Abstract 17175: Trendsin Alcoholic Cardiomyopathy Hospitalizations and In-Hospital Mortality and Comorbidity. United States, 2005-2014

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Samian Sulaiman ◽  
Arshad Jahangir ◽  
Vijayadershan Muppidi ◽  
Addis Asfaw ◽  
Muhammad Shahreyar ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Racial Differences ◽  
National Level ◽  
Median Length ◽  
Alcoholic Cardiomyopathy ◽  
Nationwide Inpatient Sample Database ◽  
Hospital Stays

Background: Yearly trends and prevalence of alcoholic cardiomyopathy (ACMP) hospitalizations and its associated in-hospital mortality, arrhythmia, complications and outcomes are not well studied on a national level. Methods: We used Nationwide Inpatient Sample database (2005-14) and identified 25402 hospitalizations for adults (≥18 yrs) with a primary or secondary diagnosis of ACMP . Since ACMP is a diagnosis of exclusion, all patients with a co-diagnosis of CAD or other causes of cardiomyopathy were excluded. Results: Taking the growth of the US general population into account, there was a decreasing number of ACMP hospital stays per 100,000 persons (4.38 in 2005 vs 3.62 in 2014; p < 0.001). Arrhythmias were present in in 48.7% of hospital stays. In-hospital mortality was 4.2% down-trending over years (4.3% 2005 vs 3.7% 2014) but this was not statistically significant (p = 0.78). Approximately 2.1% experienced cardiac arrest(uptrend from 1.4% to 3.2% in 2005-14; p <0.001). Prevalence of arrhythmia in this population has increased from 2005 to 2014 (46.5% vs 51.6%; p <0.001). Mean age was 55.01 ±12.2 yrs and 85.2% were male. Patients with arrhythmia were older (57.08 vs 53.03; p<0.01), had more comorbidities (Elixhauser index 2.55 vs 1.85; p < .01). Gender and racial differences were noted between arrhythmia and non-arrhythmia group respectively: Male (88.6% vs 82%; p< 0.01),White (68.2% vs 57.4%), Black (18.8% vs 28.5%) (p < 0.01) . AFib was the most common type of arrhythmia (30.7%), followed by V Tach (8.7%), unspecified arrhythmia (8.6%), and AFlutter (5.6%). Median charge per hospital stay was $25909. Median length of stay was 4 d. Despite that the Median length of stay (4 days) has not changed (4 days in 2005 vs 5 days in 2014; p = 16%), Median charge per hospital stay has increased from $18223.5 to $34056 : p <0.01. Cardioversion was performed in 1.2 %, Catheter ablation in 0.4 %, PPM implantation in 0.7 %, ICD in 1.5 %, cardiac catheterization in 16 % and VAD in 0.1% of hospitalizations for alcoholic cardiomyopathy. Utilization of these procedures has increased from 12% in 2005 to 14.6% in 2014 (p = 2.6%) Conclusion: There was a decreasing number of ACMP hospitalizations per 100,000 of US population. Despite the increased prevalence of arrhythmias in this population over years, the in-hospital mortality has not change, but rate of cardiac arrest has increased. The Median length of hospital stay has not changed, but the healthcare cost has significantly increased. This could be explained by the increased utilization of inpatient cardiac procedures.

The in-hospital outcomes of the use of microaxial left ventricular assist device vs intra-aortic ballon pump in acute myocardial infarction complicated by cardiogenic shock

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Jin ◽  
Y Yang ◽  
B Liu
Keyword(s):  
Cardiac Arrest ◽  
Blood Transfusion ◽  
Length Of Stay ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Bleeding Complications ◽  
Categorical Variables ◽  
Cardiac Complications

