Increased Hospital Costs Research Articles

Abstract WP187: Association of Renin Angiotensin Aldosterone Blockade and Hypotension After Carotid Artery Stenting

Background: Persistent hypotension after carotid artery stenting (CAS) can lead to adverse outcomes, prolong length of stay (LOS), and increase hospital costs. As catecholamine plays a critical role in blood pressure (BP) regulation, we aimed to determine the relationship between the use of renin-angiotensin-aldosterone inhibitor (RASI) drugs and post-CAS hypotension. Methods: A multicenter prospective study of patients with extracranial internal carotid artery stenosis and history of hypertension requiring CAS at two hospitals in China between January 2020 to May 2023. BP was recorded at frequent intervals for at least 24 hours post-CAS. Blood catecholamine concentrations were assessed in the morning of, and day immediately after, CAS in a subset of patients. Persistent hypotension was defined as systolic BP <90 mmHg or requiring vasopressor treatment for at least 6 hours. Logistic regression models assessed differences in the rates of post-CAS hypotension between RASI and non-RASI patients with adjustment for known confounding variables. Findings: There were 329 patients included: 160 in the RASI group and 169 in the non-RASI group. The RASI group had a higher rate of persistent hypotension (relative risk 1.52, P=0.031). The RASI group showed a greater decline in norepinephrine concentration after CAS compared with the non-RASI group (P=0.008). Patients with persistent post-CAS hypotension showed a similar decline in norepinephrine concentration (P=0.004) when compared with patients without persistent hypotension. Persistent hypotension prolonged LOS (P=0.014). Conclusion: Prior use of RASI for the treatment of hypertension is associated with persistent hypotension after CAS. A relation between decline of norepinephrine after stenting and persistent hypotension supports the role of catecholamine in BP control.

Association of Prediabetes and Recurrent Stroke in Atrial Fibrillation Patients: A Population-Based Analysis of Hospitalizations and Outcomes.

Prediabetes is a risk factor for ischemic stroke in atrial fibrillation (AF) patients, yet, its impact on recurrent stroke in AF patients remains understudied. Using the 2018 National Inpatient Sample, we investigated the link between Prediabetes and recurrent stroke in AF patients with prior stroke or transient ischemic attack (TIA). Among 18,905 non-diabetic AF patients, 480 (2.5%) had prediabetes. The prediabetic group, with a median age of 78, exhibited a two-fold higher risk of recurrent stroke compared to the non-prediabetic cohort (median age 82), as evidenced by both unadjusted (OR 2.14, 95% CI 1.72-2.66) and adjusted (adjusted for socio-demographics/comorbidities, OR 2.09, 95% CI 1.65-2.64, p < 0.001). The prediabetes cohort, comprising more male and Black patients, demonstrated associations with higher Medicaid enrollment, admissions from certain regions, and higher rates of hyperlipidemia, smoking, peripheral vascular disease, obesity, and chronic obstructive pulmonary disease (all p < 0.05). Despite higher rates of home health care and increased hospital costs in the prediabetes group, the adjusted odds of all-cause mortality were not statistically significant (OR 0.55, 95% CI 0.19-1.56, p = 0.260). The findings of this study suggest that clinicians should be vigilant in managing prediabetes in AF patients, and strategies to prevent recurrent stroke in this high-risk population should be considered.

Elevated Eosinophil Counts in Acute Exacerbations of Bronchiectasis: Unveiling a Distinct Clinical Phenotype.

Non-cystic fibrosis bronchiectasis is a chronic respiratory disease characterized by bronchial dilation. However, the significance of elevated eosinophil counts in acute exacerbations of bronchiectasis remains unclear. This retrospective case-control study included 169 hospitalized patients with acute exacerbations of non-cystic fibrosis bronchiectasis. Based on blood eosinophil levels, patients were categorized into eosinophilic and non-eosinophilic bronchiectasis groups. Various clinical variables, including lung function, comorbidities and clinical features were collected for analysis. The study aimed to examine the differences between these groups and their clinical phenotypes. Eosinophilic bronchiectasis (EB) was present in approximately 22% of all hospitalized patients with bronchiectasis, and it was more prevalent among male smokers (P < 0.01). EB exhibited greater severity of bronchiectasis, including worse airway obstruction, higher scores in the E-FACED (FACED combined with exacerbations) and bronchiectasis severity index (BSI), a high glucocorticoids medication possession ratio, and increased hospitalization cost (P < 0.05 or P < 0.01). Furthermore, we observed a significant positive correlation between blood eosinophil count and both sputum eosinophils (r = 0.49, P < 0.01) and serum total immunoglobulin E levels (r = 0.21, P < 0.05). Additional analysis revealed that patients with EB had a higher frequency of shortness of breath (P < 0.05), were more likely to have comorbid sinusitis (P < 0.01), and exhibited a greater number of lung segments affected by bronchiectasis (P < 0.01). These findings suggest that EB presents a distinct pattern of bronchiectasis features, confirming the notion that it is a specific phenotype.

