Medicaid payer status is associated with increased mortality and morbidity after inpatient shoulder arthroplasty: a multistate analysis, 2007–2014

Background and objectivesInpatient shoulder arthroplasty is widely performed around the USA at an increasing rate. Medicaid insurance has been identified as a risk factor for inferior surgical outcomes. We sought to identify the impact of being Medicaid-insured on in-hospital mortality, readmission, complications, and length of stay (LOS) in patients who underwent inpatient shoulder arthroplasty.MethodsWe analyzed 89 460 patient discharge records for inpatient total, partial, and reverse shoulder arthroplasties using data from the Healthcare Cost and Utilization Project’s State Inpatient Databases for California, Florida, New York, Maryland, and Kentucky from 2007 through 2014. We compared patient demographics, present-on-admission comorbidities, and hospital characteristics by insurance payer. We estimated multilevel mixed-effect multivariate logistic regression models and generalized linear models to assess insurance’s effect on in-hospital mortality, readmission, infectious complications, cardiac complications, and LOS; models controlled for patient and hospital characteristics.ResultsMedicaid-insured patients had greater odds than patients with private insurance, other insurance, and Medicare of inpatient mortality (OR: 4.61, 95% CI 2.18 to 9.73, p<0.001) and 30-day and 90-day readmissions (OR: 1.94, 95% CI 1.57 to 2.38, p<0.001; OR: 1.65, 95% CI 1.42 to 2.38, p<0.001, respectively). Compared with private insurance, other insurance, and Medicare patients, Medicaid patients had increased likelihood of developing infectious complications and were expected to have longer LOS.ConclusionsOur study supports our hypothesis that among inpatient shoulder arthroplasty patients, those with Medicaid insurance have worse outcomes than patients with private insurance, other insurance, and Medicare. These results are relatively consistent with previous findings in the literature.

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910. A Comprehensive, One Year, Hospital-Wide Snapshot of All Serious Infectious Complications in People Who Inject Drugs

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1098 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S489-S490

Author(s):

John T Henderson ◽

Evelyn Villacorta Cari ◽

Nicole Leedy ◽

Alice Thornton ◽

Donna R Burgess ◽

...

Keyword(s):

Multivariable Analysis ◽

Vertebral Osteomyelitis ◽

The United States ◽

Infectious Complications ◽

Data Set ◽

Cumulative Impact ◽

Mortality And Morbidity ◽

Icu Admission ◽

Risk Of Death ◽

The Impact

Abstract Background There has been a dramatic rise in IV drug use (IVDU) and its associated mortality and morbidity, however, the scope of this effect has not been described. Kentucky is at the epicenter of this epidemic and is an ideal place to better understand the health complications of IVDU in order to improve outcomes. Methods All adult in-patient admissions to University of Kentucky hospitals in 2018 with an Infectious Diseases (ID) consult and an ICD 9/10 code associated with IVDU underwent thorough retrospective chart review. Demographic, descriptive, and outcome data were collected and analyzed by standard statistical analysis. Results 390 patients (467 visits) met study criteria. The top illicit substances used were methamphetamine (37.2%), heroin (38.2%), and cocaine (10.3%). While only 4.1% of tested patients were HIV+, 74.2% were HCV antibody positive. Endocarditis (41.1%), vertebral osteomyelitis (20.8%), bacteremia without endocarditis (14.1%), abscess (12.4%), and septic arthritis (10.4%) were the most common infectious complications. The in-patient death rate was 3.0%, and 32.2% of patients were readmitted within the study period. The average length of stay was 26 days. In multivariable analysis, infectious endocarditis was associated with a statistically significant increase in risk of death, ICU admission, and hospital readmission. Although not statistically significant, trends toward mortality and ICU admission were identified for patients with prior endocarditis and methadone was correlated with decreased risk of readmission and ICU stay. FIGURE 1: Reported Substances Used FIGURE 2: Comorbidities FIGURE 3: Types of Severe Infectious Complications Conclusion We report on a novel, comprehensive perspective on the serious infectious complications of IVDU in an attempt to measure its cumulative impact in an unbiased way. This preliminary analysis of a much larger dataset (2008-2019) reveals some sobering statistics about the impact of IVDU in the United States. While it confirms the well accepted mortality and morbidity associated with infective endocarditis and bacteremia, there is a significant unrecognized impact of other infectious etiologies. Additional analysis of this data set will be aimed at identifying key predictive factors in poor outcomes in hopes of mitigating them. Disclosures All Authors: No reported disclosures

