Medical Resource Utilization Research Articles

Derivation and validation of a model to predict acute kidney injury following cardiac surgery in patients with normal renal function

Background The study aimed to construct a clinical model based on preoperative data for predicting acute kidney injury (AKI) following cardiac surgery in patients with normal renal function. Methods A total of 22,348 consecutive patients with normal renal function undergoing cardiac surgery were enrolled. Among them, 15,701 were randomly selected for the training group and the remaining for the validation group. To develop a model visualized as a nomogram for predicting AKI, logistic regression was performed with variables selected using least absolute shrinkage and selection operator regression. The discrimination, calibration, and clinical value of the model were evaluated. Results The incidence of AKI was 25.2% in the training group. The new model consisted of nine preoperative variables, including age, male gender, left ventricular ejection fraction, hypertension, hemoglobin, uric acid, hypomagnesemia, and oral renin-angiotensin system inhibitor and non-steroidal anti-inflammatory drug within 1 week before surgery. The model had a good performance in the validation group. The discrimination was good with an area under the receiver operating characteristic curve of 0.740 (95% confidence interval, 0.726–0.753). The calibration plot indicated excellent agreement between the model prediction and actual observations. Decision curve analysis also showed that the model was clinically useful. Conclusions The new model was constructed based on nine easily available preoperative clinical data characteristics for predicting AKI following cardiac surgery in patients with normal kidney function, which may help treatment decision-making, and rational utilization of medical resources.

Rates of Permanent Pacemaker Implantation in the Elderly in a State-wide Australian Cohort From 2009–2018

Permanent pacemaker implantation (PPI) has become standard of care for significant bradyarrhythmia since the early 1960s. Understanding pacemaker utilisation and projection in our ageing populations has important implications for medical resource utilisation.

Comparison Between Early Appendicectomy and Delayed Appendicectomy in Treating Acute Appendicitis

Background: Acute appendicitis is the most common emergency condition that faces the surgeon worldwide. The overall lifetime risk of having acute appendicitis is estimated to be 6–7 %, with a peak incidence between 10 and 30 years. Early and sometimes immediate appendicectomy is standard, fearing the risk of pathological progression into perforation, gangrenous appendicitis, and abscess formation. However, recently, this practice has been challenged by authors giving a suggestion that appendicectomies can be delayed in some cases and still devoid of adverse postoperative outcomes. Objective: This study aimed at comparing the two groups regarding the following postoperative outcomes: WBC count on a postoperative day one, time last to a soft liquid diet, rate of complication, length of in-hospital stay, and the need for admission within 30 days of doing the surgery. Patients and Methods: This is a prospective randomized study of 341 patients (196 male and 145 female) who underwent appendicectomy over a period of eleven months (May 2019- March 2020) in Baquba Teaching Hospital in Diyala Governorate. The patients categorized into two groups for making the comparison (all underwent appendectomy): group A: 181 patients (male 108, female 73) include those who are operated on within 8 hours of arrival to the hospital and group B: 160 patients (male 81, female 79) include those who are operated on after 8 hours of arrival to the hospital. The patients in the two groups were compared regarding the following postoperative outcomes as WBC count at day one postoperatively, time duration to a liquid diet, rate of complication, length of in-hospital stay, and finally, the need for readmission during the first 30 days of doing the surgery. Results: Regarding the mean white blood cell count at the first postoperative day, it was lower for group B. than that for group A (p-value 0.0018). With regard to the timing of starting having liquid diet, there was no significant difference, and the patients in the two groups started oral liquid diet within the first 24 hours (p-value 0.0715). There was no significant difference between the two groups regarding the immediate and early postoperative complication rate; 0.02% in group A and 0.37% for group B (p-value 0.4022), the length of postoperative hospital stay was the same for the two groups, ranging between 2 days and less than one day (p value 0.0826). There was no significant difference between the two groups regarding the need for readmission within 30 days, 0.016% in group A and 0.025% in group B (p-value 0.9984). Conclusion: This study concluded that delayed appendicectomy was safe and feasible for patients with uncomplicated appendicitis. Despite that the clinical outcomes of delayed appendicectomy were not better than those with early appendicectomy. Also Delayed appendicectomy can improve the quality of care provided by the residents, surgeons, anesthetists and theater staff, enhance patient's quality of care, and it allows an increased efficient utilization of medical resources and theaters for other life-threatening emergency cases.