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

BackgroundIn the past quite a long time, intraoperative cholangiography(IOC)was necessary during laparoscopic cholecystectomy (LC). Now magnetic resonance cholangiopancreatography (MRCP) is the main method for diagnosing common bile duct stones (CBDS). Whether MRCP can replace IOC as routine examination before LC is still inconclusive. The aim of this study was to analyze the clinical data of patients undergoing LC for cholecystolithiasis, and to explore the necessity and feasibility of preoperative routine MRCP in patients with cholecystolithiasis.MethodsAccording to whether MRCP was performed before operation, 184 patients undergoing LC for cholecystolithiasis in the Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University from January 1, 2017 to December 31, 2018 were divided into non-MRCP group and MRCP group for this retrospective study. The results of preoperative laboratory test, abdominal ultrasound and MRCP, biliary related comorbidities, surgical complications, hospital stay and hospitalization expenses were compared between the two groups.ResultsAmong the 184 patients, there were 83 patients in non-MRCP group and 101 patients in MRCP group. In MRCP group, the detection rates of cholecystolithiasis combined with CBDS and common bile duct dilatation by MRCP were higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in non-MRCP group (8.43%) was significantly higher (P < 0.05) than that in MRCP group (0%). There was no significant difference in hospital stay (P > 0.05), but there was significant difference in hospitalization expenses (P < 0.05) between the two groups. According to the stratification of gallbladder stone patients with CBDS, hospital stay and hospitalization expenses were compared, and there was no significant difference between the two groups (P > 0.05).ConclusionsThe preoperative MRCP can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by abdominal ultrasound, which is helpful to plan the surgical methods and reduce the surgical complications. From the perspective of health economics, routine MRCP in patients with cholecystolithiasis before LC does not increase hospitalization costs, and is necessary and feasible.

Application of the (fr)AGILE scale in the evaluation of multidimensional frailty in elderly inpatients from internal medicine wards: a cross-sectional observational study.

With the rapid growth of an aging global population and proportion, the prevalence of frailty is constantly increasing. Therefore, finding a frailty assessment tool suitable for clinical application by physicians has become the primary link in the comprehensive management of frailty in elderly patients. This study used the (fr)AGILE scale to investigate the frailty status of elderly patients from internal medicine wards and identified relevant factors that affect the severity of frailty. In this study, 408 elderly inpatients in internal medicine departments of Qilu Hospital of Shandong University from May 2021 to August 2022 were enrolled as research subjects, and a cross-sectional observational study was conducted. Researchers evaluated the frailty based on the (fr)AGILE scale score. The general condition, past medical history, physical examination, laboratory examination, nutrition control score, intervention and treatment measures and other elderly patient information was collected. Logistic regression analysis was used to analyze the relevant factors that affect the severity of frailty and hospitalization costs. According to the (fr)AGILE scale score, the elderly patients were divided into groups to determine whether they were frail and the severity of the frailty. Among them, 164 patients were in the prefrailty stage, which accounted for 40.2%. There were 188 cases of mild frailty that accounted for 46.1%, and 56 cases of moderate to severe frailty that accounted for 13.7%. Decreased grip strength, elevated white blood cell levels, and low sodium and potassium are independent risk factors affecting the severity of frailty. As the severity of frailty increases, the proportion of sodium, potassium, albumin supplementation as well as anti-infection gradually increases. Frailty is a common elderly syndrome with a high incidence among elderly patients in internal medicine departments. The main manifestations of frailty vary with different severity levels. Inflammation, anemia, and poor nutritional status can lead to an increase in the severity of frailty as well as blood hypercoagulability, myocardial damage, and additional supportive interventions. This ultimately leads to prolonged hospitalization and increased hospitalization costs.

Hospital services utilisation and cost before and after COVID-19 hospital treatment: Evidence from Indonesia.

