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Anil Nanda - One of the best experts on this subject based on the ideXlab platform.
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thursday september 27 2018 1 05 pm 2 05 pm understanding anxiety and depression when performing spine surgery 119 impact of psychiatric comorbidities on short term outcomes following intervention for lumbar degenerative disc disease
The Spine Journal, 2018Co-Authors: Piyush Kalakoti, Anil Nanda, Daniel M Sciubba, Andrew J Pugely, Matthew J Mcgirt, Kanika Sharma, Karthik Madhavan, Richard P Menger, Hai SunAbstract:BACKGROUND CONTEXT Limited literature exists on the prevalence and impact of psychiatric comorbidities on outcomes in patients undergoing surgery for with lumbar degenerative disc disease (LDDD). PURPOSE To investigate the impact of psychiatric diseases on short-term outcomes in patients undergoing fusion surgery for LDDD. STUDY DESIGN/SETTING Retrospective, observational cohort study. PATIENT SAMPLE A total of 126,044 adult patients (>18 years) registered in the Nationwide Inpatient Sample database (2002-2011) and undergoing an elective spine fusion for LDDD. OUTCOME MEASURES Discharge to rehabilitation facility, length of stay, Hospitalization Cost, and short-term postsurgical complications (neurological, respiratory, cardiac, gastro-intestinal, wound complication and infections, venous thromboembolism, and acute-renal failure). METHODS Multivariable regression techniques were used to explore the association of psychiatric comorbidities on short-term outcomes by adjusting for patient demographics, clinical and hospital characteristics. As a part of sensitivity analysis, propensity scores matching methods and inverse weighting technique was utilized. RESULTS Of the 126,044 adult patients undergoing fusion surgery for LDDD (mean age: 54.91 years, 58% female), approximately 18% had a psychiatric disease. Multivariable regression analysis revealed patients with psychiatric disease undergoing fusion surgery have higher likelihood for unfavorable discharge (OR 1.41; 95%CI 1.35–1.47; p CONCLUSIONS Our study quantifies the estimates for presence of concomitant psychiatric comorbid conditions on short-outcomes in patients undergoing fusions for LDDD. The data provides supporting evidence for adequate preoperative planning and postsurgical care. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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the impact of comorbidities regional trends and hospital factors on discharge dispositions and hospital Costs after acoustic neuroma microsurgery a united states nationwide inpatient data sample study 2005 2009
Neurosurgical Focus, 2012Co-Authors: Ashish Sonig, Jai Deep Thakur, Imad Saeed Khan, Rishi Wadhwa, Anil NandaAbstract:Object Hospitalization Cost and patient outcome after acoustic neuroma surgery depend on several factors. There is a paucity of data regarding the relationship between demographic features such as age, sex, race, insurance status, and patient outcome. Apart from demographic factors, there are several hospital-related factors and regional issues that can affect outcomes and hospital Costs. To the authors' knowledge, no study has investigated the issue of regional disparity across the country in terms of Cost of Hospitalization and discharge disposition. Methods The authors analyzed the Nationwide Inpatient Sample (NIS) database over the years 2005–2009. Several variables were analyzed from the database, including patient demographics, comorbidities, and surgical complications. Hospital variables, such as bedsize, rural/urban location, teaching status, federal or private ownership, and the region, were also examined. Patient outcome and increased Hospitalization Costs were the dependent variables studied. R...
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is posttraumatic cerebrospinal fluid fistula a predictor of posttraumatic meningitis a us nationwide inpatient sample database study
Neurosurgical Focus, 2012Co-Authors: Ashish Sonig, Jai Deep Thakur, Prashant Chittiboina, Imad Saeed Khan, Anil NandaAbstract:Object Various factors have been reported in literature to be associated with the development of posttraumatic meningitis. There is a paucity of data regarding skull fractures and facial fractures leading to CSF leaks and their association with the development of meningitis. The primary objective of this study was to analyze the US Nationwide Inpatient Sample (NIS) database to elucidate the factors associated with the development of posttraumatic meningitis. A secondary goal was to analyze the overall Hospitalization Cost related to posttraumatic meningitis and factors associated with that Cost. Methods The NIS database was analyzed to identify patients admitted to hospitals with a diagnosis of head injury from 2005 through 2009. This data set was analyzed to assess the relationship of various clinical parameters that may affect the development of posttraumatic meningitis using binary logistic regression models. Additionally, the overall Hospitalization Cost for the head injury patients who did not underg...
Hideo Yasunaga - One of the best experts on this subject based on the ideXlab platform.
