Urban Hospitalization Increases Costs and Healthcare Utilization for Diverticulitis in the United States
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Introduction: The purpose of this study was to compare the outcomes of patients hospitalized for diverticulitis based on hospital location (rural or urban). Methods: We identified discharges from the nationwide inpatient sample with a principal diagnosis of diverticulitis (ICD-9 codes 562.11 and 562.13). Patient and hospital characteristics were summarized by hospital location (rural or urban) and differences across hospital location were tested using chi-square tests or t-tests. Outcomes were summarized by hospital location and univariate chi-square tests or t-tests were performed. The outcomes were in-hospital mortality, length of stay, and total hospital charges. We used multivariable logistic regression for in-hospital mortality to calculate adjusted odds ratios for hospital location, adjusting for age, sex, race, Elixhauser comorbidity score, hospital teaching status, and hospital region. We used multivariable linear regression for length of stay and total hospital charge, adjusting for the same variables. Length of stay and total charge were log-transformed for analysis as the original values were extremely right skewed. Results: A total of 243,995 discharges were identified with a principal diagnosis of diverticulitis. Among these patients, 15% were in rural hospitals, and 85% were in urban hospitals. In multivariable analysis, inhospital mortality did not differ significantly by hospital location (p=0.81). After adjusting for covariates in multivariable analysis, length of stay was 8.6% longer in urban than in rural hospitals (p<0.001) and total charges were 73.1% higher in urban than in rural hospitals (p<0.001). If we apply these percentages to the median values of the rural hospitals this equates to a 0.25 day increase and a $9,086 increase in urban hospitals. Conclusion: In an analysis comparing diverticulitis outcomes in rural and urban hospitals, there was no difference in mortality. Length of stay was significantly longer in urban hospitals, and total cost was significantly higher in urban hospitals, both adjusting for patient and hospital characteristics. These data prompt us to further examine the diagnostic testing and interventions which are delivered at urban hospitals that increase cost and extend hospitalization without conferring a survival advantage.Table 1: Outcomes by Hospital Location, Univariate ComparisonsKeywords:
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在治疗的选择和老病人的幸存上识别 comorbidity 的影响的目的(≥ 70 年) 与先进非小的房间肺癌症(NSCLC ) 。方法临床的特征和 177 个老病人，有好表演地位，的治疗的选择 PS ≤ 1 ) 回顾地在肿瘤学部门被分析，上海肺的医院，在到 2005 年 12 月的 2005 年 1 月之间。幸存数据仅仅在收到了化疗的那些被分析。所有病人被 comorbidity 的数字作为没有(0 ) 成层，温和(1 2 ) 并且严重(≥ 3 ) 组。结果病人，收到了化疗，的比例温和、严重的 comorbidity 是显著地不同的(79.3%，76.2%和57.4%， P = 0.038 )，并且也有关于在三个组之中的辩解的放射疗法率显著地不同(21.7%，11.7%和37.0%， P = 0.014 )。中部的幸存和 1 年的幸存在没有评价，温和、严重的 comorbidity 组，是 13.6 对 10.2 对 7.6 个月并且 53.5% 对 41.3% 对 20.8% 分别地(木头等级， P = 0.071 ) 。在 univariate 并且多，变量考克斯为分析建模，仅仅严重的 comorbidity 是有 NSCLC 的老病人的幸存的一个独立危险因素。相对比率(RR， 95% CI ) ：(2.09， 1.06 4.15 ) ， P = 0.034。结论 Comorbidity 可以稍微与先进 NSCLC 影响老病人的治疗的选择，但是仅仅严重的 comorbidity 是幸存的一个独立预示的因素。
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This study assessed optimal management of colonic diverticulitis as functions of disease location and severity and factors associated with complicated diverticulitis.This retrospective review analyzed 202 patients diagnosed between 2007 and 2014 at Chonbuk National University Hospital, South Korea, with colonic diverticulitis by using abdominopelvic computed tomography. Diverticulitis location was determined, and disease severity was categorized using the modified Hinchey classification.Patients included 108 males (53.5%) and 94 females (46.5%); of these, 167 patients (82.7%) were diagnosed with right-sided and 35 (17.3%) with left-sided colonic diverticulitis. Of the 167 patients with right-sided colonic diverticulitis, 12 (7.2%) had complicated and 155 (92.8%) had uncomplicated diverticulitis; of these, 157 patients (94.0%) were successfully managed conservatively. Of the 35 patients with left-sided colonic diverticulitis, 