To estimate hospital services utilisation and cost among the Indonesian population enrolled in the National Health Insurance (NHI) program before and after COVID-19 hospital treatment. 28,159 Indonesian NHI enrolees treated with laboratory-confirmed COVID-19 in hospitals between May and August 2020 were compared to 8,995 individuals never diagnosed with COVID-19 in 2020. A difference-in-difference approach is used to contrast the monthly all-cause utilisation rate and total claims of hospital services between these two groups. A period of nine months before and three to six months after hospital treatment were included in the analysis. A substantial short-term increase in hospital services utilisation and cost before and after COVID-19 treatment was observed. Using the fifth month before treatment as the reference period, we observed an increased outpatient visits rate in 1-3 calendar months before and up to 2-4 months after treatment (p<0.001) among the COVID-19 group compared to the comparison group. We also found a higher admissions rate in 1-2 months before and one month after treatment (p<0.001). Consequently, increased hospital costs were observed in 1-3 calendar months before and 1-4 calendar months after the treatment (p<0.001). The elevated hospital resource utilisation was more prominent among individuals older than 40. Overall, no substantial increase in hospital outpatient visits, admissions, and costs beyond four months after and five months before COVID-19 treatment. Individuals with COVID-19 who required hospital treatment had considerably higher healthcare resource utilisation in the short-term, before and after the treatment. These findings indicated that the total cost of treating COVID-19 patients might include the pre- and post-acute period.

Association of hospital volume and operative approach with clinical and financial outcomes of elective esophagectomy in the United States.

Literature regarding the impact of esophagectomy approach on hospitalizations costs and short-term outcomes is limited. Moreover, few have examined how institutional MIS experience affects costs. We thus examined utilization trends, costs, and short-term outcomes of open and minimally invasive (MIS) esophagectomy as well as assessing the relationship between institutional MIS volume and hospitalization costs. All adults undergoing elective esophagectomy were identified from the 2016-2020 Nationwide Readmissions Database. Multiple regression models were used to assess approach with costs, in-hospital mortality, and major complications. Additionally, annual hospital MIS esophagectomy volume was modeled as a restricted cubic spline against costs. Institutions performing > 16 cases/year corresponding with the inflection point were categorized as high-volume hospitals (HVH). We subsequently examined the association of HVH status with costs, in-hospital mortality, and major complications in patients undergoing minimally invasive esophagectomy. Of an estimated 29,116 patients meeting inclusion, 10,876 (37.4%) underwent MIS esophagectomy. MIS approaches were associated with $10,600 in increased incremental costs (95% CI 8,800-12,500), but lower odds of in-hospital mortality (AOR 0.76; 95% CI 0.61-0.96) or major complications (AOR 0.68; 95% CI 0.60, 0.77). Moreover, HVH status was associated with decreased adjusted costs, as well as lower odds of postoperative complications for patients undergoing MIS operations. In this nationwide study, MIS esophagectomy was associated with increased hospitalization costs, but improved short-term outcomes. In MIS operations, cost differences were mitigated by volume, as HVH status was linked with decreased costs in the setting of decreased odds of complications. Centralization of care to HVH centers should be considered as MIS approaches are increasingly utilized.

Care fragmentation is associated with increased mortality after ileostomy creation

BackgroundIleostomy is the mainstay treatment option for various gastrointestinal conditions. Given the increased risk of post-discharge complications and high readmission rates that can be further aggravated by receiving care at different facilities (care fragmentation), further examination is necessary. We thus used a national cohort to explore the associations of care fragmentation among ileostomy patients experiencing adverse outcomes and increased hospitalization expenditures. MethodsAll adult hospitalizations for ileostomy were tabulated from the 2016 to 2020 Nationwide Readmissions Database. Those readmitted within 90 days after discharge were included for analysis. Patients treated at a different facility than the original location where the index ileostomy was performed were categorized into the care-fragmented cohort. Multivariable regressions were developed to characterize the association of the care-fragmented cohort with postoperative outcomes, readmissions, and expenditures. ResultsOf 52,254 patients with ileostomy creation hospitalizations with 90-day nonelective readmission, 9,045 (17.3%) experienced care fragmentation. Following risk adjustment, those experiencing care fragmentation faced increased odds of mortality (adjusted odds ratio 1.81, 95% confidence interval 1.54–2.12), cardiac (adjusted odds ratio 1.63, 95% confidence interval 1.42–1.85), respiratory (adjusted odds ratio 1.71, 95% confidence interval 1.53–1.91), infectious (adjusted odds ratio 1.33, 95% confidence interval 1.23–1.43), and thromboembolic (adjusted odds ratio 1.28, 95% confidence interval 1.13–1.45) complications. Furthermore, patients experiencing care fragmentation were more likely to have increased hospitalization costs ($1,700, 95% confidence interval 0.8–2.5). ConclusionCare fragmentation in ileostomy patients demonstrated an increased risk for mortality, postoperative complications, and increased hospitalization expenses. To mitigate risks for adverse outcomes, future studies should evaluate the impacts of inter-hospital communication with the goal of improving care continuity and optimizing healthcare delivery for care-fragmented populations.

