scholarly journals A nationwide analysis of 16 year trends in cardiac transplantation for cardiac sarcoidosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Isath ◽  
S Perembeti ◽  
A Correa ◽  
A Chahal ◽  
D Padmanabhan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Heart Transplant ◽  
Cardiac Transplantation ◽  
Cardiac Sarcoidosis ◽  
Average Length ◽  
Private Insurance ◽  
The United States ◽  
Teaching Hospitals ◽  
Cardiac Transplant ◽  
The Mean

Abstract Background Orthotopic heart transplant (OHT) is indicated for end-stage heart failure due to cardiac sarcoidosis (CS). However, utilization of OHT for CS has been controversial due to concern for involvement of other organs by sarcoidosis affecting long term outcomes. Purpose Our objective was to study the trends in OHT in patients with CS in the United States using Healthcare Cost and Utilization Project (HCUP) National (nationwide) Inpatient Sample (NIS) from 1999 to 2014. Methods Using NIS data, we identified patients older than 18 years with cardiac sarcoidosis using codes ICD 9-CM codes of 135 and 425.8. Among these patients, we identified those who underwent cardiac transplantation using ICD 9-CM procedure codes 37.5 and 33.6. We presented categorical data as percentages and continuous data as mean or median as appropriate. Results A weighted total of 24231 hospitalizations for CS was extracted from 1999 to 2014 of which 248 (1.02%) CS patients underwent OHT. The trends in cardiac transplant for CS is as shown in Figure 1. The mean age of CS patients undergoing OHT was 51.7±1.1 years and 60.4% (n=150) were males. 114 (45.9%) were Caucasians and 27.8% (n=25) were African-American. 100% of the transplants were performed at medium (n=5) or large sized (n=243) teaching hospitals and 97.9% of cardiac transplants were also done at teaching hospitals. Heart transplants were mostly done in the South (36.3%) followed by Midwest (26.2%), West (25%) and Northeast (12.5%). Private insurance was the major payor source which covered 149 (60.1%) patients followed by Medicare covering 65 (26.2%) patients. A total of 10 (3.9%) cardiac sarcoidosis patients died during the same hospitalization for cardiac transplantation. Following OHT, 84.2% (n=209) were discharged home and 11.6% (n=29) to short term hospitalization. The mean cost of hospitalization for OHT in CS when adjusted for inflation was 535144±56060 dollars while the average length of stay for heart transplant for CS was 46.2±6.6 days. Conclusions Cardiac transplant trends in CS have not changed from 1999 to 2014 despite recent studies showing improved outcomes and are associated with substantial cost of hospitalization and length of stay. Majority of cardiac transplant was done in Caucasians despite cardiac sarcoidosis being more common in African-Americans. Funding Acknowledgement Type of funding source: None

A nationwide analysis of 16 year trends in cardiac transplantation for acute myocarditis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Isath ◽  
S Perembeti ◽  
A Correa ◽  
S Haider ◽  
K Ho ◽  
...  
Keyword(s):  
United States ◽  
Heart Transplant ◽  
Cardiac Transplantation ◽  
Average Length ◽  
Acute Myocarditis ◽  
Private Insurance ◽  
The United States ◽  
Baseline Characteristic ◽  
Cardiac Transplants ◽  
The Mean

