Costs of fracture-related infection: the impact on direct hospital costs and healthcare utilisation.

PURPOSE: Fracture-Related Infection (FRI) is associated with high medical costs and prolonged healthcare utilization. However, limited data is available on the financial impact. The purpose of this study was to investigate the impact of FRI on direct hospital costs and healthcare utilization. METHODS: This was a retrospective cohort study in a level-1 trauma centre in the Netherlands. Patients ≥ 18 years, after open reduction and internal fixation of a long bone fracture between January 1st 2016 and November 1st 2021, were included. Exclusion criteria were Injury Severity Score (ISS) ≥ 16, indefinable data on costs or incomplete follow-up. Hospital costs related to fracture treatment were individually calculated based on procedure codes raised with a fixed percentage of overhead expenses, in line with hospital billing policies. RESULTS: In total, 246 patients were included with a median follow-up of 1 year (IQR 0.6-1.8). A total of 45 patients developed FRI, of whom 15 patients had an FRI recurrence. Compared to non-FRI patients, median hospital costs from an FRI patient without and with recurrence, were respectively three (3.1) and seven (7.6) times higher. Compared to non-FRI patients, increased costs in patients with FRI or recurrent FRI are due to respectively a fivefold or even tenfold prolonged length-of-stay, two or seven additional infection-related surgeries, and 21 or 55 days of intravenous antibiotic treatment. CONCLUSION: Direct healthcare costs of patients with single occurrence of FRI after long bone fracture treatment are three times higher compared to non-FRI patients. In case of FRI-recurrence, the differences in costs might even increase to sevenfold. To put this in perspective, cost of severely injured trauma patients were recently established at approximately 25.000 euros. Compared to non-FRI patients, increased costs in patients with FRI or recurrent FRI are due to respectively a fivefold or even tenfold prolonged length-of-stay, two or seven additional infection-related surgeries and 21 or 55 days of intravenous antibiotic treatment. Not only from patient perspective but also from a financial aspect, it is important to focus on prevention of (recurrent) FRI.

Hospital Outcomes in Patients Who Developed Acute Respiratory Distress Syndrome After Community-Acquired Pneumonia.

Purpose: To identify risk factors for and outcomes in acute respiratory distress syndrome (ARDS) in patients hospitalized with community-acquired pneumonia (CAP). Methods: This is a retrospective study using the Premier Healthcare Database between 2016 and 2020. Patients diagnosed with pneumonia, requiring mechanical ventilation (MV), antimicrobial therapy, and hospital admission ≥2 days were included. Multivariable regression models were used for outcomes including in-hospital mortality, hospital length of stay (LOS), intensive care unit (ICU) LOS, and days on MV. Results: 1924 (2.7%) of 72 107 patients with CAP developed ARDS. ARDS was associated with higher mortality (33.7% vs 18.9%; adjusted odds ratio 2.4; 95% confidence interval [CI] 2.16-2.66), longer hospital LOS (13 vs 9 days; adjusted incidence risk ratio (aIRR) 1.24; 95% CI 1.20-1.27), ICU LOS (9 vs 5 days; aIRR 1.51; 95% CI 1.46-1.56), more MV days (8 vs 5; aIRR 1.54; 95% CI 1.48-1.59), and increased hospitalization cost ($46 459 vs $29 441; aIRR 1.50; 95% CI 1.45-1.55). Conclusion: In CAP, ARDS was associated with worse in-patient outcomes in terms of mortality, LOS, and hospitalization cost. Future studies are needed to explore outcomes in patients with CAP with ARDS and explore risk factors for development of ARDS after CAP.

Hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia.

BACKGROUND: Since 2005, the healthcare system in Ethiopia has implemented policies to promote the provision of free maternal healthcare services. The primary goal of these policies is to enhance the accessibility of maternity care for women from various socioeconomic backgrounds. Additionally, the aim is to increase the utilization of maternity services, such as institutional deliveries, by removing financial obstacles that pregnant women may face. Even though maternity services are free of charge. The hidden cost has unquestionably been a key obstacle in seeking and utilizing health care services. Significant payments due to delivery services could create a heavy economic burden on households. OBJECTIVES: To determine the hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia 2023. METHODS: A facility-based cross-sectional study was conducted on 411 postpartum women in Gamo Zone Public Health Hospitals from December 1, 2022, to January 30, 2023. The systematic sampling technique was applied to reach study units. Data was collected using the Kobo Toolbox Data Collection Tool and exported to SPSS statistical software version 27 for analysis. Simple linear regression and multiple linear regression were done to see the association of variables. The significance level was declared at a P-value < 0.05 in the final model. RESULT: The median hidden cost of hospital-based delivery was 1142 Ethiopian birr (ETB), with a range (Q) of 2262 (504-2766) ETB. Monthly income of the family (ß = 0.019), obstetrics complications (ß = 0.033), distance from the health facility (ß = 0.003), and mode of delivery (ß = 0.072), were positively associated with the hidden cost of hospital-based delivery. While, rural residence (ß = -0.041) was negatively associated with the outcome variable. CONCLUSION: This study showed the hidden cost of hospital based delivery was relatively high. Residence, monthly income of the family, obstetric complications, mode of delivery, and distance from the health facility were statistically significant. It is important to take these factors into account when designing health intervention programs and hospitals should prioritize the availability of essential drugs and medical supplies within their facilities to address direct medical costs in hospitals.

