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Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest 2013; 143:532-538. [PMID: 23381318 DOI: 10.1378/chest.12-0447] [Citation(s) in RCA: 224] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Ultrasound guidance enables visualization of the needle insertion site for thoracentesis and paracentesis. The improved accuracy of needle placement using ultrasound may reduce risk of complications and their costs associated with these procedures. Using claims data from the Premier Perspective hospital database from January 1, 2007, through December 31, 2008, we conducted an observational cohort study examining the effect of ultrasound guidance on risk of pneumothorax among patients undergoing thoracentesis and on risk of bleeding complications after paracentesis. Patients at elevated risk of these outcomes for reasons beyond the procedure of interest were excluded. Adjusted risk of events was assessed using multivariate logistic regression controlling for patient and hospitalization characteristics. Hospitalization cost and length of stay (LOS) were estimated using multivariate ordinary least squares regression of log-transformed values. We analyzed 61,261 thoracentesis and 69,859 paracentesis patient records. Approximately 45% of these procedures were ultrasound guided. Pneumothorax occurred in 2.7% (n = 1,670) of patients undergoing thoracentesis. Of patients undergoing paracentesis, 0.8% (n = 565) experienced bleeding complications. After adjustment, ultrasound guidance reduced the risk of pneumothorax after thoracentesis by 19% (OR, 0.81; 95% CI, 0.74-0.90) and by 68% for bleeding complications after paracentesis (OR, 0.32; 95% CI, 0.25-0.41). Pneumothorax increased the total cost of hospitalization by $2,801 (P < .001) and LOS by 1.5 days (P < .001). Bleeding complications increased cost by $19,066 (P < .0001) and LOS by 4.3 days (P < .0001). The data indicate that ultrasound guidance is associated with decreased risk of pneumothorax with thoracentesis and of bleeding complications with paracentesis. These complications resulted in measurable increases in hospitalization costs and LOS.
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Mercaldi CJ, Lanes S, Bradt J. Comparative risk of bloodstream infection in hospitalized patients receiving intravenous medication by open, point-of-care, or closed delivery systems. Am J Health Syst Pharm 2013; 70:957-65. [PMID: 23686602 DOI: 10.2146/ajhp120464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The impact of i.v. drug delivery via point-of-care (POC)-activated and closed systems versus traditional manual admixture systems on the risk of hospital-acquired bloodstream infection (BSI) is examined. METHODS Using data from a proprietary hospital database, a retrospective observational cohort study of patients receiving one or more i.v. drug administrations via POC-activated or closed systems during a three-year period (2007-09) was conducted. Cases of hospital-acquired BSI were identified using diagnosis codes and billing charges for blood cultures and antibiotic use. The risk of BSI in patients with exposure to POC-activated systems, closed systems, or both relative to that of patients exposed to open systems was estimated by odds ratios (ORs) calculated by multivariate logistic regression analysis. RESULTS The evaluated data indicated that of the 4,073,864 patients included in the study cohort, 0.5% (n = 20,251) experienced hospital-acquired BSI. After adjusting for selected confounding variables, the use of POC-activated systems was associated with a 16% reduction in BSI risk relative to the use of open systems (OR, 0.84; 95% confidence interval [CI], 0.76-0.93), and the use of closed systems correlated with a 12% risk reduction (OR, 0.88; 95% CI, 0.82-0.96). Patients who received i.v. drugs via both POC-activated and closed systems appeared to derive the greatest relative risk reduction benefit (OR, 0.12; 95% CI, 0.06-0.23). CONCLUSION Use of POC-activated and closed systems for i.v. drug delivery was associated with a significantly reduced risk of hospital-acquired BSI compared with exclusive use of open systems in a large population of hospitalized patients.
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Affiliation(s)
- Catherine J Mercaldi
- Epidemiology and Database Analytics, United BioSource Corporation, Lexington, MA 02420, USA
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Ward A, Crean S, Mercaldi CJ, Collins JM, Boyd D, Cook MN, Arrighi HM. Prevalence of apolipoprotein E4 genotype and homozygotes (APOE e4/4) among patients diagnosed with Alzheimer's disease: a systematic review and meta-analysis. Neuroepidemiology 2011; 38:1-17. [PMID: 22179327 DOI: 10.1159/000334607] [Citation(s) in RCA: 211] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 10/19/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Population allele frequencies of apolipoprotein E (APOE) vary by geographic region. The purpose of this study is to summarize and evaluate published estimates for the prevalence of APOE e4 carrier status among the population diagnosed with Alzheimer's disease (AD) by geographic region and country. METHODS A systematic review of English-language publications from January 1, 1985, through May 31, 2010, was conducted. Studies reporting APOE e4 status for patients diagnosed with AD were included in the analysis; trials and autopsies were excluded. APOE e4 data were pooled, and prevalence and 95% confidence intervals (CIs) were calculated. RESULTS Pooled estimates for APOE e4 carrier prevalence data were derived from 142 independent samples: 48.7% (95% CI: 46.5-51.0), and from 73 samples for e4/4 (homozygotes): 9.6% (95% CI: 8.4-10.8). The highest estimates were in Northern Europe: 61.3% (95% CI: 55.9-66.7), e4/4 prevalence: 14.1% (95% CI: 12.2-16.0). The lowest estimates were in Asia and Southern Europe. Substantial heterogeneity of these prevalence estimates was observed. CONCLUSIONS APOE e4 genotype prevalence varies among AD patients by region and within each country. Further exploration is warranted to better understand the substantial heterogeneity of these prevalence estimates.