Abstract Background Orthotopic heart transplant (OHT) is indicated in 1–8% of patients with myocarditis. However, national trends in the utilization of transplantation and outcomes in myocarditis across the United States are not well established. Purpose Our objective was to study the trends and baseline characteristic of myocarditis patients undergoing heart transplant in the United States using Healthcare Cost and Utilization Project (HCUP) National (nationwide) Inpatient Sample (NIS) from 1999 to 2014. Methods Using NIS data, we identified patients older than 18 years with myocarditis using codes ICD9 codes of 422.0 and 422.9. Among these patients, we identified those who underwent cardiac transplantation using ICD9 procedure codes 37.5 and 33.6. We presented categorical data as percentages and continuous data as mean or median as appropriate. Results We identified a total of 62,264 hospitalizations for myocarditis from 1999–2014. 430 (0.69%) myocarditis patients underwent OHT which consisted of 0.82% of all 29990 cardiac transplants identified in the same period. The trends in OHT for myocarditis is as shown in Figure 1. The mean age was 32.9±2.4 years and 51.1% (n=219) were females. 235 (54.6%) were Caucasians and 60 (13.9%) were Hispanic. Majority of the transplants were performed at medium (16%) and large sized hospitals (80.4%). Cardiac transplants were mainly done at teaching hospitals (98.9%). Further, with regards to the geographical distribution of transplant procedure, most were done in the West (37.2%) followed by South (25.3%), Northeast (21.4%) and Mid-west (16%) of the United States. Private insurance was the major payor source which covered 245 (58%) patients followed by Medicaid covering 112 (26%) patients. A total of 26 (6%) myocarditis patients died during the same hospitalization for OHT. In terms of discharge following OHT in myocarditis 85.8% (n=369) were discharged home and 8.1% (n=35) to short term hospitalization. The average length of stay for OHT for myocarditis was 64.3±6.3 days. Also, the mean cost of hospitalization for heart transplant in myocarditis when adjusted for inflation was 789,566±93,108 dollars. In-patient mortality following OHT was not significantly different in large sized hospital compared to small and medium sized hospitals (7.6% vs 5.7%, p=0.54). However, the cost of hospitalization was significantly lesser in small and medium sized hospitals (588,363±154,349 vs 826,864±106,110 dollars, p<0.0001). Conclusions Only a small percentage of OHT is done for myocarditis with high proportion done in female when compared to OHT for other etiologies. Further studies need to be done to compare long term outcomes of heart transplant in myocarditis. Funding Acknowledgement Type of funding source: None

Airway Management of Epiglottitis: A National Perspective

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P62-P62
Author(s):  
Jason L Acevedo ◽  
Lina Lander ◽  
Sukgi S Choi ◽  
Rahul K Shah
Keyword(s):  
Average Length ◽  
Private Insurance ◽  
Teaching Hospitals ◽  
Airway Intervention ◽  
Average Length Of Stay ◽  
Care Facilities ◽  
The Mean ◽  
National Perspective ◽  
And Training ◽  
Total Charges

Objective To describe demographics and utilization in the treatment of epiglottitis. Methods The Kids’ Inpatient Database (KID) was used to extract data for patients 7 years old and younger with a diagnosis of epiglottitis; children undergoing airway intervention (intubation or tracheostomy) were studied. Results 33 patients were identified that were either intubated (n=31) or had a tracheotomy (n=3); 1 patient that had a tracheotomy was intubated prior. The mean age of patients was 1.7 years old; 58% being 2 years older or less. 52% were male, and 42% were Caucasian. Average length of stay was 17.7 days (range=0–199). January and October were the most common months for admission (n=5, each). Of admissions - Texas and Massachusetts handled the most (n=4, each). Average total charges were $83860. Private insurance was the primary payor in 55% of cases; 18% patients were discharged to shortterm care facilities. 73% of cases were managed at teaching hospitals; all tracheotomies were at teaching hospitals. There were no mortalities. Conclusions In the post-HiB era, epiglottitis has become a rare entity. Of children under 7 years of age, only 33 required airway intervention in the 36 states sampled in 2003. More than half of affected children were, on average, 2 years old and younger. Airway intervention for epiglottitis is associated with high total charges and prolonged hospitalization. Epiglottitis is a rare, expensive, and protracted disease to treat in the HiB vaccine era. The infrequency of this disease has significant implications for resident education and training.

scholarly journals Does cardiac transplant protect against broken hearts?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Isath ◽  
S Perembeti ◽  
A Correa ◽  
S Rao ◽  
A Chahal ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Average Length ◽  
Myocardial Dysfunction ◽  
Case Reports ◽  
Fold Increase ◽  
Circulatory Support ◽  
Cardiac Transplant ◽  
Transplant Recipients ◽  
The Mean ◽  
Heart Transplant Recipients

