Nonadherence to follow-up recommendations is common for dogs and cats undergoing orthopedic surgery

OBJECTIVE To evaluate owner adherence to recommendations for follow-up examination of dogs and cats following orthopedic procedures and identify factors associated with adherence versus nonadherence. SAMPLE Medical records of 485 dogs and cats that underwent orthopedic surgery. PROCEDURES Cases were categorized as urgent or elective. Information obtained from the medical records consisted of species, age, body weight, proximity to the hospital, procedure cost, recommendations for coaptation, use of financial aid, and number of owners. Cases were considered adherent to follow-up recommendations if, at the latest visit or communication, no further visits were recommended. Cases were considered nonadherent if owners did not return for recommended follow-up visits. RESULTS Overall adherence to follow-up recommendations was 65.8% (319/485). Elective cases were 1.6 times as likely to be adherent to follow-up recommendations as were urgent cases, dog cases were 2.4 times as likely to be adherent as were cat cases, and cases with multiple owners listed were 2.1 times as likely to be adherent as were cases with 1 owner listed. Distance from the hospital had a statistically significant association with adherence, but the effect was not clinically important. Age, weight, coaptation, procedure cost, and use of financial aid were not significantly associated with adherence. CONCLUSIONS AND CLINICAL RELEVANCE The percentage of dogs and cats lost to follow-up following orthopedic surgery at an academic veterinary teaching hospital was substantial (166/485 [34.2%]). Efforts to improve follow-up adherence are especially indicated for animals undergoing urgent procedures, animals with single owners, and cats.

A lifecycle cost model considering both component and system burn-in for operationally unrepairable systems

PurposeThis study presents a lifecycle cost model considering multi-level burn-in for operationally unrepairable systems including assembly and warranty costs. A numerical method to obtain system reliability under component replacement during burn-in is also presented with derived error bounds.Design/methodology/approachThe final system reliability after component and system burn-in is obtained and warranty costs are computed. On failure during operation, the system is replaced with another that undergoes an identical burn-in procedure. Cost behaviours for a small and large system are shown in a numerical example.FindingsThere are more cost savings when system burn-in is conducted for a large system whereas a strategy focusing on component burn-in only can also result in cost savings for small systems. In addition, a minimum system burn-in duration is required before cost savings are achieved for these operationally unrepairable systems.Originality/valueThe operationally unrepairable system is a niche class of systems which small satellites fall under and no such study has been conducted before. The authors present a different approach towards the testing of small satellites for a constellation mission.

Optimal Measuring and Energy Planning of Smart Grid Considering the Battery Lifetime by Using FFA

The ceaselessly developing request for power in this world privileges a productive and dependable framework of energy sources. Disseminated energy assets such as wind-based energy and solar-based energy can remain shared inside a smart grid to source energy to the utilizers in a feasible way. In arranging to safeguard the extra dependable and conservative energy source, the battery-operated capacity system is coordinated inside the smart grid. In this objective, the operational cost of smart grid is decreased by financial planning in view of the ideal estimate of the battery-operated system and the period of battery procedure. Hence, the actual period battery procedure cost is modelled in view of the perceptiveness of release individually in the time interim. In addition, the anticipated economic planning with battery-operated measuring is improved by using the Fire-Fly algorithm (FFA). The adequacy of FFA is associated through other metaheuristic strategies in relations of execution estimation files, which remain price of power also misfortune of power supply possibility. The proposed method results show that this method diminishes the price of the grid and also achieves the optimum estimate of the battery-operating to the smart grid.