Abstract Purpose To compare the outcomes of patients with AMI underwent percutaneous coronary intervention (PCI) complicated by cardiogenic shock treated with IABP vs MLVAD. Methods The Nationwide Inpatient Sample (NIS) database is the largest inpatient registry in the U.S. We used NIS year 2009–2014 to identify adult patients admitted for AMI, who received PCI and complicated by cardiogenic shock. Based on the use of IABP or MLVAD, the study population was divided into 2 groups. To reduce selection bias, we performed propensity score matching using Kernell method. Patient characteristics, hospital characteristics, and comorbidities were matched. Logistic regression was used for categorical variables including in-hospital mortality, requirement of blood transfusion, sepsis, cardiac arrest and cardiac complications (including iatrogenic complications, hemopericardium, and cardiac tamponade). Poisson regression was used for continuous variables including length of stay and total cost. Results A total of 49837 patients were identified. With propensity score match, 34132 patients in IABP group were matched to 1430 patients in MLVAD group. Compared with MLVAD group, the IABP group had lower in-hospital mortality rates (28.29% vs 40.36%, OR 0.58 (0.42–0.81), p=0.002), lower rate of blood transfusion (9.63% vs 11.50%, OR 0.49 (0.27–0.88), p=0.017), and lower cost (47167 vs 70429 USD, p&lt;0.001). IABP and MLVAD group had similar length of stay (8.9 versus 9.3 days, p=0.882), rates of cardiac complication (6.50% vs 7.24%, OR 0.56 (0.26–1.19), p=0.134), rates of sepsis (9.30% vs 14.98%, OR 0.66 (0.38–1.14), p=0.133), and rates of cardiac arrest (37.84% vs 41.05%, OR 0.70 (0.45–1.10), p=0.123). Conclusion In patients with AMI underwent PCI and complicated by cardiogenic shock, MLAVD compared with IABP was associated with higher risk of in-hospital mortality, requirement of blood transfusion indicating presence of major bleeding complications, and cost, although study interpretation is limited by retrospective observational design. Further research is warranted to elucidate the optimal MCSD in these patients. Funding Acknowledgement Type of funding source: None

scholarly journals The modified Blumgart anastomosis after pancreaticoduodenectomy: a retrospective single center cohort study

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Georgi Kalev ◽  
Christoph Marquardt ◽  
Herbert Matzke ◽  
Paul Matovu ◽  
Thomas Schiedeck
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Pancreatic Fistula ◽  
Pancreatic Head ◽  
Suture Technique ◽  
Postoperative Pancreatic Fistula ◽  
Intermediate Care ◽  
Pancreatic Head Resection ◽  
Pancreatic Anastomosis

AbstractObjectivesThe postoperative pancreatic fistula (POPF) is a major complication after pancreatic head resection whereby the technique of the anastomosis is a very influencing factor. The literature describes a possible protective role of the Blumgart anastomosis.MethodsPatients after pancreatic head resection with reconstruction through the modified Blumgart anastomosis (a 2 row pancreatic anastomosis through mattress sutures of the parenchyma and duct to mucosa pancreaticojejunostomy, Blumgart-group) were compared with patients after pancreatic head resection and reconstruction through the conventional pancreatojejunostomy (single suture technique of capsule and parenchyma to seromuscularis, PJ-group). The Data were collected retrospectively. Depending on the propensity score matching in a ratio of 1:2 comparison groups were set up. Blumgart-group (n=29) and PJ-group (n=56). The primary end point was the rate of POPF. Secondary goals were duration of operation, length of hospital stay, length of stay on intermediate care units and hospital mortality.ResultsThe rate of POPF (biochemical leak, POPF “grade B” and POPF “grade C”) was less in the Blumgart-group, but without statistical relevance (p=0.23). Significantly less was the rate of POPF “grade C” in the Blumgart-group (p=0.03). Regarding the duration of hospital stay, length of stay on intermediate care units and hospital mortality, there was no relevant statistical difference between the groups (p=0.1; p=0.4; p=0.7). The duration of the operation was significantly less in the Blumgart-group (p=0.001).ConclusionsThe modified Blumgart anastomosis technique may have the potential to decrease major postoperative pancreatic fistula.

