BACKGROUND Several studies have described the burden of trauma care but few have explored the economic burden of trauma inpatient costs from a payer’s perspective or highlighted differences in average costs per person by payer status. This study gives a conservative inpatient National trauma cost estimate, and describes variation in average inpatient trauma cost by payer status. METHODS A retrospective analysis of patients who received trauma care at hospitals in the Nationwide Inpatient Sample (NIS) for the years 2005–2010 was conducted. Our sample patients were selected using appropriate ICD-9-CM codes to identify admissions due to traumatic injury. Data were weighted to provide national population estimates and all cost and charges were converted to 2010 US Dollar equivalents. Generalized linear models were used to describe costs by payer status, adjusting for patient characteristics, such as age, sex, race, and hospital characteristics, such as location, teaching status and patient case mix. RESULTS A total of 2,542,551 patients were eligible for study, with payer status as follows: 672,960 (26.47%) patients with private insurance, 1,244,817 (48.96%) patients with Medicare, 262,256 (10.31%) with Medicaid, 195,056 (7.67%) of patients with self-pay, 18,506 (0.73%) with no charge, and 150,956 (5.94%) on other types of insurance. The estimated yearly trauma inpatient cost burden was highest for Medicare at $17,551,393,082(46.79%), followed by private insurance $10,772,025,421 (28.72%), Medicaid $3,711,686,012 (9.89%), self-pay $2,831,438,460 (7.55%), other payer types $2,370,187,494 (6.32%), and $274,598,190 (0.73%) for patients who were not charged for their inpatient trauma treatment. Our adjusted national inpatient trauma yearly costs were estimated at $37,511,328,659 US dollars. Privately insured patients had significantly higher mean cost than per person than Medicare, Medicaid, self-pay, or no charge patients. CONCLUSION This study demonstrates that the distribution of trauma burden across payers is significantly different from that of the overall healthcare system, and suggests that while the burden of trauma is high, the burden of self-pay/non-reimbursed inpatient services is actually lower than that of overall medical care. Level of Evidence: Prognostic study with Level II evidence
Neuroinflammation and reactive oxygen species are thought to mediate the pathogenesis of Alzheimer’s disease (AD), suggesting that mild cognitive impairment (MCI), a prodromal stage of AD, may be driven by similar insults. Several studies document that hypoxia-inducible factor 1 (HIF-1) is neuroprotective in the setting of neuronal insults, since this transcription factor drives the expression of critical genes that diminish neuronal cell death. HIF-1 facilitates glycolysis and glucose metabolism, thus helping to generate reductive equivalents of NADH/NADPH that counter oxidative stress. HIF-1 also improves cerebral blood flow which opposes the toxicity of hypoxia. Increased HIF-1 activity and/or expression of HIF-1 target genes, such as those involved in glycolysis or vascular flow, may be an early adaptation to the oxidative stressors that characterize MCI pathology. The molecular events that constitute this early adaptation are likely neuroprotective, and might mitigate cognitive decline or the onset of full-blown AD. On the other hand, prolonged or overwhelming stressors can convert HIF-1 into an activator of cell death through agents such as Bnip3, an event that is more likely to occur in late MCI or advanced Alzheimer’s dementia.
PSB increases the risk of intra- or postoperative hemodynamic depression in CAS and might increase the risk of major adverse cardiovascular events. Given the added complications and the lack of evidence supporting long term patency, PSB should be only selectively used.
This is the first study that documents higher reintervention rates for femoral-popliteal bypass compared with angioplasty and stenting. We believe that the main reason for this finding is the fact that the bypass patients had significantly more advanced disease. This, emphasizes that one must consider the patient population undergoing intervention when comparing revascularization procedures. A prospective randomized trial is needed to determine the overall better treatment option.
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