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Damle, Rachelle, and Karim Alavi. "The University Healthsystem Consortium clinical database: An emerging resource in colorectal surgery research." Seminars in Colon and Rectal Surgery 27, no. 2 (June 2016): 92–95. http://dx.doi.org/10.1053/j.scrs.2016.01.006.
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Sutton, J. M., A. J. Hayes, G. C. Wilson, R. C. Quillin, K. Wima, I. M. Paquette, J. J. Sussman, S. A. Ahmad, S. A. Shah, and D. E. Abbott. "Validation of the University HealthSystem Consortium Clinical Database: Concordance and Discordance with Patient-Level Institutional Data." Journal of Surgical Research 186, no. 2 (February 2014): 497. http://dx.doi.org/10.1016/j.jss.2013.11.081.
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Davenport, Daniel L., Clyde W. Holsapple, and Joseph Conigliaro. "Assessing Surgical Quality Using Administrative and Clinical Data Sets: A Direct Comparison of the University HealthSystem Consortium Clinical Database and the National Surgical Quality Improvement Program Data Set." American Journal of Medical Quality 24, no. 5 (July 7, 2009): 395–402. http://dx.doi.org/10.1177/1062860609339936.
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Hinojosa, Marcelo W., Viken R. Konyalian, Zuri A. Murrell, J. Esteban Varela, Michael J. Stamos, and Ninh T. Nguyen. "Outcomes of Right and Left Colectomy at Academic Centers." American Surgeon 73, no. 10 (October 2007): 945–48. http://dx.doi.org/10.1177/000313480707301002.
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Few studies have compared outcomes of right colectomy (RC) and left colectomy (LC) with respect to both benign and malignant disease. The objective of this study was to compare outcomes of RC versus LC for benign and malignant disease using a national administrative database of academic medical centers. Using International Classification of Diseases, 9th Revision diagnosis and procedure codes, data was obtained from the University HealthSystem Consortium Clinical Data Base for patients that underwent RC and LC for benign and malignant disease between 2002 and 2006. The main outcomes compared were demographics, length of hospital stay, observed to expected in-hospital mortality, complications, 30-day readmission, and mean cost. There were a total of 27,483 patients; 12,971 patients (47.2%) underwent RC. Compared with LC for benign disease, RC was associated with a shorter length of stay, lower overall complications, lower wound infections, lower 30-day readmissions, and lower cost. Compared with LC for malignant disease, RC was associated with lower overall complications, lower wound infections, and lower cost. In this analysis of academic centers, RC was associated with a lower length of stay, lower morbidity, and lower cost when compared with LC for benign and malignant disease.
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Ang, Darwin N., and Kevin E. Behrns. "Using a Relational Database to Improve Mortality and Length of Stay for a Department of Surgery: A Comparative Review of 5200 Patients." American Surgeon 79, no. 7 (July 2013): 706–10. http://dx.doi.org/10.1177/000313481307900715.
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The emphasis on high-quality care has spawned the development of quality programs, most of which focus on broad outcome measures across a diverse group of providers. Our aim was to investigate the clinical outcomes for a department of surgery with multiple service lines of patient care using a relational database. Mortality, length of stay (LOS), patient safety indicators (PSIs), and hospital-acquired conditions were examined for each service line. Expected values for mortality and LOS were derived from University HealthSystem Consortium regression models, whereas expected values for PSIs were derived from Agency for Healthcare Research and Quality regression models. Overall, 5200 patients were evaluated from the months of January through May of both 2011 (n = 2550) and 2012 (n = 2650). The overall observed-to-expected (O/E) ratio of mortality improved from 1.03 to 0.92. The overall O/E ratio for LOS improved from 0.92 to 0.89. PSIs that predicted mortality included postoperative sepsis (O/E:1.89), postoperative respiratory failure (O/E:1.83), postoperative metabolic derangement (O/E:1.81), and postoperative deep vein thrombosis or pulmonary embolus (O/E:1.8). Mortality and LOS can be improved by using a relational database with outcomes reported to specific service lines. Service line quality can be influenced by distribution of frequent reports, group meetings, and service line-directed interventions.
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Varelas, Panayiotis N., Dan Eastwood, Hyun J. Yun, Marianna V. Spanaki, Lotfi Hacein Bey, Christos Kessaris, and Thomas A. Gennarelli. "Impact of a neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit." Journal of Neurosurgery 104, no. 5 (May 2006): 713–19. http://dx.doi.org/10.3171/jns.2006.104.5.713.
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Object The aim of this study was to evaluate the impact of a newly appointed neurointensivist on outcomes in head-injured patients in the neurological/neurosurgical intensive care unit (NICU). Methods The mortality rate, length of stay (LOS), and discharge disposition of all patients with head trauma who had been admitted to a 10-bed tertiary care university hospital NICU were compared between two 19-month periods, before and after the appointment of a neurointensivist. Data regarding these patients were collected using the hospital database and the University HealthSystem Consortium (UHC) database. Samples of medical records were reviewed for Glasgow Coma Scale (GCS) score documentation. The authors analyzed data pertaining to 328 patients before and 264 after the neurointensivist's appointment. The unadjusted mean in-hospital mortality rate increased 1.1% in the after period, but this increase was significantly lower compared with the UHC-based expected increase of 8.1% in the mortality rate during the same period (p < 0.0001). The unadjusted mean mortality rate in the NICU decreased from 13.4 to 12.9% (relative mortality rate reduction 4%) and the mean NICU LOS increased from 3.1 to 3.6 days (relative NICU LOS increase 16%), both nonsignificantly. A 51% reduction in the NICU-associated mortality rate (p = 0.01), a 12% shorter hospital LOS (p = 0.026), and 57% greater odds of being discharged to home or to rehabilitation (p = 0.009) were found in the after period in multivariate models after controlling for baseline differences between the two time periods. Better documentation of the GCS score by the NICU team was also found in the after period (from 60.4 to 82%, p = 0.02). Conclusions The institution of a neurointensivist-led team model had an independent, positive impact on patient outcomes, including a lower NICU-associated mortality rate and hospital LOS, improved disposition, and better chart documentation.
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Carmichael, Joseph C., Hossein Masoomi, Steven Mills, Michael J. Stamos, and Ninh T. Nguyen. "Utilization of Laparoscopy in Colorectal Surgery for Cancer at Academic Medical Centers: Does Site of Surgery Affect Rate of Laparoscopy?" American Surgeon 77, no. 10 (October 2011): 1300–1304. http://dx.doi.org/10.1177/000313481107701005.
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Use of laparoscopy in colorectal cancer surgery is still limited. The aim of this study was to determine the rate of use of laparoscopic colorectal surgery for cancer at academic medical centers and to evaluate if the site of surgery influences the rate of use. Clinical data of patients who underwent laparoscopic or open colon and rectal resections for cancer from 2007 to 2009 were obtained from the University HealthSystem Consortium database. Data concerning rate of laparoscopy, length of stay, morbidity, and risk-adjusted mortality were obtained. During the 36-month study period, 22,780 operations were performed. The overall rate for use of laparoscopy was 14.8 per cent. Laparoscopy was most often used for total colectomy (22.6%), sigmoid colectomy (17.3%), cecectomy (17.1%), and right hemicolectomy (17.0%). Laparoscopy was most infrequently used for abdominoperineal resection (8.0%), transverse colectomy (10.0%), and left hemicolectomy (13.1%). Length of stay for laparoscopic colon and rectal procedures was 3.2 days shorter than for open surgery. Although the benefits of laparoscopic colorectal surgery for cancer have been demonstrated, the use of laparoscopy for colorectal resection remains under 20 per cent for colon cancer and under 10 per cent for rectal cancer. Further studies are needed to determine the factors limiting the use of laparoscopy in colorectal surgery.
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David, Michael Z., Sofia Medvedev, Samuel F. Hohmann, Bernard Ewigman, and Robert S. Daum. "Increasing Burden of Methicillin-Resistant Staphylococcus aureus Hospitalizations at US Academic Medical Centers, 2003–2008." Infection Control & Hospital Epidemiology 33, no. 8 (August 2012): 782–89. http://dx.doi.org/10.1086/666640.
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Objective.The incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in the United States decreased during 2005–2008, but noninvasive community-associated MRSA (CA-MRSA) infections also frequently lead to hospitalization. We estimated the incidence of all MRSA infections among inpatients at US academic medical centers (AMCs) per 1,000 admissions during 2003–2008.Design.Retrospective cohort study.Setting and Participants.Hospitalized patients at 90% of nonprofit US AMCs during 2003–2008.Methods.Administrative data on MRSA infections from a hospital discharge database (University HealthSystem Consortium [UHC]) were adjusted for underreporting of the MRSA V09.0 International Classification of Diseases, Ninth Revision, Clinical Modification code and validated using chart reviews for patients with known MRSA infections in 2004–2005, 2006, and 2007.Results.The mean sensitivity of administrative data for MRSA infections at the University of Chicago Medical Center in three 12-month periods during 2004–2007 was 59.1%. On the basis of estimates of billing data sensitivity from the literature and the University of Chicago Medical Center, the number of MRSA infections per 1,000 hospital discharges at US AMCs increased from 20.9 (range, 11.1–47.7) in 2003 to 41.7 (range, 21.9–94.0) in 2008. At the University of Chicago Medical Center, among infections cultured more than 3 days prior to hospital discharge, CA-MRSA infections were more likely to be captured in the UHC billing-derived data than were healthcare-associated MRSA infections.Conclusions.The number of hospital admissions for any MRSA infection per 1,000 hospital admissions overall increased during 2003–2008. Use of unadjusted administrative hospital discharge data or surveillance for invasive disease far underestimates the number of MRSA infections among hospitalized patients.
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Villamere, James, Alana Gebhart, Stephen Vu, and Ninh T. Nguyen. "Body Mass Index is Predictive of Higher In-hospital Mortality in Patients Undergoing Laparoscopic Gastric Bypass but Not Laparoscopic Sleeve Gastrectomy or Gastric Banding." American Surgeon 80, no. 10 (October 2014): 1039–43. http://dx.doi.org/10.1177/000313481408001028.
