Abstract 16698: Comparison of Hospital Length of Stay Between Hospitalized Non-Valvular Atrial Fibrillation Patients Treated With Either Apixaban or Warfarin

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Amanda Farr ◽  
Yonghua Jing ◽  
Stephen Johnston ◽  
Jeffrey Trocio ◽  
Shalabh Singhal ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Length Of Stay ◽  
Primary Diagnosis ◽  
Hospital Length ◽  
Cost Driver ◽  
Hospital Length Of Stay ◽  
Sensitivity Analyses ◽  
Index Hospitalization ◽  
Economic Implications ◽  
Replacement Procedure

Hospital length of stay (LOS) is an important cost driver for hospitals and payers alike. Hospitalized non-valvular atrial fibrillation (NVAF) patients treated with apixaban may have shorter LOS than those treated with warfarin because of the absence of need for INR monitoring in apixaban. Thus, this study compared LOS between hospitalized NVAF patients treated with either apixaban or warfarin. This was a retrospective, observational cohort study based on a large U.S. database including diagnosis, procedure, and drug administration information from over 600 acute-care hospitals. Patients selected for study were aged ≥18 years and had a hospitalization record with an ICD-9-CM diagnosis code for atrial fibrillation (AF) in any position from Jan-1-2013 to Feb-28-2014 (index hospitalization). Patients with diagnoses indicative of rheumatic mitral valvular heart disease or a valve replacement procedure during index hospitalization were excluded. Patients were required to have been treated with either apixaban or warfarin, and not treated with rivaroxaban or dabigatran, during index hospitalization. Apixaban patients were propensity score (PS) matched to warfarin patients at a 1:1 ratio, using patient demographic/clinical and hospital characteristics. Study outcome was LOS, calculated as discharge date minus admission date; a sensitivity analysis calculated LOS as discharge date minus first anticoagulant administration date. Subanalyses were conducted among patients with a primary diagnosis of AF. The study included 832 apixaban patients matched to 832 warfarin patients. Patients had a mean age of 74 years and 46% were female. Mean [standard deviation (SD)] and median LOS was significantly (P<0.001) shorter in apixaban patients (4.5 [4.2] and 3 days) than in warfarin patients (5.4 [5.0] and 4); results were consistent in sensitivity analyses of LOS after first anticoagulant administration date (2.8 [3.5] and 2 days for apixaban vs. 3.9 [3.9] and 3 for warfarin, P<0.001). Subanalyses yielded very similar results. Among NVAF patients, apixaban treatment was associated with shorter hospital LOS when compared with warfarin treatment. These findings may have important clinical and economic implications for hospitals, payers, and patients.

Length of stay for inpatient incompetent to stand trial patients: importance of clinical and demographic variables

CNS Spectrums ◽  
2020 ◽  
Vol 25 (5) ◽  
pp. 734-742
Author(s):  
Charles Broderick ◽  
Allen Azizian ◽  
Katherine Warburton
Keyword(s):  
Length Of Stay ◽  
Psychiatric Hospitals ◽  
Primary Diagnosis ◽  
Hospital Length ◽  
Demographic Variables ◽  
Hospital Length Of Stay ◽  
State Psychiatric ◽  
State Psychiatric Hospitals ◽  
Violent Acts ◽  
Incompetent To Stand Trial

ObjectiveWe investigated clinical and demographic variables to better understand their relationship to hospital length of stay for patients involuntarily committed to California state psychiatric hospitals under the state’s incompetent to stand trial (IST) statutes. Additionally, we determined the most important variables in the model that influenced patient length of stay.MethodsWe retrospectively studied all patients admitted as IST to California state psychiatric hospitals during the period January 1, 2010 through June 30, 2018 (N = 20 041). Primary diagnosis, total number of violent acts while hospitalized, age at admission, treating hospital, level of functioning at admission, ethnicity, sex, and having had a previous state hospital admission were evaluated using a parametric survival model.ResultsThe analysis showed that the most important variables related to length of stay were (1) diagnosis, (2) number of violent acts while hospitalized, and (3) age of admission. Specifically, longer length of stay was associated with (1) having a diagnosis of schizophrenia or neurocognitive disorder, (2) one or more violent acts, and (3) older age at admission. The other variables studied were also statistically significant, but not as influential in the model.ConclusionsWe found significant relations between length of stay and the variables studied, with the most important variables being (1) diagnosis, (2) number of physically violent acts, and (3) age at admission. These findings emphasize the need for treatments to target cognitive issues in the seriously mentally ill as well as treatment of violence and early identification of violence risk factors.

