Examining the Impact of Rehospitalization on Healthcare Cost of Myocardial Infarction Patients in Beijing: A Retrospective Observational Study

Introduction

To examine the impact of rehospitalization on the healthcare expenditure of myocardial infarction (MI) patients in Beijing.

Methods

Retrospective data of MI patients were retrieved from the Beijing Medical Insurance Database, an administrative database of social medical reimbursement activities for the urban population in Beijing, China. Ten percent of patients diagnosed with MI from January 1 to December 31, 2012 were randomly selected and their first hospitalization was considered as the index event. Their hospital utilization after the index event was extracted till September 30, 2013. Rehospitalization was defined as an event of hospital admission due to the same diagnosis and with a time interval of at least 14 days from the most recent admission. The healthcare cost of patients was analyzed, including inpatient cost and outpatient cost. Patients’ demographic characteristics, co-morbidities, and length of hospital stay were also collected from the database.

Results

Of the 1235 MI patients identified, 335 (mean age of 66.14 ± 15.04 years; 84.18% males) had rehospitalization. The rate of MI recurrence was 27.13%. The annual healthcare expense was significantly higher for MI patients with rehospitalization compared to MI patients without rehospitalization (99,920.43 ± 84,113.52 CNY vs. 58,877.89 ± 93,942.90 CNY; P < 0.001). The significant positive predictors of incurring healthcare expenditure were male gender, age 45 years old or more, length of stay at first hospital admission, whether having rehospitalization (yes/no), co-morbidity (heart failure and diabetes), and admission to a tertiary hospital at first hospital admission.

Conclusion

There was a high risk of MI recurrence for patients in Beijing. The annual healthcare cost of MI patients with rehospitalization was significantly higher than MI patients without rehospitalization. Male patients of 45 years old or more with heart failure and diabetes are likely to incur higher healthcare expenditure.

     

Urinary Retention and Medication Utilization on a Palliative Care Unit: A Retrospective Observational Study

Urinary retention is a common problem at end-of-life that may be a result of medications used to control other symptoms. To determine whether use of retention-causing drugs was associated with catheterization for urinary retention among palliative care unit (PCU) patients, the authors reviewed charts of 91 consecutively admitted patients to a hospital-based PCU. Utilization of eight classes of retention-causing medications (opioids, antidopaminergics, benzodiazepines, anticholinergics, antidepressants, calcium channel antagonists, nonsteroidal anti-inflammatory drugs [NSAIDs], and H1 histamine antagonists) was compared between those catheterized for urinary retention (n = 34) and those never catheterized (n = 31). All patients used medication from more than one class of retention-causing medication. A statistically significant association with urinary retention occurred for antidopaminergic medications, but not other drug classes. The total number of classes of retention-causing medications was not associated with catheterization. These findings question whether urinary retention need hinder medication use for symptom management at end-of-life. Tapering of antidopaminergic medications, compared with other drug classes studied, may be more likely to resolve retention.     

Preventive Effects of Renin-angiotensin System Inhibitors on Oxaliplatin-induced Peripheral Neuropathy: A Retrospective Observational Study

Purpose

Oxaliplatin-induced peripheral neuropathy has remained an unresolved issue in clinical practice. Our previous study hypothesized that inhibition of the renin-angiotensin system (RAS) may produce a preventive effect on oxaliplatin-induced neuropathy. The aim of this study was to clarify whether RAS inhibitors prevent oxaliplatin-induced peripheral neuropathy.

Olmesartan,Other Antihypertensives,and Chronic Diarrhea Among Patients Undergoing Endoscopic Procedures: A Case-Control Study