Resolving the Burden of Low Back Pain in Military Service Members and Veterans (RESOLVE): Protocol for a Multisite Pragmatic Clinical Trial.

Physical therapy (PT) is frequently used for the management of low back pain (LBP) within the US Departments of Defense (DOD) and Veterans Affairs (VA). However, variations in PT practice patterns and use of ineffective interventions lower the quality and increase the cost of care. Although adherence to the clinical practice guidelines (CPGs) can improve the outcomes and cost-effectiveness of LBP care, PT CPG adherence remains below 50%. The Resolving the Burden of Low Back Pain in Military Service Members and Veterans (RESOLVE) trial will evaluate the effectiveness of an active PT CPG implementation strategy using an education, audit, and feedback model for reducing pain, disability, medication use, and cost of LBP care within the DOD and VA health care systems. The RESOLVE trial will include 3,300 to 7,260 patients with LBP across three DOD and two VA medical facilities using a stepped-wedge study design. An education, audit, and feedback model will be used to encourage physical therapists to better adhere to the PT CPG recommendations. The Oswestry Disability Index and the Defense and Veterans Pain Rating Scale will be used as primary outcomes. Secondary outcomes will include the LBP-related medication use, medical resource utilization, and biopsychosocial predictors of outcomes. Statistical analyses will be based on the intention-to-treat principle and will use linear mixed models to compare treatment conditions and examine the interactions between treatment and subgrouping status (e.g., limb loss). The RESOLVE trial will provide a pragmatic approach to evaluate whether better adherence to PT CPGs can reduce pain, disability, medication use, and LBP care cost within the DOD and VA health care systems.

PP553 Study On The Utilization Of Medical Resources In Patients With Malignant Tumors in China

IntroductionMalignant tumors have become a major public health problem and their treatment cost is increasing rapidly in China, but treatment aimed at healing diseases or extending patients’ life. There is little empirical research on utilization of healthcare resources of terminally ill cancer patients. In order to explore the optimal treatment decision for patients and provide information for relevant decision makers, this study analyzed the consumption status of medical resources in patients with cancer during the whole treatment period, and the current medical resource utilization efficiency in different levels of hospital for end-stage cancer patients.MethodsThis study was based on the clinical treatment and payment data of 2,536 cases of patients with lung cancer from the medical insurance database during the period of 2007 to 2014 in Hubei province. We retrospectively analyzed patients’ medical expenditure and utilization of different medical resources during their whole treatment period as well as at the end stage.ResultsThe per capita inpatient expenditures of patients under 50 years old was 193,000 CNY (27,451 USD), while that of the patients over 70 years were 80,000–90,000 CNY (11,379–12,802 USD). Secondly, the medical expenditures spent during the last 6 months of life accounted for 66.1 percent of the total expenditures. Lastly, the medical expenditure spent in tertiary hospitals accounted for 95.3 percent of the total expenditure, and the expenditure was 14,200 ± 17,030 CNY (2,019.82 ± 2,422.36 USD) per visit.ConclusionsPopulation aging is not the only factor causing the rise of medical expenditure. The unclear objectives of treatment and the reverse of medical resource allocation are also important factors to boost the growth of medical expenditure. It is necessary to improve the healthcare insurance payment system, strengthen the capacity of primary medical institutions, and develop the palliative care system in China.

PCV50 Economic Burden of Major Cardiovascular Diseases and Ischemic Stroke in Saudi Arabia: A Cost of Illness Study

Cardiovascular diseases (CVD) are the leading cause of mortality in Saudi Arabia resulting to approximately 45.7% of all deaths cases. CVD represent a major economic burden to any healthcare system due to the high utilization of medical resources. This study aimed to estimate the economic burden and resource utilization of Acute Coronary Syndrome (ACS) and Ischemic Stroke (IS) patients in Saudi Arabia. This was a retrospective, single-center cost of illness study conducted from healthcare perspective. Patients medical records from Prince Sultan Cardiac Center (PSCC) in Riyadh were reviewed from January through December 2018. Patients who had a confirmed diagnosis of ACS or IS were included in this study. Prices and healthcare costing data were collected from the Ministry of Health, and PSCC business centre costing data. Descriptive statistics were performed. A total of 316 patients were eligible for this study. The average annual cost of each ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) patient was SAR 54,877 and SAR 50,215, respectively. The average annual cost of each unstable and stable angina patient was SAR 43,838 and SAR 41,640, respectively. The average annual cost per IS patient was SAR 89,739. The major drivers of costs among all study population were costs related to procedures which accounted for 39% of the total costs, followed hospitalization and medication costs (27% and 11%, respectively). ACS and IS comprise a heavy economic burden to Saudi healthcare system. The results of this study may inform efficient policy making by considering proper methods of recourses allocations especially for services that consume larger portions of the budgets dedicated to CVD and IS. Further studies are required to investigate the economic value of CVD and IS interventions, programs and services, a step that may help lowering the economics burden of CVD and IS in Saudi Arabia.