Influence of affective disorders on outcomes after suboccipital decompression for adult Chiari I malformation

IntroductionAffective disorders (AD) have been shown to influence patient outcomes and healthcare resource utilization across several pathologies, though this relationship has not been described in patients with Chiari I malformations (CM-I). The aim of this study was to determine the impact of comorbid AD on postoperative events and healthcare resource utilization in adults following suboccipital decompression for CM-I. MethodsA retrospective study was performed using the 2016–2019 National Inpatient Sample database. Adults who underwent suboccipital decompression for CM-I were identified using ICD-10-CM codes. Patients were stratified into two cohorts, those with AD and those without (No AD). Patient demographics, comorbidities, operative characteristics, perioperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of prolonged length of stay (LOS), exorbitant admission costs, and non-routine discharge (NRD). ResultsA total of 3985 patients were identified, of which 2780 (69.8%) were in the No AD cohort and 1205 (30.2%) were in the AD cohort. Patient demographics were similar, except for a greater proportion of Female patients than the No AD cohort (p = 0.004). Prevalence of some comorbidities varied between cohorts, including obesity (p = 0.030), ADHD (p < 0.001), GERD (p < 0.001), smoking (p < 0.001), and chronic pulmonary disease (p < 0.001). The AD cohort had a greater proportion of patients with 1–2 (p < 0.001) or ≥ 3 comorbidities (p < 0.001) compared to the No AD cohort. A greater proportion of patients in the AD cohort presented with headache compared to the No AD cohort (p = 0.003). Incidence of syringomyelia was greater in the No AD cohort (p = 0.002). A greater proportion of patients in the No AD cohort underwent duraplasty only (without cervical laminectomy) compared to the AD cohort (p = 0.021). Healthcare resource utilization was similar between cohorts, with no significant differences in mean LOS (No AD: 3.78 ± 3.51 days vs. 3.68 ± 2.71 days, p = 0.659), NRD (No AD: 3.8% vs. AD: 5.4%, p = 0.260), or mean admission costs (No AD: $20,254 ± 14,023 vs. AD: $29,897 ± 22,586, p = 0.284). On multivariate analysis, AD was not independently associated with extended LOS [OR (95%CI): 1.09 (0.72–1.65), p = 0.669], increased hospital costs [OR (95%CI): 0.98 (0.63–1.52), p = 0.930], or NRD [OR (95%CI): 1.39 (0.65–2.96), p = 0.302]. ConclusionOur study suggests that the presence of an AD may not have as much of an impact on postoperative events and healthcare resource utilization in adult patients undergoing Chiari decompression. Additional studies may be warranted to identify other potential implications that AD may have in other aspects of healthcare in this patient population.

A Novel Risk Score to Predict Thirty-Day Readmissions after Acute Type A Aortic Dissections

Background: Readmissions following acute type A aortic dissections (ATAAD) are associated with potentially worse clinical outcomes and increased hospital costs. Predicting which patients are at risk for readmission may guide patient management prior to discharge. Methods: The National Readmissions Database was utilized to identify patients treated for ATAAD between 2010 and 2018. Univariate mixed effects logistic regression was used to assess each variable. Variables were assigned risk points based off the bootstrapped (bias-corrected) odds ratio of the final variable model according to the Johnson's scoring system. A mixed effect logistic regression was run on the risk score (sum of risk points) and 30-day readmission. Calibration plots and predicted readmission curves were generated for model assessment. Results: A total of 30,727 type A aortic dissections were identified. The majority of ATAAD (66%) were in men with a median age of 61 years and 30-day readmission rate of 19.4%. The risk scores ranging from –1 to 14 mapped to readmission probabilities between 3.5% and 29% for ATAAD. The predictive model showed good calibration and receiver operator characteristics with an area under the curve (AUC) of 0.81. Being a resident of the hospital state (OR: 2.01 [1.64, 2.47], p &lt; 0.001) was the highest contributor to readmissions followed by chronic kidney disease (1.35 [1.16, 1.56], p = 0), discharge to a short-term facility (1.31 [1.09, 1.57], p = 0.003), and developing a myocardial infarction (1.20 [1.00, 1.45], p = 0.048). Conclusions: The readmission model had good predictive capability given by the large AUC. Being a resident in the State of the index admission was the most significant contributor to readmission.