Show me the money! Associations between tree canopy and hospital costs in cities for cardiovascular disease events in a longitudinal cohort study of 110,134 participants.

Health benefits from urban greening are assumed to translate into reduced healthcare expenditure, yet few studies have tested this. A total of 110,134 participants in the Sax Institute's 45 and Up Study in the Australian cities of Sydney, Newcastle, or Wollongong were linked with hospital cost data for cardiovascular disease (CVD) events (e.g., acute myocardial infarctions) up to 30 June 2018. Associations between percentages of total green space, tree canopy, and open grass within 1.6 km of participants homes and annual per person measured CVD-related hospital costs were analysed using generalised linear model (GLM) with gamma density as a component of a two-part mixture model, adjusting for confounders. Overall, 26,243 participants experienced a CVD-related hospitalisation. Incidence was lower among participants with 10 % more tree canopy (OR 0.98, 95 %CI 0.96, 0.99), but not with higher total green space or open grass percentages. Total costs of hospitalisations per year were lower with 10 % more tree canopy (means ratio 0.96, 95 %CI 0.95, 0.98), but also higher with 10 % more open grass (means ratio 1.04, 95 %CI 1.02, 1.06). It was estimated that raising tree canopy cover to 30 % or more for individuals with currently less than 10 % could lead to a within-sample annual saving per person of AU$ 193 overall and AU$ 569 for those who experienced one or more CVD-related hospital admissions. This projects to an estimated annual health sector cost reduction of AU$ 19.3 million per 100,000 individuals for whom local tree canopy cover is increased from less than 10 % to 30 % or higher. In conclusion, this longitudinal study is among the first to analyse measured healthcare cost data in relation to urban green space in general, and with differentiation between major types of greenery relevant to urban planning policies in cities around the world. In sum, this study advances an increasingly important and international focus of research by reporting on the lower burden of CVD and fewer associated hospitalisations stemming from upstream investments that protect and restore urban tree canopy, which not only translates into substantial reduced costs for the health sector, but also helps to create regenerative cities and flourishing communities.

Outcomes and Costs in Patients with Immune Thrombotic Thrombocytopenic Purpura Receiving Front-Line Versus Delayed Caplacizumab: A US Hospital Database Study.

European real-world data indicate that front-line treatment with caplacizumab is associated with improved clinical outcomes compared with delayed caplacizumab treatment. The objective of the study was to describe the characteristics, treatment patterns, and outcomes in hospitalized patients with an immune-mediated thrombotic thrombocytopenic purpura (iTTP) episode treated with front-line versus delayed caplacizumab in the US. This retrospective cohort analysis of a US hospital database included adult patients (≥18 years) with an acute iTTP episode (a diagnosis of thrombotic microangiopathy and ≥1 therapeutic plasma exchange [TPE] procedure) from January 21, 2019, to February 28, 2021. Unadjusted baseline characteristics, treatment patterns, healthcare resource utilization, and costs were compared between patients who received front-line versus delayed (<2 vs ≥2 days after TPE initiation) caplacizumab treatment. Out of 39 patients, 16 (41.0%) received front-line and 23 (59.0%) received delayed treatment with caplacizumab. Baseline characteristics and symptoms were similar between the two groups. Patients who received front-line caplacizumab treatment had significantly fewer TPE administrations (median: 5.0 vs 12.0); and a significantly shorter hospital stay (median: 9.0 days vs 16.0 days) than patients receiving delayed caplacizumab therapy. Both of these were significantly lower in comparison of means (t-test P < .01). Median inpatient costs (inclusive of caplacizumab costs) were 54% higher in the delayed treated patients than in the front-line treated patients (median: $112 711 vs $73 318). TPE-specific cost was lower in the front-line treated cohort (median: $6 989 vs $10 917). In conclusion, front-line treatment with caplacizumab had shorter hospitalizations, lower healthcare resource utilization, and lower costs than delayed caplacizumab treatment after TPE therapy.

Service Utilization Patterns and Direct Medical Costs of Hospitalization in Patients With Renal Failure Before and After Initiating Home Peritoneal Dialysis.

