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1.
Am Surg ; 86(3): 256-260, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32223807

RESUMEN

Minimally invasive sigmoid colectomy via the laparoscopic approach (LA) has numerous benefits. We seek to compare outcomes between laparoscopic and robotic sigmoid colectomies. We analyzed the data using the National Inpatient Sample database between 2008 and 2014. Utilization and outcome measures were compared. The seven-year average number of patients who underwent elective sigmoid colectomy in the United States from 2008 to 2014 was estimated to be 197,053. Of these, 95.1 per cent were conducted using the LA. The mean age was 58.33 + 13.6 years and 58.23 + 12.8 years in laparoscopic and robotic approaches, respectively. No significant differences existed in respect to morbidities. Postoperative complications were comparable with respect to other complications. Length of hospital stay was statistically significantly shorter in the robot-assisted approach compared with the LA (mean 4.8 + 4 vs 5.7 + 5 days, respectively, P < 0.001). Patients who underwent robotic surgery had significantly higher total hospital charges than those who underwent laparoscopic surgery (median $45,057 vs $57,871 USD, P < 0.001). The advent of robot-assisted surgery has provided more options for patients and surgeons. Compared with laparoscopy, robot-assisted sigmoid colectomy has no clinical advantages in morbidity and mortality. However, the robotic approach has a significantly higher total charge to the patient.


Asunto(s)
Colectomía/métodos , Costos de Hospital , Laparoscopía/métodos , Tiempo de Internación/economía , Procedimientos Quirúrgicos Robotizados/economía , Adulto , Anciano , Colectomía/economía , Colon Sigmoide/cirugía , Análisis Costo-Beneficio , Bases de Datos Factuales , Procedimientos Quirúrgicos Electivos/economía , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Estudios de Seguimiento , Costos de la Atención en Salud , Humanos , Laparoscopía/economía , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Medición de Riesgo , Procedimientos Quirúrgicos Robotizados/métodos , Estados Unidos
2.
N Z Med J ; 133(1508): 29-42, 2020 01 17.
Artículo en Inglés | MEDLINE | ID: mdl-31945041

RESUMEN

AIMS: Length of hospital stay (LOS) for acute coronary syndrome (ACS) has important clinical and cost implications. We report recent trends and predictors of ACS hospitalisation LOS in New Zealand. METHODS: Using routine national hospitalisation datasets, we calculated mean LOS for ACS admissions annually from 2006 to 2016, by demographics, ACS subtype and ACS procedures (coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)). We also identified predictors of longer LOS. RESULTS: Among 185,962 ACS hospitalisations, mean LOS decreased from 7.8 to 6.7 days between 2006 and 2016 (adjusted decrease = -0.18 days/year). Decline in LOS was observed for all demographic subgroups by age, sex, ethnicity and deprivation quintile. While coronary angiography and PCI rates increased during this time, LOS declined for all management strategies. However, the adjusted rate of decline was greater for patients receiving coronary angiography without revascularisation (-0.24 days/year), PCI (-0.22 days/year) and CABG (0.33 days/year)-than those not receiving angiography (-0.14 days/year), P<0.001. A greater decline occurred for NSTEMI and STEMI (9.4 to 7.5 days and 7.8 to 6.2 days, respectively) than UA (5.4 to 4.9 days). Predictors of longer LOS in 2016 were older age, female, Maori or Pacific ethnicity, not receiving coronary angiography, initial presentation to a non-interventional hospital and CABG. CONCLUSIONS: Mean LOS for ACS hospitalisations declined between 2006 and 2016. The decline was greatest in the increasing proportion of patients who received a coronary angiogram. Further reductions in LOS may be achieved by implementation of nationally agreed pathways for adequate and timely access to coronary angiography.


Asunto(s)
Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/terapia , Hospitalización/estadística & datos numéricos , Tiempo de Internación/economía , Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Angiografía Coronaria/métodos , Angiografía Coronaria/tendencias , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/tendencias , Grupos Étnicos/estadística & datos numéricos , Femenino , Hospitalización/tendencias , Humanos , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Infarto del Miocardio sin Elevación del ST/epidemiología , Infarto del Miocardio sin Elevación del ST/fisiopatología , Infarto del Miocardio sin Elevación del ST/terapia , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/tendencias , Infarto del Miocardio con Elevación del ST/epidemiología , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/terapia , Factores Sexuales
3.
Am J Cardiol ; 125(1): 29-33, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31711633

RESUMEN

Contrast-induced acute kidney injury (AKI) is a common and severe complication of percutaneous coronary intervention (PCI). Despite its substantial burden, contemporary data on the incremental costs of AKI are lacking. We designed this large, nationally representative study to examine: (1) the independent, incremental costs associated with AKI after PCI and (2) to identify the departmental components of cost contributing to the incremental costs associated with AKI. In this observational cross-sectional study from the Premier database, we analyzed 1,443,297 PCI patients at 518 US hospitals from 1/2006 to 12/2015. Incremental cost of AKI from a hospital perspective obtained by a microcosting approach, was estimated using mixed-effects, multivariable linear regression with hospitals as random effects. Costs were inflation-corrected to 2016 US$. AKI occurred in 82,683 (5.73%) of the PCI patients. Those with AKI had higher hospitalization cost than those without ($38,869, SD 42,583 vs $17,167 SD 13,994, p <0.001). After adjustment, the incremental cost associated with an AKI was $9,448 (95% confidence interval $9,338 to $9,558, p <0.001). AKI was also independently associated with an incremental length of stay of 3.6 days (p <0.001). Room and board costs were the largest driver of AKI costs ($4,841). Extrapolated to the United States, our findings imply an annual AKI cost burden of 411.3 million US$. In conclusion, in this national study of PCI patients, AKI was common and independently associated with ∼$10,000 incremental costs, implying a substantial burden of AKI costs in US hospitals. Successful efforts to prevent AKI in patients who underwent PCI could result in meaningful cost savings.