Abstract Background Takotsubo cardiomyopathy (TC) is a reversible stress-induced myocardial dysfunction with increased sympathetic activity caused by excessive release of catecholamines playing a central role in its pathophysiology. The occurrence of TC in transplanted hearts is rare given the complete denervation done during transplantation. However, it has been demonstrated that 40% of transplant recipients undergo sympathetic re-innervation. There have only been case reports describing TC in post-transplant recipients. Purpose To evaluate the incidence, baseline characteristics and outcomes of TC occurring in heart transplant recipients using Healthcare Cost and Utilization Project (HCUP) National (nationwide) Inpatient Sample (NIS) in United States from 2009 to 2014. Methods Using NIS data, we identified patients who underwent cardiac transplantation using ICD9 procedure codes 37.5 and 33.6. Among these patients, we identified those admitted to the hospital with diagnosis of TC based on ICD-9-CM code 429.83. We presented categorical data as percentages and continuous data as mean or median as appropriate. Results We identified 257 hospitalizations for TC in heart transplant recipient patients. There was an approximately 9-fold increase in admissions from 11 in 2009 to 95 in 2014. Among patients with TC, the mean age was 65.3±1.8 years and majority were female (76.6%). A majority of patients were Caucasians (63%) followed by smaller proportion of African-Americans (13.2%). In-patient mortality in patients admitted with TC following heart transplant was 11.3% (n=29). During the hospitalization, 4.8% of patients had cardiogenic shock and 2.8% required mechanical circulatory support. The average length of stay for patients with TC was 16.6±3.3 days. The mean cost of hospitalization for these patients when adjusted for inflation were 237248±55709 dollars. Conclusion TC can still occur in substantially in heart transplant recipients and should be considered one of the differential diagnosis in transplant patients presenting to the hospital. Funding Acknowledgement Type of funding source: None

scholarly journals THU0442 GOUT AND HEART FAILURE IN THE US: A NATIONAL PERSPECTIVE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 458.2-458
Author(s):  
G. Singh ◽  
M. Sehgal ◽  
A. Mithal
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Confidence Intervals ◽  
Burden Of Illness ◽  
Average Length ◽  
Private Insurance ◽  
Significant Risk ◽  
Case Fatality ◽  
The United States ◽  
The Us

Background:Heart failure (HF) is the eighth leading cause of death in the US, with a 38% increase in the number of deaths due to HF from 2011 to 2017 (1). Gout and hyperuricemia have previously been recognized as significant risk factors for heart failure (2), but there is little nationwide data on the clinical and economic consequences of these comorbidities.Objectives:To study heart failure hospitalizations in patients with gout in the United States (US) and estimate their clinical and economic impact.Methods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. We examined all inpatient hospitalizations in the NIS in 2017, the most recent year of available data, with a primary or secondary diagnosis of gout and heart failure. Over 69,800 ICD 10 diagnoses were collapsed into a smaller number of clinically meaningful categories, consistent with the CDC Clinical Classification Software.Results:There were 35.8 million all-cause hospitalizations in patients in the US in 2017. Of these, 351,735 hospitalizations occurred for acute and/or chronic heart failure in patients with gout. These patients had a mean age of 73.3 years (95% confidence intervals 73.1 – 73.5 years) and were more likely to be male (63.4%). The average length of hospitalization was 6.1 days (95% confidence intervals 6.0 to 6.2 days) with a case fatality rate of 3.5% (95% confidence intervals 3.4% – 3.7%). The average cost of each hospitalization was $63,992 (95% confidence intervals $61,908 - $66,075), with a total annual national cost estimate of $22.8 billion (95% confidence intervals $21.7 billion - $24.0 billion).Conclusion:While gout and hyperuricemia have long been recognized as potential risk factors for heart failure, the aging of the US population is projected to significantly increase the burden of illness and costs of care of these comorbidities (1). This calls for an increased awareness and management of serious co-morbid conditions in patients with gout.References:[1]Sidney, S., Go, A. S., Jaffe, M. G., Solomon, M. D., Ambrosy, A. P., & Rana, J. S. (2019). Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017. JAMA Cardiology. doi:10.1001/jamacardio.2019.4187[2]Krishnan E. Gout and the risk for incident heart failure and systolic dysfunction. BMJ Open 2012;2:e000282.doi:10.1136/bmjopen-2011-000282Disclosure of Interests: :Gurkirpal Singh Grant/research support from: Horizon Therapeutics, Maanek Sehgal: None declared, Alka Mithal: None declared

Hypercalcemia as a predictor of adverse treatment outcomes in DLBCL during chemotherapy: A national inpatient database study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19571-e19571
Author(s):  
Dennis Danso Kumi ◽  
Trilok Shrivastava ◽  
Maha A.T. Elsebaie ◽  
hisham laswi ◽  
Kriti Ahuja ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Private Insurance ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
B Cell Lymphoma ◽  
Adverse Outcomes ◽  
Medical Complications ◽  
Predictors Of Mortality ◽  
Comorbidity Index ◽  
The Mean

