IMPORTANCE About half of people younger than 65 years with private insurance are enrolled in a high-deductible health plan (HDHP). While these plans entail substantially higher out-of-pocket costs for patients with chronic medical conditions who require ongoing care, their effect on patients undergoing surgery who require acute care is poorly understood. It is plausible that higher out-of-pocket costs may lead to delays in care and more complex surgical conditions. OBJECTIVE To determine the association between enrollment in HDHPs and presentation with incarcerated or strangulated hernia.
DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort analysis included privately insured patients aged 18 to 63 years from a large commercial insurance claims database who underwent a ventral or groin hernia operation from January 2016 through June 2019 and classified their coverage as either a traditional health plan or an HDHP per the Internal Revenue Service's definition. Multivariable regression, adjusting for demographic and clinical covariates, was used to examine the association between enrollment in an HDHP and the primary outcome of presentation with an incarcerated or strangulated hernia.EXPOSURES Traditional health plan vs HDHP.
MAIN OUTCOMES AND MEASURES Presence of an incarcerated or strangulated hernia per International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes.RESULTS Among 83 281 patients (71.9% men and 28.1% women; mean [SD] age, 48.7 [10.9] years) who underwent hernia surgery, 27 477 (33.0%) were enrolled in an HDHP and 21 876 (26.2%) had a hernia that was coded as incarcerated or strangulated. The mean annual deductible was considerably higher for those in the HDHP group than their traditional health plan counterparts
Despite widespread implementation of colorectal cancer (CRC) screening, CRC continues to be in the top 5 leading causes of cancer-related deaths in the United States. 1 The study by Cheng et al 2 examines the survival benefit of early-onset (ie, age <50 years) CRC compared with diagnosis at age 51 to 55 years. Cheng et al 2 found a modest survival benefit for patients with early-onset CRC,
Adhesions are the result of intra-abdominal scar tissue that can form after abdominal or pelvic surgery. Despite advances in surgical technique and extensive research devoted to their prevention, adhesions remain the most common cause of small bowel obstructions (SBOs), accounting for 56% of SBOs. 1 It is estimated that more than 90% of patients who undergo abdominal or pelvic surgery will develop postoperative adhesions. Additionally, adhesions can cause chronic pain, infertility, and increased complexity of subsequent intra-abdominal operations. Considerable time and effort have been devoted to devising methods to prevent adhesions, from modifications in surgical technique to the development of mechanical barriers or chemical compounds. To date, none of these methods have been proven to eliminate the incidence of adhesion-related complications (ARCs).The development of adhesions after abdominal surgery is mediated by inflammatory pathways involving cyclooxygenase enzymes and other profibrotic cytokines. Although numerous barriers derived from various forms of polysaccharides have shown some success in lowering rates of ARCs, some may be associated with higher risk of surgical site infection. 2 Thus, there has been an increased focus on the inflammatory pathway leading to adhesions as a potential target for adhesion prevention. Statins have been used for decades to lower low-density lipid cholesterol by inhibiting 3-hydroxy-3-methylglutaryl coenzyme reductase. Animal and cell studies have demonstrated statins also have anti-inflammatory effects by downregulating proinflammatory cytokines. 3 However, the association of statin use with postoperative ARCs in humans has not been studied prior to the article by Scott and colleagues. 4 Current innovations in adhesion prevention, ranging from laparoscopic and surgical techniques to adhesion barriers, have been shown to reduce ARCs. 2,5 However, these methods may not be applicable to all operative settings, such as emergent surgery or a contaminated surgical field.Pharmacological treatments present another option to prevent adhesions. While new drugs require considerable resources, time, and cost to bring to market, Scott and colleagues 4 present a valuable opportunity to consider currently used drugs, such as statins, that are known to target the pathways leading to adhesion formation. Statins have been in use for decades and are among the most prescribed medications in the United States, with 26% of adults older than 40 years old taking a statin to lower cholesterol. By using robust epidemiological methods and large populationrepresentative data sets from 2 countries, the authors 4 found that concurrent statin use was associated with a decreased hazard of ARCs and SBOs in patients undergoing abdominal surgery in a dosedependent manner. The authors 4 used 2 large population data sets, The Health Improvement Network (THIN) from the United Kingdom and Optum Clinformatics Data Mart (Optum) data set from the United States, to examine the association between preoperative st...
Background-BASE (building, antenna, span, earth) jumping involves jumping from fixed objects with specialized parachutes. BASE jumping is associated with less aerodynamic control and flight stability than skydiving because of the lower altitude of jumps. Injuries and fatalities are often attributed to bad landings and object collision.Methods-We performed a retrospective analysis of the 2010À2014 National Emergency Department Sample database, a nationally representative sample of all visits to US emergency departments (EDs). BASE jumping-associated injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes [E004.0]. Outcomes evaluated included morbidity, mortality, inpatient admission, and costs. Adjusted analyses accounting for survey methodology were performed.Results-After weighting, 1790 BASE-associated ED presentations were identified with 358 §28 injuries annually. A total of 1313 patients (73%) were aged 18 to 44 y, and 1277 (71%) were male. Nine hundred seventy-six (55%) multiple body system injuries and 677 (38%) isolated extremity injuries were reported. There were 1588 (89%) patients discharged home from the ED; only 144 (7%) were admitted as inpatients. On multivariate logistic regression, only anatomic site of injury was associated with inpatient admission (odds ratio=0.6, P<0.001, 95% CI 0.5À0.8). Including ED and inpatient costs, BASE injuries cost the US healthcare system approximately $1.7 million annually. No deaths were identified within the limitations of the survey design.Conclusions-Although deemed one of the most dangerous extreme sports, many patients with BASE injuries surviving to arrival at definitive medical care do not require inpatient admission.
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