Asunto(s)
Lesión Renal Aguda/economía , Predicción , Costos de Hospital/tendencias , Tiempo de Internación/economía , Intervención Coronaria Percutánea/efectos adversos , Complicaciones Posoperatorias/economía , Sistema de Registros , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Ahorro de Costo , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología
4.
Med Care ; 58(3): 234-240, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31876661

RESUMEN

BACKGROUND: As there has been increasing pressure on acute care services to redefine how their care is delivered, hospital-affiliated freestanding emergency departments (FREDs) have rapidly expanded in some markets. Little is known about the populations served or the quality of care provided by these facilities. OBJECTIVE: The objective of this study was to compare patient visit characteristics, geographic catchment areas, and operational performance between hospital-affiliated FREDs and hospital-based emergency departments (HEDs). RESEARCH DESIGN: This was a population-based retrospective observational analysis of 19 FREDs and 5 HEDs in a single health system over a 1-year period. We abstracted patient visit data from the electronic health record and supplemented catchment area data with the 2016 American Community Survey. We analyzed lengths of stay using generalized linear models adjusted for age, severity, and insurance status. RESULTS: FREDs had lower proportions of visits from nonwhite patients and more visits from privately insured patients than HEDs, with similar proportions of uninsured patient visits. These trends were mirrored in catchment area analyses. FRED visits were lower acuity, with fewer imaging and laboratory tests performed. The adjusted mean length of stay for discharged patients was 109 minutes for FREDs compared with 169 minutes for HEDs. For admitted or transferred patients, adjusted lengths of stay were 213 minutes at FREDs and 287 minutes at HEDs. CONCLUSIONS: Hospital-affiliated FREDs serve more affluent and less diverse patient populations and geographic communities. Relative to HEDs, they have lower acuity patient visits with fewer tests, and they have shorter lengths of stay, even after adjustment for patient visit characteristics.


Asunto(s)
Instituciones de Atención Ambulatoria , Servicio de Urgencia en Hospital , Tiempo de Internación/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Instituciones de Atención Ambulatoria/economía , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Áreas de Influencia de Salud , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Hospitales , Humanos , Seguro de Salud , Tiempo de Internación/economía , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Estudios Retrospectivos
5.
Support Care Cancer ; 28(1): 113-122, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30993450

RESUMEN

PURPOSE: Limited information is available regarding elderly patients experiencing febrile neutropenia (FN). This study evaluated FN-related care among elderly cancer patients who received high/intermediate FN-risk chemotherapy and experienced ≥ 1 FN episodes. METHODS: We used Medicare data to identify patients aged ≥ 66 years who initiated high/intermediate FN-risk chemotherapy between 1 January 2008 and 31 August 2015 to treat breast cancer (BC), lung cancer (LC), or non-Hodgkin lymphoma (NHL) and had ≥ 1 FN episodes. We identified within-cycle FN episodes for each chemotherapy cycle on Part A inpatient claims or outpatient or Part B claims. We described the FN-related care setting (inpatient hospital, outpatient emergency department [ED], or outpatient non-ED) and reported mean total cost of FN-related care per episode overall and by care setting (adjusted to 2015 US$). RESULTS: We identified 2138, 3521, and 2862 patients with BC, LC, and NHL, respectively, with ≥ 1 FN episodes (total episodes: 2407, 3840, 3587, respectively). Most FN episodes required inpatient care (BC, 88.1%; LC, 93.0%; NHL, 93.2%) with mean hospital length of stay (LOS) 6.2, 6.5, and 6.8 days, respectively. Intensive care unit admission was required for 20.4% of BC, 29.0% of LC, and 25.7% of NHL hospitalizations (mean LOS: 4.7, 4.7, 5.5 days, respectively). The mean total cost of FN care per episode was $11,959 BC, $14,388 LC, and $15,006 NHL, with inpatient admission the costliest care component ($11,826; $14,294; and $14,873; respectively). CONCLUSIONS: Among elderly patients with BC, LC, or NHL who experienced FN, most FN episodes required costly hospital care, highlighting the FN burden on healthcare systems.


Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Neutropenia Febril Inducida por Quimioterapia/economía , Neutropenia Febril Inducida por Quimioterapia/terapia , Costos de la Atención en Salud , Neoplasias Pulmonares/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Factores de Edad , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/economía , Neoplasias de la Mama/epidemiología , Neutropenia Febril Inducida por Quimioterapia/epidemiología , Costos y Análisis de Costo , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Servicios de Salud para Ancianos/economía , Servicios de Salud para Ancianos/estadística & datos numéricos , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Neoplasias Pulmonares/economía , Neoplasias Pulmonares/epidemiología , Linfoma no Hodgkin/economía , Linfoma no Hodgkin/epidemiología , Masculino , Medicare/economía , Estudios Retrospectivos , Estados Unidos/epidemiología
6.
BMC Infect Dis ; 19(1): 1028, 2019 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-31795953

