R. Grim

Economics of Appendicitis: Cost Trend Analysis of Laparoscopic Versus Open Appendectomy from 1998 to 2008

BACKGROUND Laparoscopic appendectomy (LA) has become more acceptable for the treatment of appendicitis over the last decade; however, its cost benefit compared to open appendectomy (OA) remains under debate. The purpose of this study is to evaluate the utilization of LA and its cost effectiveness based on total hospital charges stratified by complexity of disease and complications compared to OA. MATERIAL AND METHODS Nationwide Inpatient Sample data from 1998 to 2008 with the principal diagnosis of appendicitis were included. Appendicitis cases were divided by simple and complex (peritonitis or abscess) and subdivided by OA, LA, and lap converted to open (CONV). Total charges (2008 value), length of stay (LOS), and complications were assessed by disease presentation and operative approach. RESULTS Between 1998 and 2008, 1,561,518 (54.3%) OA, 1,231,643 (42.8%) LA, and 84,662 (2.9%) CONV appendectomies were performed. LA had shorter LOS (2 d) than OA (3 d) and CONV (5 d) (P<0.001). CONV (7.4%) cases had more complications than OA (3.7%) and LA (2.6%). LA (

Evaluating Causes for Unplanned Hospital Readmissions of Palliative Care Patients

19,978) and CONV (

Critical Outcomes in Nonrobotic vs Robotic-Assisted Cardiac Surgery

28,103) are costlier than OA (

Changing Epidemiology of Acute Appendicitis in the United States: Study Period 1993–2008

15,714) based on normalized cost for simple and complex diseases (P<0.001). CONCLUSIONS LA is more prevalent but its cost is higher in both simple and complex cases. Cost and complications increase if the case is converted to open. OA remains the most cost effective approach for patients with acute appendicitis.

Factors associated with delayed recovery in athletes with concussion treated at a pediatric neurology concussion clinic

This study evaluated reasons why palliative care patients were readmitted within 30 days of discharge. A secondary purpose was to determine whether length of stay (LOS) was different between readmission reasons. From July 2006 to June 2007, 156 palliative care readmissions were identified. Codes were assigned to each readmission and included compliance issues, discharge planning, disease process, new diagnosis, premature discharge, surgical complications, and other. Results demonstrated that disease progression (63%) and development of new co-morbidities (17%) were the primary readmission causes. No significant differences among readmission causes for LOS were identified. As the primary reason for readmission was the disease process, a closer look at the most common disease processes and the specific complications that resulted in a readmission would be helpful in planning patient care.

The Efficacy of the Nurse Navigator in a Community Hospital Breast Care Program

IMPORTANCE As robotic-assisted cardiac surgical procedures increase nationwide, surgeons need to be educated on the safety of the new modality compared with that of open technique. OBJECTIVE To compare complications, length of stay (LOS), actual cost, and mortality between nonrobotic and robotic-assisted cardiac surgical procedures. DESIGN, SETTING, AND PARTICIPANTS Weighted data on cardiac patients who had undergone operations involving the valves or septa and vessels, as well as other heart and pericardium procedures, from January 1, 2008, to December 31, 2011, were obtained from the Nationwide Inpatient Sample via the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Propensity score matching was used to match each robotic-assisted case to 2 nonrobotic cases on 14 characteristics. MAIN OUTCOMES AND MEASURES Complications, median LOS, actual cost, and mortality. RESULTS Exploratory analysis found a total of 1,374,653 cardiac cases (1,369,454 [99.6%] nonrobotic and 5199 [0.4%] robotic-assisted cases). After propensity score matching, there were 10,331 (66.5%) nonrobotic cases and 5199 (33.5%) robotic-assisted cases. Cardiac operations included 1630 (10.5%) involving the valves or septa, 6616 (42.6%) involving the vessels, and 7284 (46.9%) other heart and pericardium procedures. Robotic-assisted compared with nonrobotic surgery had a higher median cost (

Changing Demographics in Laparoscopic Cholecystectomy Performed in the United States Hospitalizations from 1998-2010

39,030 vs

Locally advanced primary recto-sigmoid cancers: Improved survival with multivisceral resection

36,340; P < .001) but lower LOS (5 vs 6 days; P < .001) and lower mortality (1.0% vs 1.9%; P < .001). Robotic-assisted surgery had significantly fewer complications for all operation types (30.3% vs 27.2%; P < .001). CONCLUSIONS AND RELEVANCE Overall, robotic-assisted surgery has significantly reduced median LOS, complications, and mortality compared with nonrobotic surgery. Results of this study support the contention that robotic-assisted surgery is as safe as nonrobotic surgery and offers the surgeon an additional technique for performing cardiac surgery.