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BJUI Compass Jun 2024To investigate the racial and socioeconomic (income) differences in receipt of and time to surgical care for urinary incontinence (UI) and erectile dysfunction (ED)...
OBJECTIVES
To investigate the racial and socioeconomic (income) differences in receipt of and time to surgical care for urinary incontinence (UI) and erectile dysfunction (ED) occurring post-radical prostatectomy (RP) and/or radiation therapy (RT).
MATERIALS AND METHODS
Utilizing the Medicare Standard Analytical Files (SAF), a retrospective cohort study was performed on data of patients diagnosed with prostate cancer (PCa) from 2015 to 2021. Patients who underwent RP and/or RT and who subsequently developed UI and/or ED were grouped into four cohorts: RP-ED, RP-UI, RT-ED and RT-UI. County-level median household income was cross-referenced with SAF county codes, classified into income quartiles, and used as a proxy for patient income status. The rate of surgical care was compared between groups using two-sample t-test and log-rank test. Cox proportional hazards modelling was used to determine covariate-adjusted impact of race on time to surgical care.
RESULTS
The rate of surgical care was 6.8, 3.61 3.07, and 1.54 per 100 person-years for the RP-UI, RT-UI, RP-ED, and RT-ED cohorts, respectively. Cox proportional regression analysis revealed that Black men were statistically more likely to receive ED surgical care (RP-ED AHR:1.79, 95% CI:1.49-2.17; RT-ED AHR:1.50, 95% CI:1.11-2.01), but less likely to receive UI surgical care (RP-UI AHR:0.80, 95% CI:0.67-0.96) than White men, in all cohorts except RT-UI. Surgical care was highest among Q1 (lowest income quartile) patients in all cohorts except RT-UI.
CONCLUSIONS
Surgical care for post-PCa treatment complications is low, and significantly impacted by racial and socioeconomic (income) differences. Prospective studies investigating the basis of these results would be insightful.
PubMed: 38873355
DOI: 10.1002/bco2.342 -
PloS One 2024To determine the incidence of newly diagnosed liver disorders (LD) up to 3.5-year post-acute COVID-19, and risk factors associated with new LD.
PURPOSE
To determine the incidence of newly diagnosed liver disorders (LD) up to 3.5-year post-acute COVID-19, and risk factors associated with new LD.
METHODS
We analyzed 54,699 COVID-19 patients and 1,409,547 non-COVID-19 controls from March-11-2020 to Jan-03-2023. New liver disorders included abnormal liver function tests, advanced liver failure, alcohol and non-alcohol related liver disorders, and cirrhosis. Comparisons were made with ambulatory non-COVID-19 patients and patients hospitalized for other lower respiratory tract infections (LRTI). Demographics, comorbidities, laboratory data, incomes, insurance status, and unmet social needs were tabulated. The primary outcome was new LD at least two weeks following COVID-19 positive test.
RESULTS
Incidence of new LD was not significantly different between COVID-19 and non-COVID-19 cohorts (incidence:1.99% vs 1.90% p>0.05, OR = 1.04[95%CI: 0.92,1.17], p = 0.53). COVID-19 patients with new LD were older, more likely to be Hispanic and had higher prevalence of diabetes, hypertension, chronic kidney disease, and obesity compared to patients without new LD. Hospitalized COVID-19 patients had no elevated risk of LD compared to hospitalized LRTI patients (2.90% vs 2.07%, p>0.05, OR = 1.29[0.98,1.69], p = 0.06). Among COVID-19 patients, those who developed LD had fewer patients with higher incomes (14.18% vs 18.35%, p<0.05) and more with lower incomes (21.72% vs 17.23%, p<0.01), more Medicare and less Medicaid insurance, and more patients with >3 unmet social needs (6.49% vs 2.98%, p<0.001) and fewer with no unmet social needs (76.19% vs 80.42%, p<0.001).
CONCLUSIONS
Older age, Hispanic ethnicity, and obesity, but not COVID-19 status, posed increased risk for developing new LD. Lower socioeconomic status was associated with higher incidence of new LD.
Topics: Humans; COVID-19; Male; Female; Risk Factors; Middle Aged; Incidence; Aged; Liver Diseases; SARS-CoV-2; Adult; New York City; Comorbidity; Pandemics
PubMed: 38870207
DOI: 10.1371/journal.pone.0303151 -
Cureus May 2024The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented restrictions on the general public and disturbances to the routines of hospitals worldwide....