An assessment of prevalence and expenditure associated with discharge brain MRI in preterm infants

To assess national expenditure associated with preterm-infant brain MRI and potential impact of reduction per Choosing Wisely campaign 2015 recommendation to “avoid routine screening term-equivalent or discharge brain MRIs in preterm-infants”. Cross-sectional U.S. trend data from the Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) database (2006, 2009, 2012, 2016) was used to estimate overall national expenditure associated with brain MRI among infants with gestational age (GA) ≤36 weeks, and also when classified as ‘not indicated’ (NI-MRI) i.e., equivalent to routine use without clinical indications and regarded as low-value service (LVS). Associated cost was determined by querying CMS-database for physician-fee-schedules to find the highest global procedure-cost per cycle, then adjusting for inflation. Sensitivity-analyses were conducted to account for additional clinical charges associated with NI-MRI. 3,768 (0.26%) of 1,472,236 preterm-infants had brain MRI across all cycles (inflation-adjusted total $3,690,088). Overall proportion of brain MRIs increased across 2006–2012 from 0.25%-0.33% but decreased in 2016 to 0.16% (P<0.001). Inflation-adjusted overall expenditure by cycle was: 2006, $1,299,130 (95% CI: $987,505, $1,610,755); 2009, $1,194,208 (95% CI: $873,487, $1,516,154); 2012, $931,836 (95% CI: $666,114, $1,197,156); and 2016, $264,648 (95% CI: $172,061, $357,280). Prevalence for NI-MRI in 2006, 2009, 2012 and 2016 was 86% (n = 809), 88% (n = 940), 89% (n = 1028) and 50% (n = 299), respectively; and 70% were in infants 35–36 weeks GA. NI-MRI prevalence was not different over time by payer-type (Medicaid, private), sex or race/ethnicity (white, black, Hispanic); larger hospital size was significantly associated across 2006–2012 but this declined for all sizes in 2016, with most decline in larger hospitals (P for interaction <0.05). NI-MRI expenditure sensitivity-analysis with addition of cycle median total-admission-charge to inflation-adjusted CMS-fee was $1,190,919/$518,343, for 2012/2016 cycles respectively. National MRI prevalence in preterm infants (both overall and LVS) and associated expenditure decreased substantially post recommendation; however, annual savings are modest and unlikely to be >$1.2 million.

Local Anesthesia Alone for Postaxial Polydactyly Surgery in Infants

Background: Surgical excision for postaxial polydactyly type B is advocated to avoid long-term complications. Excision with local anesthesia (LA) in infancy represents a safe and effective treatment for this condition, although general anesthesia (GA) is employed by many surgeons. We present a comparison of surgical outcomes, cost, and time between LA and GA to support widespread change in management. Methods: A retrospective review of patients under 12 months of age undergoing surgical polydactyly excision by a single surgeon was performed. Anesthesia type, patient demographics, and complications were recorded. Comparisons were made between LA and GA groups on procedure cost, operating time, length of stay (LOS), and time from procedure end to discharge. Stepwise forward regression was used to identify the best model for predicting total costs. Results: Ninety-one infants with a mean age of 3 months (±1.9) were examined; 51 (56%) underwent LA alone, 40 (44%) underwent GA. Mean operating time was 11.53 ± 4.36 minutes, with no difference observed between anesthesia groups ( P = .39). LA infants had a significantly shorter LOS (2.5 vs 3.5 hours; P < .05), quicker postoperative discharge (32 vs 65 minutes, P < .05), and fewer overall expenses, 2803 vs 6067 U.S. dollars (USD), P < .05. Two minor surgical complications (1 in each group) were reported. Conclusions: This study demonstrates significantly decreased cost, LOS, and time to discharge using LA alone for surgical excision of postaxial polydactyly type B. Results suggest the approach is quick, economical, and avoids the risks of GA in early infancy.

Comparison of Cost and Efficacy of Trufill® vs Histoacryl® n-Butyl Cyanoacrylate for Translumbar Type 2 Endoleak Embolization

