The George Washington University Hospital is a for-profit hospital, located in Washington, D.C. in the United States. It is affiliated with the George Washington University School of Medicine and Health Sciences. The current facility opened on August 23, 2002, with 371 beds in a 400,000 sq ft (37,200 m2) building, housing more than $45 million of medical equipment and costing over $96 million to construct. The hospital is licensed by the District of Columbia Department of Consumer and Regulatory Affairs and accredited by the U.S. Joint Commission.Since 1997, the George Washington University Hospital has been jointly owned and operated by a partnership between a subsidiary of Universal Health Services and the George Washington University.C.C..C.
Recurrent lumbar disc herniation (RLDH) is a common complication after discectomy, occurring in 2%–25% of patients and contributing to higher reoperation rates, reduced satisfaction, and substantial direct and indirect costs. This review evaluates the economic consequences of RLDH and the relative cost-effectiveness of available management strategies. A systematic search of OVID, MEDLINE, and the Cochrane Library was performed through August 2025. Peer-reviewed, English-language studies were included if they examined adults (≥18 years) with RLDH and reported economic data. Exclusion criteria were studies limited to primary, cervical, or thoracic herniations; animal or cadaveric models; and abstracts. Extracted variables included study design, sample size, follow-up duration, and cost components. Of 283 records identified, 220 were screened and 35 underwent full-text review. Six studies met inclusion criteria, with 2 added through citation searching. Reported costs varied considerably: repeat discectomy added $6,907 in one analysis, while fusion increased expenses by more than 350%. Across studies, repeat discectomy remained the most cost-efficient option, providing comparable outcomes with reduced perioperative expenditures. Conservative management had the lowest immediate direct costs (≈$2,300) but likely underestimates the overall burden due to unmeasured productivity losses. Annular closure devices demonstrated potential cost savings of $2,000–5,000 over 2–5 years. RLDH imposes a substantial economic burden. Heterogeneity in costing methods remains a major limitation which hinders evidence-based determinations. Greater transparency, methodological standardization, and incorporation of societal perspectives are essential to accurately assess the socioeconomic impact of RLDH.
The integration of robotic systems into minimally invasive surgery offers significant advantages, including enhanced precision, reduced invasiveness, and improved patient outcomes. However, sustaining these benefits requires optimization of operational efficiency to justify the substantial resource investment associated with robotic technologies. This review examines strategies to enhance efficiency in robotic-assisted surgery using a four-pillar framework: (1) team structure and leadership; (2) organization of care; (3) procedural standardization; and (4) parallel task overlap. Evidence from the literature and practice-informed observations suggests that well-coordinated multidisciplinary teams, structured perioperative planning, and optimized operating room organization can reduce delays and improve workflow efficiency. Standardization of equipment setup and surgical steps further enhances procedural predictability, while parallel tasking minimizes downtime and improves operating room capacity. When combined with continuous training and iterative process evaluation, these strategies may optimize robotic surgical performance, improve cost efficiency, and support high-quality, patient-centered care.
BACKGROUND:Acute decompensated heart failure (ADHF) is commonly managed in emergency departments (ED) and poses significant morbidity and mortality burden. This study quantifies trends in demographics and healthcare charges related to ADHF across EDs in the US. METHODS:A descriptive retrospective epidemiological analysis of nationally representative ED visit-level data was conducted using the Nationwide Emergency Department Sample (NEDS) database from 2016 to 2021. NEDS is a publicly available database maintained by the Healthcare Cost and Utilization Project (HCUPS). Adult patients with acute heart failure (HFrEF or HFpEF) were identified through ICD-10 codes. Survey-weighted estimates were used to generate national counts and characterize demographics, comorbidities, hospital characteristics, and disposition outcomes. Temporal trends in ED visits, admission rates, and healthcare charges were analyzed. RESULTS:A total of 10,041,919 ED encounters for ADHF were identified, with 43.6% female and a mean age of 69.8 years. Of these, 33.7% lived in low-income areas, and 83.6% were treated in metropolitan hospitals (primarily in the South, 40.8%). Most patients (82.8%) were admitted from the ED, with a low in-ED mortality rate of 0.1%. Of all patients, 5% were non-compliant with care. Trend analysis shows an increasing number of ADHF patients and rising non-compliance rates, with mean total hospital charges escalating from $71,578 in 2016 to $98,705 in 2021. CONCLUSION:This study underscores the substantial burden of ADHF on the healthcare system, with rising admissions and charges, contrasting with low in-ED mortality. Addressing these trends is essential to mitigate resource strain and enhance patient outcomes.
Fenestrated endovascular aneurysm repair (FEVAR) has become a preferred approach for complex aortic pathology involving visceral vessels, particularly in patients at high risk for open repair. Tuberculosis aortitis is rare, with few documented cases involving the visceral aorta. This case describes a 68-year-old man with a history of bladder cancer undergoing immunotherapy who developed penetrating aortic ulcers (PAUs) secondary to suspected tuberculosis aortitis and underwent successful laser FEVAR. This case highlights the feasibility and efficacy of laser FEVAR for complex aortic disease such as tuberculosis aortitis and demonstrates its role as a life-saving strategy in high-risk patients.
BACKGROUND AND OBJECTIVES: Forestier's disease, also known as diffuse idiopathic skeletal hyperostosis, causes abnormal ossification, commonly affecting the anterior cervical spine. Symptomatic patients can experience dysphagia, dyspnea, hoarseness, or aspiration due to the mass effect exerted on midline structures of the neck. When conservative measures have failed, surgical removal or thinning of the osteophytes often alleviates these symptoms. This study offers a case series of patients treated surgically for “diffuse idiopathic skeletal hyperostosis-phagia,” a scoring system to identify appropriate surgical candidates, and a management algorithm. METHODS: A single-institution, retrospective chart review identified patients who underwent surgical osteophyte removal for Forestier's disease. Preoperative and postoperative evaluations included Glottal Function Index, Penetration-Aspiration Scale, imaging studies including barium swallow tests, and qualitative reports of symptoms. Perioperative imaging, operative time, length of hospital stay, postoperative complications, and the need for enteral (nonoral) nutritional support were assessed. RESULTS: Six patients who underwent surgical osteophyte removal for management of Forestier's disease were identified. Five of these patients experienced improvement in their preoperative dysphagia as measured by various quantitative and qualitative tests. Two patients had same-day surgery, and no patient was in the hospital for more than 4 days. No patient required a feeding tube perioperatively. All patients tolerated a regular diet at their first follow-up visit. One patient had a postoperative seroma which did not affect his ability to swallow and was treated conservatively. Areas for improvement in patient screening, preoperative evaluation, and postoperative surveillance were noted. CONCLUSION: Together, the results demonstrate the utility of surgical osteophyte removal for the management of Forestier's disease. We propose a novel scoring system and management algorithm including standardized clinical and radiographic evaluations, a conservative management trial, multidisciplinary evaluation, and standardized postoperative surveillance.
