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[PMID]:28746714
[Au] Autor:Cerullo M; Chen SY; Dillhoff M; Schmidt C; Canner JK; Pawlik TM
[Ad] Endereço:Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
[Ti] Título:Association of Hospital Market Concentration With Costs of Complex Hepatopancreaticobiliary Surgery.
[So] Source:JAMA Surg;152(9):e172158, 2017 Sep 20.
[Is] ISSN:2168-6262
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Trade-offs involved with market competition, overall costs to payers and consumers, and quality of care have not been well defined. Less competition within any given market may enable provider-driven increases in charges. Objective: To examine the association between regional hospital market concentration and hospital charges for hepatopancreaticobiliary surgical procedures. Design, Setting, and Participants: This study included all patients undergoing hepatic or pancreatic resection in the Nationwide Inpatient Sample from January 1, 2003, through December 31, 2011. Hospital market concentration was assessed using a variable-radius Herfindahl-Hirschman Index (HHI) in the 2003, 2006, and 2009 Hospital Market Structure files. Data were analyzed from November 19, 2016, through March 2, 2017. Interventions: Hepatic or pancreatic resection. Main Outcomes and Measures: Multivariable mixed-effects log-linear models were constructed to determine the association between HHI and total costs and charges for hepatic or pancreatic resection. Results: Weighted totals of 38 711 patients undergoing pancreatic resection (50.8% men and 49.2% women; median age, 65 years [interquartile range, 55-73 years]) and 52 284 patients undergoing hepatic resection (46.8% men and 53.2% women; median age, 59 years [interquartile range, 49-69 years]) were identified. Higher institutional volume was associated with lower cost of pancreatic resection (-5.4%; 95% CI, -10.0% to -0.5%; P = .03) and higher cost of hepatic resection (13.4%; 95% CI, 8.2% to 18.8%; P < .001). For pancreatic resections, costs were 5.5% higher (95% CI, 0.1% to 11.1%; P = .047) in unconcentrated hospital markets relative to moderately concentrated markets, although overall charges were 8.3% lower (95% CI, -14.0% to -2.3%; P = .008) in highly concentrated markets. For hepatic resections, hospitals in highly concentrated markets had 8.4% lower costs (95% CI, -13.0% to -3.6%; P = .001) compared with those in unconcentrated markets and charges that were 13.4% lower (95% CI, -19.3% to -7.1%; P < .001) compared with moderately concentrated markets and 10.5% lower (95% CI, -16.2% to -4.4%; P = .001) compared with unconcentrated markets. Conclusions and Relevance: Higher market concentration was associated with lower overall charges and lower costs of pancreatic and hepatic surgery. For complex, highly specialized procedures, hospital market consolidation may represent the best value proposition: better quality of care with lower costs.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Digestório/economia
Preços Hospitalares/estatística & dados numéricos
[Mh] Termos MeSH secundário: Competição Econômica
Hepatectomia/economia
Seres Humanos
Pancreatectomia/economia
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1001/jamasurg.2017.2158


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[PMID]:29287888
[Au] Autor:Espahbodi M; Yan K; Chun RH; McCormick ME
[Ad] Endereço:Medical College of Wisconsin, Department of Otolaryngology & Communication Sciences, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA. Electronic address: mespahbodi@gmail.com.
[Ti] Título:Management trends of infantile hemangioma: A national perspective.
[So] Source:Int J Pediatr Otorhinolaryngol;104:84-87, 2018 Jan.
