Introduction: In this paper we investigate the possible connection between socioeconomic status as demarcated by employment and in-surance status and consumption of healthcare resources in spine surgery patients. Meth...Introduction: In this paper we investigate the possible connection between socioeconomic status as demarcated by employment and in-surance status and consumption of healthcare resources in spine surgery patients. Methods: The clinical records of 1599 spine surgery pa-tients counted from 2008-2009 were reviewed. The largest groups of patients belonged to MS-DRG 460 (N = 585) and to MS-DRG 473 (N = 700). These two MS-DRG patient groups were used as the study cohort representing patients who, by definition, did not have serious comor-bidities or complications. Results: Unemployed non-cervical patients tended to stay on average 1.8 days longer in hospital and had on average $5800 higher hospital charges. No major differ-ences were noted in length of stay and hospital cost between government and private insurance patients. However, self-pay non-cervical fusion patients had notable increases in length of stay and hospital cost, especially in the >39 and <60 age group with the difference in length of stay amounting to 5 days and in hospital charges to $10,000. Univariate analysis with DRG (460 or 473) as a covariate showed significant impact from employment status on length of stay (F = 4.259, P = 0.014) and less significant impact from payor category on hospital charges (F = 2.229, P = 0.064) in the economically-productive 40 -59 age group. Conclusions: In general, no increase in hospital resource consumption was noted except among self-pay patients, the same group seemingly least able to afford expensive healthcare.展开更多
Cerebrovascular accidents occur in elderly patients in whom neurodegenerative changes increase the risk of vascular permeation and concomitant intracranial bleeding. In rare cases, intracerebral massive hemorrhage hap...Cerebrovascular accidents occur in elderly patients in whom neurodegenerative changes increase the risk of vascular permeation and concomitant intracranial bleeding. In rare cases, intracerebral massive hemorrhage happens in hospitalized patients with apparently stable clinical picture. We report two cases illustrating this phenomenon, discuss the possible pathomechanism involved in those tragic incidents and suggest possible prevention measures for these patients. A negative CT image in a patient with neurological symptoms, especially who are on warfarin with or without considerably elongated coagulation time, may be subject to a sudden intracranial hemorrhage. Microvascular abnormalities might be detected on perfusion CT imaging and should therefore be performed in all CT negative patients with close observation for 24 hours before contemplating discharge.展开更多
Introduction: As the U.S. population undergoes continuous shifts the population’s health profile changes dynamically resulting in more or less expression of certain psychiatric disorders and utilization of health-car...Introduction: As the U.S. population undergoes continuous shifts the population’s health profile changes dynamically resulting in more or less expression of certain psychiatric disorders and utilization of health-care resources. In this paper, we analyze national data on the psychiatric morbidity of American patients and their summated cost in different age groups. Methods: The latest data (2009) on the number of hospital discharges and national bill (hospital charges) linked with psychiatric disorders were extracted from the Nationwide Inpatient Sample (NIS). Results: National data shows that mood disorders are the largest diagnostic category in terms of percentage of psychiatri-crelated discharges in the 1 - 17 years age group. The proportion decreases gradually as age progresses while delirium, dementia, amnestic and other cognitive disorders increase exponentially after 65 years of age. Schizophrenia and other psychotic disorders as well as alcohol and substance-related disorders peak in the working age groups (18 - 64 years). From an economic point of view, mood disorders in the 18 - 44 age group has the highest national bill ($5.477 billion) followed by schizophrenic and other psychotic disorders in the same age group ($4.337 billion) and mood disorders in the 45 - 64 age group ($4.310 billion). On the third place come schizophrenic and other psychotic disorders in the 45 - 64 age group ($3.931 billion). Conclusion: This paper illustrates the high cost of psychiatric care in the U.S., especially the large fraction of healthcare money spent on working-age patients suffering from mood disorders. This underlines psychiatric cost-efficiency as a vital topic in the current healthcare debate.展开更多
Background: What is the quantitative relationship between repeated surgical intervention and unemployment in the spine surgery population? And, does the literature pay sufficient attention to this important aspect of ...Background: What is the quantitative relationship between repeated surgical intervention and unemployment in the spine surgery population? And, does the literature pay sufficient attention to this important aspect of spine surgery outcome? Methods: This was a retrospective review of 905 patients of working age undergoing one of three types of spine surgery. The index surgery at the time of the study was either on the cervical or lumbar spine. We retrospectively collected data on patients’ employment status and history of prior spine surgery. In this study, history of prior spine surgery was coded using two nominal (categorical) variables: The number of previous spine surgeries (0, 1, 2, ≥3) and the variability of location of previous spine surgeries (cervical, lumbar). We also looked into scientific publications related to spine surgery and probed “employment” and “reoperation” awareness in randomized controlled trials (RCTs). In addition, we queried some common factors that are known to play an important role in exacerbating the unemployment