You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 201170 HEALTHCARE COST AND UTILIZATION PROJECT: STATE VARIATION IN RENAL TRAUMA OUTCOMES AND OVERALL COSTS Alex Vanni, Jim Hotaling, Christian Hamlat, Christopher Mack, and Bryan Voelzke Alex VanniAlex Vanni Seattle, WA More articles by this author , Jim HotalingJim Hotaling Seattle, WA More articles by this author , Christian HamlatChristian Hamlat Seattle, WA More articles by this author , Christopher MackChristopher Mack Seattle, WA More articles by this author , and Bryan VoelzkeBryan Voelzke Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.134AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous analysis of the National Trauma Data Bank has revealed variation in renal trauma care among regions of the United States. Unfortunately, this dataset is not population-based, thus weakening any conclusions. The Healthcare Cost and Utilization Project (HCUP) is a population-based dataset sponsored by the Agency for Healthcare Research and Quality. Determining the degree of statewide variation in renal trauma is vital to improving health care quality and costs. Our primary aim is to quantify the state variation of nephrectomy, inpatient case fatality rate, and hospital costs associated with renal injury. METHODS A retrospective cohort study of the HCUP State Inpatient Database was performed to identify all patients hospitalized with renal injury from participating states during 2001, 2004, and 2007. We examined the state of record for each treating hospital as the unit of analysis and used nehprectomy, case fatalities and total hospital costs as a metric of health care delivery. Relative risks (RR) of nephrectomy and inpatient case fatality were calculated using the state as the primary exposure of interest in a Poisson regression model. Year and hospital specific cost-to-charge ratios from HCUP were used to convert recorded hospital charges to estimated costs. Cost ratios were calculated and total hospitalization costs were expressed in 2007 dollars. RESULTS 14,590 patients were hospitalized with renal trauma in 24 states. Blunt trauma accounted for 91.1% of patients with a mean Injury Severity Score of 14.6. On a national level, the prevalence of trauma-related nephrectomy was 5.3%, median length of stay was 5 days, and median hospital costs were $28,975. With Washington as the referent state for nephrectomy, the risk varied from 27% lower in Vermont (RR 0.73; 95%CI 0.40, 1.34) to 79% higher in New York (RR 1.79; 95% CI 1.27, 2.51). With Kentucky as the referent state for inpatient case fatality, the risk was up to 3.1 fold higher in Massachusetts (RR 3.10; 95% CI 2.04, 4.70). With Maryland as the referent state for total hospital costs, costs varied from 5% higher in Rhode Island (RR 1.05; 95% CI 0.92, 1.20) to 77% higher in California (RR 1.77; 95% CI 1.58, 1.98). CONCLUSIONS There was significant state variation in the cost, use of nephrectomy, and death following renal injury among hospitalized patients. Our findings of state variation in outcomes and costs necessitate further evaluation to improve renal trauma care delivery. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e30-e31 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Vanni Seattle, WA More articles by this author Jim Hotaling Seattle, WA More articles by this author Christian Hamlat Seattle, WA More articles by this author Christopher Mack Seattle, WA More articles by this author Bryan Voelzke Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...