RESUMEN

BACKGROUND: Pseudomonas aeruginosa-related pneumonia is an ongoing healthcare challenge. Estimating its financial burden is complicated by the time-dependent nature of the disease. METHODS: Two hundred thirty-six cases of Pseudomonas aeruginosa-related pneumonia were recorded at a 2000 bed German teaching hospital between 2011 and 2014. Thirty-five cases (15%) were multidrug-resistant (MDR) Pseudomonas aeruginosa. Hospital- and community-acquired cases were distinguished by main diagnoses and exposure time. The impact of Pseudomonas aeruginosa-related pneumonia on the three endpoints cost, reimbursement, and length of stay was analyzed, taking into account (1) the time-dependent nature of exposure, (2) clustering of costs within diagnostic groups, and (3) additional confounders. RESULTS: Pseudomonas aeruginosa pneumonia is associated with substantial additional costs that are not fully reimbursed. Costs are highest for hospital-acquired cases (€19,000 increase over uninfected controls). However, community-acquired cases are also associated with a substantial burden (€8400 when Pseudomonas aeruginosa pneumonia is the main reason for hospitalization, and €6700 when not). Sensitivity analyses for hospital-acquired cases showed that ignoring or incorrectly adjusting for time-dependency substantially biases results. Furthermore, multidrug-resistance was rare and only showed a measurable impact on the cost of community-acquired cases. CONCLUSIONS: Pseudomonas aeruginosa pneumonia creates a substantial financial burden for hospitals. This is particularly the case for nosocomial infections. Infection control interventions could yield significant cost reductions. However, to evaluate the potential effectiveness of different interventions, the time-dependent aspects of incremental costs must be considered to avoid introduction of bias.


Asunto(s)
Infecciones Comunitarias Adquiridas/economía , Infección Hospitalaria/economía , Costos de Hospital , Hospitalización/economía , Neumonía Bacteriana/economía , Infecciones por Pseudomonas/economía , Pseudomonas aeruginosa , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infección Hospitalaria/tratamiento farmacológico , Farmacorresistencia Bacteriana Múltiple , Femenino , Alemania , Hospitales de Enseñanza , Humanos , Tiempo de Internación/economía , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/tratamiento farmacológico , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología
7.
South Med J ; 112(12): 599-603, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31796966

RESUMEN

OBJECTIVES: Admitted patients boarding in the emergency department (ED) while awaiting inpatient beds represent a bottleneck in patient flow. We sought to examine the impact on patient flow and potential for cost savings by an active management of boarded ED medical admissions by a hospitalist-led team, which included a hospitalist, an advanced practitioner, and a case manager. METHODS: This was a retrospectively conducted analysis of a quality improvement pilot intervention implemented at a large tertiary center. We analyzed patients admitted under observation status between April 1, 2016 and June 30, 2016. We calculated the difference for length of stay (in hours) and direct cost between patients in the intervention group and a usual care group from a similar time period in the prior year matched on the all patients refined-diagnosis related groups (APR-DRG) and severity of illness (SOI) level. RESULTS: One hundred seventy-five observation patients were managed by the hospitalist team during the 3-month pilot period. This group had an average hospital stay of 26.0 hours compared with 29.7 hours in the usual care group. Direct costs resulted in the following results: average cost for the intervention patient group $1452 (±$775) versus $2524 (±$894) group, for an average savings of $1072 (P < 0.001), with a total estimated direct cost savings of $187,660. CONCLUSIONS: Active management of ED boarding patients by a hospitalist-led team is feasible and can lead to hospital cost savings and decrease in hospital stay. The findings from this pilot resulted in a decision to make the ED hospitalist-led team permanent in our institution. The evaluation of the program may help other hospitals to decide whether this intervention is worth pursuing in their own organization.


Asunto(s)
Servicio de Urgencia en Hospital , Médicos Hospitalarios , Tiempo de Internación/economía , Admisión del Paciente , Grupo de Atención al Paciente/organización & administración , Aglomeración , Capacidad de Camas en Hospitales , Humanos , Massachusetts , Readmisión del Paciente/estadística & datos numéricos , Proyectos Piloto , Estudios Retrospectivos
8.
PLoS One ; 14(12): e0227131, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31887211

RESUMEN

BACKGROUND: Well-advised priority setting in prevention and treatment of injuries relies on detailed insight into costs of injury. This study aimed to provide a detailed overview of medical and productivity costs due to injury up to two years post-injury and compare these costs across subgroups for injury severity and age. METHODS: A prospective longitudinal cohort study followed all adult (≥18 years) injury patients admitted to a hospital in Noord-Brabant, the Netherlands. Patients filled out questionnaires 1 week, 1, 3, 6, 12 and 24 months after trauma, including items on health care consumption from the medical consumption questionnaire (iMCQ) and productivity loss from the productivity cost questionnaire (PCQ). Furthermore, injury severity was defined by Injury Severity Score (ISS). Data on diagnostics was retrieved from hospital registries. We calculated medical costs, consisting of in-hospital costs and post-hospital medical costs, and productivity costs due to injury up to two years post-injury. RESULTS: Approximately 50% (N = 4883) of registered patients provided informed consent, and 3785 filled out at least one questionnaire. In total, the average costs per patient were €12,190. In-hospital costs, post-hospital medical costs and productivity costs contributed €4810, €5110 and €5830, respectively. Total costs per patient increased with injury severity, from €7030 in ISS1-3 to €23,750 in ISS16+ and were lowest for age category 18-24y (€7980), highest for age category 85 years and over (€15,580), and fluctuated over age groups in between. CONCLUSION: Both medical costs and productivity costs generally increased with injury severity. Furthermore, productivity costs were found to be a large component of total costs of injury in ISS1-8 and are therefore a potentially interesting area with regard to reducing costs.


