An analysis of inpatient dental surgical rates.
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Blue Cross Blue Shield Insurance Plans↗
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Results for “Insurance, Surgical”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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The impact of the new DMERC medical policy on surgical dressings.
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Bandages↗
Results of a second-opinion program for coronary artery bypass graft surgery.
Second opinions for surgical procedures are now being sought by patients or are required by insurance carriers. We examined outcomes among 88 patients (76 men; average age, 59 years) referred for a second opinion as to the need for coronary artery bypass graft surgery. All patients had undergone coronary arteriography, which disclosed in 63 (72%) multivessel coronary artery disease, while in the remaining 25 patients single-vessel disease involved the left anterior descending coronary artery. Continuation of medical therapy was recommended for 74 (84%) of the 88 patients. Sixty of these 74 patients chose this option and continued to receive medical therapy without any fatalities during a follow-up period of 27.8 months. The remaining 14 patients elected to cross over to surgical therapy at an average of 11.3 months from the second opinion. We conclude that second opinions for selected, motivated patients slated for coronary artery bypass graft operation afford a significant and safe option. Moreover, a majority of patients will adhere to a second opinion recommending medical therapy, thus reducing the need for surgical intervention by as much as 50%. Since the study was based on a small sample size of self-selected patients, these data require caution in extrapolating to the general population with coronary artery disease.
Adult↗
Overhead analysis in a surgical practice: a brief communication.
Evaluating overhead is an essential part of any business, including that of the surgeon. By examining each component of overhead, the surgeon will have a better grasp of the profitability of his or her practice. The overhead discussed in this article includes health insurance, overtime, supply costs, rent, advertising and marketing, telephone costs, and malpractice insurance. While the importance of evaluating and controlling overhead in a business is well understood, few know that overhead increases do not always imply increased expenses. National standards have been provided by the Medical Group Management Association. One method of evaluating overhead is to calculate the amount spent in terms of percent of net revenue. Net revenue includes income from patients, from interest, and from insurers less refunds. Another way for surgeons to evaluate their practice is to calculate income and expenses for two years, then calculate the variance between the two years and the percentage of variance to see where they stand.
Advertising↗
The night after surgery. Postoperative management of the pediatric outpatient--surgical and anesthetic aspects.
Outpatient or "ambulatory" anesthesia and surgery has revolutionized the way surgery is practiced in the United States. Safe, reliable, inexpensive, and convenient outpatient surgery is an attractive option for parents, children, health care providers, and insurers.
Ambulatory Surgical Procedures↗
Semirigid and malleable penile implants.
Unless complications such as infection, erosion, or excessive bleeding develop and unless an inordinate number of malpractice suits ensue, I believe that the outpatient setting for implantation of a penile prosthesis will become increasingly utilized. As emphasized at the beginning of this article, the essential basis for success is thorough evaluation of the candidates for implantation, detailed and documented informed consent, and the elimination as outpatient candidates of poor-risk patients such as certain insulin-dependent diabetics. Patients who are good surgical and postsurgical risks are totally acceptable for outpatient operation. The cost to the patient and insurance carriers is drastically reduced. There is every reason to believe that, in the hands of the highly qualified surgeon, this type of intervention is safe, reliable, and cost-effective.
Ambulatory Surgical Procedures↗
Risk adjustment for complications of hysterectomy: utility of routinely collected administrative data.
