Trends and Factors Impacting Healthcare Charges and Length of Stay for Cholecystectomies: A New York State Population-based Analysis

Background: Gallbladder disease confers a significant economic toll on the United States healthcare system. This study aims to characterize current trends and features of the cholecystectomy population and identify factors that influence the length of stay and total charges. Methods: Case information was extracted for laparoscopic and open cholecystectomies from 2013-2016 using the New York Statewide Planning and Research Cooperative System (SPARCS) database. Descriptive, comparative, and multivariable linear regression analysis was conducted on 58,141 cases assessing age group, race, gender, admission presentation, surgical technique, insurance status, year of operation and severity of illness by the length of stay and total charges. Results: Of all procedures, 91.6% were laparoscopic, and 79.4% were emergent on admission. Total procedures trended down, while laparoscopic and emergent cases steadily increased (p<0.0001). Total charges increased during the study period, while the length of stay decreased (p<0.0001). Open and emergent procedures were associated with a higher cost and longer inpatient stays (p<0.0001). Open procedures were proportionally more common among elderly, male patients, and in elective cases (p<0.0001). Emergent presentation was more common in females, non-whites, and younger patients (p<0.0001). Regression model showed that male gender, open operation, Black race, and emergent presentation were independent predictors for a longer stay and greater total charges (p<0.0001). Medicare insurance predicted lower total charges but longer length of stay (p<0.0001). Conclusion: Race, insurance, procedure type, and patient presentation influence hospital charges and stays following cholecystectomy. Understanding these trends will allow policymakers and providers to limit the healthcare burden of cholecystectomy

Using structured pathology data to predict hospital-wide mortality at admission

Early prediction of in-hospital mortality can improve patient outcome. Current prediction models for in-hospital mortality focus mainly on specific pathologies. Structured pathology data is hospital-wide readily available and is primarily used for e.g. financing purposes. We aim to build a predictive model at admission using the International Classification of Diseases (ICD) codes as predictors and investigate the effect of the self-evident DNR ("Do Not Resuscitate") diagnosis codes and palliative care codes. We compare the models using ICD-10-CM codes with Risk of Mortality (RoM) and Charlson Comorbidity Index (CCI) as predictors using the Random Forests modeling approach. We use the Present on Admission flag to distinguish which diagnoses are present on admission. The study is performed in a single center (Ghent University Hospital) with the inclusion of 36 368 patients, all discharged in 2017. Our model at admission using ICD-10-CM codes (AUCROC = 0.9477) outperforms the model using RoM (AUCROC = 0.8797 and CCI (AUCROC = 0.7435). We confirmed that DNR and palliative care codes have a strong impact on the model resulting in a decrease of 7% for the ICD model (AUCROC = 0.8791) at admission. We therefore conclude that a model with a sufficient predictive performance can be derived from structured pathology data, and if real-time available, can serve as a prerequisite to develop a practical clinical decision support system for physicians

The Impact of the Second Wave of the COVID-19 Pandemic on Non-COVID Hospital Care in a Tertiary Hospital in Spain

