The impact of comorbidities, regional trends, and hospital factors on discharge dispositions and hospital costs after acoustic neuroma microsurgery: a United States nationwide inpatient data sample study (2005–2009)

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Hospitalization cost and patient outcome after acoustic neuroma surgery depend on several factors. There is a paucity of data regarding the relationship between demographic features such as age, sex, race, insurance status, and patient outcome. Apart from demographic factors, there are several hospital-related factors and regional issues that can affect outcomes and hospital costs. To the authors' knowledge, no study has investigated the issue of regional disparity across the country in terms of cost of hospitalization and discharge disposition.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors analyzed the Nationwide Inpatient Sample (NIS) database over the years 2005–2009. Several variables were analyzed from the database, including patient demographics, comorbidities, and surgical complications. Hospital variables, such as bedsize, rural/urban location, teaching status, federal or private ownership, and the region, were also examined. Patient outcome and increased hospitalization costs were the dependent variables studied.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 2589 admissions from 242 hospitals were analyzed from the NIS data over the years 2005–2009. The mean age was 48.99 ± 13.861 years (± SD), and 304 (11.7%) of the patients were older than 65 years. The cumulative cost incurred by the hospitals from 2005 to 2009 was $948.77 million. The mean expenditure per admission was $76,365.09 ± $58,039.93. The mean total charges per admission rose from $59,633.00 in 2005 to $97,370.00 in 2009. The factors that predicted most significantly with other than routine (OTR) disposition outcome were age older than 65 years (OR 2.22, 95% CI 1.411–3.518; p &lt; 0.001), aspiration pneumonia (OR 16.085, 95% CI 4.974–52.016; p &lt; 0.001), and meningitis (OR 11.299, 95% CI 3.126–40.840; p &lt; 0.001). When compared with patients with Medicare and Medicaid, patients with private insurance had a protective effect against OTR disposition outcome. Higher comorbidities predicted independently for OTR disposition outcome (OR 1.409, 95% CI 1.072–1.852; p = 0.014). The West region predicted negatively for OTR disposition outcome. Large hospitals were independently associated with higher hospital charges (OR 4.269, 95% CI 3.106–5.867; p &lt; 0.001). The West region had significantly higher (p &lt; 0.001) mean hospital charges than the other regions. Patient factors such as meningitis and aspiration pneumonia were strong independent predictors of increased hospital charges (p &lt; 0.001). Higher comorbidities (OR 1.297, 95% CI 1.036–1.624; p = 0.023) and presence of neurofibromatosis Type 2 (OR 2.341, 95% CI 1.479–3.707; p &lt; 0.001) were associated with higher hospital charges.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The authors' study shows that several factors can affect patient outcome and hospital charges for patients who have undergone acoustic neuroma surgery. Factors such as younger age, higher ZIP code income, less comorbidity, private insurance, elective surgery, and the West region predicted for better disposition outcome. However, the West region, higher comorbidities, and weekend admissions were associated with higher hospitalization costs.</jats:p></jats:sec>

Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003–2010

“…18 On analysis we found that 81.33% of the patients with weekday admissions and 92.1% of those with elective admissions underwent surgery on the day of admission, compared with 17.52% of those with weekend admissions and 34.3% of those with nonelective admissions (p < 0.05). Interestingly, 0.9% of the pa- tients with nonelective admissions underwent surgery at another center 1 day prior to the admission at the index center, compared with 0.2% of the patients with elective admissions (p < 0.05), whereas none of those with weekend admissions underwent surgery prior to the admission at the index center.…”

“…As described in our study, discharge disposition to home was considered to be "routine" disposition as mentioned in the NIS, and discharges to all other places (Transfer to Short-Term Hospital, Skilled Nursing Facility, Intermediate Care Facility, Another Type of Facility, Home Health Care, Against Medical Advice, and Died) were categorized as "other than routine" (OTR) disposition. 18 Cost of the hospitalization was calculated using the variable "Total charges" (TOTCHG) in the NIS database. Percentiles of the cost were calculated and recoded as "high cost" (≥ 75th percentile, $74,284) and "low cost" (< 75th percentile) for the analysis.…”

Myelomeningocele: surgical trends and predictors of outcome in the United States, 1988–2010

“…2,32,49,51 In our study, the mean total hospital charge for initial in-hospital care was estimated to be $89,250 (in 2010 US dollars). Given that we investigated hospital charge rather than true payer cost, this cost is higher than a 2002-2003 estimate of mean payer cost for the 1st year of life of $50,000 ($59,250 in 2010 US dollars).…”

Impact of transfer status on hospitalization cost and discharge disposition for acute ischemic stroke across the US

“…An earlier study 20 has shown that hospital factors alone can affect clinical outcome. To understand the influence of hospital factors on patient outcome and complications, the following coded variables in the NIS database were studied: 1) region of hospital (in the NIS database, the US is divided into the following regions: Northeast, Midwest, South, and West), 2) ownership of hospital (government or private), 3) elective versus nonelective admission, 4) location of hospital (rural or urban), 5) bed size of hospital (small, medium, or large), 6) teaching status of hospital (teaching or nonteaching), 7) admission day 13 (MondayFriday vs Saturday-Sunday), and 8) transfer status/admis-sion status (direct admission or transfer-in from another facility).…”

“…20 OTR discharge dispositions included final outcomes like transfer to a short-term hospital facility, skilled nursing facility, intermediate care, or home health care; transfer against medical advice; and death. Discharge disposition to home without home health care was considered a routine discharge disposition.…”