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High body mass index (BMI) has been shown to be a factor predictive of increased morbidity and mortality in several single-institution studies. Using the University HealthSystem Consortium clinical database, we examined the impact of BMI on in-hospital mortality for patients who underwent laparoscopic gastric bypass, sleeve gastrectomy, and gastric banding between October 2011 and February 2014. Outcomes were examined within each procedure according to BMI groups of 35 to 49.9, 50.0 to 59.9, and 60.0 kg/m2 or greater. Outcome measures included in-hospital mortality, major complications, length of hospital stay, 30-day readmission, and cost. A total of 40,102 bariatric procedures were performed during this time period. For gastric bypass, there was an increase of in-hospital mortality (0.01 and 0.02 vs 0.34%; P < 0.01) and major complications (0.93 and 0.99 vs 2.62%; P < 0.01) in the BMI 60 kg/m2 or greater group. In contrast, sleeve gastrectomy and gastric banding had no association between BMI and rates of mortality and major complications. Cost increased with increasing BMI groups for all procedures. A strong association was found between BMI 60 kg/m2 or greater and higher in-hospital mortality and major complication rates for patients who underwent laparoscopic gastric bypass but not in patients who underwent sleeve gastrectomy or gastric banding.
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Jacob, R. Lorie, Jonah Geddes, Shirley McCartney, and Kim J. Burchiel. "Cost analysis of awake versus asleep deep brain stimulation: a single academic health center experience." Journal of Neurosurgery 124, no. 5 (May 2016): 1517–23. http://dx.doi.org/10.3171/2015.5.jns15433.
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OBJECT The objective of this study was to compare the cost of deep brain stimulation (DBS) performed awake versus asleep at a single US academic health center and to compare costs across the University HealthSystem Consortium (UHC) Clinical Database. METHODS Inpatient and outpatient demographic and hospital financial data for patients receiving a neurostimulator lead implant (from the first quarter of 2009 to the second quarter of 2014) were collected and analyzed. Inpatient charges included those associated with International Classification of Diseases, Ninth Revision (ICD-9) procedure code 0293 (implantation or replacement of intracranial neurostimulator lead). Outpatient charges included all preoperative charges ≤ 30 days prior to implant and all postoperative charges ≤ 30 days after implant. The cost of care based on reported charges and a cost-to-charge ratio was estimated. The UHC database was queried (January 2011 to March 2014) with the same ICD-9 code. Procedure cost data across like hospitals (27 UHC hospitals) conducting similar DBS procedures were compared. RESULTS Two hundred eleven DBS procedures (53 awake and 158 asleep) were performed at a single US academic health center during the study period. The average patient age ( ± SD) was 65 ± 9 years old and 39% of patients were female. The most common primary diagnosis was Parkinson’s disease (61.1%) followed by essential and other forms of tremor (36%). Overall average DBS procedure cost was $39,152 ± $5340. Asleep DBS cost $38,850 ± $4830, which was not significantly different than the awake DBS cost of $40,052 ± $6604. The standard deviation for asleep DBS was significantly lower (p ≤ 0.05). In 2013, the median cost for a neurostimulator implant lead was $34,052 at UHC-affiliated hospitals that performed at least 5 procedures a year. At Oregon Health & Science University, the median cost was $17,150 and the observed single academic health center cost for a neurostimulator lead implant was less than the expected cost (ratio 0.97). CONCLUSIONS In this single academic medical center cost analysis, DBS performed asleep was associated with a lower cost variation relative to the awake procedure. Furthermore, costs compared favorably to UHC-affiliated hospitals. While asleep DBS is not yet standard practice, this center exclusively performs asleep DBS at a lower cost than comparable institutions.
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Gillum, Leslie A., and S. Claiborne Johnston. "Are Outcomes of Ischemic Strokes Improved When a Neurologist is Attending?" Stroke 32, suppl_1 (January 2001): 383. http://dx.doi.org/10.1161/str.32.suppl_1.383.
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P239 BACKGROUND: Whether admission of stroke patients to neurologists is associated with improved outcomes is uncertain. Though prior studies suggested ischemic stroke patients under the care of neurologists had lower rates of in-hospital mortality than those treated by internists, these studies were uncontrolled for the possibility that patients with better prognosis were admitted to neurologists. METHODS: The University HealthSystem Consortium administrative database contains patient information from 84 large academic health centers and associates. Discharge abstracts for ischemic strokes admitted through emergency rooms 1997–1999 were obtained. Database variables were validated by comparison with a detailed chart review of 927 patients at 36 institutions. Attending physician specialty was evaluated as a predictor of in-hospital mortality using chi-square statistics and multivariable logistic regression. To determine whether hospital rates of stroke admission to neurologists were predictive of in-hospital mortality, generalized estimating equations (GEE) were used. This multivariable method accounts for clustering of observations at institutions, which broadens confidence intervals (CI). All multivariable analyses were adjusted for age, gender, race, admission status, and treatment volume. RESULTS: Of 28,571 ischemic strokes admitted through the emergency department, 58% were admitted to neurologists. Univariate analyses demonstrated a lower risk of in-hospital mortality in cases admitted to neurologist (4.7%) compared to non-neurologists (9.4%; p<0.001). Adjustment for case-mix did not alter the association (odds ratio, 0.48; 95% CI, 0.43–0.53; p<0.001). However, risk of death was not lower at hospitals admitting a larger portion of ischemic stroke cases to neurologists (p=0.54) as would be expected if admission to neurologists led to improved outcomes. CONCLUSIONS: In academic medical centers, ischemic stroke patients admitted to neurologists are less likely to die in the hospital compared to those admitted to other services. However, this may be due to selection of patients with better prognosis for admission to neurologists.
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Khorana, Alok A., Charles W. Francis, Eva Culakova, Richard I. Fisher, Nicole M. Kuderer, and Gary H. Lyman. "Thromboembolism in Hospitalized Neutropenic Cancer Patients." Journal of Clinical Oncology 24, no. 3 (January 20, 2006): 484–90. http://dx.doi.org/10.1200/jco.2005.03.8877.
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Purpose Cancer is associated with thrombosis, but the frequency of thromboembolism in hospitalized cancer patients receiving current chemotherapy regimens is not known. We investigated venous and arterial thromboembolism and associated outcomes in hospitalized cancer patients actively receiving therapy, as identified by neutropenia. Methods We conducted a retrospective cohort study using the discharge database of the University HealthSystem Consortium. This included 66,106 adult neutropenic cancer patients with 88,074 hospitalizations between 1995 and 2002 at 115 medical centers in the United States. Results Thromboembolism was reported in 5,272 patients (8%), with 5.4% patients developing venous thromboembolism and 1.5% developing arterial thromboembolism during the first hospitalization. Patients with lymphoma and leukemia accounted for one third of venous and nearly one half of arterial events. Clinical variables most frequently associated with thromboembolism were age ≥ 65 years; primary site of cancer, including lung, GI, gynecologic, and brain; and comorbidities, including infection, pulmonary and renal disease, and obesity. In-hospital mortality was significantly greater in patients with venous (odds ratio [OR] = 2.01; 95% CI, 1.83 to 2.22) or arterial thromboembolism (OR = 5.04; 95% CI, 4.38 to 5.79). From 1995 to 2002, there was a 36% increase in venous events and a 124% increase in arterial events (P < .0001 for trend). Conclusion Thromboembolism is frequent in hospitalized neutropenic cancer patients, including in perceived low-risk subgroups such as patients with hematologic malignancies and nonmetastatic disease, and seems to be increasing. Thromboembolism is associated with increased in-hospital mortality. Increased efforts at thromboprophylaxis are warranted.
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Young, Donald S., Bruce S. Sachais, and Leigh C. Jefferies. "Effect of Disease Complications on Hospital Costs." Clinical Chemistry 48, no. 1 (January 1, 2002): 140–49. http://dx.doi.org/10.1093/clinchem/48.1.140.
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Abstract Background: To test the hypothesis that complications increase the use of resources in managing patients in hospitals, we examined the costs of managing patients with the same disease with and without complications. Methods: We used a database developed by the University HealthSystems Consortium that contains the costs of managing more than 1 million patients in 60 University hospitals. We created a simplified database of the costs of 457 445 patients in 111-paired diagnosis-related groups (DRGs) that were classified as either having or not having complications and/or comorbidities. Costs were calculated from the ratio of costs to charges within the individual hospitals. Results: The median costs of managing patients with complications were higher than those for managing patients without complications, confirming the appropriateness of the dual classification. Notably, these extra costs were largely incurred through increased length of stay. Of note, the cost per day for DRGs with complications and/or comorbidities was most often less than that for the corresponding uncomplicated conditions. Although accommodation costs generally were the largest single component of total costs for both complicated and uncomplicated conditions, in only 31 DRGs (15 with complications, 16 without) did they account for more than one-half the total costs. Laboratory and drug costs were higher for complicated conditions, but as a proportion of total costs were comparable for complicated and uncomplicated conditions. Conclusions: Complications in patients are associated with increased hospital costs, although the costs per day of hospitalization are often less than in patients without such complications.
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Young, Donald S., Bruce S. Sachais, and Leigh C. Jefferies. "Laboratory Costs in the Context of Disease." Clinical Chemistry 46, no. 7 (July 1, 2000): 967–75. http://dx.doi.org/10.1093/clinchem/46.7.967.
