Background: There is limited information on current cost estimates associated with intertrochanteric hip fractures in the United States. The purpose of the present study was to estimate the incidence and economic burden of both intertrochanteric and all hip fracture types in the Medicare patient population to the U.S. health-care system. Methods: This retrospective database analysis of the 2014 Medicare database involved Standard Analytic File (SAF) 5% sample claims and total enrollment files. Patients ≥65 years of age with a new principal diagnosis of hip fracture (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 820.xy) who were continuously enrolled for 18 months were included; those with intertrochanteric hip fracture were further identified with use of ICD-9-CM code 820.21. The total direct medical costs associated with hip fracture in the 90-day and 12-month post-fracture periods were estimated. The relevant costs were estimated on the basis of a propensity-score-matched analysis. The health-care services responsible for major expenses within the 90-day episode-of-care period were also identified. Results: The total annual direct medical costs associated with all hip fractures was $50,508 per patient, resulting in a yearly estimate of $5.96 billion to the U.S. health-care system. Intertrochanteric hip fractures accounted for an annual estimate of $52,512 per patient, corresponding to an overall annual economic burden of $2.63 billion to the U.S. health-care system and representing 44% of all hip fracture costs. Inpatient hospitalization and skilled nursing facility services jointly accounted for 76.3% of the $44,135 estimated cost per patient and 75.6% of the $42,388 estimated cost per patient within the 90-day post-acute care period for intertrochanteric and all hip fractures, respectively. Conclusions: Hip fracture represents a substantial economic burden to the U.S. health-care system, accounting for $5.96 billion per year, with intertrochanteric hip fracture accounting for 44% of total costs. Level of Evidence: Economic and decision analysis, Level IV . See Instructions for Authors for a complete description of levels of evidence. Clinical Relevance: The present study provides a comprehensive and updated annual estimate of the economic burden of all hip fracture types and estimates the economic burden of intertrochanteric hip fractures in the Medicare population; to our knowledge, prior availability of this information in the literature is limited.

Hospital-acquired pressure injuries (HAPI) are a societal burden and considered potentially preventable. Data on risk factors and HAPI burden are important for effective prevention initiatives. This study of the 2009-2014 US Premier Healthcare Database identified HAPI risk factors and compared outcomes after matching HAPI to non-HAPI patients. The cumulative incidence of HAPI was 0.28% (47 365 HAPI among 16 967 687 total adult inpatients). Among the matched sample of 110 808 patients (27 702 HAPI), the strongest risk factors for HAPI were prior PI (odds ratio [OR] = 12.52, 95% confidence interval [CI] = 11.93-13.15), prior diabetic foot ulcer (OR = 3.43, 95% CI = 3.20-3.68), and malnutrition (OR = 3.11, 95% CI = 3.02-3.20). HAPI patients had longer adjusted length of stay (3.7 days, P < .0001), higher total hospitalization cost ($8014, P < .0001), and greater odds of readmissions through 180 days (OR = 1.60, 95% CI = 1.55-1.65). This study demonstrates how big data may help quantify HAPI burden and improve internal hospital processes by identifying high-risk patients and informing best practices for prevention.

Pressure injuries are one of the most common and costly complications occurring in US hospitals. With up to 3 million patients affected each year, hospital‐acquired pressure injuries (HAPIs) place a substantial burden on the US healthcare system. In the current study, US hospital discharge records from 9.6 million patients during the period from October 2009 through September 2014 were analysed to determine the incremental cost of hospital‐acquired pressure injuries by stage. Of the 46 108 patients experiencing HAPI, 16.3% had Stage 1, 41.0% had Stage 2, 7.0% had Stage 3, 2.8% had Stage 4, 7.3% had unstageable, 14.6% had unspecified, and 10.9% had missing staging information. In propensity score‐adjusted models, increasing HAPI severity was significantly associated with higher total costs and increased overall length of stay when compared with patients not experiencing a HAPI at the index hospitalisation. The average incremental cost for a HAPI was $21 767. Increasing HAPI severity was significantly associated with greater risk of in‐hospital mortality at the index hospitalisation compared with patients with no HAPI, as well as 1.5 to 2 times greater risk of 30‐, 60‐, and 90‐day readmissions. Additionally, increasing HAPI severity was significantly associated with increasing risk of other hospital‐acquired conditions, such as pneumonia, urinary tract infections, and venous thromboembolism during the index hospitalisation. By preventing pressure injuries, hospitals have the potential to reduce unreimbursed treatment expenditures, reduce length of stay, minimise readmissions, prevent associated complications, and improve overall outcomes for their patients.

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Patients with CCO-treated PUs returned to inpatient and outpatient hospital settings less often compared with medicinal honey-treated PUs. These results from real-world administrative data help to gain a better understanding of the clinical characteristics of patients with PUs treated with these two debridement methods and the economic implications of debridement choice in the acute care setting.

well as on the duration of use of anticoagulant and antiarrhythmic drugs and hospital stays. Carto Thermocool Smarttouch catheter; amiodarone, sotalol, propafenone; rivaroxaban, dabigatran and apixaban were the treatment approaches used for the cost analysis in this study. The cost analyses were made based on the perspective of the Social Security Institution in Turkey. RESULTS: The costs per AFib patient of drug therapy versus catheter ablation were as follows: antiarrhythmic drug (4.0088 TRY vs 112 TRY), function tests (1.194 TRY vs 0 TRY), physician visits (837 TRY vs 78 TRY), heart tests (4.918 TRY vs 683 TRY), anticoagulant drug (21.502 TRY vs 392 TRY), medical devices and procedures (0 TRY vs 14.615 TRY) and hospital stay (1.620 TRY vs 312 TRY). The number of threedimensional radio frequency catheter ablation procedures performed in Turkey in 2017 is 500. The total cost of AFib treatment for 500 patients was 17.079.30 TRY with drug therapy and 8.096.386 TRY with three-dimensional complex mapping catheter ablation. CONCLUSIONS: These results propose that catheter ablation requires less costly treatment than drug therapy for AFib patients in Turkey.

Despite advancements in surgical technique and component design, implant loosening, stiffness, and instability remain leading causes of total knee arthroplasty (TKA) failure. Patient-specific instruments (PSI) aid in surgical precision and in implant positioning and ultimately reduce readmissions and revisions in TKA. The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, and 365 days in PSI-guided TKA patients. We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017 Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital, and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate 30, 60, and 90 days and 1-year readmission rate. The study matched 3,358 TKAs with PSI with TKA without PSI patients. Mean total hospital costs were statistically significantly (p < 0.0001) lower for TKA with PSI ($14,910; 95% confidence interval [CI]: $14,735–$15,087) than TKA without PSI patients ($16,018; 95% CI: $15,826–$16,212). TKA with PSI patients were 31% (odds ratio [OR]: 0.69; 95% CI: 0.51–0.95; p-value = 0.0218) less likely to be readmitted at 30 days; 35% (OR: 0.65; 95% CI: 0.50–0.86; p-value = 0.0022) less likely to be readmitted at 60 days; 32% (OR: 0.68; 95% CI: 0.53–0.88; p-value = 0.0031) less likely to be readmitted at 90 days; 28% (OR: 0.72; 95% CI: 0.60–0.86; p-value = 0.0004) less likely to be readmitted at 365 days than TKA without PSI patients. Hospitals and health care professionals can use retrospective real-world data to make informed decisions on using PSI to reduce hospital cost and readmission rate, and improve outcomes in TKA patients.

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