ObjectiveTo investigate a recent association between the use of the angiotensin receptor-blocker (ARB) olmesartan and a severe enteropathy resembling celiac disease.Patients and MethodsWe searched our endoscopy database for all outpatient esophagogastroduodenoscopy (EGD) or colonoscopy examinations in patients aged at least 50 years during the period January 1, 2007, to March 31, 2013. Cases were those whose examination indication was diarrhea, and controls were those whose examination indication was esophageal reflux (EGD) or colorectal cancer screening (colonoscopy). We compared cases with controls with regard to the proportion of those listing olmesartan among their medications. Secondary exposures were the proportion of those taking nonolmesartan ARBs or other antihypertensive medications. We also examined biopsy results to determine whether there were histologic changes associated with the use of olmesartan.ResultsWe identified 2088 patients undergoing EGD and 12,428 patients undergoing colonoscopy meeting inclusion criteria. On multivariate analysis, there was no statistically significant association between olmesartan and diarrhea among those undergoing EGD (odds ratio, 1.99; 95% CI, 0.79-5.00) or colonoscopy (odds ratio, 0.63; 95% CI, 0.23-1.74). Review of pathology reports of the EGD and colonoscopy groups showed no association between the use of olmesartan and the histologic diagnosis of celiac disease (P=.61) or microscopic colitis (P=1.0), respectively.ConclusionOur findings suggest that neither olmesartan nor other ARBs were associated with diarrhea among patients undergoing endoscopy. The spruelike enteropathy recently associated with olmesartan is likely a rare adverse effect and milder presentations are unlikely.     

61例腹腔手术后继发出血的临床分析:单中心回顾性研究

  目的  探讨腹腔手术后继发出血的原因和干预时机,以优化治疗方案。  方法  回顾性分析北京协和医院2013年1月至2018年12月腹腔手术后继发出血患者的临床资料,分析出血原因、治疗方案及预后情况。  结果  61例符合纳入和排除标准的腹腔手术后继发出血患者入选本研究,其中男性49例,女性12例,以胰十二指肠切除术患者最多(50.8%,31/61),其次为肝脏手术(16.4%,10/61)和胃部手术(14.8%,9/61)。56例患者明确了出血原因,其中创面渗血和/或创面小动脉活动性出血24例(42.9%,24/56),吻合口出血11例(19.6%,11/56)。出血后多数患者采取手术止血(65.6%,40/61),成功率为87.5%;其次采取介入栓塞止血(24.6%,15/61),成功率为26.7%,差异具有统计学意义(P＜0.01)。成功止血55例、死亡5例,1例患者放弃治疗。  结论  腹腔大手术后出血机率更高,手术止血效果可能优于介入栓塞止血。     

Utilisation of Blood Components in Cardiac Surgery: A Single-Centre Retrospective Analysis with Regard to Diagnosis-Related Procedures

Background

More blood components are required in cardiac surgery than in most other medical disciplines. The overall blood demand may increase as a function of the total number of cardiothoracic and vascular surgical interventions and their level of complexity, and also when considering the demographic ageing. Awareness has grown with respect to adverse events, such as transfusion-related immunomodulation by allogeneic blood supply, which can contribute to morbidity and mortality. Therefore, programmes of patient blood management (PBM) have been implemented to avoid unnecessary blood transfusions and to standardise the indication of blood transfusions more strictly with aim to improve patients'' overall outcomes.

Methods

A comprehensive retrospective analysis of the utilisation of blood components in the Department of Cardiac Surgery at the University Hospital of Münster (UKM) was performed over a 4-year period. Based on a medical reporting system of all medical disciplines, which was established as part of a PBM initiative, all transfused patients in cardiac surgery and their blood components were identified in a diagnosis- and medical procedure-related system, which allows the precise allocation of blood consumption to interventional procedures in cardiac surgery, such as coronary or valve surgery.

Results

This retrospective single centre study included all in-patients in cardiac surgery at the UKM from 2009 to 2012, corresponding to a total of 1,405-1,644 cases per year. A blood supply was provided for 55.6-61.9% of the cardiac surgery patients, whereas approximately 9% of all in-patients at the UKM required blood transfusions. Most of the blood units were applied during cardiac valve surgery and during coronary surgery. Further surgical activities with considerable use of blood components included thoracic surgery, aortic surgery, heart transplantations and the use of artificial hearts. Under the measures of PBM in 2012 a noticeable decrease in the number of transfused cases was observed compared to the period from 2009 to 2011 before implementation of the PBM initiative (red blood cells p < 0.002; fresh frozen plasma p < 0.0006; platelets p < 0.00006).