23 (65.7%) had complicated and 12 (34.3%) had uncomplicated diverticulitis; of these, 23 patients (65.7%) were managed surgically. Among patients with right-sided diverticulitis, those with complicated disease were significantly older (54.3 ± 12.7 years vs. 42.5 ± 13.4 years, P = 0.004) and more likely to be smokers (66.7% vs. 32.9%, P = 0.027) than those with uncomplicated disease. However, among patients with left-sided diverticulitis, those with complicated disease had significantly lower body mass index (BMI; 21.9 ± 4.7 kg/m2 vs. 25.8 ± 4.3 kg/m2, P = 0.021) than those with uncomplicated disease.Conservative management may be effective in patients with right-sided diverticulitis and patients with uncomplicated left-sided colonic diverticulitis. Surgical management may be required for patients with complicated left-sided diverticulitis. Factors associated with complicated diverticulitis include older age, smoking and lower BMI.
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'Against all odds', as this paper uses the term, confronts the fact that people at work often face situations challenging their professional values and orientation. They must decide whether to stick to their ethical principles or set them aside in the interest of a prevailing system that otherwise stacks the odds against them. The odds people in their professions may face result from limits, boundaries, obstacles or emerging risks.
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Prologue: Why the Odds Don't Change for the Poor Part One: Weighing the Odds 1. The Odds Against Escaping from Poverty 2. The Odds Against Going to College Part Two: Beating the Odds 3. A Portrait of Twenty-Four Who Succeeded 4. Hitting the Jackpot: Entree to the Elites 5. Betting the Farm: The Struggle Just to Get in the Door Part Three: Improving the Odds 6. Nine Mentors Who Changed the Odds 7. The Lesson: One Arm Around One Child 8. Evening the Odds: Making College Possible for the Poor Resource: Brief Biographies of the Twenty-Four Students Inverviewed.
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Too often—in perhaps as many as 30% of cases—the clinical diagnosis of diverticulitis has been refuted by pathologic study of bowel tissue removed at surgery. Pointing out that the “classical” signs of diverticulitis are invariably present in these operated patients, Drs. Almy and Fleischner propose more specific criteria for distinguishing true diverticulitis from other types of diverticular disease.
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Comorbidity may be an important reason for head and neck surgeons to treat elderly patients less intensively. This article provides an overview of the influence of age and comorbidity on choice of therapy, postoperative complications, and survival.Several retrospective studies show that elderly patients can undergo surgery if they do not have severe comorbid disorders. Severe comorbidity influences the rate of postoperative complications, and the higher complication rate in older patients reported in some studies is probably due to a higher level of comorbidity. Comorbidity also affects the survival of cancer patients, but several studies have failed to detect a relation between age and survival after correction for comorbidity. Thus, although severe comorbidity may influence the choice of treatment, patient age as such should not be a reason to exclude patients from intensive therapy.If severe comorbidity is not present, elderly patients should receive standard treatment for head and neck cancer. Treatment choice should be based on medical findings and patient preference, not on chronologic age.
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We analyze the efficiency of English football betting markets between 2002 and 2006. We find evidence of a positive favourite-longshot bias for both home odds and away odds. Draw odds are instead characterized by a negative longshot bias. We also identify a draw bias in the sense that betting at draw odds yields a higher return than betting at home or away odds. Finally, we investigate betting strategies that exploit the variance of odds between bookmakers.
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