The Military Orthopedics Tracking Injuries and Outcomes Network: A Solution for Improving Musculoskeletal Care in the Military Health System.

Musculoskeletal injuries are an endemic amongst U.S. Military Service Members and significantly strain the Department of Defense's Military Health System. The Military Health System aims to provide Service Members, military retirees, and their families the right care at the right time. The Military Orthopedics Tracking Injuries and Outcomes Network (MOTION) captures the data that can optimize musculoskeletal care within the Military Health System. This report provides MOTION structural framework and highlights how it can be used to optimize musculoskeletal care. MOTION established an internet-based data capture system, the MOTION Musculoskeletal Data Portal. All adult Military Health System patients who undergo orthopedic surgery are eligible for entry into the database. All data are collected as routine standard of care, with patients and orthopedic surgeons inputting validated global and condition-specific patient reported outcomes and operative case data, respectively. Patients have the option to consent to allow their standard of care data to be utilized within an institutional review board approved observational research study. MOTION data can be merged with other existing data systems (e.g., electronic medical record) to develop a comprehensive dataset of relevant information. In pursuit of enhancing musculoskeletal injury patient outcomes MOTION aims to: (1) identify factors which predict favorable outcomes; (2) develop models which inform the surgeon and military commanders if patients are behind, on, or ahead of schedule for their targeted return-to-duty/activity; and (3) develop predictive models to better inform patients and surgeons of the likelihood of a positive outcome for various treatment options to enhance patient counseling and expectation management. This is a protocol article describing the intent and methodology for MOTION; thus, to date, there are no results to report. MOTION was established to capture the data that are necessary to improve military medical readiness and optimize medical resource utilization through the systematic evaluation of short- and long-term musculoskeletal injury patient outcomes. The systematic enhancement of musculoskeletal injury care through data analyses aligns with the National Defense Authorization Act (2017) and Defense Health Agency's Quadruple Aim, which emphasizes optimizing healthcare delivery and Service Member medical readiness. This transformative approach to musculoskeletal care can be applied across disciplines within the Military Health System.

The disease burden of mucormycosis in Japan: results from a systematic literature review and retrospective database study

Objective To evaluate outcomes, healthcare resource utilization, and costs associated with mucormycosis in inpatient settings in Japan. Methods We performed a systematic literature review, followed by a retrospective database study using hospital health claims for patients in Japan hospitalized with a diagnosis of mucormycosis between January 2010 and January 2019. Outcomes assessed included duration of index hospitalization; index stay mortality; hospital readmission within 30, 60, and 90 days after index hospitalization discharge; drug/treatment utilization and patterns; number of patients examined for mucormycosis during the index hospitalization; and index stay inpatient costs. Results From our systematic literature review of articles describing 133 patients with mucormycosis, mortality in the index hospitalization was 55.6%. From our database study of 126 patients hospitalized for mucormycosis, mortality during the index hospitalization was 35.7% and mean index stay duration was 94 days. Hematologic malignancies were the most common risk factor in the literature review and the most common comorbidity in the database study. During the index stay, 39 patients (31.0%) received liposomal amphotericin B (L-AMB) treatment and 74 patients (58.7%) received other antifungal treatments. Median total inpatient costs for the index hospitalization were equivalent to approximately US$60,945, including US$29,283 in drug costs. Conclusions This study investigated the healthcare resource utilization and cost of medical resources caused by mucormycosis in Japan. The drug costs for antifungal treatments comprised about half of total inpatient costs. Mucormycosis leads to high mortality, high healthcare resource utilization, and high costs.