OBJECTIVES: This study aimed to determine the hospital service utilization patterns and direct healthcare hospital costs before and during peritoneal dialysis (PD) at home. METHODS: A retrospective cohort study of patients with kidney failure (KF) was conducted at a Mexican Social Security Institute hospital for the year 2014. Cost categories included inpatient emergency room stays, inpatient services at internal medicine or surgery, and hospital PD. The study groups were (1) patients with KF before initiating home PD, (2) patients with less than 1 year of home PD (incident), and (3) patients with more than 1 year of home PD (prevalent). Costs were actualized to international dollars (Int$) 2023. RESULTS: We found that 53% of patients with KF used home PD services, 42% had not received any type of PD, and 5% had hospital dialysis while waiting for home PD. The estimated costs adjusting for age and sex were Int$5339 (95% CI 4680-9746) for patients without home PD, Int$17 556 (95% CI 15 314-19 789) for incident patients, and Int$7872 (95% CI 5994-9749) for prevalent patients; with significantly different averages for the 3 groups (P < .001). CONCLUSIONS: Although the use of services and cost is highest at the time of initiating PD, over time, using home PD leads to a significant reduction in use of hospital services, which translates into institutional cost savings. Our findings, especially considering the high rates of KF in Mexico, suggest a pressing need for interventions that can reduce healthcare costs at the beginning of renal replacement therapy.

The hospital costs of complications following major abdominal surgery: a retrospective cohort study.

OBJECTIVE: Postoperative complications following major abdominal surgeries is a pressing concern for hospital care and health economics. Given the paucity of available cost data for patients undergoing major abdominal surgery, we evaluated the number and the severity of postoperative complications following major abdominal surgeries and calculated the costs borne by a single centre university hospital within an Australian healthcare system. RESULTS: The overall incidence of postoperative complications for 1790 adult patients undergoing major abdominal surgeries (i.e., colonic, liver, small bowel resections and Whipple procedures) between January 2013 and June 2018 was 75.2%. Of these complications, 56.9% were minor (Clavien-Dindo (CVD) Grades I or II) and 15.5% were major (CVD Grades III or IV). As the severity of complications increased, median adjusted total hospital costs rose significantly, with a median (interquartile range [IQR]) of AUD 29,519.70 (IQR 21,828.80-40,527.90) in CVD Grade II versus AUD 50,702.40 (IQR 35,866.00-69,296.80) in CVD Grade III (p <.001). Further, developing one, two or three complications resulted in significantly increased hospital costs by AUD 2618.30 (13.3% increase), AUD 3605.50 (16.2% increase) and AUD 3173.00 (12.3% increase) (p <.0001), respectively, with an exponential spike in costs incurred by patients who developed more than three complications (AUD 23,719.70; 81.7% increase; p < 0001).

What Are the Differences in Hospital Cost Associated With the Use of Cemented Versus Cementless Femoral Stems in Hemiarthroplasty and Total Hip Arthroplasty for the Treatment of Femoral Neck Fracture?

BACKGROUND: The purpose of this study was to determine if there is a difference in hospital costs associated with the use of cemented versus cementless femoral stems in hemiarthroplasty (HA) and total hip arthroplasty (THA) for the treatment of femoral neck fracture (FNF). METHODS: This retrospective cohort study utilizes the 2019 Medicare Provider Analysis and Review Limited Data Set. Patients undergoing arthroplasty for the treatment of FNF were identified. Patients were grouped by cemented or cementless femoral stem fixation. There were 16,148 patients who underwent arthroplasty for FNF available: 4,913 THAs (3,705 patients who had cementless femoral stems and 1,208 patients who had cemented femoral stems) and 11,235 HAs (6,099 patients who had cementless femoral stems and 5,136 who had cemented femoral stems). Index hospital costs were estimated by multiplying total charges by cost-to-charge ratios. Costs were analyzed using univariable and multivariable generalized linear models. RESULTS: Cemented femoral stem THA generated 1.080 times (95% confidence interval, 1.06 to 1.10; P < .001), or 8.0%, greater index hospital costs than cementless femoral stem THA, and cemented femoral stem HA generated 1.042 times (95% confidence interval, 1.03 to 1.05; P < .001), or 4.2%, greater index hospital costs than cementless femoral stem HA. CONCLUSIONS: Cemented femoral stems for FNF treated with either THA or HA are associated with only a small portion of increased cost compared to cementless femoral stems. Providers may choose the method of arthroplasty stem fixation for the treatment of FNF based on what they deem most appropriate for the specific patient.

Predictive value of frailty assessment tools in patients undergoing surgery for gastrointestinal cancer: An observational cohort study.

