MP64-20 THE IMPACT OF SURGEON VOLUME ON THE MORBIDITY AND COSTS OF PARTIAL NEPHRECTOMY IN THE UNITED STATES: A CONTEMPORARY POPULATION-BASED ANALYSIS

Abstract Background Since 2006, the New Vaccine Surveillance Network has conducted active, population-based surveillance for acute gastroenteritis (AGE) hospitalizations and emergency department (ED) visits in 3 United States counties. Trends in the epidemiology and disease burden of rotavirus hospitalizations and ED visits were examined from 2006 to 2016. Methods Children < 3 years of age hospitalized or visiting the ED with AGE were enrolled from January 2006 through June 2016. Bulk stool specimens were collected and tested for rotavirus. Rotavirus-associated hospitalization and ED visit rates were calculated annually with 2006–2007 defined as the prevaccine period and 2008–2016 as the postvaccine period. Rotavirus genotype trends were compared over time. Results Over 11 seasons, 6954 children with AGE were enrolled and submitted a stool specimen (2187 hospitalized and 4767 in the ED). Comparing pre- and postvaccine periods, the proportion of children with rotavirus dramatically declined for hospitalization (49% vs 10%) and ED visits (49% vs 8%). In the postvaccine era, a biennial pattern of rotavirus rates was observed, with a trend toward an older median age. G1P[8] (63%) was the predominant genotype in the prevaccine period with a significantly lower proportion (7%) in the postvaccine period (P < .001). G2P[4] remained stable (8% to 14%) in both periods, whereas G3P[8] and G12P[8] increased in proportion from pre- to postvaccine periods (1% to 25% and 17% to 40%), respectively. Conclusions The epidemiology and disease burden of rotavirus has been altered by rotavirus vaccination with a biennial disease pattern, sustained low rates of rotavirus in children < 3 years of age, and a shift in the residual genotypes from G1P[8] to other genotypes.

Download Full-text

1390 THE IMPACT OF URETEROSCOPY ON THE RATE OF SECONDARY BLADDER CANCER IN THE UNITED STATES: A POPULATION-BASED ASSESSMENT

The Journal of Urology ◽

10.1016/j.juro.2011.02.1237 ◽

2011 ◽

Vol 185 (4S) ◽

Author(s):

Max Kates ◽

Gina Badalato ◽

Olga Yeshchina ◽

Neda Sadeghi ◽

James McKiernan

Keyword(s):

United States ◽

Bladder Cancer ◽

The United States ◽

Population Based ◽

The Impact

Download Full-text

Hospitalization trends and outcomes for adults with metastatic cancers in the United States: 2004-2013.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18111 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18111-e18111

Author(s):

Oladimeji Akinboro ◽

Odunayo Olorunfemi ◽

Daniel Pomerantz ◽

Stephen Jesmajian ◽

Gbolahan Ogunbayo ◽

...

Keyword(s):