Abstract 491: Racial Disparities in the Trends of Acute Myocardial Infarction Outcomes Among Medicaid Patients, 2007-2011

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Oluwole M Adegbala ◽  
Akintunde Akinjero ◽  
Samson Alliu ◽  
Adeyinka C Adejumo ◽  
Emmanuel Akintoye ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
African Americans ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Racial Disparities ◽  
Racial Differences ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Racial Groups

Background: Although, in-hospital mortality from acute myocardial infarction (AMI) have declined in the United States recently, there is a gap in knowledge regarding racial differences in this trend. We sought to evaluate the effect of race on the trends in outcomes after Acute Myocardial Infarction among Medicaid patients in a nationwide cohort from 2007-2011 Methods: We extracted data from the Nationwide Inpatient Sample (NIS) for all hospitalizations between 2007 and 2011 for Medicaid patients aged 45 years or older with principal diagnosis of AMI using ICD-9-CM codes. Primary outcome of this study was all cause in-hospital mortality. We then stratified hospitalizations by racial groups; Whites, African Americans and Hispanics, and assessed the time trends of in-hospital mortality before and after multivariate analysis. Results: The overall mortality from AMI among Medicaid patients declined during the study period (8.80% in 2007 to 7.46% in 2011). In the adjusted models, compared to 2007, in-hospital mortality from AMI for Medicaid patients decreased across the 3 racial groups; Whites (aOR= 0.88, CI=0.70-0.99), African Americans (aOR=0.76, CI=0.57-1.01), Hispanics (aOR=0.87, CI=0.66-1.25). While the length of hospital stay declined significantly among African American and Hispanic with 2 days and 1.76 days decline respectively, the length of stay remained unchanged for Whites. There was non-significant increase in the incidence of stroke across the various racial groups; Whites (aOR= 1.23, CI=0.90 -1.69), African Americans (aOR=1.10, CI=0.73 -1.64), Hispanics (aOR=1.03, CI=0.68-1.55) when compared to 2007. Conclusion: In this study, we found that in-hospital mortality from AMI among Medicaid patients have declined across the racial groups. However, while the length of stay following AMI declined for African Americans and Hispanics with Medicaid insurance, it has remained unchanged for Whites. Future studies are necessary to identify determinants of these significant racial disparities in outcomes for AMI.

scholarly journals Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana

2020 ◽  
Author(s):  
Sarah Peiffer ◽  
Anna E. Ssentongo ◽  
Laura Keeney ◽  
Forster Amponsah-Manu ◽  
Richard Yeboako ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Univariate Analysis ◽  
Gastrointestinal Surgery ◽  
Significant Risk ◽  
Morbidity And Mortality ◽  
Surgical Trauma ◽  
Rural Ghana ◽  
Laparoscopic Equipment ◽  
Hospital Stays

Abstract Background/Purpose: Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients at Eastern Regional Hospital (ERH) in Ghana. Methods: This is a retrospective review of perioperative morbidity and mortality in children <18 years at ERH in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study. Univariate analysis was performed using Pearson’s chi-square tests or Fisher’s exact tests. Variables that were significant on univariate analysis were included in multivariable logistic regression models adjusted for age and gender.Results: We analyzed 468 patients <18 years of age with a median length of stay (LOS) of 3 days. The 90-day readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19%) and appendectomy (15%). Gastrointestinal surgery, surgical trauma, surgical infection and lack of insurance were significantly associated with prolonged LOS. Young age and female gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. Conclusions: Malaria infection is a significant risk factor for readmission, which should be investigated and treated in pediatric surgical patients in rural Ghana. Ensuring that all patients have insurance may result in shorter hospital stays. Provision of laparoscopic equipment may reduce hospital stays for patients undergoing gastrointestinal surgery. Expansion of the surgical work force, particularly pediatric surgeons, could improve perioperative survival in the very young population.

scholarly journals Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana

2020 ◽  
Author(s):  
Sarah Peiffer ◽  
Anna E. Ssentongo ◽  
Laura Keeney ◽  
Forster Amponsah-Manu ◽  
Richard Yeboako ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Univariate Analysis ◽  
Gastrointestinal Surgery ◽  
Significant Risk ◽  
Morbidity And Mortality ◽  
Surgical Trauma ◽  
Rural Ghana ◽  
Laparoscopic Equipment ◽  
Hospital Stays