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Affiliation(s)
- Alex Ward
- Center for Epidemiology and Database Analytics, United BioSource Corporation, Lexington, MA 02420, USA.
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Wadström J, Martin AL, Estok R, Mercaldi CJ, Stifelman MD. Comparison of hand-assisted laparoscopy versus open and laparoscopic techniques in urology procedures: a systematic review and meta-analysis. J Endourol 2011; 25:1095-104. [PMID: 21740261 DOI: 10.1089/end.2010.0348] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Hand-assisted laparoscopic surgery (HALS) is an integral part of the urologist's armamentarium. We aimed to perform a comprehensive meta-analysis comparing HALS renal surgery with open and laparoscopic techniques. METHODS A systematic review and meta-analysis of HALS renal procedures (donor nephrectomy, nephrectomy, or nephroureterectomy) from 1996 to 2007 was performed. RESULTS Sixty-two studies of 30 donor nephrectomy, 21 radical nephrectomy, and 14 nephroureterectomy procedures in 5446 patients were included in the analysis. In donor nephrectomy, estimated blood loss (EBL) was statistically significant for HALS vs the open and laparoscopic cohorts, -69.0 mL (95% confidence interval [CI], -129.7, -8.2) and -40.1 mL (95% CI, -68.2, -12.0), respectively. Length of stay (LOS) was shorter compared with the open group, -1.7 days (95% CI, -2.3, -1.1). For nephroureterectomy, EBL (-29.9 mL (95% CI, -242.3, 182.5)), and LOS (-1.5 d [95% CI, -2.8, -0.3]) again favored HALS vs open procedures. Operating room (OR) time and warm ischemia time (WIT) were statistically significant in favor of HALS donor nephrectomy vs the laparoscopic cohort; -36.8 minutes (95% CI, -61.3, -12.3) and -1.3 minutes (95% CI, -1.8, -0.7), respectively. For radical nephrectomy, both EBL -232.9 mL (95% CI, -383.6, -82.2) and LOS -2.4 days (95% CI, -3.5, -1.3) were statistically significant, favoring HALS vs the open group. CONCLUSION We report the largest meta-analysis of HALS renal surgery to date. When compared with open surgery, HALS allows for a significant decrease in EBL and LOS. Compared with laparoscopic donor nephrectomy, HALS resulted in a significant decrease in blood loss, OR time, and WIT.
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Affiliation(s)
- Jonas Wadström
- Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
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Pontes-Arruda A, Liu FX, Turpin RS, Mercaldi CJ, Hise M, Zaloga G. Bloodstream Infections in Patients Receiving Manufactured Parenteral Nutrition With vs Without Lipids. JPEN J Parenter Enteral Nutr 2011; 36:421-30. [DOI: 10.1177/0148607111420061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
| | | | - Robin S. Turpin
- Global Health Economics, Baxter Healthcare, Deerfield, Illinois
- Public Policy Department, Thomas Jefferson Hospital, Philadelphia, Pennsylvania
| | | | - Mary Hise
- Global Health Economics, Baxter Healthcare, Deerfield, Illinois
| | - Gary Zaloga
- Global Health Economics, Baxter Healthcare, Deerfield, Illinois
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Turpin RS, Canada T, Rosenthal VD, Nitzki-George D, Liu FX, Mercaldi CJ, Pontes-Arruda A. Bloodstream Infections Associated With Parenteral Nutrition Preparation Methods in the United States. JPEN J Parenter Enteral Nutr 2011; 36:169-76. [DOI: 10.1177/0148607111414714] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robin S. Turpin
- Global Health Economics, Baxter Healthcare, Deerfield, Illinois
- Public Policy Department, Thomas Jefferson Hospital, Philadelphia, Pennsylvania
| | - Todd Canada
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victor D. Rosenthal
- International Nosocomial Infection Control Consortium, Buenos Aires, Argentina
