In-hospital outcomes and prevalence of comorbidities in patients with infective endocarditis with and without heart blocks: Insight from the National Inpatient Sample

2020 ◽  
pp. jim-2020-001501
Author(s):  
Shakeel M Jamal ◽  
Asim Kichloo ◽  
Michael Albosta ◽  
Beth Bailey ◽  
Jagmeet Singh ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Heart Block ◽  
Kidney Injury ◽  
Primary Diagnosis ◽  
Cost Of Care ◽  
Adverse Outcomes ◽  
Cardiac Resynchronization ◽  
National Inpatient Sample

Infective endocarditis (IE) complicated by heart block can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart block are lacking. Patients with a primary diagnosis of IE with or without heart block were identified by querying the Healthcare Cost and Utilization Project database, specifically the National Inpatient Sample for the years 2013 and 2014, based on International Classification of Diseases Clinical Modification Ninth Revision codes. During 2013 and 2014, a total of 18,733 patients were admitted with a primary diagnosis of IE, including 867 with concurrent heart blocks. Increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), and cost of care ($282,573 vs $223,559) were found for patients with IE complicated by heart block. Additionally, these patients were more likely to develop cardiogenic shock (8.9% vs 3.2%), acute kidney injury (40.1% vs 32.6%), and hematologic complications (19.3% vs 15.2%), and require placement of a pacemaker (30.6% vs 0.9%). IE and concurrent heart block resulted in increased requirement for aortic (25.7% vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements. Conclusion was made that IE with concurrent heart block worsens in-hospital mortality, length of stay, and cost for patients. Our analysis demonstrates an increase in cardiac procedures, specifically aortic and/or mitral valve replacements, and Implantable Cardiovascular Defibrillator/Cardiac Resynchronization Therapy/ Permanent Pacemaker (ICD/CRT/PPM) placement in IE with concurrent heart block. A close telemonitoring system and prompt interventions may represent a significant mitigation strategy to avoid the adverse outcomes observed in this study.

Abstract 15593: In Hospital Outcomes and Prevalence of Comorbidities in Patients With Infective Endocarditis With and Without Heart Blocks - Insight From a National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shakeel Jamal ◽  
Asim Kichloo ◽  
michael Albosta ◽  
Beth Bailey ◽  
Ronak Soni ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Heart Block ◽  
Kidney Injury ◽  
Cost Of Care ◽  
Adverse Outcomes ◽  
National Inpatient Sample ◽  
Cardiac Procedures ◽  
Inpatient Outcomes ◽  
Tele Monitoring

Objective: To study inpatient outcomes of infective endocarditis (IE) with concurrent heart blocks Introduction: IE complicated with heart blocks can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart blocks are lacking. Methods: Patients with a principle diagnosis of IE with or without heart blocks were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, the National Inpatient Sample for year 2013 and 2014 based on ICD9 codes. Results: During 2013 and 2014, a total of 18,733 patients were admitted with a diagnosis of IE, out of whom 867 had concurrent heart blocks. There was an increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), cost of care (282,573 vs 223,559), cardiogenic shock (8.9% vs 3.2%), placement of an ICD/CRT/PPM (30.6% vs 0.9%), acute kidney injury (40.1% vs 32.6%) and hematologic complications (19.3 vs 15.2%) in patients admitted with IE with heart blocks as compared to those with IE but without heart block. Infective endocarditis and concurrent heart block resulted in increased requirement for aortic (25.7 vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements as compared to IE without heart block. Conclusions: IE with concurrent heart block worsens in-hospital mortality, length and cost of hospital stay. Our analysis clearly demonstrates an increase in the indications for cardiac procedures, specifically aortic and/or mitral valve replacements and ICD/CRT/PPM placement. A close tele monitoring system and prompt interventions may represent a significant mitigation strategy to avoid adverse outcomes observed in this study.

