Influence of Obesity Diagnosis With Organ Dysfunction, Mortality, and Resource Use Among Children Hospitalized With Infection in the United States

2016 ◽  
Vol 32 (5) ◽  
pp. 339-345 ◽  
Author(s):  
Nidhi Maley ◽  
Achamyeleh Gebremariam ◽  
Folafoluwa Odetola ◽  
Kanakadurga Singer
Keyword(s):  
Organ Dysfunction ◽  
Multivariable Analysis ◽  
Clinical Manifestations ◽  
Severity Of Illness ◽  
The United States ◽  
Hospital Charges ◽  
Obesity Status ◽  
Hospital Stays ◽  
Us Children ◽  
The Impact

Background: Sepsis induces inflammation in response to infection and is a major cause of mortality and hospitalization in children. Obesity induces chronic inflammation leading to many clinical manifestations. Our understanding of the impact of obesity on diseases, such as infection and sepsis, is limited. The objective of this study was to evaluate the association of obesity with organ dysfunction, mortality, duration, and charges during among US children hospitalized with infection. Methods: Retrospective study of hospitalizations in children with infection aged 0 to 20 years, using the 2009 Kids’ Inpatient Database. Results: Of 3.4 million hospitalizations, 357 701 were for infection, 5685 of which were reported as obese children. Obese patients had higher rates of organ dysfunction (7.35% vs 5.5%, P < .01), longer hospital stays (4.1 vs 3.5 days, P < .001), and accrued higher charges (US$29 019 vs US$21 200, P < .001). In multivariable analysis, mortality did not differ by obesity status (odds ratio: 0.56, 95% confidence interval: 0.23-1.34), however severity of illness modified the association between obesity status and the other outcomes. Conclusions: While there was no difference in in-hospital mortality by obesity diagnosis, variation in organ dysfunction, hospital stay, and hospital charges according to obesity status was mediated by illness severity. Findings from this study have significant implications for targeted approaches to mitigate the burden of obesity on infection and sepsis.

scholarly journals 910. A Comprehensive, One Year, Hospital-Wide Snapshot of All Serious Infectious Complications in People Who Inject Drugs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S489-S490
Author(s):  
John T Henderson ◽  
Evelyn Villacorta Cari ◽  
Nicole Leedy ◽  
Alice Thornton ◽  
Donna R Burgess ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Vertebral Osteomyelitis ◽  
The United States ◽  
Infectious Complications ◽  
Data Set ◽  
Cumulative Impact ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
Risk Of Death ◽  
The Impact

Abstract Background There has been a dramatic rise in IV drug use (IVDU) and its associated mortality and morbidity, however, the scope of this effect has not been described. Kentucky is at the epicenter of this epidemic and is an ideal place to better understand the health complications of IVDU in order to improve outcomes. Methods All adult in-patient admissions to University of Kentucky hospitals in 2018 with an Infectious Diseases (ID) consult and an ICD 9/10 code associated with IVDU underwent thorough retrospective chart review. Demographic, descriptive, and outcome data were collected and analyzed by standard statistical analysis. Results 390 patients (467 visits) met study criteria. The top illicit substances used were methamphetamine (37.2%), heroin (38.2%), and cocaine (10.3%). While only 4.1% of tested patients were HIV+, 74.2% were HCV antibody positive. Endocarditis (41.1%), vertebral osteomyelitis (20.8%), bacteremia without endocarditis (14.1%), abscess (12.4%), and septic arthritis (10.4%) were the most common infectious complications. The in-patient death rate was 3.0%, and 32.2% of patients were readmitted within the study period. The average length of stay was 26 days. In multivariable analysis, infectious endocarditis was associated with a statistically significant increase in risk of death, ICU admission, and hospital readmission. Although not statistically significant, trends toward mortality and ICU admission were identified for patients with prior endocarditis and methadone was correlated with decreased risk of readmission and ICU stay. FIGURE 1: Reported Substances Used FIGURE 2: Comorbidities FIGURE 3: Types of Severe Infectious Complications Conclusion We report on a novel, comprehensive perspective on the serious infectious complications of IVDU in an attempt to measure its cumulative impact in an unbiased way. This preliminary analysis of a much larger dataset (2008-2019) reveals some sobering statistics about the impact of IVDU in the United States. While it confirms the well accepted mortality and morbidity associated with infective endocarditis and bacteremia, there is a significant unrecognized impact of other infectious etiologies. Additional analysis of this data set will be aimed at identifying key predictive factors in poor outcomes in hopes of mitigating them. Disclosures All Authors: No reported disclosures

scholarly journals Prescription Opioid Abuse: Gleaning insights from hospital and vital records data

