[Chronic comorbidity and homogeneity in diagnostic related groups]

Trends in incidence and outcomes of revision total hip arthroplasty in Spain: a population based study

Background

To analyze changes in incidence and outcomes of patients undergoing revision total hip arthroplasty (RTHA) over an 8-year study period in Spain.

Methods

We selected all surgical admissions in individuals aged ≥ 40 years who underwent RTHA (ICD-9-CM procedure code 81.53) between 2001 and 2008 from the Spanish National Hospital Discharge Database. Age- and sex-specific incidence rates, Charlson co-morbidity index, length of stay (LOS), costs and in-hospital mortality (IHM) were estimated for each year. Multivariate analyses were conducted to asses time trends.

Results

32, 280 discharges of patients (13, 391 men/18, 889 women) having undergone RTHA were identified. Overall crude incidence showed a small but significant increase from 20.2 to 21.8 RTHA per 100, 000 inhabitants from 2001 to 2008 (p < 0.01).

The incidence increased for men (17.7 to 19.8 in 2008) but did not vary for women (22.3 in 2001 and 22.2 in 2008). Greater increments were observed in patients older than 84 years and in the age group 75-84. In 2001, 19% of RTHA patients had a Charlson Index ≥ 1 and this proportion rose to 24.6% in 2008 (p < 0.001). The ratio RTHA/THA remained stable and around 20% in Spain along the entire period

The crude overall in-hospital mortality (IHM) increased from 1.16% in 2001 to 1.77% (p = 0.025) in 2008. For both sexes the risk of death was higher with age, with the highest mortality rates found among those aged 85 or over. After multivariate analysis no change was observed in IHM over time. The mean inflation adjusted cost per patient increased by 78.3%, from 9, 375 to 16, 715 Euros from 2001 to 2008.

After controlling for possible confounders using Poisson regression models, we observed that the incidence of RTHA hospitalizations significantly increased for men and women over the period 2001 to 2008 (IRR 1.10, 95% CI 1.03-1.18 and 1.08, 95% CI 1.02-1.14 respectively).

Conclusions

The crude incidence of RTHA in Spain showed a small but significant increase from 2001 to 2008 with concomitant reductions in LOS, significant increase in co-morbidities and cost per patient.

Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System

Background

While the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, additionally, to explore factors associated with the decision to perform early hip fracture repair.

Methods

A cohort of 56,500 patients of 60-years-old and over, hospitalized for hip fracture during the period 2002 to 2005 in all the public hospitals in 8 Spanish regions, were followed up using administrative databases to identify the time to surgical repair and in-hospital mortality. We used a multivariate logistic regression model to analyze the relationship between the timing of surgery (< 2 days from admission) and in-hospital mortality, controlling for several confounding factors.

Results

Early surgery was performed on 25% of the patients. In the unadjusted analysis early surgery showed an absolute difference in risk of mortality of 0.57 (from 4.42% to 3.85%). However, patients undergoing delayed surgery were older and had higher comorbidity and severity of illness. Timeliness for surgery was not found to be related to in-hospital mortality once confounding factors such as age, sex, chronic comorbidities as well as the severity of illness were controlled for in the multivariate analysis.

Conclusions

Older age, male gender, higher chronic comorbidity and higher severity measured by the Risk Mortality Index were associated with higher mortality, but the time to surgery was not.

Changes in the epidemiology of hepatitis A in Spain (2005–2008): trends of acute hepatitis A hospitalizations, comorbidities, and costs associated with the hospitalization

INTRODUCTION

The objective of this study is to analyze data related to hospitalization, comorbidities, median stays and costs associated with the hospitalization cases of hepatitis A in Spain, during the 2005-2008 periods.

METHODS

A retrospective study of the characteristics of acute hepatitis A patients admitted to Spanish hospitals was performed using the minimum basic dataset. Costs were calculated using the diagnosis-related groups for the disease.

RESULTS

The total number of hospitalized patients diagnosed with acute hepatitis A was 2395 (2.66/100,000 inhabitants); 61.5% were diagnosed in men. The highest rate corresponds to the group aged 20-39 years (4.01/100,000 inhabitants). When compared with year 2005 ascending tendencies in hospitalization was found for the year 2008 (incidence rate ratio 1.36 confidence interval 95% 1.32-1.39). Twenty-four deaths (1%) were reported out of the total of hospitalized patients. The median hospital stay was 5 days. An increase of cost from euro 1.272.608 in the year 2005 to euro 2.586.657 in 2008 was observed. Therefore, the total cost derived from these hospitalizations, above the retail price index, has increased by 90%.