United States ◽

Hospital Mortality ◽

Metastatic Cancer ◽

The United States ◽

Population Based ◽

Policy Implications ◽

Teaching Hospitals ◽

Hospitalization Rates ◽

Complications Of Surgery ◽

The Impact

e18111 Background: Metastatic cancer accounts for 90% of cancer deaths. However, the impact of metastatic cancer on hospitalization patterns and in-hospital mortality is unknown. We sought to examine trends in hospitalizations and mortality among adults with metastatic cancers in the United States. Methods: We obtained data from the National Inpatient Sample for hospitalized adults, aged ≥18 years, with metastatic cancer listed as a discharge diagnosis from 2004 to 2013. We estimated and trended the following: i) proportion of hospitalized adults with metastatic cancers; ii) leading causes of hospitalization for adults with metastatic cancer; and iii) in-hospital mortality among adults with metastatic cancer. Independent associations of in-hospital mortality with age, gender, race/ethnicity, payment source, and hospital type were examined with multivariable logistic regression. Survey weights were applied in estimating the population-based rates, odds ratios, and confidence intervals (CI). Results: 3.0% (95% CI 2.9-3.1%) and 3.2% (95% CI 3.0-3.3%) of hospitalized adults had metastatic cancers in 2004 and 2013, respectively ( P for trend 0.07). The leading causes of hospitalization from 2004 to 2013 were: maintenance chemotherapy/radiotherapy – 3.5% (95% CI 3.2-3.8%); pneumonia – 3.2% (95% CI 3.1-3.3%); complications of surgery, medical care, devices, and implants – 2.8% (95% CI 2.8-2.9%); fluid/electrolyte abnormalities – 2.4% (95% CI 2.4-2.5%); and heart failure/pulmonary circulation diseases – 2.2% (95% CI 2.1-2.2%). In-hospital mortality for patients with metastatic cancer declined from 10.3% (95% CI 9.9-10.7%) in 2004 to 8.1% (95% CI 7.8-8.3%) in 2013 ( P for trend < 0.01). Higher odds of in-hospital mortality were consistently seen each year with increasing age, non-Hispanic blacks, self-payment, and admissions at hospitals other than urban teaching hospitals. Conclusions: The relative hospitalization rates for adults with metastatic cancer remain stable. Significant declines in in-hospital mortality for these patients are noted but disparities are seen for certain groups. The economic burden and policy implications of these findings for end-of-life care warrant further investigation.

Download Full-text

Epidemiology and trends of cryptococcosis in the United States from 2000 to 2007: A population-based study

International Journal of STD & AIDS ◽

10.1177/0956462417732649 ◽

2017 ◽

Vol 29 (5) ◽

pp. 453-460 ◽

Cited By ~ 10

Author(s):

Abdel AM Shaheen ◽

Ranjani Somayaji ◽

Robert Myers ◽

Christopher H Mody

Keyword(s):

United States ◽

Hospital Costs ◽

International Classification Of Diseases ◽

The United States ◽

Population Based ◽

Weighted Estimate ◽

Hospital Discharges ◽

Cryptococcal Disease ◽

Age Adjusted Rates ◽

The Impact

Cryptococcal disease, caused by Cryptococcus neoformans and Cryptococcus gattii, is associated with significant morbidity and mortality but limited data exist on its incidence and impact. A study utilizing the Nationwide Inpatient Sample from 2000 to 2007 to examine the epidemiology and impact of cryptococcal disease in the United States was undertaken. The International Classification of Diseases 9th Version code was used to identify hospital discharges with diagnosis of Cryptococcus (117.5). Our primary outcome was the incidence rate of cryptococcal admissions. The impact of AIDS, age, and sex on hospitalization rates, mortality, and costs was assessed. The results showed that a total of 10,077 hospitalizations for cryptococcosis occurred corresponding to a weighted estimate of 49,010 cases. The median age was 43 years (interquartile range 34–54), and 26% were female. Approximately 64% of cases occurred in persons with AIDS. Although rates declined overall, age-adjusted rates were significantly higher in males with AIDS than in uninfected persons (p < 0.001). The mortality rate decreased but was greater in HIV-uninfected versus infected cohorts (12% versus 10%, p < 0.001). Conversely, hospital costs were greater in persons with AIDS ($40,671 versus $40,096, p=0.02). Although cryptococcal disease rates are decreasing over time, the associated mortality and costs remain concerning.

Download Full-text

Association of paternal age with perinatal outcomes between 2007 and 2016 in the United States: population based cohort study

BMJ ◽

10.1136/bmj.k4372 ◽

2018 ◽

pp. k4372 ◽

Cited By ~ 48

Author(s):

Yash S Khandwala ◽

Valerie L Baker ◽

Gary M Shaw ◽

David K Stevenson ◽

Ying Lu ◽

...

