Cachexia & debility diagnoses in hospitalized children and adolescents with complex chronic conditions: evidence from the Kids’ Inpatient Database

Objective: To characterize the frequency, cost, and hospital-reported outcomes of cachexia and debility in children and adolescents with complex chronic conditions (CCCs). Methods: We identified children and adolescents (aged ≤20 years) with CCCs, cachexia, and debility in the Kids’ Inpatient Database [Healthcare Cost and Utilization Project, Agency for Healthcare Research & Quality]. We then compared the characteristics of patients and hospitalizations, including cost and duration of stay, for CCCs with and without cachexia and/ or debility. We examined factors that predict risk of inpatient mortality in children and adolescents with CCCs using a logistic regression model. We examined factors that impact duration of stay and cost in children and adolescents with CCCs using negative binomial regression models. All costs are reported in US dollars in 2014 using Consumer Price Index inflation adjustment. Results: We estimated the incidence of hospitalization of cachexia in children and adolescents with CCCs at 1,395 discharges during the sample period, which ranged from 277 discharges in 2003 to 473 discharges in 2012. We estimated the incidence of hospitalization due to debility in children and adolescents with CCCs at 421 discharges during the sample period, which ranged from 39 discharges in 2003 to 217 discharges in 2012. Cachexia was associated with a 60% increase in the risk of inpatient mortality, whereas debility was associated with a 40% decrease in the risk of mortality. Cachexia and debility increased duration of stay in hospital (17% and 39% longer stays, respectively). Median cost of hospitalization was $15,441.59 and$23,796.16 for children and adolescents with cachexia and debility, respectively. Conclusions: Incidence of hospitalization for cachexia in children and adolescents with CCCs is less than that for adults but the frequency of cachexia diagnoses increased over time. Estimates of the incidence of hospitalization with debility in children and adolescents with CCCs have not been reported, but our study demonstrates that the frequency of these discharges is also increasing

One-year prevalence, comorbidities and cost of cachexia-related inpatient admissions in the USA

Background: Cachexia is a condition characterized as a loss in body mass or metabolic dysfunction and is associated with several prevalent chronic health conditions including many cancers, COPD, HIV, and kidney disease, with between 10 and 50% of patients with these conditions having cachexia. Currently there is little research into cachexia and our objective is to characterize cachexia patients, their healthcare utilisation, and associated hospitalization costs. Given the increasing prevalence of chronic diseases, it is important to better understand cachexia so that the condition can be better diagnosed and managed. Methods: We utilized one year (2009) of the Nationwide Inpatient Sample (NIS). The NIS represents all inpatient stays at a random 20% sample of all hospitals within the United States. We grouped cachexia individuals by primary or secondary discharge diagnosis and then compared those with cachexia to all others in terms of length of stay (LOS) and total cost. Finally we looked into factors predicting increased LOS using a negative binomial model. Results: We estimated US prevalence for cachexia-related inpatient admissions at 161,898 cases. Cachexia patients were older, with an average age of 67.95 versus 48.10 years in their non-cachexia peers. Hospitalizations associated with cachexia had an increased LOS compared to non-cachexia patients (6 versus 3 days), with average costs per stay $4641.30 greater. Differences were seen in loss of function (LOF) with cachexia patients, mostly in the major LOF category (52.60%), whereas non-cachexia patients were spread between minor, moderate, and major LOF (36.28%, 36.11%, and 21.26%, respectively). Significant positive predictors of increased LOS among cachexia patients included urban hospital (IRR=1.21, non-teaching urban; IRR=1.23, teaching urban), having either major (IRR=1.41) or extreme (IRR=2.64) LOF, and having a primary diagnosis of pneumonia (IRR=1.15). Conclusion: We have characterized cachexia and seen it associated with increased length of stay, increased cost, and more severe loss of function in patients compared to those without cachexia

Higher In-Hospital Complications in Ankle Fusion Than Ankle Arthroplasty

Category: Ankle Introduction/Purpose: Ankle fusion and total ankle arthroplasty (TAA) are common surgical procedures used to treat ankle morbidity. Little is known about the comparative rates of in-hospital complications between patients treated with ankle fusion and TAA. Methods: Data from the 2002-2013 Nationwide Inpatient Sample releases were analyzed. 4,451 TAA patients and 16,277 ankle fusion patients were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) 81.11 and 81.56 procedure codes, respectively. ICD-9-CM diagnosis codes were utilized to classify major or minor in-hospital complications. Fusion and TAA patients were exact matched on age, gender, race, hospital type, geographical region, comorbidities, and diabetes status. Minor and major in-hospital complications, including mortality were compared using chi-square and multivariate logistic regression. Results: Exact matches were identified for 4,174 (93.8%) TAA patients, with a mean age of 62.2 years. The major in-hospital complication rate for ankle fusion patients was 14.7% (615 of 4,174) versus 6.4% (269 of 4,174) for TAA patients (p< .01). The minor complication rate for ankle fusion was 3.9% (169 of 4,174) compared to 4.6% (167 of 4,174) for TAA (p=0.91). Fewer than 10 patients in either group died (p=0.59). After adjusting for case-mix, ankle fusion patients were 2.46 times more likely to experience major complications (OR: 2.46, 95% CI 2.11-2.88) than TAA patients. Conclusion: Compared to a matched cohort of ankle fusion patients, TAA patients are less likely to experience major in-hospital complications. These findings suggest that TAA may be a safer surgery than ankle fusion