The Case for Brachytherapy: Why It Deserves a Renaissance

The recent global events related to the coronavirus disease of 2019 pandemic have significantly changed the medical landscape and led to a shift in oncologic treatment perspectives. There is a renewed focus on preserving treatment outcomes while maintaining medical accessibility and decreasing medical resource utilization. Brachytherapy, which is a vital part of the treatment course of many cancers (particularly prostate and gynecologic cancers), has the ability to deliver hypofractionated radiation and thus shorten treatment time. Studies in the early 2000s demonstrated a decline in brachytherapy usage despite data showing equivalent or even superior treatment outcomes for brachytherapy in disease sites, such as the prostate and cervix. However, newer data suggest that this trend may be reversing. The renewed call for shorter radiation courses based on data showing equivalent outcomes will likely establish hypofractionated radiation as the standard of care across multiple disease sites. With shifting reimbursement, brachytherapy represents the pinnacle in hypofractionated, conformal radiation therapy, and with extensive long-term data in support of the treatment modality brachytherapy is primed for a renaissance.

Trial in Progress: Quantifying the Humanistic and Socioeconomic Burden of Paroxysmal Nocturnal Hemoglobinuria in the COMMODORE Burden of Illness Study

Background Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease associated with major complications such as thrombotic events and impaired renal function. Prior to the introduction of C5 inhibitors in 2007, PNH had been fatal in about 35% of patients within 5 years of diagnosis; yet, this fatality rate continues in countries without access to these medications. Worldwide access to the C5 inhibitor eculizumab is hindered by the unavailability of treatment, and in places where treatment is approved, cost of treatment, reimbursement issues, infrastructure, or patient restrictions may further impede access (Risitano et al, Am J Hematol. 2018; Risitano et al, Front Immunol. 2019). PNH treatment places a significant economic burden on healthcare systems. In a number of countries, this has resulted in negative health technology appraisals (HTAs), indicative that optimal care and resource utilization are not being achieved (Coyle et al, Med Decis Making. 2014). New therapies with more convenient modes of administration may have the potential to improve how PNH is clinically treated and may have a positive effect on the economic burden and access to C5 inhibitors globally. Robust data on the real-life burden and cost of PNH are therefore needed to assess the impact of current therapies and establish a baseline for new therapeutic approaches. The data derived from this study will be used to support HTA processes and inform the value of new therapies for PNH. Objectives The COMMODORE Burden of Illness (BOI) study will quantify the direct medical costs (eg, treatment and hospitalization), direct nonmedical costs (eg, travel), and indirect costs (eg, impact on work productivity and family burden) associated with PNH for patients and care providers and determine the impact of PNH on health-related quality of life (HRQoL). Study Design and Methods This is an international, prevalence-based, bottom-up, burden of illness study containing both retrospective and prospective data collection. The study will be overseen by an expert reference group consisting of multidisciplinary stakeholders. The study protocol and materials will be submitted for ethical approval to the University of Chester in the United Kingdom. Physicians will provide information on sociodemographic, clinical, and medical resource utilization using an electronic case record form (eCRF). Through patient and public involvement and engagement, patients, after giving informed consent, will provide further information on the economic and HRQoL impact of PNH by completing patient-reported outcome surveys. Patients from France, Germany, United Kingdom, and China will be included. The study aims to recruit 94 physicians reporting 350 patient eCRFs with an expected return of 140 patient surveys and longitudinal data collection after 6 to 12 months for each patient. Mean per-patient costs, including direct medical and nonmedical costs, and indirect resource utilization will be calculated by multiplying the individual resource utilization with country-specific unit costs. National economic burden will be extrapolated by applying national prevalence estimates of PNH. Additionally, the impact of PNH on HRQoL in patients will be assessed within this study. Summary The COMMODORE BOI study aims to characterize current PNH treatment via quantification of the humanistic and socioeconomic burden at the patient, healthcare system, and societal level to enhance the evidence base for treatment and decision-making in this community. Final results are expected be available by the second quarter of 2022. Disclosures Hampton: F. Hoffmann-La Roche Ltd: Current Employment, Current equity holder in publicly-traded company, Other: All authors received support for third party writing assistance, furnished by Scott Battle, PhD, provided by F. Hoffmann-La Roche, Basel, Switzerland.. Katz:F. Hoffmann-La Roche Ltd: Current Employment, Other: All authors received support for third party writing assistance, furnished by Scott Battle, PhD, provided by F. Hoffmann-La Roche, Basel, Switzerland.. Shang:F. Hoffmann-La Roche Ltd: Current Employment, Current equity holder in publicly-traded company, Other: All authors received support for third party writing assistance, furnished by Scott Battle, PhD, provided by F. Hoffmann-La Roche, Basel, Switzerland.. Dhillon:F. Hoffmann-La Roche Ltd: Other: All authors received editorial support for this abstract, furnished by Scott Battle, funded by F. Hoffmann-La Roche Ltd, Basel, Switzerland. ; HCD Economics: Current Employment. Hubberstey:HCD Economics: Current Employment; Huntingdon's Disease Youth Organization: Membership on an entity's Board of Directors or advisory committees; F. Hoffmann-La Roche Ltd: Other: All authors received editorial support for this abstract, furnished by Scott Battle, funded by F. Hoffmann-La Roche Ltd, Basel, Switzerland. .