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Reka Sundaram-Stukel ◽  
Ousmane Diallo ◽  
Benjamin Wiseman ◽  
Richard E. Miller
Keyword(s):  
Mental Health ◽  
Prescription Drug ◽  
Prescription Drugs ◽  
The United States ◽  
Hospital Charges ◽  
Prescription Opioids ◽  
Opioid Prescription ◽  
Discharge Data ◽  
Operative Recovery ◽  
The Impact

ObjectiveIn this paper we used hospital charges to assess costs incurred dueto prescription drug/opioid hospitalizationsIntroductionThere is a resurgence in the need to evaluate the economic burdenof prescription drug hospitalizations in the United States. We used theWisconsin 2014 Hospital Discharge data to examine opioid relatedhospitalization incidence and costs. Fentanyl, a powerful syntheticopioid, is frequently being used for as an intraoperative agent inanesthesia, and post-operative recovery in hospitals. According to a2013 study, synthetic Fentanyl is 40 times more potent than heroinand other prescription opioids; the strength of Fentanyl leads tosubstantial hospitalizations risks. Since, 1990 it has been availablewith a prescription in various forms such as transdermal patches orlollipops for treatment of serious chronic pain, most often prescribedfor late stage cancer patients. There have been reported fatal overdosesassociated with misuse of prescription fentanyl. In Wisconsin numberof total opioid related deaths increased by 51% from 2010 to 2014with the number of deaths involving prescription opioids specificallyincreased by 23% and number of deaths involving heroin increasedby 192%. We hypothesized that opioids prescription drugs, as a proxyof Fentanyl use, result in excessive health care costs.MethodsOpioid hospitalizations was defined as any mention of the ICD9codes (304,305) in any diagnostic field or the mention of (:E935.09) onthe first listed E-code. Our analysis used the Heckman 2-stage model,a method often used by Economists in absence of randomized controltrials. In presence of unobserved choice, for example opioid relatedhospitalizations, there usually is a correlation between error in anunderlying function (fentanyl prescription) and an estimated function(hospital charges) that introduces a selection bias. Heckman treats thiscorrelation between errors as an omitted variable bias. Therefore, weestimate a Heckman two step model using hospitalization: where theselection function is the probability of being hospitalized for syntheticopioid via logistic regression. Finally, we estimate the hospitalcharges realized if the patient was given opioids.ResultsMale patients are significantly more likely to be hospitalized foropioids than are female patients; while white patients are significantlymore likely to be admitted for opioid usage than other racialgroups. We also find that comorbid factors, such as mental health,significantly impact hospital charges associated with opioid use. Wefind that persons with private health insurance are associated withhigher rates of opioid use.ConclusionsUsing a Heckman two step approach we show that comorbidconditions such as mental health, Hepatitis C, injuries, etc significantlyaffect hospital charges associated with hospitalization. We usethese findings to explore the impact of the 2013 rule mandatingdoctors share opioid prescription information on the incidence ofopioid related death and hospital charges associated with opioidprescriptions. This work is policy relevant because alternatives toopioid prescription such as meditation, pain management therapiesmay be relevant.

scholarly journals Estimated Burden of Community-Onset Respiratory Syncytial Virus–Associated Hospitalizations Among Children Aged <2 Years in the United States, 2014–15

2019 ◽  
Vol 9 (5) ◽  
pp. 587-595 ◽  
Author(s):  
Carmen S Arriola ◽  
Lindsay Kim ◽  
Gayle Langley ◽  
Evan J Anderson ◽  
Kyle Openo ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Census Data ◽  
The United States ◽  
Surveillance Network ◽  
Detection Probabilities ◽  
Syncytial Virus ◽  
Us Children ◽  
Us Census ◽  
The Impact ◽  
Community Onset

