65Utilization of percutaneous left atrial appendage closure in patients with atrial fibrillation in the United States: analysis from national inpatient sample 2016

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Wu ◽  
K Ho
Keyword(s):  
Length Of Stay ◽  
Left Atrial Appendage ◽  
National Inpatient Sample ◽  
Left Atrial Appendage Closure ◽  
Total Cost ◽  
The Us ◽  
Comorbidity Index ◽  
The Mean ◽  
Mean Time ◽  
Related Mortality

Abstract Introduction/Background In recent years, the percutaneous left atrial appendage closure (LAAC) has been gaining its popularity in the US. However its use in the US in recent years has not been well described. Purpose To provide an updated cross-sectional survey of performance of percutaneous LAAC in the US at national database level. Methods We use ICD-10 disease and procedure code to identify all the percutaneous LAAC performed in 2016 in US from national inpatient sample database. The demographic feature, comorbidity, mean time to procedure, mortality, complication rate, length of stay, total cost were described. Procedure related complication Including any vascular, cardiac, respiratory, neurologic and renal complications defined by AHRQ as patient safety indicators. Results There is approximately a total of 7550 percutaneous LAAC performed in the US in 2016. The majority of the patients were elderly (mean age 66.83±0.34), white (80.41%) male (59.04%). The mean Charlson Comorbidity Index score is 1.74, with hypertension (76.75%), diabetes (29.23%) being the most common comorbidity. The mean time to procedure is 1.98±0.11 days. The procedure related mortality is 2.06%, whereas the complication rate is 19.6%. The average length of stay is 10.77 day, with an average total cost of 239.67 thousand dollars. Baseline characterlistisc and outcomes Total percutaneous LAAC (estimated from sample) 7550 Age, years 66.83±0.34 Male, % 59.04 White, % 80.41 Mean Charlson Comorbidity Index 1.74±0.31 Hypertension, % 76.75 Diabetes, % 29.23 CKD, % 21.42 Mean Time to procedure, days 1.98±0.11 Mortality, % 2.06 Length of Stay, days 10.77±0.25 Any Complication, % 19.6 Total Cost, thousand dollars 239.67±10.01 Values are reported as mean ± SD. Categorical variables are represented as frequency. Conclusion A total of 7550 percutaneous LAAC was performed in US in 2016. The procedure related mortality is 2.06%, with an average time to procedure of 1.98 days and a length of stay of 10.77 days.

scholarly journals National Trends for Primary and Revision Lumbar Disc Arthroplasty Throughout the United States

2017 ◽  
Vol 8 (2) ◽  
pp. 172-177 ◽  
Author(s):  
Comron Saifi ◽  
Alejandro Cazzulino ◽  
Caroline Park ◽  
Joseph Laratta ◽  
Philip K. Louie ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Lumbar Disc ◽  
The United States ◽  
Care Utilization ◽  
National Inpatient Sample ◽  
Disc Arthroplasty ◽  
Total Cost ◽  
Lumbar Disc Arthroplasty ◽  
The Mean

Study Design: Retrospective database study. Objectives: Analysis of economic and demographic data concerning lumbar disc arthroplasty (LDA) throughout the United States to improve value-based care and health care utilization. Methods: The National Inpatient Sample database was queried for patients who underwent primary or revision LDA between 2005 and 2013. Demographic and economic data included total surgeries, costs, length of stay, and frequency of routine discharge. The National Inpatient Sample database represents a 20% sample of discharges from US hospitals weighted to provide national estimates. Results: Primary LDA decreased 86% from 3059 to 420 from 2005 to 2013. The mean total cost of LDA increased 33% from $17 747 to $23 804. The mean length of stay decreased from 2.8 to 2.4 days. The mean routine discharge (home discharge without visiting nursing care) remained constant at 91%. Revision procedures (removal, supplemental fixation, or reoperation at the treated level) declined 30% from 194 to 135 cases over the study period. The mean revision burden, defined as the ratio of revision procedures to the sum of primary and revision procedures, was 12% (range 6% to 24%). The mean total cost of revisions ranged from $12 752 to $22 282. Conclusions: From 2005 to 2013, primary LDA significantly declined in the United States by 86% despite several studies pointing to improved efficacy and cost-efficiency. This disparity may be related to a lack of surgeon reimbursement from insurance companies. Congruently, the number of revision LDA cases has declined 30%, while revision burden has risen from 6% to 24%.

Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

2021 ◽  
pp. 1
Keyword(s):  
Postoperative Complications ◽  
Ileal Conduit ◽  
Perioperative Complications ◽  
Movement Time ◽  
Oral Intake ◽  
Total Cost ◽  
Handsewn Anastomosis ◽  
Significant Difference ◽  
The Mean ◽  
Mean Time

Background and objective: Ileal conduit for urinary diversion can be completed using either end-to-end handsewn or stapled anastomosis. This study aimed to compare stepled and handsewn anastomosis methods in terms of complications, hospitalization and cost. Materials and methods: Forty-three patients were included in the hand-sewn and 44 patients in the stapler group. After creating an ileal conduit, continuity of the loop was achieved either with handsewn or stapler method. Patients' demographic data, time to onset of bowel movement, time to transit to oral intake, time to removal of the drain, perioperative and postoperative complications, mortality and total costs were retrospectively recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in terms of the mean to the onset of bowel movements (p = 0.51) and the mean time to transit to oral intake (p = 0.23). The mean time to removal of the drain was significantly lower in the stapler group (p = 0.023). Perioperative complications were seen in eight patients in the handsewn group, while none of the patients in the stapler group developed perioperative complication (p = 0.003). Postoperative complications were similar between both groups (p = 0.75). The duration of hospitalization was statistically significantly lower in the stapler group (p = 0.004) and the mean total cost was statistically significantly more advantageous (p < 0.001). Conclusion: No significant difference was found between stapler and handsewn anastomosis techniques in terms of postoperative complications. On the other hand, hospitalization and total cost were in favour of stapler technique, showing that this technique can be used safely.

scholarly journals The updated Charlson comorbidity index is a useful predictor of mortality in patients with Staphylococcus aureus bacteraemia

2018 ◽  
Vol 146 (16) ◽  
pp. 2122-2130 ◽  
Author(s):  
H. G. Ternavasio-de la Vega ◽  
F. Castaño-Romero ◽  
S. Ragozzino ◽  
R. Sánchez González ◽  
M. P. Vaquero-Herrero ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Charlson Comorbidity Index ◽  
Regression Models ◽  
Model Fit ◽  
Logistic Regression Models ◽  
Relevant Variables ◽  
Comorbidity Index ◽  
The Mean ◽  
Related Mortality ◽  
Better Than

AbstractThe objective was to compare the performance of the updated Charlson comorbidity index (uCCI) and classical CCI (cCCI) in predicting 30-day mortality in patients with Staphylococcus aureus bacteraemia (SAB). All cases of SAB in patients aged ⩾14 years identified at the Microbiology Unit were included prospectively and followed. Comorbidity was evaluated using the cCCI and uCCI. Relevant variables associated with SAB-related mortality, along with cCCI or uCCI scores, were entered into multivariate logistic regression models. Global model fit, model calibration and predictive validity of each model were evaluated and compared. In total, 257 episodes of SAB in 239 patients were included (mean age 74 years; 65% were male). The mean cCCI and uCCI scores were 3.6 (standard deviation, 2.4) and 2.9 (2.3), respectively; 161 (63%) cases had cCCI score ⩾3 and 89 (35%) cases had uCCI score ⩾4. Sixty-five (25%) patients died within 30 days. The cCCI score was not related to mortality in any model, but uCCI score ⩾4 was an independent factor of 30-day mortality (odds ratio, 1.98; 95% confidence interval, 1.05–3.74). The uCCI is a more up-to-date, refined and parsimonious prognostic mortality score than the cCCI; it may thus serve better than the latter in the identification of patients with SAB with worse prognoses.