e19571 Background: Hypercalcemia occurs in up to 7% of NHL and up to 18% in diffuse large B-cell lymphoma (DLBCL) representing about 60% of cases. Thus far, there are only a few studies that have established the poor prognosis between hypercalcemia and outcomes in DLBCL. We sought to outline specific acute complications that can during admission for chemotherapy in patients with hypercalcemia. Methods: This is a retrospective analysis of hospital admission using the National Inpatient Sample database (2018), including 15,636 adult patients with DLBCL admitted for chemotherapy. We obtained descriptive data, conducted chi-square test, and stratified logistic regression to look for possible chemotherapy related acute medical complications & predictors of mortality in DLBCL with & without hypercalcemia. Study limitations included lack of long term follow up, variations in chemotherapy and possible under-reporting of test subjects. Results: The mean age among DLBCL patients with & without hypercalcemia were 65.41 and 58.52 years respectively and the mean length of stay were 6.56 and 4.98 days respectively. Patient’s race, type of insurance and Charlson’s comorbidity index were found to be significant predictors of mortality in patients with DLBCL admitted for chemotherapy. Among race, Hispanics & Asian or Pacific islanders were found to be at higher risk for mortality, while patients who had private insurance were found to be associated with higher mortality risk (p<0.01). Similarly, Native Americans (aOR 8.72, 1.93-39.34, p<0.01) and patients with Charlson comorbidity index of 4 or more were at higher risk of mortality (aOR 4.34, 2.30-8.18, p<0.01). In regard to acute medical complications, DLBCL patients with hypercalcemia were at higher risk for tumor lysis syndrome (TLS) (aOR 3.86, p<0.01), acute kidney injury (AKI) (aOR 4.28, p<0.01) and hyperuricemia (aOR 9.74, p<0.01). There was no significant association of hypercalcemia in DLBCL with hyperkalemia, fluid overload, ICU admission, mortality, total cost, or length of stay. Conclusions: Hypercalcemia is associated with higher adverse outcomes during chemotherapy treatment in patients with DLBCL including TLS, hyperuricemia, and AKI during chemotherapy admission. This confirms to the overall accession of poor outcomes as published by other studies.[Table: see text]

Abstract TP405: IV TPA Utilization and Outcomes in Young Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Pamela Cheng ◽  
Ling Zheng ◽  
Steven Cen ◽  
Peggy Nguyen ◽  
Sebina Bulic ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Average Length ◽  
Pediatric Population ◽  
Cerebrovascular Disorders ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Total Charge ◽  
Inpatient Mortality ◽  
Stroke Patients

Objective: Cerebrovascular disorders are among the top ten causes of death in the pediatric population. The incidence is felt to be 1-2 per 100,000, although this number could be higher due to poor recognition. Our objective is to describe the incidence, tPA utilization, inpatient mortality, length of stay, and cost associated with stroke in pediatric population. Methods: Ischemic stroke cases between the ages of 1 and 17 years were obtained from the Nationwide Inpatient Sample (NIS) for the period from January 1, 2000 through December 31, 2014. The primary outcome was inpatient mortality. The secondary outcome was LOS and total cost per day. National trend estimate followed HCUP methodical standard which adopted the design change at 2012 with appropriate trend weight. Weighted estimates were made via SURVEYMEAN procedure and presented as national estimate ± standard error from sampling. SAS9.4 was used for the analysis. Results: From January 2000 through December 2014, there were an estimated 12908±1087 pediatric cases with ischemic stroke, 157±28 (1.2%±0.2%) had TPA. Pediatric ischemic stroke patients were predominantly discharged from urban, large-bed-size, teaching hospitals (40.7%±3.9%), more likely to be white (39.3%±1.8%) and male (52.5%±1.2%), most prevalent among those aged 16 years old (10.3%±0.8%). Overall inpatient mortality was 3.0±0.3 per 100 discharges. Median LOS was 4.0±0.1 days. Median total charge per day was $ 8162±348. Majority of pediatric ischemic stroke patients discharged routinely to home or self-care (75.8%±1.2%). Conclusion: This study highlights that during the prespecified time frame of four years there was an estimated 12908±1087 ischemic strokes in the pediatric population and less than 2% of children received alteplase. Hospital mortality was 3.0% ± 0.3%. The average length of stay was 4 days with an estimated cost of $8162+/- 348 per day. The majority of pediatric patients were discharged home.

scholarly journals Palliative Care in the Kyrgyz Republic

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 35s-35s
Author(s):  
Bakyt Shaimbetov ◽  
Astra Arzymatova
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Pain Score ◽  
Average Length ◽  
Kyrgyz Republic ◽  
Home Based ◽  
Average Pain ◽  
Palliative Care Services ◽  
The Mean ◽  
Care System