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Abstract Background: To determine the contribution of laboratory costs to the overall costs of managing hospital patients with different diseases, we studied the costs of laboratory testing overall and in relation to the other costs incurred during hospitalization. Methods: We used a database developed by the University HealthSystems Consortium containing >1 million patients in 60 University Hospitals with diseases included in 486 diagnosis-related groups (DRGs). Laboratory costs included in the database comprised those associated with testing in the clinical laboratory together with those incurred in point-of-care testing and anatomic pathology but not those involving blood products and their transfusion. Results: The mean laboratory costs to manage surgical patients were greater than those to manage medical patients in 19 of the 25 major diagnostic categories. The median laboratory costs for patients with liver transplants exceeded $8000, and the laboratory costs to support other organ transplants were among the highest. The highest proportion of total costs attributable to the laboratory was 18.3% for acute leukemia and kidney and urinary tract signs and symptoms, both in children. Laboratory costs were <1.0% of the total costs for only 15 DRGs. The highest median daily laboratory cost, $416, was attributable to liver transplant patients. Several conditions had median laboratory costs less than $30 per day, in spite of lengths of stay that exceeded 10 days in some cases. Conclusions: Although laboratory costs generally average 6% of the total costs for surgical conditions and 9% of the total costs for medical conditions, there is considerable variability. In general, laboratory costs were relatively poorly correlated with total costs. However, observation of high daily laboratory costs for many DRGs suggests that reducing length of stay would reduce both laboratory and total costs.
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Young, Donald S., Bruce S. Sachais, and Leigh C. Jefferies. "The Costs of Disease." Clinical Chemistry 46, no. 7 (July 1, 2000): 955–66. http://dx.doi.org/10.1093/clinchem/46.7.955.
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Abstract Background: To date there have been no studies identifying and comparing the component costs to treat a large number of diseases for hospitalized inpatients. Methods: Hospital costs were analyzed for 486 diagnosis-related groups (DRGs) relating to >1.3 million patient discharges from 60 University Hospital members of the University HealthSystems Consortium. For each DRG, length of stay, total cost, and key cost components were analyzed, including accommodation, intensive care, and surgery. Results: In general, total costs of diseases classified as surgical exceeded those classified as medical. Diseases involving organ transplantation typically cost more than other diseases. However, within the studied population, the two DRGs accounting for most total healthcare dollars were percutaneous cardiovascular procedures and management of neonates with immaturity or respiratory failure. Conclusions: Considering six key cost components, as well as disease complexity and length of stay, the best predictors of total costs for medical conditions were the length of stay and accommodation (housing, meals, nursing services) costs, whereas for surgical conditions, the best predictor of total costs was laboratory costs. This analysis may be used within an individual institution to identify surgical or medical diagnoses with total or component costs at variance with the group mean. A hospital may focus its cost reduction efforts to make decisions to expand, alter, or eliminate particular clinical programs based on comparison of its own total and component costs with those from other hospitals in the database.
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Hammers, Ronald, Susan Anzalone, James Sinacore, and Thomas C. Origitano. "Neurosurgical mortality rates: what variables affect mortality within a single institution and within a national database?" Journal of Neurosurgery 112, no. 2 (February 2010): 257–64. http://dx.doi.org/10.3171/2009.6.jns081235.
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Object Mortality rate is a common outcome measure used by patients, families, physicians, insurers, and health care policy makers to evaluate and measure the quality of health care. The mortality index is a heavily used metric to measure survival, and is a key indicator in hospital report cards and national rankings. The significance of this metric is belied by the literature, which fails to accurately detail the overall mortality rate within the neurosurgical population. Given that there is no gold standard that can be used as a baseline, it is difficult to make durable interinstitutional comparisons concerning performance. In Part I of this paper, the authors examined an academic neurosurgical program's mortality rate and the effect of certain variables on this rate. In Part II, they assumed a broader perspective, examining a group of institutions, the University HealthSystem Consortium (UHC) Clinical Database/Resource Manager, and identifying factors that may be responsible for variability in the mortality index between hospitals. Methods Over a 36-month period, the authors' neurosurgical service performed 3650 procedures. Monthly “mortality and morbidity” conference logs were reviewed to collect information on the number of deaths. Deaths were classified according to elective or nonelective admission status. Additionally, the authors reviewed the UHC Clinical Database/Resource Manager for information regarding mortality rates in various other neurosurgical programs. These data reflected a 12-month period. Comparisons of hospital mortality indices were based on the percentage of transferred patients (both emergency department [ED] and inpatient), whether a hospital was a designated Level 1 trauma center, whether a hospital was designated a certified stroke center, and also based on the number of Medicaid patients treated. Results Sixty-two patients met the criteria to be considered neurosurgery-related deaths at the authors' institution (1.7% of all cases): 9 elective admissions (15%), 3 nonelective direct admissions (5%), 24 transfer patients (39%), and 26 ED admissions (42%). Causes of death included trauma (40%), stroke (33%), tumor (14%), spinal disease (8%), and infection (6%). Evaluation of the UHC data revealed that a mortality index of ≥ 1.00 was seen in the following hospital types: trauma centers, hospitals with 11–20% Medicaid patients, and those with > 50,000 ED admissions. A nonstatistically significant trend toward increasing mortality rates was seen in hospitals with a lower percentage of elective neurosurgical cases, in Level 1 trauma centers, and in hospitals that were not certified stroke centers. Significance was seen in comparisons of hospitals with the highest and lowest mortality index quartiles in the following groups: trauma centers, hospitals with > 10% Medicaid patients, and hospitals with a high number of ED visits. Conclusions Many variables appear to impact the mortality rate within the neurosurgical population. The authors' observations have illuminated some of the reasons why: the data are elusive, documentation is variable, and the modes of statistical analysis are questionable. The first step in addressing this issue is to identify that there is a problem. The authors believe that this study has done so. Presently there is no definitive or reliable source for rating the quality of overall neurosurgical care, nor is there a good and complete source for understanding the quality of neurosurgical care in the US. It is important to view these results as the initial steps to a better understanding of patient outcomes, their measures, and their impact on neurosurgical practice.
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Young, Donald S., Bruce S. Sachais, and Leigh C. Jefferies. "Comparative Costs of Treating Adults and Children within Selected Diagnosis-related Groups." Clinical Chemistry 48, no. 1 (January 1, 2002): 150–60. http://dx.doi.org/10.1093/clinchem/48.1.150.
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Abstract Background: There have been no large-scale analyses of resource utilization comparing the overall costs to treat pediatric patients vs adult patients. Likewise, there have been no studies evaluating the costs of the various components of hospitalization (e.g., accommodation, laboratory, radiology, and drugs) among adult and pediatric populations. Methods: To study the effect of age on the costs of treating patients, we have evaluated 43 conditions with matching diagnosis-related groups (DRGs) for children and adults. Using a database developed by the University HealthSystems Consortium, we examined the major non-physician components of hospital costs, including accommodation, surgery, pharmacy, radiology, and laboratory for 1 346 028 patient admissions to 60 University hospitals. These costs were derived from the ratio of costs to charges based on the Centers for Medicare and Medicaid Services PPS UB-2 cost reports. Results: The total non-physician cost of treating adults was generally greater than that for children within paired DRGs. Some of this difference may be attributable to the overall longer stay of adults in hospital. For conditions that were nominally the same, radiology, laboratory, and drug costs, especially tended to be higher for adults than for children. This was most marked when the costs were evaluated on a per diem basis. There tended to be greater variability in the costs of treating children than adults within the paired DRGs, as evidenced by greater differences between the median and mean costs. Conclusions: Among University hospitals, the costs of managing children are typically less than for adults with the same nominal condition. In these hospitals, there tends to be less use of laboratory, radiology, and pharmacy services for children than for adults.
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Fennell, Vernard S., Nikolay L. Martirosyan, Sheri K. Palejwala, G. Michael Lemole, and Travis M. Dumont. "Morbidity and mortality of patients with endovascularly treated intracerebral aneurysms: does physician specialty matter?" Journal of Neurosurgery 124, no. 1 (January 2016): 13–17. http://dx.doi.org/10.3171/2014.11.jns141030.
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OBJECT Endovascular treatment of cerebrovascular pathology, particularly aneurysms, is becoming more prevalent. There is a wide variety in clinical background and training of physicians who treat cerebrovascular pathology through endovascular means. The impact of clinical training background on patient outcomes is not well documented. METHODS The authors conducted a retrospective analysis of a large national database, the University HealthSystem Consortium, that was queried in the years 2009–2013. Cases of both unruptured cerebral aneurysms and subarachnoid hemorrhage treated by endovascular obliteration were studied. Outcome measures of morbidity and mortality were evaluated according to the specialty of the treating physician. RESULTS Elective embolization of an unruptured aneurysm was the procedure code and primary diagnosis, respectively, for 12,400 cases. Patients with at least 1 complication were reported in 799 cases (6.4%). Deaths were reported in 193 cases (1.6%). Complications and deaths were varied by specialty; the highest incidence of complications (11.1%) and deaths (3.0%) were reported by neurologists. The fewest complications were reported by neurosurgeons (5.4%; 1.4% deaths), with a higher incidence of complications reported in cases performed by neurologists (p < 0.0001 for both complications and deaths) and to a lesser degree interventional radiologists (p = 0.0093 for complications). Subarachnoid hemorrhage was the primary diagnosis and procedure for 8197 cases. At least 1 complication was reported in 2385 cases (29%) and deaths in 983 cases (12%). The number of complications and deaths varied among specialties. The highest incidence of complications (34%) and deaths (13.5%) in subarachnoid hemorrhage was in cases performed by neurologists. The fewest complications were in cases by neurosurgeons (27%), with a higher incidence of complications in cases performed by neurologists (34%, p < 0.0001), and a trend of increased complications with interventional radiologists (30%, p < 0.0676). The lowest incidence of mortality was in cases performed by neurosurgeons (11.5%), with a significantly higher incidence of mortality in cases performed by neurologists (13.5%, p = 0.0372). Mortality rates did not reach statistical significance with respect to interventional radiologists (12.1%, p = 0.4884). CONCLUSIONS Physicians of varied training types and backgrounds use endovascular treatment of ruptured and unruptured intracerebral aneurysms. In this study there was a statistically significant finding that neurosurgically trained physicians may demonstrate improved outcomes with respect to endovascular treatment of unruptured aneurysms in this cohort. This finding warrants further investigation.
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Khorana, Alok A., Charles W. Francis, Eva Culakova, Richard I. Fisher, Nicole Kuderer, and Gary H. Lyman. "Thromboembolism in Hospitalized Neutropenic Cancer Patients." Blood 104, no. 11 (November 16, 2004): 2199. http://dx.doi.org/10.1182/blood.v104.11.2199.2199.
