In-hospital risk of venous thromboembolism and bleeding and associated costs for patients undergoing total hip or knee arthroplasty

Abstract

Objective:

Benefits of anti-coagulation for venous thromboembolism (VTE) prevention in total hip and knee arthroplasty (THA/TKA) may be offset by increased risk of bleeding. The aim was to assess in-hospital risk of VTE and bleeding after THA/TKA and quantify any increased costs.

Methods:

Healthcare claims from the Premier Perspective^TM Comparative Hospital Database (January 2000–September 2008) were selected for subjects ≥18 years with ≥1 diagnosis code for THA/TKA. VTE was defined as ≥1 code for deep vein thrombosis or pulmonary embolism. Bleeding was classified as major/non-major. Incremental in-hospital costs associated with VTE and bleeding were calculated as cost differences between inpatients with VTE or bleeding matched 1:1 with inpatients without VTE or bleeding.

Results:

A total of 820,197 inpatient stays were identified: 8042 had a VTE event and 7401 a bleeding event (2740 major bleeding). The risks of VTE, any bleeding, and major bleeding were 0.98, 0.90, and 0.33/100 inpatient stays, respectively. Mean incremental in-hospital costs per inpatient were $2663 for VTE, $2028 for bleeding, and $3198 for major bleeding.

Limitations:

These included possible inaccuracies or omissions in procedures, diagnoses, or costs of claims data; no information on the amount of blood transfused or decreases in the hemoglobin level to evaluate bleeding event severity; and potential biases due to the observational design of the study.

Conclusions:

In-hospital risk and incremental all-cause costs with THA/TKA were higher for VTE than for bleeding. Despite higher costs, major bleeding occurred less frequently than VTE, suggesting a favorable benefit/risk profile for VTE prophylaxis in THA/TKA.     

Supply chain risk analysis: a shipbuilding industry case

A lack of empirical studies on Supply Chain Risk Management (SCRM) is observed, especially in the industries of large projects. Therefore, this paper conducts a risk analysis on the Brazilian Shipbuilding Industry by generating an initial risk profile. A panel was conducted with executives from major shipyards, and the primary risks were identified, assessed, and evaluated. Findings corroborate the academic literature, reinforcing that companies recognise the importance of SCRM, but the concept is incipient and far from being successfully implemented in real life. Despite the fact that the shipyards identified important risks, the focus was on internal factors. Because the industry was exposed to risks from the external environment, no risk mitigation actions existed, resulting in the bankruptcy of many shipbuilders. This research is an initial step toward investigating SCRM techniques, offering academics a novel empirical approach that can serve as a systematic risk management tool for supply chain planning.     

风险投资与孵化器结合初探

建立孵化器，是促进科技成果转化、培育科技型中小企业的有效途径,是被实践证明了的加速高新技术产业化的重要经验，也是建设国家创新体系的重要组成部分。对孵化器和风险投资结合的初步研究，可以更好地把两相融合，更好地培育科技型中小企业，从而加速高新技术产业化进程。     

Dynamic decision trees for building resilience into future eco-cities

Intensifying global urbanization and environmental changes bring about the imperative of sustainable urban development and decisions upon inescapable pressures and risks, but knowledge integration between disciplines is a limiting contextual challenge. This paper proposes a reformulation, in terms of urban risk management, of an earlier developed ontological scenario generation method. The procedure consists of several steps: (i) identification-and-prioritization of main pressures, (ii) paired discussion of pressures using four-cell matrices, (iii) re-visit of the pressures' priority order, (iv) articulation of short-listed pressures as decision-making questions, and (v) generation of scenarios via “yes/no” responses to each question, in their order of priority. In this article, the method feeds upon the general context described in recent multi-disciplinary urban studies and public strategic plans in the city of Iasi (Romania), to propose a formal procedure for enabling the acceleration of productive decision making towards city sustainability. Answering three top priority questions, namely “Implement a business-friendly and efficient governance system?”, “Develop a resource management system?”, and “Carry out a human capital accelerator strategy?” results in a 4-scenario set: Receding City, Wanting City, Promising City, Inspiring City. The scenarios are discussed in terms of systemic risks at the end of post-communist transition and beginning of the socio-economic convergence with Western Europe.     

基于金融衍生工具组合的财务风险管理

本文将金融衍生工具套期保值这一行为作为一种投资行为。在分析各种金融衍生工具单独使用进行套期保值时带来的操作性非系统风险的基础上,借鉴投资组合的基本理论,使用组合的金融衍生工具套期保值,从而既可以达到单独使用金融衍生工具控制财务风险的目的,又可以在一定程度上降低由于金融市场自身极强的波动性带来的风险,具有一定的现实意义。     

财政收支项目审计中确定重要性水平的意义

进一步加强财政收支审计是国家审计机关的重要任务,但在实践工作中审计人员对确定财政收支审计项目重要性水平的意义认识不够,导致审计随意性大、审计目标与责任定位不清、审计成本较高,最终加大了审计风险。文章主要说明合理确定财政收支项目的重要性水平对降低审计风险,提高财政收支审计质量的重大意义。     

论社会审计的风险及防范

审计是一种综合性经济监督活动。社会经济活动的复杂性和不确定性使社会审计面临的风险越来越大。本文从审计风险的涵义大手,介绍了审计风险的形式和审计风险的基本特征;从主观和客观两个方面分析了影响审计风险的因素,并提出了防范审计风险的具体措施。对规避和降低社会审计风险,提高社会审计工作质量具有重要意义。     

我国保险资金运用风险分析

随着保险资金规模的不断扩大,其面临的投资风险也越来越大。分析结果表明,保险资金投资于国债、基础设施建设的风险相对较低;投资于银行存款的风险主要是政府运用利率手段调节宏观经济的结果;而投资于股票市场和证券投资基金的风险非常大。同时,算例分析显示,保险资金应扩大债券类资产的投资份额,慎重选择证券投资基金和股票。     

外汇风险对冲和公司价值:基于中国跨国公司的实证研究

2005年7月人民币汇改以来,人民币升值,特别是相对于美元大幅升值,其不利影响开始显现,我国不少跨国公司使用外汇衍生品来对冲人民币汇率升值带来的风险。然而,尽管不少国外学者对金融衍生品使用和公司价值的关系进行了深入研究,但以中国公司为样本的研究仍很少见。中信泰富等衍生品投机事件和2008年金融危机的发生使得我国学者对金融衍生工具的作用和性质争议不断,使用外汇衍生品对冲外汇风险是否增加公司价值仍是一个有待深入研究的问题。本文基于2007年至2009年968家中国跨国公司的数据,实证检验了外汇衍生品使用和公司价值的关系,发现外汇衍生品使用带来了约10%的价值溢价,这一重要发现和基于发达国家的不少研究相一致。该研究成果支持了外汇衍生品在汇率风险管理中的积极作用和加快发展我国外汇衍生品市场特别是交易所市场以掌握人民币汇率定价权的重要性和紧迫性。     

金融市场风险测量方法综述

近十来年,风险测量方法在收益和风险剧烈波动的股票市场中的作用日益突出,无论是金融机构还是监管当局对金融市场风险的管理与测量也都给予了足够的重视,回顾与展望金融市场风险测量研究方法对于该方面的研究也具有一定的积极意义.