Objective: To determine the ability of risk adjustment methods that use routinely collected administrative data to explain variability in complication rates after hysterectomy.Methods: Discharge data on all non-radical hysterectomies performed in North Carolina between January 1988 and September 1994 were obtained from the North Carolina Medical Database Commission. Complications were categorized as 1) surgical (eg, hemorrhage, organ injury) and 2) medical (eg, myocardial infarction, pneumonia). Comorbidities included peritoneal adhesions and chronic medical problems. Hospital charges were adjusted for inflation. Univariate analyses were performed using the Kruskall-Wallis test for skewed continuous variables and chi(2) tests for categorical variables. Multivariate analysis was performed using unconditional logistic regression, with complication rate as the dependent variable.Results: There were 107,648 cases performed at 134 hospitals, with an overall complication rate of 9.5%. When cancer and pregnancy cases were excluded, the surgical complication rate was 5.0%, medical 3.2%. Patients with surgical complications were significantly younger (median age 42 vs 46) and had significantly higher total hospital charges (median $8,127 vs $7,496) than patients with medical complications. Complication rates for individual hospitals varied from 1.5% to 29.3%, with rates highest for academic medical centers (24.3% vs 7.2% for non-teaching hospitals). Significant predictors of complications in univariate analyses included type of hysterectomy, indication, age >/=65 years, insurance status, and teaching hospital status. Coded comorbid conditions were variable in their association with complications. Adjusted odds ratios, controlled for indication and type of procedure, for age >/=65, Medicaid or no insurance, and teaching hospital status were all greater for medical complications than for surgical complications in multivariate analysis (table).The predictive ability of multivariate analysis was better for medical complications than for surgical complications (C-statistic for medical complication model 0.763 vs 0.644 for surgical complications).Conclusions: Surgical complications of hysterectomy are more common, occur in younger women, and are associated with higher hospital charges than medical complications. Complication rates vary widely between hospitals, with teaching hospitals having the highest rates. This difference persists after adjustment for coded comorbidities. Possible explanations for the inability of multivariate analysis to explain the wide range in observed complication rates include 1) shortcomings in the available data or models, such as variability in coding practices between hospitals or variability in surgical difficulty between hospitals that is not captured with ICD-9-CM codes (eg, uterine size, cancer stage) and 2) variability in the quality of care between hospitals. Further research is needed to help determine the role of each of these explanations. Risk adjustment methods that use administrative data based on currently available coding standards are poor predictors of surgical complication rates after hysterectomy and should not be used to reach conclusions about quality of care.
Journal Article↗
Driving whilst plastered: is it safe, is it legal? A survey of advice to patients given by orthopaedic surgeons, insurance companies and the police.
Many patients, immobilised in a plaster cast after a fracture of the upper or lower limb, wish to drive. They frequently ask permission to do so from the treating surgeon. Insurance companies are apparently willing to insure these patients to drive if they obtain their doctors permission. The DVLA guidelines are unhelpful in these circumstances. We therefore established current practice within the south west region by canvassing 126 consultant orthopaedic surgeons, 27 insurance companies and the 6 regional police constabularies, sending them specific clinical scenarios and asking how they would advise these patients regarding safety to drive. The results were as follows: sixty-seven (53%) of surgeons responded of which 97% gave specific advice regarding safety to drive. The insurance companies were generally unwilling to respond and a national response was received from the Association of Chief Constables, which specifically stated that safety to drive was for the individual patient to decide and the doctor should not give advice. We consider this to be unsatisfactory for all parties and suggest how this situation could be improved for both the patient and other road users welfare.
Automobile Driving↗
Advocating for the woman with breast cancer.
Health care workers and breast cancer survivors have an important role to play as advocates for breast cancer patients. At the most basic level, advocates must ensure that the patient has access to medical care. In addition they must help to ensure that the quality of care is optimal, enhancing the likelihood of survival, rehabilitation, and psychological adaptation. This article describes important advocacy issues for women with breast cancer, including informational needs, patient-physician communication, choice of primary surgical treatment, reconstructive surgery, adjuvant therapy, psychosocial issues, and employment and insurance problems.
Breast Neoplasms↗
[Results of interlocking nailing of distal tibial fractures].
Between 1982 and 1989, 117 fractures of the distal part of the lower leg were surgically treated in the Trauma Clinic belonging to the employers' liability insurance company in Frankfurt/Main. A follow-up examination of 85 of these patients, based on X-ray series, clinical reports, and insurance files, shows the functional results. Because of the high proportion of good to excellent results (95.4%), we consider fracture of the distal tibia a good indication for interlocking nailing, even from the aspect of the borderline indication of fracture in the fifth sixth. In open fractures of the distal part of the lower leg we consider the change of method from primary stabilization with external fixation to secondary interlocking nailing an appropriate procedure. The methods presented for internal fixation of fractures of the distal tibia by interlocking nailing allow early partial and full weight-bearing with the stability needed for exercising.
Adult↗
Perioperative fluid management in microvascular surgery.