Supplementary Materials: The supplementary information can be accessed and downloaded at: https://www.mdpi.com/article/10.3390/jcm12175507/s1In 2020, Spain ranked fourth among European countries with the highest excess mortality due to COVID-19 disease. This study evaluates the impact of the COVID-19 pandemic on non-COVID patients in a tertiary hospital during the second pandemic wave in Spain (22 June 2020-6 December 2020). Data from Virgen del Rocio University Hospital in Seville during that timeframe were compared with the data from the same period in the preceding two years (2018-2019). Between-group comparisons were performed using the Chi-squared test, Student's t-test, or Mann-Whitney U tests, as appropriate. A total of 63,137 non-COVID patients were included in this study. During the second pandemic wave, a 19% decrease was observed in the annual number of non-COVID admissions overall (18,260 vs. 22,439, p < 0.001), but a 10% increase in the proportion of emergency admissions (60.6% vs. 54.93%, p < 0.001), a higher severity level of patients (1.79 vs. 1.72, p < 0.001), a longer in-hospital stay (7.02 vs. 6.74 days, p < 0.001), a 26% increase in non-COVID mortality (4.9% vs. 3.9%, p < 0.001), and a 50% increase in global mortality (5.9 vs. 3.9, p < 0.001) were also observed. In terms of both medical and surgical diagnoses, a significant reduction in the number of admissions and an increase in in-hospital mortality were observed. These results demonstrate the significant impact of the pandemic on hospital care, similar to what was previously observed during the initial wave in the same hospital. Our findings emphasize the need to include non-COVID patients when assessing the broad impact of the pandemic on healthcare, beyond its direct effects on COVID-19 patients.“Programa Beatriz Galindo” Ministry of Universities, the Government of SpainUniversity of Seville, Spai

The Impact of Daylight and Window Views on Health and Recovery: A Quash-Experimental Study of Patients with Heart Disease in a Cardiac ICU

Heart disease is the leading cause of death in the United States. Being diagnosed with heart disease can lead to depression, anxiety, sleep disruption, and delirium symptoms, which can cause prolonged hospital stays among patients. Evidence suggests that the presence of daylight and window views can influence these symptoms positively. However, no studies to date have differentiated the impact of daylight from window views on heart disease patients or addressed how window use can impact patient recovery in cardiac intensive care units (CICUs). This IRB-approved study employed a retrospective and prospective quasiexperimental approach to investigate CICU rooms of the same size with daylight and views (patient bed parallel to the full-height, south-facing window), rooms with daylight and no views (patient bed perpendicular to the window), and windowless rooms. The first phase of the study entailed analyzing retrospective data between 2015 to 2019. In the second phase, 21 CICU patients were recruited through purposive sampling. Data regarding depression/anxiety, sleep quality, and lighting were collected prospectively through questionnaires, actigraphy, and data loggers. Linear regression models were developed for each outcome of interest to control for confounding variables. Based on the results, rooms with windows supported patient recovery in general; however, rooms with daylight and views significantly reduced patients’ typical CICU LOS compared to the windowless rooms. While room type was not significantly associated with mortality and delirium, patients receiving palliative care and opioid medications in rooms with daylight and views had significantly lower odds of mortality and delirium than other iii patients. In phase two, the availability of daylight in windowed rooms significantly improved CICU patients’ perceived sleep quality. Patients in windowed rooms also reported a lower average anxiety/depression score; however, the difference was not statistically significant. Moreover, higher light levels in rooms significantly reduced analgesic intake and improved actigraphic sleep efficiency among patients. This study helps architects with design decisions regarding CICU room layouts by indicating the bed orientation that best supports patient recovery. Identifying the type of patients who benefit most from direct access to daylight and views can also help CICU stakeholders with patient assignments and hospital training programs

GKV-Routinedatenanalysen zur Unterstützung des Market Access von Arzneimitteln, Impfstoffen und Medizintechnik - Empirische Beispiele zur Machbarkeit

