Increasing national burden of hospitalizations for skin and soft tissue infections in children
ABSTRACT The number of children requiring treatment of skin and soft tissue infections (SSTIs) has increased since the emergence of methicillin-resistant Staphylococcus aureus.
The 2000, 2003, and 2006 Kids' Inpatient Databases were queried for patients with a primary diagnosis of SSTI. Weighted data were analyzed to estimate temporal changes in incidence, incision and drainage (I&D) rate, and economic burden. Factors associated with I&D were analyzed by multivariable logistic regression.
Pediatric SSTI admissions increased (1) in number, (2) as a fraction of all hospital admissions, and (3) in incidence per 100,000 children from the years 2000 (17,525 ± 838; 0.65%; 23.2) to 2003 (27,463 ± 1652; 0.99%; 36.2) and 2006 (48,228 ± 2223; 1.77%; 62.7). Children younger than 3 years accounted for 49.6% of SSTI admissions in 2006, up from 32.5% in 2000. Utilization of I&D increased during the study period from 26.0% to 43.8%. Factors most associated with requiring I&D were age less than 3 years and calendar year 2006 (both P < .001). Hospital costs per patient increased over time and were higher in the group of patients who required I&D ($4296 ± $84 vs $3521 ± $81; P < .001; year 2006). Aggregate national costs reached $184.0 ± $9.4 million in 2006.
The recent spike in pediatric SSTIs has disproportionately affected children younger than 3 years, and an increasing fraction of these children require I&D. The national economic burden is substantial.
- [Show abstract] [Hide abstract]
ABSTRACT: Background: Traditionally, thyroid surgery has been an inpatient procedure due to the risk of several well-documented complications. Recent research suggests that for selected patients, outpatient thyroid surgery is safe and feasible, with the additional potential benefit of cost savings. In recognition of these observations, we hypothesized that there would be an increase in U.S. outpatient thyroidectomies with a concurrent decline in inpatient thyroidectomies over time. Methods: Comparative cross-sectional analyses of the National Survey of Ambulatory Surgery (NSAS) and Nationwide Inpatient Sample (NIS) databases from 1996 and 2006 were performed. All cases of thyroid surgery were extracted, as well as data on age, gender, and insurance status. Diagnoses and surgical cases were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnostic and treatment codes. Hospital charges were acquired from the NIS 1996 and 2006 and NSAS 2006 releases, plus imputed data where necessary. After survey weights were applied, patient characteristics, diagnoses, and procedures were compared for inpatient versus outpatient procedures. Results: The total number of thyroidectomies increased 39% from 66,864 to 92,931 cases per year during the study timeframe. Outpatient procedures increased by 61%, while inpatient procedures increased by 30%. The proportion of privately-insured inpatients declined slightly from 63.8% to 60.1%, while those covered by Medicare increased from 22.8% to 25.8%. In contrast, the proportion of privately-insured outpatients declined sharply from 76.8% to 39.9%, while those covered by Medicare rose from 17.2% to 45.7%. These trends coincided with a small increase in mean inpatient age from 50.2 to 52.3 years and larger increase in mean outpatient age from 50.7 to 58.1 years. Inflation-adjusted per capita charges for inpatient thyroidectomies more than doubled from $9,934 in 1996 to $22,537 in 2006, while aggregate national inpatient charges tripled from $464 million to $1.37 billion. By comparison, in 2006 per capita charges for outpatient thyroidectomy totaled $7,222. Conclusions: From 1996 to 2006, there has been a concurrent modest increase in inpatient and pronounced increase in outpatient thyroidectomies in the U.S., with a consequential demographic shift and economic impact.Thyroid: official journal of the American Thyroid Association 11/2012; 23(6). DOI:10.1089/thy.2012.0218 · 3.84 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has spread rapidly throughout the world in the last decade. We sought to demonstrate the impact of the emergence of CA-MRSA in Western Canada on physician visits, incision-and-drainage procedures, and antibiotic prescribing for skin and soft tissue infections (SSTI). We used the provincial physician billing system to determine the rate of physician visits (per 1,000 population per year) of SSTI and incision-and-drainage procedures. A database capturing all outpatient prescriptions in the province was anonymously linked to associated physician billing codes to quantify prescriptions associated with SSTI. Antibiotic prescriptions (overall and class specific) were expressed as their defined daily dose (DDD) per 1,000 inhabitants per day. Between 1996 and 2008, the rate of visits for all SSTI increased by 15%, and the majority of visits did not include an incision-and-drainage procedure. The rate of antibiotic prescribing for SSTI increased by 49%. The majority of this increase was attributable to the higher rates of use of clindamycin (627%), trimethoprim-sulfamethoxazole (380%), cephalosporins (160%), and amoxicillin-clavulanate (627%). Health care utilization and antibiotic prescribing rates for SSTI, but not incision-and-drainage procedures, have increased in association with the CA-MRSA epidemic. While much of the increase in antibiotic use reflects an appropriate change to trimethoprim-sulfamethoxazole, there is room for education regarding the limitations of cephalosporins and clindamycin, given current susceptibility profiles.Antimicrobial Agents and Chemotherapy 12/2012; 56(12). DOI:10.1128/AAC.00649-12 · 4.45 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: To describe trends in national resource utilization for pediatric skin and soft tissue infection (SSTI) hospitalizations. This was a cross-sectional analysis of hospital discharges from 1997 to 2009 within the Healthcare Cost and Utilization Project Kids' Inpatient Database for children with isolated SSTIs. Outcomes examined included patient and hospital characteristics, number of hospitalizations, and resource utilization including length of stay (LOS), hospital charges, and performance of incision and drainage (I&D). Trends in resource utilization were assessed by using linear regression in a merged data set with survey year as the primary independent variable. Multivariate logistic regression was conducted for 2009 data to assess factors associated with increased I&D. The weighted proportion of SSTI hospitalizations among all hospitalizations doubled (0.46% vs 1.01%) from 1997 to 2009. During the same period, patient demographic trends included a shift to increased hospitalizations in infant and preschool-age groups as well as publicly insured children. Mean LOS decreased from 3.11 to 2.71 days. Increased resource utilization included changes in mean charges from $6722 to $11 534 per hospitalization and a twofold increase in I&D (21% to 44%). Factors associated with I&D include young age, African American race, female gender, publicly or uninsured children, and southern region of the United States. SSTI is responsible for an emerging increase in health services utilization. Additional study is warranted to identify interventions that may effectively address this public health burden.PEDIATRICS 03/2013; 131(3):e718-25. DOI:10.1542/peds.2012-0746 · 5.30 Impact Factor