Conclusion

Until now, cardiac surgery comes along with a significant blood supply. By using a case-related data evaluation programme, the consumption of each blood component can be linked to clinical performance groups and, if necessary, to individual patients. Based on the results obtained from this retrospective analysis, prospective studies are underway to begin conducting target / actual performance comparisons to better understand the individual decision-making by the attending physicians with respect to transfusions.Key Words: Cardiac surgery, Haemotherapy, Blood supply, Blood transfusion, Patient blood management     

鼻内镜下手术切除鼻腔鼻窦内翻性乳头状瘤术中情况及复发情况比较研究

目的对鼻腔鼻窦内翻性乳头状瘤患者采用鼻内镜下手术方式切除的术中及复发情况进行探讨。方法选取笔者所在医院2014年5月~2016年5月收治的鼻腔鼻窦内翻性乳头状瘤患者共88例,随机分为鼻侧切开组和鼻内镜组,各组共有44例患者。用传统的鼻翼切开手术切除肿瘤治疗鼻侧切开组患者,用鼻内镜下手术治疗鼻内镜组,对比鼻侧切开组和鼻内镜组的手术时间、手术期间出血量及术后疼痛程度等指标,并进行一年随访,统计两组患者术后的总复发率等指标。结果用两种手术方式均成功切除病患鼻腔鼻窦内翻性乳头状瘤,鼻内镜组患者的手术时间为(85.3±10.8)min,术中出血量为(72.4±30.8)ml,术后疼痛VAS评分(3.5±1.1)分,与鼻侧切开组相比,P0.05。在手术后一年对两组患者进行随访,采用鼻侧切开手术治疗的患者共有30例被治愈,治愈率为68.1%,采用鼻内镜手术治疗的患者共有39例被治愈,治愈率达88.6%,达到11.3%复发率,对比两组的总复发率,差异有统计学意义(P0.05)。结论使用鼻内镜下手术切除鼻腔鼻窦内翻性乳头状瘤,手术操作精准,能够避免切开患者面部,伤口面积小,较低的复发率,预后效果显著。因此应当推广使用鼻内镜下手术治疗鼻腔鼻窦内翻性乳头状瘤。     

Incidence of Acute Suppurative Sialadenitis in End-Stage Cancer Patients: A Retrospective Observational Study

Context

Acute suppurative sialadenitis (hereafter referred to as sialadenitis) is accompanied by pain and fever and can diminish the quality of life in end-stage cancer patients; however, its incidence is not clear.

Predictors of Postoperative Nausea and Vomiting After Same-day Surgery: A Retrospective Study

PurposePostoperative nausea and vomiting (PONV) are main issues after same-day surgery. This study aimed to retrospectively evaluate the electronic medical records of patients who underwent same-day operations under general anesthesia to identify the potential risk factors for PONV.MethodsRecords of 7759 adult patients who received general anesthesia with remifentanil were reviewed. The patients were assessed for the incidence and severity of PONV. Multiple logistic regression was used to identify risk factors for PONV. A nomogram was established to predict PONV after same-day operations.FindingsOf 7759 patients, 2317 (29.9%) experienced PONV. In multiple logistic regression analysis, female sex, nonsmoker status, history of motion sickness or nausea, high body mass index (BMI), long surgical duration, laparoscopic procedure, and preoperative analgesic intake within 30 days were independent risk factors for PONV. No correlation was found between the severity of PONV and remifentanil exposure (odds ratio = 1.018; 95% CI, 0.861–1.204; P = 0.834) or remifentanil dose (odds ratio = 1.294; 95% CI, 0.760–2.205; P = 0.343). For the nomogram, which involved sex, laparoscopic procedure, BMI, history of nausea or motion sickness, and analgesic intake within 30 days, the receiver operating characteristic analysis revealed that the AUC values in the training and validation cohorts were 0.81 and 0.83, respectively.ImplicationsPredictors for PONV in same-day surgery include female sex, nonsmoker, history of motion sickness or nausea, high BMI, surgical duration >1 hour, laparoscopic procedure, and preoperative analgesic intake within 30 days. A new predictive model is feasible for predicting the incidence of PONV based on the preoperative and intraoperative predictors.     

Impact of Critical Illness Polyneuromyopathy in Rehabilitation: A Prospective Observational Study

Background

Critical illness polyneuromyopathy (CIPNM) increasingly is recognized as a source of disability in patients requiring intensive care unit (ICU) admission. The prevalence and impact of CIPNM on patients in the rehabilitation setting has not been established.