problem, such as opioid (ab)use and depression. Results: The unemployment rate was 19.4% among males and 34.8% among females. Unemployment rate correlated with the number of previous spine surgery (r = 0.077, p = 0.020), opioid use (r = 0.080, p = 0.017) and being on antidepressants (r = 0.119, p = 0.000). The unemployment rate was sta-tistically different (χ2 = 10.656, p = 0.014) among patients with different numbers of previous spine surgeries: 25.6% of de novo patients versus 28.1% of patients with one previous spine surgery, 32.7% of patients with two previous spine surgeries and 48.7% of patients with three or more previous spine surgeries. Females had significantly higher unemployment rate if they had three or more previous spine surgeries in their past (31.4%, 34.4%, 46.2% versus 83.3%, χ2 = 21.841, p = 0.000). Unemployment rate was as high as 90% in female patients with ≥3 surgeries on different regions of the spine and receiving antidepressants. Among randomized controlled trials addressing spine surgery in humans and published in English, 10.4% of reported studies mentioned opioids in their text, 4.1% (23/566) mentioned reoperation, 1.4% (8/566) mentioned employment, and none mentioned antidepressants. Conclusion: Females’ employment status is more sensitive to repeated surgical intervention, regardless of the part of the spine being targeted, reaching close to ten times the general population’s unemployment rate (83.3% versus 8%). On the other hand, a small percentage of randomized controlled trials pertaining to spine surgery deals with employment issues and reoperation rate in their outcome analysis.展开更多
As the population of the United States undergoes significant qualitative and quantitative changes the healthcare needs of the population changes accordingly. Since the “old-old” ≥85 years sector of the population i...As the population of the United States undergoes significant qualitative and quantitative changes the healthcare needs of the population changes accordingly. Since the “old-old” ≥85 years sector of the population is growing fast we embarked on studying how spine surgery profile changes across age groups. Methods: A database of 6147 spine surgery patients operated in a tertiary care center in Middle Georgia between 2003 and 2009 was divided to four age groups. The threshold for old-old age was set at 75. The percentage of old-old patients was calculated and their spine surgery profile for the whole period was studied. Changes in spine surgery profile were evaluated in relation to age group and gender. Type of surgery was determined by ICD-9 code. Results: For the whole study period, the percentage of old-old spine surgery patients was 6.7%. The percentage of old-old spine surgery patients increased from 4.7% in 2003 to 7.3% in 2009. Females were preponderant in the later three age groups (53.8%, 53.2% and 55.0%) while males were more in the 2 = 1446.958, P = 0.000). The spine surgery profile for the whole study period was characterized by shifts in the ≥75 age group toward less primary fusions of the cervical and lumbar spine and more refusions of the lumbar spine, more intervertebral disk excisions and more canal exploratory operations in older-old patients. In addition to the age factor, the gender factor had an impact on the spine surgery profile. Statistically significant differences (P < 0.5) were noted between males and females in each age group. Conclusions: Spine surgery profile shows a tendency toward less invasive procedures in the older-old population unless indicated by previous surgery failures, upper neck injuries or osteoporosis-induced fractures.展开更多
文摘Introduction: In this paper we investigate the possible connection between socioeconomic status as demarcated by employment and in-surance status and consumption of healthcare resources in spine surgery patients. Methods: The clinical records of 1599 spine surgery pa-tients counted from 2008-2009 were reviewed. The largest groups of patients belonged to MS-DRG 460 (N = 585) and to MS-DRG 473 (N = 700). These two MS-DRG patient groups were used as the study cohort representing patients who, by definition, did not have serious comor-bidities or complications. Results: Unemployed non-cervical patients tended to stay on average 1.8 days longer in hospital and had on average $5800 higher hospital charges. No major differ-ences were noted in length of stay and hospital cost between government and private insurance patients. However, self-pay non-cervical fusion patients had notable increases in length of stay and hospital cost, especially in the >39 and <60 age group with the difference in length of stay amounting to 5 days and in hospital charges to $10,000. Univariate analysis with DRG (460 or 473) as a covariate showed significant impact from employment status on length of stay (F = 4.259, P = 0.014) and less significant impact from payor category on hospital charges (F = 2.229, P = 0.064) in the economically-productive 40 -59 age group. Conclusions: In general, no increase in hospital resource consumption was noted except among self-pay patients, the same group seemingly least able to afford expensive healthcare.
文摘Cerebrovascular accidents occur in elderly patients in whom neurodegenerative changes increase the risk of vascular permeation and concomitant intracranial bleeding. In rare cases, intracerebral massive hemorrhage happens in hospitalized patients with apparently stable clinical picture. We report two cases illustrating this phenomenon, discuss the possible pathomechanism involved in those tragic incidents and suggest possible prevention measures for these patients. A negative CT image in a patient with neurological symptoms, especially who are on warfarin with or without considerably elongated coagulation time, may be subject to a sudden intracranial hemorrhage. Microvascular abnormalities might be detected on perfusion CT imaging and should therefore be performed in all CT negative patients with close observation for 24 hours before contemplating discharge.
