Reduce Hospital Costs Research Articles

A cost analysis of treating postoperative periprosthetic femoral fractures following hip replacement surgery in a UK tertiary referral centre

AimThis study aims to evaluate costs associated with periprosthetic femoral fracture (PFF) treatment at a UK tertiary referral centre. MethodsThis study included 128 consecutive PFFs admitted from 02/04/2014–19/05/2020. Financial data were provided by Patient Level Information and Costing Systems. Primary outcomes were median cost and margin. Secondary outcomes were length of stay, blood transfusion, critical care, 30-day readmission, 2-year local complication, 2-year systemic complication, 2-year reoperation and 30-day mortality rates. Statistical comparisons were made between treatment type. Statistical significance was set at p<0.05. ResultsAcross the cohort, median cost was £15,644.00 (IQR £11,031.00-£22,255.00) and median loss was £3757.50 (£599.20-£8296.20). The highest costs were ward stay (£3994.00, IQR £1,765.00-£7,013.00), theatre utilisation (£2962.00, IQR £0.00-£4,286.00) and overheads (£1705.10, IQR £896.70-£2432.20). Cost (£17,455.00 [IQR, £13,194.00-£23,308.00] versus £7697.00 [IQR £3871.00-£10,847.00], p<0.001) and loss (£4890.00 [IQR £1308.00-£10,009.00] versus £1882.00 [IQR £313.00-£3851.00], p = 0.02) were greater in the operative versus the nonoperative group. There was no difference in cost (£17,634.00 [IQR £12,965.00-£22,958.00] versus £17,399.00 [IQR £13,394.00-£23,404.00], p = 0.98) or loss (£5374.00 [IQR £1950.00-£10,143.00] versus £3860.00 [IQR -£95.50-£7601.00], p = 0.21) between the open reduction and internal fixation (ORIF) and revision groups. More patients required blood transfusion in the operative versus the nonoperative group (17 [17.9%] versus 0 [0.0%], p = 0.009). There was no difference in any clinical outcome between the ORIF and revision groups (p>0.05). ConclusionPFF treatment costs are high with inadequate reimbursement from NHS tariff. Work is needed to address this disparity and reduce hospital costs. Cost should not be used to decide between ORIF and revision surgery.

Development of a warning score for early detection of colorectal anastomotic leakage: Hype or hope?

Colorectal anastomotic leakage (CAL), a severe postoperative complication, is associated with high morbidity, hospital readmission, and overall healthcare costs. Early detection of CAL remains a challenge in clinical practice. However, some decision models have been developed to increase the diagnostic accuracy of this event. To develop a score based on easily accessible variables to detect CAL early. Based on the least absolute shrinkage and selection operator method, a predictive classification system was developed [Early ColoRectAL Leakage (E-CRALL) score] from a prospective observational, single center cohort, carried out in a colorectal division from a non-academic hospital. The score performance and CAL threshold from postoperative day (POD) 3 to POD5 were estimated. Based on a precise analytical decision model, the standard clinical practice was compared with the E-CRALL adoption on POD3, POD4, or POD5. A cost-minimization analysis was conducted, on the assumption that all alternatives delivered similar health-related effects. In this study, 396 patients who underwent colorectal resection surgery with anastomosis, and 6.3% (n = 25) developed CAL. Most of the patients who developed CAL (n = 23; 92%) were diagnosed during the first hospital admission, with a median time of diagnosis of 9.0 ± 6.8 d. From POD3 to POD5, the area under the receiver operating characteristic curve of the E-CRALL score was 0.82, 0.84, and 0.95, respectively. On POD5, if a threshold of 8.29 was chosen, 87.4% of anastomotic failures were identified with E-CRALL adoption. Additionally, score usage could anticipate CAL diagnosis in an average of 5.2 d and 4.1 d, if used on POD3 and POD5, respectively. Regardless of score adoption, episode comprehensive costs were markedly greater (up to four times) in patients who developed CAL in comparison with patients who did not develop CAL. Nonetheless, the use of the E-CRALL warning score was associated with cost savings of €421442.20, with most (92.9%) of the savings from patients who did not develop CAL. The E-CRALL score is an accessible tool to predict CAL at an early timepoint. Additionally, E-CRALL can reduce overall healthcare costs, mainly in the reduction of hospital costs, independent of whether a patient developed CAL.

