PP164 Identifying Complications Of Partial Nephrectomy Using Physician Claims

2018 ◽  
Vol 34 (S1) ◽  
pp. 130-131
Author(s):  
Jian Sun ◽  
Tania Stafinski ◽  
Fernanda Inagaki Nagase ◽  
Devidas Menon
Keyword(s):  
Ambulatory Care ◽  
Partial Nephrectomy ◽  
Kidney Cancer ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Incidence Rates ◽  
Open Group ◽  
Robot Assisted ◽  
Before And After ◽  
Chi Squared

Introduction:Many population-based studies identify surgical complications using hospital discharge abstract databases (DAD). With DAD, however, complications occurring after the discharge date cannot be followed up. This study used physician claims data to identify the complications of partial nephrectomy, and to compare the rates of complications of open, laparoscopic, and robot-assisted nephrectomies.Methods:Physician claims, DAD, and ambulatory care data from April 2003 to March 2016 were provided by Alberta Health. DAD and ambulatory care data were used to extract information on patients with kidney cancer who underwent partial nephrectomy. All physician claims within 30 days before and after surgery for the cohort were extracted. The numbers of the same International Classification of Diseases, Ninth Revision (ICD-9), codes before and after surgery were compared. If a number increased after surgery, this diagnosis was initially identified as a complication. All diagnoses with neoplasms were excluded. The incidence rates of complications for the three surgery groups were calculated. Chi-squared tests were conducted for the following nephrectomy comparisons: laparoscopic versus open; robot-assisted versus open; and robot-assisted versus laparoscopic.Results:A total of 1,890 kidney cancer patients had partial nephrectomies. Among them, 1,080, 411, and 399 had open, laparoscopic, and robot-assisted nephrectomies, respectively. One patient who had two different nephrectomies on the same day was excluded from analysis. The robot-assisted group had lower rates of digestive complications (ICD-9: 537–578, 787, 789, 998.6) and infections (ICD-9: 004–041, 998.5) than the open group, and higher rates of genitourinary complications (ICD-9: 584–599, 788, 997.5) than the laparoscopy group. The robot-assisted group had lower rates than the open group for most of the complication categories, but the differences were not statistically significant.Conclusions:Robot-assisted surgery appears to be superior to open surgery, but no better than laparoscopic surgery, in terms of minimizing the risk of complications following partial nephrectomy.

scholarly journals Osteoarthritis and risk of hospitalization for ambulatory care sensitive conditions: A general population-based cohort study

Rheumatology ◽  
2021 ◽  
Author(s):  
Ali Kiadaliri ◽  
Martin Englund
Keyword(s):  
Ambulatory Care ◽  
Hazard Model ◽  
Population Based ◽  
Incidence Rates ◽  
Ambulatory Care Sensitive Conditions ◽  
Chronic Obstructive ◽  
Main Diagnosis ◽  
Increased Risk ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

Abstract Objective To determine the association between osteoarthritis (OA) and risk of hospitalization for ambulatory care sensitive conditions (HACSCs). Methods We included all individuals aged 40–85 years who resided in Skåne, Sweden on 31st December 2005 with at least one healthcare consultation during 1998–2005 (n = 515 256). We identified those with a main diagnosis of OA between January 1, 1998 and December 31, 2016. People were followed from January 1st 2006 until an HACSC, death, relocation outside Skåne, or December 31st 2016 (whichever occurred first). OA status was treated as a time-varying covariate (those diagnosed before January 1, 2006 considered as exposed for whole study period). We assessed relative (hazard ratios (HRs) using Cox proportional hazard model) and absolute (hazard difference using additive hazard model) effects of OA on HACSCs adjusted for potential confounders. Results Crude incidence rates of HACSCs were 239 (95% CI 235, 242) and 151 (150, 152) per 10 000 person-years among OA and non-OA persons, respectively. The OA persons had an increased risk of HACSCs (HR [95% CI] 1.11 [1.09, 1.13]) and its subcategories of medical conditions except chronic obstructive pulmonary disease (HR [95% CI] 0.86 [0.81, 0.90]). There were 20 (95% CI 16, 24) more HACSCs per 10 000 person-years in OA compared with non-OA persons. While HRs for knee and hip OA were generally comparable, only knee OA was associated with increased risk of hospitalization for diabetes. Conclusion OA is associated with an increased risk of HACSCs, highlighting the urgent need to improve outpatient care for OA patients.

