Veerajalandhar Allareddy

Specificity of procedure volume and in-hospital mortality association.

Objective:Several studies have examined the association between procedure-specific volume and in-hospital mortality and concluded that high-volume hospitals have lower mortality rates when compared with low-volume hospitals. There is a paucity of studies examining the association between unrelated procedure volume and in-hospital mortality. The objective of our study is to examine the procedure-specific volume–outcome association as well as unrelated procedure volume–outcome association for 5 procedures: coronary artery bypass graft (CABG), percutaneous coronary interventions (PCI), elective abdominal aortic aneurysm repair (AAA), pancreatectomy (PAN), and esophagectomy (ESO). Methods:Nationwide Inpatient Sample for years 2000 through 2003 was used. All discharges with primary procedure codes for CABG, PCI, AAA, PAN, and ESO were selected. The average number of procedures performed by the hospitals per year during the study period was computed, and hospitals were categorized as having met or not met the Leapfrog Group-recommended volume thresholds. Procedure specific and unrelated procedure volume–in-hospital mortality association was examined by using multivariable logistic regression analysis. Procedure volume–in-hospital mortality association was adjusted for patient and hospital characteristics. Results:For all 5 procedures, hospitals that did not meet Leapfrog Group volume thresholds were associated with significantly higher odds for in-hospital mortality when compared with hospitals that met Leapfrog Group volume thresholds (P < 0.05). Hospital volume levels for PAN or ESO did not influence outcomes following CABG, PCI, and AAA. Similarly, hospital volumes for CABG, PCI, and AAA did not influence the outcomes for PAN or ESO. Conclusions:Hospital volume–in-hospital mortality association appears largely to be specific to the procedure being studied.

Effect of meeting Leapfrog volume thresholds on complication rates following complex surgical procedures.

Background:There is limited published data on the relationship between hospital volume and postoperative complications. The objectives of the current study are to examine the association between hospital volume and complications and also to examine the association between complications and in-hospital mortality following 5 complex surgical procedures. Methods:The Nationwide Inpatient Sample for years 2000 to 2003 was used. Patients who underwent coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), elective abdominal aortic aneurysm repair (AAA), pancreatectomy (PAN), and esophagectomy (ESO) as primary procedures were selected. Hospital volumes were calculated as suggested by the Leapfrog Group evidence-based hospital referral criteria. The association between hospital volume and complications were examined by multivariable logistic regression analyses, adjusting for patient and hospital characteristics. Results:A total of 261551 CABG, 573072 PCI, 35104 AAA, 4931 PAN, and 2473 ESO procedures were selected for analysis. A total of 580 hospitals performed the CABG procedures during the study period in this dataset. The corresponding numbers of hospitals for PCI, AAA, PAN, and ESO were 714, 1207, 758, and 555 respectively. In-hospital complication rates following CABG, PCI, AAA, PAN, and ESO were 26.45%, 6.74%, 23.81%, 39.28%, and 46.30%, respectively. High-volume hospitals for all the procedures were associated with lower odds for in-hospital mortality when compared with low-volume hospitals (P < 0.05). High-volume hospitals were associated with significantly lower odds for at least one complication following 3 of the 5 procedures (PCI, AAA, and PAN) and specifically for significantly lower odds for respiratory complications following CABG, AAA, and PAN, digestive complications following PAN, hemorrhage/hematoma complications following PCI, and septicemia following PCI and PAN when compared with low-volume hospitals (P < 0.05). Conclusion:Lower mortality rates in high-volume hospitals can be partly, though not completely, attributed to lower complication rates. Future studies must focus on identifying other potential pathways for reduced mortality in high-volume hospitals.

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

Firearm related injuries amongst children: Estimates from the nationwide emergency department sample

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

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

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.

Epidemiology of Hospital-based Emergency Department Visits Due to Sports Injuries

OBJECTIVE The objective of this study is to provide estimates of firearm related injuries in children seeking care in hospital based emergency departments. METHODS The Nationwide Emergency Department Sample (NEDS) for the year 2008 was used for the current study. All ED visits occurring amongst children aged less than or equal to 18 years and that had an External Cause of Injury (E-Code) for any of the firearm related injuries were selected for analysis. RESULTS A total of 14,831 ED visits (in children) in the United States had a firearm injury. The average age of the ED visits was 15.9 years. Males constituted a predominant proportion of all ED visits (89.2%). A total of 494 patients died in the emergency departments (3.4% of all ED visits) whilst 323 died following in-patient admission into the same hospital (6% of all inpatient admissions). The most frequently documented firearms were assaults by firearms and explosives (55% of all ED visits), accidents caused by firearms and air gun missiles (33.6%), and injuries by firearms that were undetermined (7.4%). The average charge for each ED visit was

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

3642 (25th percentile is

Outcomes of Acute Chest Syndrome in Adult Patients with Sickle Cell Disease: Predictors of Mortality

1146, median is

Self Inflicted Injuries among Children in United States – Estimates from a Nationwide Emergency Department Sample

2003, and 75th percentile is

Hospital Based Emergency Department Visits Attributed to Child Physical Abuse in United States: Predictors of In-Hospital Mortality

4404). The mean charge for those visits that resulted in in-patient admission into the same hospital was