Abstract 14519: End Stage Heart Failure Patients With Do-Not-Resuscitate Code Status Have Dramatically Reduced Hospitalization Cost and Length of Stay

Introduction: End-stage CHF (ES-CHF) poses a significant burden on healthcare system, DNR orders are often associated with comfort care measures, decreased pain and suffering, as well as healthcare resource utilization (cost and LOS). Objective: To quantify the discrepancy in cost and LOS between ES-CHF patients with DNR orders versus without DNR code status. Methodology: Nationwide Inpatient Sample (NIS) database years 2017-2018 was invoked for hospitalizations with primary or secondary diagnosis of ES-CHF, DNR status, comorbidities, and hospitalization outcome using ICD-10 codes. Characteristics of ES-CHF hospitalization with DNR versus no DNR code status were compared. Because of the nature of NIS database, timing of diagnoses and DNR code status could not be established, thus regression analysis for predictors of hospital charges, cost, and LOS was not feasible. Regression analyses were performed to explore predictors of mortality. Stata/MP 16.0 software was used. Results: 40,655 adult hospitalization had the diagnosis of ES-CHF in years 2017-2018 in the United States, among them, 12,300 (30%) had DNR code status, 35% were females, 83% of patients had &gt;=3 comorbid conditions (Charlson comorbidity index&gt;=3). Overall inpatient mortality rate was 12% (25% vs 7% in DNR vs no DNR group, respectively, p&lt;0.001), mean LOS was 10+-15 days (8 vs 11 days in DNR vs no DNR group, respectively, p&lt;0.001), mean total hospital charges was $159,122+-358,186 ($79,434 vs $193,873 in DNR vs no DNR group, respectively, p&lt;0.001). Significantly higher rates of CABG history, atrial fibrillation, COPD, peripheral vascular disease, hypothyroidism, CKD, liver disease, electrolyte disturbances, AKI, and sepsis were found among DNR group. In all patients with ES-CHF, independent predictors of inpatient mortality included older age, DNR status, history of CABG, peripheral vascular disease, liver disease, electrolyte disturbances, smoking, AKI, and sepsis. Conclusion: The presence of DNR code status in ES-CHF patients admitted to the hospital for any was associated with had dramatically reduced hospital charges and cost by more than the half, and with significantly shorter LOS.

The cost of hospitalizations for treatment of hemodialysis catheter-associated blood stream infections in children: a retrospective cohort study.

Hospitalization costs for treatment of hemodialysis (HD) catheter-associated blood stream infections (CA-BSI) in adults are high. No studies have evaluated hospitalization costs for HD CA-BSI in children or identified factors associated with high-cost hospitalizations. We analyzed 160 HD CA-BSIs from the Standardizing Care to Improve Outcomes in Pediatric End-stage Kidney Disease (SCOPE) collaborative database linked to hospitalization encounters in the Pediatric Health Information System (PHIS) database. Charge-to-cost ratios were used to convert hospitalization charges reported in PHIS database to estimated hospital costs. Generalized linear mixed modeling was used to assess the relationship between higher-cost hospitalization (cost above 50th percentile) and patient and clinical characteristics. Generalized linear regression models were used to assess differences in mean service line costs between higher- and lower-cost hospitalizations. The median (IQR) length of stay for HD CA-BSI hospitalization was 5 (3-10) days. The median (IQR) cost for HD CA-BSI hospitalization was $18,375 ($11,584-$36,266). ICU stay (aOR 5.44, 95% CI 1.62-18.26, p = 0.01) and need for a catheter procedure (aOR = 6.08, 95% CI 2.45-15.07, p < 0.001) were associated with higher-cost hospitalization. Hospitalizations for HD CA-BSIs in children are often multiple days and are associated with substantial costs. Interventions to reduce CA-BSI may reduce hospitalization costs for children who receive chronic HD. A higher resolution version of the Graphical abstract is available as Supplementary information.

Outpatient parenteral antimicrobial therapy in Germany: a prospective cohort study protocol

IntroductionOutpatient parenteral antimicrobial therapy (OPAT) means intravenous administration of antibiotics outside the hospital. The antibiotics are administered at the patient’s home. The advantages are the shortening of the inpatient stay,...

Hospitalization Costs for Diabetes Related Lower Extremity Amputation at a Referral Hospital in KwaZulu Natal, South Africa.

