Min Kyeong Lee

Hospital-based emergency department visits involving dental conditions: Profile and predictors of poor outcomes and resource utilization

BACKGROUND Untreated dental conditions may progress to lesions that are severe enough to necessitate emergency visits to hospitals. The authors conducted a study to investigate nationally representative trends in U.S. hospital-based emergency department (ED) visits involving dental conditions and to examine patient-related characteristics associated with ED charges. METHODS The authors used the Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality, for the years 2008 through 2010. They selected all ED visits involving patients with a diagnosis of either dental caries, pulpal or periapical lesions, gingival or periodontal conditions, or mouth cellulitis or abscess. Outcomes examined included post-ED disposition status and hospital ED charges. RESULTS During the study period, 4,049,361 ED visits involved diagnosis of a dental condition, which is about 1 percent of all ED visits occurring in the entire United States. Uninsured patients made about 40.5 percent of all dental condition-related ED visits. One hundred one patients in the study died in EDs. The mean hospital ED charge per visit was approximately

Comparison of Trends and Outcomes of Carotid Artery Stenting and Endarterectomy in the United States, 2001 to 2010

760 (adjusted to 2010 dollars), and the total ED charges across the entire United States during the three-year study period was

Hospital Emergency Department Visits Attributed to Pulpal and Periapical Disease in the United States in 2006

2.7 billion. CONCLUSIONS Patients without insurance are a cohort at high risk of seeking dental care in hospital-based ED settings. A substantial amount of hospital resources are used to treat dental conditions in ED settings. Patients with mouth cellulitis, periodontal conditions and numerous comorbidities are likely to incur higher ED charges. PRACTICAL IMPLICATIONS Dental conditions can be treated more effectively in a dental office setting than in hospital-based settings.

Rate of percutaneous coronary intervention for the management of acute coronary syndromes and stable coronary artery disease in the United States (2007 to 2011).

Background—Given the controversy regarding whether carotid endarterectomy (CEA) or carotid artery stenting (CAS) may be superior for stroke prevention, it is uncertain how recent clinical evidence, guidelines, and reimbursement policies have influenced the volume and outcomes after these procedures. Methods and Results—We conducted a serial, cross-sectional study with time trends of patients undergoing CAS (n=124 265) and CEA (n=1 260 647) between 2001 and 2010 from the Nationwide Inpatient Sample database. During the 10-year period, the frequency of CEA declined, whereas CAS use slowly increased. After multivariate propensity score–matched analysis, CAS was associated with an increased risk of death (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.40–2.04), stroke (OR, 1.43; 95% CI, 1.23–1.66), and major adverse events including death, stroke, and myocardial infarction (OR, 1.25; 95% CI, 1.13–1.39). In asymptomatic patients, there was no significant difference in major adverse events (OR, 1.08; 95% CI, 0.92–1.20; P=0.16 [P <0.001 for interaction between procedure type and symptom status]) between CAS and CEA. Importantly, there was a significant improvement in CAS outcomes during the course of 10 years (reduction in death [OR, 0.51; 95% CI, 0.49–0.67; P for trend=0.03] and major adverse events [OR, 0.75; 95% CI, 0.66–0.84; P for trend=0.05] comparing years 2010 versus 2001). Conclusions—In US hospitals between 2001 and 2010, CAS was associated with worse in-hospital outcomes, partly attributable to selection and ascertainment bias. Asymptomatic patients undergoing CAS versus CEA had similar adjusted rates of major adverse events. CAS outcomes improved significantly during the course of the decade likely attributable to improvements in patient selection, operator skills, and technological advancements.

Effect of occurrence of infection-related never events on length of stay and hospital charges in patients undergoing radical neck dissection for head and neck cancer.

BACKGROUND Relatively localized conditions such as infection of the pulp or periapical tissues if left untreated could spread and require hospital care. The objectives of this study were to assess the prevalence of such hospital-based emergency department (ED) visits, to quantify hospital charges associated with those visits, and to identify characteristics of those members of the population who are likely to make such visits. METHODS The experimental design of this study involves the use of The Nationwide Emergency Department Sample for the year 2006. All discharges with a primary diagnosis code for pulpal and periapical diseases (International Classification of Disease, Clinical Modification [ICD-9-CM] code of 522) were selected for analysis. All estimates were projected to national levels using the discharge weight variables. RESULTS In the United States, during the year 2006, a total of 403,149 ED visits had a primary diagnosis code for pulp and periapical diseases. The average patient age was 32.9 years. The mean hospital charge for ED visits was

Outcomes of hospitalizations attributed to periapical abscess from 2000 to 2008: a longitudinal trend analysis.

480, and the total charges for all the ED visits in the United States was

Outcomes in Patients Hospitalized for Periapical Abscess in the United States

163,692,957. Among the ED visits, 5,721 were admitted to the same hospital for inpatient care. The mean length of stay after hospitalization was 2.95 days. The uninsured (39.92%) constituted the largest proportion of all ED visits. CONCLUSIONS This study identifies high-risk groups that are likely to present to hospital-based EDs for the treatment of pulp and periapical diseases. This highlights the need for significant resources to treat such patients in a hospital care setting.

Prevalence and impact of complications on outcomes in patients hospitalized for oral and oropharyngeal cancer treatment

Although the benefit of percutaneous coronary interventions (PCIs) for patients presenting with acute coronary syndromes (ACS) has been established in numerous studies, the role of PCI in stable coronary artery disease (CAD) remains controversial. With the publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluations trial and the appropriate use criteria for coronary artery revascularization, we sought to examine the impact of these treatment strategies and guidelines on the current practice of PCI in United States. We conducted a serial cross-sectional study with time trends of patients undergoing PCI for ACS and stable CAD from 2007 to 2011. The annual rate of all PCI decreased by 27.7% from 10,785 procedures per million adults per year in 2007 to 2008 to 7,801 procedures per million adults per year in 2010 to 2011 (p=0.03). Although there was no statistically significant decrease in the PCI utilization for ACS from 2007 to 2011, PCI utilization for stable CAD decreased by 51.7% (from 2,056 procedures per million adults per year in 2008 to 992 procedures per million adults per year in 2011, p=0.02). Hospitals with a higher volume of PCI experienced a more significant decrease. Decrease in PCI utilization for stable CAD was statistically significant for patients with Medicare and private insurance/health maintenance organization (44.5%, p=0.03 and 59.5%, p=0.007, respectively). In conclusion, the rate of PCI decreased substantially starting from 2009 in the United States. Most of the decrease was attributed to the reduction in PCI utilization for stable CAD.

Emergency Department Visits With Facial Fractures Among Children and Adolescents: An Analysis of Profile and Predictors of Causes of Injuries

OBJECTIVE To estimate the impact of infection-related never events (postoperative pneumonia, Clostridium difficile infection, infection with microorganisms resistant to penicillin, postoperative infections, and decubitus ulcers) following radical neck dissections for head and neck cancers. STUDY DESIGN The 2008 Nationwide Inpatient Sample was used to select hospitalizations with HNC that underwent radical neck dissections. Predictor variables were occurrence of never events and other patient- and hospital-level factors. Outcome variables were hospitalization charges and length of stay (LOS). Regression analyses were used to measure the association between predictors and outcomes. RESULTS Among 10,660 hospitalizations, prevalence of never events ranged from 0.2% to 5.0%. Mean hospitalization charge and LOS were

Factors associated with length of stay and hospital charges for patients hospitalized with mouth cellulitis

75,654 and 6.8 days, respectively. Never events were associated with 5.6-10.0 longer LOS and