scholarly journals Trends of venous thromboembolism risk before and after diagnosis of gout: a general population-based study

Rheumatology ◽  
2019 ◽  
Vol 59 (5) ◽  
pp. 1099-1107 ◽  
Author(s):  
Lingyi Li ◽  
Natalie McCormick ◽  
Eric C Sayre ◽  
John M Esdaile ◽  
Diane Lacaille ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
General Population ◽  
Population Based ◽  
Incidence Rates ◽  
Vein Thrombosis ◽  
Hazard Ratios ◽  
Thrombosis Risk ◽  
Before And After ◽  
Health Database ◽  
Deep Vein

Abstract Objective To estimate the overall risk and the temporal trend of venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE) before and after gout diagnosis in an incident gout cohort compared with the general population. Methods We conducted a matched cohort study using a province-wide population-based administrative health database in Canada. We calculated incidence rates (IRs) and multivariable adjusted hazard ratios (HRs) for the risk of VTE, DVT and PE before and after gout diagnosis. Results Among 130 708 incident individuals with gout (64% male, mean age 59 years), 2071 developed VTE, 1377 developed DVT and 1012 developed PE. IRs per 1000 person-years for gout were 2.63, 1.74 and 1.28 compared with 2.03, 1.28 and 1.06 for non-gout, respectively. The fully adjusted HRs (95% CI) for VTE, DVT and PE were 1.22 (1.13, 1.32), 1.28 (1.17, 1.41) and 1.16 (1.05, 1.29). For the pre-gout period, the fully adjusted HRs (95% CI) were 1.51 (1.38, 1.64), 1.55 (1.40, 1.72) and 1.47 (1.31, 1.66) for VTE, DVT and PE. During the third, second and first years preceding gout, the fully adjusted HRs for VTE were 1.44, 1.56 and 1.62. During the first, second, third, fourth and fifth years after gout, the fully adjusted HRs were 1.63, 1.29, 1.33, 1.28 and 1.22. Similar trends were also seen for DVT and PE. Conclusion Increased risks of VTE, DVT and PE were found both before and after gout diagnosis. The risk increased gradually before gout, peaking in the year prior to diagnosis, and then progressively declined. Gout-associated inflammation may contribute to venous thrombosis risk.

A SEER-based multiethnic picture of cholangiocarcinoma in the United States pre and post the advent of gemcitabine/cisplatin.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 448-448
Author(s):  
Kabir Mody ◽  
Samuel O Antwi ◽  
David O Hodge ◽  
Zahara Meghji ◽  
Sikander Ailawadhi ◽  
...  
Keyword(s):  
United States ◽  
Overall Survival ◽  
Older Patients ◽  
The United States ◽  
Population Based ◽  
Incidence Rates ◽  
Hazard Ratios ◽  
Before And After ◽  
Using Data ◽  
Ethnic Variations

448 Background: Cholangiocarcinoma (CCA) is a rare, lethal cancer with five-year survival of less than 10%. Although incidence rates have been increasing in the United States, ethnic variations in survival have not been investigated. We examined multi-ethnic variation in overall survival (OS) and CCA-specific survival (CSS) using data from the population-based Surveillance Epidemiology and End Results (SEER) program in the four year periods before and after introduction of gemcitabine/cisplatin as treatment for CCA. Methods: The study included data from 9,975 CCA cases reported in SEER between 2006 and 2013. Multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CIs) were calculated to examine overall and cholangiocarcinoma-specific survival by ethnicity, age, gender and in the pre- and post- gemcitabine/cisplatin era (2006-2009 vs. 2010-2013). Results: Compared to non-Hispanic Whites, Hispanics had poorer 3-year OS (HR = 1.18, 95% CI = 1.10-1.26) and 3-year CCA-specific survival (HR = 1.25, 95% CI = 1.16-1.35). Similarly, non-Hispanic Blacks had 3-year OS (HR = 1.22, 95% CI = 1.12-1.30) and 3-year CCA-specific survival (HR = 1.24, 95% CI = 1.13-1.37). Males and older patients also were found to have shorter survival compared to females and younger patients. Also noted was an increase in CCA incidence rate over time (2006-2013) of 5.93%. Among those < 50 versus ≥50 years old, a 23% higher rate of incidence in those < 50 was noted. Overall survival and CSS were both significantly improved for patients post-advent of Gemcitabine/Cisplatin. Statistically significant improvement in CSS pre- and post-advent of Gemcitabine/Cisplatin was noted in non-hispanic whites (p < 0.001) and Hispanics (p = 0.02). Conclusions: Hispanics and non-Hispanic Blacks have worse survival after diagnosis with CCA. Further studies are needed to determine the determinants of poor survival among these groups toward targeted intervention. Significant improvements in OS and CSS have been seen after the advent of Gemcitabine/Cisplatin. The incidence of CCA is rising faster in young persons, under the age of 50, compared with older patients.