The aim of intravenous fluid therapy in microvascular surgery is to maintain intravascular fluid volume for optimal tissue blood flow and oxygen transport to all tissues, including the free transferred tissue. General problems include the prolonged surgical procedures, frequently resulting in hypothermia and peripheral vasoconstriction, which may affect blood flow to the transplanted tissue. The surgical wounds may also be extensive, and can cause profound and sometimes underestimated fluid and blood loss. The choice of fluids is important, since free flaps and replants are at increased risk of developing edema, due to lack of lymphatic drainage and a decreased ability to reabsorb excessive interstitial fluid. Therefore, it is suggested that crystalloids be used only for insensible fluid loss, but that synthetic colloids (preferably pentastarch) be used for the replacement of plasma constituents. Hypertonic saline may have beneficial effects in ischemic and edematous flaps and replants. To optimize blood flow to the free flap, it is advisable to use moderate hemodilution. This facilitates the maintenance of high cardiac output and low peripheral vascular resistance. In addition, body temperature should be kept as close to normal as possible and, after completion of the microvascular anastomosis, arterial blood pressure should be kept near normal, to insure adequate perfusion pressure.
Anastomosis, Surgical↗
Recipients of hip replacement for arthritis are less likely to be Hispanic, independent of access to health care and socioeconomic status.
OBJECTIVE: To compare the proportion of Hispanics among recipients of hip replacements for primary articular disorders, recipients of knee replacements for the same reason, and persons hospitalized for other reasons. METHODS: Twelve of the 17 accredited hospitals in Bexar County, Texas, in which hip or knee replacement surgery is performed permitted us to review their medical records. From 1993 through 1995, 3,100 elective, non-fracture-related, hip or knee replacements were performed. These individuals were matched by age, sex, hospital, and month of admission with 4,604 persons hospitalized for other reasons. Age, sex, ethnic background, type of medical insurance, median household income by zip code of residence, joint replaced, and surgical diagnosis were abstracted from the medical records. The validity of variables abstracted from the medical records was tested by comparison with self-report data in 115 patients interviewed prior to elective hip or knee replacement surgery. RESULTS: During the study period, 2,275 subjects had a total knee replacement and 825 had a total hip replacement. Recipients of hip replacements were significantly less likely to be Hispanic than were recipients of knee replacements (19.5% versus 29.9%; odds ratio [OR] 0.57, 95% confidence interval [95% CI] 0.46-0.71; P < or = 0.001) or persons hospitalized for other reasons (29.4% Hispanic; OR 0.67, 95% CI 0.55-0.81). The under-representation of Hispanics was more pronounced among persons undergoing hip replacement for osteoarthritis compared with recipients of knee replacements for the same disease (OR 0.48, 95% CI 0.37-0.62). This pattern persisted after adjusting for age, sex, type of medical insurance, and median household income by the zip code of residence. Concordance between medical records and self-report data on ethnic background was high (kappa = 0.93). CONCLUSION: Recipients of hip replacement are less likely to be Hispanic than are other hospitalized persons with a similar level of access to care. The reasons for this under-representation probably involve factors in addition to lack of access to health care and low socioeconomic status. Further research is needed to understand the nature of such factors.
Arthritis↗
[Retrospective analysis of falls in an inpatient rehabilitation centre for rheumatic and orthopaedic diseases].
AIM: To analyse the frequency and circumstances of falls in an inpatient rehabilitation centre. METHODS: In a survey all falls reported to the Austrian accident insurance carrier were analysed and external circumstances of falls were evaluated. The survey covers a period of 64 months (Jan 2000 to April 2005): 10 820 inpatients (234 502 patient days); mean age 52.8 years; 1,252 patients aged >/= 70 years; 47 % male, 53 % female. RESULTS: Of 223 accidents registered, 140 (62.8 %) were falls. Of these, 17 patients had to be referred to a surgical unit for further treatment. In total, 1.29 % of all patients fell during their stay (with report to the accident insurance carrier), 0.16 % suffered major injuries from falls (with referral to surgical unit). Females fell more frequently than males. 39 % of the falls were associated with physical therapy. Most falls occurred in daytime. The location in the centre or the day of week showed no major influence on the frequency of falls. Falls occurred slightly more often in the first part of the three-week inpatient stay. CONCLUSION: The high total number of falls shows that falls are important in an inpatient rehabilitation centre for rheumatic and orthopaedic diseases. The analysis did not reveal any special location inside the rehabilitation centre with an increased risk of falls calling for urgent interventions. The active and activating physical therapies do not seem to increase the number of falls significantly.
Accidental Falls↗
[The Norwegian Patient Insurance System. Documentation of patient information and use of medical experts in cases of injuries].