Impact of perioperative red blood cell transfusion on the prognosis of patients with epithelial ovarian cancer

BackgroundSurgery for advanced ovarian cancer tends to be extensive. We performed an analysis to determine whether perioperative red blood cell transfusion (PRBCT) is associated with a poor prognosis in women with epithelial ovarian cancer (EOC). MethodsOur retrospective analysis included 314 women. The Mann-Whitney rank-sum test and chi-square test were used to analyze the clinical characteristics of the PRBCT and non-PRBCT groups, and Cox proportional hazard models were used for the multivariate analysis. ResultsPRBCT was associated with higher relapse and mortality rates in 121 (38.54 %) patients. After multivariate analysis, transfused patients were 1.59 times at risk of death (hazard ratio [HR] = 1.59; 95%CI, 1.12–2.25) and 1.63 times at risk of recurrence (HR = 1.63; 95%CI, 1.22–2.18) than non-transfused patients. ConclusionsPRBCT could prolong hospital stay, and increased hospital costs were significantly associated with increased cancer recurrence and overall mortality in patients with EOC.

Predictive value of frailty assessment tools in patients undergoing surgery for gastrointestinal cancer: An observational cohort study.

Few studies have simultaneously compared the predictive value of various frailty assessment tools for outcome measures in patients undergoing gastrointestinal cancer surgery. Therefore, it is difficult to determine which assessment tool is most relevant to the prognosis of this population. To investigate the predictive value of three frailty assessment tools for patient prognosis in patients undergoing gastrointestinal cancer surgery. This single-centre, observational, prospective cohort study was conducted at the Affiliated Lianyungang Hospital of Xuzhou Medical University from August 2021 to July 2022. A total of 229 patients aged ≥ 18 years who underwent surgery for gastrointestinal cancer were included in this study. We collected baseline data on the participants and administered three scales to assess frailty: The comprehensive geriatric assessment (CGA), Fried phenotype and FRAIL scale. The outcome measures were the postoperative severe complications and increased hospital costs. The prevalence of frailty when assessed with the CGA was 65.9%, 47.6% when assessed with the Fried phenotype, and 34.9% when assessed with the FRAIL scale. Using the CGA as a reference, kappa coefficients were 0.398 for the Fried phenotype and 0.291 for the FRAIL scale (both P < 0.001). Postoperative severe complications and increased hospital costs were observed in 29 (12.7%) and 57 (24.9%) patients, respectively. Multivariate logistic analysis confirmed that the CGA was independently associated with increased hospital costs (odds ratio = 2.298, 95% confidence interval: 1.044-5.057; P = 0.039). None of the frailty assessment tools were associated with postoperative severe complications. The CGA was an independent predictor of increased hospital costs in patients undergoing surgery for gastrointestinal cancer.

Economic Burden of Delayed Diagnosis in Patients with Pulmonary Arterial Hypertension (PAH).

The aim of this study was to assess health care resource utilization (HRU) and costs associated with delayed pulmonary arterial hypertension (PAH) diagnosis in the United States. Eligible adults with newly diagnosed PAH from Optum's de-identified Clinformatics® Data Mart Database (2016-2021) were assigned to mutually exclusive cohorts based on time between first PAH-related symptom and first PAH diagnosis (i.e., ≤12 months' delay, >12 to ≤24 months' delay, >24 months' delay). All-cause HRU and health care costs per patient per month (PPPM) were assessed during the first year following diagnosis and compared across cohorts using regression analysis adjusted for baseline covariates. Sensitivity analyses were conducted to assess outcomes during all available follow-up post-diagnosis. Among 538 patients (mean age: 65.6 years; 60.6% female), 60.8% had ≤12 months' delay, 23.4% had a delay of >12 to ≤24 months, and 15.8% had >24 months' delay. Compared with ≤12 months, delays of >12 to ≤24 months and >24 months were associated with increased hospitalizations (incidence rate ratio [95% confidence interval]: 1.40 [1.11-1.71] vs 1.71 [1.29-2.12]) and outpatient visits (1.17[1.06-1.30] vs 1.26 [1.08-1.41]). Longer delays were also associated with more intensive care unit (ICU) stays and 30-day readmissions. Diagnosis delays translated into excess costs PPPM of US$3986 [1439-6436] for >12 to ≤24 months and US$5366 [2107-8524] for >24 months compared with ≤12months' delay; increased hospitalization costs (US$3248 [1108-5135] and US$4048 [1401-6342], respectively) being the driver. Sensitivity analyses yielded similar trends. Delayed PAH diagnosis is associated with significant incremental economic burden post-diagnosis, driven by hospitalizations including ICU stays and 30-day readmissions, highlighting the need for increased awareness and a potential benefit of earlier screening.