[Is] ISSN:1872-8464
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The primary management of infantile hemangioma (IH) has changed since 2008, with the initiation of propranolol. The change that propranolol has affected on resource utilization is unknown. MATERIALS AND METHODS: The Kids' Inpatient Database (KID) in 2003, 2006, 2009, and 2012 was queried for ICD-9 codes for IH in children under age three. The number of patients undergoing the following procedures of interest: tracheostomy, tracheoscopy and laryngoscopy with biopsy, and excision of skin lesion were evaluated. Data was analyzed for demographics and details on the admission. Trends were identified. Weighted statistical analyses were performed with SAS 9.4. RESULTS: The number of qualified admissions significantly increased over the years (9271 in 2003-12029 in 2012, OR 1.042 per year increase, p < 0.001). The mean age at admission ranged from 26 to 28 days but did not vary over time (p = 0.54). The percentage undergoing tracheostomy significantly decreased from 1.05% in 2003 to 0.27% in 2012 (p = 0.0055), and the percentage undergoing tracheoscopy and laryngoscopy with biopsy significantly decreased from 7.29% in 2003 to 4.20% in 2012 (p = 0.011) among those with IH of unspecified or other sites. The percentage undergoing skin lesion excision also significantly decreased from 1.87% in 2003 to 1.03%, in 2012 (p = 0.0038) among those with IH of skin and subcutaneous tissue. These findings suggest a potential impact of propranolol. After adjusting for inflation, the total hospital charges increased from a mean of $17,838 in 2003 to an adjusted mean of $41,306 in 2012 (p < 0.0001). CONCLUSIONS: Total admissions and hospital charges in children with IH has increased from 2003 to 2012. The percentage of patients undergoing tracheostomy, tracheoscopy and laryngoscopy with biopsy, and skin lesion excision significantly decreased in 2012 compared to 2003, suggesting a potential impact of propranolol. Further studies are needed to examine these changes more closely.
[Mh] Termos MeSH primário: Biópsia/tendências
Endoscopia/tendências
Hemangioma/cirurgia
Traqueostomia/tendências
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Bases de Dados Factuais
Feminino
Hemangioma/tratamento farmacológico
Preços Hospitalares
Hospitalização/estatística & dados numéricos
Seres Humanos
Lactente
Classificação Internacional de Doenças
Tempo de Internação
Masculino
Propranolol/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
9Y8NXQ24VQ (Propranolol)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171231
[St] Status:MEDLINE


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[PMID]:29428043
[Au] Autor:Golob JF; Como JJ; Claridge JA
[Ti] Título:Trauma Surgeons Save Lives-Scribes Save Trauma Surgeons!
[So] Source:Am Surg;84(1):144-148, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:With the advent of the electronic medical record, the documentation burden of the trauma surgeon has become overwhelming. To help, our trauma division added scribes to the rounding team. We hypothesized that scribe utilization would improve our documentation efficiency and offer a financial benefit to the institution. A review of trauma surgeon documentation and billing was performed at a Level I trauma center over two time periods: January to May 2014 (no scribes) and January to May 2015 (scribes). The number of notes written by trauma surgeons was obtained, as were documentation charges. Documentation efficiency was determined by noting both the hour of the day in which inpatient progress notes were written and the number of notes written after patient discharge. In the 2014 period, a total of 9726 notes were written by trauma attendings. In the 2015 period, 10,933 were written. Despite having 407 fewer trauma patient-days in the 2015 period, the group wrote 343 notes/week versus 298 notes/week (P = 0.008). More inpatient progress notes were written earlier in the working day and fewer were written in the evening. Fewer notes were written after patient discharge (12.7 vs 8.4%). A total of 1,664 hours of scribe time were used over the 5-month period, generating an expense of $32,787. The additional notes generated by scribes resulted in $191,394 in charges. Conservatively, assuming a 20 per cent charge reimbursement, the cost of the scribes was covered. The addition of scribes to the daily trauma rounding team improved note efficiency and increased charge capture at our center.
[Mh] Termos MeSH primário: Custos e Análise de Custo/economia
Documentação/economia
Registros Eletrônicos de Saúde
Preços Hospitalares
Administradores de Registros Médicos/economia
Centros de Traumatologia/economia
Centros de Traumatologia/recursos humanos
[Mh] Termos MeSH secundário: Registros Eletrônicos de Saúde/economia
Registros Eletrônicos de Saúde/normas
Seres Humanos
Pacientes Internados
Alta do Paciente
Cirurgiões/economia
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:29428038
[Au] Autor:Shubinets V; Fox JP; Lanni MA; Tecce MG; Pauli EM; Hope WW; Kovach SJ; Fischer JP
[Ti] Título:Incisional Hernia in the United States: Trends in Hospital Encounters and Corresponding Healthcare Charges.
