The association of frailty status with nutritional risk and the effect on outcomes in elderly surgical inpatients / 中华临床营养杂志

Objective:To study the association of frailty status with nutritional risk and the effect on clinical outcomes among elderly surgical inpatients.Methods:Elderly inpatients from the surgery department of Beijing Hospital were enrolled from January to June 2021. Frail scale and nutritional risk screening 2002 (NRS 2002) were used for frailty evaluation and nutrition risk screening. The influence of frailty and associated nutrition risk in elderly surgical inpatients was analyzed.Results:487 elderly surgical patients were included, of whom 131 cases were in the non-frailty group, 279 cases were in the pre-frailty group and 77 cases were in the frailty group, according to the Frail scale score. 146 cases were at nutritional risk, of whom 8 (6.1% of 131) were in the non-frailty group, 87 (31.2% of 279) in the pre-frailty group and 51 (66.2% of 77) were in the frailty group. According to univariate/multivariate logistic regression analysis of frailty in elderly surgical patients, a higher NRS 2002 score, older age, and the presence of multiple concurrent diseases (≥ 5) were significantly associated with frailty ( P < 0.001). The Frail scale score was positively correlated with NRS 2002 score ( r = 0.448, P < 0.01). Multiple comparisons showed that frailty had statistically significant effects on hospital stay and medical costs in elderly surgical patients ( P < 0.05). Conclusions:The prevalence of frailty is higher in elderly surgical patients, and the prevalence of nutritional risk increases with the progression of frailty. Frailty can lead to prolonged hospital stays and increased hospital costs in elderly surgical patients.

New grey correlation and degree of structure variation analysis of hospitalization cost of childhood pneumonia / 上海交通大学学报（医学版）

Objective • To understand the structural changes and related reasons of the average cost of hospitalization of childhood pneumonia in Shanghai, and to propound related policy suggestion. Methods • New grey correlation and degree of structural variation analysis were used to research the average cost of hospitalization of 22 543 children with pneumonia from 2015 to 2018 in a children's specialized hospital in Shanghai. The average cost included 5 categories, i.e. medicine cost, material cost, examination and laboratory cost, labour cost and bed occupation cost. The relational degree and structural changes between each average cost and the average cost of hospitalization were discussed. Results • The new grey correlation analysis showed that the relational degree sort order of each average cost from the highest to the lowest were average examination and laboratory cost (γ3=1.000 0), average medicine cost (γ1=0.862 5), average bed occupation cost (γ5=0.845 1), average labour cost (γ4=0.796 8) and average material cost (γ2=0.786 3). The degree of structure variation analysis showed that the contribution rate of structure variation (CSV) sort order of each average cost in 2015-2018 from the highest to the lowest were average medicine cost (CSV1=36.22%), average bed occupation cost (CSV5=27.65%), average examination and laboratory cost (CSV3=13.91%), average material cost (CSV2=13.78%) and average labour cost (CSV4=8.44%). The average medicine cost and average material cost were negative variation. Conclusion • The average examination and laboratory cost and average medicine cost are the main factors that influenced the average cost of hospitalization of childhood pneumonia. The proportion of the average labour cost is relatively low. It is suggested that the cost structure like raising labour charges and optimizing diagnosis and treatment process should be further adjusted in order to control the growth of medical costs.

Hospitalization costs and their determining factors among patients undergoing kidney transplantation: a cross-sectional descriptive study

ABSTRACT BACKGROUND: Cost evaluation is a key tool in monitoring expenditure for budget management. It increases the efficiency of possible changes through identifying potential savings and estimating the resources required to make such changes. However, there is a lack of knowledge of the total cost of hospitalization up to the clinical outcome, regarding patients admitted for kidney transplantation. Likewise, there is a lack of data on the factors that influence the amounts spent by hospital institutions and healthcare systems. OBJECTIVES: To describe the costs and determining factors relating to hospitalization of patients undergoing kidney transplantation. DESIGN AND SETTING: Cross-sectional descriptive study with a quantitative approach based on secondary data from 81 patients who were admitted for kidney transplantation at a leading transplantation center in southern Brazil. METHODS: The direct costs of healthcare for patients who underwent kidney transplantation were the dependent variable, and included personnel, expenses, third-party services, materials and medicines. The factors that interfered in the cost of the procedure were indirect variables. The items that made up these variables were gathered from the records of the internal transplantation committee and from the electronic medical records. The billing sector provided information on the direct costs per patient. RESULTS: The estimated total cost of patients' hospitalization was R$ 1,257,639.11 (US$ 571,010.44). Out of this amount, R$ 1,237,338.31 (US$ 561,793.20) was paid by the Brazilian National Health System and R$ 20,300.80 (US$ 9,217.24) by the transplantation center's own resources. The highest costs related to the length of hospital stay and clinical complications such as sepsis and pneumonia. CONCLUSIONS: The costs of hospitalization for kidney transplantation relate to the length of hospital stay and clinical complications.