BACKGROUND: Few studies have simultaneously compared the predictive value of various frailty assessment tools for outcome measures in patients undergoing gastrointestinal cancer surgery. Therefore, it is difficult to determine which assessment tool is most relevant to the prognosis of this population. AIM: To investigate the predictive value of three frailty assessment tools for patient prognosis in patients undergoing gastrointestinal cancer surgery. METHODS: This single-centre, observational, prospective cohort study was conducted at the Affiliated Lianyungang Hospital of Xuzhou Medical University from August 2021 to July 2022. A total of 229 patients aged ≥ 18 years who underwent surgery for gastrointestinal cancer were included in this study. We collected baseline data on the participants and administered three scales to assess frailty: The comprehensive geriatric assessment (CGA), Fried phenotype and FRAIL scale. The outcome measures were the postoperative severe complications and increased hospital costs. RESULTS: The prevalence of frailty when assessed with the CGA was 65.9%, 47.6% when assessed with the Fried phenotype, and 34.9% when assessed with the FRAIL scale. Using the CGA as a reference, kappa coefficients were 0.398 for the Fried phenotype and 0.291 for the FRAIL scale (both P < 0.001). Postoperative severe complications and increased hospital costs were observed in 29 (12.7%) and 57 (24.9%) patients, respectively. Multivariate logistic analysis confirmed that the CGA was independently associated with increased hospital costs (odds ratio = 2.298, 95% confidence interval: 1.044-5.057; P = 0.039). None of the frailty assessment tools were associated with postoperative severe complications. CONCLUSION: The CGA was an independent predictor of increased hospital costs in patients undergoing surgery for gastrointestinal cancer.

Delayed discharges at a tertiary rehabilitation centre in Saudi Arabia: contributing factors and cost impact.

There are various challenges in discharging hospitalized patients with disabilities. Discharge process for individuals with disabilities is multifactorial and can vary from one health system to another. The current study is aimed to explore the factors contributing to delayed discharges and to determine the number of exceeded bed days and subsequent cost impact at a government rehabilitation facility in Saudi Arabia. This retrospective cohort study was conducted at the Rehabilitation Hospital of King Fahad Medical City, Riyadh. All the 2285 discharges from inpatient rehabilitation from August 2011 to March 2017 were included in the study. Patients with delayed discharge were identified. Information about the diagnosis and reasons for delayed discharge was obtained from the rehabilitation hospital bed utilization data. The cost impact was calculated based on the number of days patients stayed beyond the estimated length of stay for each diagnosis. Of the 2285 discharges, 531 (23.3%) were delayed. The most common clinical conditions of patients with delayed discharge included spinal cord injury (n = 168, 31.6%) and traumatic brain injury (n = 145, 27.3%). The factors that led to delayed discharges were medical complications (n = 352, 66.7%), organizational factors (n = 83, 15.7%), family factors (n = 46, 8.7%), and external factors (n = 46, 8.7%). A total of 21 817 hospital bed days were exceeded, with an approximate estimated cost of 80 million Saudi Arabian Riyals. Early rehabilitation and enhancement of the discharge process may significantly decrease delayed discharge rates. Strategies need to be adapted to identify patients at risk of delayed discharge based on the factors highlighted in this study. Development of long-term care capacity, community services, and optimizing family and social support can promote timely discharge.

Propuesta de modelo para el cálculo de desperdicio asociado al procesamiento de instrumental quirúrgico consignado / Model proposal for calculating waste associated with processing consigned surgical instruments / Proposta de modelo para cálculo de desperdício associado ao processamento de instrumentais cirúrgicos consignados

Objetivo: evaluar el desperdicio generado por el procesamiento de instrumental quirúrgico consignado en cirugías ortopédicas electivas y proponer un modelo para el cálculo del desperdicio asociado al procesamiento de instrumental quirúrgico consignado. Método: estudio de caso, cuantitativo, descriptivo-exploratorio, realizado en un hospital universitario grande, en dos fases: (1) retrospectiva, mediante la consulta de registros administrativos de cirugías ortopédicas electivas canceladas, con previsión de uso de materiales consignados, para identificar las subespecialidades con mayor demanda; y (2) prospectiva, por medio de observaciones directas, no participantes, del procesamiento de instrumental quirúrgico consignado preparado para las cirugías identificadas, y de la propuesta de un modelo para el cálculo del desperdicio asociado al procesamiento de estos materiales. Resultados: se identificaron las cirugías de artroplastia de cadera, artrodesis de columna y artroplastia de rodilla con mayor demanda, resultando en 854 cajas de instrumental quirúrgico consignado procesado y sin uso. El desperdicio del procesamiento se estimó en R$ 34.340,18 (US$ 6,359.30). Conclusión: la ecuación propuesta permitió calcular el desperdicio relacionado con la producción y la no utilización de cajas de instrumental quirúrgico consignado para procedimientos ortopédicos, y puede equipar a los enfermeros para la planificación basada en datos institucionales, asistenciales y financieros, con el objetivo de aprovechar mejor los recursos por medio de la identificación del desperdicio.

Objective: to evaluate the waste generated from processing surgical instruments consigned in elective orthopedic surgeries and propose a model for calculating waste associated with processing consigned surgical instruments. Method: a quantitative, descriptive-exploratory case study carried out in a large university hospital in two phases: (1) retrospective by consulting administrative records of canceled elective orthopedic surgeries, with provision for the use of consigned materials for identification of the sub-specializations with the greatest demand; and (2) prospective through direct, non-participant observations of processing consigned surgical instruments prepared for the identified surgeries and proposition of a model for calculating waste associated with processing these materials. Results: hip arthroplasty, spine arthrodesis and knee arthroplasty surgeries were identified as presenting the greatest demand, resulting in 854 boxes of consigned surgical instruments processed and unused. Processing waste was estimated at R$34,340.18 (US$6,359.30). Conclusion: the proposed equation made it possible to calculate the waste related to the production and non-use of boxes of surgical instruments consigned for orthopedic procedures and can equip nurses for planning based on institutional, care and financial data, aiming to make better use of resources through waste identification.