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phenytoin versus fosphenytoin for second line treatment of status epilepticus propensity score matching analysis using a nationwide inpatient database
Seizure-european Journal of Epilepsy, 2020Co-Authors: Kensuke Nakamura, Hiroyuki Ohbe, Hiroki Matsui, Kiyohide Fushimi, Hiromu Naraba, Hidehiko Nakano, Yuji Takahashi, Hideo YasunagaAbstract:Abstract Purpose For status epilepticus, the choice of antiepileptic drugs for second-line treatment after benzodiazepine remains controversial: phenytoin or fosphenytoin are recommended, however, it has been unknown which is better. Using a nationwide database, we compared the efficacy and safety of them. Method An observational study conducted with the Japanese Diagnosis Procedure Combination inpatient database identified adult patients who had been admitted for status epilepticus and who had received intravenous diazepam on the day of admission from January 1, 2011 through December 31, 2015. Propensity score matching was applied to compare outcomes of the phenytoin and fosphenytoin groups. Results The analysis examined data of 5265 patients: 2969 patients received phenytoin; 2296 received fosphenytoin, on the day of admission. One-to-one propensity score matching created 1871 matched pairs. No significant difference was found for vasopressor use on the day of admission (4.2 % vs. 4.4 %; odds ratio 1.07; 95 % confidence intervals 0.77–1.48; p = 0.69), or for mechanical ventilation on the day of admission, in-hospital mortality, length of hospital stay, or total Hospitalization Cost. Higher age, comorbidity of cardiac diseases and lower body mass index were associated significantly with increased vasopressor use, whereas the dose of phenytoin equivalents and the choice of fosphenytoin were not. Conclusions This nationwide observational study found no evidence that fosphenytoin provides higher efficacy or safety than phenytoin for treatment of status epilepticus in adults after diazepam. Age, cardiac disease and low body mass index were identified as independent risk factors for vasopressor use in both phenytoin and fosphenytoin.
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levetiracetam vs fosphenytoin for second line treatment of status epilepticus propensity score matching analysis using a nationwide inpatient database
Frontiers in Neurology, 2020Co-Authors: Kensuke Nakamura, Hiroyuki Ohbe, Hiroki Matsui, Aiki Marushima, Kiyohide Fushimi, Yoshiaki Inoue, Yuji Takahashi, Hideo YasunagaAbstract:OBJECTIVE: Status epilepticus is a major emergency condition. The choice of antiepileptic drugs for second-line treatment after benzodiazepine remains controversial, including levetiracetam versus fosphenytoin. We compare the safety of intravenous levetiracetam and fosphenytoin as a second-line treatment in patients with status epilepticus using a nationwide database. METHODS: An observational study conducted with the Japanese Diagnosis Procedure Combination inpatient database identified adult patients who had been admitted for status epilepticus and who had received intravenous diazepam on the day of admission from March 1, 2011 to March 31, 2018. Patients who received intravenous levetiracetam on the day of admission were defined as the levetiracetam group and those who received intravenous fosphenytoin on the day of admission were defined as the fosphenytoin group. Propensity score matching was performed to compare outcomes obtained for the levetiracetam and fosphenytoin groups. RESULTS: The analysis examined data of 5667 patients. Overall, 1,403 (25%) patients received levetiracetam; 4,264 (75%) received fosphenytoin. One-to-one propensity score matching created 1,363 matched pairs. No significant difference was found in in-hospital mortality (5.2% vs. 5.1%; odds ratio, 1.03; 95% confidence interval, 0.73–1.46). The proportion of vasopressor use on the day of admission was significantly lower for the levetiracetam group than for the fosphenytoin group (3.2% vs. 4.9%; odds ratio, 0.63; 95% confidence interval, 0.43–0.92). No significant difference was found in other secondary outcomes including total Hospitalization Cost. CONCLUSION: Levetiracetam was related to significantly reduced vasopressor use on the day of admission than that found for fosphenytoin, in adult status epilepticus.
Yinong Youngxu - One of the best experts on this subject based on the ideXlab platform.
