Analysis of hospitalization costs related to fall injuries in elderly patients

BACKGROUND With the aging world population,the incidence of falls has intensified and fallrelated hospitalization costs are increasing.Falls are one type of event studied in the health economics of patient safety,and many developed countries have conducted such research on fall-related hospitalization costs.However,China,a developing country,still lacks large-scale studies in this area.AIM To investigate the factors related to the hospitalization costs of fall-related injuries in elderly inpatients and establish factor-based,cost-related groupings.METHODS A retrospective study was conducted.Patient information and cost data for elderly inpatients(age≥60 years,n=3362)who were hospitalized between 2016 and 2019 due to falls was collected from the medical record systems of two grade-A tertiary hospitals in China.Quantile regression(QR)analysis was used to identify the factors related to fall-related hospitalization costs.A decision tree model based on the chi-squared automatic interaction detector algorithm for hospitalization cost grouping was built by setting the factors in the regression results as separation nodes.RESULTS The total hospitalization cost of fall-related injuries in the included elderly patients was 180479203.03 RMB,and the reimbursement rate of medical benefit funds was 51.0%(92039709.52 RMB/180479203.03 RMB).The medical material costs were the highest component of the total hospitalization cost,followed(in order)by drug costs,test costs,treatment costs,integrated medical service costs and blood transfusion costs The QR results showed that patient age,gender,length of hospital stay,payment method,wound position,wound type,operation times and operation type significantly influenced the inpatient cost(P<0.05).The cost grouping model was established based on the QR results,and age,length of stay,operation type,wound position and wound type were the most important influencing factors in the model.Furthermore,the cost of each combination varied significantly.CONCLUSION Our grouping model of hospitalization costs clearly reflected the key factors affecting hospitalization costs and can be used to strengthen the reasonable control of these costs.

Influencing factors of hospitalization costs for glaucoma patients under clinical pathway management

Background:To investigate and analyze the hospitalization costs of inpatients with primary acute angle closure glaucoma(PACG),and to explores the influencing factors of hospitalization cost and to provide reference for specialized hospitals to carry out clinical pathways.Methods:The first page diagnostic data of PACG patients’medical records were collected,and an Excel database was established according to the International Classification of Diseases(ICD-10)code.Statistical analysis of hospitalization data was performed using SPSS 17.0 software.Results:Hospitalization days and clinical pathway which affect the change of the hospitalization cost(P<0.001).Conclusions:Hospitalization day is an important factor affecting the hospitalization cost,reducing unnecessary hospitalization time can control the increase of hospitalization cost.

Cost of Stroke Care at Public Hospitals in Brazzaville and Implication of Third Parties in Stroke Care Expenditure

Background: Among the main challenges of healthcare system throughout the world, there is stroke management. It is important to have data on the in-hospital costs of stroke care to help decision-makers to implement a health insurance system. Objectives: To evaluate the in-hospital costs of stroke care in Brazzaville;to determine the factors influencing the total mean in-hospital cost of stroke care;to identify third parties contributing to stroke care expenditure. Methods: This was a cross-sectional prospective and analytical study. It was carried out at 4 public hospitals in Brazzaville (University Hospital Center, Chinese and Congolese Friendship Hospital, Talanga&#239; Hospital and Makélékélé Hospital), from May to August 2019 (4 months). It focused on patients who had a first episode of stroke confirmed by brain imaging and were at least 18 years old. The bottom-up approach was used to determine the in-hospital costs of stroke care. Results: This study included 109 patients who fulfilled inclusion criteria. Their mean age was 59.2 ± 13.7 years old, with limits of 35 and 90 years old. The total direct in-hospital cost of stroke care was 47,308,330 francs CFA (72,122 euro). The total mean in-hospital cost of stroke care was 1,389,590 francs CFA (2118 euro). The mean cost of intracerebral hemorrhage care was 510,988 francs CFA (779 euro) versus 373,457 francs CFA (569 euro) for cerebral arterial infarction care. The following factors affected the total mean cost of stroke care: type of hospital (p < 0.0001), length of hospital stay (p = 0.001), type of stroke (p = 0.01), stroke severity (p = 0.001) and complications (p = 0.001). The level of contribution to stroke care expenditure covered by third parties was: 78% for patient families;2.8% for community self-help associations. Conclusion: In Congo, the mean in-hospital cost of stroke care is elevated considering the guaranteed minimum wage of 70,000 francs CFA (107 euro). Five factors affect the total mean cost of stroke care. Patient families are the main financial assistance system for stroke care expenditure. To minimize the heavy financial burden induced by stroke on patients, households and families, it is important to implement a health insurance system and strengthen the stroke prevention program.

Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.

Predictive value of frailty assessment tools in patients undergoingsurgery for gastrointestinal cancer: An observational cohort study

BACKGROUND Few studies have simultaneously compared the predictive value of various frailty assessment tools for outcome measures in patients undergoing gastrointestinal cancer surgery.Therefore,it is difficult to determine which assessment tool is most relevant to the prognosis of this population.AIM To investigate the predictive value of three frailty assessment tools for patient prognosis in patients undergoing gastrointestinal cancer surgery.METHODS This single-centre,observational,prospective cohort study was conducted at the Affiliated Lianyungang Hospital of Xuzhou Medical University from August 2021 to July 2022.A total of 229 patients aged≥18 years who underwent surgery for gastrointestinal cancer were included in this study.We collected baseline data on the participants and administered three scales to assess frailty:The comprehen-sive geriatric assessment(CGA),Fried phenotype and FRAIL scale.The outcome measures were the postoperative severe complications and increased hospital RESULTS The prevalence of frailty when assessed with the CGA was 65.9%,47.6%when assessed with the Fried phenotype,and 34.9%when assessed with the FRAIL scale.Using the CGA as a reference,kappa coefficients were 0.398 for the Fried phenotype and 0.291 for the FRAIL scale(both P<0.001).Postoperative severe complications and increased hospital costs were observed in 29(12.7%)and 57(24.9%)patients,respectively.Multivariate logistic analysis confirmed that the CGA was independently associated with increased hospital costs(odds ratio=2.298,95%confidence interval:1.044-5.057;P=0.039).None of the frailty assessment tools were associated with postoperative severe complications.CONCLUSION The CGA was an independent predictor of increased hospital costs in patients undergoing surgery for gastro-intestinal cancer.

江西省某三级甲等医院2型糖尿病患者次均住院费用新灰色关联分析

目的分析江西省某三级甲等医院2型糖尿病患者次均住院费用的构成以及影响次均住院费用的主要因素,为有效控制此类患者的住院费用及减轻疾病经济负担提供依据。方法选取江西省某三级甲等医院2015—2018年1928例2型糖尿病患者的住院费用明细,利用新灰色关联分析法对患者住院各项费用的关联度、贡献率以及变动率等指标进行分析。结果2015—2018年,次均住院费用的构成比和关联系数最大的影响因素是治疗费,而结构贡献率最高的因素是药品费;与次均住院费用关联度最大的前三项目顺位分别是治疗费(0.9650)、药品费(0.9100)和检查费(0.8125);结构贡献率最高的前三项目顺位是药品费(30.00%)、护理费(11.69%)和诊察费(10.61%),三者累计结构贡献率达到52.30%。结论治疗费、药品费和检查费是影响患者次均住院费用最主要的因素,但服务性项目的收费较低。建议着重控制药品费用的增长,适当减轻检查类项目对费用的影响,严格规范临床路径,合理提高服务性项目费用的比例,进一步体现医护人员的劳务价值,构建糖尿病精细化管理体系,丰富健康管理内涵。