CONCLUSION

The incidence of hospitalized patients diagnosed with acute hepatitis A in Spain has remained stable from 2005 to 2007 and increased significantly in the year 2008. Therefore, a change in the epidemiology of hepatitis A may be taking place in Spain and this disease could become a public problem in the young adult population. It is necessary to conduct a cost-effectiveness study to assess the need for including hepatitis A in the universal immunizations schedule.

Trends of adverse drug reactions related-hospitalizations in Spain (2001-2006)

Background

Adverse drug reactions (ADR) are a substantial cause of hospital admissions. We conducted a nationwide study to estimate the burden of hospital admissions for ADRs in Spain during a six-year period (2001-2006) along with the associated total health cost.

Methods

Data were obtained from the national surveillance system for hospital data (Minimum Basic Data Set) maintained by the Ministry of Health and Consumer Affairs, and covering more than 95% of Spanish hospitals. From these admissions we selected all hospitalization that were code as drug-related (ICD-9-CM codes E), but intended forms of overdoses, errors in administration and therapeutics failure were excluded. The average number of hospitalizations per year, annual incidence of hospital admissions, average length of stay in the hospital, and case-fatality rate, were calculated.

Results

During the 2001-2006 periods, the total number of hospitalized patients with ADR diagnosis was 350,835 subjects, 1.69% of all acute hospital admissions in Spain. The estimated incidence of admissions due to ADR decreased during the period 2001-2006 (p < 0.05). More than five percent of patients (n = 19,734) died during an ADR-related hospitalization. The drugs most commonly associated with ADR-related hospitalization were antineoplastic and immunosuppressive drugs (n = 75,760), adrenal cortical steroids (n = 47,539), anticoagulants (n = 26,546) and antibiotics (n = 22,144). The costs generated by patients in our study increased by 19.05% between 2001 and 2006.

Conclusions

Approximately 1.69% of all acute hospital admissions were associated with ADRs. The rates were much higher for elderly patients. The total cost of ADR-related hospitalization to the Spanish health system is high and has increased between 2001 and 2006. ADRs are an important cause of admission, resulting in considerable use of national health system beds and a significant number of deaths.

Trends of acute hepatitis B hospitalizations, comorbidities, fatality rate, and costs associated with the hospitalization in Spain (2001-2006)

INTRODUCTION

The objective of this study is to analyze data related to hospitalization, comorbidities, fatality rate, average stays, and costs associated with hospitalized cases of acute hepatitis B in Spain, during 2001-2006.

METHODS

A retrospective study to analyze the characteristics of acute hepatitis B patients admitted to Spanish hospitals was performed using the minimum basic data set. Costs were calculated using the diagnosis-related groups for the disease.

RESULTS

The total number of hospitalized patients diagnosed with acute hepatitis B was 2160, of which 73.8% were diagnosed in men. The highest rate corresponds to the group aged 20-39 years (2.33/100 000 inhabitants). Ninety deaths (4.2%) were reported out of the total hospitalized patients. The average hospital stay was 10 days. The trends in the rate of hospitalized acute hepatitis B cases were not statistically significant. There were no differences found in the average length of stay or in the cost during the study period. The estimated total cost was 7 451 098 euros.

CONCLUSION

The rate of hospitalized acute hepatitis B patients in Spain did not change during the 2001-2006 period. Having an adequate surveillance system and continuing with the universal immunization and risk group programs, and health education, remain a high priority.

Trends of hepatitis A hospitalizations and costs associated with the hospitalization in Spain (2000-2005)

The objective of this study was to analyse data related to hospitalization, comorbidities, average stays and costs associated with the hospitalization cases of hepatitis A in Spain, during the period between 2000 and 2005. A retrospective, descriptive study of the epidemiological characteristics of hepatitis A patients admitted to Spanish hospitals was performed using, as an information source, the Minimum Basic Data Set. National hospitalization rates were calculated for hepatitis A. Comorbidities, mortality, average and median stays, and mean medical costs related to hospitalization were analysed. Costs were calculated using Diagnosis-Related Groups for the disease. The total number of hospitalized patients with hepatitis A diagnosis was 2351 subjects (rate 1.87/100,000 inhabitants). The highest rate corresponds to the group aged between 20 and 39 years (3.07/100,000 inhabitants). Some 60.1% of hospitalized hepatitis A cases were diagnosed in men. Twenty-two deaths (0.9%) out of the total of hospitalized subjects were reported. The average hospital stay caused by hepatitis A was 6.8 days. The trends in the rate of hospitalized hepatitis A cases in Spain, from the year 2000 to 2005, were not statistically significant. Differences were found neither in the hospitalization percentage, nor in the average length of stay. An increase of cost from 836,278 euro in the year 2000 to 1,272,608 euro in the year 2005 was observed. The rate of hospitalized hepatitis A subjects in Spain has not changed over the period 2000-2005. The total cost derived from these hospitalizations has increased by 52%.