OBJECTIVEIn the future, payers may not cover unplanned 90-day emergency room (ER) visits or readmissions after elective lumbar spine surgery. Prior studies using large administrative databases lack granularity and/or use a proxy for actual cost. The purpose of this study was to identify risk factors and subsequent costs associated with 90-day ER visits and readmissions after elective lumbar spine surgery.METHODSA prospective, multisurgeon, single-center electronic medical record was queried for elective lumbar spine fusion surgeries from 2013 to 2017. Predictive models were created for 90-day ER visits and readmissions.RESULTSOf 5444 patients, 729 (13%) returned to the ER, most often for pain (n = 213, 29%). Predictors of an ER visit were prior ER visit (OR 2.5), underserved zip code (OR 1.4), and number of chronic medical conditions (OR 1.4). In total, 421 (8%) patients were readmitted, most frequently for wound infection (n = 123, 2%), exacerbation of chronic obstructive pulmonary disease (n = 24, 0.4%), and sepsis (n = 23, 0.4%). Predictors for readmission were prior ER visit (OR 1.96), multiple chronic conditions (OR 1.69), obesity (nonobese, OR 0.49), race (African American, OR 1.43), admission status (ER admission, OR 2.29), and elevated hemoglobin A1c (OR 1.80). The mean direct hospital cost for an ER visit was $1971, with 75% of visits costing less than $1890, and the average readmission cost was $7347, with 75% of readmissions costing less than $8820. Over the 5-year study period, the cost to the institution for 90-day return ER visits was $5.1 million.CONCLUSIONSRisk factors for 90-day ER visit and readmission after elective lumbar spine surgery include medical comorbidities and socioeconomic factors. Proper patient counseling, appropriate postoperative pain management, and optimization of modifiable risk factors prior to surgery are areas to focus future efforts to lower 90-day ER visits and readmissions and reduce healthcare costs.
details of system dynamics, the RMT was able to capture email: {vbrozhOl, yehia.khalil, adel.elmaghraby, correctly spectral fluctuations of heavy nuclei [11], and of mmkantOl}@louisville.edu many other complex systems [5]. It was extended towards a much wider range of applications. Abstract-The traffic behavior of the University of LouisvilleIn particular, the self-averaging effect of random matrices network with the interconnected backbone routers and the was shown to be able to model the fading, wideband, multiuser number of Virtual Local Area Network (VLAN) subnets is and multi-antenna which are the key features characterizing investigated using the Random Matrix Theory (RMT) approach. We employ the system of equal interval time series of traffic the wireless channels. The RMT based analysis is used to counts at all router to router and router to subnet connections as study the reduced-rank receivers, in which the input signal is a representation of the inter-domain traffic. The cross-correlation projected onto a lower dimensional subspace [15]. The large matrix C of the real and simulated traffic rate changes between system performance of iterative receivers is evaluated with different traffic time series is calculated and tested against null-the RMT techniques in [24], [25]. The spectral properties hypothesis of random interactions. t , l l lThe majority of the eigenvalues Ai of matrix C fall within the of random matrices have also been used to evaluate the bounds predicted by the RMT for the eigenvalues of random performance of multi-antenna systems with correlated fading correlation matrices. The inverse participation ratio (IPR) of [15]. Other applications of the RMT based analysis to signal congested traffic shows the higher level of localization (fewer processing and communications techniques are still emerging. number of randomly interacting network nodes). In other words, the IPR level signifies the start of congestion or correlated traffic.In this paper, we focus on the wired inter-domain comHence, the RMT based model for multiple input multiple output munication of routers and subnets of the university campus (MIMO) system widely accepted in wireless communication network. Disregarding the infrastructure of the network, we domain is quite applicable for analysis and modeling of traffic concentrate on network traffic count time series and their large dynamics of wired systems. In particular, the IPR of the RMT scale correlations. predicted boundaries in real traffic can be used as a congestion The contributions of this study are as follows: indicator in network congestion control mechanisms. . We propose the application constraints free methodology CATEGORIES AND SUBJECT DESCRIPTORS of network-wide traffic time series interactions analysis. The information about broadcast domains and routing C.2.3 [Computer-Communication Networks]: Network protocols is irrelevant for our analysis. Operations . Using the RMT, we are able to separate the random interactions from the system specific interactions. The GE...
Data Centers (DC) suffer from an increasing number of threats; these are exaggerated by the incredible growth of critical data volumes in addition to vulnerabilities in technologies used for distributed architectures.This paper demonstrates the need to define a new metric for "resilience level" to complement other system metrics such as performance, availability, robustness and fault tolerance. In addition, "data center" resilience's evaluation framework and its advantages are presented.
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