Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients

<p>Abstract</p> <p>Background</p> <p>Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts.</p> <p>Methods</p> <p>A retrospective analysis was conducted using Premier's Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery) during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions) was examined, and hospital costs and length of stay (LOS) were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary least squares (OLS) regression, adjusting for demographics, hospital characteristics, and other baseline characteristics. Models using generalized estimating equations (GEE) were also used to measure the impact of bleeding-related complications on costs while accounting for the effects related to the clustering of patients receiving care from the same hospitals.</p> <p>Results</p> <p>A total of 103,829 cardiac, 216,199 vascular, 142,562 non-cardiac thoracic, 45,687 solid organ, 362,512 general, 384,132 reproductive organ, 246,815 knee/hip replacement, and 107,187 spinal surgeries were identified. Overall, the rate of bleeding-related complications was 29.9% and ranged from 7.5% to 47.4% for reproductive organ and cardiac, respectively. Overall, incremental LOS associated with bleeding-related complications or transfusions (unadjusted for covariates) was 6.0 days and ranged from 1.3 to 9.6 days for knee/hip replacement and non-cardiac thoracic, respectively. The incremental cost per hospitalization associated with bleeding-related complications and adjusted for covariates was highest for spinal surgery ($17,279) followed by vascular ($15,123), solid organ ($13,210), non-cardiac thoracic ($13,473), cardiac ($10,279), general ($4,354), knee/hip replacement ($3,005), and reproductive organ ($2,805).</p> <p>Conclusions</p> <p>This study characterizes the increased hospital LOS and cost associated with bleeding-related complications and/or transfusions occurring as a consequence of surgery, and supports implementation of blood-conservation strategies.</p

Using remote sensing to assess the relationship between crime and the urban layout

[EN] The link between place and crime is at the base of social ecology theories of crime that focus in the relationship of the characteristics of geographical areas and crime rates. The broken windows theory states that visible cues of physical and social disorder in a neighborhood can lead to an increase in more serious crime. The crime prevention through environmental design (CPTED) planning approach seeks to deter criminal behavior by creating defensible spaces. Based on the premise that a settlement's appearance is a reflection of the society, we ask whether a neighborhood's design has a quantifiable imprint when seen from space using urban fabric descriptors computed from very high spatial-resolution imagery. We tested which land cover, structure and texture descriptors were significantly related to intra-urban homicide rates in Medellin, Colombia, while controlling for socioeconomic confounders. The percentage of impervious surfaces other than clay roofs, the fraction of clay roofs to impervious surfaces, two structure descriptors related to the homogeneity of the urban layout, and the uniformity texture descriptor were all statistically significant. Areas with higher homicide rates tended to have higher local variation and less general homogeneity; that is, the urban layouts were more crowded and cluttered, with small dwellings with different roofing materials located in close proximity to one another, and these regions often lacked other homogeneous surfaces such as open green spaces, wide roads, or large facilities. These results seem to be in agreement with the broken windows theory and CPTED in the sense that more heterogeneous and disordered urban layouts are associated with higher homicide rates.This research was made possible by funding from EAFIT University (EAFIT-435-000060) and the Medellin City Hall EnlazaMundos program. The authors thank the anonymous reviewers and Hermilson Velazquez, Andr es Ramírez Hassan and Gustavo Canavire for their insightful observations and suggestions during the different stages of this projectPatiño Quinchía, JE.; Duque, JC.; Pardo Pascual, JE.; Ruiz Fernández, LÁ. (2014). Using remote sensing to assess the relationship between crime and the urban layout. Applied Geography. 55:48-60. https://doi.org/10.1016/j.apgeog.2014.08.016S48605

Nationwide epidemiological study of severe gallstone disease in Taiwan

<p>Abstract</p> <p>Background</p> <p>Our study aimed to assess the nationwide trends in the incidence of severe gallstone disease in Taiwan among adults aged ≥20.</p> <p>Methods</p> <p>A retrospective longitudinal study was conducted using Taiwan National Health Insurance Research Database collected during 1997–2005. Patients with incident severe gallstone disease (acute cholecystitis, biliary pancreatitis, acute cholangitis) and gallstone-related procedures (elective and non-elective cholecystectomy, endoscopic retrograde cholangiopancreatography [ERCP]) that led to hospital admission were identified using ICD-9-CM diagnostic and procedure codes. Annual incidence rates of gallstone-related complications and procedures were calculated and their 95% confidence intervals (CI) were estimated assuming a Poisson distribution.</p> <p>Results</p> <p>The hospital admission rate for severe gallstone disease increased with advancing age and the age-standardized rate (95% CI) per 1000 population was 0.60 (0.59–0.60) for men and 0.59 (0.59–0.60) for women. Men had a higher rate of acute cholecystitis, probably due to the substantially lower rate of elective cholecystectomy among men than women. For those aged 20–39, hospital admissions for all gallstone-related complications and procedures increased significantly. For those aged ≥60, incidences of biliary pancreatitis, acute cholangitis, and hospital admission for gallstone receiving ERCP increased significantly without substantial change in the incidence of acute cholecystitis and despite a decreased rate of elective cholecystectomy.</p> <p>Conclusion</p> <p>This population-based study found a substantial increase in the rate of admission for severe gallstone disease among those aged 20–39. Concurrently, the incidences of biliary pancreatitis and acute cholangitis have risen among those aged ≥60.</p

