs associated with pediatric infection in Dubai, UAE. Methods: This 10-year retrospective cohort study (Jan. 1, 2014–Sept. 30, 2023) utilized Dubai Real-World Database, a private insurance claims database. Patients aged &lt;18 years with a first-episode diagnosis claim (primary or secondary, or a hospital admission) for RSV any time during the index period (Jan. 1, 2014–June 30, 2023) were included. Outcomes were analyzed during a 3-month follow-up. Patients were stratified into 3 cohorts: Cohort 1 (&lt;2 years), Cohort 2 (2 to &lt;6 years), and Cohort 3 (6 to &lt;18 years). Results: Of 28 011 patients identified, 25 729 were aged &lt;18 years with RSV infection. An increasing trend in reported cases was observed from 2014 to 2022, with an average annual increase of 55%. Half of study patients (49.3%) belonged to Cohort 1, with a mean age of 0.6 years, while less than 2% had known risk factors and 22% of the patients in cohort 1 were hospitalized. In Cohort 1, 32.0% had upper respiratory tract infections, 39.4% had lower respiratory tract infections, and 44.4% of patients had an “other respiratory disease.” The average length of hospitalization was about 4 days across all cohorts. The total hospitalization cost was highest in patients &lt;2 years, amounting to US $9 798 174 (median, US $2241.30). Conclusion: Among the RSV patients, 49.3% were &lt;2 years of age and few had recognized risk factors. Among patients &lt;2 years, 22% were hospitalized, with an average hospital stay of 4 days; the cost of hospitalization totaled US $9 798 174. These findings can inform healthcare stakeholders about future policy measures and the need for effective preventive strategies.

Retrospective Analysis of RSV Infection in Pediatric Patients: Epidemiology, Comorbidities, Treatment, and Costs in Dubai (2014-2023)

Background: Infections attributable to respiratory syncytial virus (RSV) are a major cause of hospitalization among young children worldwide. Despite substantial clinical and economic burden, real-world data associated with RSV infections in the United Arab Emirates (UAE) are limited. Objectives: This study aimed to assess among children (&lt;18 years) diagnosed with RSV the epidemiology, seasonality, comorbidities, treatment patterns, length of hospital stay, healthcare resource utilization (HCRU), and costs associated with pediatric infection in Dubai, UAE. Methods: This 10-year retrospective cohort study (Jan. 1, 2014–Sept. 30, 2023) utilized Dubai Real-World Database, a private insurance claims database. Patients aged &lt;18 years with a first-episode diagnosis claim (primary or secondary, or a hospital admission) for RSV any time during the index period (Jan. 1, 2014–June 30, 2023) were included. Outcomes were analyzed during a 3-month follow-up. Patients were stratified into 3 cohorts: Cohort 1 (&lt;2 years), Cohort 2 (2 to &lt;6 years), and Cohort 3 (6 to &lt;18 years). Results: Of 28 011 patients identified, 25 729 were aged &lt;18 years with RSV infection. An increasing trend in reported cases was observed from 2014 to 2022, with an average annual increase of 55%. Half of study patients (49.3%) belonged to Cohort 1, with a mean age of 0.6 years, while less than 2% had known risk factors and 22% of the patients in cohort 1 were hospitalized. In Cohort 1, 32.0% had upper respiratory tract infections, 39.4% had lower respiratory tract infections, and 44.4% of patients had an “other respiratory disease.” The average length of hospitalization was about 4 days across all cohorts. The total hospitalization cost was highest in patients &lt;2 years, amounting to US $9 798 174 (median, US $2241.30). Conclusion: Among the RSV patients, 49.3% were &lt;2 years of age and few had recognized risk factors. Among patients &lt;2 years, 22% were hospitalized, with an average hospital stay of 4 days; the cost of hospitalization totaled US $9 798 174. These findings can inform healthcare stakeholders about future policy measures and the need for effective preventive strategies.

Promoting application of enhanced recovery after surgery protocols during perioperative localized abdominal and thoracic neuroblastomas.