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Abstract Background: Cancer is associated with thrombosis, but the frequency of thromboembolism in hospitalized cancer patients receiving contemporary chemotherapy regimens is not known. We investigated the frequency of arterial and venous thromboembolism in hospitalized cancer patients receiving active therapy (as identified by the presence of neutropenia) and characterized its association with in-hospital mortality. Methods: We conducted a retrospective cohort study using the discharge database of the University HealthSystem Consortium. This included 66,106 adult neutropenic cancer patients with 88,074 hospitalizations between 1995 and 2002 at 115 academic medical centers. Patients were identified using ICD-9-CM codes that contained at least one diagnosis of malignant disease and agranulocytosis. Patients with thromboembolism were identified using codes for venous thrombosis, pulmonary embolism, arterial embolism, acute cerebrovascular disease, and acute coronary arterial disease. The association of VTE with clinical variables was studied in univariate analysis and in a multivariate logistic regression model. The chi-square test was used to compare categorical variables, and Cochran-Armitage test to determine trend. Results: Thromboembolism was reported in 5,272 patients (8%), with 5.4% patients developing venous and 1.5% arterial thromboembolism during the first hospitalization. There was a significant association between the occurrence of venous and arterial thromboembolism (OR 1.73, 95%CI, 1.38–2.16). Venous thromboembolism was more frequent in patients with metastatic disease (OR, 1.23, 95% CI 1.13–1.34), but arterial thromboembolism was not (OR, 0.59, 95% CI, 0.51–0.69). In-hospital mortality was significantly greater in patients with venous (OR 2.01, 95% CI 1.83– 2.22) or arterial thromboembolism (OR 5.04, 95% CI, 4.38–5.79), even in patients without metastatic disease. Patients with lymphoma or leukemia accounted for one-third of venous events and one-half of arterial events. Clinical variables most frequently associated with thromboembolism in a multivariate logistic regression analysis were age ≥ 65 years, primary sites of cancer including lung, gastrointestinal, gynecologic and brain, length of stay ≥ 10 days, and comorbidities including infection, pulmonary and renal disease, and obesity. From 1995 to 2002, there was a 36% increase in venous and a 124 % increase in arterial events (P for trend <0.0001) (see Figure). Conclusions: The incidence of thromboembolism is high across all cancer subgroups including patients with hematologic malignancies and with non-metastatic disease, commonly perceived to be at lower risk for thromboembolism. Of particular concern is the increasing frequency of venous and arterial thromboembolism. Prospective studies are necessary to characterize the risks and benefits of thromboprophylaxis in this patient population. Figure Figure
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Iannuzzi, Michael C., James C. Iannuzzi, Andrew Holtsbery, Stuart M. Wright, and Stephen J. Knohl. "Comparing Hospitalist-Resident to Hospitalist-Midlevel Practitioner Team Performance on Length of Stay and Direct Patient Care Cost." Journal of Graduate Medical Education 7, no. 1 (March 1, 2015): 65–69. http://dx.doi.org/10.4300/jgme-d-14-00234.1.
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Abstract Background A perception exists that residents are more costly than midlevel providers (MLPs). Since graduate medical education (GME) funding is a key issue for teaching programs, hospitals should conduct cost-benefit analyses when considering staffing models. Objective Our aim was to compare direct patient care costs and length of stay (LOS) between resident and MLP inpatient teams. Methods We queried the University HealthSystems Consortium clinical database (UHC CDB) for 13 553 “inpatient” discharges at our institution from July 2010 to June 2013. Patient assignment was based on bed availability rather than “educational value.” Using the UHC CDB data, discharges for resident and MLP inpatient teams were compared for observed and expected LOS, direct cost derived from hospital charges, relative expected mortality (REM), and readmissions. We also compared patient satisfaction for physician domain questions using Press Ganey data. Bivariate analysis was performed for factors associated with differences between the 2 services using χ2 analysis and Student t test for categorical and continuous variables, respectively. Results During the 3-year period, while REM was higher on the hospitalist-resident services (P < .001), LOS was shorter by 1.26 days, and per-patient direct costs derived from hospital charges were lower by $617. Patient satisfaction scores for the physician-selected questions were higher for resident teams. There were no differences in patient demographics, daily discharge rates, readmissions, or deaths. Conclusions Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. The findings offer guidance when considering GME costs and inpatient staffing models.
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Amin, Beejal Y., Tsung-Hsi Tu, William W. Schairer, Lumine Na, Steven Takemoto, Sigurd Berven, Vedat Deviren, Christopher Ames, Dean Chou, and Praveen V. Mummaneni. "Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets." Journal of Neurosurgery: Spine 18, no. 2 (February 2013): 134–38. http://dx.doi.org/10.3171/2012.10.spine12559.
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Object Administrative databases are increasingly being used to establish benchmarks for quality of care and to compare performance across peer hospitals. As proposals for accountable care organizations are being developed, readmission rates will be increasingly scrutinized. The purpose of the present study was to assess whether the all-cause readmissions rate appropriately reflects the University of California, San Francisco (UCSF) Medical Center hospital's clinically relevant readmission rate for spine surgery patients and to identify predictors of readmission. Methods Data for 5780 consecutive patient encounters managed by 10 spine surgeons at UCSF Medical Center from October 2007 to June 2011 were abstracted from the University HealthSystem Consortium (UHC) using the Clinical Data Base/Resource Manager. Of these 5780 patient encounters, 281 patients (4.9%) were rehospitalized within 30 days of the previous discharge date. The authors performed an independent chart review to determine clinically relevant reasons for readmission and extracted hospital administrative data to calculate direct costs. Univariate logistic regression analysis was used to evaluate possible predictors of readmission. The two-sample t-test was used to examine the difference in direct cost between readmission and nonreadmission cases. Results The main reasons for readmission were infection (39.8%), nonoperative management (13.4%), and planned staged surgery (12.4%). The current all-cause readmission algorithm resulted in an artificially high readmission rate from the clinician's point of view. Based on the authors' manual chart review, 69 cases (25% of the 281 total readmissions) should be excluded because 39 cases (13.9%) were planned staged procedures; 16 cases (5.7%) were unrelated to spine surgery; and 14 surgical cases (5.0%) were cancelled or rescheduled at index admission due to unpredictable reasons. When these 69 cases are excluded, the direct cost of readmission is reduced by 29%. The cost variance is in excess of $3 million. Predictors of readmission were admission status (p < 0.0001), length of stay (p = 0.0001), risk of death (p < 0.0001), and age (p = 0.021). Conclusions The authors' findings identify the potential pitfalls in the calculation of readmission rates from administrative data sets. Benchmarking algorithms for defining hospitals' readmission rates must take into account planned staged surgery and eliminate unrelated reasons for readmission. When this is implemented in the calculation method, the readmission rate will be more accurate. Current tools overestimate the clinically relevant readmission rate and cost.
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Hatch, Jonathan L., Michael J. Bauschard, Shaun A. Nguyen, Paul R. Lambert, Ted A. Meyer, and Theodore R. McRackan. "Malignant Otitis Externa Outcomes: A Study of the University HealthSystem Consortium Database." Annals of Otology, Rhinology & Laryngology 127, no. 8 (July 2, 2018): 514–20. http://dx.doi.org/10.1177/0003489418778056.
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Objective: To characterize factors that affect outcomes for patients with malignant otitis externa (MOE). Methods: Retrospective review of inpatients with MOE was performed. Patient demographics, comorbid conditions, complications, procedures, and mortalities were analyzed. Results: A total of 786 patients with MOE were identified. The mean hospitalization length of stay (LOS) was 18.6 days (SD = 19.7). The overall mortality rate was 2.5% (n = 20), and complication rate was 4.3% (n = 34). Increasing age significantly and positively correlated with the incidence of MOE (r = 0.979, P < .0001). Factors that were associated with an increased rate of mortality were sepsis (odds ratio [OR] = 18.5; ES = 0.94; 95% CI, 0.47-1.42), congestive heart failure (OR = 3.1; ES = 0.42; 95% CI, 0.02-0.82), weight loss (OR = 10.2; ES = 1.23; 95% CI, 0.61-1.85), and coagulopathy (OR = 8.8; ES = 1.84; 95% CI, 0.91-2.77). Surgical intervention was performed in 19.2% (n = 151) of patients. Facial nerve involvement was present in 15.5% (n = 122) of patients and was associated with a significantly longer LOS of 12.9 days (SD = 19.6; ES = 0.21; 95% CI, 0.03-0.41). Conclusions: This large multi-institutional database study of MOE demonstrates that several patient factors impact the LOS and mortality. Patients at risk for unfavorable outcomes include the elderly, male gender, comorbidities, or cranial nerve involvement.
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Marino, Matthew, Horace Spencer, Sam Hohmann, Donald Bodenner, and Brendan C. Stack. "Costs of Outpatient Thyroid Surgery from the University HealthSystem Consortium (UHC) Database." Otolaryngology–Head and Neck Surgery 150, no. 5 (February 4, 2014): 762–69. http://dx.doi.org/10.1177/0194599814521583.
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Eldar-Lissai, Adi, Leon E. Cosler, and Gary H. Lyman. "Economic Analysis of Prophylactic Pegfilgrastim in Cancer Patients Receiving Chemotherapy." Blood 104, no. 11 (November 16, 2004): 2212. http://dx.doi.org/10.1182/blood.v104.11.2212.2212.
