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The 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable. To examine whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI). Adult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts, or New York and subject to the policy. DESIGN We used an interrupted times series design to assess whether the hospital-acquired conditions policy was associated with changes in billing rates for VCAI and CAUTI. Before the policy, billing rates for VCAI and CAUTI were increasing (prepolicy odds ratio per quarter for VCAI, 1.17 [95% CI, 1.11-1.23]; for CAUTI, 1.19 [1.16-1.23]). The policy was associated with an immediate drop in billing rates for VCAI and CAUTI (odds ratio for change at policy implementation for VCAI, 0.75 [95% CI, 0.69-0.81]; for CAUTI, 0.87 [0.79-0.96]). In the postpolicy period, we observed a decreasing trend in the billing rate for VCAI and a leveling-off in the billing rate for CAUTI (postpolicy odds ratio per quarter for VCAI, 0.98 [95% CI, 0.97-0.99]; for CAUTI, 0.99 [0.97-1.00]). The Centers for Medicare & Medicaid Services hospital-acquired conditions policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates. These billing rates, however, may not correlate with changes in clinically meaningful patient outcomes and may reflect changes in coding practices.

Background: The treatment of type 1 Chiari malformation (CM-1) with posterior fossa decompression without (PFD) or with duraplasty (PFDD) is controversial. The authors analyze both options in a national sample of pediatric patients. Methods: Utilizing the Kids' Inpatient Database, CM-1 patients undergoing PFD or PFDD from 2000 through 2009 were analyzed. Results: 1,593 patients with PFD and 1,056 with PFDD were evaluated. The average age was 10.3 years, slightly younger in PFD (9.8 vs. 10.9 years, p = 0.001). PFDD patients were more likely White (81.2 vs 75.6%, p = 0.04) and less likely admitted emergently (8.4 vs. 13.8%, p = 0.007). They also underwent more reoperations (2.1 vs. 0.7%, p = 0.01), had more procedure-related complications (2.3 vs. 0.8%, p = 0.003), a longer length of stay (4.4 vs. 3.8 days, p = 0.001) and higher charges (USD 35,321 vs. 31,483, p = 0.01). Conclusions: This large national study indicates that PFDD is performed more often in Caucasians, less so emergently, and associated with significantly more complications and immediate reoperations, while PFD is more frequent in those with syringomyelia and more economical, requiring fewer hospital resources. Overall, PFD is more favorable for CM-1, though it would be prudent to conduct a prospective trial, as this analysis is limited by data on preoperative presentations and long-term outcomes.

Objective This study examines the relationship between opioid use disorder (OUD) and healthcare use, especially regarding length of stay, total charges, and costs in U.S. hospitals from 2005 to 2020. Methods We used the Healthcare Cost & Utilization Projects (HCUP) National Inpatient Sample (NIS) data to compare these outcomes between patients with and without OUD. We applied generalized linear modeling (GLM) with gamma distribution and log link to assess the effect of OUD on the three outcomes. Results Our results show that hospital stays for patients with OUD were significantly longer, while total charges and costs were lower than those without OUD. Over time, there was a tendency towards convergence between total charges and costs for OUD and non-OUD patients. The study also revealed that the severity of illness was strongly related to length of stay, total charge, and total cost, and OUD patients with greater illness severity and comorbid conditions demonstrated increased outcomes compared to those without OUD, with increased total costs and charges in 2020. Conclusions Our results offer important insights into the healthcare impact of OUD. Future studies should use patient-level data to better understand the overall healthcare use per person rather than per hospital stay, as well as more recent years of data to study greater Covid-19 specific impacts. Implications The study emphasizes the need for more efforts to decrease the prevalence of OUD in the U.S. to help ease the pressure on the healthcare system. It also demonstrates the potential influence of the severity of illness and comorbidity on healthcare use, suggesting a need for specific interventions for patients with severe conditions.

The financial burden of hospitalization from life-threatening infectious diseases on the U.S. healthcare system is substantial and continues to increase. The purpose of this study was to identify key predictors of high hospital charges for infective endocarditis at a major university-affiliated cardiac care centre in West Virginia. A retrospective electronic medical records’ review was undertaken of all adult patients admitted for endocarditis between 2014–2018. Multiple linear regression analysis assessed the total charges billed to the patient account for their endocarditis hospitalization in the medical record. Hospital charges have increased 12-fold during 2014–2018. Among the 486 patients, the median hospital charge was $198 678. About 47% of the patients underwent surgery incurring 70% of the total charges. Patients with hospital stays of ≥50 days accounted for a third of all charges. The multiple linear regression model accounted for 85% of the linear variance in the hospital charges. Median charges increased by 30.87% for patients with ≥9 consultations, 60.32% for those who died in the hospital, and 81.85% for those who underwent surgical intervention. The study findings showed that complex care requiring multiple consultations, surgical interventions, and longer hospital stays were significantly associated with higher hospital charges for endocarditis treatment.