Predictors of Medical and Surgical Complications After Robot-Assisted Partial Nephrectomy: An Analysis of 1139 Patients in a Multi-Institutional Kidney Cancer Database

2017 ◽  
Vol 31 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Eric J. Moskowitz ◽  
David J. Paulucci ◽  
Balaji N. Reddy ◽  
Kyle A. Blum ◽  
Daniel C. Rosen ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Kidney Cancer ◽  
Surgical Complications ◽  
Robot Assisted

scholarly journals 1761. Effect of Carbapenem-Resistant Enterobacteriaceae (CRE) Surveillance Case Definition Change on CRE Epidemiology—Selected US Sites, 2015–2016

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S61-S62
Author(s):  
Nadezhda Duffy ◽  
Sandra N Bulens ◽  
Hannah Reses ◽  
Maria S Karlsson ◽  
Uzma Ansari ◽  
...  
Keyword(s):  
Census Data ◽  
Clinical Laboratory ◽  
Population Based ◽  
Incidence Rates ◽  
Case Definition ◽  
Emerging Infections ◽  
Convenience Sample ◽  
Active Population ◽  
Carbapenem Resistant ◽  
Before And After

Abstract Background Carbapenem-resistant Enterobacteriacae (CRE) are an urgent US public health threat. CDC reported CRE incidence to be 2.93/100,000 population in 2012–2013 in selected sites but changed the CRE surveillance case definition in 2016 to improve sensitivity for detecting carbapenemase-producing (CP) CRE. We describe CRE epidemiology before and after the change. Methods Eight CDC Emerging Infections Program sites (CO, GA, MD, MN, NM, NY, OR, TN) conducted active, population-based CRE surveillance in selected counties. A case was defined as having an isolate of E. coli, Enterobacter, or Klebsiella meeting a susceptibility phenotype (figure) at a clinical laboratory from urine or a normally sterile body site in a surveillance area resident in a 30-day period. We collected data from medical records and defined cases as community-associated (CA) if no healthcare risk factors were documented. A convenience sample of isolates were tested for carbapenemase genes at CDC by real-time PCR. We calculated incidence rates (per 100,000 population) by using US Census data. Case epidemiology and the proportion of CP-CRE isolates in 2015 versus 2016 were compared. Results In total, 442 incident CRE cases were reported in 2015, and 1,149 cases were reported in 2016. Most isolates were cultured from urine: 87% in 2015 and 92% in 2016 (P &lt; .001). The crude overall pooled mean incidence in 2015 was 2.9 (range by site: 0.45–7.19) and in 2016 was 7.48 (range: 3.13–15.95). The most common CRE genus was Klebsiella (51%) in 2015, and in 2016 was Enterobacter (41%, P &lt; 0.001). Of the subset of CRE isolates tested at CDC, 109/227 (48%) were CP-CRE in 2015 and 109/551 (20%) were CP-CRE in 2016. In 2015, 52/442 (12%) of cases were CA CRE, and in 2016, 267/1,149 (23%) were CA CRE (P &lt; 0.001). In 2016, 3/111 (2.7%) of CA CRE isolates tested were CP-CRE. Conclusion A large increase in reported CRE incidence was observed after the change in the case definition. The new case definition includes a substantially larger number of Enterobacter cases. A decrease in CP-CRE prevalence appears to be driven by an increase in non-CP-CRE cases. Although CP-CRE in the community still appear to be rare, a substantial proportion of phenotypic CRE appear to be CA, and CDC is undertaking efforts to further investigate CA CRE, including CP-CRE. Disclosures G. Dumyati, Seres: Scientific Advisor, Consulting fee.