Diabetes mellitus is a significant risk factor for lower extremity amputations (LEA), both alone and in combination with peripheral vascular disease and infection. Currently, in Africa, more than half of the cases do not meet the recommended blood glucose control levels to prevent complications suggesting that the risk of complications is high. The study aims to estimate hospitalization costs of diabetes-related lower extremities amputation for patients consulted at a referral hospital in 2015/16. The study was a retrospective analysis using a mixed costing approach and based on 2015/16 financial year data inflated to 2020 at a 32-bed vascular unit of a quaternary care health facility. Patient level data were extracted from the hospital information system for length of stay, medication provided, laboratory and radiological investigations, and other clinical services offered. The total summative cost for managing all 34 patients amounted to $ 568 407 or a mean unit cost per patient of $ 16 718 based on 2015/16 prices, and when adjusted to 2020, prices amounted to $ 728 997 or $ 21 441 per patient. The mean unit cost per patient for foot amputation was $ 12 598 based on 2015/16 prices, and when adjusted to 2020, prices amounted to $ 16 157 per patient, whilst the mean cost per patient for lower limb amputation was $ 16 718 based on 2015/16 prices, and when adjusted to 2020 prices, amounted to $ 21 441 per patient. Hospital costs associated with diabetes related amputation varied by whether the patient was admitted to intensive care unit or not, and the major cost drivers were general ward costs, compensation of employees, and radiology services. A comprehensive audit of the referral process and care process at the facility level as well as technical efficiency analysis, is required to identify inefficiencies that could reduce hospital costs for managing diabetes complications.

Case mix-based resource allocation under uncertainty in hospitals: Physicians being the scarce resource

Hospitals are struggling to maintain a balance between demand and the capacity of resources. It is difficult because demand is highly uncertain and resource capacity is limited. Among hospital resources, physicians are one of the most vital and scarce resources without whom hospitals cannot function. Along with ensuring the availability of physicians, planning on their allocation as per the hospital case mix is expected for quality care. This has motivated us to conduct a study on case-mix-based physician allocation in hospitals. Henceforth, to help hospitals in such challenging decision-making, we propose a two-stage stochastic programming approach in which decisions on regular physician allocation and their capacity adjustments (by overtime, outsourcing, and hiring) in each hospital department are a trade-off between expected cost and patient demand fulfillment. We test the allocations and adjustments with the data of a multispecialty hospital in India, finding solutions to expect a 27.44% cost reduction with patient demand fulfillment when compared with the current allocation of the case study hospital. Results from sensitivity analysis inferred that our proposed model performs well in all sets of variations prevailing in any hospital like patient demand, treatment times, and physician allocation cost parameters. To our best knowledge, this is the first paper that focuses on optimal physician allocation decisions in all the departments of a multispecialty department under uncertain demand and treatment times and the results have also indicated that our proposed model performs well compared to the current allocation model of the hospital. Hence, it is a remarkable contribution towards healthcare service delivery and hospital cost reduction.

No Difference in Two-Year Revisions Between Hybrid Fusion and Two-Level Anterior Discectomy and Fusion: A National Database Study.

Retrospective Cohort. This study utilized a large national database to compare two-year revision rates, in addition to complications and costs, of hybrid surgery (HS) compared to two-level anterior cervical discectomy and fusion (ACDF). This study used the PearlDiver Mariner dataset selecting for patients aged 18 and older who had at least 90-day active longitudinal follow-up who underwent two-level ACDF or two-level Hybrid surgery (single level ACDF and single level CDA). Patients with prior spinal trauma, infection, cancer, or posterior fusion were excluded. Primary outcomes measures were 90-day major and minor medical complications, ED visits, readmissions, as well as two-year revisions. Patients were also assessed for postoperative dysphagia, incidental durotomy, vascular injury, 90-day surgical site, and implant complications. Additionally, hospitalization and postoperative costs were evaluated. There were 4570 two-level ACDF surgeries and 888 hybrid surgeries. After matching the cohorts, no statistical differences in demographics were found. There were no differences in reoperation rates at all measured time points nor 2-year complications. HS had a lower incidence of major (1.6% vs 3.1%, P = .003) and minor complications (3.0% vs 4.6%, P = .009) than ACDF. 90-day readmission was lower in the HS cohort (2.8% vs 4.2%), P = .024. HS was associated with reduced hospitalization costs -$2614 (-$3916 to -$904, P < .001). 3516 patients had ACDF, and 699 had HS with at least 2years of follow-up. Hybrid surgery is a safe and effective surgical treatment for cervical disease in appropriately selected patients.

Impact of the Maryland Global Budget Revenue Program on Lobectomies for Lung Cancer

INTRODUCTION: In 2014, Maryland introduced a “Global Budget Revenue” (GBR) program in an effort to reduce hospital costs by prospectively capping annual hospital revenue at a predetermined amount, thereby incentivizing hospitals to reduce expenditures while maintaining quality. Our objective was to investigate the impact of the GBR model on thoracic surgery outcomes. METHODS: We used the Maryland Health Services Cost Review Commission (HSCRC) database to retrospectively review adult patients who underwent lobectomy for primary lung cancer between 2012 and 2018. Patients were dichotomized as “pre-GBR” if they underwent lobectomy prior to 2014, and “post-GBR” if they underwent lobectomy in 2014 or later. RESULTS: Baseline demographics between the two groups were comparable, although patients in the post-GBR group were less likely to be uninsured (0.2% vs 1.1%, p < 0.01). In-hospital mortality was similar between the two groups (1.0% vs 1.5%, p = 0.20), as was 30-day readmission rate (8.2% vs 7.9%, p = 0.80). On average, patients in the post-GBR era had a shorter length of stay (5.7 days vs 6.1 days, p = 0.02), but were more likely to be discharged with home health services (23.4% vs 19.5%, p = 0.01). CONCLUSION: These results suggest successful incentivization to reduce hospital length of stay with implementation of the GBR model, without evidence of inadvertent negative consequences such as increased mortality or need for readmission. The increased use of home health services suggest a multi-disciplinary approach will be integral to reducing overall health expenditures under this model, and demonstrates promise for use of the GBR model in thoracic surgery.