Abstract Background/Purpose: Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients at Eastern Regional Hospital (ERH) in Ghana. Methods: This is a retrospective review of perioperative morbidity and mortality in children <18 years at ERH in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study . Univariate analysis was performed using Pearson’s chi-square tests or Fisher’s exact tests. Variables that were significant on univariate analysis were included in multivariable logistic regression models adjusted for age and gender.Results: We analyzed 468 patients <18 years of age with a median length of stay (LOS) of 3 days. The 90-day readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19%) and appendectomy (15%). Gastrointestinal surgery, surgical trauma, surgical infection and lack of insurance were significantly associated with prolonged LOS. Young age and female gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. Conclusions: Malaria infection is a significant risk factor for readmission, which should be investigated and treated in pediatric surgical patients in rural Ghana. Ensuring that all patients have insurance may result in shorter hospital stays. Provision of laparoscopic equipment may reduce hospital stays for patients undergoing gastrointestinal surgery. Expansion of the surgical work force, particularly pediatric surgeons, could improve perioperative survival in the very young population.

scholarly journals The impact of diabetes on outcomes, length of stay and costs in acute kidney injury patients: a cross-sectional multicenter study in China

2020 ◽  
Author(s):  
Lishan Tan ◽  
Li Chen ◽  
Lingyan Li ◽  
Jinwei Wang ◽  
Xiaoyan Huang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
The Impact ◽  
Physician Diagnosis

Abstract Background : With the increasing worldwide prevalence and disease burden of diabetic mellitus, data on the impact of diabetes on acute kidney injury (AKI) patients in China are limited.Methods: A nationwide cross-sectional and retrospective study was conducted in China, which included 2,223,230 hospitalized adult patients and covered 82% of the country’s population. Diabetes was identified according to blood glucose, hemoglobin A1c levels, physician diagnosis and drug use. In total, 7604 AKI patients were identified, and 1404 and 6200 cases were defined as diabetic and non-diabetic respectively. Clinical characteristics, outcome, in-hospital stay, and costs of AKI patients with and without diabetes were compared. Multivariable logistic and linear regression analyses were conducted to evaluate the association of diabetes with mortality and renal recovery in the admitted AKI patients.Results: In this survey, AKI patients with diabetes were older, male-dominated (61.9%), with more comorbidities, and higher serum creatinine levels. Compared to patients without diabetes, a significant upswing in all-cause in-hospital mortality, hospital stay, and costs were found in those with diabetes ( p <0.05). After adjusted for relevant covariables, diabetes was independently associated with failed renal recovery (OR=1.13, p =0.04), rather than all-cause in-hospital mortality (OR=1.09, p =0.39). Also, diabetic status was positively associated with length of stay ( β =0.04, p =0.04) and costs ( β =0.09, p <0.01) in hospital after adjusted for possible confounders. Conclusions: Failed renal recovery, rather than all-cause in-hospital mortality, is independently associated with diabetes in hospitalized AKI patients. Moreover, diabetes is significantly correlated with in-hospital stay and expenditures in AKI.

scholarly journals Predictors and outcomes of acute respiratory failure in hospitalised patients with acute pancreatitis

2020 ◽  
pp. flgastro-2020-101496
Author(s):  
Mahesh Gajendran ◽  
Bharat Prakash ◽  
Abhilash Perisetti ◽  
Chandraprakash Umapathy ◽  
Vineet Gupta ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Significant Risk ◽  
Hospital Length Of Stay ◽  
Systemic Complications ◽  
Nationwide Inpatient Sample Database ◽  
Hospitalised Patients

Background and aimAcute pancreatitis (AP) is associated with organ failures and systemic complications, most commonly acute respiratory failure (ARF) and acute kidney injury. So far, no studies have analysed the predictors and hospitalisation outcomes, of patients with AP who developed ARF. The aim of this study was to measure the prevalence of ARF in AP and to determine the clinical predictors for ARF and mortality in AP.MethodsThis is a retrospective cohort study using the Nationwide Inpatient Sample database from the year 2005–2014. The study population consisted of all hospitalisations with a primary or secondary discharge diagnosis of AP, which is further stratified based on the presence of ARF. The outcome measures include in-hospital mortality, hospital length of stay and hospitalisation cost.ResultsIn our study, about 5.4% of patients with AP had a codiagnosis of ARF, with a mortality rate of 26.5%. The significant predictors for ARF include sepsis, pleural effusion, pneumonia and cardiogenic shock. Key variables that were associated with a higher risk of mortality include mechanical ventilation, age more than 65 years, sepsis and cancer (excluding pancreatic cancer). The presence of ARF increased hospital stay by 8.3 days and hospitalisation charges by US$103 460.ConclusionIn this study, we demonstrate that ARF is a significant risk factor for increased hospital mortality, greater length of stay and higher hospitalisation charges in patients with AP. This underlines significantly higher resource utilisation in patients with a dual diagnosis of AP-ARF.