Objetivo: avaliar o desperdício gerado pelo processamento de instrumentais cirúrgicos consignados em cirurgias ortopédicas eletivas e propor um modelo de cálculo de desperdício associado ao processamento de instrumentais cirúrgicos consignados. Método: estudo quantitativo, descritivo-exploratório, do tipo estudo de caso, realizado em hospital universitário de grande porte, em duas fases: (1) retrospectiva pela consulta aos registros administrativos de cirurgias ortopédicas eletivas canceladas, com previsão de uso de materiais consignados para identificação das subespecialidades com maior demanda e (2) prospectiva por meio de observações diretas, não participantes, do processamento de instrumentais cirúrgicos consignados preparados para as cirurgias identificadas e proposição de modelo de cálculo de desperdício associado ao processamento desses materiais. Resultados: foram identificadas as cirurgias de artroplastia de quadril, artrodese de coluna e artroplastia de joelho, com maior demanda, resultando em 854 caixas de instrumentais cirúrgicos consignados processados e não utilizados. O desperdício do processamento foi estimado em R$ 34.340,18 (US$ 6,359.30). Conclusão: a equação proposta permitiu calcular o desperdício relacionado à produção e não utilização de caixas de instrumentais cirúrgicos consignados para procedimentos ortopédicos e pode instrumentalizar os enfermeiros para o planejamento pautado em dados institucionais, assistenciais e financeiros, visando ao melhor aproveitamento dos recursos através da identificação do desperdício.

Gestão de custos: microcusteio por absorção em um pronto-socorro durante a pandemia de COVID-19 / Cost management: microcosting by absorption in an emergency room during the COVID-19 pandemic / Gestión de costos: microcosteo por absorción en un servicio de urgencias durante la pandemia de COVID-19

Objetivo: analisar os custos operacionais de um pronto-socorro relacionados ao atendimento de pacientes COVID-19 em 2020 e 2021. Método: estudo transversal, descritivo de abordagem quantitativa. A mensuração dos custos utilizou-se da perspectiva do gestor hospitalar, por meio de microcusteio por absorção. Custos diretos, indiretos e variáveis, foram avaliados de cima para baixo (top-down). Resultados: o perfil predominante foi de homens, com idades entre 61 e 70 anos, casados, brancos e moradores de Londrina (Paraná, Brasil). O tempo médio de internação para pacientes graves foi 12,20 dias e, para os demais, 8,38 dias. O desfecho principal foi a alta hospitalar. Os custos operacionais em 2020 foram de R$28.461.152,87, já em 2021 os valores encontrados foram R$43.749.324,61. O custo médio do paciente-dia foi de R$2.614,45 em 2020 para R$3.351,93 em 2021. Conclusão: verificou-se aumento dos custos no período estudado. Conhecer os custos operacionais do pronto-socorro, possibilita o planejamento financeiro institucional contribuindo para qualificar a tomada de decisões gerenciais.

Objective: to analyze the operating costs of an emergency room related to the care of COVID-19 patients in 2020 and 2021. Method: cross-sectional, descriptive study with a quantitative approach. The measurement of costs was used from the perspective of the hospital manager, through absorption micro-costing. Direct, indirect and variable costs were evaluated from top to bottom (top-down). Results: the predominant profile was men, aged between 61 and 70 years, married, white and living in Londrina (Paraná, Brazil). The mean length of stay for critically ill patients was 12.20 days and for the others, 8.38 days. The main outcome was hospital discharge. Operating costs in 2020 were BRL 28,461,152.87, while in 2021 the values found were BRL 43,749,324.61. The average patient-day cost went from R$2,614.45 in 2020 to R$3,351.93 in 2021. Conclusion: costs increased in the study period. Be aware of the operational costs of emergency room, enablement or institutional financial planning, contributing to qualify management decision-making.

Objetivo: analizar los costos operativos de un servicio de urgencias relacionado con la atención de pacientes con COVID-19 en los años 2020 y 2021. Método: estudio descriptivo transversal con enfoque cuantitativo. Se utilizó la medición de costos desde la perspectiva del gestor del hospital, a través del microcosteo por absorción. Los costos directos, indirectos y variables se evaluaron de arriba hacia abajo (top-down). Resultados: el perfil predominante fue el de hombres, con edad entre 61 y 70 años, casados, blancos y residentes en Londrina (Paraná, Brasil). La estancia media de internación de los pacientes críticos fue de 12,20 días y, de los demás, de 8,38 días. El resultado principal fue el alta hospitalaria. Los costos operacionales en 2020 fueron de R$ 28.461.152,87, mientras que en 2021 los valores encontrados fueron de R$ 43.749.324,61. Los costos medios del paciente/día aumentaron de R$2.614,45 en 2020 a R$3.351,93 en 2021. Conclusión: se observó un aumento de los costos en el periodo estudiado. Conocer los costos operativos de un servicio de urgencias posibilita la planificación financiera institucional, contribuyendo a calificar la toma de decisiones gerenciales.