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Abstract Introduction: Neutropenia and its complications are major dose-limiting toxicities of systemic cancer chemotherapy. Febrile neutropenia (FN) generally prompts immediate hospitalization for evaluation and empiric broad-spectrum antibiotics adding to the cost of cancer care. Randomized controlled trials (RCTs) have demonstrated that prophylactic recombinant granulocyte colony-stimulating factor (rG-CSF; filgrastim) is capable of reducing the risk of FN, infection related mortality (IRM) and duration of hospitalization associated with FN. In the absence of compelling clinical indications, current guidelines support the use of prophylactic G-CSF only when using regimens associated with FN risk of 40% or higher. While recent RCTs have demonstrated that a long acting, pegylated form (pegfilgrastim) is at least as effective and safe as filgrastim, its economic impact has received little study. Methods: An economic analysis was conducted comparing prophylactic pegfilgrastim to no prophylactic growth factor in patients receiving systemic chemotherapy. Direct medical cost estimates (US$ 2002) were obtained from the University HealthSystem Consortium and Marketscan databases. Pegfilgrastim costs were based on the average wholesale Red Book© prices. Risk and efficacy estimates were based on recent RCTs and meta-analysis of prophylactic rG-CSF. Sensitivity analyses and estimation of cost neutral thresholds for the range of feasible values of all variables were conducted based on cost-minimization. Results: Under baseline conditions (FN= 17%; RRR=0.941), an incremental cost savings with pegfilgrastim of $428 was estimated. At baseline, a cost neutral threshold for FN risk of 14.6% was estimated with an expected cost for either strategy of $2721. Sensitivity analysis demonstrates a baseline threshold for RRR of 0.74 with lower rates of RRR supported by increasing hospital cost or length of stay, increasing infection-related mortality or incorporation of indirect costs. Threshold estimates for FN risk were robust over all possible values assumed for RRR of infection related mortality. The FN risk threshold falls below 10% when hospitalization cost per day exceeds $3000. Further results, including a Monte-Carlo simulation will be presented. Conclusions: Incorporation of recent RCTs and cost data into clinically relevant models demonstrates that pegfilgrastim is cost saving at levels of FN risk associated with common chemotherapy regimens (< 20%). Primary prophylaxis with pegfilgrastim should be considered in patients being treated for curative intent with moderately myelosuppressive regimens.
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Behrns, Kevin E., Darwin Ang, Huazi Liu, Steven J. Hughes, Holly Creel, Millie Russin, and Timothy C. Flynn. "Faculty Clinical Quality Goals Drive Improvement in University HealthSystem Consortium Outcome Measures." American Surgeon 78, no. 7 (July 2012): 749–54. http://dx.doi.org/10.1177/000313481207800712.
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Mortality, length of stay (LOS), patient safety indicators (PSIs), and hospital-acquired conditions (HACs) are routinely reported by the University HealthSystem Consortium (UHC) to measure quality at academic health centers. We hypothesized that a clinical quality measurable goal assigned to individual faculty members would decrease UHC measures of mortality, LOS, PSIs, and HACs. For academic year (AY) 2010–2011, faculty members received a clinical quality goal related to mortality, LOS, PSIs, and HACs. The quality metric constituted 25 per cent of each faculty member's annual evaluation clinical score, which is tied to compensation. The outcomes were compared before and after goal assignment. Outcome data on 6212 patients from AY 2009–2010 were compared with 6094 patients from AY 2010–2011. The mortality index (0.89 vs 0.93; P = 0.73) was not markedly different. However, the LOS index decreased from 1.01 to 0.97 ( P = 0.011), and department-wide PSIs decreased significantly from 285 to 162 ( P = 0.011). Likewise, HACs decreased from 54 to 18 ( P = 0.0013). Seven (17.9%) of 39 faculty had quality grades that were average or below. Quality goals assigned to individual faculty members are associated with decreased average LOS index, PSIs, and HACs. Focused, relevant quality assignments that are tied to compensation improve patient safety and outcomes.
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Halpern, Anna B., Eva Culakova, Roland B. Walter, and Gary H. Lyman. "Risk Factors, Mortality, and Costs of Adults with Acute Myeloid Leukemia (AML) Admitted to the Intensive Care Unit (ICU): A Longitudinal Cohort Study." Blood 126, no. 23 (December 3, 2015): 531. http://dx.doi.org/10.1182/blood.v126.23.531.531.
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Abstract BACKGROUND: The survival expectations of adults with AML have significantly improved over the last 4 decades, partly due to supportive care advancements that have enabled the delivery of increasingly intensive treatment modalities. Even today, however, mortality is high and long-term sequelae are substantial for adults with AML if ICU support becomes necessary. Thus far, information on risk factors for ICU admission and subsequent outcomes in these patients largely stems from small, single-institution studies. Additionally, existing studies have not focused on resource utilization or cost. We therefore utilized the University HealthSystem Consortium (UHC) database to examine risk factors, length of stay (LOS), mortality, and cost associated with ICU admission for adults with AML hospitalized in centers across the United States (U.S.) over a 9-year period. METHODS: A longitudinal discharge database derived from 239 U.S. UHC participating hospitals was used to retrospectively study adults with AML hospitalized between 2004 and 2012. Clinical data from discharge summaries from each hospital was extracted by certified coders and cost data from all payers was analyzed. This data was then merged to create the central UHC database. To identify the patient population of interest, we developed inclusion criteria based on ICD-9 CM code information. To be included, patient claims had to contain a diagnosis of active AML. Patients were excluded if their disease was in remission or if they had undergone a hematopoietic stem cell transplant. For those with >1 admission during the observation period, one hospitalization was selected randomly for analysis. Primary outcomes included total hospitalization duration, ICU admission and LOS, mortality, and cost (adjusted to 2014 dollars). Independent variables included age, gender, race, year of hospitalization, geographic location, hospital size, comorbidities (e.g. cardiac disease, thrombosis), and types of infectious complications. For binary outcomes, risk categories were compared using unadjusted odds ratios (ORs). Data are presented as means, proportions, or ORs followed by their 95% confidence intervals. RESULTS: 43,334 hospitalized adult patients with AML were identified. The mean age was 59 years and 41.3% were age ≥65. 54.9% were male, 73.0% Caucasian, 9.6% Black, 4.9% Hispanic, 2.6% Asian, and 9.9% other/unknown. Overall, 26.0% of patients were admitted to the ICU during their hospitalization with a mean ICU LOS of 9.3 days (9.1-9.6). Risk factors for ICU admission included black race (OR=1.2 [1.12-1.29]), hospitalization in the South (OR=1.58 [1.50-1.66]), ≥1 comorbidity (OR=3.61 [3.37-3.86]), and diagnosis of invasive fungal infection (OR=2.35 [2.14-2.59]; p<.0001 for all factors). Overall in-hospital mortality was 17.9% (17.5-18.3%), but was significantly higher for patients requiring ICU care (43.4% vs. 9.0%, p<.0001). Risk factors associated with mortality in those admitted to the ICU included age ≥60 (OR=1.39 [1.29-1.49]), non-white race (OR=1.25 [1.15-1.36]), hospitalization on the West Coast (OR=1.26 [1.14-1.40]), number of comorbidities (trend p<.0001; Figure 1), and invasive fungal infection (OR=1.89 [1.63-2.18]; p<.0001 for all risk factors). In-hospital mortality for ICU patients remained relatively constant over the observation period: 40.6% of patients requiring ICU support died in 2004 vs. 39.9% in 2012 (trend p=.62). Overall, mean LOS was 16 days and total hospitalization cost was $50,176 ($3,263/ day). Mean hospitalization cost increased with each increasing comorbidity from $32,153 to $109,783 per stay for those with 0 vs. ≥5 comorbidities (trend p <.0001; Figure 2). Costs for patients admitted to the ICU were significantly higher than for those who did not require the ICU at $82,350 vs. $38,766, respectively (p<.0001). CONCLUSION: ICU admission for adults with AML is associated with high mortality and cost that both increase proportionally with the number of comorbidities.Factors associated with ICU admission and mortality in AML patients include both non-modifiable demographic factors (age, race, and geographic location), and medical characteristics (number of comorbidities and underlying infections). These factors may be useful in identifying patients at increased risk for ICU admission early and provide an opportunity for the testing of primary prevention and intervention strategies. Disclosures Walter: Amgen, Inc.: Research Funding; Pfizer, Inc.: Consultancy; AstraZeneca, Inc.: Consultancy; Covagen AG: Consultancy; Seattle Genetics, Inc.: Research Funding; Amphivena Therapeutics, Inc.: Consultancy, Research Funding. Lyman:Amgen: Research Funding.
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Xu, Ran, Ronald E. Polk, Lynda Stencel, Denise K. Lowe, Roy Guharoy, Raj W. Duggal, Michelle Wiest, Kimberly S. Putney, and Nora B. Flint. "Antibiogram compliance in University HealthSystem Consortium participating hospitals with Clinical and Laboratory Standards Institute guidelines." American Journal of Health-System Pharmacy 69, no. 7 (April 1, 2012): 598–606. http://dx.doi.org/10.2146/ajhp110332.
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Smith, Haller, Jonathan D. Boone, Eric D. Thomas, Cynthia G. Brumfield, Warner K. Huh, Ronald D. Alvarez, Charles A. Leath, and John M. Straughn. "Use of the University HealthSystem Consortium Database and a Departmental Quality Committee to Evaluate Adverse Outcomes in a Large Inpatient Gynecologic Oncology Practice." Journal of the American College of Surgeons 221, no. 4 (October 2015): S99. http://dx.doi.org/10.1016/j.jamcollsurg.2015.07.229.
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Mitchell, Robert E., Byron T. Lee, Michael S. Cookson, Daniel A. Barocas, S. Duke Herrell, Peter E. Clark, Joseph A. Smith, and Sam S. Chang. "RADICAL NEPHRECTOMY SURGICAL OUTCOMES IN THE UNIVERSITY HEALTHSYSTEM CONSORTIUM DATABASE: THE IMPACT OF HOSPITAL CASE VOLUME, HOSPITAL SIZE AND GEOGRAPHIC LOCATION ON 40,000 PATIENTS." Journal of Urology 179, no. 4S (April 2008): 164. http://dx.doi.org/10.1016/s0022-5347(08)60475-9.
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Hatch, Jonathan L., Michael J. Bauschard, Shaun A. Nguyen, Paul R. Lambert, Ted A. Meyer, and Theodore R. McRackan. "National Trends in Vestibular Schwannoma Surgery: Influence of Patient Characteristics on Outcomes." Otolaryngology–Head and Neck Surgery 159, no. 1 (March 27, 2018): 102–9. http://dx.doi.org/10.1177/0194599818765717.