Asunto(s)
Costo de Enfermedad , Eficiencia , Costos de la Atención en Salud/estadística & datos numéricos , Puntaje de Gravedad del Traumatismo , Heridas y Traumatismos/economía , Absentismo , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Países Bajos , Aceptación de la Atención de Salud/estadística & datos numéricos , Presentismo/economía , Presentismo/estadística & datos numéricos , Estudios Prospectivos , Sistema de Registros/estadística & datos numéricos , Distribución por Sexo , Encuestas y Cuestionarios/estadística & datos numéricos , Heridas y Traumatismos/complicaciones , Heridas y Traumatismos/diagnóstico , Adulto Joven
9.
West J Emerg Med ; 20(6): 885-892, 2019 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-31738715

RESUMEN

INTRODUCTION: On January 1, 2014, the State of Maryland implemented the Global Budget Revenue (GBR) program. We investigate the impact of GBR on length of stay (LOS) for inpatients in emergency departments (ED) in Maryland. METHODS: We used the Hospital Compare data reports from the Centers for Medicare and Medicaid Services (CMS) and CMS Cost Reports Hospital Form 2552-10 from January 1, 2012-March 31, 2016, with GBR hospitals from Maryland and hospitals from West Virginia (WV), Delaware (DE), and Rhode Island (RI). We implemented difference-in-differences analysis and investigated the impact of GBR implementation on the LOS or ED1b scores of Maryland hospitals using a mixed-effects model with a state-level fixed effect, a hospital-level random effect, and state-level heterogeneity. RESULTS: The GBR impact estimator was 9.47 (95% confidence interval [CI], 7.06 to 11.87, p-value<0.001) for Maryland GBR hospitals, which implies, on average, that GBR implementation added 9.47 minutes per year to the time that hospital inpatients spent in the ED in the first two years after GBR implementation. The effect of the total number of hospital beds was 0.21 (95% CI, 0.089 to 0.330, p-value = 0 .001), which suggests that the bigger the hospital, the longer the ED1b score. The state-level fixed effects for WV were -106.96 (95% CI, -175.06 to -38.86, p-value = 0.002), for DE it was 6.51 (95% CI, -8.80 to 21.82, p-value=0.405), and for RI it was -54.48 (95% CI, -82.85 to -26.10, p-value<0.001). CONCLUSION: Our results indicate that GBR implementation has had a statistically significant negative impact on the efficiency measure ED1b of Maryland hospital EDs from January 2014 to April 2016. We also found that the significant state-level fixed effect implies that the same inpatient might experience different ED processing times in each of the four states that we studied.


Asunto(s)
Presupuestos/organización & administración , Eficiencia Organizacional/economía , Servicio de Urgencia en Hospital/organización & administración , Tiempo de Internación/economía , Gobierno Estatal , Control de Costos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Reforma de la Atención de Salud , Costos de Hospital , Humanos , Tiempo de Internación/estadística & datos numéricos , Maryland , Medicaid/organización & administración , Modelos Estadísticos , Estados Unidos
10.
Plast Reconstr Surg ; 144(4): 540e-549e, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31568278

RESUMEN

BACKGROUND: The number of free flap take-backs and successful salvages following microsurgical breast reconstruction decreases as time from surgery increases. As a result, the cost of extended inpatient monitoring to achieve a successful flap salvage rises rapidly with each postoperative day. This study introduces a simplified cost-utility model of inpatient flap monitoring and identifies when cost-utility exceeds the thresholds established for other medical treatments. METHODS: A retrospective review of a prospectively maintained database was performed of patients who underwent microsurgical breast reconstruction to identify flap take-back and salvage rates by postoperative day. The number of patients and flaps that needed to be kept on an inpatient basis each day for monitoring to salvage a single failing flap was determined. Quality-of-life measures and incremental cost-effectiveness ratios for inpatient flap monitoring following microsurgical breast reconstruction were calculated and plotted against a $100,000/quality-adjusted life-year threshold. RESULTS: A total of 1813 patients (2847 flaps) were included. Overall flap take-back and salvage rates were 2.4 percent and 52.3 percent, respectively. Of the flaps taken back, the daily take-back and salvage rates were 56.8 and 60.0 percent (postoperative day 0 to 1), 13.6 and 83.3 percent (postoperative day 2), 11.4 and 40.0 percent (postoperative day 3), 9.1 and 25.0 percent (postoperative day 4), and 9.1 and 0.0 percent (>postoperative day 4), respectively. To salvage a single failing flap each day, the number of flaps that needed to be monitored were 121 (postoperative day 0 to 1), 363 (postoperative day 2), 907 (postoperative day 3), 1813 (postoperative day 4), and innumerable for days beyond postoperative day 4. The incremental cost-effectiveness ratio of inpatient flap monitoring begins to exceed a willingness-to-pay threshold of $100,000/quality-adjusted life-year by postoperative day 2. CONCLUSION: The health care cost associated with inpatient flap monitoring following microsurgical breast reconstruction begins to rise rapidly after postoperative day 2.


Asunto(s)
Análisis Costo-Beneficio , Colgajos Tisulares Libres/economía , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Mamoplastia/economía , Mamoplastia/métodos , Microcirugia , Adulto , Femenino , Humanos , Persona de Mediana Edad , Monitoreo Fisiológico , Estudios Retrospectivos
11.
Vasc Health Risk Manag ; 15: 385-393, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31564888