Abstract 17260: In Hospital Outcomes and Prevalence of Comorbidities in Patients With ST Elevation Myocardial Infarction With and Without Infective Endocarditis - Insight From National Inpatient Sample (2013-2014)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shakeel Jamal ◽  
farah Wani ◽  
Amina Khan ◽  
Asim Kichloo ◽  
Beth Bailey ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Respiratory Failure ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Valve Replacement ◽  
Kidney Injury ◽  
St Elevation Myocardial Infarction ◽  
National Inpatient Sample ◽  
St Elevation

Introduction: In infective endocarditis (IE), embolization to the coronary arteries is an uncommon phenomenon but can contribute to transmural infarction presenting as ST elevation myocardial infarction (STEMI). Due to limited date, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI with and without underlying IE. Hypothesis: Morbidity and morbidity exponentiates in STEMI with comorbid IE when compared to without IE. Methods: Patients with primary diagnosis of STEMI with and without IE were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, National Inpatient Sample for year 2013 and 2014 based on ICD9 codes Results: During 2013 and 2014, a total of 117, 386 patients were admitted with the principle diagnosis of STEMI, out of whom 305 had comorbid IE. There was an increased in-hospital mortality (27.5% vs 10.8%, increased length of stay (14 vs 5 days), acute kidney injury (44.9% vs 18.7%), stroke (23.6% vs 3%), aortic valve replacement (9.5% vs 0.3%), mitral valve replacement (0.2%-5.2%), sepsis (50% vs 6%) and acute respiratory failure (36.7% vs 16.7%) in patients with STEMI with IE when compared to patients with STEMI and without comorbid IE. STEMI without IE had higher number of angiographies (58.7% vs 25.9%) and percutaneous coronary interventions (50.7% vs 14.4%) during their hospital course when compared to STEMI with IE. Conclusions: We conclude that hospitalized STEMI patients with concomitant diagnosis of IE are at higher risk of in-hospital mortality, increased LOS, AKI, stroke, valve replacements, and acute respiratory failure. Clinical trials that compare optimal interventions in these patients would be needed in future.

Abstract 17073: In Hospital Outcomes in Patients With Infective Endocarditis With and Without Liver Cirrhosis - Insight From National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shakeel Jamal ◽  
muhammad shah zaib ◽  
Asim Kichloo ◽  
Iqra Riaz ◽  
Beth Bailey ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Bleeding Complications ◽  
National Inpatient Sample ◽  
Preoperative Risk ◽  
Preoperative Risk Assessment ◽  
General Data

Introduction: Chronic liver disease is known to be an important prognostic factor in determining morbidity and mortality in preoperative risk assessment and mortality in general. Data are limited on outcomes in patients with infective endocarditis (IE) and comorbid concurrent liver cirrhosis. Objective of our study is to evaluate the clinical outcomes of patient with IE with and without underlying liver cirrhosis and determining in-hospital mortality and outcomes of interest i.e. renal failure, cardiogenic shock, hematologic (coagulopathy/thrombocytopenia) and hepatic complications (hepatic encephalopathy/hepatitis). Hypothesis: Liver Cirrhosis worsen clinical outcomes in patients with IE. Methods: Patients with principle diagnosis of IE with and without liver cirrhosis were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, National Inpatient Sample for year 2013 and 2014 based on ICD9 codes. Results: During 2013 and 2014, a total of 17, 952 patients were admitted with diagnosis of IE, out of whom 780 had concurrent liver cirrhosis. There was an increased in-hospital mortality [15.6% vs 10.2%, aOR 1.57(1.27-1.93)], acute kidney injury [41.4% vs 32.6%, aOR 1.45(1.24-1.69)], coagulopathy/thrombocytopenia [32.1 vs 14.7%, aOR 2.87(2.44-3.37)] in patients with IE with liver cirrhosis when compared to patients with IE without liver cirrhosis. IE without liver cirrhosis underwent increased number of interventions i.e. aortic (7.2 vs 3.7%, 0.51(0.34-0.76)] and mitral (4.9% vs 3.4%, aOR 0.39(0.23-0.69)] valvular replacements as compared to without liver cirrhosis. Conclusions: Liver cirrhosis is an important prognostic marker of in-hospital mortality in patients with concurrent IE. High risk surgical state with coagulopathy, bleeding complications, worsening hepatic complications and renal dysfunction lead to higher mortality.

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.