[So] Source:Am Surg;84(1):118-125, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Incisional hernia (IH) is a challenging, potentially morbid condition. This study evaluates recent trends in hospital encounters associated with IH care in the United States. Using Nationwide Inpatient Sample databases from 2007 to 2011, annual estimates of IH-related hospital discharges, charges, and serious adverse events were identified. Significance in observed trends was tested using regression modeling. From 2007 to 2011, there were 583,054 hospital discharges associated with a diagnosis of IH. 81.1 per cent had a concurrent procedure for IH repair. The average discharge included a female patient (63.2%), 59.8 years of age, with either Medicare (45.3%) or Private insurance (38.3%) as the anticipated primary payer. Comparing 2007 to 2011, significant increases in IH discharges (12%; 2007 = 109,702 vs 2011 = 123,034, P = 0.009) and IH repairs (10%; 2007 = 90,588 vs 2011 = 99,622, P < 0.001) were observed. This was accompanied by a 37 per cent increase in hospital charges (2007 = $44,587 vs 2011 = $60,968, P < 0.001), resulting in a total healthcare bill of $7.3 billion in 2011. Significant trends toward greater patient age (2007 = 59.7 years vs 2011 = 60.2 years, P < 0.001), higher comorbidity index (2007 = 3.0 vs 2011 = 3.5, P < 0.001), and increased frequency of serious adverse events (2007 = 13.5% vs 2011 = 17.7%, P < 0.001) were noted. Further work is needed to identify interventions to mitigate the risk of IH development.
[Mh] Termos MeSH primário: Herniorrafia/economia
Preços Hospitalares
Hérnia Incisional/economia
Pacientes Internados
Laparoscopia/economia
Tempo de Internação/economia
Telas Cirúrgicas/economia
[Mh] Termos MeSH secundário: Custos e Análise de Custo
Feminino
Preços Hospitalares/tendências
Hospitais
Seres Humanos
Hérnia Incisional/diagnóstico
Hérnia Incisional/etiologia
Hérnia Incisional/cirurgia
Masculino
Medicare
Meia-Idade
Alta do Paciente/economia
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:28455909
[Au] Autor:Wittlieb-Weber CA; Rossano JW; Weber DR; Lin KY; Ravishankar C; Mascio CE; Shaddy RE; O'Connor MJ
[Ad] Endereço:Division of Pediatric Cardiology, University of Rochester Medical Center, Rochester, NY, USA.
[Ti] Título:Emergency department utilization in pediatric heart transplant recipients.
[So] Source:Pediatr Transplant;21(4), 2017 Jun.
[Is] ISSN:1399-3046
[Cp] País de publicação:Denmark
[La] Idioma:eng
[Ab] Resumo:We used the NEDS database (2010) to evaluate ED utilization in PED HT recipients compared to other patient populations with focus on characteristics of ED visits, risk factors for admission, and charges. We analyzed 433 ED visits by PED HT recipients (median age 8 [range: 0-18] years). The most common primary diagnosis category was infectious (n=163, 37.6%), with pneumonia being the most common infectious etiology. When compared to all PED visits, HT visits were more likely to result in hospital admission (32.6% versus 3.9%, P<.001), had greater hospital LOS (median of 3 days [IQR 2-4] versus 2 days [IQR 1-4], P=.001), and accumulated greater total hospital charges (median $26 317 [IQR $11 438-$46 407] versus $12 332 [IQR $7092-$22 583], P<.001). When compared to visits by other SOT recipients, results varied with similar rates of hospital admission for HT, LUNGT, and KT visits and similar LOS for HT and KT visits but differing total hospital charges. Although PED HT recipients account for a small percentage of overall ED visits, they are more likely to be hospitalized and require greater resource utilization compared to the general PED population, but not when compared to other SOT recipients.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/utilização
Transplante de Coração
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Bases de Dados Factuais
Serviço Hospitalar de Emergência/economia
Serviço Hospitalar de Emergência/estatística & dados numéricos
Feminino
Preços Hospitalares/estatística & dados numéricos
Seres Humanos
Lactente
Recém-Nascido
Tempo de Internação/economia
Tempo de Internação/estatística & dados numéricos
Modelos Logísticos
Masculino
Admissão do Paciente/economia
Admissão do Paciente/estatística & dados numéricos
Complicações Pós-Operatórias/economia
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/terapia
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1111/petr.12936


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[PMID]:29224750
[Au] Autor:Atwood CM; Gnagi SH; Teufel RJ; Nguyen SA; White DR
[Ad] Endereço:Department of Otolaryngology Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA. Electronic address: cmatwood@email.sc.edu.