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Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction

Sao Paulo Medical Journal ◽

10.1590/s1516-31802006000400003 ◽

2006 ◽

Vol 124 (4) ◽

pp. 186-191 ◽

Cited By ~ 6

Author(s):

Afonso Celso Pereira ◽

Roberto Alexandre Franken ◽

Sandra Regina Schwarzwälder Sprovieri ◽

Valdir Golin

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Right Ventricular ◽

Left Ventricular ◽

Hospital Death ◽

Inferior Wall ◽

Mortality And Morbidity ◽

Killip Class ◽

Increased Risk ◽

The Impact

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

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Impact of Comorbidities on Length of Stay and Mortality in Hospitalized Patients with Cancer and Febrile Neutropenia

Blood ◽

10.1182/blood.v124.21.2601.2601 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2601-2601 ◽

Cited By ~ 3

Author(s):

Eva Culakova ◽

Marek S. Poniewierski ◽

Jeffrey Crawford ◽

David C. Dale ◽

Gary H. Lyman

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Research Funding ◽

Infectious Complications ◽

Hospitalized Patients ◽

Cancer Type ◽

Patients With Cancer ◽

Time Period ◽

Increased Risk ◽

The Impact

Background: Hematologic toxicities are common side effects of cancer chemotherapy. Despite advances in supportive care, febrile neutropenia (FN) continues to represent a serious adverse event often requiring hospitalization and is associated with an increased risk of mortality. The purpose of this analysis was to investigate the impact of comorbidities and infectious complications on in-patient length of stay (LOS) and mortality in hospitalized patients with cancer and neutropenia over the past decade. Methods: Hospitalization data from the University Health Consortium database inclusive of the years 2004-2012 from 239 US medical centers were analyzed. Cancer type, presence of neutropenia, comorbidities, and infection type were based on ICD-9-CM codes recorded during hospitalization. This analysis includes adult patients with malignant disease and neutropenia. Patients undergoing bone marrow or stem cell transplantation were excluded. For patients with multiple hospitalizations, the first admission during the time period studied was utilized. Primary study outcomes included hospital length of stay (LOS≥10 days) and in-hospital mortality. Multivariate logistic regression analysis was utilized to study the impact of major comorbidities on the primary outcomes. Major comorbidities under consideration included heart, liver, lung, renal, cerebrovascular, peripheral-vascular disease, diabetes and venous thromboembolism. Results: Among 135,309 patients with cancer hospitalized with neutropenic events, one-third were age 65 years or older and 51% were male. Approximately one-quarter (24.5%) of patients experienced more than one admission with FN. The mean (median) length of stay increased progressively from 11.1 (6) days in 2004 to 12.8 (7) days in 2012. Patients with leukemia, lymphoma and central nervous system (CNS) malignancies experienced the longest mean LOS (21.4, 10.5, 10.2 days, respectively). Overall, 50,846 (37.6%) had a LOS≥10 days and 10,261 (7.6%) patients died during the hospitalization with no difference seen over the time period of observation. (P=.30). Greater rates of mortality were observed in patients with lung (11.2%) or CNS (9.3%) malignancies, and leukemia (9.3%). Infectious complications were documented in 59.5% of patients and their presence was associated with greater LOS≥10 days (48.2% vs. 22.0%) and higher mortality (11.2% vs. 2.3%). Greater LOS≥10 days (51.6% vs. 37.1%) and increased mortality (9.8% vs. 7.5%) were also observed among obese patients with cancer. Likewise, patients with multiple comorbid conditions had more prolonged hospitalizations and a greater risk of in-hospital mortality. (Table) Abstract 2601. Table Solid tumors Lymphoma LeukemiaNo. of comorbiditiesNo. of patients% died% with LOS≥10 daysNo. of patients% died% with LOS≥10 daysNo. of patients% died% with LOS≥10 days017,8580.911.28,1890.617.010,3950.853.5118,1723.417.97,7512.626.611,3803.463.2214,2508.927.25,3868.141.08,6039.769.937,49918.038.42,86118.455.25,04022.877.742,70525.151.41,06033.670.52,00438.183.1≥ 560235.262.327839.980.657749.087.0All patients*61,0867.022.625,5256.632.237,9999.265.4 LOS – length of stay; * 10,699 patients with other type or multiple tumors not included in the table The trend toward longer LOS and greater mortality with increased number of comorbidities persisted in multivariate analyses after adjusting for cancer type, age, gender, ethnicity and type of infection (odds ratio (OR) per +1 comorbidity increase: [mortality: OR =1.89; 95% CI: 1.85-1.92; P<.0001], [LOS: OR=1.56; 95% CI: 1.54-1.58; P<.0001]). Conclusions: Major medical comorbidities are common among hospitalized patients with cancer and neutropenia. Importantly, such comorbidities are associated with prolonged hospitalization and increased risk of in-hospital mortality with significantly worse outcomes in patients with lymphoma or leukemia. Greater awareness of risk factors associated with poor prognosis in cancer patients hospitalized with neutropenic complications as well as validated risk tools to better identify low risk as well high risk patients may guide more personalized cancer care, potentially improving clinical outcomes and lowering the cost of care. Disclosures Crawford: Amgen: Consultancy. Dale:Amgen: Consultancy, Honoraria, Research Funding. Lyman:Amgen: Research Funding.

