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Brandon Sherrod, Michael Karsy, Jian Guan, Andrea A. Brock, Ilyas M. Eli, Erica F. Bisson and Andrew T. Dailey

.1 to $5.4 million depending on injury level and patient age. 14 , 30 Fractures of the spine without SCI are thought to occur approximately 3 times as often as fractures with SCI. Numerous studies have utilized large epidemiology databases to better understand the effect of patient age, race, comorbidities, and surgical procedures on outcomes, including disposition, cost, and mortality. The National Inpatient Sample (NIS) and the Kid Inpatient Database (KID) have been widely utilized to evaluate outcomes after SCI in both adult and pediatric patients. 2 , 3 , 5 , 8

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Piyush Kalakoti, Symeon Missios, Richard Menger, Sunil Kukreja, Subhas Konar and Anil Nanda

, 50 are equally limited because of individual hospitals’ limited sample size and geographic variations. In the era of heath care accountability, establishing quality metrics and identifying modifiable risk factors that contribute to adverse events are critical. Such knowledge can potentially aid during presurgical evaluation, shared decision making, and outcome prediction. The National Inpatient Sample (NIS), the largest all-payer hospital inpatient database, represents a stratified validated sample of 20% of all inpatient admissions to nonfederal hospitals

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Jonathan Dallas, Chevis N. Shannon and Christopher M. Bonfield

study was to characterize the cost of NMS fusion by using a nationally representative sample that characterizes all NMS fusions across the US (specifically, the National Inpatient Sample [NIS]). Furthermore, this study sought to characterize the effect of hospital characteristics and regional variation on cost. By doing so, this would allow for identification of broad predictors of increased cost that could, in turn, be used by future investigations to identify modifiable sources of increased cost. Similarly, future studies could use this analysis as a reference to

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Mohammed Ali Alvi, Lorenzo Rinaldo, Panagiotis Kerezoudis, Leonardo Rangel-Castilla, Mohamad Bydon, Harry Cloft and Giuseppe Lanzino

bypass have shifted, is not fully understood. As such, we aimed to investigate temporal trends in the utilization of EC-IC bypass in general and for specific indications using the National Inpatient Sample (NIS, previously known as Nationwide Inpatient Sample), with a specific interest in differences before and after 2011. In addition, previous studies examining national trends in EC-IC bypass utilization noted increasing rates of periprocedural adverse events coinciding with a shift in procedural quantity to lower-volume hospitals. 2 We also assessed for the

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Oliver Y. Tang, James S. Yoon, Anna R. Kimata and Michael T. Lawton

neurotrauma. Our aim was to determine if there is a pediatric neurotrauma VOR that can inform systemic changes in neurosurgical care to optimize outcomes for children with brain injury. Methods Data Sources: National Inpatient Sample and National Trauma Data Bank We analyzed pediatric tICH admissions from two independent national databases: the National Inpatient Sample (NIS) and the National Trauma Data Bank (NTDB). The NIS is the largest national, all-payer inpatient database. 20 It is a 20% stratified random sample of all US community hospital discharges, representing

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Chelsea J. Hendow, Alexander Beschloss, Alejandro Cazzulino, Joseph M. Lombardi, Philip K. Louie, Andrew H. Milby, Andrew J. Pugely, Ali K. Ozturk, Steven C. Ludwig and Comron Saifi

utilization. The purpose of this study was to determine epidemiological trends in both primary and revision AA fusion in order to evaluate the revision burden of AA fusion. Performing a longitudinal analysis allows for assessment of the yearly trends and economic impact of AA fusion. Identifying both hospital charge and cost data for AA fusion allows surgeons, policy makers, and hospital administrators to make informed decisions and improve cost-effective care. In this study, we utilized data from the National Inpatient Sample (NIS) database to compare two large national

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Shivanand P. Lad, Justin G. Santarelli, Chirag G. Patil, Gary K. Steinberg and Maxwell Boakye

Object

Spinal arteriovenous malformations (AVMs) are rare and understudied vascular lesions that cause neurological insult by mass effect, venous obstruction, and vascular steal. These lesions are challenging entities to treat because of their complicated anatomy and physiology. Current management options include open microsurgery, endovascular embolization, and stereotactic radiosurgery.

Methods

Our study used the National Inpatient Sample database to analyze outcome data for spinal AVMs treated nationwide over an 11-year period from 1995 through 2006. Trends in procedural management, hospital course, and epidemiology of spinal AVMs are investigated.