Comparison of hospital length of stay between hospitalized non-valvular atrial fibrillation patients treated with either apixaban or warfarin

2015 ◽  
Vol 43 (3) ◽  
pp. 172-179 ◽  
Author(s):  
Amanda M. Farr ◽  
Yonghua Jing ◽  
Stephen Johnston ◽  
Jeffrey Trocio ◽  
Shalabh Singhal ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay

scholarly journals Impact of Vasopressor Initiation and Discontinuation Sequence on Mortality in Septic Shock: A Retrospective Review

2020 ◽  
pp. 1-7
Author(s):  
Cara McDaniel ◽  
Andrew Moyer ◽  
Cara McDaniel ◽  
Judah Brown ◽  
Michael Baram
Keyword(s):  
Septic Shock ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Primary Endpoint ◽  
Primary Diagnosis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Apache Ii Score ◽  
Vasoactive Agent ◽  
Intra Abdominal Infection

Background: Little data exists guiding clinicians on how or when to initiate and discontinue the second vasoactive agent in the setting of septic shock refractory to norepinephrine monotherapy. Methods: This retrospective cohort study evaluated patients with a primary diagnosis of septic shock admitted to the intensive care unit receiving norepinephrine in addition to concomitant vasopressors. The primary endpoint was the incidence of all-cause in-hospital mortality when adding adjunctive vasopressors to norepinephrine either before the dose reached 2 mcg/kg/min (early adjunctive vasopressor) or after (late adjunctive vasopressor). Secondary endpoints included the incidence of clinically significant hypotension when discontinuing norepinephrine before or after vasopressin in the same population. Results: Forty-six patients were included (early adjunctive vasopressor [n=36]; late adjunctive vasopressor [n=10]), with a median age of 69 years and APACHE II score of 27. Fewer patients in the early adjunctive vasopressor cohort had malignancy prior to admission (16.7% vs. 60%, p=0.0117), however, more patients were managed in the surgical ICU (44.4% vs. 0%, p=0.0202) with intra-abdominal infection (33.3% vs. 0%, p=0.0439). The primary endpoint of all-cause in-hospital mortality was not statistically different between the early and late adjunctive vasopressor groups (75% vs. 90%, respectively, p=0.4203). Longer ICU and hospital length of stay in the early adjunctive vasopressor cohort was observed (9 days vs 3 days, p=0.0061; 11 days vs 3 days, p=0.0026, respectively). Twenty-two patients were included in analysis of vasopressor discontinuation sequence with no significant differences in mortality, incidence of hypotension, or ICU/hospital length of stay. Conclusion: Among patients with septic shock on multiple vasopressors, addition of adjunctive vasopressor before reaching a norepinephrine dose of 2 mcg/kg/min was associated with longer in-hospital and ICU survival but exhibited no difference in overall mortality. Discontinuation of vasopressin before norepinephrine led to longer total vasopressor duration without a difference in rates of hypotension. Future prospective studies are warranted.

scholarly journals Predictors of Hospital Length of Stay among Patients with Low-risk Pulmonary Embolism

10.36469/9744 ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 84-94
Author(s):  
Li Wang ◽  
Onur Baser ◽  
Phil Wells ◽  
W. Frank Peacock ◽  
Craig I. Coleman ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Length Of Stay ◽  
Troponin I ◽  
Hospital Length ◽  
Short Length ◽  
Low Risk ◽  
Cost Driver ◽  
Hospital Length Of Stay ◽  
Health Administration ◽  
Efficient Treatment

Background: Increased hospital length of stay is an important cost driver in hospitalized low-risk pulmonary embolism (LRPE) patients, who benefit from abbreviated hospital stays. We sought to measure length-of-stay associated predictors among Veterans Health Administration LRPE patients. Methods: Adult patients (aged ≥18 years) with ≥1 inpatient pulmonary embolism (PE) diagnosis (index date = discharge date) between 10/2011-06/2015 and continuous enrollment for ≥12 months pre- and 3 months post-index were included. PE patients with simplified Pulmonary Embolism Stratification Index score 0 were considered low risk; all others were considered high risk. LRPE patients were further stratified into short (≤2 days) and long length of stay cohorts. Logistic regression was used to identify predictors of length of stay among low-risk patients. Results: Among 6746 patients, 1918 were low-risk (28.4%), of which 688 (35.9%) had short and 1230 (64.1%) had long length of stay. LRPE patients with computed tomography angiography (Odds ratio [OR]: 4.8, 95% Confidence interval [CI]: 3.82-5.97), lung ventilation/perfusion scan (OR: 3.8, 95% CI: 1.86-7.76), or venous Doppler ultrasound (OR: 1.4, 95% CI: 1.08-1.86) at baseline had an increased probability of short length of stay. Those with troponin I (OR: 0.7, 95% CI: 0.54-0.86) or natriuretic peptide testing (OR: 0.7, 95% CI: 0.57-0.90), or more comorbidities at baseline, were less likely to have short length of stay. Conclusion: Understanding the predictors of length of stay can help providers deliver efficient treatment and improve patient outcomes which potentially reduces the length of stay, thereby reducing the overall burden in LRPE patients.