Claims for compensation for surgical injuries submitted to the Norwegian System of Compensation for Injuries to Patients were analysed with respect to the written documentation of the case, patient information and the medical experts involved. Documentation of the indication for treatment, the surgical procedures and the injury were good, and acceptable in more than 90% of the case reports. Preoperative information on the patient was only documented in the report in 5% of the cases. There has been some discussion on the way in which medical experts used in the evaluation of patients claims are selected. In order to increase the legitimation of the medical experts we suggest that the Norwegian System of Compensation for Injuries to Patients and the Norwegian Board of Health should consider using the same set of rules for selecting experts. To improve the quality of patients' treatment and for security reasons, the System of Compensations of Injuries to Patients' data on documentation of patient information and categorized reports on the medical errors should be periodically reported to the hospitals.
Clinical Competence↗
Determinants of caesarean delivery among women hospitalized for childbirth in a remote population in China.
OBJECTIVE: To assess determinants of a high Caesarean delivery rate in a remote population in China. METHODS: A prospective cohort study including 20,891 women who gave birth between January 1, 1997, and June 30, 1998, in one of the 18 hospitals participating in a hospital-based regional perinatal surveillance system in Qingyuan, a remote rural region in Guangdong province, China. RESULTS: Of the 20,891 pregnant women registered by the Qingyuan Perinatal Surveillance System, 7.5% were delivered by elective Caesarean section, and 18.4% were delivered by non-elective Caesarean section. The most common indications for elective Caesarean delivery were socio-cultural, non-medical reasons, such as the woman's fear of pain, her wish to give birth on a date or at a time believed to be particularly auspicious, or her belief that delivery by Caesarean section would protect the baby's brain. Factors strongly related to elective Caesarean delivery included insurance status, maternal age, plurality, preeclampsia and eclampsia, gestational age, and birth weight. The most common indication for non-elective Caesarean delivery was cephalopelvic disproportion. Factors strongly related to non-elective Caesarean delivery included maternal age, preeclampsia and eclampsia, placenta previa, gestational age, and birth weight. CONCLUSION: Non-medical causes, including a woman's insurance status and her personal and social demands, accounted for a large proportion of elective Caesarean deliveries in this remote population in China.
Adult↗
Medicare CACs (Carrier Advisory Committees) and the surgical community: why surgeons should get involved.
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Centers for Medicare and Medicaid Services, U.S.↗
[Benign prostatic hyperplasia--dos the frequency of operations depend on insurance status?].
In this epidemiologic study, conducted in a representative age-stratified cohort of the town of Zurich, 1221 men aged 65, 70, 75, 80 and 85 years (accidentally at least 200 men in each of the five age groups) returned the correctly completed questionnaire containing standardized questions on those symptoms, which can be caused by BPH, also on digital rectal examination of the prostate gland, done by urologist or family doctor, and therefore, if the BPH has been diagnosed and, for that reason, if surgical or nonsurgical treatment. Calculating the age-specific prevalence of BPH and the prostate symptom score (international PSS), this study evaluates the relation between prostatectomy (results of surgery) and the health-insurance status. The logistic regression as multivariate analysis, the effects of age and professional education adjusted in the first step, reveals that the insurance status does not reflect the indication for surgery. The means of PSS are very low in men, BPH being never diagnosed, moderate in men with prostatectomy and higher in men with diagnosed BPH but without need for surgery, highest in men with subjective and objective indication for surgical intervention: the means of PSS by insurance status are in each of these four groups homogeneous. On the other hand, persons with only basic health-insurance seem much more to omit the digital examination of the prostate gland. Nevertheless, the complaints or symptoms caused by BPH, as stated by the patients in a quantitative manner of increasing severity, take care that the patient himself, not waiting too long, decides to visit a doctor. The quality of life, examined by classes of PSS, depends clearly from the persisting symptoms; the insurance status cannot show statistically any evident influence.
Age Factors↗
Surgical exploration of the abdominal lymphatic system in patients with malignancies.
In the management of selected patient with malignant diseases, laparotomy can be useful for determining the anatomic extent of disease in order to individualize appropriate intensive treatment. The decision to subject a patient to a staging laparotomy requires joint decisions by surgeons, radiation therapists, chemotherapists, and diagnostic radiologists, after a thorough preoperative abdominal evaluation has been made. The lymphangiogram is especially important for directing the surgeon to a single node of concern. Special efforts must be made to insure that the specific node in question is biopsied. The justification of such a surgical procedure assumes that definitive decisions in management of such patients will result in an improved prognosis. While this appears to be the case with Hodgkin's disease and lymphomas, studies are underway to prove this assumption in other neoplasms. For most patients, staging laparotomy presently represents an investigational procedure of value only in selected patients. The critical problem is how these patients can be identified.
Biopsy↗