MENJAGA POLA MAKAN SERTA EDUKASI GIZI PADA ANAK SEKOLAH DASAR

Indonesia is currently facing two different nutrition crises due to shifting nutrition. Based on the findings of nutrition screening conducted in a number of elementary schools in Cilincing Subdistrict, North Jakarta, malnutrition occurs in 28% of the population, with the prevalence of obesity being three times greater than underweight. Malnutrition can interfere with normal growth and development of children, increase the risk of disease, and increase hospital costs. After a meeting with the school, it was decided that nutrition education was needed for elementary school students as they had never received nutrition teaching before. The aim of this study was to improve knowledge about balanced nutrition among school-age children and school administrators. In SD Rorotan 03 and SD Rorotan 07, Cilincing sub-district, North Jakarta, the nutrition education was conducted in April 2018 after preparation in March 2018. "Tumpeng Gizi Balang" (TGS), "10 Messages of Balanced Nutrition," and a Santing Decline Chart" were among the education resources. The research findings show that raising primary school students' awareness of balanced nutrition can be achieved through lecture-style nutrition teaching. Education participants know the types of foods that make up the staple diet, as well as fruits, vegetables, and protein sources. Therefore, nutrition education is a successful program to improve primary school students' knowledge, attitudes and behaviours regarding balanced nutrition.&#x0D;

Improving the Hydrophobicity of Plasticized Polyvinyl Chloride for Use in an Endotracheal Tube.

An endotracheal tube (ETT) is a greatly appreciated medical device at the global level with widespread application in the treatment of respiratory diseases, such as bronchitis and asthma, and in general anesthesia, to provide narcotic gases. Since an important quantitative request for cuffed ETTs was recorded during the COVID-19 pandemic, concerns about infection have risen. The plasticized polyvinyl chloride (PVC) material used to manufacture ETTs favors the attachment of microorganisms from the human biological environment and the migration of plasticizer from the polymer that feeds the microorganisms and promotes the growth of biofilms. This leads to developing infections, which means additional suffering, discomfort for patients, and increased hospital costs. In this work, we propose to modify the surfaces of some samples taken from commercial ETTs in order to develop their hydrophobic character using surface fluorination by a plasma treatment in SF6 discharge and magnetron sputtering physical evaporation from the PTFE target. Samples with surfaces thus modified were subsequently tested using XPS, ATR-FTIR, CA, SEM + EDAX, profilometry, density, Shore A hardness, TGA-DSC, and biological antimicrobial and biocompatibility properties. The obtained results demonstrate a successful increase in the hydrophobic character of the plasticized PVC samples and biocompatibility properties.

Abstract 18420: Appropriateness and Cost Analysis of Adult Inpatient Transthoracic Echocardiograms in a Community Hospital

Introduction: Although inpatient transthoracic echocardiograms (TTEs) are important for guiding patient management, their overuse could be a concern leading to delayed discharges, unnecessary burden on hospital staff, and increased hospital costs. We analyzed the appropriateness, benefits, cost expenditure and unnecessary burden of TTE testing. Methods: A retrospective cohort analysis of a subset of patients undergoing TTEs in 2022 from a community hospital was performed. Appropriateness of use criteria (AUC) in accordance with American Society of Echocardiography and alteration in medical management was evaluated by 3 independent reviewers. Hospital cost analysis was performed based on median TTE cost ($682), yearly total adult TTEs performed (n=4,636), AUC criteria, and alteration in management under Maryland all-payer insurance model. Results: In 234 TTEs matched by age, gender, and race, AUC was not met in 32.5% of patients. Most TTEs were indicated for LV function assessment and ACS (Figure). Change in management was significantly higher in patients who met vs. not meeting AUC (54 vs. 11%, p&lt;0.001). In patients meeting AUC, men had a higher change in management compared to women (61 vs. 46%, p = 0.05). No significant differences were found in the percentage of patients who benefitted from inpatient TTE by subgroups based on indications, except for cardiac trauma. Inappropriate TTE testing led to a yearly loss of approximately $313,000 in hospital revenue and an additional loss of $150,000/year for every 5% of patients who meet AUC with no alteration in medical management. Conclusion: In this community hospital analysis, nearly one-third of adult inpatient TTEs were obtained outside the recommendations of established guidelines. Strategies to improve adherence to ASE guidelines and patient selection for TTE testing are warranted to reduce unnecessary resource utilization and healthcare costs.