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 16: Racial Disparities in Clinical Outcomes and Resource Utilization in Acute Ischemic Stroke Hospitalizations in the United States: Results from the 2012 National Inpatient Sample

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Nilay Kumar ◽  
Anand Venkatraman ◽  
Neetika Garg
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Racial Minorities ◽  
National Inpatient Sample ◽  
The Us ◽  
To Receive ◽  
Total Charges

Background and objectives: There are limited data on racial differences in clinical and economic outcomes of acute ischemic stroke (AIS) hospitalizations in the US. We sought to ascertain the effect of race on AIS outcomes in a population based retrospective cohort study. Methods: We used the 2012 National Inpatient Sample (NIS), which is the largest database of inpatient stays in the US, to identify cases of AIS using ICD9-CM codes 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91 and 437.1 in patients >=18 years of age. Cases with missing data on race were excluded (5% of study sample). Primary outcome was in-hospital mortality. Secondary outcomes included proportion receiving endovascular mechanical thrombectomy (EMT) or thrombolysis, mean inflation adjusted charges and length of stay. Linear and logistic regression was used to test differences in continuous and categorical outcomes respectively. Survey techniques were used for all analyses. Results: There were 452, 330 hospitalizations for AIS in patients >=18 years in 2012. In univariate logistic regression using race as predictor, in-hospital mortality was significantly lower for Blacks (p<0.001), Hispanics (p=0.025) and Native Americans (p=0.047) compared to Whites. However, after adjusting for age, sex, Charlson comorbidity index, EMT and thrombolysis only blacks had a significantly lower mortality compared to whites (OR 0.74, 95% CI 0.66 - 0.82, p<0.001). Black patients were less likely to receive thrombolysis (OR 0.87, 95% CI 0.79 - 0.95; p=0.003) whereas Asian or Pacific Islanders were more likely to receive thrombolysis (OR 1.20, 95% CI 1.01 - 1.44; p=0.043) compared to whites. There was no difference in rates of EMT by race (p=0.18). Total charges and length of stay were significantly higher in racial minorities compared to whites (table). Conclusions: Blacks hospitalized for AIS have significantly lower in-hospital mortality compared to whites but are significantly less likely to receive thrombolysis compared to whites. Total charges and length of stay are significantly higher for racial minorities. Future studies should investigate mechanisms of this apparent protective effect of black race on in-hospital mortality in AIS.

scholarly journals P192 Crystallising care: improving hospital gout management

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Benjamin D Clarke ◽  
Mark D Russell ◽  
Andrew I Rutherford ◽  
James B Galloway ◽  
John Stack
Keyword(s):  
Length Of Stay ◽  
Hospital Admissions ◽  
British Society ◽  
Published Data ◽  
Incidence Trends ◽  
Joint Aspiration ◽  
Difficult Condition ◽  
The Mean ◽  
Clinical Records ◽  
Mean Time