To investigate the safety and efficacy of the application of enhanced recovery after surgery (ERAS) protocols in the perioperative period of abdominal and thoracic localized neuroblastomas (NBs). In this retrospective study, 68 children with NBs who underwent surgical resection of the tumor were enrolled. The ERAS protocols for NB excision were implemented in the ERAS group (n = 39) and the consequences were compared with children treated with traditional care (n = 29, TRAD group). The main outcomes of our interest included the incidence of surgery-related complications, the postoperative length of stay (LOS), and the Face/Legs/Activity/Cry/Consolability (FLACC) quantitative table from postoperative days (POD) 1-5. We also evaluated the median intraoperative fluid volume and anesthesia recovery time; blood glucose levels at the beginning of anesthesia, POD1, and 3; WBC counts, CRP values, and the concentration of plasma nutritional indicators on POD1 and 3; time of early ambulation, first anal exhaust, total enteral nutrition (TEN), and discontinue intravenous infusion postoperatively; usage proportion and duration of abdominal and thoracic drainages, nasogastric decompression tubes and urinary catheters; cost of hospitalization, parental satisfaction rate, and readmission rate of surgery ward within 30days. Compared to the TRAD group, the ERAS group had lower surgery-related complications, albeit not significantly (P > 0.05); the median postoperative LOS decreased from 11.0 to 8.0days (P < 0.001), the LOS of abdominal NB was significantly shortened (P < 0.001) compared to thoracic NB (P = 0.07) between the two groups; the FLACC scores decreased significantly from POD1-5 (all P < 0.01). The ERAS group had an improved median intraoperative infusion speed (5.0mL/kg/h vs 8.0mL/kg/h), time of early ambulation (1.0days vs 3.0days), first anal exhaust (2.0days vs 2.0days), TEN (5.0 vs 7.0days), discontinuation of intravenous infusion (5.0days vs 8.0days), and total cost of hospitalization (33,897.2 Yuan vs 38,876.3 Yuan); (all P < 0.01). The usage proportion and duration of surgical drainages and tubes were apparently reduced. The mean blood glucose level was higher at the beginning of anesthesia but lower on POD1 and 3 in the ERAS group (P < 0.01). No statistically significant difference was detected in WBC counts and concentrations of hemoglobin and albumin between the two groups of patients (P > 0.05), while the concentrations of prealbumin on POD3 were higher and the CRP level on POD1 was lower in the ERAS group than the TRAD group (P < 0.01). The satisfaction rate of parents was only slightly higher, but the difference was not statistically significant (P = 0.730). No obvious differences were observed in the aspects of NB resection (P = 0.462) and 30-day readmissions of surgery ward (P = 1.000). The application of ERAS protocols has a significant potential to accelerate perioperative rehabilitation in children undergoing abdominal and thoracic NBs' surgical resection.

The discussion of the relationship between cardiopulmonary bypass and postoperative thyroid function changes in pediatric congenital heart disease, and the analysis of oral thyroid hormone therapy and cardiac prognosis.

This study aims to investigate the relationship between CPB factors and changes in TH levels in postoperative patients and the effect of oral levothyroxine sodium tablets on outcomes in patients with postoperative TF abnormalities. Select patients who underwent CHD surgery between September 2017 and September 2023 and were aged 13 years or younger. The relationship between CPB and postoperative TF changes and the influencing factors were analyzed. In addition, patients with different diseases and ages were divided into the medication group and the non-medication group. The primary outcome was postoperative ejection fraction (EF), and the secondary outcomes were PICU hospitalization days and total hospital cost. Seven hundred 53 patients were included. The longer the CPB time and ACC time, the lower the postoperative triiodothyronine (T3) and thyroxin (T4) levels (p < 0.001 and p < 0.001). The longer the CPB time, the more pronounced the postoperative T3 level abnormality (p < 0.001). The longer the CPB time, ACC time, and DHCA time, the more pronounced the postoperative T4 level abnormalities (p < 0.001 and p < 0.001 and p = 0.046). The postoperative EF of patients in the medication group was slightly higher than that of the non-medication group, and the EF before discharge was significantly higher than that of the non-medication group (p = 0.021, p = 0.015, and p = 0.024). Postoperative PICU days in the medication group [3.0 (2.0,7.0) versus4.0 (2.0,10.0), p = 0.020] were shorter than the non-medication group, and the proportion of ≤ 5days was more [154 (66.1%) versus304 (58.5%), p = 0.047]. The total hospitalization cost was slightly lower in the medication group (p < 0.05). The duration of CPB, ACC, and DHCA in the open surgery process for CHD affects patients' thyroid function in the postoperative period. In our study, we found that oral levothyroxine sodium tablets are beneficial to the children's postoperative recovery.