160 The Impact of the Dependent Coverage Provision on Neurosurgical Population

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 240-240
Author(s):  
Matthew Decker ◽  
John David Mayfield ◽  
Paul Kubilis ◽  
Maryam Rahman
Keyword(s):  
Hospital Mortality ◽  
Age Groups ◽  
Primary Diagnosis ◽  
Cost Of Care ◽  
Hospital Length Of Stay ◽  
Control Cohort ◽  
Neurosurgical Patients ◽  
Comorbidity Index ◽  
Dependent Coverage ◽  
The Impact

Abstract INTRODUCTION The Dependent Coverage Provision (DCP), a provision of the Patient Protection and Affordable Care Act (ACA), enables dependents aged 19 25 to remain on parental insurance without restrictions. This increased access to health insurance for the population with the highest uninsured rate. Its impact has not been studied in neurosurgical population where the cost of care is disproportional based on insurance status. METHODS A National Inpatient Sampling database query was performed comparing an experimental (ages 19–25) and a control cohort (ages 27–33) and metrics before (January 2007 March 2009) and after DCP implementation (October 2011 December 2014). Those with a primary diagnosis of traumatic brain injury (TBI), ischemic or hemorrhagic stroke (Stroke) or primary brain tumor (Tumor) had the following metrics obtained: uninsured rate, comorbidity index, hospital length of stay (LOS), in-hospital mortality rates, and disposition status home. A difference-in-difference analysis was performed comparing the cohorts to assess direct effects of DCP. RESULTS >There was a significant decrease in the uninsured rate for TBI (p <.0001) and Stroke (p = .0019) patients but not for Tumor (p = .6663) patients after implementation of the DCP. There was no significant change in the comorbidity index, LOS, or in-hospital mortality for any diagnosis over the study period. An improvement occurred in these metrics in both age groups, however, the differences were insignificant. Lastly, there was an increase for the TBI control cohort to be discharged home (p = .0288) that was not observed elsewhere. CONCLUSION The DCP did decrease the uninsured rate in most neurosurgical patients. Other quality metrics were not different between the pre-DCP and post-DCP cohorts although both groups showed improvement in these metrics over time. The impact of the ACA on quality of care for neurosurgical patients should be further investigated.

scholarly journals Bending the cost curve: time series analysis of a value transformation programme at an academic medical centre

2019 ◽  
Vol 28 (6) ◽  
pp. 449-458 ◽  
Author(s):  
Steven C Chatfield ◽  
Frank M Volpicelli ◽  
Nicole M Adler ◽  
Kunhee Lucy Kim ◽  
Simon A Jones ◽  
...  
Keyword(s):  
Time Series ◽  
Length Of Stay ◽  
Time Series Analysis ◽  
Hospital Mortality ◽  
Cost Of Care ◽  
Medical Centre ◽  
Academic Medical Centre ◽  
Series Analysis ◽  
Academic Medical ◽  
The Cost

BackgroundReducing costs while increasing or maintaining quality is crucial to delivering high value care.ObjectiveTo assess the impact of a hospital value-based management programme on cost and quality.DesignTime series analysis of non-psychiatric, non-rehabilitation, non-newborn patients discharged between 1 September 2011 and 31 December 2017 from a US urban, academic medical centre.InterventionNYU Langone Health instituted an institution-wide programme in April 2014 to increase value of healthcare, defined as health outcomes achieved per dollar spent. Key features included joint clinical and operational leadership; granular and transparent cost accounting; dedicated project support staff; information technology support; and a departmental shared savings programme.MeasurementsChange in variable direct costs; secondary outcomes included changes in length of stay, readmission and in-hospital mortality.ResultsThe programme chartered 74 projects targeting opportunities in supply chain management (eg, surgical trays), operational efficiency (eg, discharge optimisation), care of outlier patients (eg, those at end of life) and resource utilisation (eg, blood management). The study cohort included 160 434 hospitalisations. Adjusted variable costs decreased 7.7% over the study period. Admissions with medical diagnosis related groups (DRG) declined an average 0.20% per month relative to baseline. Admissions with surgical DRGs had an early increase in costs of 2.7% followed by 0.37% decrease in costs per month. Mean expense per hospitalisation improved from 13% above median for teaching hospitals to 2% above median. Length of stay decreased by 0.25% per month relative to prior trends (95% CI −0.34 to 0.17): approximately half a day by the end of the study period. There were no significant changes in 30-day same-hospital readmission or in-hospital mortality. Estimated institutional savings after intervention costs were approximately $53.9 million.LimitationsObservational analysis.ConclusionA systematic programme to increase healthcare value by lowering the cost of care without compromising quality is achievable and sustainable over several years.