Abstract Background Respiratory syncytial virus (RSV) is a major cause of hospitalizations in young children. We estimated the burden of community-onset RSV-associated hospitalizations among US children aged &lt;2 years by extrapolating rates of RSV-confirmed hospitalizations in 4 surveillance states and using probabilistic multipliers to adjust for ascertainment biases. Methods From October 2014 through April 2015, clinician-ordered RSV tests identified laboratory-confirmed RSV hospitalizations among children aged &lt;2 years at 4 influenza hospitalization surveillance network sites. Surveillance populations were used to estimate age-specific rates of RSV-associated hospitalization, after adjusting for detection probabilities. We extrapolated these rates using US census data. Results We identified 1554 RSV-associated hospitalizations in children aged &lt;2 years. Of these, 27% were admitted to an intensive care unit, 6% needed mechanical ventilation, and 5 died. Most cases (1047/1554; 67%) had no underlying condition. Adjusted age-specific RSV hospitalization rates per 100 000 population were 1970 (95% confidence interval [CI],1787 to 2177), 897 (95% CI, 761 to 1073), 531 (95% CI, 459 to 624), and 358 (95% CI, 317 to 405) for ages 0–2, 3–5, 6–11, and 12–23 months, respectively. Extrapolating to the US population, an estimated 49 509–59 867 community-onset RSV-associated hospitalizations among children aged &lt;2 years occurred during the 2014–2015 season. Conclusions Our findings highlight the importance of RSV as a cause of hospitalization, especially among children aged &lt;2 months. Our approach to estimating RSV-related hospitalizations could be used to provide a US baseline for assessing the impact of future interventions.

Clinical outcomes and financial impacts of malnutrition in sepsis

2020 ◽  
Vol 26 (3) ◽  
pp. 175-178
Author(s):  
Jessica McLaughlin ◽  
Nibras Chowdhury ◽  
Svetolik Djurkovic ◽  
Omer Shahab ◽  
Mehmet Sayiner ◽  
...  
Keyword(s):  
Critically Ill ◽  
Statistical Significance ◽  
The United States ◽  
Registered Dietitian ◽  
Nutritional Screening ◽  
Financial Outcomes ◽  
Specialized Care ◽  
Hospital Stays ◽  
Financial Impacts ◽  
The Impact

Background: In the United States in 2014 approximately 1.7 million adults were hospitalized with sepsis, resulting in about 270,000 deaths. Malnutrition in hospitalized patients contributes to increased morbidity, mortality, and costs, especially in the critically ill population. Aim: Our goal was to investigate the prevalence of malnutrition in sepsis and the impact it has on clinical and financial outcomes in our most critically ill patients. Methods: We implemented nutritional screening by a registered dietitian of 1000 patients admitted with sepsis to specialized care units. We calculated the prevalence of malnutrition, and compared outcomes including mortality, length of stay, and financial costs. Results: About 10% of patients with sepsis admitted to our specialized care units were diagnosed with malnutrition on admission after implementation of mandatory assessment. Conclusions: Although mortality did not reach statistical significance, these patients had more comorbidities, longer hospital stays, and higher total costs.

Heart Failure Related Hospitalizations Are Associated with Increased Morbidity and Mortality in Pediatric Oncology Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4482-4482
Author(s):  
Britton Keeshan ◽  
Kimberly Y Lin ◽  
Matthew J O'Connor ◽  
Jill P Ginsberg ◽  
Richard Aplenc ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Pediatric Oncology ◽  
Multivariable Analysis ◽  
The United States ◽  
Morbidity And Mortality ◽  
Hospital Charges ◽  
Oncology Patients ◽  
Patients With Heart Failure ◽  
Inpatient Database

