Objectives: As demand for TKA in Australia is steadily growing over the past decade, there is increasing interest in optimizing the post-acute care to reduce hospitalization and overall financial burden. Post-operative recovery is influenced by many factors, such as management protocols or patient characteristics. Hence, this study aims to describe the real-world hospital LOS and discharge disposition of TKA patients at an acute hospital. Methods: This retrospective cohort study included 106 out of 121 unilateral primary TKA patients (diagnosis for gonarthrosis, ICD-10-AM) between January 2013 and December 2015. Primary and secondary outcomes were LOS, discharge readiness and destination respectively. Baseline demographic, clinical events and implant type data were captured. Descriptive analyses are reported with means and standard deviations for continuous variables and frequency and percentage for categorical variables. The difference in actual LOS and discharge readiness was examined for factors that may affect this outcome. Results: Provisional results from 106 TKA patients (median age 69.2 years; 65% female; 82% obese, 94.4% ASA II-III) showed a mean LOS of 6.0 days (SD: 2.8, 95% CI 5.5-6.6). 98% of the patients were discharged home with or without home care support. 31.1% of patients had rehabilitation. All patients achieved discharge readiness before actual discharge. Only 18% of patients were discharged on the same day they achieved discharge readiness. Analysis shows significantly longer days for actual discharge for patients having clinical events, such as transfusion or other procedures. Conclusions: Our real-world study showed that while the hospital displayed a mean LOS within the national reported average, patients could achieve discharge readiness 1.5 days earlier. However, patient clinical events could induce delays in actual discharge. Alongside fast-track programs to optimize patient care path and costs, these findings can potentially help healthcare providers to further enhance recovery and potentially reduce LOS according to patient profiles.
A299 underlying impaired renal function (serum creatinine ≥ 1.6 mg/dl, estimated glomerular filtration rate ≤ 50 ml/min/1.73m2) with or without diabetes. Treatment pattern data for CI-AKI management and CM utilization were obtained from a survey of cardiologists, radiologists and nephrologists (n= 15) and validated via an advisory board. Cost inputs for hospitalization, labs, diagnostic tests, and haemodialysis were obtained from national fee schedules and hospital charge data. CM costs were based on wholesale acquisition costs. The BIM base-case scenario assumes CM utilization of iohexol-240 (38.8%), iohexol-300 (21.0%), and iopamidol (200-370) (40.2%); the projected scenario assumes iodixanol (270-320) is utilized at an increasing rate of 30%, 50% and 100% in years 1-3, respectively. Results: With 1,881 patients undergoing CA or PCI, the model estimates 668 (35.5%) high-risk, eligible patients annually.
foot and amputation) and poor glycemic control as measured by HbA1c. ReSultS: A total of 285,761 patients were included in the analysis. Mean age was 62 years and mean duration of diabetes was 7.3 years; 61.2% were female and 61.6% had waist circumference above threshold (male: > 90cm, female: > 80cm). Most patients (68.9%) did not achieve glycemic control (i.e. had HbA1c > 6.5%). A majority (88%) of patients had at least one comorbidity, with hypertension being the most common (76.4%) followed by dyslipidemia (67.5%) and nephropathy (10.9%). Factors that were significantly associated with increased odds of an elevated HbA1c were a longer duration of diabetes (OR:3.06), waist circumference above threshold (OR:1.30), dyslipidemia (OR:1.21) and presence of IHD (OR:1.12). In contrast, age (OR:0.96), female sex (OR:0.95), presence of hypertension (OR:0.84) and CeVD (OR:0.85) reduced the odds of poor control. Total number of comorbidities and presence of retinopathy, nephropathy, diabetic foot ulcer and amputation were not associated with elevated HbA1c. ConCluSionS: In terms of the impact of comorbidities, our results were mixed. Impact depended on the type of comorbidity present. The total number of comorbidities did not affect outcome. Our analysis did not allow directionality of the association to be ascertained.objeCtiveS: Glycemic control as measured by hemoglobin A1c (HbA1c) is an important outcome in evaluations of the real-world effectiveness of bariatric surgery (BxS) in patients with type 2 diabetes mellitus (T2DM), but cannot be assessed directly in insurance claims data. This study assessed whether cessation of antihyperglycemic medication following BxS is an acceptable proxy for glycemic control without continued use of antihyperglycemic medication. MethodS: Patients age≥ 18yr who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy from 2005Q1 through 2015Q2 were selected from the de-identified Optum Integrated Claims/EHR database. Patients were required to have (a) health plan enrollment for 180d pre-BxS (baseline) and 2yr post-BxS; (b) BMI≥ 30, diagnosed T2DM, and an antihyperglycemic medication fill during baseline; and (c) HbA1c measured both at baseline and during 366-730d post-BxS. Post-BxS glycemic control (HbA1c< 7%; < 6% as sensitivity analysis) was assessed using first HbA1c measure during 366-730d post-BxS; antihyperglycemic cessation was defined as zero antihyperglycemic medication fills during 366-730d post-BxS. ReSultS: 80 T2DM patients on antihyperglycemic therapy who underwent BxS were eligible for inclusion (baseline characteristics: 55% RYGB; 45% sleeve gastrectomy; median age= 55yr; 63% female; median BMI= 44.7; 39% insulin users; 40% with HbA1c< 7%; 10% with HbA1c< 6%). During 366-730d post-BxS, 52 patients (65%) ceased use of antihyperglycemic medications; among this group, 92% had HbA1c< 7% and 70% had HbA1c< 6% post-BxS. Among the 28 patients who continued using antihyperglycemic medications 366-730d post-BxS, 50% had HbA1c< 7% and 14% had HbA1c< 6% post-BxS. Among the ...
s181 thinking, and lack of motivation. Treatment for schizophrenia is life-long and is associated with significant healthcare costs in both the inpatient and outpatient settings. The objective of the present study was to examine the inpatient hospital length of stay (LOS) and hospital charges in patients with schizophrenia. Methods: This retrospective study examined data from a US electronic health record database (Cerner HealthFacts®). Patients were required to have an ICD9/10 diagnosis of schizophrenia and designation of an inpatient admission. Visit-based data for medications, LOS, and hospital charges were analyzed for patients who received antipsychotics. Results: The study included 44,672 schizophrenia patients (39% female, 61% male), with a mean (SD) age of 48.8 (16.2) years who received antipsychotics. The median (25th-75th percentiles) hospital LOS was 138.4 (71.6-263.3) hours for patients who received antipsychotics. The median hospital charge was $19,379 ($10,205 -$43,798). The top five generic drugs received by these patients were haloperidol (42%), risperidone (32%), olanzapine (27%), quetiapine (26%) and aripiprazole (12%). ConClusions: This analysis examined the LOS and total charges for schizophrenia patients who received antipsychotics and provides initial insights into potentially relevant economic trends in the schizophrenia patient population.
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