BackgroundMinimally Invasive Liver Resection (MILR) techniques range from a hybrid-technique to full robotic approaches. When compared with open techniques, MILR has been shown to be advantageous by reducing pain, complications, length of stay and blood loss. The aim of this study was to compare clinical outcomes and hospital resource utilization between full laparoscopic, hand-assisted, and robotic liver resections among major (≥ 3 segments) and minor (≤ 2 segments) resections.MethodsA single-center comparative retrospective review was completed on 214 patients undergoing full laparoscopic, hand-assisted, or robotic liver resection procedures between 2005 and 2018.ResultsAmong minor resections: 85 full laparoscopic, 40 hand-assisted, and 35 robotic liver resection cases were analyzed; and among major resections: 13, 33, and 8 cases were analyzed, respectively. In the adjusted subgroup analysis of minor resections, OR time was significantly longer for the minor hand-assisted group (x¯ = 181 min; p < 0.05), and the average lesion size was smaller for the minor full laparoscopic group (x¯ = 4.2 cm; p < 0.05). Overall, direct hospital charges were lowest in the group of patients who underwent a minor resection using the full laparoscopic technique (x¯ = $39,054.90; p < 0.05), compared to the robotic technique. Due to the smaller sample size (n = 54) in the major resection subgroup, only two significant observations were made - the full laparoscopic group had the least amount of blood loss (x¯ = 227 cc; p < 0.05) and incurred the least amount of room and board charges compared to the other two techniques.ConclusionsThe robotic approach appears favorable for minor resections as evidenced by shorter length of stay but more costly than full laparoscopy. Clinical outcomes appear to be more dependent upon the magnitude of the resection (i.e. major vs. minor) than the MILR technique chosen. Randomized trials may be indicated to discern the best indications and advantages of each technique.

Aspiration pneumonia is a subset of pneumonias prevalent in elderly patients and patients with neurologic disorders. Researchers in previous studies mostly reported incidence and/or mortality rates based on regional data or in specific subgroups of patients. There is a paucity of nationwide data in the contemporary U.S. To describe U.S. national trends in acute care hospital admission for aspiration pneumonia from 2002 to 2012. We used the U.S. National (Nationwide) Inpatient Sample database to identify patients admitted with a primary diagnosis of aspiration pneumonia between 2002 and 2012. We estimated trends in the incidence, in-hospital mortality, length of stay, and total hospitalization cost for patients admitted for aspiration pneumonia and stratified on the basis of patient age (≥65 yr vs. <65 yr). Multivariable logistic regression analysis was used to identify independent predictors for in-hospital mortality. A total of 406,798 patients (weighted total, 1,741,517) admitted for aspiration pneumonia were included in this study. There were 84,200 (20.7%) patients younger than 65 years of age and 322,598 patients (79.3%) aged 65 years or older. From 2002 to 2012, the overall incidence of aspiration pneumonia decreased from 8.2 to 7.1 cases per 10,000 people, and in-hospital mortality decreased from 18.6 to 9.8%. For patients aged 65 years or older, the incidence decreased from 40.7 to 30.9 cases per 10,000 people, and the in-hospital mortality decreased from 20.7 to 11.3%. The median total hospitalization charges increased in both groups (age ≥65 yr, from $16,173 to $30,280; age <65 yr, from $17,517 to $30,526). In multivariable logistic analysis, patients aged 65 years or older or treatment in a nonteaching hospital were independent predictors of in-hospital mortality. The incidence and mortality of patients admitted to acute care hospitals for aspiration pneumonia decreased between 2002 and 2012 in the United States. This difference was more evident for elderly patients. However, the cost of hospitalization almost doubled. Being older than 65 years of age is an independent predictor of in-hospital mortality among patients admitted for aspiration pneumonia. Strategies to prevent aspiration pneumonia in the community should be implemented in the aging U.S.