Abstract 19082: Cardiac Events and Mortality During Admissions for Delivery in Women with Congenital Heart Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Robert M Hayward ◽  
Elyse Foster ◽  
Zian H Tseng
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Cardiac Arrest ◽  
Heart Disease ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Congenital Heart ◽  
Cardiac Events ◽  
Live Births ◽  
History Of

Background: Labor, delivery, and the postpartum period are a time of increased arrhythmia and congestive heart failure (CHF) incidence. With improvements in the treatment of congenital heart disease (CHD), more women are reaching childbearing age and may be at increased risk for cardiac events and mortality during pregnancy and delivery. Methods: The Healthcare Cost and Utilization Project was used to identify admissions for vaginal and cesarean delivery in California hospitals between 1/1/2005 and 12/31/2011. We compared length of stay, in-hospital mortality, incident CHF, cardiac arrest, and incident arrhythmias for women without CHD to women with non-complex CHD (NC-CHD) and complex CHD (C-CHD). Results: We identified 2,720,980 deliveries resulting in 2,770,382 live births (74% of live births in the state over this period), which included 3,218 women with NC-CHD and 248 women with C-CHD. History of CHF was more common in women with CHD (8.1% for C-CHD, 2.6% for NC-CHD, and 0.08% for women without CHD, p<0.00005 for NC-CHD compared to no CHD and for C-CHD compared to no CHD). Those with CHD were more likely to undergo cesarean section (Table 1). Length of stay was significantly longer in women with CHD (2.6 ± 2.3 days for women without CHD, 3.4 ± 10.2 days for women with NC-CHD and 5.0 ± 13.3 days for women with C-CHD). In-hospital mortality was not significantly higher in women with CHD (Table 1). Incident heart failure, arrhythmias, and cardiac arrest were uncommon in all groups (Table 1). Conclusions: In this study of 2.7 million women admitted to California hospitals for delivery, women with CHD were more likely to undergo cesarean section and had longer length of stay. Despite more frequent history of CHF in women with CHD, incident CHF and arrhythmias were rare during hospitalization. In-hospital mortality and cardiac arrest were not higher in CHD patients. These results suggest that in pregnant women with CHD, cardiac events and mortality at the time delivery are uncommon.

scholarly journals COVID in women in Brazil: length of stay and outcomes of first hospitalizations

Rev Rene ◽  
2021 ◽  
Vol 22 ◽  
pp. e61049
Author(s):  
Erica de Brito Pitilin ◽  
Maicon Henrique Lentsck ◽  
Vanessa Aparecida Gasparin ◽  
Larissa Pereira Falavina ◽  
Vander Monteiro da Conceição ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Ecological Study ◽  
Length Of Hospital Stay ◽  
Secondary Diagnosis ◽  
Chi Square ◽  
Hospital Stays ◽  
Underlying Diseases

Objective: to analyze the length of hospital stay and outcomes of the first hospitalizations due to COVID-19 of women at the beginning of the pandemic. Methods: ecological study with data on COVID-19 hospitalizations of women. Data classification was done by states, regions, age, length of hospital stay, main and secondary diagnosis (underlying diseases), and outcome. Kruskal-Wallis, Mann-Whitney, and chi-square tests were used for the analysis. Results: the Southeast region had the highest number of hospitalizations (0.6%). Of the total number of hospitalizations, 14.6% required an intensive care unit. The length of hospital stay of women over 50 years was significant for Brazil (p<0.001). There was an association between length of hospital stay and levels 2 and 3 of comorbidity. Deaths in women over 50 years old were significant in Brazil, Northeast, and Southeast (p<0.001). Conclusion: women over 50 years old with comorbidities are associated with longer hospital stays and deaths.

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