P2769Racial differences in outcomes among acute pulmonary embolism patients: a nationwide analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Shi
Keyword(s):  
Pulmonary Embolism ◽  
Regression Analysis ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Primary Diagnosis ◽  
Total Cost ◽  
Rehabilitation Facilities ◽  
The Impact ◽  
White Patients

Abstract Background Limited data is available regarding racial disparities in patients admitted for acute pulmonary embolism. Purpose We aimed to examine the impact of racial differences on outcomes in patients admitted for acute pulmonary embolism. Methods We used the Nationwide Inpatient Sample, which represents 20% of community hospital discharges in the US, to identify adult patients who were discharged with the primary diagnosis of acute pulmonary embolism in 2016 with ICD-10 codes. Logistic regression analysis and linear regression analysis were used to compare patients with different races. Outcomes were focused on in-hospital mortality, total cost, length of stay and disposition, adjusting gender, age, Charlson comorbid index and socioeconomic variables. Results In 2016, 35,526 patients were admitted with a primary diagnosis of acute pulmonary embolism. White patients were more likely to be older and with higher income. After adjusting for the above variables, white patients had lower total cost of hospitalization (p<0.0001), shorter length of stay (p<0.0001), lower in-hospital mortality (adjusted odds ratio = 0.79, p=0.001), and more likely to be discharged to rehabilitation facilities compared to being discharged home. Outcomes in white vs non-white patients Conclusion Among acute pulmonary embolism hospitalizations, white patients generally had better outcomes despite being older in age, and were more likely to be transferred to rehabilitation facilities after discharge.

New Criterion to Evaluate Acute-on-Chronic Kidney Injury Based on the Creatinine Reference Change

2020 ◽  
Vol 51 (6) ◽  
pp. 453-462
Author(s):  
Xin Xu ◽  
Long Wang ◽  
Mengqi Xiong ◽  
Sheng Nie ◽  
Zhangsuo Liu ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Ckd Progression ◽  
Clinical Prognosis ◽  
Reference Change Value ◽  
Chronic Kidney Injury ◽  
Increased Risk ◽  
Ckd Stage

Background: The lack of consensus criteria of acute on chronic kidney injury (ACKI) affects the judgment for its clinical prognosis. Methods: In this study, we analyzed the data from 711,615 hospitalized adults who had at least 2 serum creatinine (SCr) tests within 30 days. We estimated the reference change value (RCV) of SCr given initial SCr level in adults without known risks of acute kidney injury other than chronic kidney disease (CKD). We proposed a criterion for ACKI based on the RCV of SCr (cROCK), which defined ACKI as a ≥25% increase in SCr in 7 days. We validated cROCK by its association with the risks of in-hospital mortality, death after discharge, and CKD progression in a large cohort of patients with CKD stage 3. Results: In 21,661 patients with CKD stage 3, a total of 3,145 (14.5%), 1,512 (7.0%), and 221 (1.0%) ACKI events were detected by both cROCK and Kidney Disease Improving Global Outcomes (KDIGO), cROCK only, and KDIGO only, respectively. cROCK detected 40% more ACKI events than KDIGO. Compared with patients without ACKI by both definitions, those with cROCK- but not KDIGO-defined ACKI had a significantly increased risk of in-hospital mortality (hazard ratio [HR] 5.53; 95% CI 3.75–8.16), death after discharge (HR 1.51; 95% CI 1.21–1.83), and CKD progression (OR 5.65; 95% CI 3.05–10.48). Conclusions: RCV-based criterion (cROCK) for ACKI is clinically valid in that it has a substantially improved sensitivity in identifying patients with high risk of adverse outcomes.

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