Background: Bleeding from a colonic diverticulum is serious in aged patients. The aim of this study was to determine the risk factors for high-cost hospitalization of colonic diverticular bleeding using the diagnosis procedure combination (DPC) data. Methods: From January 2009 to December 2015, 78 patients with colonic diverticular bleeding were identified by DPC data in Saga Medical School Hospital. All patients underwent colonic endoscopy within 3 days. The patients were divided into 2 groups: the low-cost group (DPC cost of <500,000 yen) and the high-cost group (DPC cost of >500,000 yen). Results: Univariate analysis revealed that aging, hypertension, rebleeding, a low hemoglobin concentration at admission, and blood transfusion were risk factors for high hospitalization cost. Multivariate analysis revealed that rebleeding (OR 5.3; 95% CI 1.3-21.3; p = 0.017) and blood transfusion (OR 3.8; 95% CI 1.01-14.2; p = 0.048) were definite risk factors for high hospitalization cost. Conclusion: Rebleeding and blood transfusion were related to high hospitalization cost for colonic diverticular bleeding.

This study aimed to evaluate causative factors for prolonged hospitalization based on hospitalization status, type of hospital ward, and comorbidities, specifically diabetes mellitus and infectious diseases, in 20,876 patients hospitalized in Saga University Hospital from April 1, 2012, to February 28, 2015. Prolonged hospitalization was defined as hospital days exceeding period 3 in the diagnosis procedure combination system. Among all factors, causative (risk) factors for prolonged hospitalization were evaluated by multiple logistic regression analysis. Multivariate analysis indicated causative factors for prolonged hospitalization were aging, comorbid diabetes mellitus, time spent in the intensive care unit, and infectious diseases contracted during hospitalization. The risk factors for contracting infectious diseases during hospitalization were aging, male sex, comorbid diabetes mellitus, and increased number of days spent in period 3 in the diagnosis procedure combination code. These data indicated that critical factors for discharge from hospital within an appropriate time frame were prevention of infectious diseases during hospitalization, and a fast and effective therapeutic approach to patients in the intensive care unit.

This study aimed i) to investigate about items with high relevance for aspiration pneumonia during hospitalization among cases evaluated using Diagnosis Procedure Combination data, and ii) to determine whether the concern factors for aspiration pneumonia during hospitalization were exacerbated with the trend of the time. The Diagnosis Procedure Combination data were gathered from 2010 through to 2015 with 63,390 cases at Saga University Hospital. The occurrence of concern factors of aspiration pneumonia during hospitalization were compared in the two time periods set (2010–2012 and 2013–2015). The concern factors included: male, age, dysphagia at admission and during hospitalization, use and days in the emergency care unit or high care unit, use of the intensive care unit, and use of an ambulance. Age, dysphagia, and use of the intensive care unit were time-dependently exacerbated. The incidence of aspiration pneumonia during hospitalization in hospitalized cases did not differ between years 2010–2012 and 2013–2015. Aspiration pneumonia during hospitalization complicated with surgery and number days in the emergency care unit or high care unit diminished in years 2013–2015. Despite an increased concern of aspiration pneumonia during hospitalization, the complication rate of aspiration pneumonia during hospitalization did not increase.

No abstract

Background: Although there have been studies comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), few comparative cost-benefit analyses using reimbursement data have been performed, especially in Japan. Data from the Diagnosis Procedure Combination/Per-Diem Payment System (DPC/PDPS), a reimbursement system in Japan, may be useful in performing a cost-benefit analysis. Methods and Results: Between July 2008 and March 2016, a total of 48,177 patients were admitted to Saga University Hospital. Using DPC/PDPS data, we identified 638 patients without a history of myocardial infarction who underwent PCI (Group PCI, n=462) or isolated CABG (Group CABG, n=176). There were no marked differences in the mortality rate, but the incidence of myocardial infarction was higher in Group PCI. A multivariate logistic regression analysis showed that performing PCI was a significant risk factor for myocardial infarction. The number of admissions was smaller in Group CABG, but the medical cost was higher and the total hospital stay was longer than in Group PCI. However, after three or more PCIs, the difference in medical cost disappeared between PCI and CABG. Conclusions: In our single-center experience, we were able to show that, while there was no marked difference in the survival rate, the incidence of myocardial infarction was higher with PCI than with CABG. PCI required multiple admissions but was less costly than CABG. The feasibility of using the DPC/PDPS data for costbenefit analysis of procedures like PCI and CABG should be confirmed in a multi-center study.