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comparing the impact of high dose versus standard dose influenza vaccines on Hospitalization Cost for cardiovascular and respiratory diseases economic assessment in the us veteran population during 5 respiratory seasons using an instrumental variable method
Vaccine, 2021Co-Authors: Robertus Van Aalst, Ellyn M Russo, Nabin Neupane, Salaheddin M Mahmud, Jan Wilschut, Ayman Chit, Maarten J Postma, Sandrine I Samson, Yinong YoungxuAbstract:Abstract Objectives Cost savings associated with high-dose (HD) as compared to standard-dose (SD) influenza vaccination in the United States (US) Veteran’s Health Administration (VHA) population have been attributed to better protection against Hospitalization for cardiac and respiratory diseases. The relative contribution of each of these disease categories to the reported savings remains to be explored. Methods During a recently completed study of HD versus SD vaccine effectiveness (conducted in the VHA over five respiratory seasons from 2010/11 through 2014/15), we collected Cost data for all healthcare services provided at both VHA and Medicare-funded facilities. In that analysis, we compared the Costs of vaccination and hospital care for patients admitted with either cardiovascular or respiratory disease. Treatment selection bias and other confounding factors were adjusted using an instrumental variable (IV) method. In this brief report we use the same study cohort and methods to stratify the results by patients admitted for cardiovascular disease (CVD) and those admitted for respiratory disease. Results We analyzed 3.5 million SD and 0.16 million HD person-seasons. The IV-adjusted rVEs were 14% (7–20%) against Hospitalizations for CVD and 15% (5–25%) against respiratory Hospitalizations. Net Cost savings per HD recipient were $138 ($66–$200) for CVD related Hospitalizations and $62 ($10–$107) for respiratory disease related Hospitalizations. Conclusions In the US VHA population, the reduction in Hospitalizations for CVD over five respiratory seasons contributed twice the Cost savings (per HD recipient) of the reduction in Hospitalizations for respiratory disease.
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economic assessment of a high dose versus a standard dose influenza vaccine in the us veteran population estimating the impact on Hospitalization Cost for cardio respiratory disease
Vaccine, 2019Co-Authors: Robertus Van Aalst, Ellyn M Russo, Nabin Neupane, Salaheddin M Mahmud, Vincent Mor, Jan Wilschut, Ayman Chit, Maarten J Postma, Yinong YoungxuAbstract:Abstract Objective To compare the economic impact of high-dose trivalent (HD) versus standard-dose trivalent (SD) influenza vaccination on direct medical Costs for cardio-respiratory Hospitalizations in adults aged 65 years or older enrolled in the United States (US) Veteran’s Health Administration (VHA). Methods Leveraging a relative vaccine effectiveness study of HD versus SD over five respiratory seasons (2010/11 through 2014/15), we collected Cost data for healthcare provided to the same study population both at VHA and through Medicare services. Our economic assessment compared the Costs of vaccination and hospital care for patients experiencing acute cardio-vascular or respiratory illness. Results We analyzed 3.5 million SD and 158,636 HD person-seasons. The average Cost of HD and SD vaccination was $23.48 (95% CI: $21.29 - $25.85) and $12.21 (95% CI: $11.49 - $13.00) per recipient, respectively, while the Hospitalization rates for cardio-respiratory disease in HD and SD recipients were 0.114 (95% CI: 0.108–0.121) and 0.132 (95% CI: 0.132–0.133) per person-season, respectively. Attributing the average Cost per Hospitalization of $11,796 (95% CI: $11,685 - $11,907) to the difference in Hospitalization rates, we estimated savings attributable to HD to be $202 (95% CI: $115 – $280) per vaccinated recipient. Conclusions For the five-season period of 2010/11 through 2014/15, HD influenza vaccination was associated with net Cost savings due to fewer Hospitalizations, and therefore lower direct medical Costs, for cardio-respiratory disease as compared to SD influenza vaccination in the senior US VHA population.
Kensuke Nakamura - One of the best experts on this subject based on the ideXlab platform.
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phenytoin versus fosphenytoin for second line treatment of status epilepticus propensity score matching analysis using a nationwide inpatient database
Seizure-european Journal of Epilepsy, 2020Co-Authors: Kensuke Nakamura, Hiroyuki Ohbe, Hiroki Matsui, Kiyohide Fushimi, Hiromu Naraba, Hidehiko Nakano, Yuji Takahashi, Hideo YasunagaAbstract:Abstract Purpose For status epilepticus, the choice of antiepileptic drugs for second-line treatment after benzodiazepine remains controversial: phenytoin or fosphenytoin are recommended, however, it has been unknown which is better. Using a nationwide database, we compared the efficacy and safety of them. Method An observational study conducted with the Japanese Diagnosis Procedure Combination inpatient database identified adult patients who had been admitted for status epilepticus and who had received intravenous diazepam on the day of admission from January 1, 2011 through December 31, 2015. Propensity score matching was applied to compare outcomes of the phenytoin and fosphenytoin groups. Results The analysis examined data of 5265 patients: 2969 patients received phenytoin; 2296 received fosphenytoin, on the day of admission. One-to-one propensity score matching created 1871 matched pairs. No significant difference was found for vasopressor use on the day of admission (4.2 % vs. 4.4 %; odds ratio 1.07; 95 % confidence intervals 0.77–1.48; p = 0.69), or for mechanical ventilation on the day of admission, in-hospital mortality, length of hospital stay, or total Hospitalization Cost. Higher age, comorbidity of cardiac diseases and lower body mass index were associated significantly with increased vasopressor use, whereas the dose of phenytoin equivalents and the choice of fosphenytoin were not. Conclusions This nationwide observational study found no evidence that fosphenytoin provides higher efficacy or safety than phenytoin for treatment of status epilepticus in adults after diazepam. Age, cardiac disease and low body mass index were identified as independent risk factors for vasopressor use in both phenytoin and fosphenytoin.