RESUMEN

Background: Perioperative health care utilization and costs in patients undergoing elective fast-track vs standard endovascular aneurysm repair (EVAR) remain unclear. Methods: The fast-track EVAR group included patients treated with a 14 Fr stent graft, bilateral percutaneous access, no general anesthesia or intensive care monitoring, and next-day hospital discharge. The standard EVAR group was identified from Medicare administrative claims using a matching algorithm to adjust for imbalances in patient characteristics. Hospital outcomes included operating room time, intensive care monitoring, hospital stay, secondary interventions, and major adverse events (MAEs). Perioperative outcomes occurring from hospital discharge to 30 days postdischarge included MAE, secondary interventions, and unrelated readmissions. Results: Among 1000 matched patients (250 fast-track; 750 standard), hospital outcomes favored the fast-track EVAR group, including shorter operating room time (2.30 vs 2.83 hrs, P<0.001), shorter hospital stay (1.16 vs 1.69 d, P<0.001), less need for intensive care monitoring (4.4% vs 48.0%, P<0.001), and lower secondary intervention rate (0% vs 2.4%, P=0.01). Postdischarge outcomes also favored fast-track EVAR with a lower rate of MAE (0% vs 7.2%, P<0.001) and all-cause readmission (1.6% vs 6.8%, P=0.001). The total cost to the health care system during the perioperative period was $26,730 with fast-track EVAR vs $30,730 with standard EVAR. Total perioperative health care costs were $4000 (95% CI: $3130-$4830) lower with fast-track EVAR vs standard EVAR, with $2980 in savings to hospitals and $1030 savings to health care payers. Conclusion: A fast-track EVAR protocol using a 14 Fr stent graft resulted in shorter procedure time, lower intensive care utilization, faster discharge, lower incidence of MAE, lower readmission rates, and lower perioperative costs compared to standard EVAR.


Asunto(s)
Aneurisma de la Aorta Abdominal/economía , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/economía , Procedimientos Endovasculares/economía , Costos de Hospital , Alta del Paciente/economía , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Prótesis Vascular/economía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Ahorro de Costo , Análisis Costo-Beneficio , Cuidados Críticos/economía , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Tiempo de Internación/economía , Masculino , Tempo Operativo , Readmisión del Paciente/economía , Diseño de Prótesis , Sistema de Registros , Retratamiento/economía , Stents/economía , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos
12.
J Diabetes Res ; 2019: 2363292, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31583247

RESUMEN

Background: Diabetes mellitus (DM) has become a significant worldwide public health problem and economic burden because a great proportion of healthcare costs has been spent on the treatment of DM and its related complications. The aim of this study was to examine the costs and length of stay (LoS) of hospitalizations due to diabetes-related complications in Taiwan. Methods: This study is a retrospective claim database analysis using the Longitudinal Cohort of Diabetes Patients, with 2012 used as the base year. The hospitalization costs and LoS per admission were estimated for each complication of interest using data from the LHDB 2004 to 2012 cohorts. The presence of eight DM-related complications were identified using the ICD-9-CM codes and procedure codes. ANOVA was used to examine the relationships of diabetes duration with the LoS and costs of the complications. Results: A total of 27,473 DM patients who were hospitalized in 2012 due to one of the examined DM-related complications were identified. The most common complications that caused the hospitalizations were nonfatal stroke (34.7%) and nonfatal ischemic heart disease (IHD) (28.7%). Amputation was the complication with the longest hospital stay, with a mean ± SD of 21.6 ± 14.1 days, followed by nonfatal stroke (13.6 ± 11.3), ulcer (12.7 ± 11.8), and fatal IHD (12.2 ± 13.6). The complications with the greatest hospitalization cost were fatal IHD (mean = TWD 306,209.8; median = TWD 221,417.0; 1TWD = 0.034USD) and fatal myocardial infarction (mean = TWD 272,840.1; median = TWD 174,008). Conclusions: This study indicates that DM-related complications are associated with significant hospital LoS and costs. The study results could be useful for economic evaluations of diabetes treatments and the estimation of the overall economic impact of diabetes.


Asunto(s)
Complicaciones de la Diabetes/economía , Costos de la Atención en Salud , Hospitalización/economía , Tiempo de Internación/economía , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Complicaciones de la Diabetes/terapia , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
13.
Am Surg ; 85(9): 949-955, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31638505

RESUMEN

Regionalizing surgical care to high-volume centers has improved outcomes for endocrine surgery. This shift is associated with increased travel time, costs, and morbidity within certain patient populations. We examined travel time-related differences in demographics, health-care utilization, thyroid-specific disease, and cost for patients undergoing thyroid surgery at a single high-volume center. Data were extracted from the 2005 to 2014 ACS-NSQIP and clinical data repository for patients undergoing thyroid surgery. Travel times between patients' home address and the hospital were calculated using Google Earth under assumptions of standard road conditions and speed restrictions. Travel time was divided into <2 hours versus ≥2 hours. Primary outcomes were hospital cost and 30-day morbidity. Factors associated with travel time and primary outcomes were analyzed using appropriate bivariate tests and multivariable regression modeling. A total of 1046 thyroid procedures were included, with median (IQR) travel time of 68.8 (40.1-107.2) minutes. Eight hundred forty-seven (80.9%) patients traveled <2 hours compared with 199 (19.1%) traveled ≥2 hours. Patients traveling ≥2 hours were more likely to have complex thyroid disease (37.7% vs 27.6%, P = 0.005), uninsured status (31.1% vs 11.8%, P < 0.001), lower preoperative morbidity risk (2.3% vs 2.7%, P = 0.02), and longer length of stay (1.21 vs 1.07 days, P = 0.04), but similar median operative times (163 vs 165 minutes, P = 0.89). Average cost was higher for patients traveling ≥2 hours ($7300 vs $6846 [2014 USD], P = 0.05). Despite observed patient differences, hospital costs and postoperative morbidity did not differ after adjustment. Existing management practices and the nature of the disease process may be protective against the potential negative effects of regionalization.