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Objective To characterize current vestibular schwannoma (VS) surgery outcomes with a nationwide database and identify factors associated with increased complications and prolonged hospital course. Study Design Retrospective review utilizing the University HealthSystem Consortium national inpatient database. Setting US academic health centers. Subjects and Methods Data from patients undergoing VS surgery were analyzed over a 3-year time span (October 2012 to September 2015). Surgical outcomes, such as length of stay (LOS), complications, and mortality, were analyzed on the basis of race, sex, age, and comorbidities during the 30-day postoperative period. Results A total of 3697 VS surgical cases were identified. The overall mortality rate was 0.38%, and the overall complication rate was 5.3%. Advanced age significantly affected intensive care unit LOS, mortality, and complications ( P = .04). Comorbidities, including hypertension, obesity, and depression, also significantly increased complication rates ( P = .02). Sixty-eight patients (1.8%) had a history of irradiation, and they had a significantly increased LOS ( P = .03). Conclusion Modern VS surgery has a low mortality rate and a relatively low rate of complications. Several factors contribute to high complication rates, including age and comorbidities. These data will help providers in counseling patients on which treatment course might be best suited for them.
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Casey, Donald E., Kyung Chang, and Rami T. Bustami. "Evaluation of Hospitalization for Infections That Are Present on Admission." American Journal of Medical Quality 26, no. 6 (July 1, 2011): 468–73. http://dx.doi.org/10.1177/1062860611409198.
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Hospitals have experienced increasing requirements for public reporting of various infection rates using clinical and administrative data. Until recently, such reports have not included analysis of “present on admission” (POA), an indicator designed to assess whether such infections are hospital acquired. The authors evaluated the frequency of the POA coding designation for 167 University HealthSystem Consortium hospitals for sepsis/septicemia (S-S), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile infection (CDI). The authors found that 70% of hospitalizations of patients with S-S, 86% of patients with MRSA, and 67% of patients with CDI had these conditions coded POA. The authors recommend that public reporting of hospital infection rates include POA status and that all health care organizations and providers should work more closely together to identify early and prevent such serious infections.
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Varela, J. Esteban, Samuel E. Wilson, and Ninh T. Nguyen. "Outcomes of Bariatric Surgery in the Elderly." American Surgeon 72, no. 10 (October 2006): 865–69. http://dx.doi.org/10.1177/000313480607201005.
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The Medicare Coverage Advisory Committee recently concluded that evidence supports the safety and effectiveness of bariatric surgery in the general adult population. However, more information is needed on the role of bariatric surgery in the elderly. The aim of this study was to examine the outcome of bariatric surgery in the elderly performed at academic centers. Using International Classification of Diseases, 9th Revision diagnosis and procedure codes, we obtained data from the University HealthSystem Consortium Clinical Data Base for all elderly (>60 years) and nonelderly (19–60 years) patients who underwent bariatric surgery for the treatment of morbid obesity between 1999 and 2005. Outcome measures, including patient characteristics, length of stay, 30-day readmission, morbidity, and observed and expected (risk-adjusted) mortality, were compared between groups. Bariatric surgery in the elderly represents 2.7 per cent (n = 1,339) of all bariatric operations being performed at academic centers. Of the 99 University HealthSystem Consortium centers performing bariatric surgery, 78 centers (79%) perform bariatric surgery in the elderly. Compared with nonelderly patients, elderly patients who underwent bariatric surgery had more comorbidities, longer lengths of stay (4.9 days vs 3.8 days, P < 0.01), more overall complications (18.9% vs 10.9%, P < 0.01), pulmonary complications (4.3% vs 2.3%, P < 0.01), hemorrhagic complications (2.5% vs 1.5%, P < 0.01), and wound complications (1.7% vs 1.0%). The in-hospital mortality rate was also higher in the elderly group (0.7% vs 0.3%, P = 0.03). When risk adjusted, the observed-to-expected mortality ratio for the elderly group was 0.9. In a subset of elderly patients with a pre-existing cardiac condition (n = 236), the in-hospital mortality was 4.7 per cent. Bariatric surgery in the elderly represents only a small fraction of the number of bariatric operations performed at academic centers. Although the morbidity and mortality is higher in the elderly, bariatric surgery in the elderly is considered as safe as other gastrointestinal procedures because the observed mortality is better than the expected (risk-adjusted) mortality.
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Cauble, Stephanie, Ali Abbas, Lydia Bazzano, Sabeen F. Medvedev, Sofia Medvedev, Luis A. Balart, and Nathan J. Shores. "1166 Are Men and Women Treated Differently With Regard To Hepatocellular Carcinoma? Analysis of an Inpatient Database From Academic Medical Centers at the University Healthsystem Consortium." Gastroenterology 142, no. 5 (May 2012): S—213. http://dx.doi.org/10.1016/s0016-5085(12)60799-9.
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Mitchell, Robert E., Byron T. Lee, Michael S. Cookson, Daniel A. Barocas, S. Duke Herrell, Peter E. Clark, Joseph A. Smith, and Sam S. Chang. "IMMEDIATE SURGICAL OUTCOMES FOR RADICAL PROSTATECTOMY IN THE UNIVERSITY HEALTHSYSTEM CONSORTIUM DATABASE: THE IMPACT OF HOSPITAL CASE VOLUME, HOSPITAL SIZE, AND GEOGRAPHIC REGION ON 48,000 PATIENTS." Journal of Urology 179, no. 4S (April 2008): 164. http://dx.doi.org/10.1016/s0022-5347(08)60474-7.
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Williams, Tamara L., T. Andrew Bowdle, Bradford D. Winters, Stephen D. Pavkovic, and Marilyn K. Szekendi. "Guidewires Unintentionally Retained During Central Venous Catheterization." Journal of the Association for Vascular Access 19, no. 1 (March 1, 2014): 29–34. http://dx.doi.org/10.1016/j.java.2013.12.001.
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Abstract Background: A number of mechanical complications can occur during the insertion of a central venous catheter (CVC), including breakage or loss of the wire and unrecognized failure to remove the wire. Complications related to retention of a guidewire can be serious or fatal. Methods: Incident reports on retained CVC guidewires entered into the University HealthSystem Consortium (UHC) Safety Intelligence Patient Safety Organization (PSO) database (Chicago, IL) over a 5-year period were reviewed to improve our understanding of their circumstances, causes, and related patient outcomes. Findings: A total of 42 events that involved retention of a whole guidewire or a fragment of a wire were found in the UHC Safety Intelligence PSO database from 2008 through 2012. Although one-third of these events were discovered during or at the end of the CVC insertion procedure, retained CVC guidewires were commonly discovered days to years after the procedure and on imaging tests performed for unrelated reasons or during other subsequent care. Managers who reviewed the events commonly recommended education and training to prevent retained CVC guidewires, but factors contributing to these events such as distractions and emergency situations also suggest the need for a device design that prevents the occurrence. Conclusions: Efforts to prevent the loss of CVC guidewires should include clinician education and the development of a device design that prevents inadvertent guidewire loss and alerts clinicians when the end of the guidewire is near.
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Reavis, Kevin M., Marcelo W. Hinojosa, Brian R. Smith, James B. Wooldridge, Sindhu Krishnan, and Ninh T. Nguyen. "Hospital Volume is Not a Predictor of Outcomes after Gastrectomy for Neoplasm." American Surgeon 75, no. 10 (October 2009): 932–36. http://dx.doi.org/10.1177/000313480907501015.
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Studies have shown conflicting data with regard to the volume and outcome relationship for gastrectomy. Using the University HealthSystem Consortium national database, we examined the influence of the hospital's volume of gastrectomy on outcomes at academic centers between 2004 and 2008. Outcome measures, including length of stay, 30-day readmission, morbidity, and in-hospital mortality, were compared among high- (13 or greater), medium- (6 to 12), and low-volume (five or less) hospitals. There were 10 high- (n = 593 cases), 36 medium- (n = 1076 cases), and 75 low-volume (n = 500 cases) hospitals. There were no significant differences between high- and low-volume hospitals with regard to length of stay, overall complications, 30-day readmission rate, and in-hospital mortality (2.4 vs 4.4%, respectively, P = 0.06). Despite the small number of gastrectomies performed at the low-volume hospitals, these same hospitals performed a large number of other types of gastric surgery such as gastric bypass for the treatment of morbid obesity (102 cases/year). Within the context of academic medical centers, lower annual volume of gastrectomy for neoplasm is not a predictor of poor outcomes which may be explained by the gastric operative experience derived from other types of gastric surgery.
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Reavis, Kevin M., Brian R. Smith, Marcelo W. Hinojosa, and Ninh T. Nguyen. "Outcomes of Esophagectomy at Academic Centers: An Association between Volume and Outcome." American Surgeon 74, no. 10 (October 2008): 939–43. http://dx.doi.org/10.1177/000313480807401012.
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Studies have shown that esophagectomies performed at high-volume centers have lower in-hospital mortality. However, the volume-outcome relationship for esophagectomy performed at academic centers is unknown. Using the University HealthSystem Consortium national database, we examined the influence of the hospital's volume of esophagectomy on outcome at academic centers between January 2003 and October 2007. Outcomes including length of stay, 30-day re-admission, morbidity, and observed and expected mortality were compared between high (>12), medium (6–12), and low-volume centers’ (≤5) annual cases. There were 30 high (n = 3984), 23 medium (n = 822), and 54 low-volume (n = 430) hospitals. Compared with low-volume counterparts, high-volume hospitals had shorter lengths of stay (14.1 vs 17.2 days, P < 0.01), fewer overall complications (51.1% vs 56.5%, P = 0.03), fewer cardiac complications (1.1% vs 2.5%, P = 0.01), fewer pulmonary complications (18.5% vs 29.8%, P < 0.01), fewer hemorrhagic complications (3.2% vs 6.7%, P < 0.01), fewer patients requiring skilled nursing facility care (9.5% vs 19.7% P < 0.01), and lower in-hospital mortality (2.5% vs 5.6%, P < 0.01). The observed-to-expected mortality ratio was 0.6 for high-volume and 1.0 for low-volume centers. Within the context of academic centers, there is a threshold of >12 esophagectomies annually whereby there is a lower mortality and improved outcome.