[Ti] Título:Blood transfusion in children with sickle cell disease undergoing tonsillectomy.
[So] Source:Int J Pediatr Otorhinolaryngol;103:117-120, 2017 Dec.
[Is] ISSN:1872-8464
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Tonsillectomy is the second most common surgery in children with sickle cell disease. These children are at an increased risk of perioperative complications due to vaso-occlusive events. Although controversial, preoperative blood transfusions are sometimes given in an effort to prevent such complications. The purpose of this study is to analyze trends in the use of blood transfusion for management of children with sickle cell disease (SCD) undergoing tonsillectomy in a national database. METHODS: Patients in the 1997-2012 KID with a primary procedure matching the ICD-9 procedure code for tonsillectomy (28.2-28.3) and diagnosis code for SCD (282.60-282.69) were examined. Patients were split into groups by blood transfusion status and compared across variables including complication rate, length of stay (LOS), and hospital charges. Statistical analysis included chi-square test for trend, Mann-Whitney U test, and independent t-test. RESULTS: 1133 patients with SCD underwent tonsillectomy. There was a strong positive correlation between increasing chronologic year and the proportion of patients receiving blood transfusions, 47 (30.1%) in 1997 to 78 (42.5%) in 2012 (r = 0.94, p = 0.005). During this period, there was no significant change in the rate of complications (r = -0.1, p = 0.87). Overall, patients receiving blood transfusion had a longer mean LOS (3.1 ± 2.4 days vs. 2.5 ± 2.2 days, p < 0.005) and higher mean charge ($17,318 ± 13,191 vs. $13,532 ± 12,124, p < 0.005) compared to patients who did not receive blood transfusion. The rate of complications in the transfusion group, 18 of 352(5.1%), was not significantly different (p = 0.48) from the group without transfusion, 40 of 626 (6.4%). CONCLUSIONS: From 1997 to 2012, there was a significant increase in the proportion of patients with SCD receiving perioperative blood transfusions for tonsillectomy. While the frequency of transfusion rose, those who received a transfusion had similar complication rates with increased charges and length of hospital stays compared to those who did not receive a transfusion.
[Mh] Termos MeSH primário: Anemia Falciforme/complicações
Transfusão de Sangue/estatística & dados numéricos
Tonsilectomia/efeitos adversos
[Mh] Termos MeSH secundário: Anemia Falciforme/cirurgia
Criança
Pré-Escolar
Bases de Dados Factuais
Feminino
Preços Hospitalares/estatística & dados numéricos
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE


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[PMID]:29209725
[Au] Autor:Berwick DM
[Ad] Endereço:Institute for Healthcare Improvement, Cambridge, Massachusetts.
[Ti] Título:Moral Choices for Today's Physician.
[So] Source:JAMA;318(21):2081-2082, 2017 Dec 05.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Temas Bioéticos
Custos de Medicamentos/ética
Preços Hospitalares/ética
Papel do Médico
[Mh] Termos MeSH secundário: Conservação dos Recursos Naturais
Direito Penal
Seres Humanos
Princípios Morais
Refugiados
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.16254


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[PMID]:28809954
[Au] Autor:Singh JA; Yu S
[Ad] Endereço:Medicine Service, Birmingham VA Medical Center, Birmingham, Alabama, United States of America.