S1363 Utilization of Palliative Care Service in Patients With Liver Cirrhosis in an Underserved Area, 2015-2019

Introduction: Palliative care is a service with a very wide vision and potent tool. Palliative care applies early in the course of terminal illness in conjunction with therapies intended to prolong life; it is not limited to end-of-life care. Patients with liver cirrhosis only have one healing treatment, a liver transplant, but the limitation in the number of donor organs and eligibility criteria reduces the number of transplants. The MELD-Na score provides validated mortality prognostic for the next 90 days in patients with liver cirrhosis. This study aimed to determine if palliative care services are underutilized and could be more evident in uninsured or undocumented patients. Methods: Objective: Describe the use of Palliative Care service in patients with liver cirrhosis stratified by MELD Na score. Data retrieved from Valley Baptist Medical Center in Harlingen Cerner included all patients 18 years or older with diagnoses of fibrosis or liver cirrhosis on admission or made during the hospital stay from January 2015 to December 2019. The total number of patients was 150. Results: Distribution by sex, male 83 (55.33%), female 67 (44.67%). The mean age was 63.07 years. Predominant etiology of cirrhosis was alcoholism 64(42.67%), NASH 11 (7.33%), Viral 5 (3.33%), Other 15 (10%), and unknown 55 (36.67%). With legal status 140 patients (93.33%), and without 10 patients (6.67%). Patients with insurance 131 (87.33%) and without 19 (12.67%). Patients underwent palliative care services 16 (10.67%). A total of 50 (33.33%) patients underwent EGD. A total of 31 (20.6%) patients underwent paracentesis. (Figure) Conclusion: Our result showed that the number of patients with palliative care consultations was under the expected percentage. In an external study, of 59,687 hospitalized adults with terminal decompensated cirrhosis, 29.1% received palliative care. In multiple studies, palliative care was associated with a lower procedure burden after adjusting for other factors; it was associated with a cost reduction of $8892. In our study, the cost was not evaluated, but it is expected that the patient with palliative care consults will reduce hospitalization costs. Most of the patients had insurance and legal status. The dispersion of the MELD-Na score was similar in patients with and without palliative care consultations. Our patients had a high number of EGD and paracentesis for ascites. (Table) Table 1. - Palliative care/Hospice consult Yes % No % Total Female 11 68.75 56 41.79 67 Male 5 31.25 78 58.21 83 Total 16 10.67 134 89.33 150 Figure 1.: MELD-Na score in patients divided by palliative care consult.

Effect of electrical impedance-guided PEEP in reducing pulmonary complications after craniotomy: study protocol for a randomized controlled trial

ObjectiveThe purpose of this study is to explore whether electrical impedance tomography (EIT)-guided individualized positive end-expiratory pressure (PEEP) can reduce the incidence of pulmonary complications within 1 week following a craniotomy compared with a single PEEP (PEEP = 6 cmH2O) from dura suturing to extubation.MethodsA randomized controlled trial will be conducted at the Second Affiliated Hospital of Soochou University. Five hundred forty patients undergoing a craniotomy in the supine position will be randomly allocated into the P6 (PEEP = 6 cmH2O) or Pi (individualized PEEP) group. Both groups of patients will receive a lung recruitment maneuver before suturing the dura. Then, the P6 group will receive 6 cmH2O PEEP, and the Pi group will receive EIT-guided individualized PEEP. The incidence and severity score of pulmonary complications within 1 week following surgery, the lung ultrasound score (LUS), regional cerebral oxygen saturation (rScO2), and PaO2/FiO2 before anesthesia (T0), 10 min after extubation (T1), 24 h after extubation (T2), and 72 h after extubation (T3) will be compared between the two groups. The duration of surgery and anesthesia, the level and duration of PEEP during surgery, the volume of liquid intake and output during surgery, and the postoperative ICU and hospital stays will be recorded. The main outcome of this study will be the incidence of pulmonary complications within 1 week after surgery.DiscussionThe purposes of this study are to determine whether EIT-guided individualized PEEP from the beginning of dura suturing to extubation reduces the incidence of pulmonary complications within 1 week after a craniotomy compared with a single constant PEEP and to evaluate the length of ICU and hospital stays. If our results are positive, this study will show that EIT-guided individualized PEEP is better than a single constant PEEP and can further improve the prognosis of neurosurgical patients and reduce hospitalization costs, which will promote the wide application of individualized PEEP in clinical anesthesia.Trial registrationChinese Clinical Trial Registry CHiCTR2100051200. Registered on 15 September 2021.