Abstract Introduction: Cardiomyopathy is a well-described complication of cancer therapy in pediatric patients. However, the prevalence and outcomes of heart failure related hospitalizations in these patients are unknown. We hypothesize that while heart failure related hospitalizations are uncommon in pediatric oncology patients, they are likely associated with increased morbidity and mortality. Methods: We performed retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database, a nationwide database of pediatric hospitalizations in the United States, for oncology patients with and without heart failure for years 2000, 2003, 2006, and 2009. Results: Heart failure was identified in 914 of 259,432 (0.4%) pediatric oncology admissions. Patients with heart failure were more likely to be non-white (52.2 vs 43%, p<0.001), less likely to be in the highest income bracket (23.9 vs 27.5%, p=0.014), more likely to have leukemia (40.7 vs 31.3%, p<0.001), and more likely to undergo bone marrow transplantation on admission (5.0 vs 1.6%, p<0.001). Several morbidities were significantly more common in patients with heart failure including respiratory failure [16.4% vs 1.3%, odds ratio (OR) 14.6, 95% CI 12.2-17.4), sepsis (21.9% vs 7.2%, OR 3.6, 95% CI 3.1-4.3), stroke (1.5% vs 0.6%, OR 2.5, 95% CI 1.5-4.3), and renal failure (11.7% vs 1.2%, OR 10.9, 95% CI 8.9-13.3). Length of stay (LOS) and hospital charges were also significantly greater in oncology patients with heart failure patients compared to those without; median LOS 9 (IQR 4-25) vs 4 days (IQR 2-6); median hospital charges $58,023 (IQR 18,835-169,826) vs $18,161 (IQR 8,860-39,640); p<0.001 for both. Hospital mortality was significantly greater in oncology patients with heart failure compared to those without (13.3% vs 1.3%; OR 11.5, 95% CI 9.5-14.0). On multivariable analysis, heart failure was independently associated with hospital mortality in pediatric oncology patients (OR 2.21, 95% CI 1.63-3.00). Conclusion: Heart failure is an uncommon but serious complication in hospitalized pediatric oncology patients. The presence of heart failure was associated with increased morbidities, resource utilization, and mortality. Further study is needed for the prevention and treatment of heart failure in this population. Disclosures Aplenc: Sigma Tau: Honoraria.

scholarly journals Association Between Interhospital Competition and Hospital Resource Use for Cranial Neurosurgery: Analysis of 513 271 Admissions

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Oliver Young Tang ◽  
Krissia M Rivera Perla ◽  
Steven A Toms
Keyword(s):  
Market Competition ◽  
Severity Of Illness ◽  
Hospital Charges ◽  
Inpatient Cost ◽  
Future Research ◽  
Hospital Resource ◽  
Hospital Markets ◽  
Patient Demographics ◽  
Accounting Reports ◽  
The Impact

Abstract INTRODUCTION Previous research has indicated that interhospital competition influences hospital resource utilization. However, the impact of competition on neurosurgical expenditures has not been characterized. METHODS We identified all admissions for cranial neurosurgery in the National Inpatient Sample database from 2006 to 2009 using corresponding DRG codes. The 2 chosen years contain data on the Herfindahl–Hirschman Index (HHI), a validated measure of hospital market competition ranging from 0 (significant competition) to 1 (monopolization). We converted hospital charges to costs using hospital-specific all-payer inpatient cost-to-charge ratios from supplementary files analyzing hospital accounting reports. We assessed how HHI was associated with neurosurgical charges and costs using multivariate linear regression to adjust for 15 confounding variables: patient demographics (age, sex, race, insurance, and household income), severity measures (severity of illness and risk of mortality scores, number of procedures, and comorbidities), hospital characteristics (bedsize, location/teaching status, ownership, region, and area wage index), and length of stay. RESULTS There were 513 271 neurosurgical admissions in 2006 and 2009. The median HHI for hospitals was 0.275 (range = 0.099-0.724). Average inflation-adjusted neurosurgical charges ($62, 098-$77, 812, P < .001) and costs ($21, 385-$22, 389, P < .001) both rose from 2006 to 2009. Increased interhospital competition was associated with greater neurosurgical charges (+ $3,283 for −0.10 HHI, P = .04). Patients in more competitive hospital markets incurred higher charges for cerebrovascular (+ $2,916 for −0.10 HHI, P = .02), ventriculostomy (+ $5,272 for -0.10 HHI, P = .03), and functional operations (+ $9,871 for −0.10 HHI, P = .04) specifically, but not tumor or neurotrauma surgery (both P > .05). However, interhospital competition was not significantly associated with neurosurgical costs. CONCLUSION Greater interhospital competition was associated with elevated charges for neurosurgery, but not costs. These disparate findings may be due to economic factors reflected only in charges like marketing expenses, unpaid patient bills, and institutional reimbursement rates. Amidst ongoing practice consolidation and reimbursement reform, future research should characterize the mechanisms by which competition may affect neurosurgical expenditures.