The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented restrictions on the general public and disturbances to the routines of hospitals worldwide. These restrictions are now being relaxed as the number of vaccinated individuals increases and as the rates of incidence and prevalence decrease; however, they left a lasting impact on healthcare systems that is still being felt today. This retrospective study evaluated the total number of canceled or missed outpatient clinic appointments in a Neurological Surgery department before and after peak COVID-19 restrictions and attempted to assess the impact of these disruptions on neurosurgical clinical attendance. We also attempted to compare our data with the data from another surgical subspecialty department. We evaluated 32,558 scheduled appointments at the Loyola University Medical Center Department of Neurological Surgery, as well as 139,435 scheduled appointments with the Department of Otolaryngology. Appointments before April 2020 were defined as pre-COVID, while appointments during or after April 2020 were defined as post-COVID. Here, we compare no-show and non-attendance rates (no-shows plus late-canceled appointments) within the respective time range. Overall, we observed that before COVID-19 restrictions were put into place, there was an 8.9% no-show rate and a 17.4% non-attendance rate for the Department of Neurological Surgery. After COVID restrictions were implemented, these increased to 10.9% and 18.3%, respectively. Greater no-show and cancellation rates (9.8% in the post-COVID era vs 8.0% in the pre-COVID era) were associated with varying socioeconomic and racial demographics. African-American patients (2.56 times higher), new-visit patients (1.67 times higher), and those with Medicaid/Medicare insurance policies (1.48 times higher) were at the highest risk of no-show in the post-COVID era compared to the pre-COVID era.
PubMed: 38868276
DOI: 10.7759/cureus.60159 -
JAMA Surgery Jun 2024The prevalence of robotic-assisted anterior abdominal wall (ventral) hernia repair has increased dramatically in recent years, despite conflicting evidence of patient...
IMPORTANCE
The prevalence of robotic-assisted anterior abdominal wall (ventral) hernia repair has increased dramatically in recent years, despite conflicting evidence of patient benefit. Whether long-term hernia recurrence rates following robotic-assisted repairs are lower than rates following more established laparoscopic or open approaches remains unclear.
OBJECTIVE
To evaluate the association between robotic-assisted, laparoscopic, and open approaches to ventral hernia repair and long-term operative hernia recurrence.
DESIGN, SETTING, AND PARTICIPANTS
Secondary retrospective cohort analysis using Medicare claims data examining adults 18 years and older who underwent elective inpatient ventral, incisional, or umbilical hernia repair from January 1, 2010, to December 31, 2020. Data analysis was performed from January 2023 through March 2024.
EXPOSURE
Operative approach to ventral hernia repair, which included robotic-assisted, laparoscopic, and open approaches.
MAIN OUTCOMES AND MEASURES
The primary outcome was operative hernia recurrence for up to 10 years after initial hernia repair. To help account for potential bias from unmeasured patient factors (eg, hernia size), an instrumental variable analysis was performed using regional variation in the adoption of robotic-assisted hernia repair over time as the instrument. Cox proportional hazards modeling was used to estimate the risk-adjusted cumulative incidence of operative recurrence up to 10 years after the initial procedure, controlling for factors such as patient age, sex, race and ethnicity, comorbidities, and hernia subtype (ventral/incisional or umbilical).
RESULTS
A total of 161 415 patients were included in the study; mean (SD) patient age was 69 (10.8) years and 67 592 patients (41.9%) were male. From 2010 to 2020, the proportion of robotic-assisted procedures increased from 2.1% (415 of 20 184) to 21.9% (1737 of 7945), while the proportion of laparoscopic procedures decreased from 23.8% (4799 of 20 184) to 11.9% (946 of 7945) and of open procedures decreased from 74.2% (14 970 of 20 184) to 66.2% (5262 of 7945). Patients undergoing robotic-assisted hernia repair had a higher 10-year risk-adjusted cumulative incidence of operative recurrence (13.43%; 95% CI, 13.36%-13.50%) compared with both laparoscopic (12.33%; 95% CI, 12.30%-12.37%; HR, 0.78; 95% CI, 0.62-0.94) and open (12.74%; 95% CI, 12.71%-12.78%; HR, 0.81; 95% CI, 0.64-0.97) approaches. These trends were directionally consistent regardless of surgeon procedure volume.
CONCLUSIONS AND RELEVANCE
This study found that the rate of long-term operative recurrence was higher for patients undergoing robotic-assisted ventral hernia repair compared with laparoscopic and open approaches. This suggests that narrowing clinical applications and evaluating the specific advantages and disadvantages of each approach may improve patient outcomes following ventral hernia repairs.