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.

Risk of Financial Toxicity Among Adults Undergoing Lung and Esophageal Resections for Cancer

Although financial toxicity, defined as the harmful financial burden experienced by patients undergoing cancer treatment, has been of growing interest, data in thoracic oncology are lacking. We aimed to examine the risk of financial toxicity among patients undergoing surgical resection of thoracic malignancies. Adults undergoing lobectomy, pneumonectomy, or esophagectomy for cancer were identified in the 2012-2021 National Inpatient Sample (NIS). Risk of financial toxicity was defined as health expenditure (total hospitalization costs for the uninsured and maximum out-of-pocket costs for the insured) exceeding 40% of post-subsistence income. Multivariable logistic regressions were used to identify factors associated with financial toxicity risk. Of 384,340 patients, 69.5% had government-funded insurance, 27.2% private insurance, and 1.0% were uninsured. Compared to those with insurance, uninsured patients were more commonly Black and Hispanic and less commonly electively admitted. Mortality, complications, LOS, and costs were comparable regardless of insurance status. Approximately 68.9% of uninsured and 17.3% of insured patients were at risk of financial toxicity, and incidence of financial toxicity remained stable over time. After risk adjustment, complications were associated with over 2-fold increased risk of financial toxicity among uninsured (AOR 2.21, 95% CI 1.38-3.55). Among the insured, Black, Hispanic, and publicly insured patients demonstrated greater risk of financial toxicity, while minimally invasive operations and metropolitan hospitals exhibited lower risk of financial toxicity. Concordant with prior work examining financial toxicity in abdominal oncologic surgery, thoracic surgery demonstrates a comparable burden of financial toxicity. Referral policies and care subsidization may be considered in patients undergoing thoracic malignancy resections at risk for financial toxicity.

Comparing surgical outcomes of powered versus manual surgical staplers: a systematic review and meta-analysis.

The growing use of staplers, manual and powered, especially in minimally invasive surgeries, necessitates evaluating their efficacy in gastrointestinal and thoracic surgeries. Parameters analysed include anastomotic and air leakage rates, bleeding, infection, cost, and operative duration. We searched Cochrane Library, CINAHL, EMBASE, PubMed, and Web of Science using terms like "surgical staplers," "manual staplers," "automatic staplers," and "powered staplers." We assessed study quality using the Joanna Briggs Institute (JBI) Critical Appraisal tools and conducted meta-analysis using Review Manager software. A total of 43,104 patients with a mean age of 60.8 were involved in the studies. The meta-analysis revealed a significant reduction in anastomotic leaks in GI surgery patients (OR 0.31, p = 0.0001) and a significant decrease in postoperative air leakage in thoracic surgery patients (OR 0.65, p = 0.05) when powered staplers were employed. Additionally, we observed a significant decline in hemostasis-related complications for both thoracic and GI surgeries (OR 0.48, p = 0.002) with the use of powered staplers. Although individually costlier than manual staplers, powered staplers significantly decreased total hospitalisation costs (MD -1725.82, p < 0.00001) amoungst the thoracic surgeries, due to the cost saved on remedying the lower rate of complications compared to manual staplers. It also decreased the average operative times in thoracic and GI surgeries, although not significant (p = 0.06, p = 0.07 respectively). Powered staplers surpass manual staplers by reducing operative duration, total hospital costs, and complications like anastomotic leaks and bleeding. Hence, they are poised to become the preferred alternative in future surgeries.

In-hospital outcomes of cardiac tamponade in patients with pulmonary hypertension: A contemporary analysis.