Outcomes following polypectomy for malignant colorectal polyps are similar to those following surgery in the general population

Gut ◽  
2017 ◽  
Vol 68 (1) ◽  
pp. 111-117 ◽  
Author(s):  
Anthony Lopez ◽  
Anne-Marie Bouvier ◽  
Valérie Jooste ◽  
Vanessa Cottet ◽  
Gaëlle Romain ◽  
...  
Keyword(s):  
General Population ◽  
Recurrence Rate ◽  
Surgical Resection ◽  
Endoscopic Resection ◽  
Population Based ◽  
Incidence Rates ◽  
Colorectal Polyps ◽  
Transanal Resection ◽  
Net Survival ◽  
Before And After

ObjectivePopulation-based studies on colorectal malignant polyps (MPs) are scarce. The aim of this study was to describe time trends in the incidence of colorectal MPs before and after the introduction of a colorectal mass-screening programmein 2003 and to assess outcomes (survival and recurrence) after endoscopic or surgical resection in patients with MPs.DesignWe included 411 patients with MPs diagnosed between 1982 and 2011 in a well-defined population. Age-standardised incidence rates were calculated. Univariate and multivariate 5-year recurrence and net survival analyses were performed according to gross morphology.ResultsAge-standardised incidence of MPs in patients aged 50–74 years doubled from 5.4 in 1982–2002 to 10.9 per 100 000 in 2003–2011. Pedunculated MPs were more frequently resected endoscopically (38.2%) than were sessile MPs (19.1%; p<0.001). For patients with pedunculated MPs and a pathological margin ≥1 mm, the 5 -year cumulative recurrence rate did not differ significantly between surgical and endoscopic resection (8.2% and 2.4%, respectively). For patients with sessile MPs, it was 3.0% after first-line or second-line surgical resection, 8.6% after endoscopic resection and 17.9% after transanal resection (p=0.016). The recurrence rate decreased dramatically for patients with sessile MPs from 11.3% (1982–2002) to 1.2% (2003–2009) (p=0.010) and remained stable for pedunculated MPs at 4.6% and 6.7%, respectively. Five-year net survival was 81.0% when pathological margins were <1 mm and 95.6% when ≥1 mm (p=0.024).ConclusionOutcomes following polypectomy in patients with a pathological margin ≥1 mm are similar to those following surgery in the general population. Endoscopic resection needs to be completed by surgery if pathological margins are less than 1 mm.

Epidemiology and Medication Pattern Change of Psoriatic Diseases in Taiwan from 2000 to 2013: A Nationwide, Population-based Cohort Study

2018 ◽  
Vol 45 (3) ◽  
pp. 385-392 ◽  
Author(s):  
James Cheng-Chung Wei ◽  
Lin-Hong Shi ◽  
Jing-Yang Huang ◽  
Xue-Fen Wu ◽  
Rui Wu ◽  
...  
Keyword(s):  
Anatomical Therapeutic Chemical ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Incidence Rates ◽  
Research Database ◽  
Chi Square ◽  
Classification Code ◽  
Classification Of Diseases ◽  
Taiwan National Health Insurance

Objective.To analyze the trend of prevalence and incidence rates for psoriatic arthritis (PsA) and psoriasis in Taiwan, and to determine the changes in medication patterns.Methods.Data were collected from the Taiwan National Health Insurance Research Database, which covered at least 95% of the population from 2000 to 2013. International Classification of Diseases, 9th edition (ICD-9) was used to identify PsA (ICD-9 696.0) and other psoriasis (ICD-9 696.1). Medications were identified by Anatomical Therapeutic Chemical Classification code. We calculated the annual age standardized prevalence and incidence rate of PsA and psoriasis in individuals aged ≥ 16 years from 2000 to 2013, and used the Poisson regression to test the trends by Wald chi-square statistic.Results.The prevalence (per 100,000 population) of psoriatic diseases between 2000 and 2013 increased from 11.12 to 37.75 for PsA, and from 179.2 to 281.5 for psoriasis. The incidence (per 100,000 person-yrs) increased from 3.64 to 6.91 in PsA, while there was no significant change in psoriasis. Prevalence and incidence in PsA were more rapidly increased than in psoriasis. Sex ratio (men to women) of PsA decreased from 2.0 to 1.5 in 2000 and 2013, respectively. There was an increase in the use of disease-modifying antirheumatic drugs (DMARD), especially biologics, which is significantly different from topical therapies.Conclusion.The prevalence and incidence rates of psoriatic disease, especially PsA, were increasing in Taiwan. The medication pattern showed an increase in DMARD and biologics, while use of topical therapies decreased.