Primary Closure Versus Delayed Primary Closure in Perforated Appendix: A Comparative Study

Introduction: The elimination of unpleasant and time-consuming dressing changes, as well as the potential reduction in overall hospital costs, are potential benefits of primary closure. Recent studies suggest that perforated appendicitis may usually be principally closed without an increase in the wound infection rate compared to delayed primary closure, suggesting that the disagreement surrounding the best ways of wound management has died down. Objective: Studying the efficacy of primary versus delayed primary closure for appendectomy in patients with perforations Study design: Ayyub Teaching Hospital Abbottabad and Timergara Teaching Hospital Dir Lower. Study duration from January 2021 to June 2021. Material and Methods: Perforated appendix patients undergoing appendectomy between the ages of 18 and 45 were included. When an appendectomy was performed, the appendicular stump was not invaginated as is sometimes done nowadays. Interrupted 2/0 vicryl was used to stand in for muscles. Within the PC group, the external oblique was stitched shut with a continuous vicryl 0 suture. Using only regular saline, the wound washed and disinfected. For patients having delayed primary closure, dressing changes occurred daily; in the case of infection dressing changes occurred twice daily until the wound was closed. After the third postoperative day or once the infection had subsided in cases of infected wounds, the wound was closed after rejuvenating the edges. On the seventh postoperative day patients were evaluated for wound infection and length of hospital stay using the operational definition of success. Results: The patients' mean age was 37.3± 610.49 years. The average number of days someone spent in the hospital was 7.38 (1.25). Women made up 37 (or 61.70%) of the total, while men accounted for 23 (or 38.30%). Thirteen patients, or 21.70 percent, had an infected wound. Wound infections occurred in 11 patients in Group-A (the primary closure group) but only 2 patients in Group-B (the delayed closure group) (delayed primary closure). When comparing the rate of wound infection in groups B and A, a statistically significant difference was discovered (p=0.005). Hospitalization time was shorter for those in group A (6.24± 0.47 days) compared to those in group B (8.53± 0.51 days); p 0.001. Conclusion: Patients with a perforated appendix benefit more with primary closure than from delayed primary closure. Keywords: Primary closure, delayed primary closure, and a perforated appendix

Prospective Observational Cohort Study of Tenecteplase Versus Alteplase in Routine Clinical Practice.

A 10-hospital regional network transitioned to tenecteplase as the standard of care stroke thrombolytic in September 2019 because of potential workflow advantages and reported noninferior clinical outcomes relative to alteplase in meta-analyses of randomized trials. We assessed whether tenecteplase use in routine clinical practice reduced thrombolytic workflow times with noninferior clinical outcomes. We designed a prospective registry-based observational, sequential cohort comparison of tenecteplase- (n=234) to alteplase-treated (n=354) stroke patients. We hypothesized: (1) an increase in the proportion of patients meeting target times for target door-to-needle time and transfer door-in-door-out time, and (2) noninferior favorable (discharge to home with independent ambulation) and unfavorable (symptomatic intracranial hemorrhage, in-hospital mortality or discharge to hospice) in the tenecteplase group. Total hospital cost associated with each treatment was also compared. Target door-to-needle time within 45 minutes for all patients was superior for tenecteplase, 41% versus 29%; adjusted odds ratio, 1.85 (95% CI, 1.27-2.71); P=0.001; 58% versus 41% by Get With The Guidelines criteria. Target door-in-door-out time within 90 minutes was superior for tenecteplase 37% (15/43) versus 14% (9/65); adjusted odds ratio, 3.62 (95% CI, 1.30-10.74); P=0.02. Favorable outcome for tenecteplase fell within the 6.5% noninferiority margin; adjusted odds ratio, 1.26 (95% CI, 0.89-1.80). Unfavorable outcome was less for tenecteplase, 7.3% versus 11.9%, adjusted odds ratio, 0.77 (95% CI, 0.42-1.37) but did not fall within the prespecified 1% noninferior boundary. Net benefit (%favorable-%unfavorable) was greater for the tenecteplase sample: 37% versus 27%. P=0.02. Median cost per hospital encounter was less for tenecteplase cases ($13 382 versus $15 841; P<0.001). Switching to tenecteplase in routine clinical practice in a 10-hospital network was associated with shorter door-to-needle time and door-in-door-out times, noninferior favorable clinical outcomes at discharge, and reduced hospital costs. Evaluation in larger, multicenter cohorts is recommended to determine if these observations generalize.