Lessons from a COVID-19 hospital, Republic of Korea

ObjectiveTo document the experiences of converting a general hospital to a coronavirus disease 2019 (COVID-19) designated hospital during an outbreak in Daegu, Republic of Korea.MethodsThe hospital management formed an emergency task force team, whose role was to organize the COVID-19 hospital. The task force used different collaborative channels to redistribute resources and expertise to the hospital. Leading doctors from the departments of infectious diseases, critical care and pulmonology developed standardized guidelines for treatment coherence. Nurses from the infection control team provided regular training on donning and doffing of personal protective equipment and basic safety measures.FindingsKeimyung University Daegu Dongsan hospital became a red zone hospital for COVID-19 patients on 21 February 2020. As of 29 June 2020, 1048 COVID-19 patients had been admitted to the hospital, of which 22 patients died and five patients were still being treated in the recovery ward. A total of 906 health-care personnel worked in the designated hospital, of whom 402 were regular hospital staff and 504 were dispatched health-care workers. Of these health-care workers, only one dispatched nurse acquired COVID-19. On June 15, the hospital management and Daegu city government decided to reconvert the main building to a general hospital for non-COVID-19 patients, while keeping the additional negative pressure rooms available, in case of resurgence of the disease.ConclusionCentralized coordination in frontline hospital operation, staff management, and patient treatment and placement allowed for successful pooling and utilization of medical resources and manpower during the COVID-19 outbreak.

Early prediction of disease progression in COVID-19 pneumonia patients with chest CT and clinical characteristics

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread to become a worldwide emergency. Early identification of patients at risk of progression may facilitate more individually aligned treatment plans and optimized utilization of medical resource. Here we conducted a multicenter retrospective study involving patients with moderate COVID-19 pneumonia to investigate the utility of chest computed tomography (CT) and clinical characteristics to risk-stratify the patients. Our results show that CT severity score is associated with inflammatory levels and that older age, higher neutrophil-to-lymphocyte ratio (NLR), and CT severity score on admission are independent risk factors for short-term progression. The nomogram based on these risk factors shows good calibration and discrimination in the derivation and validation cohorts. These findings have implications for predicting the progression risk of COVID-19 pneumonia patients at the time of admission. CT examination may help risk-stratification and guide the timing of admission.

Towards efficient federated learning‐based scheme in medical cyber‐physical systems for distributed data

SummaryIn recent years, Cyber‐Physical Systems (CPS) and Artificial Intelligence (AI) have made good progress in the medical field. The medical CPS (MCPS) based on AI can realize the efficient and reasonable utilization of medical resources and improve the quality of medical process. However, current MCPS are still facing several challenges, and the privacy protection of medical data is one of the most critical challenges. Since medical data is stored in different hospitals, most studies collect data from decentralized hospitals to train a disease diagnosis model, which is not conducive to the privacy protection of patients. And in some existing solutions, it is also difficult for doctors to select the optimal model from multiple models in clinical diagnosis. In this paper, we propose a novel scheme based on federated learning in MCPS for training disease diagnosis models from distributed medical image data. Our scheme is divided into three parts: the model provider, the server, and the consumer, and a detailed working process is designed for each part. This scheme can not only effectively solve the problem of privacy protection, but also solve the problem of model selection for doctors and save storage space. It can ensure that consumers automatically get a steadily improved disease diagnosis model. This scheme is performed on simulated distributed medical image datasets. The experimental results show the effectiveness and superiority of our scheme.