PubMed: 38865153
DOI: 10.1001/jamasurg.2024.1696 -
JAMA Network Open Jun 2024Insurance barriers to cancer care can cause significant patient and clinician burden.
IMPORTANCE
Insurance barriers to cancer care can cause significant patient and clinician burden.
OBJECTIVE
To investigate the association of insurance denial with changes in technique, dose, and time to delivery of radiation oncology treatment.
DESIGN, SETTING, AND PARTICIPANTS
In this single-institution cohort analysis, data were collected from patients with payer-denied authorization for radiation therapy (RT) from November 1, 2021, to December 8, 2022. Data were analyzed from December 15, 2022, to December 31, 2023.
EXPOSURE
Insurance denial for RT.
MAIN OUTCOMES AND MEASURES
Association of these denials with changes in RT technique, dose, and time to treatment delivery was assessed using χ2 tests.
RESULTS
A total of 206 cases (118 women [57.3%]; median age, 58 [range, 26-91] years) were identified. Most insurers (199 [96.6%]) were commercial payers, while 7 (3.4%) were Medicare or Medicare Advantage. One hundred sixty-one patients (78.2%) were younger than 65 years. Of 206 cases, 127 (61.7%) were ultimately authorized without any change to the requested RT technique or prescription dose; 56 (27.2%) were authorized after modification to RT technique and/or prescription dose required by the payer. Of 21 cases with required prescription dose change, the median decrease in dose was 24.0 (range, 2.3-51.0) Gy. Of 202 cases (98.1%) with RT delivered, 72 (34.9%) were delayed for a mean (SD) of 7.8 (9.1) days and median of 5 (range, 1-49) days. Four cases (1.9%) ultimately did not receive any authorization, with 3 (1.5%) not undergoing RT, and 1 (0.5%) seeking treatment at another institution.
CONCLUSIONS AND RELEVANCE
In this cohort study of patients with payer-denied cases, most insurance denials in radiation oncology were ultimately approved on appeal; however, RT technique and/or effectiveness may be compromised by payer-mandated changes. Further investigation and action to recognize the time and financial burdens on clinicians and clinical effects on patients caused by insurance denials of RT is needed.
Topics: Humans; Female; Middle Aged; Male; Aged; Adult; Aged, 80 and over; Radiation Oncology; United States; Insurance, Health; Neoplasms; Academic Medical Centers; Cohort Studies
PubMed: 38865128
DOI: 10.1001/jamanetworkopen.2024.16359 -
BMJ Open Respiratory Research Jun 2024Herpes zoster (HZ) is a painful condition caused by reactivation of the varicella-zoster virus. The objectives of this study were to compare HZ incidence in adults with...
BACKGROUND
Herpes zoster (HZ) is a painful condition caused by reactivation of the varicella-zoster virus. The objectives of this study were to compare HZ incidence in adults with asthma versus adults without asthma and to compare healthcare resource use as well as direct costs in adults with HZ and asthma versus adults with asthma alone in the USA.
METHODS
This retrospective longitudinal cohort study included adults aged ≥18 years across the USA. Patients were identified from Optum's deidentified Clinformatics Data Mart Database, an administrative claims database, between 1 October 2015 and 28 February 2020, including commercially insured and Medicare Advantage with part D beneficiaries. Cohorts of patients with and without asthma, and separate cohorts of patients with asthma and HZ and with asthma but not HZ, were identified using International Classification of Diseases 10th Revision, Clinical Modification codes. HZ incidence, healthcare resource use and costs were compared, adjusting for baseline characteristics, between the relevant cohorts using generalised linear models.
RESULTS
HZ incidence was higher in patients with asthma (11.59 per 1000 person-years) than patients without asthma (7.16 per 1000 person-years). The adjusted incidence rate ratio (aIRR) for HZ in patients with asthma, compared with patients without asthma, was 1.34 (95% CI 1.32 to 1.37). Over 12 months of follow-up, patients with asthma and HZ had more inpatient stays (aIRR 1.11; 95% CI 1.02 to 1.21), emergency department visits (aIRR 1.26; 95% CI 1.18 to 1.34) and outpatient visits (aIRR 1.19; 95% CI 1.16 to 1.22), and direct healthcare costs that were US dollars ($) 3058 (95% CI $1671 to $4492) higher than patients with asthma without HZ.
CONCLUSION
Patients with asthma had a higher incidence of HZ than those without asthma, and among patients with asthma HZ added to their healthcare resource use and costs.