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Nguyen, Ninh T., Catherine Christie, Hossein Masoomi, Taraneh Matin, Kelly Laugenour, and Samuel Hohmann. "Utilization and Outcomes of Laparoscopic Versus Open Paraesophageal Hernia Repair." American Surgeon 77, no. 10 (October 2011): 1353–57. http://dx.doi.org/10.1177/000313481107701018.
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The optimal operative approach for repair of diaphragmatic hernia remains debated. The aim of this study was to examine the utilization of laparoscopy and compare the outcomes of laparoscopic versus open paraesophageal hernia repair performed at academic centers. Data was obtained from the University HealthSystem Consortium database on 2726 patients who underwent a laparoscopic (n = 2069) or open (n = 657) paraesophageal hernia repair between 2007 and 2010. The data were reviewed for demographics, length of stay, 30-day readmission, morbidity, in-hospital mortality, and costs. For elective procedures, utilization of laparoscopic repair was 81 per cent and was associated with a shorter hospital stay (3.7 vs 8.3 days, P < 0.01), less requirement for intensive care unit care (13% vs 35%, P < 0.01), and lower overall complications (2.7% vs 8.4%, P < 0.01), 30-day readmissions (1.4% vs 3.4%, P < 0.01) and costs ($15,227 vs $24,263, P < 0.01). The in-hospital mortality was 0.4 per cent for laparoscopic repair versus 0.0 per cent for open repair. In patients presenting with obstruction or gangrene, utilization of laparoscopic repair was 57 per cent and was similarly associated with improved outcomes compared with open repair. Within the context of academic centers, the current practice of paraesophageal hernia repair is mostly laparoscopy. Compared with open repair, laparoscopic repair was associated with superior perioperative outcomes even in cases presenting with obstruction or gangrene.
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Taylor, Jolyn S., Claire A. Marten, Kimberly A. Potts, Lynn M. Cloutier, Katherine E. Cain, Shauna L. Fenton, Tara N. Tatum, et al. "What Is the Real Rate of Surgical Site Infection?" Journal of Oncology Practice 12, no. 10 (October 2016): e878-e883. http://dx.doi.org/10.1200/jop.2016.011759.
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Purpose: Surgical site infections (SSIs) are associated with patient morbidity and increased health care costs. Although several national organizations including the University HealthSystem Consortium (UHC), the National Surgical Quality Improvement Program (NSQIP), and the National Healthcare Safety Network (NHSN) monitor SSI, there is no standard reporting methodology. Methods: We queried the UHC, NSQIP, and NHSN databases from July 2012 to June 2014 for SSI after gynecologic surgery at our institution. Each organization uses different definitions and inclusion and exclusion criteria for SSI. The rate of SSI was also obtained from chart review from April 1 to June 30, 2014. SSI was classified as superficial, deep, or organ space infection. The rates reported by the agencies were compared with the rates obtained by chart review using Fisher’s exact test. Results: Overall SSI rates for the databases were as follows: UHC, 1.5%; NSQIP, 8.8%; and NHSN, 2.8% (P < .001). The individual databases had wide variation in the rate of deep infection (UHC, 0.7%; NSQIP, 4.7%; NHSN, 1.3%; P < .001) and organ space infection (UHC, 0.4%; NSQIP, 4.4%; NHSN, 1.4%; P < .001). In agreement with the variation in reporting methodology, only 19 cases (24.4%) were included in more than one database and only one case was included in all three databases (1.3%). Conclusion: There is discordance among national reporting agencies tracking SSI. Adopting standardized metrics across agencies could improve consistency and accuracy in assessing SSI rates.
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Basu, Swati K., Isabel D. Fernandez, Susan G. Fisher, Barbara L. Asselin, and Gary H. Lyman. "Length of Stay and Mortality Associated With Febrile Neutropenia Among Children With Cancer." Journal of Clinical Oncology 23, no. 31 (November 1, 2005): 7958–66. http://dx.doi.org/10.1200/jco.2005.01.6378.
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Purpose The aim of this study was to evaluate risk factors for longer length of stay (los) and mortality among hospitalized children with cancer who have febrile neutropenia. Methods This study involved analysis of longitudinal data from the University HealthSystem Consortium database from 1995 to 2002. All patients who were 21 years or younger, with diagnostic codes for both neoplastic disease and febrile neutropenia at discharge, were included. Results A total of 12,446 patients were identified for the study. The los was 5 days or less for 6,799 patients, and greater than 5 days for 5,647 patients. The mortality rate was 3%. On bivariate analysis, race, age, cancer type, and associated complications (bacteremia/sepsis, hypotension, pneumonia, and fungal infections) were significantly associated with longer length of stay and death. On multivariate analysis, age group, race, cancer type (acute myeloid leukemia, multiple cancers v acute lymphoblastic leukemia), and the complication variables were significantly associated with increased risk of longer los and death. Certain types of cancer (Hodgkin's disease, osteosarcoma/Ewing’s sarcoma, rhabdomyosarcoma, compared with acute lymphoblastic leukemia) and year of discharge after 1995 were significantly associated with a reduced risk of longer length of stay and/or mortality. Conclusion Race, age group, year of discharge, associated complications, and cancer type were significantly associated with risk of longer los and mortality. These factors may potentially help in identifying high-risk patients who might benefit from targeted antibiotic therapy or prophylactic hematopoietic growth factor support.
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Applegate, Stacey E., and D. Scott Lim. "Incidence of stroke in patients with d-transposition of the great arteries that undergo balloon atrial septostomy in the University Healthsystem Consortium Clinical Data Base/Resource Manager." Catheterization and Cardiovascular Interventions 76, no. 1 (January 25, 2010): 129–31. http://dx.doi.org/10.1002/ccd.22463.
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Ward, Kristy K., Nina R. Shah, Mitzie-Ann Davis, Cheryl C. Saenz, Michael T. McHale, and Steven C. Plaxe. "Creating a risk of readmission (ROR) score for gynecologic oncology (GO) patient." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6636. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6636.
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6636 Background: The annual cost of 30 day hospital readmissions in the US is $16 billion. The objectives of this study are to determine factors associated with readmission among GO patients, and to create a risk score to identify populations at the highest risk of readmission. Methods: The University HealthSystem Consortium database was queried to identify readmissions among GO patients from 1/1/08 through 9/30/12. Risk factors for 30 day readmission were determined by univariate and multivariate analysis. For each risk factor found to be independently associated with readmission, the low risk group was scored 0 and the high risk group scored 1. The ROR score is the sum of the individual scores. Probability of readmission was calculated for each ROR score. Results: Overall, the readmission rate for GO patients was 4.5%. Vulvar cancer, medical MSDRG, urgent or emergent admission, length of stay > 4 days, and coverage by a public payer (during 1st admission) each was independently associated with readmission. Probability of readmission increases significantly with increasing risk score. Patients with a ROR score of 0 or 1 have a readmission rate of 3.9% (95% CI 3.7% to 4.1%); patients with a ROR score of >1 have a readmission rate of 10.7% (95% CI 10.1% to 11.2%). Conclusions: Specific risk factors and composite risk score are associated with 30 day readmission rate among GO patients. The patient specific ROR score may be used to target transitions of care interventions aimed at reducing readmissions. [Table: see text] [Table: see text]
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Steelman, Victoria M., Tamara L. Williams, Marilyn K. Szekendi, Amy L. Halverson, Suzanne M. Dintzis, and Stephen Pavkovic. "Surgical Specimen Management: A Descriptive Study of 648 Adverse Events and Near Misses." Archives of Pathology & Laboratory Medicine 140, no. 12 (September 9, 2016): 1390–96. http://dx.doi.org/10.5858/arpa.2016-0021-oa.
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Context.— Surgical specimen adverse events can lead to delays in treatment or diagnosis, misdiagnosis, reoperation, inappropriate treatment, and anxiety or serious patient harm. Objectives.— To describe the types and frequency of event reports associated with the management of surgical specimens, the contributing factors, and the level of harm associated with these events. Design.— A retrospective review was undertaken of surgical specimen adverse events and near misses voluntarily reported in the University HealthSystem Consortium Safety Intelligence Patient Safety Organization database by more than 50 health care facilities during a 3-year period (2011–2013). Event reports that involved surgical specimen management were reviewed for patients undergoing surgery during which tissue or fluid was sent to the pathology department. Results.— Six hundred forty-eight surgical specimen events were reported in all stages of the specimen management process, with the most common events reported during the prelaboratory phase and, specifically, with specimen labeling, collection/preservation, and transport. The most common contributing factors were failures in handoff communication, staff inattention, knowledge deficit, and environmental issues. Eight percent of the events (52 of 648) resulted in either the need for additional treatment or temporary or permanent harm to the patient. Conclusions.— All phases of specimen handling and processing are vulnerable to errors. These results provide a starting point for health care organizations to conduct proactive risk analyses of specimen handling procedures and to design safer processes. Particular attention should be paid to effective communication and handoffs, consistent processes across care areas, and staff training. In addition, organizations should consider the use of technology-based identification and tracking systems.
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Freburger, Janet K. "An Analysis of the Relationship Between the Utilization of Physical Therapy Services and Outcomes for Patients With Acute Stroke." Physical Therapy 79, no. 10 (October 1, 1999): 906–18. http://dx.doi.org/10.1093/ptj/79.10.906.
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Abstract Background and Purpose. Little research has been conducted on the outcomes of care for people who have had a stroke. In this study, the relationship between physical therapy utilization and outcomes of care for patients with acute stroke was examined. Subjects. The sample consisted of 6,342 patients treated in US academic health center hospitals in 1996 who survived their inpatient stay and received physical therapy. Methods. The primary data source was the University HealthSystem Consortium Clinical Data Base. Physical therapy use was assessed by examining physical therapy charges. Outcomes of care were assessed in terms of the total cost of care (ie, whether the cost of care was more costly or less costly than expected, taking into account patient characteristics) and in terms of discharge destination (ie, whether the patient was discharged home or elsewhere). Regression analyses were conducted to examine the relationship between physical therapy use and outcomes. Results. Physical therapy use was directly related to a total cost of care that was less than expected and to an increased probability of discharge home. Conclusion and Discussion. The results of this study provide preliminary evidence to support the use of physical therapy in the acute care of patients with strokes and indicate the need for further study of this topic.