Abstract 55 Currently, there are 22,984 cancer patients registered in the Kyrgyz Republic. In 2014, 5,552 new patients were diagnosed with malignant tumors and 3,219 of them died the same year. Total cancer rates in the country are steadily growing with 89.1 cases/100,000 population in 2012, 89.6 cases/100,000 population in 2013 and 95.1 cases/100,000 population in 2014. With growing cancer prevalence, need for accessible and sustainable palliative care system is rapidly increasing. In 2012, a Strategy of Palliative Care Development in the Kyrgyz Republic for 2012-2016 was proposed to address provision of patient palliative care in the country. As a result, the Kyrgyz government accepted a policy of referring patients to Palliative care facilities based on medical diagnosis and, therefore, these services must be monitored for quality control. We examined developmental progress of palliative care system in the Kyrgyz Republic and its outcomes. Data were collected from 453 terminal cancer patients registered in the Department of Palliative Care of the National Oncology Center. We used the average length of stay and the subsequent place of care as process indicators, as well as changes in the mean pain score as outcome measurements. There were considerable variations among services with regards to the mean length of stay (i.e., 6 to 28 days for each admission) and subsequent place of care, even after stratification by service level. The mean change in average pain score varied from −1.5 to 2.1, and remained significant after case-mix adjustment. We discovered significant variations in palliative care services quality in relation to the average length of stay, subsequent places of care as well as alterations in the average pain score. Continuous evaluation of changes in the establishment and outcomes of palliative care services will assist in the development of comparative analysis and evaluation of public policies of the national Palliative Care system. In accordance with the Soros Foundation-Kyrgyzstan, a new initiative is currently being implemented by the National Center of Oncology: “Creating an integrated palliative care service model at home.” The purpose of this project is expansion of home-based end-of-life services provided by a multidisciplinary team for terminal patients in the city of Bishkek. As a part of the initiative, 87 patients have already received home-based palliative care assistance. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from either author.

Trends and presentation patterns of acute rheumatic fever hospitalisations in the United States

2019 ◽  
Vol 29 (11) ◽  
pp. 1387-1390
Author(s):  
Tyler Bradley-Hewitt ◽  
Chris T. Longenecker ◽  
Vuyisile Nkomo ◽  
Whitney Osborne ◽  
Craig Sable ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Rheumatic Fever ◽  
Private Insurance ◽  
Case Fatality ◽  
The United States ◽  
Hospital Charges ◽  
The South ◽  
Asian Pacific Islanders ◽  
Asian Pacific

AbstractObjective:Rheumatic fever, an immune sequela of untreated streptococcal infections, is an important contributor to global cardiovascular disease. The goal of this study was to describe trends, characteristics, and cost burden of children discharged from hospitals with a diagnosis of RF from 2000 to 2012 within the United States.Methods:Using the Kids’ Inpatient Database, we examined characteristics of children discharged from hospitals with the diagnosis of rheumatic fever over time including: overall hospitalisation rates, age, gender, race/ethnicity, regional differences, payer type, length of stay, and charges.Results:The estimated national cumulative incidence of rheumatic fever in the United States between 2000 and 2012 was 0.61 cases per 100,000 children. The median age was 10 years, with hospitalisations significantly more common among children aged 6–11 years. Rheumatic fever hospitalisations among Asian/Pacific Islanders were significantly over-represented. The proportion of rheumatic fever hospitalisations was greater in the Northeast and less in the South, although the highest number of rheumatic fever admissions occurred in the South. Expected payer type was more likely to be private insurance, and the median total hospital charges (adjusted for inflation to 2012 dollars) were $16,000 (interquartile range: $8900–31,200). Median length of stay was 3 days, and the case fatality ratio for RF in the United States was 0.4%.Conclusions:Rheumatic fever persists in the United States with an overall downwards trend between 2003 and 2012. Rheumatic fever admissions varied considerably based on age group, region, and origin.