Asunto(s)
Costos de Hospital , Hospitales de Alto Volumen , Aceptación de la Atención de Salud , Complicaciones Posoperatorias , Enfermedades de la Tiroides/economía , Enfermedades de la Tiroides/cirugía , Viaje , Adulto , Femenino , Humanos , Tiempo de Internación/economía , Masculino , Pacientes no Asegurados , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/economía , Centros de Atención Terciaria , Factores de Tiempo , Virginia
14.
Am Surg ; 85(9): 1044-1050, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31638522

RESUMEN

Enhanced recovery after surgery (ERAS) may improve patients' postoperative course. Our center implemented the ERAS protocol for the colorectal service in 2016, and then expanded to multiple service lines over the course of 1.5 years. Our aim was to determine whether broad implementation of ERAS protocols across different service lines could improve patient care. All ERAS patients from 2018 were captured prospectively. For each service line using ERAS, one full year of data preceding ERAS was compared. ERAS service lines included colorectal, gynecology laparoscopic, gynecology open, hepatopancreaticobiliary, urology - nephrectomy and cystectomy, spinal fusion, cardiac surgery-coronary artery bypass grafting. ERAS and pre-ERAS services were compared based on length of stay (LOS), complications, readmission, and mortality rates. In addition, hospital costs were collected during this time frame. ERAS protocols significantly decreased LOS for colorectal, gynecology, and spine. Complications were significantly decreased in colorectal, gynecology, urology, and spine. Readmissions did not significantly increase in any service line except spine. There was no significant change in mortality. ERAS proved to save the hospital 1847 days and cost saving of almost $5 million in 2018. Implementing ERAS broadly improved patient outcomes (LOS, complications, readmission, and mortality) while providing cost savings to the hospital.


Asunto(s)
Protocolos Clínicos , Procedimientos Quirúrgicos Electivos/economía , Procedimientos Quirúrgicos Electivos/normas , Costos de Hospital , Cuidados Posoperatorios/economía , Cuidados Posoperatorios/normas , Mejoramiento de la Calidad , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/economía , Readmisión del Paciente/economía , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/prevención & control
15.
Health Serv Res ; 54(6): 1184-1192, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31657002

RESUMEN

OBJECTIVE: To investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs. DATA SOURCES AND STUDY SETTING: Retrospective cohort study from 2012 to 2016 using Medicare claims and SNF assessment data, including SNF admissions for Medicare fee-for-service beneficiaries. STUDY DESIGN: We first estimate how changes in Medicare's SNF copayment on the 21st day of a patient's benefit period affect length of SNF stay. We then use benefit day on admission as an instrumental variable to estimate the impact of SNF length of stay related to the copayment policy on readmission and Medicare payment. PRINCIPAL FINDINGS: From 2012 to 2016, we examined 291 134 SNF admissions. Higher benefit day on SNF admission was strongly associated with shorter SNF stays. A 1-day shorter SNF stay was associated with higher readmission rate within 30 days of hospital discharge (1.5 percentage points; 95% CI 1.4-1.6, P < .001) and within 30 days of SNF discharge (0.9 percentage points; 95% CI 0.8-1.0), lower total Medicare payment for the 90-day episode after hospital discharge ($396; 95% CI 361-431, P < .001), but $179 higher payment for the 90 days after SNF discharge (95% CI 149-210, P < .001), offsetting the lower payment for the shorter index SNF stay. CONCLUSIONS: Medicare's SNF copayment policy is associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy has unintended and negative effects on patient outcomes.


Asunto(s)
Gastos en Salud/estadística & datos numéricos , Hospitalización/economía , Tiempo de Internación/economía , Medicare/economía , Alta del Paciente/economía , Instituciones de Cuidados Especializados de Enfermería/economía , Atención Subaguda/economía , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Medicare/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricos , Atención Subaguda/estadística & datos numéricos , Estados Unidos
16.
Am Surg ; 85(10): 1129-1133, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657308

RESUMEN

Best management for acute appendicitis (AA) in adults with liver cirrhosis is controversial and needs more investigation. We aimed to examine the impact of different treatment modalities on outcomes in this complex patient population. The Nationwide Inpatient Sample database from 2012 to 2014 was queried to identify AA patients with no cirrhosis, compensated cirrhosis (CC), and decompensated cirrhosis (DC). Each cohort was further stratified according to the treatment type: nonoperative management, open appendectomy, and laparoscopic appendectomy (LA). Chi-square, ANOVA, and binary regression analyses were used to determine differences between groups and risk factors for mortality and complications, with P < 0.05 considered statistically significant. A total of 108,289 AA patients were analyzed; of those, 304 with CC and 134 with DC were identified. Compared with CC and no cirrhosis, DC patients had significantly higher mortality, higher cost, and longer hospital length of stay. LA is accompanied by higher survival, lower cost, shorter duration of hospitalization, and lower incidence of complications across all groups. We conclude that LA is the best management strategy for AA in cirrhotic patients. Even in decompensated cirrhotics, which are associated with worse clinical outcomes, LA is still a favorable option over open appendectomy and nonoperative management.


Asunto(s)
Apendicectomía/métodos , Apendicitis/cirugía , Laparoscopía , Cirrosis Hepática/complicaciones , Enfermedad Aguda , Adulto , Análisis de Varianza , Apendicectomía/efectos adversos , Apendicectomía/economía , Apendicectomía/mortalidad , Apendicitis/complicaciones , Apendicitis/mortalidad , Distribución de Chi-Cuadrado , Conversión a Cirugía Abierta/estadística & datos numéricos , Costos y Análisis de Costo , Femenino , Precios de Hospital , Mortalidad Hospitalaria , Humanos , Incidencia , Laparoscopía/economía , Laparoscopía/mortalidad , Tiempo de Internación/economía , Cirrosis Hepática/clasificación , Cirrosis Hepática/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Análisis de Regresión , Factores de Riesgo , Resultado del Tratamiento
17.
BMC Public Health ; 19(1): 1399, 2019 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-31660928