Im Verlauf des Market Access Prozesses sehen sich die Hersteller von Arzneimitteln, Impfstoffen und Medizintechnik mit einer Vielzahl von Fragestellungen konfrontiert. Diese umfassen bspw. solche über ungedeckte medizinische Bedarfe, zur Epidemiologie von Erkrankungen und der Versorgungssituation von Patienten. Sie betreffen Krankheitskosten, die Effektivität und Sicherheit von Wirkstoffen bzw. Medizintechnik in der realen Versorgungssituation und die Positionierung der eigenen Produkte gegenüber Wettbewerbern. Auf Abrechnungsdaten der Gesetzlichen Krankenversicherung (sog. GKV-Routinedaten) basierende Studien haben seit Jahren ihren festen Platz in der nationalen und internationalen Versorgungsforschung. Sie liefern einen wichtigen Beitrag zum Verständnis der Versorgungssituation von Patienten in unterschiedlichsten Indikationen, von häufigen Erkrankungen, welche breite Teile der Bevölkerung betreffen bis hin zu seltenen Erkrankungen mit geringen Fallzahlen. Die vorliegende kumulative Dissertation untersucht anhand von elf ausgewählten empirischen Beispielen das Potential von GKV-Routinedaten-basierten Versorgungsforschungsstudien, den Market Access von Arzneimitteln, Impfstoffen und Medizintechnik aus Perspektive der jeweiligen Hersteller zu unterstützen. Anhand von sechs Modulen werden Fragestellungen des Market Access von Arzneimitteln beantwortet. Drei dieser Module untersuchen Aspekte der seltenen Erkrankungen Non-CF-Bronchiektasen (NCFB) und Phenylketonurie (PKU). Sie erheben neben Kennzahlen der Epidemiologie ergänzend Krankheitskosten sowie die Last durch Begleiterkrankungen, Arzneimitteltherapien und Hospitalisierungen. Zwei weitere Module betreffen die Indikation Asthma bronchiale. Sie thematisieren die Identifikation der Krankheitsschwere und analysieren die Kosten der Erkrankung diesbezüglich, sowie hinsichtlich Alters- und Geschlechtsunterschieden. Ein nächstes Modul untersucht die Auswirkungen und Kosten von Eisenmangel bei Patienten mit Herzinsuffizienz und vergleicht verschiedene Behandlungsalternativen hinsichtlich Krankheitskosten und Effektivität. Vier Module zeigen Studien aus dem Bereich des Market Access von Impfstoffen. In drei Studien werden die Effekte von aktualisierten Empfehlungen der Ständigen Impfkommission (STIKO) am Beispiel der Pneumokokken-Schutzimpfung untersucht. Eine Studie analysiert die Pneumonie-Erkrankungsrate in verschiedenen Risikopopulationen. Zwei Studien vergleichen die Impfquote und Impfadhärenz von „reifgeborenen“ und „frühgeborenen“ Säuglingen vor und nach der Änderung der Impfempfehlung. Ein weiteres Modul beschreibt die Krankheitslast von HPV-assoziierten anogenitalen Erkrankungen bei jungen Frauen. Abschließend erhebt ein Modul die Kosten und Ressourcenverbräuche von Wirbelsäulenoperationen sowie möglichen Folgeoperationen – eine Studie zur Unterstützung des Market Access von Medizintechnik. Im Rahmen der vorliegenden kumulativen Dissertation konnte anhand von elf empirischen Beispielen gezeigt werden, dass GKV-Routinedaten-basierte Versorgungsforschungsstudien für Hersteller von Arzneimitteln, Impfstoffen und Medizintechnik ein geeignetes Instrument zur Unterstützung des Market Access ihrer Produkte darstellen können.As part of the market access process, manufacturers of drugs, vaccines and medical technology are confronted with a variety of research questions. These include, for example, questions about unmet medical needs, the epidemiology of diseases and the care situation of patients. They concern medical costs, the effectiveness and safety of products in the real-life healthcare situation, and the positioning of the company’s own products compared to competitors. Studies based on statutory health insurance (SHI) claims data have had a firm place in national and international health services research for many years. They provide an important contribution to the understanding of the healthcare situation of patients in a wide variety of indications, from common diseases affecting large parts of the population to rare diseases with small sample size. This cumulative dissertation examines the potential of SHI claims data based health service research studies to support the market access of drugs, vaccines and medical technology from the perspective of the respective manufacturers. Six modules answer research questions regarding the market access of drugs. Three of these modules examine aspects of the rare diseases non-cystic fibrosis bronchiectasis (NCFB) and phenylketonuria (PKU). In addition to epidemiological data, they collect data on the costs of illness and the burden of concomitant diseases, drug therapies and hospitalizations. Two further modules concern the indication asthma. They thematize the identification of disease severity and analyze the cost of the disease in terms of age and sex differences. A next module examines the effects and costs of iron deficiency in patients with heart failure and compares different treatment alternatives in terms of cost of illness and effectiveness. Four modules present studies from the field of vaccine market access. Three studies examine the effects of updated recommendations of the Standing Committee on Vaccination (STIKO), using pneumococcal vaccination as an example. One study analyzes pneumonia rates in different risk populations. Two studies compare the vaccination rate and vaccination adherence of "mature" and "preterm" infants before and after the change in vaccination recommendation. Another module describes the disease burden of HPV-associated anogenital disease in young women. Finally, one module analyzes the costs and resource utilization of instrumental spinal surgeries and potential reoperations - a study to support the market access of medical technology. On the basis of eleven empirical examples this cumulative dissertation showed that SHI claims data based health services research studies can represent a meaningful instrument for manufacturers of drugs, vaccines and medical technology to support the market access of their products