Objectives. In August 1993 a group of house staff and nursing staff at MetroHealth Medical Center formed a quality improvement team to evaluate the process of medical care on the inpatient wards. Using standard continuous quality improvement (CQI) methods, a team of medical interns, nurses, and other health professionals involved in patient care on the medicine inpatient service designed interdisciplinary, daily work rounds to improve the care of patients on the inpatient wards. Methods. The authors conducted a randomized, controlled firm trial of the impact of interdisciplinary rounds on the inpatient medicine services. The trial lasted 6 months (November 1993-April 1994) and included 1,102 admissions randomly assigned to experimental or control teams by the pre-existing firm system. Of the 1,102 admissions included in the study, 535 were randomized to medical services with traditional rounds and 567 to medical services with interdisciplinary rounds. The outcomes studied included length of stay (LOS), total hospital charges, provider satisfaction, and ancillary service efficiency. Results. Unadjusted analysis for logtransformed data showed lower length of stay and total charges for the interdisciplinary group. The mean LOS for interdisciplinary rounds was 5.46 days, compared with 6.06 days for traditional care (P = 0.006), whereas mean total charges were $6,681 and $8,090 (P = 0.002) for the two groups, respectively. After multivariate regression analysis using a propensity score that included gender, age, marital status, admission source, diagnosis-related group (DRG) weight, and primary diagnosis by International Classification of Diseases, Ninth Revision (ICD-9) cluster, these differences remained statistically significant. Conclusions. Previous studies of interdisciplinary teams have failed to show statistically significant cost savings. This study involving more patients shows both cost and LOS decreases with the use of interdisciplinary teams. At the end of the 6-month trial, interdisciplinary rounds were instituted on all medicine inpatient services.

PurposeThis study investigates the impact of patient characteristics and demographics on hospital charges for tonsillectomy as a treatment for pediatric obstructive sleep apnea (OSA). The aim is to identify potential disparities in hospital charges and contribute to efforts for equitable access to care.MethodsData from the 2016 Healthcare Cost and Utilization Project (HCUP) Kid Inpatient Database (KID) was analyzed. The sample included 3,304 pediatric patients undergoing tonsillectomy ± adenoidectomy for OSA. Variables such as age, race, length of stay, hospital region, residential location, payer information, and median household income were collected. The primary outcome variable was hospital charge. Statistical analyses, including t-tests, ANOVA, and multiple linear regression, were conducted.ResultsAmong 3,304 pediatric patients undergoing tonsillectomy for OSA. The average total charges for tonsillectomy were $26,400, with a mean length of stay of 1.70 days. Significant differences in charges were observed based on patient race, hospital region, and payer information. No significant differences were found based on gender, discharge quarter, residential location, or median household income. Multiple linear regression showed race, hospital region, and residential location were significant predictors of total hospital charges.ConclusionThis study highlights the influence of patient demographics and regional factors on hospital charges for pediatric tonsillectomy in OSA cases. These findings underscore the importance of addressing potential disparities in healthcare access and resource allocation to ensure equitable care for children with OSA. Efforts should be made to promote fair and affordable treatment for all pediatric OSA patients, regardless of their demographic backgrounds.

Objective Degenerative spondylolisthesis and spinal canal stenosis are some of the more common clinical conditions associated with low back pain, with various surgical techniques available, ranging from standalone decompression to fusion. Interspinous spacer devices (ISD) have emerged as an intermediary surgical option. The aim was to compare 90-day all-cause readmission rates between techniques, with secondary outcomes including total hospital charges and postoperative complications. Methods Utilizing the 2020 Nationwide Readmissions Database (NRD), adult patients (> 18 years) were selected by primary diagnosis ICD-10 code for spondylolisthesis and/or spinal stenosis. Patients were categorized by surgical treatment: ISD, decompression, or single-level posterior fusion. Treatment techniques were compared using a multivariable logistic and linear regression while adjusting for potential confounding factors. Propensity score adjustments were performed as a sensitivity analysis. Results In total 37,503 patients met our inclusion criteria, with (81.2%) having received a decompression, 18.3% a fusion and 0.49% an ISD. The 90-day all-cause readmission rates were 8%, 9%, and 9% respectively ( p = 0.85). ISD had the lowest mean raw hospital charges at $109,676 ( p < 0.001), compared to fusion charges of $205,024. Early c omplication rates were similar across all groups, except for neurological and gastrointestinal complications. Conclusion ISD had comparable readmission and early postoperative complication rates versus decompression or fusion surgeries, with lower raw charges compared to fusion. Our results suggest that ISD may be a viable option for some patients compared to more traditional surgical techniques for spondylolisthesis or spinal stenosis. Further research into the long-term cost-effectiveness and clinical outcomes will be needed.