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Impact of admission month and hospital teaching status on outcomes in subarachnoid hemorrhage: evidence against the July effect

Journal of Neurosurgery ◽

10.3171/2011.8.jns11324 ◽

2012 ◽

Vol 116 (1) ◽

pp. 157-163 ◽

Cited By ~ 35

Author(s):

Robert J. McDonald ◽

Harry J. Cloft ◽

David F. Kallmes

Keyword(s):

Subarachnoid Hemorrhage ◽

Hospital Mortality ◽

Hospital Admissions ◽

Adverse Outcomes ◽

Discharge Disposition ◽

July Effect ◽

Teaching Status ◽

Discharge Status ◽

The Impact ◽

Hospital Characteristics

Object The authors sought to identify the presence of a “July effect,” a transient increase in adverse outcomes during July, among a cohort of spontaneous subarachnoid hemorrhage (SAH) admissions recorded in the National Inpatient Sample (NIS). Methods The discharge status, admission month, patient demographics, treatment parameters, and hospital characteristics among spontaneous SAH admissions were extracted from the 2001–2008 NIS. Multivariate regression was used to determine whether an unfavorable discharge status and/or in-hospital mortality significantly increased in summer months in a pattern suggestive of a July effect. Additional models were generated to assess the impact of hospital teaching status on these outcomes. Results Among 57,663,486 hospital admissions from the 2001–2008 NIS, 52,879 cases of spontaneous SAH (ICD-9-CM 430) were treated at teaching (36,914 cases [70%]) and nonteaching (15,965 cases [30%]) facilities. Regression models failed to reveal a July effect for in-hospital mortality (χ2 = 0.75, p = 1.000) or unfavorable discharges (χ2 = 1.69, p = 0.999) among monthly SAH admissions, although they did suggest a significant reduction in these outcomes (in-hospital mortality, OR = 0.89, p < 0.001; unfavorable discharges, OR = 0.88, p < 0.001) among teaching hospitals as compared with nonteaching hospitals after adjustment for disparities in demographic, treatment, and hospital characteristics. Conclusions The discharge disposition among SAH admissions within the NIS was not suggestive of a July effect but did reveal that teaching institutions have significantly lower rates of adverse outcomes when compared with nonteaching hospitals. Note, however, that the origins of this difference related to teaching status remain unclear.