Study on the Spatial Differentiation of Public Health Service Capabilities of European Union under the Background of the COVID-19 Crisis.

Access to public health services is a cause that benefits the people and concerns the vital interests of the people. Everyone has access to basic health care services. The continuous improvement in people’s health is an important indicator of the improvement in people’s quality of life. This paper selects data from the European Union (EU) on aspects of public health expenditure, medical care resources, and government emergency coordination capacity from the period 2008 to 2017. Principal component analysis and factor analysis are used to measure their public health service capacity scores and conduct a comparative analysis. On this basis, the TOBIT model is adopted to explore the driving factors that lead to the spatial differentiation of public health service capabilities, and to combine it with the data of the COVID-19 epidemic as of 8 August 2020 from the official announcements of the World Health Organization and governments for further thinking. The results indicate that the public health service capacity of countries in the EU is showing a gradual increase. The capacity in Western Europe is, in turn, higher than that of Northern Europe, Southern Europe and Eastern Europe. In addition, the overall capacity in Western Europe is relatively high, but it is not balanced and stable, while Northern Europe has remained stable and balanced at a high level. Population density, degree of opening up, education level, economic development level, technological innovation level, and degree of aging have a positive effect on public health service capabilities. The level of urbanization has a negative effect on it. However, in countries with strong public health service capabilities, the epidemic of COVID-19 is more severe. The emergence of this paradox may be related to the detection capabilities of countries, the high probability of spreading thCOVID-19 epidemic, the inefficient implementation of government policy, the integrated system of the EU and the adverse selection of youth. This paper aims to improve the ability of the EU to respond to public health emergencies, improve the utilization of medical and health resources, and better protect people’s health from the perspective of public health service capacity.

Are casualties from mass-casualty Motor Vehicle Crashes different from casualties of other Motor Vehicle Crashes?

IntroductionMass Casualty Incidents (MCI) by Motor Vehicle Crashes (MVCs) are most common type of MCIs. Casualties from MCIs usually require more hospitalization resources. The purpose of this study was to compare the injury characteristics, survivability, and medical resource utilization of casualties from Mass-Casualty Motor Vehicle Crashes (MC-MVCs) and casualties from other (non MCI) MVCs. MethodsThis retrospective cohort study examined a population of 50,321 Israeli casualties hospitalized due to MVCs between 1998 and 2017, of which 595 (1.2%) were admitted from a MC-MVC. Analysis included type of motor vehicle involved and collision circumstances, injury characteristics, hospital resource utilization, and demographics. ResultsThe results suggest that most casualties from MC-MVCs were bus passengers who were injured when the vehicle rolled over. Injuries from MC-MVCs were more urgent as almost two times more MC-MVCs casualties were rushed directly from the emergency room into the operating rooms and intensive care units than casualties of regular MVCs. Mortality rate was higher in MC-MVCs compared to regular MVCs (2.69% compared to 1.46%, respectively; p = .013). Severe injuries (ISS≥16) were more frequent in MC-MVCs (23.40% versus 15.53%, p < .0001). Casualties from MC-MVCs required more hospitalization resources, including ICU admission, surgery, and extended lengths of stay. The multivariate analysis demonstrated that mass casualty conditions are predictive of severe injuries even when controlling for age, gender, and collision circumstances. ConclusionsThis study demonstrates that hospitals receiving casualties from MC-MVCs should expect not only a multitude of casualties, rather also the need to treat more urgent and severe injuries, in more body regions per casualty, and expect higher admissions rates to intensive care units and operation rooms under MCI conditions.

Predictors of Inappropriate Helicopter Transport.