Keyword(s):

United States ◽

Gestational Diabetes ◽

Premature Birth ◽

Perinatal Outcomes ◽

The United States ◽

Population Based ◽

Paternal Age ◽

Advanced Paternal Age ◽

The Us ◽

The Impact

AbstractObjectiveTo evaluate the impact of advanced paternal age on maternal and perinatal outcomes in the United States.DesignRetrospective, population based cohort study.SettingUS.Population40 529 905 documented live births between 2007 and 2016.Main outcome measuresPrimary perinatal outcomes were gestational age, birth weight, Apgar score at five minutes, admission to a neonatal intensive care unit, need for postpartum antibiotics, and seizures. Primary maternal outcomes were gestational diabetes and pre-eclampsia. Secondary outcome was the number of preventable perinatal events.ResultsHigher paternal age was associated with an increased risk of premature birth, low birth weight, and low Apgar score. After adjustment for maternal age, infants born to fathers aged 45 years or older had 14% higher odds of premature birth (odds ratio 1.14, 95% confidence interval 1.13 to 1.15), independent of gestational age, and 18% higher odds of seizures (1.18, 0.97 to 1.44) compared with infants of fathers aged 25 to 34 years. The odds of gestational diabetes was 34% higher (1.34, 1.29 to 1.38) in mothers with the oldest partners. 13.2% (95% confidence interval 12.5% to 13.9%) of premature births and 18.2% (17.5% to 18.9%) of gestational diabetes in births associated with older fathers were estimated to be attributable to advanced paternal age.ConclusionsAdvanced paternal age is associated with negative effects on both mothers and offspring. Given the relatively low prevalence of advanced paternal age in the US, population level impacts are currently modest. Nevertheless, as advanced paternal age has doubled in the US over the past generation, further investigation is warranted of the impact on birth outcomes and public health.

Download Full-text

27 The impact of traumatic injuries on medical expenditures in the united states: a population-based study

Injury Prevention ◽

10.1136/injuryprev-2015-041654.27 ◽

2015 ◽

Vol 21 (Suppl 2) ◽

pp. A10.1-A10 ◽

Cited By ~ 1

Author(s):

Suliman Alghnam ◽

Roland Thorpe ◽

Darrell Gaskin

Keyword(s):

United States ◽

The United States ◽

Population Based ◽

Medical Expenditures ◽

Population Based Study ◽

Traumatic Injuries ◽

The Impact

Download Full-text

Population-Based Analysis of Firearm Injuries among Young Children in the United States, 2010–2015

The American Surgeon ◽

10.1177/000313481908500518 ◽

2019 ◽

Vol 85 (5) ◽

pp. 449-455 ◽

Cited By ~ 1

Author(s):

Alan Cook ◽

David Hosmer ◽

Laurent Glance ◽

Bindu Kalesan ◽

Jordan Weinberg ◽

...

Keyword(s):

United States ◽

Young Children ◽

Hospital Mortality ◽

Gunshot Wounds ◽

The United States ◽

Population Based ◽

Older Children ◽

Firearm Injuries ◽

One Year ◽

The Impact

Firearm violence in the United States knows no age limit. This study compares the survival of children younger than five years to children and adolescents of age 5–19 years who presented to an ED for gunshot wounds (GSWs) in the United States to test the hypothesis of higher GSW mortality in very young children. A study of GSW patients aged 19 years and younger who survived to reach medical care was performed using the Nationwide ED Sample for 2010–2015. Hospital survival and incidence of fatal and nonfatal GSWs in the United States were the study outcomes. A multilevel logistic regression model estimated the strength of association among predictors of hospital mortality. The incidence of ED presentation for GSW is as high as 19 per 100,000 population per year. Children younger than five years were 2.7 times as likely to die compared with older children (15.3% vs 5.6%). Children younger than one year had the highest hospital mortality, 33.1 per cent. The mortality from GSW is highest among the youngest children compared with older children. This information may help policy makers and the public better understand the impact of gun violence on the youngest and most vulnerable Americans.

Download Full-text