Next generation of growth-sparing techniques: preliminary clinical results of a magnetically controlled growing rod in 14 patients

Session 3A - Early Onset Scoliosis: Paper no. 33SUMMARY: Growth-sparing techniques are commonly used for the treatment of progressive EOS. The standard growing rod (GR) technique requires multiple surgeries for lengthening. The preliminary results of MCGR has shown the comparable outcomes to standard GR without the need for repeated surgery which can be expected to reduce the overall complication rate in GR surgery. INTRODUCTION: The growing rod (GR) technique for management of progressive Early-Onset Scoliosis (EOS) is a viable alternative but with a high complication rate attributed to frequent surgical lengthenings. The safety and efficacy of a non-invasive Magnetically Controlled Growing Rod (MCGR) has been previously reported in a porcine model. We are reporting the preliminary results of this technique in EOS. METHODS: Retrospective review of prospectively collected multi-center data. Only patients who underwent MCGR surgery and at least 3 subsequent spinal distractions were included in this preliminary review. Distractions were performed in clinic without anesthesia or analgesics. T1-T12 and T1-S1 height and the distraction distance inside the actuator were analyzed in addition to conventional clinical and radiographic data. RESULTS: Patients (N=14; 7 F and 7 M) had a mean age of 8y+10m (3y+6m to 12y+7m) and underwent a total of 14 index surgeries (SR: index single rod in 5 and DR: dual rod in 9) and 91 distractions. There were 5 idiopathic, 4 neuromuscular, 2 congenital, 2 syndromic and one NF. Mean follow-up (FU) was 10 months (5.8-18.2). Mean Cobb changed from 57° pre-op to 35° post-op and correction was maintained (35°) at latest FU. T1-T12 increased by 4 mm for SR and 10 mm for DR with mean monthly gain of 0.5 and 1.39, respectively. T1-S1 gain was 4 mm for SR and 17 mm for DR with mean monthly gain of 0.5 mm for SR and 2.35 mm for DR. The mean interval between index surgery and the first distraction was 66 days and thereafter was 43 days. Complications included one superficial infection in (SR), one prominent implant (DR) and minimal loss of initial distraction in three after index MCGR (all SR). Overall, partial loss of distraction was observed following 14 of the 91 distractions (one DR and 13 SR). This loss was regained in subsequent distractions. There was no neurologic deficit or implant failure. CONCLUSION: MCGR appears to be safe and provided adequate distraction similar to the standard GR technique without the need for repeated surgeries. DR patients had better initial curve correction and greater spinal height. No major complications were observed during the short follow-up period. The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an ‘off label’ use).postprin

Federal Register

Daily publication of the U.S. Office of the Federal Register contains rules and regulations, proposed legislation and rule changes, and other notices, including "Presidential proclamations and Executive Orders, Federal agency documents having general applicability and legal effect, documents required to be published by act of Congress, and other Federal agency documents of public interest" (p. ii). Table of Contents starts on page iii