scholarly journals Incidence Rates and Risk of Hospital Registered Infections among Schizophrenia Patients before and after Onset of Illness: A Population-Based Nationwide Register Study

2018 ◽  
Vol 7 (12) ◽  
pp. 485 ◽  
Author(s):  
Monika Pankiewicz-Dulacz ◽  
Egon Stenager ◽  
Ming Chen ◽  
Elsebeth Stenager
Keyword(s):  
Premature Mortality ◽  
Population Based ◽  
Incidence Rates ◽  
Poisson Models ◽  
Before And After ◽  
Health Related ◽  
Almost All ◽  
Nationwide Register Study ◽  
Occurrence Patterns ◽  
The Impact

Infections in schizophrenia patients are associated with an increased premature mortality. However, our knowledge about the burden of infections in schizophrenia is scarce. The aims of this study were to (1) determine the prevalence of clinically important hospital registered infections in the period of five years prior to and five years after the diagnosis, (2) estimate the risk of infections before and after the schizophrenia diagnosis and, (3) evaluate the impact of comorbidity on the risk of infections in schizophrenia. Using combined data from Danish national registers, we sampled a cohort of all persons born in Denmark in the period 1975–1990 and obtained health-related records from 1995–2013. Occurrence patterns and the risk of infections were measured as annual incidence rates and incidence rates ratios, estimated using Poisson models. Medical conditions from the Charlson Index were considered as a measure of comorbidity. The analyses showed that schizophrenia patients had a significantly elevated risk of almost all types of hospital registered infections during the period of the study when compared to the controls. Comorbidity increased rates of infections by 176%. The results suggest that the risk of infections is elevated in the schizophrenia population and physical illness is an important risk factor.

scholarly journals Incidence and Survival Trends of Pancreatic Cancer in Girona: Impact of the Change in Patient Care in the Last 25 Years

2020 ◽  
Vol 17 (24) ◽  
pp. 9538
Author(s):  
Adelaida García-Velasco ◽  
Lluís Zacarías-Pons ◽  
Helena Teixidor ◽  
Marc Valeros ◽  
Raquel Liñan ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Incidence Rates ◽  
Future Research ◽  
Kaplan Meier ◽  
Standard Population ◽  
European Standard Population ◽  
Classification Of Diseases ◽  
Incident Cases

(1) Background: We investigated the incidence and survival trends for pancreatic cancer (PC) over the last 25 years in the Girona region, Catalonia, Spain; (2) Methods: Data were extracted from the population-based Girona Cancer Registry. Incident PC cases during 1994–2015 were classified using the International Classification of Diseases for Oncology Third Edition (ICD-O-3). Incidence rates age-adjusted to the European standard population (ASRE) and world standard population (ASRW) were obtained. Trends were assessed using the estimated annual percentage of change (EAPC) of the ASRE13. Observed and relative survivals (RS) were estimated with the Kaplan–Meier and Pohar Perme methods, respectively; (3) Results: We identified 1602 PC incident cases. According to histology, 44.4% of cases were exocrine PC, 4.1% neuroendocrine, and 51.1% malignant-non-specified. The crude incidence rate (CR) for PC was 11.43 cases-per-100,000 inhabitants/year. A significant increase of incidence with age and over the study period was observed. PC overall 5-year RS was 7.05% (95% confidence interval (CI) 5.63; 8.84). Longer overall survival was observed in patients with neuroendocrine tumours (5-year RS 61.45%; 95% CI 47.47; 79.55). Trends in 5-year RS for the whole cohort rose from 3.27% (95% CI 1.69–6.35) in 1994–1998 to 13.1% (95% CI 9.98; 17.2) in 2010–2015; (4) Conclusions: Incidence rates of PC in Girona have increased in the last two decades. There is a moderate but encouraging increase in survival thorough the study period. These results can be used as baseline for future research.

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