Abdominal and Vaginal Radical Hysterectomy Among U.S. Women aged 65 Years and Older

1996 ◽  
Vol 12 (2) ◽  
pp. 377-387 ◽  
Author(s):  
Saeid B. Amini ◽  
Steven A. Weight ◽  
Zhong Yuan ◽  
Alfred A. Rimm
Keyword(s):  
Older Women ◽  
Abdominal Hysterectomy ◽  
The United States ◽  
Hospital Charges ◽  
Trend Test ◽  
Asian Countries ◽  
Patients With Cancer ◽  
Hospital Stays ◽  
Radical Abdominal Hysterectomy ◽  
Stay Hospital

AbstractUnlike most European and Asian countries, radical vaginal hysterectomy (RVH) is not performed often in the United States, especially among older women. To examine the changes in RVH over the years, trends in hospital stay, hospital charges, and patient survival, we studied women aged 65 years and older undergoing RVH and compared them with patients receiving radical abdominal hysterectomy (RAH). During the study period there were a total of 288 RVH surgeries compared with 4,835 RAH surgeries. There were no significant changes in the number or proportion of RVH patients over 8 years (p =.50, trend test). On the average, RVH patients were significantly older and had shorter hospital stays. Among patients without cancer, there were no significant differences in the age, race, or survival of patients having either RVH or RAH. Similar results were obtained for patients with cancer.

The impact of comorbid pain and depression in the United States: results from a nationally representative survey

2019 ◽  
Vol 19 (2) ◽  
pp. 319-325 ◽  
Author(s):  
Simranpal Dhanju ◽  
Sidney H. Kennedy ◽  
Susan Abbey ◽  
Joel Katz ◽  
Aliza Weinrib ◽  
...  
Keyword(s):  
Functional Limitation ◽  
The United States ◽  
Cross Sectional ◽  
Depression Status ◽  
Co Morbidity ◽  
Hospital Stays ◽  
Secondary Outcomes ◽  
Nationally Representative ◽  
Sectional Analysis ◽  
The Impact

Abstract Background and aims The co-morbidity between pain and depression is a target of interest for treatment. However most of the published literature on the topic has used clinical cohorts as the population of interest. The goal of this study was to use a nationally representative sample to explore how health outcomes varied across pain and depression status in a cohort sampled from the general US population. Methods This was a cross-sectional analysis of adults ≥18 years in the 2009–2010 National Health and Nutrition Examination Survey. The cohort was stratified into: no pain/depression, pain alone, depression alone, and pain with depression. The primary outcome was self-reported general health status, and secondary outcomes were healthcare visits, overnight hospital stays and functional limitation. Survey weighted logistic regression was used to adjust for potential confounders. Results The cohort consisted of 4,213 individuals, of which 186 (4.4%) reported concurrent pain and depression. 597 (14.2%) and 253 (6.0%) were classified with either pain or depression alone, respectively. The majority of individuals with co-morbid pain and depression reported poor health (65.1%, p<0.001) and were significantly more likely than those with neither condition to rate their health as poor after adjustment (OR: 7.77, 95% CI: 4.24–14.26, p<0.001). Those with pain only or depression only were also more likely to rate their health as poor, albeit to a lesser extent (OR: 2.21, 95% CI: 1.21–2.34, p<0.001; OR: 3.75, 95% CI: 2.54–5.54, p<0.001, respectively). A similar pattern was noted across all secondary outcomes. Most notably, those with co-morbid pain and depression were the most likely to endorse functional limitation (OR: 13.15, 95% CI: 8.00–21.61, p<0.001). Comparatively, a similar trend was noted amongst those with pain only or depression only, though with a reduced effect size (OR: 4.23, 95% CI: 3.12–4.77, p<0.001; OR: 5.13, 95% CI: 3.38–7.82, p<0.001). Conclusions Co-morbid pain and depression in the general population resulted in markedly worse outcomes versus isolated pain or depression. Further, the effect appears to be synergistic. Given the substantial burdens of pain and depression, future treatments should aim to address both conditions simultaneously. Implications As a result of the co-morbidity between pain and depression, patients presenting with either condition should increase the index of suspicion among clinicians and prompt screening for the reciprocal condition. Early intervention for co-morbid pain and depression has the potential to mitigate future incidence of chronic pain and major depression.