RESUMEN

BACKGROUND: Head injuries account for 650,000 annual deaths worldwide. The cost for treating head injury was estimated at US $200 million annually. This contributes to economic impoverishment in low income countries like Ethiopia. Hence, this study was aimed to assess the cost of Traumatic Head Injury (THI) and associated factors in the University of Gondar Specialized Referral Hospital. METHOD: An institution-based cross-sectional study was conducted from March 01 to May 30, 2017. A total of 387 THI patients were included in the study. An interviewer-administered questionnaire was used for data collection. Direct costs and indirect costs were measured by using the bottom-up approach. Data were entered into Epi-Info version 7 and imported to SPSS version 20 for analysis. Simple and multiple linear regression analysis were done to identify factors associated with cost of THI. RESULTS: The mean cost of THI per patient was 4673.43 Ethiopian Birr (ETB), 95% CI (4523.6-4823.3), and length of hospital stay averaged 1.73, 95% CI (1.63-1.82). Direct non-medical cost, like transportation fee 1896.19 ETB (±762.56 SD) and medical costs 1101.66 ETB (±534.13 SD) were account for 40.57 and 23.58% of total costs respectively. The indirect cost, loss of income by patient and their attendant due to injury, was 1675.58 ETB (+ 459.26 SD). Patients with moderate and severe levels of injury have 635.167 ETB (Standardized coefficient = 0.173, p < 0.001) and 773.621 ETB (Standardized coefficient = 0. 132, p < 0.001) increased costs, respectively, compared to mild level THI patients. Costs for patients ages 31-45 years were 252.504 ETB (Standardized coefficient = - 0.066, p = 0.046) lower than costs for those 5-14 years old. The cost of THI patients increased by 1022.853 ETB for each additional day of hospital length of stay (Standardized coefficient = 0.648, p < 0.001). CONCLUSION: Most expenses of the THI were from direct non-medical cost. Prior health service use, length of stay, level of injury, and age were significant predictors of cost of THI.


Asunto(s)
Costos y Análisis de Costo/estadística & datos numéricos , Traumatismos Craneocerebrales/economía , Hospitales Universitarios/economía , Derivación y Consulta/economía , Adolescente , Adulto , Niño , Preescolar , Traumatismos Craneocerebrales/terapia , Estudios Transversales , Etiopía , Femenino , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
18.
BMC Health Serv Res ; 19(1): 743, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31651305

RESUMEN

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic bacterial organism resistant to first line antibiotics. Acquisition of MRSA is often classified as either healthcare-associated or community-acquired. It has been shown that both healthcare-associated and community-acquired infections contribute to the spread of MRSA within healthcare facilities. The objective of this study was to estimate the incremental inpatient cost and length of stay for individuals colonized or infected with MRSA. Common analytical methods were compared to ensure the quality of the estimate generated. This study was performed at Alberta Ministry of Health (Edmonton, Alberta), with access to clinical MRSA data collected at two Edmonton hospitals, and ministerial administrative data holdings. METHODS: A retrospective cohort study of patients with MRSA was identified using a provincial infection prevention and control database. A coarsened exact matching algorithm, and two regression models (semilogarithmic ordinary least squares model and log linked generalized linear model) were evaluated. A MRSA-free cohort from the same facilities and care units was identified for the matched method; all records were used for the regression models. Records span from January 1, 2011 to December 31, 2015, for individuals 18 or older at discharge. RESULTS: Of the models evaluated, the generalized linear model was found to perform the best. Based on this model, the incremental inpatient costs associated with hospital-acquired cases were the most costly at $31,686 (14,169 - 60,158) and $47,016 (23,125 - 86,332) for colonization and infection, respectively. Community-acquired MRSA cases also represent a significant burden, with incremental inpatient costs of $7397 (2924 - 13,180) and $14,847 (8445 - 23,207) for colonization and infection, respectively. All costs are adjusted to 2016 Canadian dollars. Incremental length of stay followed a similar pattern, where hospital-acquired infections had the longest incremental stays of 35.2 (16.3-69.5) days and community-acquired colonization had the shortest incremental stays of 3.0 (0.6-6.3) days. CONCLUSIONS: MRSA, and in particular, hospital-acquired MRSA, places a significant but preventable cost burden on the Alberta healthcare system. Estimates of cost and length of stay varied by the method of analysis and source of infection, highlighting the importance of selecting the most appropriate method.


Asunto(s)
Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/economía , Anciano , Alberta , Antibacterianos/economía , Antibacterianos/uso terapéutico , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/economía , Infección Hospitalaria/economía , Infección Hospitalaria/prevención & control , Femenino , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Pacientes Internos/estadística & datos numéricos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Meticilina/economía , Meticilina/uso terapéutico , Persona de Mediana Edad , Estudios Retrospectivos
19.
Nutr. hosp ; 36(5): 1001-010, sept.-oct. 2019. tab
Artículo en Inglés | IBECS | ID: ibc-184619