Retrospective study of sacral neuromodulator implantations in a French hospital center: Lifespan and hospital costs assessment.

PURPOSE: Sacral nerve neuromodulation (SNM) is a safe and effective therapy for the management of fecal and/or urinary incontinence. The generators InterStim™ and InterStim™ II (Medtronic™) are non-rechargeable active implantable medical devices with a limited lifespan. The aims of this study were to assess the generators' median lifespan for all indications and the long-term hospital costs of the therapy. METHODS: This was a retrospective monocentric study that included 215 patients aged over 18 years who were treated by SNM for fecal incontinence and/or urinary incontinence. Lifespan was considered as the amount of time between definitive implantation and observed battery depletion by the surgeon and was assessed by the Kaplan-Meier method. Costs were assessed according to the activity-based pricing of the French public health care system. RESULTS: The median observed lifetime of stimulators implanted in our center was 7.29 years and 5.9 years for InterStim™ and InterStim™ II, respectively. The difference observed between the two generations was statistically significant. The modelling of primary implantation and renewal costs allowed us to observe that the decrease in the lifetime of Interstim™ II is associated with an increase in hospital costs over time. The retrospective study design is one limitation and we did not take into consideration stimulation's settings. CONCLUSIONS: The InterStim™ II lifespan is shorter than the first-generation device. This is associated with an increase of the long-term hospital costs. Additional information about the new neuromodulator will be required to choose the most appropriate IPG for the patient while optimizing the costs.

The role of payment and financing in achieving health equity.

OBJECTIVE: The aim was to identify healthcare payment and financing reforms to promote health equity and ways that the Agency for Healthcare Research and Quality (AHRQ) may promote those reforms. DATA SOURCES AND STUDY SETTING: AHRQ convened a payment and financing workgroup-the authors of this paper-as part of its Health Equity Summit held in July 2022. This workgroup drew from its collective experience with healthcare payment and financing reform, as well as feedback from participants in a session at the Health Equity Summit, to identify the evidence base and promising paths for reforms to promote health equity. STUDY DESIGN: The payment and financing workgroup developed an outline of reforms to promote health equity, presented the outline to participants in the payment and financing session of the July 2022 AHRQ Health Equity Summit, and integrated feedback from the participants. DATA COLLECTION/EXTRACTION METHODS: This paper did not require novel data collection; the authors collected the data from the existing evidence base. PRINCIPAL FINDINGS: The paper outlines root causes of health inequity and corresponding potential reforms in five domains: (1) the differential distribution of resources between healthcare providers serving different communities, (2) scarcity of financing for populations most in need, (3) lack of integration/accountability, (4) patient cost barriers to care, and (5) bias in provider behavior and diagnostic tools. CONCLUSIONS: Additional research is necessary to determine whether the proposed reforms are effective in promoting health equity.

Analysis of hospital and payer costs of care: aggressive warming versus routine warming in abdominal major surgery.

Background: Hypothermia is common and active warming is recommended in major surgery. The potential effect on hospitals and payer costs of aggressive warming to a core temperature target of 37°C is poorly understood. Methods: In this sub-analysis of the PROTECT trial (clinicaltrials.gov, NCT03111875), we included patients who underwent radical procedures of colorectal cancer and were randomly assigned to aggressive warming or routine warming. Perioperative outcomes, operation room (OR) scheduling process, internal cost accounting data from the China Statistical yearbook (2022), and price lists of medical and health institutions in Beijing were examined. A discrete event simulation (DES) model was established to compare OR efficiency using aggressive warming or routine warming in 3 months. We report base-case net costs and sensitivity analyses of intraoperative aggressive warming compared with routine warming. Costs were calculated in 2022 using US dollars (USD). Results: Data from 309 patients were analyzed. The aggressive warming group comprised 161 patients and the routine warming group comprised 148 patients. Compared to routine warming, there were no differences in the incidence of postoperative complications and total hospitalization costs of patients with aggressive warming. The potential benefit of aggressive warming was in the reduced extubation time (7.96 ± 4.33 min vs. 10.33 ± 5.87 min, p < 0.001), lower incidence of prolonged extubation (5.6% vs. 13.9%, p = 0.017), and decreased staff costs. In the DES model, there is no add-on or cancelation of operations performed within 3 months. The net hospital costs related to aggressive warming were higher than those related to routine warming in one operation (138.11 USD vs. 72.34 USD). Aggressive warming will have an economic benefit when the OR staff cost is higher than 2.37 USD/min/person, or the cost of disposable forced-air warming (FAW) is less than 12.88 USD/piece. Conclusion: Despite improving OR efficiency, the economic benefits of aggressive warming are influenced by staff costs and the cost of FAW, which vary from different regions and countries. Clinical trial registration: clinicaltrials.gov, identifier (NCT03111875).