Implementation of a medical intensive care team in the emergency department of a tertiary medical center in the USA

ABSTRACT Objective Critically ill patients boarding in the ED have higher mortality rates. Several strategies have been implemented to deliver care to boarding patients. Our institution opted for a strategy consisting on deploying an Intensive Care team in the ED. This article reports outcomes before-and-after implementation of that team. Methods On November 2020, a Medical Intensive Care Team was deployed in the ED. The team performed consultations for ICU patients boarding in the ED. A retrospective analysis of critically ill patients arriving to the ED before-and-after team implementation was performed. Outcome data were reviewed. Direct hospitalization costs per patient, and direct costs per department were assessed. Wilcoxon rank sum and Chisq-test were utilized to compare differences pre- and post-implementation. Multivariate analyses to model outcomes toward pre- and post-implementation and other variables were performed. Results 1,828 and 3,272 patients were included in the pre- and post-intervention groups. ICU LOS (days) pre- and post-intervention were 3 (1,6) and 3 (1,6), respectively (p = 0.41). ICU readmission rates were 6.7% pre-intervention and 7.4% post-intervention (p = 0.37). Total direct costs were US$ 19,928 (11,006, 37,815) and US$ 15,795 (9016, 28,993), respectively (p < 0.01). Multivariate analysis showed no association between team deployment and ICU LOS or readmission. However, there was association between its implementation and hospitalization cost reduction per patient of US$ 7,171. Conclusion The implementation of a Medical Intensive Care team in the ED is not associated with a reduction of ICU LOS or ICU readmission. Nevertheless, its implementation is associated with a reduction of hospitalization costs.

The Presence of a Cost-Volume Relationship in Robotic-assisted Thoracoscopic Lung Resections.

To characterize the relationship between institutional robotic-assisted pulmonary lobectomy volume and hospitalization costs. The high cost of robotic-assisted thoracoscopic surgery (RATS) is among several drivers of hesitation among nonadopters. Studies examining the impact of institutional experience on costs of RATS lobectomy are lacking. Adults undergoing RATS lobectomy for primary lung cancers were identified from the 2016 to 2018 Nationwide Readmissions Database. A multivariable regression to model hospitalization costs was developed with the inclusion of hospital RATS lobectomy volume as restricted cubic splines. The volume corresponding to the inflection point of the spline was used to categorize hospitals as high- (HVH) or low-volume (LVH). We subsequently examined the association of HVH status with adverse events, length of stay, costs, and 30-day, nonelective readmissions. An estimated 14,756 patients underwent RATS lobectomy during the study period, with median cost of $23,000. Upon adjustment for patient and operative characteristics, hospital RATS volume was inversely associated with costs. Although only 17.2% of centers were defined as HVH, 51.7% of patients were managed at these centers. Patients at HVH and LVH had similar age, sex, and distribution of comorbidities. Notably, patients at HVH had decreased risk-adjusted odds of adverse events (adjusted odds ratio: 0.62, P <0.001), as well as significantly reduced length of stay (-0.8d, P <0.001) and costs (-$3900, P <0.001). Increasing hospital RATS lobectomy volume was associated with reduced hospitalization costs. Our findings suggest the presence of streamlined care pathways at high-volume centers, which influence costs of care.

Lower Risk of Revision Surgery After Arthroscopic Versus Open Irrigation and Débridement for Shoulder Septic Arthritis

In the treatment of native shoulder septic arthritis, the optimal irrigation and débridement modality-arthroscopic versus open-is a matter of controversy. We aim to compare revision-free survival (RFS), complications, and resource utilization between these approaches. The National Readmission Database was queried from 2016 to 2019 to identify patients using International Classification of Diseases, 10th revision, diagnostic and procedure codes. Days to revision irrigation and débridement (I&D) were calculated for patients during index admission or subsequent readmissions. Multivariate regression was used for healthcare utilization analysis. Survival analysis was done using Kaplan-Meier analysis and Cox proportional hazard regression. A total of 4,113 patients with native shoulder septic arthritis undergoing I&D were identified, 2,775 arthroscopic (67.5%) and 1,338 open (32.5%). The median follow-up was 170 days (interquartile range 79 to 265). A total of 341 patients (8.3%) underwent revision I&D at a median of 9 days. On multivariate analysis, arthroscopic I&D was associated with a reduction in hospital costs of $4,154 ( P < 0.001) and length of stay of 0.78 days ( P = 0.030). Arthroscopic I&D was associated with reduced blood transfusions (odds ratio 0.69, P = 0.001) and wound complications (odds ratio 0.30, P < 0.001). RFS was 96.4%, 94.9%, 93.3%, and 92.6% for arthroscopic I&D and 94.1%, 92.6%, 90.4%, and 89.0% for open I&D at 10, 30, 90 and 180 days, respectively ( P = 0.00043). On multivariate Cox modeling, arthroscopic I&D was associated with improved survival (hazard ratio 0.67, P = 0.00035). On stratified analysis, arthroscopic I&D was associated with improved RFS in patients aged 65 years or older ( P < 0.001), but RFS was similar in those younger than 65 years ( P = 0.17). Risk of revision I&D was markedly lower after arthroscopic I&D compared with open, although the protective benefit was limited to patients aged 65 years or older. Arthroscopy was also associated with decreased costs, length of stay, and complications. Although surgeons must consider specific patient factors, our results suggest that arthroscopic I&D is superior to open I&D. III.