Abstract 282: Dabigatran Etexilate is Associated with Shorter Hospital Length of Stay Compared to Warfarin in Patients with Nonvalvular Atrial Fibrillation

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Eileen Fonseca ◽  
David R Walker ◽  
Jerrold Hill ◽  
Gregory P Hess
Keyword(s):  
Atrial Fibrillation ◽  
Length Of Stay ◽  
Propensity Score ◽  
Dabigatran Etexilate ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Diagnosis ◽  
Newly Diagnosed ◽  
Nonvalvular Atrial Fibrillation ◽  
Matched Samples

Background: Warfarin and dabigatran etexilate (DE) are oral anticoagulants used to reduce the risk of stroke among patients with nonvalvular atrial fibrillation (NVAF). This study examined whether hospital length of stay (LOS) differed for the two therapies. Methods: LOS was evaluated for patients hospitalized with a primary or secondary discharge diagnosis of atrial fibrillation (AF) between 1/1-3/31/2011, with DE or warfarin administered during hospitalization, and excluding patients with a valvular procedure. Patients were identified from a hospital Charge Detail Masters database, consisting of 184 hospitals. Differences in LOS by therapy were estimated using propensity score-matched samples selected by nearest neighbor matching within a caliper of 0.20 standard deviations of the logit, without replacement and a 2:1 match. Covariates used to estimate the propensity score included age, gender, CHADS 2 score, comorbid conditions and hospital attributes. LOS was also analyzed in patient subgroups identified by use of specific bridging agents (low-molecular weight heparin, unfractionated heparin, combination of the heparins, or no bridging agent) and a subset categorized as newly diagnosed NVAF. Results: Matched samples included 2,372 warfarin and 1,186 DE patients selected from 19,725 warfarin and 1,190 DE patients. Covariates used for the propensity score were not significantly different in the matched samples. LOS was 1.06 days shorter for DE compared to warfarin (DE: 6.16 days vs. warfarin: 7.22 days, p<0.01). In the 4 subgroups identified by choice of bridging agent, LOS was significantly shorter for DE in 3 (0.8 to 1.4 days, p<0.011), but not the fourth (0.9 day, p=0.3). In the subset of newly diagnosed NVAF, LOS was not significantly shorter for DE when AF was the primary discharge diagnosis (0.5 day, p=0.15), but was 2.47 days shorter for DE patients (p<0.01) when AF was a secondary discharge diagnosis. Limitations of the study were small sample sizes in some subgroups and potential of residual confounding. Conclusions: Among hospitalized patients with NVAF receiving an oral anticoagualant, patients receiving DE had a shorter length of stay compared to patients receiving warfarin.

Deaths among pancreatic cancer in-hospital, and the utilization of palliative care.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16803-e16803
Author(s):  
Anup Kasi ◽  
Raed Moh'd Taiseer Al-Rajabi ◽  
Anwaar Saeed ◽  
Weijing Sun ◽  
Saqib Abbasi
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Length Of Stay ◽  
Hospital Setting ◽  
Primary Diagnosis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Utilization ◽  
Seer Data ◽  
Total Charges

e16803 Background: Pancreatic cancer has a dismal 5 year survival of 5-10%. Deaths commonly occur in-hospital as they present with acute complications. The purpose of this study is characterize this population compared to all pancreatic deaths, identify causes for admission, trends in palliative care utilization and its effect on costs and patient stay. Methods: From the years of 2002 to 2014, admissions for patients with a diagnosis of pancreatic cancer were identified using the National Inpatient Sample. Annual trends in death were compared to overalls deaths using SEER data. Trends in hospital length of stay (LOS) and total charges (TC) were assessed, as well as utilization of palliative care. The effect of palliative care utilization on hospital LOS and TC were also identified. Results: 97,389 (weighted) patient deaths occurred from 2002 to 2014, with 7,634 in 2002, compared to 7,200 in 2014. Compared to total overall deaths of 38,026 and 42,047 respectively. Signifying 25% (2002) to 21% (2014) total patients expiring in an in-patient setting. The most common billed primary diagnosis was sepsis at 15.5%, followed by acute renal failure and fluid disorder (12.5%) and liver failure (5.3%). Overall length of stay trended down from 9.0 days to 7.5 days (p < 0.001). And total charges for admission increased from $36,704 to $88,063 (p < 0.001). Palliative care consults increased from 12% in 2002 to 45% in 2014. In 2014, the TC for deaths among those who received palliative care consults was $52,612 (p < 0.001 when compared to all deaths). LOS among these patients also decreased from 7.5 days to 6.2 days. When looking at patients with sepsis who did not die, a palliative care consult decreased costs from $86,738 to $74,544 (p < 0.001). LOS was not significantly different at 8.8 days compared to 8.5 days (p = 0.15). Conclusions: A quarter of patients with pancreatic cancer die in an in-hospital setting. Palliative involvement decreased health care resource utilization. In reviewing patients who developed sepsis without in-hospital mortality, a palliative care consult decreased total charges of admission.

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