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The Effect of Diabetes on the Cognitive Trajectory of Older Adults in Mexico and the United States

The Journals of Gerontology Series B ◽

10.1093/geronb/gbaa094 ◽

2020 ◽

Author(s):

Jaqueline C Avila ◽

Silvia Mejia-Arangom ◽

Daniel Jupiter ◽

Brian Downer ◽

Rebeca Wong

Keyword(s):

United States ◽

Older Adults ◽

Linear Models ◽

The United States ◽

Mixed Effect ◽

Cognitive Domains ◽

Aging Study ◽

Nationally Representative ◽

The Impact ◽

Over Time

Abstract Objectives To study the impact of diabetes on the long-term cognitive trajectories of older adults in 2 countries with different socioeconomic and health settings, and to determine whether this relationship differs by cognitive domains. This study uses Mexico and the United States to confirm if patterns hold in both populations, as these countries have similar diabetes prevalence but different socioeconomic conditions and diabetes-related mortality. Methods Two nationally representative cohorts of adults aged 50 years or older are used: the Mexican Health and Aging Study for Mexico and the Health and Retirement Study for the United States, with sample sizes of 18,810 and 26,244 individuals, respectively, followed up for a period of 14 years. The outcome is cognition measured as a total composite score and by domain (memory and nonmemory). Mixed-effect linear models are used to test the effect of diabetes on cognition at 65 years old and over time in each country. Results Diabetes is associated with lower cognition and nonmemory scores at baseline and over time in both countries. In Mexico, diabetes only predicts lower memory scores over time, whereas in the United States it only predicts lower memory scores at baseline. Women have higher total cognition and memory scores than men in both studies. The magnitude of the effect of diabetes on cognition is similar in both countries. Discussion Despite the overall lower cognition in Mexico and different socioeconomic characteristics, the impact of diabetes on cognitive decline and the main risk and protective factors for poor cognition are similar in both countries.

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Relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis

Scientific Reports ◽

10.1038/s41598-021-93635-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daisuke Kasugai ◽

Masayuki Ozaki ◽

Kazuki Nishida ◽

Yukari Goto ◽

Kunihiko Takahashi ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Hospital Mortality ◽

Logistic Regression Analysis ◽

Mortality Risk ◽

The United States ◽

Research Database ◽

Mixed Effect ◽

Platelet Counts ◽

The Impact

AbstractIn sepsis-associated coagulopathies and disseminated intravascular coagulation, relative platelet reductions may reflect coagulopathy severity. However, limited evidence supports their clinical significance and most sepsis-associated coagulopathy criteria focus on the absolute platelet counts. To estimate the impact of relative platelet reductions and absolute platelet counts on sepsis outcomes. A multicenter retrospective observational study was performed using the eICU Collaborative Research Database, comprising 335 intensive care units (ICUs) in the United States. Patients with sepsis and an ICU stay > 2 days were included. Estimated effects of relative platelet reductions and absolute platelet counts on mortality and coagulopathy-related complications were evaluated. Overall, 26,176 patients were included. Multivariate mixed-effect logistic regression analysis revealed marked in-hospital mortality risk with larger platelet reductions between days one and two, independent from the resultant absolute platelet counts. The adjusted odds ratio (OR) [95% confidence intervals (CI)] for in-hospital mortality was 1.28[1.23–1.32], 1.86[1.75–1.97], 2.99[2.66–3.36], and 6.05[4.40–8.31] for 20–40%, 40–60%, 60–80%, and > 80% reductions, respectively, when compared with a < 20% decrease in platelets (P < 0.001 for each). In the multivariate logistic regression analysis, platelet reductions ≥ 11% and platelet counts ≤ 100,000/μL on day 2 were associated with high coagulopathy-related complications (OR [95%CI], 2.03 and 1.18; P < 0.001 and P < 0.001), while only platelet reduction was associated with thromboembolic complications (OR [95%CI], 1.43 [1.03–1.98], P < 0.001). The magnitude of platelet reductions represent mortality risk and provides a better signature of coagulopathies in sepsis; therefore, it is a plausible criterion for sepsis-associated coagulopathies.

