RESUMO
PURPOSE: To determine the extent of dental disease and associated treatment costs designed to mitigate the risk of medication-related osteonecrosis of the jaws (MRONJ) among older, socially disadvantaged veterans prior to physician's administration of antiresorptive medication for osteoporosis or malignant bone disease. MATERIALS AND METHODS: This prospective study based on over seven years (2008-2015) of data describes the type and volume of disease, treatment, work-load measures, and costs using Veterans Affairs databases. RESULTS: One hundred fifty-two outpatients (94% male, mean age 69 ± 12 years) were referred by physicians for clinical/radiographic examination and treatment. Sixteen had a healthy dentition and 17 were completely edentulous with satisfactory prostheses. Three edentulous patients required prosthesis adjustment, 116 dentate individuals required restoration of carious teeth (mean 6.3 ± 5.7) and multiple quadrant (mean 3.1 ± 1.0) scaling/subgingival curettage. In the latter group, 75 required extractions (mean 6.0 teeth, range 1-23). Clinician's (dentist and dental assistant) costs for providing care and preventive education over the 7-year timespan came to almost $132,700. CONCLUSION: Older veterans requiring initiation of antiresorptive bone medication harbor extensive, untreated dental disease requiring immediate treatment. An appropriate physician-to-dentist referral network and provision of oral care and patient education prior to initiation of medication can potentially moderate the risk of jaw osteonecrosis.
Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Custos de Cuidados de Saúde , Osteonecrose/economia , Osteonecrose/prevenção & controle , Carga de Trabalho , Idoso , Feminino , Humanos , Masculino , Osteonecrose/induzido quimicamente , Estudos Prospectivos , Gestão de RiscosRESUMO
The purpose of this study was to explore the increasing prevalence of factors affecting hospital charges for primary total hip replacement/total knee replacement (THR/TKR). This study analysed 37,918 THR and 76,727 TKR procedures performed in Taiwan from 1996 to 2004. Odds ratio (OR) and effect size (ES) were calculated to assess the relative change rate. Multiple regression models were employed to predict hospital charges. The following factors were associated with increased hospital charges: age younger than 65 years old; increased disease severity (Charlson comorbidity index [CCI] = 1 or > or = 2); absence of primary diagnoses of osteoarthritis (OA), rheumatoid arthritis (RA), avascular necrosis (AVN); treatment at a hospital or by a surgeon performing a high volume of operations; and longer average length of stay (ALOS). The Bureau of National Health Insurance (BNHI) should ensure that surgeons take precautionary measures to minimise complications and maximise quality of life after surgery. Use of joint prostheses from different manufacturers can reduce costs without compromising patient satisfaction.
Assuntos
Artroplastia de Quadril/economia , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/economia , Artroplastia do Joelho/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/economia , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/economia , Osteoartrite do Joelho/cirurgia , Osteonecrose/diagnóstico , Osteonecrose/economia , Osteonecrose/cirurgia , Prevalência , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , TaiwanAssuntos
Conservadores da Densidade Óssea/economia , Neoplasias Ósseas/tratamento farmacológico , Difosfonatos/economia , Difosfonatos/uso terapêutico , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Neoplasias Ósseas/secundário , Análise Custo-Benefício , Difosfonatos/efeitos adversos , Humanos , Arcada Osseodentária , Osteonecrose/induzido quimicamente , Osteonecrose/economiaAssuntos
Côndilo Mandibular/patologia , Programas de Rastreamento/economia , Aparelhos Ortodônticos Funcionais/efeitos adversos , Osteonecrose/diagnóstico , Articulação Temporomandibular/patologia , Análise Custo-Benefício , Humanos , Côndilo Mandibular/fisiopatologia , Ortodontia Corretiva/efeitos adversos , Osteonecrose/economia , Osteonecrose/etiologiaRESUMO
The author has been operating on cases of lunatum necrose using all usual operating methods, excluding attached vessel pisiforme transfer, increasingly over the past 9 years without an overnight stay in hospital being necessary for patients. Depending on the quality of the structure, we have not experienced any disadvantages in comparison to hospitalised patients. Regarding funding: The costs of these operations are covered and are justifiable in combination with additional hand operations within the outpatients department.