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Turpin RS, Canada T, Liu FX, Mercaldi CJ, Pontes-Arruda A, Wischmeyer P. Nutrition therapy cost analysis in the US: pre-mixed multi-chamber bag vs compounded parenteral nutrition. Appl Health Econ Health Policy 2011; 9:281-92. [PMID: 21761945 PMCID: PMC3631121 DOI: 10.2165/11594980-000000000-00000] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Bloodstream infections (BSI) occur in up to 350 000 inpatient admissions each year in the US, with BSI rates among patients receiving parenteral nutrition (PN) varying from 1.3% to 39%. BSI-attributable costs were estimated to approximate $US12 000 per episode in 2000. While previous studies have compared the cost of different PN preparation methods, this analysis evaluates both the direct costs of PN and the treatment costs for BSI associated with different PN delivery methods to determine whether compounded or manufactured pre-mixed PN has lower overall costs. OBJECTIVE The purpose of this study was to compare costs in the US associated with compounded PN versus pre-mixed multi-chamber bag (MCB) PN based on underlying infection risk. METHODS Using claims information from the Premier Perspective™ database, multivariate logistic regression was used to estimate the risk of infection. A total of 44 358 hospitalized patients aged ≥18 years who received PN between 1 January 2005 and 31 December 2007 were included in the analyses. A total of 3256 patients received MCB PN and 41 102 received compounded PN. The PN-associated costs and length of stay were analysed using multivariate ordinary least squares regression models constructed to measure the impact of infectious events on total hospital costs after controlling for baseline and clinical patient characteristics. RESULTS There were 7.3 additional hospital days attributable to BSI. After adjustment for baseline variables, the probability of developing a BSI was 30% higher in patients receiving compounded PN than in those receiving MCB PN (16.1% vs 11.3%; odds ratio = 1.56; 95% CI 1.37, 1.79; p < 0.0001), demonstrating 2172 potentially avoidable infections. The observed daily mean PN acquisition cost for patients receiving MCB PN was $US164 (including all additives and fees) compared with $US239 for patients receiving compounded PN (all differences p < 0.001). With a mean cost attributable to BSI of $US16 141, the total per-patient savings (including avoided BSI and PN costs) was $US1545. CONCLUSION In this analysis of real-world PN use, MCB PN is associated with lower costs than compounded PN with regards to both PN acquisition and potential avoidance of BSI. Our base case indicates that $US1545 per PN patient may be saved; even if as few as 50% of PN patients are candidates for standardized pre-mix formulations, a potential savings of $US773 per patient may be realized.
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Affiliation(s)
- Robin S Turpin
- Global Health Economics, Baxter Healthcare Corporation, Deerfield, IL, USA
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Mercaldi CJ, Reynolds MW, Turpin RS. Methods to identify and compare parenteral nutrition administered from hospital-compounded and premixed multichamber bags in a retrospective hospital claims database. JPEN J Parenter Enteral Nutr 2011; 36:330-6. [PMID: 21750206 DOI: 10.1177/0148607111412974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Use of parenteral nutrition (PN) is indicated for patients who are unable to meet their needs enterally. PN may be administered via custom-compounded mix or commercially available ready-to-use multichamber bags (MCB), but little is known about potential differences in clinical outcomes between these delivery systems. This study was undertaken to assess the feasibility of comparing custom-compounded and MCB PN in a large hospital claims database. METHODS Hospital claims data from the Premier Perspective Comparative Hospital Database (PCD) reported from 2005 through 2007 were analyzed. The authors searched the data for patients who received any PN products, including compounded PN and MCB PN. Coding algorithms for identifying patient characteristics, risk factors, and outcomes of interest were explored. RESULTS Using hospital billing claims, the authors identified patients in the database treated with premixed PN from multichamber bags ("MCB only," n = 4699) and patients treated with custom-compounded PN solution ("compounded PN," n = 64,315). Methods of identifying PN administration groups, patient characteristics and risk factors, outcomes of interest, and data limitations are described. CONCLUSIONS Exploratory analysis suggests that comparisons of PN administered via compounding and MCB are possible using the Premier data. The ability to control for many identifiable risk factors allows data to be presented for the use of PN and related outcomes in both a clinically sensible and relevant manner, albeit with some limitations.