Topics: Humans; Herpes Zoster; Asthma; Male; Female; Retrospective Studies; Incidence; Middle Aged; Adult; Health Care Costs; Aged; United States; Longitudinal Studies; Patient Acceptance of Health Care; Health Resources; Young Adult; Cost of Illness; Hospitalization; Adolescent
PubMed: 38862238
DOI: 10.1136/bmjresp-2023-002130 -
JAMA Network Open Jun 2024Concern has been raised about persistent sex disparities after coronary artery bypass grafting, with female patients having higher mortality. However, whether these...
IMPORTANCE
Concern has been raised about persistent sex disparities after coronary artery bypass grafting, with female patients having higher mortality. However, whether these disparities persist across hospitals of different qualities is unknown.
OBJECTIVE
To evaluate sex disparities in 30-day mortality after coronary artery bypass grafting across high- and low-quality hospitals.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional, retrospective cohort study evaluated Medicare beneficiaries undergoing coronary artery bypass grafting between October 1, 2015, and March 31, 2020. Data analysis was performed from July 1, 2023, to December 1, 2023.
EXPOSURES
The primary exposures were hospital quality and sex. For hospital quality, hospitals were placed into rank order by their overall risk-adjusted mortality rate and divided into quintiles.
MAIN OUTCOME AND MEASURES
Risk-adjusted 30-day mortality using a logistic regression model accounting for patient factors, including sex, age, comorbidities, elective vs unplanned admission, number of bypass grafts, use of arterial graft, and year of surgery.
RESULTS
A total of 444 855 beneficiaries (mean [SD] age, 71.5 [7.5] years; 120 333 [27.1%] female and 324 522 [72.9%] male) were studied. Compared with male beneficiaries, female beneficiaries were more likely to have an unplanned admission (66 425 [55.2%] vs 157 895 [48.7%], P < .001) and receive care at low-quality (vs high-quality) hospitals (odds ratio, 1.26; 95% CI, 1.23-1.29; P < .001). Overall, risk-adjusted female mortality was 4.24% (95% CI, 4.20%-4.27%), and male mortality was 2.75% (95% CI, 2.75%-2.77%), with an absolute difference of 1.48 (95% CI, 1.45-1.51) percentage points (P < .001). At the highest-quality hospitals, male mortality was 1.57% (95% CI, 1.56%-1.59%), and female mortality was 2.58% (95% CI, 2.54%-2.62%), with an absolute difference of 1.01 (95% CI, 0.97-1.04) percentage points (P < .001). At the lowest-quality hospitals, male mortality was 4.94% (95% CI, 4.88%-5.01%), and female mortality was 7.02% (95% CI, 6.90%-7.13%), with an absolute difference of 2.07 (95% CI, 1.95-2.19) percentage points (P < .001). Female beneficiaries receiving care at low-quality hospitals had a higher mortality than male beneficiaries receiving care at the high-quality hospitals (7.02% vs 1.57%, P < .001).
CONCLUSIONS AND RELEVANCE
In this cohort study of Medicare beneficiaries undergoing coronary artery bypass grafting, female beneficiaries were more likely to receive care at low-quality hospitals, where the sex disparity in mortality was double that of high-quality hospitals. Quality improvement targeting low-quality hospitals as well as equitable referral of female beneficiaries to higher-quality hospitals may narrow the sex disparity after coronary artery bypass grafting.
Topics: Humans; Coronary Artery Bypass; Female; Male; Aged; Cross-Sectional Studies; Retrospective Studies; United States; Hospitals; Healthcare Disparities; Medicare; Quality of Health Care; Sex Factors; Hospital Mortality; Aged, 80 and over
PubMed: 38861261
DOI: 10.1001/jamanetworkopen.2024.14354 -
Cureus May 2024Objective We aimed to evaluate trends in government monetary reimbursement (Medicare) for 10 of the most commonly performed pediatric orthopedic procedures from 2000 to...
Objective We aimed to evaluate trends in government monetary reimbursement (Medicare) for 10 of the most commonly performed pediatric orthopedic procedures from 2000 to 2020. Methods Utilizing the Centers for Medicare and Medicaid Services website, we collected data for 10 of the most commonly performed pediatric orthopedic surgical procedures and their variations. The reimbursement data for each procedure was taken from the Current Procedural Terminology (CPT) code, which was collected from the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services (Baltimore County, MD). The reimbursement values were adjusted for inflation to the 2022 US dollar (USD) using the changes to the Consumer Price Index. The compound annual growth rates (CAGRs) and total percentage changes in reimbursement were calculated for all the procedures and put into relative value units. Results Reimbursement for 20 of the 22 total procedures decreased by 32.65% from 2000 to 2022 after adjusting for inflation. Achilles tenotomy with local anesthesia saw the greatest decrease (-54.38%), whereas the procedure revision of spinal fusion saw the highest increase (26.00%) in mean adjusted reimbursement during this study period. Adjusted reimbursement decreased by an average of 2.08% on a yearly basis. Conclusion This study is the first to take an in-depth view and evaluate trends in procedural Medicare reimbursement for pediatric orthopedic surgery. When adjusted for inflation, Medicare reimbursement for 20 of 22 included procedures has steadily decreased from 2000 to 2022. There needs to be an increased awareness and consideration of these trends as they will be important for policymakers, hospitals, and surgeons to ensure continued access to meaningful surgical pediatric orthopedic care in the United States.
