Costs in Colectomy Episodes of Care: Opportunities to Prevent Emergency Operations and Decrease Costs.

INTRODUCTION: Payment structured around Episodes of Care is a method for incentivizing decreased care utilization after major procedures. We examined Major Bowel Episodes of Care (MB-EoC)-the focus among general surgery procedures-within a large health system to determine the contribution of emergency bowel surgery to higher costs of care. METHODS: Adult MB-EoC cases from July 2018 to June 2021 were reviewed for 90-d costs, examining patient age, insurance, diagnosis, cost of care, and contributors to cost. For patients aged ≥45 y who had nonelective care for colon cancer, incidence of prior screening colonoscopy was examined. RESULTS: We identified 1292 colectomy cases. Mean age was 65 y. Of these patients, 90% had Medicare/commercial insurance. Colon cancer comprised 41% of primary diagnoses. Twenty-eight percent of cases were nonelective, more likely to have Medicaid/underinsured (21% versus 7%, P < 0.001), and had higher utilization of postdischarge cost-drivers. Ninety-day EoC per case cost was 66% higher for emergent versus elective cases. Of eligible emergency cancer cases, 43% (40/93) had undergone prior colonoscopy within 10 y. For patients with colon cancer, 90-d EoC per case was 39% higher for emergent versus elective cases. CONCLUSIONS: Emergency MB-EoC cases disproportionally contribute to higher 90-d care utilization and costs. Efforts to increase screening colonoscopy in appropriate populations may have a substantial impact on MB-EoC costs.

High-Performance Solid-State PbS Quantum Dot-Sensitized Solar Cells Prepared by Introduction of Hybrid Perovskite Interlayer.

High-performance solid-state PbS quantum dot-sensitized solar cells (QD-SSCs) with stable 9.2% power conversion efficiency at 1 Sun condition are demonstrated by introduction of hybrid perovskite interlayer. The PbS QDs formed on mesoscopic TiO2 (mp-TiO2) by spin-assisted successive precipitation and anionic exchange reaction method do not exhibit PbSO4 but have PbSO3 oxidation species. By introducing perovskite interlayer in between mp-TiO2/PbS QDs and poly-3-hexylthiophene, the PbSO3 oxidation species are fully removed in the PbS QDs and thereby the efficiency of PbS QD-SSCs is enhanced over 90% compared to the pristine PbS QD-SSCs.