Abstract 16630: Economic Impact of Frailty in Patients Undergoing Elective Percutaneous Left Atrial Appendage Closure (LAAC) With WATCHMAN Device

Introduction: Frailty is associated with significant morbidity and mortality in older adults. Currently, standard practice after percutaneous left atrial appendage closure involves monitoring patients overnight and discharging them the following day. Hypothesis: Frailty predicts increased hospital cost and length of stay (LOS) in patients undergoing elective LAAC with WATCHMAN device. Methods: Patients aged ≥65 years who underwent elective LAAC with WATCHMAN device were identified using ICD-10 procedure code 02L73DK from 2016-2018 HCUP-NIS Database. In-hospital major adverse event (MAE) was defined as the composite of mortality, stroke (ischemic or hemorrhagic) or TIA, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery. Hospital Frailty Risk Score (HFRS) was calculated for each patient based on 109 ICD-10 diagnosis codes and classified into non-frail (HFRS &lt; 5) and frail (HFRS score ≥ 5) groups. Multivariate regression analysis was used to assess the relationship between the HFRS and hospital cost hospitalization (≥90 centile) and prolonged LOS (&gt;72 hours). Results: 28,050 patients (Age = 77.3 ± 6.4 years; Female = 42.6%) were included. Median hospitalization cost was $24,500 (inter-decile range: $14,000-37,100) and median LOS was 1 day (inter-decile range: 1-2 days) and 4.7% experienced in-hospital MAE. Frail patients (HFRS score ≥ 5) constituted 12.5% of the cohort. Increasing Hospital Frailty Risk Score was associated with a greater risk of high-cost hospitalization and LOS &gt; 72 hours (Figure). Conclusions: Increasing frailty is a significant predictor of increased hospital cost and LOS in elective LAAC. This effect is independent of age and in-hospital MAE.

Abstract 19065: Resource Utilization After Cardiac Surgery in Adults With Congenital Heart Diseases: A Nationwide Analysis

Objective: This study examined resource utilization following cardiac surgery among ACHD patients.Methods: We used the NIS (2012-2018) to identify &gt;18yo admissions with TOF, Pulmonary valve anomalies/Congenital Pulmonary Stenosis, cTGA, DORV, TGA, HLHS, and Ebstein's anomaly and Open-heart valve or Great Vessels\Conduit replacement procedures. Hospitalization costs were adjusted for inflation to 2022 US dollars using the medical care component of the US Consumer Price Index. A mixed-effect linear regression model was used to identify factors associated with increased costs.Results: Out of 91,565 admissions, 4,578 involved one of the procedures of interest. The median age was 32 (IQR 34 - 46), and 46.6% were females. The median hospitalization cost was $54,400 (IQR 40,990 - 74,520). Valve procedures were the most common (79%). Overall, 19% of admissions had multiple HRU codes, with Blood transfusions (12.5% ) and ICD/pacemakers (7.2% being the most common. The high and low tercile group had a median hospitalization cost of $92,370 (IQR 74,850 - 120,900) and $36,300, IQR 31,180 - 40,930). Hospital-level factors, complications, and the need for HRU services significantly increased hospitalization costs. Notably, in-hospital mortality was associated with a 58% cost increase. Conclusion: Although the proportion of ACHD admissions requiring cardiac surgery is relatively low, the economic burden is significantly high, particularly those with in-hospital mortality. On average, higher hospitalization costs are associated with complications, the utilization of HRU procedures, the type of hospital providing care, and the US region.

Antimicrobial prescribing in a secondary care setting during the COVID-19 pandemic.