Cardiac tamponade (CT) has an atypical presentation in patients with underlying pulmonary hypertension (PH). Evidence regarding the impact of PH on CT in-hospital outcomes is lacking. We used the National Inpatient Sample database to identify adult hospitalizations with a diagnosis of CT between 2016 and 2020, using relevant ICD-10 diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients with and without a PH. Multivariate logistic regression analyses and case-control matching were performed, adjusting for age, race, gender, and statistically significant co-morbidities between cohorts. A total of 110,285 inpatients with CT were included, of which 8,670 had PH. Patients with PH tended to be older (66 ± 15.7) and female (52.5%), had significantly higher rates of hypertension (74% vs 65%), CAD (36.9% vs. 29.6%), CKD (39% vs 23%), DM (32.1%, vs. 26.9%), chronic heart failure (19.0% vs 9.7%) and COPD (26% vs 18%)(P<0.001 for all). After multivariate logistic regression, PH was associated with higher all-cause mortality (aOR 1.29; 95% CI: 1.11-1.49), higher rates of cardiogenic shock (aOR: 1.19; 95% CI: 1.01-1.41), ventricular arrythmias (aOR: 1.63; 95% CI: 1.33-2.01), longer length of stay (11 days vs 15 days), and higher total hospitalization costs ($228,314 vs $327,429) in patients presenting with CT. Despite pericardiocentesis being associated with lower in-hospital mortality, patients with PH were less likely to undergo pericardiocentesis (aOR: 0.77; 95% CI: 0.69-0.86). PH was associated to increased in-hospital mortality and a higher rate of cardiovascular complications in an inpatient population with CT. Pericardiocentesis was associated with reduced mortality in patients with CT, regardless of whether they had PH. However, patients with PH underwent pericardiocentesis less frequently than those without PH.

Factors affecting in-hospital clinical outcomes in patients with acute limb ischemia undergoing endovascular therapy or fogarty thrombectomy: a large-scale analysis based on the JROAD-DPC database

Abstract Background The etiology of acute limb ischemia (ALI) involves embolism as well as atherosclerotic thrombosis. Although endovascular therapy (EVT) or Fogarty thrombectomy (Fogarty TE) is the recommended revascularization method for ALI, treatment choice based on patient characteristics remains controversial. Purpose This study aimed to evaluate the differences in clinical outcomes between primary treatments and identify predictive factors affecting clinical outcomes in patients with ALI. Methods This retrospective study used data from the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database, from April 2012 to March 2020. We analyzed 18,701 patients with ALI and categorized them into medication and invasive treatment groups (EVT alone, Fogarty TE alone, bypass surgery alone, and hybrid treatment). The EVT-alone and Fogarty TE-alone groups were compared after propensity score matching, considering 19 clinically relevant covariates. The primary outcomes were in-hospital mortality, major amputation, and bleeding complications (anemia requiring transfusion or endoscopic hemostasis). The secondary outcomes were major adverse cardiovascular events (myocardial infarction, coronary intervention, heart failure, stroke, and cerebral hemorrhage), major amputation and/or death, hospitalization duration, and total cost during hospitalization. Results The EVT-alone group had more patients at a higher risk of atherosclerotic disease, including peripheral artery disease (PAD), chronic kidney disease (CKD), or hemodialysis. The Fogarty TE-alone group had more patients at a higher risk of embolism, including AF or AFL. After propensity score matching, in-hospital mortality (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.29–1.92, p&amp;lt;.0001), bleeding complications (OR: 1.28, 95% CI: 1.12–1.46, p=0.0002), and major amputation rates (OR: 1.44, 95% CI: 1.17–1.76, p=0.0004) were significantly higher in the EVT-alone group than in the Fogarty TE-alone group. Major amputation and/or death rates and total hospitalization costs were higher in the EVT-alone group than in the Fogarty TE-alone group. In interaction analyses, EVT demonstrated a favorable trend of lower risks of death and/or major amputation in patients with PAD, CKD, and diabetes mellitus (all risk factors for atherosclerotic disease), especially in those with PAD and CKD. Conclusions Fogarty TE may be the preferred primary treatment for patients with ALI, particularly those without PAD or CKD.Study flowchartForest plot analyzing interaction effect

Effectiveness of an Impella versus intra-aortic balloon pump in patients who received extracorporeal membrane oxygenation: a nationwide inpatient database study