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Venous Thromboembolism in Hospitalized Patients with Multiple Myeloma: A Nationwide Analysis

Blood ◽

10.1182/blood-2018-99-116101 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3596-3596

Author(s):

Kahee A Mohammed ◽

Kristen M Sanfilippo

Keyword(s):

Multiple Myeloma ◽

Venous Thromboembolism ◽

Hospital Mortality ◽

Hospitalized Patients ◽

Major Surgery ◽

Hospital Level ◽

Prolonged Hospitalization ◽

Increased Risk ◽

The Impact ◽

Hospital Characteristics

Abstract Background: The burden of multiple myeloma has increased in last 30 years, both in US and globally. Patients with multiple myeloma are at increased risk of developing venous thromboembolism (VTE) resulting in significant morbidity and mortality. This study aimed to (1) determine patient and hospital characteristics associated with VTE, (2) assess the impact of VTE on in-hospital mortality and prolonged hospitalization, and (3) examine trends in the rates of VTE and VTE-associated in-hospital mortality and prolonged hospitalization in patients with multiple myeloma. Methods: A retrospective analysis of Nationwide Inpatient Sample, 2008 - 2014, was conducted. International Classification of Diseases-9-Clinical Modification codes were used to identify hospitalized patients (aged ≥ 18 years) with multiple myeloma. Trends in the prevalence of VTE and VTE-associated in-hospital mortality and prolonged hospitalization rates were assessed using the Cochrane-Armitage test. Weighted, multilevel hierarchical logistic regression using generalized linear mixed models with generalized estimated equations were used to examine the association between patient and hospital characteristics and study outcomes Results: Among 136,652 hospitalized patients with multiple myeloma, 4.2% were diagnosed with VTE. Although statistically insignificant, a slight increase in VTE rates were observed from 2008 to 2014 (3.9% to 4.4%) (p 0.18). In adjusted multilevel hierarchical regression, we found higher odds of VTE in male gender (odds ratio [OR] = 1.08, 95% Confidence Interval [CI] = 1.02 - 1.14), Black race (OR = 1.11, 95% CI = 1.03 - 1.19), those who had a major surgery (OR = 1.73, 95% CI = 1.62 - 1.85), and higher Elixhauser comorbidity index (OR = 3.73, 95% CI = 2.66 - 5.23). Hospital level correlates of VTE included: admission to teaching vs. non-teaching (OR = 1.07, 95% CI = 1.01 - 1.13), and admission to medium vs. small sized hospitals (OR = 1.11, 95% CI = 1.01 - 1.23), while lower odds of VTE were noted among patients admitted to hospitals located in Northeast (OR = 0.91, 95% CI = 0.84 - 0.98) vs. South. Patients diagnosed with vs. without VTE had higher odds of in-hospital mortality (OR = 1.36, 95% CI = 1.22 - 1.51) and prolonged hospital stay (OR = 1.65, 95% CI = 1.55 - 1.75). A statistically significant trend for decreasing VTE associated mortality (10.0% to 5.3%) (p <.001) and prolonged hospitalization (32.1% to 28.2%) (p <.001) rates were observed across study years. Conclusions: During the study period, there has been an increase in rate of VTE among patients with multiple myeloma. Patients with multiple myeloma and VTE had a high risk of in-hospital mortality compared to those without VTE; however, rates of VTE-associated in-hospital mortality and prolongation of hospitalization have decreased over time. Hospital level characteristics were significantly associated with VTE. These findings might reflect changing detection guidelines and better management of VTE in cancer patients. Lastly, patient level characteristics independently predict the occurrence of VTE. Given the higher in-hospital mortality associated with patients with VTE and multiple myeloma, there is a need for prospective studies to identify effective strategies to prevent VTE in this patient population and improve outcomes. Disclosures Sanfilippo: Bristol-Myers Squibb: Speakers Bureau.

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To Pack or Not to Pack: Inpatient Management of Epistaxis in the Elderly

American Journal of Rhinology and Allergy ◽

10.1177/1945892418801259 ◽

2018 ◽

Vol 32 (6) ◽

pp. 539-545 ◽

Cited By ~ 4

Author(s):

Albert H. Zhou ◽

Sei Y. Chung ◽

Michael J. Sylvester ◽

Michael Zaki ◽

Peter S. Svider ◽

...

Keyword(s):

Length Of Stay ◽

Elderly Patients ◽

Hospital Mortality ◽

The Elderly ◽

Primary Diagnosis ◽

Pulmonary Complications ◽

Nasal Packing ◽

Hospital Charges ◽

Cardiac Complications ◽

The Impact

Background Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly. Methods The 2008–2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. Results A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001). Conclusion Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.

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