PRIMARY TOTAL HIP ARTHROPLASTIES UNDER BRAZILIAN PUBLIC HEALTH SYSTEM (2012-2021).

Objectives: To describe the regional distribution of hospital admission authorizations (HAA), hospitalization costs (HC), the average length of stay (LOS), and mortality rates (MR) related to primary total hip arthroplasties (THA) funded by the Brazilian Health Unic System (SUS) from 2012 to 2021. Methods: Descriptive cross-sectional study using secondary data of public domain obtained from the Department of Informatics of SUS (DATASUS) database website. Results: A total of 125,463 HAA were released with HC of 552,218,181.04 BRL in the evaluated period. The average LOS was of 6.8 days. MR was 1.62%. Conclusion: The regional distribution of HAA was 65,756 (52%) in the Southeast; 33,837 (27%) in the South; 14,882 (12%) in the Northeast; 9,364 (8%) in Midwest; and 1,624 (1%) in North - in 2020 there was a sharp decrease of the released HAA, probably due to the COVID-19 pandemic. HC was 293,474,673.20 BRL in the Southeast; 144,794,843.11 BRL in the South; 61,751,644.36 BRL in the Northeast; 45,724,353.80 BRL in the Midwest; and 6,472,666.57 BRL in the North. The average LOS was 6.7 in the Southeast; 5.3 in the South; 9.2 in the Northeast; 7.6 in the Midwest; and, 13.6 in the North. MR was as follows: Southeast=1.88%; South=1.07%; Northeast=1.83%; Midwest=1.44%; and North=1.47%. Evidence Level III; Retrospective Comparative Study .

Objetivos: Descrever a distribuição regional das autorizações de internação hospitalar (AIH), custos de internação (CI), tempo médio de permanência (TMP) e taxa de mortalidade (TM) relacionados às artroplastias totais de quadril (ATQ) primárias financiadas pelo Sistema Único de Saúde (SUS) de 2012 a 2021. Métodos: Estudo transversal descritivo utilizando dados secundários de domínio público obtidos no site do banco de dados do Departamento de Informática do SUS (DATASUS). Resultados: Foram liberadas 125.463 AIH com CI de R$ 552.218.181,04 no período avaliado. O TMP foi de 6,8 dias. A TM foi de 1,62%. Conclusões: A distribuição regional de AIH foi de 65.756 (52%) no Sudeste; 33.837 (27%) no Sul; 14.882 (12%) no Nordeste; 9.364 (8%) no Centro-Oeste; e, 1.624 (1%) no Norte - em 2020 houve queda acentuada das AIH liberadas, provavelmente devido à pandemia COVID-19. Os CI foram de R$ 293.474.673,20 no Sudeste; R$ 144.794.843,11 no Sul; R$ 61.751.644,36 no Nordeste; R$ 45.724.353,80 no Centro-Oeste; e R$ 6.472.666,57 no Norte. O TMP foi de 6,7 no Sudeste; 5,3 no Sul; 9,2 no Nordeste; 7,6 no Centro-Oeste; e 13,6 no Norte. A TM foi como se segue: Sudeste=1,88%; Sul=1,07%; Nordeste=1,83%; Centro-Oeste=1,44%; e, Norte=1,47%. Nível de Evidência III; Estudo Retrospectivo Comparativo .

Cost-effectiveness analysis of liver transplantation in biliary atresia according to the severity of end-stage liver disease.

BACKGROUND: Timing for liver transplantation (LT) in biliary atresia (BA) children with end-stage liver disease (ESLD) is associated with all-cause mortality. The cut-off value of pediatric end-stage liver disease (PELD) score for LT consideration varies across institutions. We aimed to determine the cost-effectiveness of LT to prevent death among BA children registered on the waiting list with different severities of ESLD. METHODS: Subjects were BA children aged < 12 years at a transplant center between 2010 and 2021. A decision tree was developed for cost-effectiveness analysis from a hospital perspective to compare all-cause death between patients initially registered with a low PELD score (< 15) and a high PELD score (≥ 15). Each patient's direct medical cost was retrieved from the beginning of registration until 5 years after LT, adjusted with an inflation rate to 2022 Thai Baht (THB). RESULTS: Among 176 children, 138 (78.4%) were initially registered with the high PELD score. The cost and mortality rate of the low PELD score group (THB1,413,424 or USD41,904 per patient and 31.6% mortality) were less than the high PELD score group (THB1,781,180 or USD52,807 per patient and 47.9% mortality), demonstrating the incremental cost-effectiveness ratio (ICER) of THB2,259,717 or USD66,994 per death prevented. The cost of early post-operative admission had the highest effect on the ICER. Considering the break-even analysis, cost among children initially registered at the low PELD score was also less expensive over time. CONCLUSIONS: Registration for LT at PELD score < 15 was more cost-effective to prevent death among BA children with ESLD.