Abstract Background/Introduction Previous studies have suggested that left ventricular (LV) unloading with an intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is associated with lower mortality; however, it is unclear which is better. Purpose This study aimed to evaluate the effectiveness of LV unloading with an Impella versus IABP on in-hospital mortality and other clinical outcomes. Methods Using the Japanese Diagnosis Procedure Combination database from September 28, 2016, to March 31, 2022, we identified inpatients who received an Impella or IABP in combination with ECMO (ECPella or ECMO+IABP group, respectively). The primary outcome was in-hospital mortality and the secondary outcomes were the length of hospital stay, length of ECMO, total hospitalization cost, and complications including major bleeding, an ischemic stroke, vascular complications, and renal replacement therapy during hospitalization. Propensity score matching was performed to compare the outcomes between the groups. We performed sensitivity analyses excluding patients who received extracorporeal cardiopulmonary resuscitation. Results Of 14,525 eligible patients, 603 (4.2%) received ECPella and 13,922 (96%) received ECMO+IABP. After propensity score matching, there was no significant difference in in-hospital mortality between the two groups (58.9% versus 56.6%; risk difference, 2.3%; 95% confidence interval, -3.9% to 8.5%). A Kaplan–Meier analysis with the log-rank test showed no significant difference in the 60-day in-hospital mortality between the two groups (P value = 0.114) (Figure 1). The ECPella group had a longer hospital stay (mean 42.8 days versus 33.7 days; risk difference, 9.1 days; 95% confidence interval, 2.6 to 15.6 days), a higher total hospitalization cost (12,573,000 yen versus 6,857,000 yen; risk differences, 5,716,000 yen; 95% confidence interval, 4,439,000 yen to 6,993,000 yen), and more frequent major bleeding (8.1% versus 5.8%; risk difference, 2.0%; 95% confidence interval, 0.007% to 4.0%), vascular complications (4.1% versus 2.2%; risk difference, 2.0%; 95% confidence interval, 0.04% to 3.9%), and renal replacement therapy during hospitalization (50.6% versus 41.1%; risk difference, 9.5%; 95% confidence interval, 3.0% to 15.9%) than the ECMO+IABP group (Figure 2). The results of the sensitivity analyses, excluding 6,360 patients (44%) who received extracorporeal cardiopulmonary resuscitation, showed similar results to those for the main analyses. Conclusions This nationwide inpatient database study showed that ECPella was not associated with a survival benefit but was associated with a longer hospital stay, a higher total hospitalization cost, and more complications than ECMO+IABP.Figure 1Figure 2

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&amp;lt;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&amp;lt;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.

Robotic right colectomy versus laparoscopic right colectomy in patients with right colon cancer: a comparative study

BackgroundThe study aimed to compare the clinical outcomes of robotic right colectomy (RRC) versus laparoscopic right colectomy (LRC) in patients diagnosed with right colon cancer, given the increasing adoption of robotic surgical techniques and their potential benefits in oncologic surgery.MethodsThis retrospective comparative study included patients who underwent right colectomy at Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, between January 2019 and May 2022. The primary outcomes measured were the number of lymph nodes harvested. Key secondary outcomes included the operation time, intraoperative blood loss, postoperative complications, hospitalization costs, overall survival (OS), and disease-free survival (DFS). Data were analyzed using multivariable Cox proportional hazards regression to adjust for potential confounders.ResultsA total of 225 patients (aged 65.23 ± 11.45, 108 males) with right colon cancer were included, with 100 (44.4%) patients underwent RRC. Patients who underwent RRC had significantly more lymph nodes harvested (27.69 ± 12.59 vs. 24.43 ± 9.42, P = 0.028), and incurred higher total hospitalization costs compared to those with LRC (9.68 ± 7.12 vs. 5.28 ± 1.23 ten-thousand-yuan, P < 0.001). The OS and DFS were comparable between RRC and LRC (both P > 0.05) within a median follow-up of 27 (range, 9–44) months. Multivariable cox proportional hazards regression showed that patients underwent RRC had significantly higher risk for all-cause death compared with those underwent LRC [hazards ratio (HR) = 2.303, 95% confidence intervals (CI): 1.625–3.265, P < 0.001].ConclusionPatients underwent RRC seemed to have significantly more numbers of lymph nodes harvested and higher risk for all-cause death and higher hospitalization costs compared with those underwent LRC. These findings suggest a need for careful consideration of the benefits and risks associated with robotic versus laparoscopic right colectomy in clinical practice.Trial registrationNot applicable.