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Mercaldi CJ, Ciarametaro M, Hahn B, Chalissery G, Reynolds MW, Sander SD, Samsa GP, Matchar DB. Cost Efficiency of Anticoagulation With Warfarin to Prevent Stroke in Medicare Beneficiaries With Nonvalvular Atrial Fibrillation. Stroke 2011; 42:112-8. [DOI: 10.1161/strokeaha.110.592907] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Catherine J. Mercaldi
- From United BioSource Corp (C.J.M., M.C., B.H., M.W.R.), Bethesda, Md; hMetrix LLC (G.C.), Bala Cynwyd, Pa; Boehringer Ingelheim Pharmaceuticals, Inc (S.D.S.), Ridgefield, Conn; Center for Clinical Health Policy Research, and Department of Biostatistics and Bioinformatics (G.P.S., D.B.M.), Duke University Medical Center, Durham, NC; and Department of Medicine, Duke University Medical Center, Durham, NC, and Program in Health Services and Systems Research, Duke-NUS Graduate Medical School (D.B.M.),
| | - Mike Ciarametaro
- From United BioSource Corp (C.J.M., M.C., B.H., M.W.R.), Bethesda, Md; hMetrix LLC (G.C.), Bala Cynwyd, Pa; Boehringer Ingelheim Pharmaceuticals, Inc (S.D.S.), Ridgefield, Conn; Center for Clinical Health Policy Research, and Department of Biostatistics and Bioinformatics (G.P.S., D.B.M.), Duke University Medical Center, Durham, NC; and Department of Medicine, Duke University Medical Center, Durham, NC, and Program in Health Services and Systems Research, Duke-NUS Graduate Medical School (D.B.M.),
| | - Beth Hahn
- From United BioSource Corp (C.J.M., M.C., B.H., M.W.R.), Bethesda, Md; hMetrix LLC (G.C.), Bala Cynwyd, Pa; Boehringer Ingelheim Pharmaceuticals, Inc (S.D.S.), Ridgefield, Conn; Center for Clinical Health Policy Research, and Department of Biostatistics and Bioinformatics (G.P.S., D.B.M.), Duke University Medical Center, Durham, NC; and Department of Medicine, Duke University Medical Center, Durham, NC, and Program in Health Services and Systems Research, Duke-NUS Graduate Medical School (D.B.M.),
| | - George Chalissery
- From United BioSource Corp (C.J.M., M.C., B.H., M.W.R.), Bethesda, Md; hMetrix LLC (G.C.), Bala Cynwyd, Pa; Boehringer Ingelheim Pharmaceuticals, Inc (S.D.S.), Ridgefield, Conn; Center for Clinical Health Policy Research, and Department of Biostatistics and Bioinformatics (G.P.S., D.B.M.), Duke University Medical Center, Durham, NC; and Department of Medicine, Duke University Medical Center, Durham, NC, and Program in Health Services and Systems Research, Duke-NUS Graduate Medical School (D.B.M.),
| | - Matthew W. Reynolds
- From United BioSource Corp (C.J.M., M.C., B.H., M.W.R.), Bethesda, Md; hMetrix LLC (G.C.), Bala Cynwyd, Pa; Boehringer Ingelheim Pharmaceuticals, Inc (S.D.S.), Ridgefield, Conn; Center for Clinical Health Policy Research, and Department of Biostatistics and Bioinformatics (G.P.S., D.B.M.), Duke University Medical Center, Durham, NC; and Department of Medicine, Duke University Medical Center, Durham, NC, and Program in Health Services and Systems Research, Duke-NUS Graduate Medical School (D.B.M.),
| | - Stephen D. Sander
- From United BioSource Corp (C.J.M., M.C., B.H., M.W.R.), Bethesda, Md; hMetrix LLC (G.C.), Bala Cynwyd, Pa; Boehringer Ingelheim Pharmaceuticals, Inc (S.D.S.), Ridgefield, Conn; Center for Clinical Health Policy Research, and Department of Biostatistics and Bioinformatics (G.P.S., D.B.M.), Duke University Medical Center, Durham, NC; and Department of Medicine, Duke University Medical Center, Durham, NC, and Program in Health Services and Systems Research, Duke-NUS Graduate Medical School (D.B.M.),
| | - Gregory P. Samsa
- From United BioSource Corp (C.J.M., M.C., B.H., M.W.R.), Bethesda, Md; hMetrix LLC (G.C.), Bala Cynwyd, Pa; Boehringer Ingelheim Pharmaceuticals, Inc (S.D.S.), Ridgefield, Conn; Center for Clinical Health Policy Research, and Department of Biostatistics and Bioinformatics (G.P.S., D.B.M.), Duke University Medical Center, Durham, NC; and Department of Medicine, Duke University Medical Center, Durham, NC, and Program in Health Services and Systems Research, Duke-NUS Graduate Medical School (D.B.M.),
| | - David B. Matchar
- From United BioSource Corp (C.J.M., M.C., B.H., M.W.R.), Bethesda, Md; hMetrix LLC (G.C.), Bala Cynwyd, Pa; Boehringer Ingelheim Pharmaceuticals, Inc (S.D.S.), Ridgefield, Conn; Center for Clinical Health Policy Research, and Department of Biostatistics and Bioinformatics (G.P.S., D.B.M.), Duke University Medical Center, Durham, NC; and Department of Medicine, Duke University Medical Center, Durham, NC, and Program in Health Services and Systems Research, Duke-NUS Graduate Medical School (D.B.M.),
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