Helicopter transport (HT) is an efficient, but costly, means for injured patients to receive life-saving, definitive trauma care. Identifying the characteristics of inappropriate HT presents an opportunity to improve the utilization of this finite medical resource. Trauma registry records of all HT for a 3-year period (2016-2018) to an urban Level I trauma center were reviewed. HT was defined as inappropriate for patients who were discharged home from the emergency department or had a hospital length of stay <1 day, and who were discharged alive. Chi-square analysis and Student's t-test were used for univariate analysis. Predictors with a P value of less than .15 were subject to binary logistic regression analysis. A P value ≤.05 was considered significant. There were 713 patients who received HT during the study period. One-hundred and forty-eight (20.8%) patients met the criteria as an inappropriate HT. In univariate analysis, Glasgow Coma Scale >8, Shock Index <0.9, and fall mechanism were found to be significantly associated with inappropriate HT. Age >55 was found to be associated with an appropriate HT. The average Injury Severity Score of the inappropriate HT group was 3.86 (±3.85) compared with 16.80 (±11.23) (P = .0001, Student's t-test). Our findings suggest that there are evidence-based predictors of patients receiving inappropriate HT. Triage of HT using these predictors has the potential to decrease unnecessary deployments and reduce health care costs.

257. Persistent opioid use and resource utilization in spine surgery

BACKGROUND CONTEXT Postoperative pain control commonly involves opioid use. From 2004 to 2015, there was a significant increase in the rate of spine surgery in the US, which raised concerns about the increase in persistent use of opioid drugs after spine surgery. PURPOSE The objectives of this study were to assess the influence of opioid use during spine surgery on post-surgery opioid use and impact of health care resource utilization. STUDY DESIGN/SETTING A retrospective cohort analysis was performed using deidentified administrative data and electronic health records from the University of Utah Health system. PATIENT SAMPLE Patients undergoing spine surgery in the hospital from January 2015 to June 2018 were included. OUTCOME MEASURES The primary outcome of this study was persistent opioid use defined by (1) opioid prescription within 30 days after the index discharge followed by opioid prescription between 31 – 180 days after the index discharge, and (2) opioid prescription within 90 days after the index discharge followed by opioid prescription(s) between 91 – 180 days. Secondary outcomes of this study were the proportion of patients reporting opioid-related adverse events (ORADE) and medical resource utilization such as number of hospital readmissions during the 180-day post-discharge period. METHODS Based on the level of exposure to opioids during the initial admission for the surgery, study cohort was grouped into two, High MME (ie, morphine milligram equivalent dose greater than median) and Low MME (ie, MME equal to or less than median). Patient characteristics and outcomes were summarized using descriptive statistics, and compared between the High MME and Low MME groups using bivariate comparison. The odds ratio of being a persistent opioid user for the High vs Low MME was adjusted for the baseline characteristics using a logistic regression model. Secondary outcomes were compared between the High MME and Low MME groups using bivariate analysis including student t-test, Wilcoxon Rank-sum test and Chi-square test. RESULTS Median (IQR) amount of opioid used during index procedure for High MME (N=1225) group and Low MME (N=1226) groups were 480 (371 – 668) mg and 136 (64 – 212) mg, respectively. The proportions of persistent opioid users defined by the 30-day cutoff were 42.4% of High MME and 36.8% of Low MME. When the 90-day cutoff was used, the respective proportions of persistent opioid users were 24.8% and 21.4%. The adjusted odds ratios (95% confidence interval) of being a persistent opioid user for High MME vs Low MME were 1.29 (1.09 - 1.53) for the 30-day cutoff and 1.27 (1.04 - 1.54) for the 90-day cutoff. The rate of ORADE over the 180-day post-discharge period was significantly higher among the High MME group compared to the rate from the Low MME group (31.8% vs 26.8%, p CONCLUSIONS An increase in opioid use during inpatient admission for spine surgery is associated with a higher rate of persistent opioid use, more frequent ORADE and a greater amount of resource utilization. Optimal pain management strategy that helps to reduce the opioid use during the surgery and inpatient postsurgical period could potentially decrease persistent opioid use and lower medical resource use and cost. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

PSU3 Clinical Outcomes and Economics Associated with Surgical Aortic Valve Replacement in Taiwan