The Impact of Methicillin Resistance in Staphylococcus aureus Bacteremia on Patient Outcomes: Mortality, Length of Stay, and Hospital Charges

2005 ◽  
Vol 26 (2) ◽  
pp. 166-174 ◽  
Author(s):  
Sara E. Cosgrove ◽  
Youlin Qi ◽  
Keith S. Kaye ◽  
Stephan Harbarth ◽  
Adolf W. Karchmer ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Length Of Stay ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Bloodstream Infections ◽  
Hospital Charge ◽  
Hospital Charges ◽  
The Impact ◽  
Length Of Hospitalization

AbstractObjective:To evaluate the impact of methicillin resistance in Staphylococcus aureus on mortality, length of hospitalization, and hospital charges.Design:A cohort study of patients admitted to the hospital between July 1, 1997, and June 1, 2000, who had clinically significant S. aureus bloodstream infections.Setting:A 630-bed, urban, tertiary-care teaching hospital in Boston, Massachusetts.Patients:Three hundred forty-eight patients with S. aureus bacteremia were studied; 96 patients had methicillin-resistant S. aureus (MRSA). Patients with methicillin-susceptible S. aureus (MSSA) and MRSA were similar regarding gender, percentage of nosocomial acquisition, length of hospitalization, ICU admission, and surgery before S. aureus bacteremia. They differed regarding age, comorbidities, and illness severity score.Results:Similar numbers of MRSA and MSSA patients died (22.9% vs 19.8%; P = .53). Both the median length of hospitalization after S. aureus bacteremia for patients who survived and the median hospital charges after S. aureus bacteremia were significantly increased in MRSA patients (7 vs 9 days, P = .045; $19,212 vs $26,424, P = .008). After multivariable analysis, compared with MSSA bacteremia, MRSA bacteremia remained associated with increased length of hospitalization (1.29 fold; P = .016) and hospital charges (1.36 fold; P = .017). MRSA bacteremia had a median attributable length of stay of 2 days and a median attributable hospital charge of $6,916.Conclusion:Methicillin resistance in S. aureus bacteremia is associated with significant increases in length of hospitalization and hospital charges.

scholarly journals Iron Administration and Clinical Outcomes in Hemodialysis Patients

2002 ◽  
Vol 13 (3) ◽  
pp. 734-744
Author(s):  
Harold I. Feldman ◽  
Jill Santanna ◽  
Wensheng Guo ◽  
Howard Furst ◽  
Eunice Franklin ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
The United States ◽  
Hemodialysis Patients ◽  
Elevated Risk ◽  
Adjusted Relative Risk ◽  
Risk Of Death ◽  
Iron Administration ◽  
Parenteral Iron ◽  
Elevated Rate ◽  
The Impact

ABSTRACT. To evaluate the impact of parenteral iron administration on the survival and rate of hospitalization of US hemodialysis patients, a nonconcurrent cohort study of 10,169 hemodialysis patients in the United States in 1994 was conducted. The main outcome measures were patient survival and rate of hospitalization. After adjusting for 23 demographic and comorbidity characteristics among 5833 patients included in multivariable analysis, bills for ≤10 vials of iron over 6 mo showed no adverse effect on survival (adjusted relative risk [RR] = 0.93; 95% confidence interval [CI], 0.84 to 1.02; P = 0.14) when compared with none, but bills for >10 vials showed a statistically significant elevated rate of death (adjusted RR = 1.11; 95% CI, 1.00 to 1.24; P = 0.05). Bills for ≤10 vials of iron over 6 mo also showed no significant association with hospitalization (adjusted RR = 0.92; 95% CI, 0.83 to 1.03; P = 0.15), but bills for >10 vials showed statistically significant elevated risk (adjusted RR = 1.12; 95% CI, 1.01 to 1.25; P = 0.03). Prescribing iron in quantities of ≤10 vials over 6 mo had no association with an elevated risk of death or rate of hospitalization. More intensive dosing was associated with diminished survival and higher rates of hospitalization, even after extensive adjustment for baseline comorbidity. Although these potential risks may be offset by the known elevations in morbidity and mortality associated with anemia, these findings indicate that caution is warranted when prescribing >10 vials (1000 mg) of iron dextran over a period of 6 mo.

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