Increased antimicrobial resistance patterns lead to limited options for antimicrobial agents, affecting patient health and increasing hospital costs. To investigate the antimicrobial prescribing patterns at two district hospitals in Northern Ireland before and during the COVID-19 pandemic. A mixed prospective-retrospective study was designed to compare pre- and during pandemic antimicrobial prescribing data in both hospitals using a Global Point Prevalence Survey. Of the 591 patients surveyed in both hospitals, 43.8% were treated with 402 antimicrobials. A total of 82.8% of antimicrobial prescriptions were for empirical treatment. No significant difference existed in numbers of patients treated or antimicrobials used before and during the pandemic. There was a slight decrease of 3.3% in the compliance rate with hospital antimicrobial guidelines during the pandemic when compared with the pre-pandemic year of 2019, when it was 69.5%. Treatment based on patients' biomarker data also slightly decreased from 83.5% pre-pandemic (2019) to 81.5% during the pandemic (2021). There was no overall significant impact of the pandemic on the antimicrobial prescribing patterns in either hospital when compared with the pre-pandemic findings. The antimicrobial stewardship programmes would appear to have played an important role in controlling antimicrobial consumption during the pandemic.

Conversion THA With Concomitant Removal of Orthopaedic Hardware Should Be Reclassified as a Revision Surgery in the Medicare Severity Diagnosis-Related Group Coding Scheme: An Analysis of Cost and Resource Use.

Conversion THA, which we defined for this study as THA with concomitant removal of preexisting orthopaedic hardware, has been associated with increased hospital costs and perioperative complications compared with primary THA. Yet, conversion THA is classified as a primary procedure under the Medicare Severity Diagnosis-Related Group coding scheme, and hospitals are reimbursed based on the resource use expected for a routine primary surgery. Prior authors have argued for conversion THA to be reclassified as a revision procedure. Although prior research has focused on comparisons between conversion THAs and primary arthroplasties, little is known about the resource use of conversion THA compared with that of revision THA. (1) Do inpatient hospital costs, estimated using cost-to-charge ratios, differ between conversion THA and revision THA? (2) Do the median length of stay, intensive care unit use, and likelihood of discharge to home differ between conversion and revision THA? This was a retrospective study of the Medicare Provider Analysis and Review Limited Data Set for 2019. A total of 713,535 primary and 74,791 revision THAs and TKAs were identified initially. Exclusion criteria then were applied; these included non-fee-for-service hospitalizations, nonelective admissions, and patients with missing data. Approximately 37% (263,545 of 713,535) of primary and 34% (25,530 of 74,791) of revision arthroplasties were excluded as non-fee-for-service hospitalizations. Two percent (13,159 of 713,535) of primaries and 11% (8159 of 74,791) of revisions were excluded because they were nonelective procedures. Among the remaining 436,831 primary and 41,102 revision procedures, 31% (136,748 of 436,831) were primary THAs and 36% (14,774 of 41,102) were revision THAs. Two percent (2761 of 136,748) of primary THAs involved intraoperative removal of hardware and were classified as conversion THAs. After claims with missing data were excluded, there were 2759 conversion THAs and 14,764 revision THAs available for analysis. Propensity scores were generated using a multivariate logistic regression model using the following variables as covariates: gender, age, race, van Walraven index, hospital setting, geography, hospital size, resident-to-bed ratio, and wage index. After matching, 2734 conversion THAs and 5294 revision THAs were available for analysis. The van Walraven index, which is a weighted score of patient preoperative comorbidities, was used to measure patient health status. Hospital costs were estimated by multiplying cost-to-charge ratios obtained from the 2019 Impact File by total hospital charges. This methodology enabled the use of a large national database to mitigate the random effects of individual hospitals' unique practices and patient populations. Multivariable regression was performed after matching to determine the independent effects of surgery type (that is, conversion versus revision THA) on hospital cost, length of stay greater than 2 days, intensive care unit use, and discharge to home. There was no difference in the estimated hospital cost between conversion THA and revision THA (β = 0.96 [95% confidence interval 0.90 to 1.01]; p = 0.13). Patients undergoing conversion THA had increased odds of staying in the hospital for more than 2 days (odds ratio 1.12 [95% CI 1.03 to 1.23]; p = 0.01), increased odds of using the intensive care unit (OR 1.24 [95% CI 1.03 to 1.48]; p = 0.02), and decreased odds of being discharged to home (OR 0.74 [95% CI 0.67 to 0.80]; p < 0.001). The inpatient hospital cost of conversion THA is no different from that of revision THA, although patients undergoing conversion surgery have modestly increased odds of prolonged length of stay, intensive care unit use, and discharge to a nonhome location. These findings support the conclusion that reclassification of conversion THA is warranted. Orthopaedic surgeons must advocate for the reclassification of conversion THA using data-backed evidence or run the risk that orthopaedic procedures will be given decreased reimbursement. Level III, economic and decision analysis.