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levetiracetam vs fosphenytoin for second line treatment of status epilepticus propensity score matching analysis using a nationwide inpatient database
Frontiers in Neurology, 2020Co-Authors: Kensuke Nakamura, Hiroyuki Ohbe, Hiroki Matsui, Aiki Marushima, Kiyohide Fushimi, Yoshiaki Inoue, Yuji Takahashi, Hideo YasunagaAbstract:OBJECTIVE: Status epilepticus is a major emergency condition. The choice of antiepileptic drugs for second-line treatment after benzodiazepine remains controversial, including levetiracetam versus fosphenytoin. We compare the safety of intravenous levetiracetam and fosphenytoin as a second-line treatment in patients with status epilepticus using a nationwide database. METHODS: An observational study conducted with the Japanese Diagnosis Procedure Combination inpatient database identified adult patients who had been admitted for status epilepticus and who had received intravenous diazepam on the day of admission from March 1, 2011 to March 31, 2018. Patients who received intravenous levetiracetam on the day of admission were defined as the levetiracetam group and those who received intravenous fosphenytoin on the day of admission were defined as the fosphenytoin group. Propensity score matching was performed to compare outcomes obtained for the levetiracetam and fosphenytoin groups. RESULTS: The analysis examined data of 5667 patients. Overall, 1,403 (25%) patients received levetiracetam; 4,264 (75%) received fosphenytoin. One-to-one propensity score matching created 1,363 matched pairs. No significant difference was found in in-hospital mortality (5.2% vs. 5.1%; odds ratio, 1.03; 95% confidence interval, 0.73–1.46). The proportion of vasopressor use on the day of admission was significantly lower for the levetiracetam group than for the fosphenytoin group (3.2% vs. 4.9%; odds ratio, 0.63; 95% confidence interval, 0.43–0.92). No significant difference was found in other secondary outcomes including total Hospitalization Cost. CONCLUSION: Levetiracetam was related to significantly reduced vasopressor use on the day of admission than that found for fosphenytoin, in adult status epilepticus.
Amit P Amin - One of the best experts on this subject based on the ideXlab platform.
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incremental Cost of acute kidney injury after percutaneous coronary intervention in the united states
American Journal of Cardiology, 2020Co-Authors: Amit P Amin, Christian Mcneely, John A Spertus, Richard G Bach, Nathan Frogge, Samuel Lindner, Sudhir Jain, Steven M Bradley, Jason H WasfyAbstract:Contrast-induced acute kidney injury (AKI) is a common and severe complication of percutaneous coronary intervention (PCI). Despite its substantial burden, contemporary data on the incremental Costs of AKI are lacking. We designed this large, nationally representative study to examine: (1) the independent, incremental Costs associated with AKI after PCI and (2) to identify the departmental components of Cost contributing to the incremental Costs associated with AKI. In this observational cross-sectional study from the Premier database, we analyzed 1,443,297 PCI patients at 518 US hospitals from 1/2006 to 12/2015. Incremental Cost of AKI from a hospital perspective obtained by a microCosting approach, was estimated using mixed-effects, multivariable linear regression with hospitals as random effects. Costs were inflation-corrected to 2016 US$. AKI occurred in 82,683 (5.73%) of the PCI patients. Those with AKI had higher Hospitalization Cost than those without ($38,869, SD 42,583 vs $17,167 SD 13,994, p <0.001). After adjustment, the incremental Cost associated with an AKI was $9,448 (95% confidence interval $9,338 to $9,558, p <0.001). AKI was also independently associated with an incremental length of stay of 3.6 days (p <0.001). Room and board Costs were the largest driver of AKI Costs ($4,841). Extrapolated to the United States, our findings imply an annual AKI Cost burden of 411.3 million US$. In conclusion, in this national study of PCI patients, AKI was common and independently associated with ∼$10,000 incremental Costs, implying a substantial burden of AKI Costs in US hospitals. Successful efforts to prevent AKI in patients who underwent PCI could result in meaningful Cost savings.