Purpose: The study aimed to compare the cost and efficacy of translumbar approach type 2 endoleak repairs using either Trufill® or Histoacryl® n-BCA liquid embolic. Method and Materials: This was a retrospective review of patients who had translumbar approach type 2 endoleak repairs using either Trufill® or Histoacryl®. Patients were included if they underwent a technically successful type 2 endoleak repair via a translumbar approach with Trufill® or Histoacryl® n-BCA. A multivariable analysis was performed with the primary clinical outcome of percent change in aneurysm diameter per month compared. Procedure cost was calculated based on typical materials used. Results: 20 Trufill® and 14 Histoacryl® patients were included. The mean procedure cost was higher for Trufill® ($5,757.30 vs. $1,586.09, p ≤ 0.001). There was no significant difference between Trufill® or Histoacryl® patients for age at first embolization, gender, total number of embolizations, number of feeding branches, aneurysm sac size prior to embolization, or residual endoleak at first follow-up. Trufill® patients had more coils used (12.0 vs. 4.3, p = 0.0007), less glue used (0.9 vs. 2.1 mL, p < 0.001), longer follow-up duration (33.5 vs. 13.2 months, p = 0.002), more follow-up CT angiograms (CTA) (3.7 vs. 1.9, p = 0.01), and larger excluded aneurysm sac size at most recent CTA (7.1 cm vs. 5.9 cm, p = 0.04). Percent change in sac diameter per month was not significantly different between Trufill® and Histoacryl® (0.21% vs. -0.25%/month, p = 0.06, respectively). There were no complications. Conclusion: Use of Histoacryl® over Trufill® n-BCA resulted in significantly less procedural cost while maintaining safety and efficacy.

A-239 Cost of Neuropsychological Evaluation Comparable to Neuroimaging in the Eastern USA

Objective Anecdotal evidence indicates a belief among physicians that neuropsychological evaluation is more expensive than brain imaging procedures. Another concern is that neuropsychological evaluations are a limited resource to be utilized sparingly, likely due to insurance limits on the annual allowable units of neuropsychological evaluation. This study aimed to contextualize the cost of neuropsychological evaluation relative to common neuroimaging studies used in conditions seen by neuropsychologists. Data Selection Publically available fee schedules from 27 hospitals in the eastern U.S. were reviewed to identify standard costs of head CT, brain MRI, and 5- and 8-hour neuropsychological evaluations conducted with technicians. Data Synthesis Head CT averaged $2963 (range $282–$6007) and brain MRI averaged $4857 (range $834–$11,524). Five-hour evaluations using technicians averaged $2080 (range $698–$4165). Eight-hour evaluations using technicians averaged $3289 (range $1104–$6657). Conclusions Contrary to anecdotal concerns, neuropsychological evaluations do not appear more expensive than brain neuroimaging procedures in several eastern U.S. hospitals. Focused neuropsychological evaluations comparable to or less than head CT procedure cost. Comprehensive neuropsychological evaluations are comparable to or less than MRI brain procedure cost. These preliminary findings may dispel the notion that neuropsychological evaluations are more costly than brain imaging. Additional research is needed in all regions of the U.S.

Nationwide Analysis of Total Ankle Replacement and Ankle Arthrodesis in Medicare Patients: Trends, Complications, and Cost

Background Surgical management of end-stage ankle arthritis consists of either ankle arthrodesis (AA) or total ankle replacement (TAR). The purpose of this study was to evaluate utilization trends in TAR and AA and compare cost and complications. Methods Medicare patients with the diagnosis of ankle arthritis were reviewed. Patients undergoing surgical intervention were split into AA and TAR groups, which were evaluated for trends as well as postoperative complications, revision rates, and procedure cost. Results A total of 673 789 patients were identified with ankle arthritis. A total of 19 120 patients underwent AA and 9059 underwent TAR. While rates of AA remained relatively constant, even decreasing, with 2080 performed in 2005 and 1823 performed in 2014, TAR rates nearly quadrupled. Average cost associated with TAR was $12559.12 compared with $6962.99 for AA ( P < .001). Overall complication rates were 24.9% in the AA group with a 16.5% revision rate compared with 15.1% and 11.0%, respectively, in the TAR group ( P < .001). Patients younger than 65 years had both higher complication and revision rates. Discussion TAR has become an increasingly popular option for the management of end-stage ankle arthritis. In our study, TAR demonstrated both lower revision and complication rates than AA. However, TAR represents a more expensive treatment option. Levels of Evidence: Level III: Retrospective comparative study