Risk factors and prognosis of acute cerebral infarction patients complicated with pulmonary infection / 中国基层医药

Objective To explore the risk factors and prognosis of pulmonary infection in patients with acute cerebral infarction.Methods From May 2015 to October 2017,the clinical data of 236 patients with acute cerebral infarction in the First People's Hospital of Jinzhong were studied.The patients were divided into infection group (36 cases) and uninfected group (200 cases) according to whether or not the infection occurs.The clinical data and prognosis were compared between the two groups for half a year.Results The age,disturbance of consciousness,difficulty swallowing,invasive operation,large area cerebral infarction between the infected group and uninfected group had statistically significant differences (t =11.093,x2 =83.388,69.925,43.274,151.345,all P ＜ 0.05).Logistic regression analysis showed that the results of age,consciousness disorder,dysphagia,invasive operation and massive cerebral infarction all had statistically significant differences (all P ＜ 0.05).In the infected group,the length of hospitalization[(23.24 ± 5.61) d] and the cost of hospitalization[(15 239.24 ± 3 522.60) CNY] were significantly higher than those in the uninfected group [(15.65 ± 2.35) d,(9687.24 ± 2215.78) C NY] (t =13.671,12.486,all P ＜ 0.05).After treatment for 6 months,the neural function defect scale of the infection group [(24.26 ± 2.12) points] was significantly higher than that of the uninfected group [(16.24 ± 2.23) points],and the daily life activities ability score of the infection group[(70.12 ± 2.81) points] was significantly lower than that of the uninfected group[(79.24 ±3.25) points],the differences were statistically significant between the two groups (t =20.009,15.800,all P ＜0.05).Conclusion There are many risk factors of pulmonary infection in patients with acute cerebral infarction,such as advanced age,invasive operation,disturbance of consciousness,dysphagia,large area cerebral infarction and so on.The prognosis of patients with acute cerebral infarction complicated with pulmonary infection is poor.

Risk factors and prognosis of acute cerebral infarction patients complicated with pulmonary infection / 中国基层医药

Objective@#To explore the risk factors and prognosis of pulmonary infection in patients with acute cerebral infarction.@*Methods@#From May 2015 to October 2017, the clinical data of 236 patients with acute cerebral infarction in the First People's Hospital of Jinzhong were studied.The patients were divided into infection group (36 cases) and uninfected group (200 cases) according to whether or not the infection occurs.The clinical data and prognosis were compared between the two groups for half a year.@*Results@#The age, disturbance of consciousness, difficulty swallowing, invasive operation, large area cerebral infarction between the infected group and uninfected group had statistically significant differences (t=11.093, χ2=83.388, 69.925, 43.274, 151.345, all P<0.05). Logistic regression analysis showed that the results of age, consciousness disorder, dysphagia, invasive operation and massive cerebral infarction all had statistically significant differences(all P<0.05). In the infected group, the length of hospitalization[(23.24±5.61)d] and the cost of hospitalization[(15 239.24±3 522.60) CNY]were significantly higher than those in the uninfected group[(15.65±2.35)d, (9687.24±2215.78) CNY](t=13.671, 12.486, all P<0.05). After treatment for 6 months, the neural function defect scale of the infection group[(24.26±2.12)points] was significantly higher than that of the uninfected group[(16.24±2.23)points], and the daily life activities ability score of the infection group[(70.12±2.81)points] was significantly lower than that of the uninfected group[(79.24±3.25) points], the differences were statistically significant between the two groups(t=20.009, 15.800, all P<0.05).@*Conclusion@#There are many risk factors of pulmonary infection in patients with acute cerebral infarction, such as advanced age, invasive operation, disturbance of consciousness, dysphagia, large area cerebral infarction and so on.The prognosis of patients with acute cerebral infarction complicated with pulmonary infection is poor.

Analysis of Hospitalization Expenses of Patients With Acute Myocardial Infarction in Basic Medical Insurance of Urban Population / 中国循环杂志

Objectives: To analyze the rate of hospitalization for acute myocardial infarction (AMI) and the cost of hospitalization for urban residents participating in national basic medical insurance in China. Methods: Of the sample database of inpatients participating in the national basic medical insurance system from 2010 to 2014, 2%, 5% and 10% of the insured persons was selected from provincial cities, one prefecture-level city, and two county-level coordinating regions of each province, with a total of 2 523 265 person-times. Patients with AMI who were diagnosed with ICD-10 code I21-I22 from the hospital were selected for analysis. Results: A total of 1 347 patients were diagnosed with AMI in the sample database. It was estimated that the annual AMI hospitalization rate was 44.2 per 100 000 according to the hospitalized AMI patients from 2012 to 2014. The median hospitalization cost was 31 000 (42 000) RMB and the median length of stay was 9 (8) days. The per capita hospitalization cost of provincial insured personnel was the highest (40 000 RMB), followed by prefecture insured personnel (30 000 RMB), and the county insured personnel (15 000 RMB, P<0.001). The proportion of patients receiving percutaneous coronary intervention (PCI) in provincial and prefecture cities was significantly higher than that of county-level patients (50.1%, 43.2%, and 14.9%, respectively, P<0.001). The median hospitalization cost for PCI was 52 000 RMB, which was significantly higher than thrombolytic therapy (20 000 RMB) and conservative treatment (13 000 RMB, P<0.001). Conclusions: The cost of AMI hospitalization for patients with basic medical insurance in provincial cities, perfeture and county cities in China is significantly different, and it is related to the large difference in the proportion of patients receiving PCI or not.