PubMed: 38860071
DOI: 10.7759/cureus.60062 -
Kansas Journal of Medicine 2024This study explored the connection between social determinants and patient self-rated health at Health Ministries Clinic (HMC) in a rural Kansas community. Community...
INTRODUCTION
This study explored the connection between social determinants and patient self-rated health at Health Ministries Clinic (HMC) in a rural Kansas community. Community health centers, like HMC, strive to deliver comprehensive care that addresses patients' social needs.
METHODS
The authors employed a convenience sampling method to survey HMC patients with appointments from September to December 2018. The authors analyzed the data using Chi-square tests and descriptive statistics in RStudio, considering p <0.05 as significant.
RESULTS
Among 200 patient responses, education, income, employment, and insurance status were negatively correlated with self-rated health. Notably, 86.2% of college or graduate school graduates reported positive health ratings, compared to 40% of those who did not finish high school (χ(12, N = 185) = 25.75, p = 0.012). Lower income individuals (income <$34,000 per year) consistently rated their health poorer than their higher income counterparts (χ(12, N = 174) = 23.96, p = 0.021). Patients without insurance or with public insurance (Medicaid/ CHIP) perceived their health as worse than those on private health insurance and Medicare (χ(12, N = 137) = 35.67, p <0.001).
CONCLUSIONS
Our findings suggest that low educational attainment, income, and lack of health insurance are associated with barriers to healthcare, resulting in poor health outcomes and chronic disease among those with lower socioeconomic status. This underscores the strong association between social determinants and self-rated health among HMC patients. These results can be used by other clinics to assess the needs of their patient population and enhance community health initiatives.
PubMed: 38859989
DOI: 10.17161/kjm.vol17.21220 -
PloS One 2024Cholecystectomy remains the standard management for acute cholecystitis. Given that rates of nonoperative management have increased, we hypothesize the existence of...
BACKGROUND
Cholecystectomy remains the standard management for acute cholecystitis. Given that rates of nonoperative management have increased, we hypothesize the existence of significant hospital-level variability in operative rates. Thus, we characterized patients who were managed nonoperatively at normal and lower operative hospitals (>90th percentile).
METHODS
All adult admissions for acute cholecystitis were queried using the 2016-2019 Nationwide Readmissions Database. Centers were ranked by nonoperative rate using multi-level, mixed effects modeling. Hospitals in the top decile of nonoperative rate (>9.4%) were classified as Low Operative Hospitals (LOH; others:nLOH). Separate regression models were created to determine factors associated with nonoperative management at LOH and nLOH.
RESULTS
Of an estimated 418,545 patients, 9.9% were managed at 880 LOH. Multilevel modeling demonstrated that 20.6% of the variability was due to hospital factors alone. After adjustment, older age (Adjusted Odds Ratio [AOR] 1.02/year, 95% Confidence Interval [CI] 1.01-1.02) and public insurance (Medicare AOR 1.31, CI 1.21-1.43 and Medicaid AOR 1.43, CI 1.31-1.57; reference: Private Insurance) were associated with nonoperative management at LOH. These were similar at nLOH. At LOH, SNH status (AOR 1.17, CI 1.07-1.28) and small institution size (AOR 1.20, CI 1.09-1.34) were associated with increased odds of nonoperative management.
CONCLUSION
We noted a significant variability in the interhospital variation of the nonoperative management of acute cholecystitis. Nevertheless, comparable clinical and socioeconomic factors contribute to nonoperative management at both LOH and non-LOH. Directed strategies to address persistent non-clinical disparities are necessary to minimize deviation from standard protocol and ensure equitable care.
Topics: Humans; Cholecystitis, Acute; Male; Female; Aged; Middle Aged; United States; Hospitals; Adult; Aged, 80 and over; Cholecystectomy; Patient Readmission; Medicare; Databases, Factual
PubMed: 38857278
DOI: 10.1371/journal.pone.0300851