文摘Introduction: As the U.S. population undergoes continuous shifts the population’s health profile changes dynamically resulting in more or less expression of certain psychiatric disorders and utilization of health-care resources. In this paper, we analyze national data on the psychiatric morbidity of American patients and their summated cost in different age groups. Methods: The latest data (2009) on the number of hospital discharges and national bill (hospital charges) linked with psychiatric disorders were extracted from the Nationwide Inpatient Sample (NIS). Results: National data shows that mood disorders are the largest diagnostic category in terms of percentage of psychiatri-crelated discharges in the 1 - 17 years age group. The proportion decreases gradually as age progresses while delirium, dementia, amnestic and other cognitive disorders increase exponentially after 65 years of age. Schizophrenia and other psychotic disorders as well as alcohol and substance-related disorders peak in the working age groups (18 - 64 years). From an economic point of view, mood disorders in the 18 - 44 age group has the highest national bill ($5.477 billion) followed by schizophrenic and other psychotic disorders in the same age group ($4.337 billion) and mood disorders in the 45 - 64 age group ($4.310 billion). On the third place come schizophrenic and other psychotic disorders in the 45 - 64 age group ($3.931 billion). Conclusion: This paper illustrates the high cost of psychiatric care in the U.S., especially the large fraction of healthcare money spent on working-age patients suffering from mood disorders. This underlines psychiatric cost-efficiency as a vital topic in the current healthcare debate.
文摘Background: What is the quantitative relationship between repeated surgical intervention and unemployment in the spine surgery population? And, does the literature pay sufficient attention to this important aspect of spine surgery outcome? Methods: This was a retrospective review of 905 patients of working age undergoing one of three types of spine surgery. The index surgery at the time of the study was either on the cervical or lumbar spine. We retrospectively collected data on patients’ employment status and history of prior spine surgery. In this study, history of prior spine surgery was coded using two nominal (categorical) variables: The number of previous spine surgeries (0, 1, 2, ≥3) and the variability of location of previous spine surgeries (cervical, lumbar). We also looked into scientific publications related to spine surgery and probed “employment” and “reoperation” awareness in randomized controlled trials (RCTs). In addition, we queried some common factors that are known to play an important role in exacerbating the unemployment problem, such as opioid (ab)use and depression. Results: The unemployment rate was 19.4% among males and 34.8% among females. Unemployment rate correlated with the number of previous spine surgery (r = 0.077, p = 0.020), opioid use (r = 0.080, p = 0.017) and being on antidepressants (r = 0.119, p = 0.000). The unemployment rate was sta-tistically different (χ2 = 10.656, p = 0.014) among patients with different numbers of previous spine surgeries: 25.6% of de novo patients versus 28.1% of patients with one previous spine surgery, 32.7% of patients with two previous spine surgeries and 48.7% of patients with three or more previous spine surgeries. Females had significantly higher unemployment rate if they had three or more previous spine surgeries in their past (31.4%, 34.4%, 46.2% versus 83.3%, χ2 = 21.841, p = 0.000). Unemployment rate was as high as 90% in female patients with ≥3 surgeries on different regions of the spine and receiving antidepressants. Among randomized controlled trials addressing spine surgery in humans and published in English, 10.4% of reported studies mentioned opioids in their text, 4.1% (23/566) mentioned reoperation, 1.4% (8/566) mentioned employment, and none mentioned antidepressants. Conclusion: Females’ employment status is more sensitive to repeated surgical intervention, regardless of the part of the spine being targeted, reaching close to ten times the general population’s unemployment rate (83.3% versus 8%). On the other hand, a small percentage of randomized controlled trials pertaining to spine surgery deals with employment issues and reoperation rate in their outcome analysis.
文摘As the population of the United States undergoes significant qualitative and quantitative changes the healthcare needs of the population changes accordingly. Since the “old-old” ≥85 years sector of the population is growing fast we embarked on studying how spine surgery profile changes across age groups. Methods: A database of 6147 spine surgery patients operated in a tertiary care center in Middle Georgia between 2003 and 2009 was divided to four age groups. The threshold for old-old age was set at 75. The percentage of old-old patients was calculated and their spine surgery profile for the whole period was studied. Changes in spine surgery profile were evaluated in relation to age group and gender. Type of surgery was determined by ICD-9 code. Results: For the whole study period, the percentage of old-old spine surgery patients was 6.7%. The percentage of old-old spine surgery patients increased from 4.7% in 2003 to 7.3% in 2009. Females were preponderant in the later three age groups (53.8%, 53.2% and 55.0%) while males were more in the 2 = 1446.958, P = 0.000). The spine surgery profile for the whole study period was characterized by shifts in the ≥75 age group toward less primary fusions of the cervical and lumbar spine and more refusions of the lumbar spine, more intervertebral disk excisions and more canal exploratory operations in older-old patients. In addition to the age factor, the gender factor had an impact on the spine surgery profile. Statistically significant differences (P < 0.5) were noted between males and females in each age group. Conclusions: Spine surgery profile shows a tendency toward less invasive procedures in the older-old population unless indicated by previous surgery failures, upper neck injuries or osteoporosis-induced fractures.