Abstract Background Gout is the most common cause of a hot swollen joint, and a major contributor to inpatient rheumatology workload. Recently published data demonstrated that hospital admissions due to gout increased by 59% in England from 2006 - 2017. The mean length of stay for a gout admission was 6 days in 2017; a figure that has not changed significantly over the last decade. We hypothesised that a key contributing factor to prolonged hospital stays in patients presenting with gout attacks is delayed joint aspiration and synovial fluid analysis. We investigated time to joint aspiration, and time taken to obtain a crystal analysis result, in acute rheumatology referrals at a large tertiary centre. Methods Electronic Health Records (EHR) system data were accessed for all joint aspirate crystal analyses in a 4-month window in 2017. EHR system documentation contains all clinical notes, electronic referrals, and laboratory requests with indicative coded timestamps. Pre- and post-aspirate differential diagnoses were compiled from the clinical record. Manual verification of the clinical records ascertained whether there was any delay in discharge pertaining to a crystal analysis. For representation, time figures were rounded to the nearest hour. Results Over a 4-month period, 38 patients who had been referred to the inpatient rheumatology team at King’s College Hospital had crystal analysis performed following joint aspiration; 24 from an emergency department setting, and 14 from an inpatient ward setting. The proportions of these cases by articular distribution (with the specific joint aspirated in brackets) were: 55% monoarthritis (knee), 16% oligoarthritis (knee), 16% polyarthritis (knee), 10% polyarthritis (wrist), 3% monoarthritis (elbow). Mean time from rheumatology referral to joint aspiration was 7 hours (range 1-21; median 5; IQR 3-8). The mean time from sample acquisition to crystal analysis result was 20 hours (range 1-95; median 16; IQR 4-21). Discharges for 17/38 (45%) patients were pending crystal analysis results, of which 10/17 (59%) patients were discharged without results. Rheumatology clinician pre-test diagnostic accuracy was 55%. Comparing pre-aspirate diagnosis with final diagnosis, proportionately septic arthritis was over-diagnosed, whilst gout was under-diagnosed. Conclusion Gout remains a difficult condition to promptly differentiate and treat in hospital. Clinician workload and joint aspiration burden are rising due to global incidence trends. A move to establish a “7-day NHS” and significant bed pressures have developed since the British Society for Rheumatology (BSR) hot swollen joint guideline was published. In our centre, inadequate crystal diagnostics appear to be driving prolonged length of stay. Further evaluation of causal factors in the delay of recognition, referral and diagnostics is required. Through application of quality improvement methodology, process-mapping and driver diagrams we plan to implement a point-of-care testing (POCT) and door-to-needle (DTN) programme, researching how to improve the gout patient’s experience. Disclosures B.D. Clarke None. M.D. Russell None. A.I. Rutherford None. J.B. Galloway None. J. Stack None.

scholarly journals Rectus sheath catheters provide equivalent analgesia to epidurals following laparotomy for colorectal surgery

2015 ◽  
Vol 97 (7) ◽  
pp. 530-533 ◽  
Author(s):  
ECG Tudor ◽  
W Yang ◽  
R Brown ◽  
PM Mackey
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Malignant Disease ◽  
Colorectal Resection ◽  
Rectus Sheath ◽  
Pain Scores ◽  
Average Pain ◽  
Open Colorectal Resection ◽  
The Mean ◽  
Mean Time

Introduction Rectus sheath catheters (RSCs) are increasingly being used to provide postoperative analgesia following laparotomy for colorectal surgery. Little is known about their efficacy in comparison with epidural infusion analgesia (EIA). They are potentially better as they avoid the recognised complications associated with EIA. This study compares these two methods of analgesia. Outcomes include average pain scores, time to mobilisation and length of stay. Methods This was a 33-month single centre observational study including all patients undergoing elective open or laparoscopic-converted-to-open colorectal resection for both benign and malignant disease. Patients received either EIA or RSCs. Data were collected prospectively and analysed retrospectively. Results A total of 95 patients were identified. Indications for surgery, operation and complications were recorded. The mean time to mobilisation was significantly shorter in patients who had RSCs compared with EIA patients (2.4 vs 3.5 days, p<0.05). There was no difference in postoperative pain scores or length of stay. Conclusions RSCs provide equivalent analgesia to EIA and avoid the recognised potential complications of EIA. They are associated with a shorter time to mobilisation. Their use should be adopted more widely.

scholarly journals SUN-620 Gender Difference in the Outcome of Patients with Diabetes Admitted for Hyperosmolar Hyperglycemia. from the National Inpatient Sample

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Fatima Ahmed ◽  
Ashraf Abugroun ◽  
Manar Elhassan ◽  
Berhane Seyoum
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Lower Risk ◽  
Female Gender ◽  
Secondary Outcome ◽  
National Inpatient Sample ◽  
Patients With Diabetes ◽  
Hyperosmolar Hyperglycemic State ◽  
The Mean ◽  
The Impact