Total cost of hospitalization after internal fixation of intertrochanteric fracture / 中华创伤骨科杂志

Objective To analyze the factors influencing the total cost of hospitalization after internal fixation of intertrochanteric fracture.Methods Enrolled in this study were 142 patients with intertrochanteric fracture who had been treated at our department between March 2013 and August 2014.They were 54 men and 88 women,aged from 24 to 95 years (average 69.8 years).Intramedullary fixation was adopted in 135 cases while extramedullary fixation in 7.By AO classification,32 cases were type A 1,75 type A2 and 35 type A3.We analyzed their demographic data,fracture-associated factors,bleeding-associated factors and surgery-associated factors.For univariate analysis,the independent sample t test was performed between 2 groups.One-Way ANOVA analysis was performed among several groups.For multivariate analysis,multivariate linear regression analysis was performed.P ＜ 0.05 was regarded as statistically significant.Results The independent sample test revealed that the total cost of hospitalization for those with preoperative deep venous thrombosis (6.9 ± 1.0 × 105 (￥)) was significantly higher than for those without (5.0 ± 0.8 × 105 (￥)) and the total cost for those undergoing intramedullary fixation (5.5 ± 1.2 × 105 (￥)) was significantly higher than for those undergoing extramedullary fixation (4.4 ±0.7 × 105 (￥)) (P ＜ 0.05).The multiple linear regression analyses showed that preoperative deep venous thrombosis (t =11.750,P ＜ 0.001),perioperative transfusion (t =2.803,P =0.006),hospital stay (t =5.949,P ＜ 0.001) and intraoperative blood loss (t =2.885,P =0.005) were the independent factors influencing the total cost of hospitalization.Conclusions Preoperative deep venous thrombosis,perioperative transfusion,intraoperative blood loss,and hospital stay may influence the total cost of hospitalization for patients undergoing internal fixation of intertrochanteric fracture.More attention should be paid to control of the total cost of hospitalization in addition to ensuring the perioperative life safety.

Correlation factors of hospital stay and hospitalization costs among AIS patients / 实用医学杂志

Objective To explore the correlation factors of hospital stay and hospitalization costs among patients with acute ischemia stroke (AIS). Methods The clinical data of the patients with first diagnosis of AIS at Peking University Third Hospital in China from January 1 , 2012 to December 31 , 2012 were retrospectively analyzed to investigate the correlation factors of hospital stay and hospitalization costs using univariate analysis and multiple regression analysis. Results The study involved 496 patients, with a mean age of 63.38 years (range:26~88 years). Multivariate regression analysis showed the significant impact factors for LOS were age, pneumonia, the total score on NIHSS, medication for secondary prevention and stroke subtype. The significant impact factors for cost of hospital stay were payment method, stroke subtype, age, the total score on NIHSS and medication for secondary prevention. Conclusions Age, pneumonia, the total score on NIHSS, stroke treatment and its subtypes are the significant impact factors affecting hospital stay. Payment method, stroke subtype, age, the total score on NIHSS and medication for secondary prevention are the significant impact factors affecting costs of hospitalization.

Comprehensive analysis on quality of clinical pathway for hospitalized patients with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze clinical data of hospitalized patients with age - related cataract treated through clinical pathway in our hospital, and to investigate the effectiveness of clinical pathway in standardizing medical behavior, advancing work efficiency, and improving quality of hospital management. METHODS:Data of patients with age-related cataract, who were treated with phacoemulsification combined with intraocular lens implantation in Xi'an North Hospital, were retrospectively analyzed. In clinical pathway group, 220 patients underwent cataract surgery from October 2012 to May 2013 in accordance with clinical pathway. For control group, 213 patients with cataract receiving surgery from October 2010 to June 2011, comply with conventional process. Effect of cataract surgery, average length of hospitalization, average cost of hospitalization, and degree of satisfaction of patients were comprehensive investigated. RESULTS: In 220 patients of clinical pathway group, 209 ( 95. 0%) got improved vision, the days of hospitalization was 4. 5 ± 1. 4d, and the average hospitalized consumption was 4 522. 3 ± 285. 1 Yuan. Whereas, in control group, visual acuity in 202 (94. 8%) out of 213 patients were improved, and the length and cost of hospitalization were 5. 1±1. 7d and 4 647. 7±271. 2 Yuan. The difference of the length and cost of hospitalization between these two groups were significant (P0. 05). CONCLUSION: Practicing of age - related clinical pathway is helpful in standardizing medical heavier, optimizing clinical process, reducing health cost, improving quality of medical care, and providing evidence for hospital management innovation.