Reduced Costs, Complications, and Length of Stay After Arthroscopic Versus Open Irrigation and Débridement for Knee Septic Arthritis.

In the treatment of native knee bacterial septic arthritis, the optimal irrigation and débridement modality-arthroscopic versus open-is a matter of controversy. We aim to compare revision-free survival, complications, and resource utilization between these approaches. The National Readmission Database was queried from 2016 to 2019 to identify patients using International Classification of Diseases, 10th revision, diagnostic and procedure codes. Days to revision irrigation and débridement (I&D), if any, were calculated for patients during index admission or subsequent readmissions. Multivariate regression was used for healthcare utilization analysis. Survival analysis was done using Kaplan-Meier analysis and Cox proportional hazard regression. A total of 14,365 patients with native knee septic arthritis undergoing I&D were identified, 8,063 arthroscopic (56.1%) and 6,302 open (43.9%). The mean follow-up was 148 days (interquartile range 53 to 259). A total of 2,156 patients (15.0%) underwent revision I&D. On multivariate analysis, arthroscopic I&D was associated with a reduction in hospital costs of $5,674 and length of stay of 1.46 days (P < 0.001 for both). Arthroscopic I&D was associated with lower overall complications (odds ratio [OR] 0.63, P < 0.001), need for blood transfusion (OR 0.58, P < 0.001), and wound complications (OR 0.32, P < 0.001). Revision-free survival after index I&D was 95.3% at 3 days, 91.0% at 10 days, 88.3% at 30 days, 86.0% at 90 days, and 84.5% at 180 days. No statistically significant difference was observed between surgical approaches on Cox modeling. Risk of revision I&D did not differ between arthroscopic and open I&D; however, arthroscopy was associated with decreased costs, length of stay, and complications. Additional study is necessary to confirm these findings and characterize which patients require an open I&D. III.

Simultaneous detection of 9 respiratory pathogens using a newly developed multiplex real-time PCR panel based on an automatic molecular detection and analysis system

Timely identification of respiratory pathogens guides specific treatment, reduces hospital costs and minimizes the excessive use of antibiotics. A new multiplex real-time PCR panel was developed based on an automatic molecular detection and analysis system (AutoMolec system), consisting of three separate internally controlled assays. Mycoplasma pneumoniae, Chlamydia pneumoniae, adenovirus, human metapneumovirus, influenza B virus, respiratory syncytial virus and human parainfluenza virus 1-3 may be directly detected in original samples. The system's clinical performance was evaluated by comparison with an approved commercial kit, using 517 clinical samples. The limit of detection of the AutoMolec mRT-PCR panel ranged from 4 × 10−4 ∼3.3 TCID50/mL and no cross-reaction with common respiratory pathogens was observed. The AutoMolec mRT-PCR panel had 99.09% sensitivity and 100.0% specificity and overall detection consistency was 99.61%, making it comparable to that of the commercial kit. Therefore, the AutoMolec mRT-PCR panel has great potential for routine screening of respiratory infection in China.

Sutureless aortic valve replacement in pure aortic regurgitation: expanding the indications