High-value care for critically ill oncohematological patients: what do we know thus far?

The number of patients with cancer requiring intensive care unit admission is increasing around the world. The improvement in the pathophysiological understanding of this group of patients, as well as the increasingly better and more targeted treatment options for their underlying disease, has led to a significant increase in their survival over the past three decades. Within the organizational concepts, it is necessary to know what adds value in the care of critical oncohematological patients. Practices in medicine that do not benefit patients and possibly cause harm are called low-value practices, while high-value practices are defined as high-quality care at relatively low cost. In this article, we discuss ten domains with high-value evidence in the care of cancer patients: (1) intensive care unit admission policies; (2) intensive care unit organization; (3) etiological investigation of hypoxemia; (4) management of acute respiratory failure; (5) management of febrile neutropenia; (6) urgent chemotherapy treatment in critically ill patients; (7) patient and family experience; (8) palliative care; (9) care of intensive care unit staff; and (10) long-term impact of critical disease on the cancer population. The disclosure of such policies is expected to have the potential to change health care standards. We understand that it is a lengthy process, and initiatives such as this paper are one of the first steps in raising awareness and beginning a discussion about high-value care in various health scenarios.

Association of reintubation and hospital costs and its modification by postoperative surveillance: A multicenter retrospective cohort study.

OBJECTIVE: We estimated hospital costs associated with postoperative reintubation and tested the hypothesis that prolonged surveillance in the post-anesthesia care unit (PACU) modifies the hospital costs of reintubation. DESIGN: Retrospective observational research study. SETTING: Two tertiary care academic healthcare networks in the Bronx, New York and Boston, Massachusetts, USA. PATIENTS: 68,125 adult non-cardiac surgical patients undergoing general anesthesia between 2016 and 2021. INTERVENTIONS: The exposure variable was unplanned reintubation within 7 days of surgery. MEASUREMENTS: The primary outcome was direct hospital costs associated with patient care related activities. We used a multivariable generalized linear model based on log-transformed costs data, adjusting for pre- and intraoperative confounders. We matched our data with data from the Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP-NIS). In the key secondary analysis, we examined if prolonged postoperative surveillance, defined as PACU utilization (≥4 h) modifies the association between reintubation and costs of care. MAIN RESULTS: 1759 (2.6%) of patients were re-intubated within 7 days after surgery. Reintubation was associated with higher direct hospital costs (adjusted model estimate 2.05; 95% CI: 2.00-2.10) relative to no reintubation. In the HCUP-NIS matched cohort, the adjusted absolute difference (ADadj) in costs amounted to US$ 18,837 (95% CI: 17,921-19,777). The association was modified by the duration of PACU surveillance (p-for-interaction <0.001). In patients with a shorter PACU length of stay, reintubation occurred later (median of 2 days; IQR 1, 5) versus 1 days (IQR 0, 2; p < .001), and was associated with magnified effects on hospital costs compared to patients who stayed in the PACU longer (ADadj of US$ 23,444, 95% CI: 21,217-25,799 versus ADadj of US$ 17,615, 95% CI: 16,350-18,926; p < .001). CONCLUSION: Postoperative reintubation is associated with 2-fold higher hospital costs. Prolonged surveillance in the recovery room mitigated this effect. The cost-saving effect of longer PACU length of stay was likely driven by earlier reintubation in patients who needed this intervention.

The Cost of Operating: Analysis of Single-Use Instrument Costs for Craniotomies.

Introduction All-cause craniotomies comprise a significant portion of neurosurgical practice as well as hospital costs. While some instruments are reusable with a fixed cost, price variability for similar single-use instruments exists. A better understanding of these cost variations within cranial procedures can better inform operating physicians to be cost-sensitive stewards. Objective In this study, we examine how single-use items contribute to the overall cost of cranial procedures.  Methods A de-identified institutional database containing records of all single-use items from craniotomies between July 1, 2019, and June 30, 2020, was subject to a longitudinal analysis by three independent parties (one senior surgeon, one resident, and one medical student). Four hundred and sixty-nine unique single-use items were identified and classified by function. Similar items were combined, and a range of costs was provided. Three sample cases with sum costs were reviewed for cost division and primary contributors. Results  The category with the highest median cost across all cases was non-specialty implants comprising dural onlays, mesh, aneurysm clips, and plates. The category with the lowest median cost was personal protective equipment. The items with the most cost variability were sterile surgical patties due to the variety of sizes and preset multipacks. The proportion of cost generators varies from craniotomy indication.  Conclusion While institution dependent, awareness of cost generators in cranial cases is important for economic stewardship. For single-use items, costs are highly variable and not insignificant. Surgeons and neurosurgical departments are responsible for allocating single-use items in a responsible and efficient manner.