RESUMEN

Background: nutritional support (NS) is a core element in the treatment of underweight patients with anorexia nervosa (AN). Objective: to analyze the adherence of NS prescriptions to clinical practice guidelines (CPGs) for AN patients and to compare the effectiveness, safety, and cost of NS according to adherence. Methods: this retrospective observational study included AN patients admitted to an Eating Disorders Unit between January 2006 and December 2009 and followed until December 2014. NS prescriptions were compared with guidelines published by the American Psychiatric Association (APA), the National Institute for Clinical Excellence (NICE), and the Spanish Ministry of Health and Consumption (SMHC). Adherence was defined as percentage of hospitalizations that followed all recommendations. Results: adherence to APA and NICE/SMHC was observed in 10.2% and 73.4%, respectively, of the total of 177 hospitalizations. Body weight and body mass index were higher at admission in the NICE/SMHC adherence versus non-adherence group (p < 0.001). Weight gain rate during hospitalization was higher (p = 0.009) in "APA adherence" (135.5 g/day) versus "non-adherence" (92.1 g/day) group. Hospital stay was significantly shorter (p = 0.025) in "NICE/SMHC adherence" (39.5 days) versus "non-adherence" group (50.0 days). NICE/SMHC adherence was associated with lower costs (p = 0.006). Conclusions: NS prescriptions for anorexic patients more frequently followed NICE/SMHC than APA recommendations. Over the short-term, APA adherence was associated with improved weight gain. Patients adhering to NICE/SMHC recommendations had shorter hospital stay and reduced costs, likely due to their more favorable nutritional status at admission


Introducción: el soporte nutricional (SN) es un elemento clave en el tratamiento de la anorexia nerviosa (AN). Objetivo: analizar la adecuación de las prescripciones de SN en pacientes con AN a las guías de práctica clínica (GPC) y comparar la efectividad, seguridad y coste según la adecuación. Métodos: estudio observacional retrospectivo en pacientes con AN ingresados en una Unidad de Trastornos de Conducta Alimentaria entre enero de 2006 y diciembre de 2009. Se hizo seguimiento hasta diciembre de 2014. Se compararon las prescripciones de SN con las GPC publicadas por la Asociación Americana de Psiquiatría (APA), el Instituto Nacional de Excelencia Clínica (NICE) y el Ministerio Español de Sanidad y Consumo (MSC). Se definió adecuación como porcentaje de ingresos que cumplieron todas las recomendaciones. Resultados: el grado de adecuación a APA y NICE/MSC fue del 10,2% y 73,4%, respectivamente. El peso corporal y el índice de masa corporal al ingreso fueron mayores en el grupo "sí-adecuación" al NICE/MSC versus "no-adecuación" (p < 0,001). La tasa de ganancia ponderal fue superior (p = 0,009) en el grupo "sí-adecuación" a APA (135.5 g/día) versus "no-adecuación" (92,1 g/día). La estancia hospitalaria fue menor (p = 0,025) en "sí-adecuación" al NICE/MSC (39,5 días) versus "no-adecuación" (50,0 días). La adecuación al NICE/MSC fue asociada con menores costes (p = 0,006). Conclusiones: las prescripciones de SN se ajustaron en mayor grado al NICE/MSC que a la APA. La adecuación a APA parece relacionarse con mayor tasa de ganancia ponderal. Los pacientes que se adecuaron al NICE/MSC presentaron menores estancias hospitalarias y costes, probablemente relacionado con su estado nutricional más favorable al ingreso


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto/normas , Apoyo Nutricional , Anorexia Nerviosa/terapia , Resultado del Tratamiento , Cumplimiento de la Medicación , Anorexia Nerviosa/economía , Estudios Retrospectivos , Peso Corporal , Índice de Masa Corporal , Estado Nutricional , Tiempo de Internación/economía
20.
BMC Health Serv Res ; 19(1): 671, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533714

RESUMEN

BACKGROUND: Stroke remains a major global health problem. In China, stroke was the leading cause of death and imposed a large impact on the healthcare system. This study aimed to examine the hospitalization costs by five stroke types and the associated factors for inpatient costs of stroke in Guangzhou City, Southern China. METHODS: This was a prevalence-based, cross-sectional study. Data were obtained from urban health insurance claims database of Guangzhou city. Samples including all the reimbursement claims submitted for inpatient care with the primary diagnosis of stroke from 2006 to 2013 were identified using the International Classification of Diseases codes. Descriptive analysis and multivariate regression analysis based on the Extended Estimating Equations model were performed. RESULTS: A total of 114,872 hospitalizations for five stroke types were identified. The average age was 71.7 years old, 54.2% were male and 60.1% received medical treatment in the tertiary hospitals, and 92.3% were covered by the urban employee-based medical insurance. The average length of stay was 26.7 days. Among all the hospitalizations (average cost: Chinese Yuan (CNY) 20,203.1 = $3212.1), the average costs of ischaemic stroke (IS), subarachnoid haemorrhage (SAH), intracerebral haemorrhage (ICH), transient ischaemic attack (TIA), and other strokes were CNY 17,730.5, CNY 62,494.2, CNY 38,757.6, CNY 10,365.3 and CNY 18,920.6, respectively. Medication costs accounted for 42.9, 43.0 and 40.4% of the total inpatient costs among patients with IS, ICH and TIA, respectively, whereas for patients with SAH, the biggest proportion of total inpatient costs was from non-medication treatment costs (57.6%). Factors significantly associated with costs were stroke types, insurance types, age, comorbidities, severity of disease, length of stay and hospital levels. SAH was linked with the highest inpatient costs, followed by ICH, IS, other strokes and TIA. CONCLUSIONS: The costs of hospitalization for stroke were high and differed substantially by types of stroke. These findings could provide economic evidence for evaluating the cost-effectiveness of interventions for the treatment of different stroke types as well as useful information for healthcare policy in China.


Asunto(s)
Hospitalización/economía , Accidente Cerebrovascular/economía , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/economía , Isquemia Encefálica/terapia , China , Comorbilidad , Estudios Transversales , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Pacientes Internos , Seguro de Salud/estadística & datos numéricos , Ataque Isquémico Transitorio/economía , Ataque Isquémico Transitorio/terapia , Tiempo de Internación/economía , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/terapia , Centros de Atención Terciaria/economía , Salud Urbana/economía , Adulto Joven
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