BackgroundIn the era of transcatheter methods, patients presenting with a pure aortic regurgitation (AR) are not considered eligible for transcatheter treatment and therefore require another less invasive surgical option. We sought to review our experience with sutureless aortic valve replacement (SU-AVR) in patients presenting with symptomatic pure AR, which until now is a contraindication for implementation of sutureless valve prostheses in Europe.MethodsBetween April 2018 and June 2021, 80 consecutive patients underwent a SU-AVR for various indications at our institution. We analyzed the outcomes and postoperative complications of 12 patients presenting with a pure severe AR undergoing SU-AVR using Perceval (Corcym).ResultsThe mean age of the patients was 67 ± 9.1 years old. All patients presented with symptomatic pure AR. Patients presented with multiple comorbidities as reflected by the mean EuroSCORE-II of 3.6 ± 2.6%. Six patients (50%) underwent a concomitant CABG procedure. The mean operating- and cross clamp time was 127.25 ± 45.9 and 40.33 ± 17.3 min respectively. All isolated SU-AVR were performed via J-sternotomy or right anterolateral thoracotomy. There were no cases of device dislocation. No patients presented with a paravalvular leakage. We observed excellent mean postoperative pressure gradient at follow-up 5.7 ± 1.5 mmHg.ConclusionsOur experience with SU-AVR shows the feasibility of sutureless technologies in the aortic valve surgery due to pure AR. Besides the great technical success and excellent hemodynamics, SU-AVR in severe AR offers a great opportunity of reducing the invasivity of the surgical procedure and potentially reducing hospital cost without compromising the postoperative outcomes and in-hospital length of stay.

P40. Reduced complications but no differences in readmissions with minimally invasive versus open posterior based lumbar interbody fusion, a national study

<h3>BACKGROUND CONTEXT</h3> In single and multi-institution studies, minimally invasive (MIS) posterior and transforaminal lumbar interbody fusion (LIF) has been associated with decreased blood loss, length of stay, costs and improved short term functional outcomes. No national studies exist directly comparing MIS to traditional open posterior-based lumbar interbody fusion procedures. <h3>PURPOSE</h3> We aim to analyze the utilization of anterior MIS-LIF procedures and compare complications, readmissions and reoperations to open-LIF procedures. <h3>STUDY DESIGN/SETTING</h3> Retrospective, administrative databases. <h3>PATIENT SAMPLE</h3> National Inpatient Sample (NIS), National Readmissions Database (NRD), 2016 to 2019. <h3>OUTCOME MEASURES</h3> Readmissions, reoperations, mortality, index hospitalization complications, costs, length of stay, discharge destination. <h3>METHODS</h3> The NIS and NRD databases were queried from 2016 to 2019 to identify patients undergoing posterior-based one- or two-level LIF with a diagnosis of degenerative disc disease, spondylosis, spondylolysis and spondylolisthesis. MIS was defined as procedures utilizing percutaneous or endoscopic approaches. Multivariate regression was used to assess factors associated with procedure type, cost, LOS and discharge destination. Propensity score matching was used to compare index hospital complications, readmission and reoperations at 30, 90 and 180-day intervals. <h3>RESULTS</h3> A total 382,395 posterior-based LIF were estimated to have occurred in the US between 2016 and 2019, with 4,260 (1.1%) of those utilizing MIS techniques. The proportion of MIS procedures did not change significantly over the study period (p=0.40). Two-level procedures were identified in 27.8% and 29.4% of cases for MIS and open procedures, respectively (p=0.32). On multivariate modeling, patients receiving care in the western census regions were significantly less likely to undergo an MIS procedure (OR 0.38, p < 0.0001) relative to the midwest region, while patients receiving care in a medium sized hospital were more likely to receive an MIS procedure relative to a large hospital (OR 1.34, p=0.0003). Patients with a history of coagulopathy, cardiac arrhythmia and fluid & electrolyte disorders were significantly less likely to undergo MIS procedures. MIS procedures were associated with a decreased LOS of 0.69 days (p < 0.0001) and decreased rate of nonhome discharge (OR 0.71, p=0.003). Cost did not differ by procedure type (p=0.35). On matched analysis, MIS patients had a lower rate of overall complications (10.7 vs 14.6%, p < 0.001), neurologic complications (2.8 vs 5.2%, p < 0.001) and blood transfusion (1.7 vs 4.6%, p<0.001). In analysis of 30-day outcomes, there were no differences with regard to all cause readmission (3.5 vs 3.3%, p=0.74), related readmission (1.0 vs 1.5%, p=0.085), readmission for a specific related indication, repeat LIF or mortality. At 90 days, there were no differences in all cause readmission (6.5 vs 6.3%, p=0.81), related readmission (1.7 vs 2.5%, p=0.064), readmission for a specific related indication, repeat LIF or mortality. Finally, at 180-day analysis, there were no differences in all cause readmission (10.1 vs 9.4%, p=0.50), related readmission (2.1 vs 3.1%, p=0.076), readmission for a specific related indication, repeat LIF or mortality. <h3>CONCLUSIONS</h3> Utilization of posterior-based MIS LIF remains low nationally, with 1.1% of procedures utilizing these techniques between 2016 to 2019. MIS is associated with reduced hospital costs, length of stay and blood transfusions compared to open approaches. Short-term rates of readmission and reoperation were similar between MIS and open LIF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.