Depression and race affect hospitalization costs of heart failure patients

Objective:Depression and anxiety are frequently observed in heart failure(HF)patients;however,the effect of such factors on hospitalization costs of HF patients,and whether such costs vary by race and gender remain poorly understood.This analysis delineated the preva-lence of depression/anxiety among HF patients and estimated the effect of race and gender on hospitalization costs.Methods:We examined the 2008 files of the Tennessee Hospital Discharge Data System(HDDS)on patients(≥20 years of age)with a primary diagnosis of HF(ICD-9 codes 402,404,and 428)along with demographic data,depression/anxiety diagnoses,hospital costs,and comorbidities.Among the HF sample(n=16,889)53%were female and 23%were black.Race and gender differences in hospital costs were evaluated for the following three groups:(1)HF patients with depression/anxiety(HF+D);(2)HF-only patients without depression/anxiety(HFO);and(3)HF patients with other mental diagnoses(HF+M).Results:HF was significantly(p<0.000)higher among blacks compared to whites,and higher among males than females.Nearly 25%of HF patients had depression/anxiety(more whites and females were depressed).HF patients averaged more than 3 comorbidities(blacks had a greater number of comorbidities and hospitalization cost for the year).Costs were higher among HF+D patients compared to HFO patients.Among HF+D patients,costs were higher for black males compared with white males.These cost patterns prevailed largely because of higher comorbidities that required more re-admissions and longer hospital stays.Conclusion:Race and depression/anxiety are associated with increased hospitalization costs of HF patients.The higher costs among blacks reflect the higher burden of comorbidities,such as hypertension and diabetes,which calls for widespread dissemination,adoption,and implementation of proven interventions for the control of these comorbidities.

Hospital healthcare costs attributable to heat and future estimations in the context of climate change in Perth, Western Australia

Climate change with increasing temperature is making a significant impact on human health, including more heat-related diseases, and increasing the burden on the healthcare system. Although many studies have explored the association between increasing temperatures and negative health outcomes, research on the associated costs of heat-related diseases remains relatively sparse. Furthermore, estimations of future costs associated with heat-attributable hospital healthcare have not been well explored. This study used a distributed lag nonlinear model to estimate heat-attributable hospital healthcare costs in Perth, Western Australia. Using 2006–2012 as the baseline, future costings for 2026–2032 and 2046–2052 were estimated under RCP2.6, RCP4.5, and RCP8.5. Higher temperatures were found to be associated with increased hospital healthcare costs. The total hospital costs attributable to heat over the baseline period 2006–2012 was estimated to be 79.5 million AUD, with costs for mental health hospitalizations being the largest contributor of the heat-related conditions examined. Costs are estimated to increase substantially to 125.8–129.1 million AUD in 2026–2032, and 174.1–190.3 million AUD by midcentury under climate change scenarios. Our findings of a notable burden of heat-attributable healthcare costs now and in the future emphasize the importance of climate change adaptation measures to reduce the adverse health effects of increasing temperatures and heat exposure on the people of Perth.

Determining the hospital cost of anterior epistaxis treatment modalities at a Canadian tertiary care centre

Objective:To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada.Material and methods:A cost analysis was conducted based on a retrospective review of Emergency Department visits from January 2012 to May 2014.A consecutive sample of adult patients with a diagnosis of anterior epistaxis was included.Anterior epistaxis was managed via one of:Nasal clip,Merocel(R),Silver Nitrate cautery,Vaseline packing,other treatment or no treatment.Both the direct and indirect hospital costs(SCDN)for anterior epistaxis treatment were calculated from the hospital's perspective.Generalized linear models were used to assess the association between treatment modalities and total hospital costs while controlling for potential confounding factors.Results:Three hundred and fifty-three patients(49%female)with a mean age of(69.9±18.5)years were included in the analysis.The median(interquartile ranges)costs of treatment ranged from CS227.83(CS167.96,CS328.69)for observation to CS763.98(CS632.25,CS830.23)for Merocel(R).The overall median total hospital costs incurred across all modalities was CS566.24(CS459.61,CS753.46)for the management of anterior epistaxis.Silver Nitrate,nasal clip,and observation were statistically associated with a lower cost when compared to Merocel(R)(P<0.001)even after potential confounding factors were controlled.Conclusions:Our results show wide difference in the hospital cost of epistaxis across treatment modalities.These cost estimates can help inform future economic evaluation studies aiming to guide the allocation of health care resources for patients with epistaxis.

Can Low-Price Hospitals Ease The High Cost of Medical Services?

Going to a hospital is not an easy matter for most Chinese people, with overcrowding and soaring medical costs having become two focuses of public complaint. China's medical system has been on a marketization drive since the 1980s. A July 2005 report by the Development Research Center of the State Council, a think tank under China's cabinet, however, came to

Efficiency analysis of stenting for acute colorectal obstruction

Patients with colorectal cancer presenting with acute malignant colonic obstruction are approximately 10%-15% These patients are always in a poor general condition. Emergency surgery for acute obstructive colorectal cancer is associated with high complication rate and mortality and resulting long hospital stay and hospital cost.