Analysis of Cost Variation in Craniotomy for Tumor Using 2 National Databases

Neurosurgery ◽  
2017 ◽  
Vol 81 (6) ◽  
pp. 972-979 ◽  
Author(s):  
Corinna C Zygourakis ◽  
Caterina Y Liu ◽  
Seungwon Yoon ◽  
Christopher Moriates ◽  
Christy Boscardin ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Multivariate Analyses ◽  
Private Insurance ◽  
Western United States ◽  
Teaching Hospitals ◽  
Total Hospital Cost ◽  
Cost Variation ◽  
Hospital Factors ◽  
National Databases

Abstract BACKGROUND There is a significant increase and large variation in craniotomy costs. However, the causes of cost differences in craniotomies remain poorly understood. OBJECTIVE To examine the patient and hospital factors that underlie the cost variation in tumor craniotomies using 2 national databases: the National Inpatient Sample (NIS) and Vizient, Inc. (Irving, Texas). METHODS For 41 483 patients who underwent primary surgery for supratentorial brain tumors from 2001 to 2013 in the NIS, we created univariate and multivariate models to evaluate the effect of several patient factors and hospital factors on total hospital cost. Similarly, we performed multivariate analysis with 15 087 cases in the Vizient 2012 to 2015 database. RESULTS In the NIS, the mean inflation-adjusted cost per tumor craniotomy increased 30%, from $23 021 in 2001 to $29 971 in 2013. In 2001, the highest cost region was the Northeast ($24 486 ± $1184), and by 2013 the western United States was the highest cost region ($36 058 ± $1684). Multivariate analyses with NIS data showed that male gender, white race, private insurance, higher mortality risk, higher severity of illness, longer length of stay, elective admissions, higher wage index, urban teaching hospitals, and hospitals in the western United States were associated with higher tumor craniotomy costs (all P &lt; .05). Multivariate analyses with Vizient data confirmed that longer length of stay and the western United States were significantly associated with higher costs (P &lt; .001). CONCLUSION After controlling for patient/clinical factors, hospital type, bed size, and wage index, hospitals in the western United States had higher costs than those in other parts of the country, based on analyses from 2 separate national databases.

Cytoreductive nephrectomy in the United States: Patterns of care and patient characteristics.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 366-366 ◽  
Author(s):  
Che-Kai Tsao ◽  
Erin Moshier ◽  
Alexander C. Small ◽  
Guru Sonpavde ◽  
James Godbold ◽  
...  
Keyword(s):  
Randomized Trials ◽  
Kinase Inhibitor ◽  
Private Insurance ◽  
Patient Characteristics ◽  
The United States ◽  
Teaching Hospitals ◽  
Cytoreductive Nephrectomy ◽  
Treatment Standard ◽  
Patterns Of Use ◽  
Significant Difference

366 Background: Two randomized trials published in 2001 established cytoreductive nephrectomy (CyNx) for patients (pts) with metastatic renal carcinoma (mRCC) as a treatment standard in the cytokine era (Flanigan, J Urol, 2004). However, first-line systemic therapy for mRCC changed in 2005 with FDA approval of VEGFR tyrosine kinase inhibitor (TKIs). We evaluated the patterns of use of CyNx in the pre- and post-TKI era and characteristics of pts undergoing CyNx. Methods: The National Cancer Database was queried for pts diagnosed with mRCC between 2000 and 2008. Pts who underwent CyNx were identified and were further categorized by pre- versus post-TKI era (2000–2006 vs. 2006–2008), race, insurance status, and hospital. For these subcategories, prevalence ratios (PR) were generated using the proportion of pts with mRCC undergoing CyNx versus those not undergoing CyNx. Results: Of the 47,417 patients (pts) with mRCC diagnosed between 2000 and 2008, 25,616 pts (54%) did not undergo CyNx. The prevalence of cytoreductive nephrectomy increased 3% each year from 2000 to 2006 (p<0.0001), then decreased 3% each year from 2006 to 2008 (p=0.0048), with a significant difference between the pre- and post-2006 PR (0.97 versus 1.025; p<0.0001). Blacks (PR 1.17) and Hispanics (PR 1.05) were significantly more likely than Caucasian to not undergo CyNx (p<0.008). Pts with Medicaid (PR 1.25), Medicare (PR 1.40), and no insurance (PR 1.42) were significantly more likely than pts with private insurance to not undergo CyNx (p<0.0001). Pts diagnosed at community hospitals (PR 1.29) were significantly more likely than pts at teaching hospitals to not undergo CyNx (p <0.0001). Conclusions: The use of CyNx has declined in the post-TKI era. In addition, racial and socioeconomic disparities exist in the use of CyNx. The results of pending randomized trials evaluating the role of CyNx in the post-TKI era are awaited to optimize use of this modality.

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