Abstract Objective: There is paucity of literature on the impact of gender on outcomes of hyperosmolar hyperglycemic state (HHS) among adult patients with diabetes. The aim of this study was to evaluate the effect of gender on the outcome of these patients. Methodology: The National Inpatient Sample (NIS) was queried for all patients who were admitted with a diagnosis of hyperosmolar hyperglycemic state (HHS) during the years 2005-2014. The primary outcomes of the study were all-cause mortality, acute myocardial infarction (MI), and acute stroke. The secondary outcomes were acute kidney injury (AKI), rhabdomyolysis, acute respiratory failure (ARF), need for mechanical ventilation (MV), length of stay (LOS), and total cost of stay. Results: Overall, 188,725 patients were admitted for HHS. Mean age of males was 53.7, standard error of the mean (SEM: 0.13), and of females was 58.5 (SEM: 0.15), p&lt;0.001. Females were (43.9%), Caucasians were 37.4% while African Americans were 35.2%. Total mortality was 1.1%, MI was 1.3% and stroke was 1.1%. Most common secondary outcome was AKI seen in 31.3% followed by ARF seen in 2.9% of total. The mean cost was 7887 $ (SEM: 84.6) and mean LOS was 4.1 days (SEM: 0.03). Both males and females had equivalent rates of mortality, stroke, ARF and need for mechanical ventilation. Compared to males, females had significantly higher risk for MI 1.6% vs 1.1%, p&lt;0.001, lower risk for AKI 29.3% vs 32.9%, p&lt;0.001, lower risk for rhabdomyolysis 1.1% vs 2%, p&lt;0.001 and higher LOS 4.3 vs 3.9 days, p&lt;0..01 and higher total costs 8165.6 $ vs 7669.3 $, p &lt; 0.001. On multivariable analysis, female gender was independently predictive for higher risk for MI with adjusted odds ratio (aOR) 1.34 [95%CI: 1.08-1.67] p=0.01 and lower risk for rhabdomyolysis with aOR 0.52 [95%CI: 0.42-0.63] p&lt;0.001 and lower risk for AKI with aOR 0.74 [95%CI: 0.7-0.78] p&lt;0.001. In addition, female gender correlated with higher cost and length of stay. Conclusion: Females with hyperosmolar hyperglycemic state are at higher risk for MI and lower risk for AKI and rhabdomyolysis.

Abstract 248: National Trends in Utilization and Economic Outcomes of Catheter Ablation for Atrial Fibrillation in the United States 2003-2008

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Anant Mandawat ◽  
Aditya Mandawat ◽  
Rama Mandawat ◽  
Mahendra Mandawat
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Outcomes ◽  
The United States ◽  
Economic Outcomes ◽  
Future Research ◽  
The Us ◽  
Comorbidity Index ◽  
The Mean ◽  
National Trends

Introduction: Data on the utilization and economic outcomes of catheter ablation in atrial fibrillation (AF) is scarce, limiting the ability to make informed policy decisions. Hypothesis: We hypothesized that the number of catheter ablations for AF increased while length of stay and charges decreased. Methods: Patients > 18 years undergoing catheter ablation for AF were selected in the 2003-2008 HCUP-Nationwide Inpatient Sample, the largest all-payor inpatient database in the US. Patient demographic and clinical variables, including a Charlson comorbidity index, as well as hospital characteristics were analyzed. We calculated trends in rates of utilization, economic (mean LOS and total inflation-adjusted charges) and clinical (in-hospital mortality and in-hospital complications, defined using ICD-9 codes) outcomes using χ 2 , Mantel-Haenszel tests, and analysis of variance (ANOVA). Results: There were 40,145 admissions for catheter ablation for AF (mean age 60.01 years (SD 11.74; Range 18-98). The number of ablations increased by nearly 300% between 2003 and 2008 (Table). A comparison of use rates between 2003-2005 (early) vs 2006-2008 (late) showed a higher utilization among patients aged 65-79 (27.3% vs 34.0%), those with moderate comorbidities (30.3% vs 46.3%), and medium-sized hospitals (9.8% vs 19.7%), all p<0.001. During the study period, the mean LOS decreased by 30% while inflation-adjusted charges increased by 25% (Table). There was no significant change in clinical outcomes (Table). Conclusions: The number of catheter ablations for AF has increased rapidly. Although the procedure is being applied to a broader patient population and being performed in smaller-sized hospitals, LOS has decreased and clinical outcomes are stable. Factors contributing to and strategies to limit rising charges for this expanding procedure are important areas of future research.

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