[Ti] Título:The burden of septic arthritis on the U.S. inpatient care: A national study.
[So] Source:PLoS One;12(8):e0182577, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess the health care burden of septic arthritis in the U.S. and examine the associated factors. METHODS: We used the U.S. Nationwide Emergency Department Sample (NEDS) data of patients hospitalized with septic arthritis as the primary diagnosis from 2009-12 to assess time-trends. Multivariable-adjusted models assessed demographics, comorbidity and hospital characteristics as potential predictors of duration of hospitalization, total hospital (inpatient and ED) charges and discharge to home. RESULTS: In 2009, 2010 and 2012 in the U.S., respectively, there were 13,087, 13,662 and 13,714 hospitalizations with septic arthritis as the primary diagnosis. Respective average hospital stay was 7.4 vs. 7.4 vs. 7.2 days; total hospital charges were $601 vs. $674 vs. $759 million; and proportion discharged home were 43% vs. 43% vs. 44%. Almost 25% each were discharged to a skilled facility or with home health. Age >50 years, Medicaid and self-pay as primary payer, Northeast U.S. hospital location, teaching hospital status, heart failure and diabetes were associated with longer hospitalization; hyperlipidemia, hypertension or gout were associated with a shorter hospital stay. Similar associations were noted for higher hospital charges. Age >50 years, higher income, Medicare insurance, heart failure, diabetes and longer hospital stay were associated with lower odds, and Western U.S. hospital location and gout with higher odds, of discharge to home. CONCLUSIONS: We noted an increase in hospital charges from 2009-12, but no time trends in duration or outcomes of hospitalization for septic arthritis. Comorbidity associations with outcomes indicate the potential for developing interventions to improve outcomes.
[Mh] Termos MeSH primário: Artrite Infecciosa/economia
Pacientes Internados/estatística & dados numéricos
[Mh] Termos MeSH secundário: Serviço Hospitalar de Emergência/economia
Serviço Hospitalar de Emergência/estatística & dados numéricos
Feminino
Preços Hospitalares/estatística & dados numéricos
Hospitalização/economia
Hospitalização/estatística & dados numéricos
Seres Humanos
Tempo de Internação/economia
Tempo de Internação/estatística & dados numéricos
Masculino
Meia-Idade
Alta do Paciente/economia
Alta do Paciente/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170816
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0182577


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[PMID]:28783225
[Au] Autor:de Vries EE; Baldew VGM; den Ruijter HM; de Borst GJ
[Ad] Endereço:Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
[Ti] Título:Meta-analysis of the costs of carotid artery stenting and carotid endarterectomy.
[So] Source:Br J Surg;104(10):1284-1292, 2017 Sep.
[Is] ISSN:1365-2168
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Carotid artery stenting (CAS) is currently associated with an increased risk of 30-day stroke compared with carotid endarterectomy (CEA), whereas both interventions seem equally durable beyond the periprocedural period. Although the clinical outcomes continue to be scrutinized, there are few data summarizing the costs of both techniques. METHODS: A systematic search was conducted in MEDLINE, Embase and Cochrane databases in August 2016 identifying articles comparing the costs or cost-effectiveness of CAS and CEA in patients with carotid artery stenosis. Combined overall effect sizes were calculated using random-effects models. The in-hospital costs were specified to gain insight into the main heads of expenditure associated with both procedures. RESULTS: The literature search identified 617 unique articles, of which five RCTs and 12 cohort studies were eligible for analysis. Costs of the index hospital admission were similar for CAS and CEA. Costs of the procedure itself were 51 per cent higher for CAS, mainly driven by the higher costs of devices and supplies, but were balanced by higher postprocedural costs of CEA. Long-term cost analysis revealed no difference in costs or quality of life after 1 year of follow-up. CONCLUSION: Hospitalization and long-term costs of CAS and CEA appear similar. Economic considerations should not influence the choice of stenting or surgery in patients with carotid artery stenosis being considered for revascularization.