Results

Annually, an average of 300 patients presented with spinal AVMs requiring hospital treatment. The average length of hospital stay for this treatment has declined from more than 9 days in 1995 to 6 days in 2006. However, the average cost of a hospital stay has increased from < $30,000 to nearly $70,000. Whereas one-half of spinal AVMs were treated operatively in 1995, one-third were managed operatively in 2006.

Conclusions

Spinal AVMs are being increasingly treated by endovascular, radiosurgical, or combined means. A discussion of modern strategies to treat these disorders is presented.

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Gabriel A. Smith, Phillip Dagostino, Mitchell G. Maltenfort, Aaron S. Dumont and John K. Ratliff

Object

Considerable evolution has occurred in treatment options for cerebral aneurysms. Development of endovascular techniques has produced a significant change in the treatment of ruptured and unruptured intracranial aneurysms. Adoption of endovascular techniques and increasing numbers of patients undergoing endovascular treatment may affect health care expenditures. Geographic assessment of growth in endovascular procedures has not been assessed.

Methods

The National Inpatient Sample (NIS) was queried for ICD-9 codes for clipping and coiling of ruptured and unruptured cerebral aneurysms from 2002 to 2008. Patients with ruptured and unruptured cerebral aneurysms were compared according to in-hospital deaths, hospital length of stay, total hospital cost, and selected procedure. Hospital costs were adjusted to bring all costs to 2008 equivalents. Regional variation over the course of the study was explored.

Results

The NIS recorded 12,588 ruptured cerebral aneurysm cases (7318 clipped and 5270 coiled aneurysms) compared with 11,606 unruptured aneurysm cases (5216 clipped and 6390 coiled aneurysms), representing approximately 121,000 aneurysms treated in the study period. Linear regression analysis found that the number of patients treated endovascularly increased over time, with the total number of endovascular patients increasing from 17.28% to 57.59% for ruptured aneurysms and from 29.70% to 62.73% for unruptured aneurysms (p < 0.00001). Patient age, elective status, and comorbidities increased the likelihood of endovascular treatment (p < 0.00001, p < 0.00004, and p < 0.02, respectively). In patients presenting with subarachnoid hemorrhage (SAH), endovascular treatments were more commonly chosen in urban and academic medical centers (p = 0.009 and p = 0.05, respectively). In-hospital deaths decreased over the study period in patients with both ruptured and unruptured aneurysms (p < 0.00001); presentation with SAH remained the single greatest predictor of death (OR 38.09, p < 0.00001). Geographic analysis showed growth in endovascular techniques concentrated in eastern and western coastal states, with substantial variation in adoption of endovascular techniques (range of percentage of endovascular patients [2008] 0%–92%). There were higher costs in patients treated endovascularly, but these differences were likely secondary to presenting diagnosis and site-of-service variations.

Conclusions

The NIS database reveals a significant increase in the use of endovascular techniques, with the majority of both ruptured and unruptured aneurysms treated endovascularly by 2008. Differences in hospital costs between open and endovascular techniques are likely secondary to patient and site-of-service factors. Presentation with SAH was the primary factor affecting hospital cost and a greater percentage of endovascular procedures completed at urban academic medical centers. There is substantial regional variation in the adoption of endovascular techniques.

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Norberto Andaluz and Mario Zuccarello

national inpatient sample . Top Health Inf Manage 21 : 10 – 23 , 2000 8 Broderick J , Intracerebral hemorrhage . Gorelick PB , Alter M : Handbook of Neuroepidemiology New York , Marcel Dekker , 1994 . 141 – 167 9 Broderick JP , Adams HP Jr , Barsan W , Feinberg W , Feldmann E , Grotta J , : Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association . Stroke 30 : 905 – 915 , 1999 10 Broderick

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Philina Yee, Joseph E. Tanenbaum, Dominic W. Pelle, Don Moore, Edward C. Benzel, Michael P. Steinmetz and Thomas E. Mroz

the cervical spine. The following spine procedures are assigned within separate DRG codes: anterior, lateral, or combined approaches, fusions for more than 8 levels, and fusions for deformity, tumor, or infection. MCC are International Classification of Diseases version 10 (ICD-10) codes as defined by the Centers for Medicare and Medicaid Services. Importantly, vertebroplasty and kyphoplasty are assigned different DRGs and are excluded from the typical lumbar fusion episode. In the present study, National Inpatient Sample (NIS) data from 2013 were queried to