Clinical and Economic Outcomes in Elderly Advanced Renal Cell Carcinoma Patients Starting Pazopanib or Sunitinib Treatment: A Retrospective Medicare Claims Analysis

Introduction

Studies indicate similar survival and toxicity between pazopanib and sunitinib, but few have examined real-world outcomes among elderly patients with advanced renal cell carcinoma (RCC). The purpose of this retrospective claims analysis was to assess real-world overall survival (OS), healthcare resource utilization (HRU), and healthcare costs (both all-cause and associated with RCC diagnosis) among elderly advanced RCC patients starting pazopanib or sunitinib treatment.

Methods

Advanced RCC patients aged 65 years or older who started first-line treatment with pazopanib or sunitinib (index drug; the initiation date was the index date) were identified from the 100% Medicare database plus Part D linkage (January 1, 2006 to December 31, 2014). Patients were stratified by index drug and matched 1:1 with use of propensity scores based on baseline characteristics. OS was assessed from the index date to death and compared by Kaplan–Meier analyses and univariable Cox models; patients were censored at the end of eligibility/data. Monthly HRU and costs from an intent-to-treat perspective were compared by Wilcoxon signed-rank tests.

Results

Baseline characteristics were balanced after matching (both N = 522). Treatment with pazopanib was associated with significantly longer median OS compared with treatment with sunitinib (18.2 months vs 14.6 months, respectively; log-rank p = 0.015). Pazopanib was associated with significantly lower monthly all-cause costs compared with sunitinib ($8845 vs $10,416, respectively), as well as lower inpatient costs associated with RCC diagnosis ($1542 vs $2522), fewer monthly inpatient admissions (0.179 vs 0.262), and shorter length of inpatient stay (1.375 days vs 1.883 days; all p ≤ 0.004).

Conclusions

Among elderly Medicare patients with advanced RCC, first-line pazopanib tretament was associated with significantly longer OS, as well as lower healthcare costs and HRU, compared with first-line sunitinib treatment.

     

Impact of Early Nonadherence to Oral Antipsychotics on Clinical and Economic Outcomes Among Patients with Schizophrenia

Introduction

To quantify early nonadherence to antipsychotic medications in patients with schizophrenia and its impact on short-term antipsychotic adherence, healthcare utilization, and costs.

Methods

Patients who initiated oral antipsychotic treatment between January 1, 2006 to September 30, 2009 were identified from the MarketScan®Commercial Claims and Encounters (CCE) database (Truven Health Analytics, Ann Arbor, Michigan, USA). Patients were required to have a diagnosis of schizophrenia determined by the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code 295.x, be 13–65 years of age, and have ≥12 months of continuous coverage prior to and after (follow-up) the earliest antipsychotic usage (index event). Medication discontinuation was defined as a gap of 30 days in available therapy; early nonadherence was defined as having the gap 90 days from the index event. During the follow-up period, medication adherence was estimated with quarterly medication possession ratios (MPR), and all-cause and schizophrenia-related healthcare resource utilization and costs were determined.

Results

The mean time to discontinuation (TTD) was 39.5 ± 20.1 days for early nonadherence patients (n = 873) and 250.7 ± 103.3 days for patients who were adherent early (n = 589). Early nonadherence resulted in more hospitalizations (0.57 vs. 0.38; P = 0.0006) with longer length of stay (LOS, 5.0 vs. 3.0 days; P = 0.0013) and higher costs ($5,850 vs. $4,211; P = 0.0244); schizophrenia-related hospitalizations, LOS, and costs were also greater. Patients that were adherent used more schizophrenia-related medications (10.4 vs. 4.7; P < 0.0001), increasing pharmacy costs ($3,684 vs. $1,549; P < 0.0001). Early nonadherence was correlated with lower drug adherence at each quarter of the follow-up period.

Conclusion

Approximately 60% of patients with schizophrenia are nonadherent to antipsychotic medication early in treatment and are less likely to be adherent later. Early nonadherence resulted in more all-cause and schizophrenia-related hospitalizations with a greater LOS and cost of care.