[Mh] Termos MeSH primário: Estenose das Carótidas/cirurgia
Endarterectomia das Carótidas/economia
Custos Hospitalares
Stents/economia
[Mh] Termos MeSH secundário: Análise Custo-Benefício
Endarterectomia das Carótidas/efeitos adversos
Preços Hospitalares
Hospitalização/economia
Seres Humanos
Complicações Pós-Operatórias
Qualidade de Vida
Stents/efeitos adversos
Acidente Vascular Cerebral/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170830
[Lr] Data última revisão:
170830
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170808
[St] Status:MEDLINE
[do] DOI:10.1002/bjs.10649


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[PMID]:28754828
[Au] Autor:Dasenbrock HH; Angriman F; Smith TR; Gormley WB; Frerichs KU; Aziz-Sultan MA; Du R
[Ad] Endereço:From the Cushing Neurosurgical Outcomes Center, Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (H.H.D., T.R.S., W.B.G., K.U.F., M.A.A.-S., R.D.); and T. H. Chan School of Public Health, Harvard University, Boston, MA (H.H.D., F.A.).
[Ti] Título:Readmission After Aneurysmal Subarachnoid Hemorrhage: A Nationwide Readmission Database Analysis.
[So] Source:Stroke;48(9):2383-2390, 2017 Sep.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: The goal of this nationwide study is to evaluate the suitability of readmission as a quality indicator in the aneurysmal subarachnoid hemorrhage (SAH) population. METHODS: Patients with aneurysmal SAH were extracted from the Nationwide Readmission Database (2013). Multivariable Cox proportional hazard regression was used to evaluate predictors of a 30-day readmission, and multivariable linear regression was used to analyze the association of hospital readmission rates with hospital mortality rates. Predictors screened included patient demographics, comorbidities, severity of SAH, complications from the SAH hospitalization, and hospital characteristics. RESULTS: The 30-day readmission rate was 10.2% (n=346) among the 3387 patients evaluated, and the most common reasons for readmission were neurological, hydrocephalus, infectious, and venous thromboembolic complications. Greater number of comorbidities, increased severity of SAH, and discharge disposition other than to home were independent predictors of readmission ( ≤0.03). Although hydrocephalus during the SAH hospitalization was associated with readmission for the same diagnosis, other readmissions were not associated with having sustained the same complication during the SAH hospitalization. Hospital mortality rate was inversely associated with hospital SAH volume ( =0.03) but not significantly associated with hospital readmission rate; hospital SAH volume was also not associated with SAH readmissions. CONCLUSIONS: In this national analysis, readmission was primarily attributable to new medical complications in patients with greater comorbidities and severity of SAH rather than exacerbation of complications from the SAH hospitalization. Additionally, hospital readmission rates did not correlate with other established quality metrics. Therefore, readmission may be a suboptimal quality indicator in the SAH population.
[Mh] Termos MeSH primário: Aneurisma Roto/cirurgia
Procedimentos Endovasculares
Aneurisma Intracraniano/cirurgia
Microcirurgia
Readmissão do Paciente/estatística & dados numéricos
Hemorragia Subaracnóidea/cirurgia
[Mh] Termos MeSH secundário: Aneurisma Roto/complicações
Aneurisma Roto/epidemiologia
Comorbidade
Bases de Dados Factuais
Feminino
Número de Leitos em Hospital
Preços Hospitalares
Mortalidade Hospitalar
Seres Humanos
Hidrocefalia/epidemiologia
Seguro Saúde/estatística & dados numéricos
Aneurisma Intracraniano/complicações
Aneurisma Intracraniano/epidemiologia
Tempo de Internação/estatística & dados numéricos
Modelos Lineares
Masculino
Análise Multivariada
Modelos de Riscos Proporcionais
Indicadores de Qualidade em Assistência à Saúde
Ruptura Espontânea
Classe Social
Hemorragia Subaracnóidea/epidemiologia
Hemorragia Subaracnóidea/etiologia
Fatores de Tempo
Tromboembolia Venosa/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170730
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.016702



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