Improving delirium care in the intensive care unit: The design of a pragmatic study

<p>Abstract</p> <p>Background</p> <p>Delirium prevalence in the intensive care unit (ICU) is high. Numerous psychotropic agents are used to manage delirium in the ICU with limited data regarding their efficacy or harms.</p> <p>Methods/Design</p> <p>This is a randomized controlled trial of 428 patients aged 18 and older suffering from delirium and admitted to the ICU of Wishard Memorial Hospital in Indianapolis. Subjects assigned to the intervention group will receive a multicomponent pharmacological management protocol for delirium (PMD) and those assigned to the control group will receive no change in their usual ICU care. The primary outcomes of the trial are (1) delirium severity as measured by the Delirium Rating Scale revised-98 (DRS-R-98) and (2) delirium duration as determined by the Confusion Assessment Method for the ICU (CAM-ICU). The PMD protocol targets the three neurotransmitter systems thought to be compromised in delirious patients: dopamine, acetylcholine, and gamma-aminobutyric acid. The PMD protocol will target the reduction of anticholinergic medications and benzodiazepines, and introduce a low-dose of haloperidol at 0.5-1 mg for 7 days. The protocol will be delivered by a combination of computer (artificial intelligence) and pharmacist (human intelligence) decision support system to increase adherence to the PMD protocol.</p> <p>Discussion</p> <p>The proposed study will evaluate the content and the delivery process of a multicomponent pharmacological management program for delirium in the ICU.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00842608">NCT00842608</a></p

Previous Lung Diseases and Lung Cancer Risk: A Systematic Review and Meta-Analysis

In order to review the epidemiologic evidence concerning previous lung diseases as risk factors for lung cancer, a meta-analysis and systematic review was conducted.Relevant studies were identified through MEDLINE searches. Using random effects models, summary effects of specific previous conditions were evaluated separately and combined. Stratified analyses were conducted based on smoking status, gender, control sources and continent.A previous history of COPD, chronic bronchitis or emphysema conferred relative risks (RR) of 2.22 (95% confidence interval (CI): 1.66, 2.97) (from 16 studies), 1.52 (95% CI: 1.25, 1.84) (from 23 studies) and 2.04 (95% CI: 1.72, 2.41) (from 20 studies), respectively, and for all these diseases combined 1.80 (95% CI: 1.60, 2.11) (from 39 studies). The RR of lung cancer for subjects with a previous history of pneumonia was 1.43 (95% CI: 1.22-1.68) (from 22 studies) and for subjects with a previous history of tuberculosis was 1.76 (95% CI=1.49, 2.08), (from 30 studies). Effects were attenuated when restricting analysis to never smokers only for COPD/emphysema/chronic bronchitis (RR=1.22, 0.97-1.53), however remained significant for pneumonia 1.36 (95% CI: 1.10, 1.69) (from 8 studies) and tuberculosis 1.90 (95% CI: 1.45, 2.50) (from 11 studies).Previous lung diseases are associated with an increased risk of lung cancer with the evidence among never smokers supporting a direct relationship between previous lung diseases and lung cancer

Pathology Case Study: Nephrotic Syndrome and Gross Hematuria

The University of Pittsburgh School of Medicine's Department of Pathology has compiled a series of case studies to help both students and instructors in the health sciences field. The patient treated in this case is a 20 year-old man with flank pain. Information on the initial examination and lab results are provided in the âPatient Historyâ section. The âGross Description,â âMicroscopic Description,â âImmunofluorescence Examinationâ and âElectron Microscope Examinationâ sections provide key information and images that contributed to the patientâs diagnosis. Clicking on the âFinal Diagnosisâ will lead you to a thorough explanation of the diagnosis and illness from the patientâs doctors

Pathology Case Study: Dilated Cardiomyopathy

This is a case study presented by the University of Pittsburgh Department of Pathology in which a man presented with a large range of symptoms from chills and fever to underdeveloped calf muscles. Visitors are given both the microscopic and gross descriptions, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in cardiovascular pathology

Pathology Case Study: New Onset Diplopia and Mental Status Changes

This is a case study presented by the University of Pittsburgh Department of Pathology in which 48-year-old Caucasian woman, with previous bill of good health, presents with a headache, neck stiffness and diplopia. Aside from the physical symptoms, the patient was also confused and appeared to have symptoms of short-term memory loss. Lab results, images from a CT scan of the patientâs brain, and microscopic images of a stereotactic biopsy are included in the case study. The âFinal Diagnosisâ section includes a detailed description of the condition from the contributing doctors. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose patientâs conditions