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Yim, Josephine M., Gregory W. Albers, and Peter H. Vlasses. "Anticoagulant Therapy Monitoring with International Normalized Ratio at us Academic Health Centers." Annals of Pharmacotherapy 30, no. 12 (December 1996): 1390–95. http://dx.doi.org/10.1177/106002809603001205.
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OBJECTIVE: To assess the extent of incorporation of international normalized ratio (INR) reporting in US academic hospitals. DESIGN: Survey of academic hospital clinical laboratories in January 1995. SETTING/PARTICIPANTS: Fifty-eight academic hospital clinical laboratories at institutions that are members of the University HealthSystem Consortium. MAIN OUTCOME MEASURES: The methods for monitoring oral anticoagulant therapy at the surveyed laboratories were determined. The extent of reporting of prothrombin time (PT), PT ratio, INR, and INR therapeutic range was determined. RESULTS: All 58 of the responding hospital clinical laboratories reported INR in patients receiving oral anticoagulation. The median length of time that hospitals had been reporting INR was 24 months (range 3–108). A majority of hospitals continued to report PT values (95%) and PT reference ranges (93%) in addition to INR. Therapeutic INR ranges were reported by only 25 of the laboratories (43%). Of those that report INR ranges, many follow the published recommendations by the American College of Chest Physicians and the Food and Drug Administration. A majority of the hospitals (79%) do not confirm the accuracy of the international sensitivity index (ISI) for their own analyzers. CONCLUSIONS: Contrary to previous reports, academic hospital clinical laboratories have now adopted the more accurate system of reporting INR values in addition to PT values in patients receiving oral anticoagulation. However, better reporting of INR ranges, use of more sensitive thromboplastins, and confirmation of the accuracy of the ISI for local analyses would further improve the monitoring of oral anticoagulation.
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Mitchell, Robert E., Byron T. Lee, Michael S. Cookson, Daniel A. Barocas, S. Duke Herrell, Peter E. Clark, Joseph A. Smith Jr., and Sam S. Chang. "Immediate surgical outcomes for radical prostatectomy in the University HealthSystem Consortium Clinical Data Base: the impact of hospital case volume, hospital size and geographical region on 48 000 patients." BJU International 104, no. 10 (November 2009): 1442–45. http://dx.doi.org/10.1111/j.1464-410x.2009.08794.x.
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Freburger, Janet K. "An Analysis of the Relationship Between the Utilization of Physical Therapy Services and Outcomes of Care for Patients After Total Hip Arthroplasty." Physical Therapy 80, no. 5 (May 1, 2000): 448–58. http://dx.doi.org/10.1093/ptj/80.5.448.
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Abstract Background and Purpose. The effect of physical therapy intervention on the outcomes of care for patients treated in acute care hospitals has not been widely studied. This study examined the relationship between physical therapy utilization and outcomes of care for patients following total hip arthroplasty. Subjects. The sample consisted of 7,495 patients treated in US academic health center hospitals in 1996 who survived their inpatient stay and received physical therapy interventions. Methods. The primary data source was the University HealthSystem Consortium Clinical Data Base. Physical therapy use was assessed by examining physical therapy charges. Outcomes of care were assessed in terms of the total cost of care (ie, whether the care was more costly or less costly than expected, taking into account patient characteristics) and in terms of discharge destination (ie, whether the patient was discharged home or elsewhere). Regression analyses were conducted to examine the relationship between physical therapy use and outcomes. Results. Physical therapy intervention was directly related to a total cost of care that was less than expected and to an increased probability of discharge home. Conclusion and Discussion. The results of this study provide preliminary evidence to support the use of physical therapy intervention in the acute care of patients following total hip arthroplasty and indicate the need for further study of this topic.
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Cordero, Leandro, and Leona W. Ayers. "Duration of Empiric Antibiotics for Suspected Early-Onset Sepsis in Extremely Low Birth Weight Infants." Infection Control & Hospital Epidemiology 24, no. 9 (September 2003): 662–66. http://dx.doi.org/10.1086/502270.
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AbstractObjectives:To study multicenter antibiotic practices for suspected early-onset sepsis (EOS) with negative blood cultures (NegBCs) and to identify opportunities for reduction of antimicrobial exposure.Design:Retrospective study.Setting:Thirty academic hospitals (University HealthSystem Consortium) located in 24 states.Methods:Data were from a survey of 790 extremely low birth weight (ELBW) infants. Total antibiotic exposures (antibiotic-days per patient) were calculated.Results:On admission to the NICU, 94% of 790 ELBW infants had BCs performed and empiric antibiotics initiated. When PosBC and NegBC infants were compared, 47 patients with PosBCs were similar to 695 with NegBCs in birth weight, gestational age (GA), and mortality. Patients with suspected EOS but NegBCs given ampicillin/aminoglycosides were grouped by length of administration and GA. For GA of 26 weeks or younger, 170 infants given a short (≤ 3 days) and 157 given a long (≥ 7 days) course were similar regarding birth weight, mortality, antepartum history, and CRIB scores, but were different (P < .01) in number receiving a third antimicrobial (3% and 17%) and antibiotic-days (23 and 38). For GA of 27 weeks or older, 113 infants given a short and 77 given a long course differed (P < .01) in number receiving a third antimicrobial (2% and 23%) and antibiotic-days (19 and 30).Conclusions:Most suspected EOS infants with NegBCs are given antibiotics, but no antepartum historical risk factors or neonatal clinical signs explained prolonged administration. Discontinuing empiric antibiotics when BCs are negative in asymptomatic ELBW infants can reduce antimicrobial exposure without compromising clinical outcome.
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Grant, Jennifer, Moira C. Mcnulty, Krista Kinnard, Daniel Nagin, Ari Robicsek, Ravi Bashyal, Rema Padman, and Nirav Shah. "Using Group-Based Trajectory Temperature Modeling to Predict Postoperative Infections after Total Knee Arthroplasty." Open Forum Infectious Diseases 4, suppl_1 (2017): S338—S339. http://dx.doi.org/10.1093/ofid/ofx163.806.
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Abstract Background Fever is common in the postoperative setting and frequently physiologic. Despite this, roughly half of febrile patients undergo testing for infectious complications, of which only a few reveal infection. We analyzed whether temperature trajectories could help optimize postoperative (post-op) risk assessment in total knee arthroplasty (TKA) patients. Methods We included adult patients who underwent primary TKA between January 1, 2007–December 31, 2013 within NorthShore University HealthSystem. Patients were excluded if infection was suspected before/during surgery. Patient data were extracted from the Database Warehouse. A physician verified post-op complications by chart review. We performed group-based trajectory modeling (GBTM) with covariates: age, BMI, gender, co-morbid conditions and procedure time (STATA). We compared complications per group by χ2 test and evaluated associations with any post-op complication by multivariable (MV) logistic regression (SPSS). Results We identified 5495 independent patients, following three distinct temperature trajectories (Figure 1) – low (group 1), medium (group 2), high (group 3). Noninfectious complications were more likely than infectious complications, and complications were 5x more common in group 3 vs. group 1 (Table 1). In MV logistic regression, membership in group 3 was independently associated with developing a post-op complication, adjusting for age, presence of renal failure and presence of a cardiac arrhythmia (OR 4.4, 95% CI 3.2–6.0, P < 0.01). Conclusion GBTM may help identify TKA patients at increased risk of a post-op complication in real-time, thus helping clinicians avoid unnecessary testing and antibiotics in the post-op setting. Disclosures All authors: No reported disclosures.
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Vehviläinen, Juho, Markus B. Skrifvars, Matti Reinikainen, Stepani Bendel, Ivan Marinkovic, Tero Ala-Kokko, Sanna Hoppu, Ruut Laitio, Jari Siironen, and Rahul Raj. "Psychotropic medication use among patients with a traumatic brain injury treated in the intensive care unit: a multi-centre observational study." Acta Neurochirurgica 163, no. 10 (August 11, 2021): 2909–17. http://dx.doi.org/10.1007/s00701-021-04956-3.
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Abstract Background Psychiatric sequelae after traumatic brain injury (TBI) are common and may impede recovery. We aimed to assess the occurrence and risk factors of post-injury psychotropic medication use in intensive care unit (ICU)-treated patients with TBI and its association with late mortality. Methods We conducted a retrospective multi-centre observational study using the Finnish Intensive Care Consortium database. We included adult TBI patients admitted in four university hospital ICUs during 2003–2013 that were alive at 1 year after injury. Patients were followed-up until end of 2016. We obtained data regarding psychotropic medication use through the national drug reimbursement database. We used multivariable logistic regression models to assess the association between TBI severity, treatment-related variables and the odds of psychotropic medication use and its association with late all-cause mortality (more than 1 year after TBI). Results Of 3061 patients, 2305 (75%) were alive at 1 year. Of these, 400 (17%) became new psychotropic medication users. The most common medication types were antidepressants (61%), antipsychotics (35%) and anxiolytics (26%). A higher Glasgow Coma Scale (GCS) score was associated with lower odds (OR 0.93, 95% CI 0.90–0.96) and a diffuse injury with midline shift was associated with higher odds (OR 3.4, 95% CI 1.3–9.0) of new psychotropic medication use. After adjusting for injury severity, new psychotropic medication use was associated with increased odds of late mortality (OR 1.19, 95% CI 1.19–2.17, median follow-up time 6.4 years). Conclusions Psychotropic medication use is common in TBI survivors. Higher TBI severity is associated with increased odds of psychotropic medication use. New use of psychotropic medications after TBI was associated with increased odds of late mortality. Our results highlight the need for early identification of potential psychiatric sequelae and psychiatric evaluation in TBI survivors.