Currently aortic valve replacement is the gold standard treatment for Severe Symptomatic Aortic Valve Disease (SSAVD) and can be performed using 1 of 3 types of valves: mechanical (MV), porcine (PV), and bovine (BV). However, national-based research on mortality and medical resource utilization of surgical aortic valve replacement (SAVR) are lacking in Taiwan. The objective of this study is to understand the clinical outcomes and costs associated with SAVR for each valve type, amongst the Taiwanese population. Taiwan’s National Health Insurance Research Database (NHIRD) was used to conduct a retrospective cohort study investigating patients who received an isolated SAVR in Taiwan from 2000 to 2017. 10,725 patients with International Classification of Diseases (ICD) diagnosis codes associated with aortic valve disorders in inpatient care settings whom received a valve replacement were included. Mitral valve disease patients were excluded. We built Kaplan-Meier curves for each group and compared unadjusted survival statistics using Log-rank test. Patients receiving a BV or MV showed lower all-cause mortality rates than those receiving a PV (p<0.001). We subdivided these patients into three age groups (≦50, 51-70 and ≧71) to analyse their mortality rates separately. In all age groups, the mortality rate of patients with BV replacement was lower than PV and MV (p<0.001). PV patients had the highest length of stay in patients between year 2014 to 2017 at 22.6 days (p<0.001); Mean hospital costs in patients receiving a BV were $16,292, versus $18,117 and $18,771 for PV and MV respectively (p<0.001). These findings indicate there are statistically significant differences in key clinical and economic outcomes depending on what type of valve is used to treat SSAVD. Further studies are needed to understand which valve types optimize clinical and economic outcomes.

The Medical Resource Utilization and Financial Impact of Infection on Venous Leg Ulcers

The Medical Resource Utilization and Financial Impact of Infection on Venous Leg Ulcers

Cost savings for pVAD compared to ECMO in the management of acute myocardial infarction complicated by cardiogenic shock: An episode-of-care analysis.

Acute myocardial infarction complicated by cardiogenic shock (AMICS) occurs in up to 10% of acute myocardial infarction admissions and is associated with high mortality, frequent adverse outcomes, prolonged hospitalizations, extensive medical resource utilization, and major cost. Using hospital cost data for Medicare Fee-for-Service (FFS) patients with AMICS, we sought to evaluate in hospital and 45-day outcomes and cost, comparing patients treated with percutaneous ventricular assist device (pVAD) versus extracorporeal membrane oxygenation (ECMO). The goal of this study was to better understand clinical and economic outcomes of AMICS to help clinicians and hospitals optimize outcomes most economically for AMICS patients. A retrospective claims analysis identified patients from the full census Medicare Standard Analytic Files compiled by the Center for Medicare and Medicaid (CMS) including: Inpatient, Outpatient, Skilled Nursing Facility and Home Health files for Medicare FFS beneficiaries. Study costs were defined as the total costs incurred by providers for treating a population with AMICS. Medicare FFS beneficiaries who experienced an inpatient admission during the index period (January 1, 2015 to March 31, 2017) with a diagnosis of AMICS were eligible for study inclusion and were identified by the presence of appropriate International Classification of Diseases, Ninth and Tenth Versions (ICD-9 and ICD-10) diagnosis and procedure codes. To create a matched sample and control for any baseline differences, a 1:1 Propensity Score Matching (PSM) was performed based on criteria such as age, gender, race, geographic distribution, and 11 high-cost comorbidities (e.g., congestive HF, coronary artery disease, diabetes, etc.). Index length of stay (LOS), index costs, discharge disposition (including mortality), post-index utilization, and episode-of-care (EOC) costs were reviewed. EOC was defined as index admission for all patients plus a 45-day post index period for patients who survived the index admission. Each cohort included 338 patients. Index in-hospital mortality rates were 53% for pVAD versus 64% for ECMO (178 vs. 217; p=.0023), and total EOC in-hospital mortality rates were 66% for pVAD versus 74% for ECMO (222 vs. 250; p=.0160). Index LOS for pVAD was 27% lower versus ECMO (12.12 vs. 16.59; p=.0006). The index LOS for patients discharged alive was 25% lower for pVAD versus ECMO (17.73 vs. 23.62; p=.0016). For patients that experienced in-hospital mortality during their index stay, pVAD had a 44% lower LOS compared to ECMO (7.08 vs. 12.66; p < .0001). Following index hospitalization, the average cost savings with additional inpatient care was 31% lower for pVAD patients ($62,188 vs. $90,087; p=NS). During the EOC, pVAD patients incurred 32% lower costs compared to ECMO patients ($117,849 vs. $172,420; <.0001). This study of Medicare FFS patients demonstrates that hospitals utilizing pVAD for appropriately selected AMICS patients have reduced mortality rates and reduced index LOS with lower index facility costs and lower post index 45-day costs. The study results offer hospitals and clinicians an opportunity to improve clinical outcomes and reduce total EOC costs in treating patients with AMI complicated by CS.