Thoracic Trauma in the Oldest of the Old: An Analysis of the Nationwide Inpatient Sample

2017 ◽  
Vol 83 (5) ◽  
pp. 491-494
Author(s):  
Caleb J. Mentzer ◽  
Nathaniel J. Walsh ◽  
Asif Talukder ◽  
Zachary Klaassen ◽  
Ryan Leibrandt ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Thoracic Trauma ◽  
Nationwide Inpatient Sample ◽  
Significant Morbidity ◽  
Geriatric Population ◽  
Nationwide Inpatient Sample Database ◽  
Comorbidity Index

Thoracic trauma (TT) has the second highest mortality rate in the geriatric population. These injuries cause significant morbidity in elderly patients. Little has been done to describe the demographics and mortality of specific injuries in these patients. ICD-9 codes corresponding with thoracic trauma for patients aged >80 years were extracted from the Nationwide Inpatient Sample database from 2000 to 2010. Characteristics including gender, race, Charlson Comorbidity Index (CCI), length of stay (LOS), and in-hospital mortality (IHM) were analyzed. For females and males, mean CCI was 4.84 and 4.93, respectively (P < 0.0001), and IHM was 5.49 and 2.44 per cent, respectively (P < 0.0001). For white and non-white patients, mean CCI was 4.88 and 4.84, respectively (P < 0.05), and IHM was 3.5 and 3.19 per cent, respectively. This difference was not statistically significant (P = 0.149). Logistic regression revealed correlation coefficient between CCI and mortality was 0.314 (P < 0.0001). Fitting a regression of CCI on LOS adjusting for gender and race, the adjusted effect was 0.146 (P < 0.0001). LOS was significantly less for patients surviving hospitalization. Males had higher CCI and mortality than females. Although whites had a higher CCI than non-whites, there was no difference in IHM between these two groups.

Meningioma Resection in the Elderly: Nationwide Inpatient Sample, 1998–2002

Neurosurgery ◽  
2005 ◽  
Vol 57 (5) ◽  
pp. 866-872 ◽  
Author(s):  
Brian T. Bateman ◽  
John Pile-Spellman ◽  
Philip H. Gutin ◽  
Mitchell F. Berman
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Nationwide Inpatient Sample ◽  
Adverse Outcome ◽  
The Elderly ◽  
Elderly Age ◽  
Patient Demographics ◽  
Risks And Benefits ◽  
Nationwide Inpatient Sample Database ◽  
Length Of Hospitalization

Abstract OBJECTIVE: Morbidity and mortality rates reported for meningioma resection in the elderly vary widely. Thus, it is difficult for neurosurgeons to compare the risks and benefits of operating on elderly patients against opting for radiosurgery or watchful waiting. To address this issue, we studied the effect of advanced age on outcome after meningioma resection using the Nationwide Inpatient Sample. METHODS: We identified all patients over the age of 20 in the Nationwide Inpatient Sample database who underwent surgical resection of a meningioma between 1998 and 2002 and were admitted from home. Primary outcomes were in-hospital mortality, adverse outcome (defined as death or discharge to a facility other than home), and length of hospitalization. Multivariate models were constructed to assess the effect of elderly age on the primary outcomes, adjusting for patient demographics, comorbid medical conditions, and hospital surgical volume. RESULTS: There were 8861 patients in the Nationwide Inpatient Sample database who underwent resection of meningioma during the study period; 26.0% were age 70 or older. Each of the primary outcomes demonstrated a marked effect of advancing age. The in-hospital mortality rate was higher in the elderly than in the nonelderly (4.0% versus 1.1%, P &lt; 0.001), as was the rate of discharge to a facility other than home (53.2% versus 16.6%, P &lt; 0.001). Elderly patients also had a longer mean length of stay (7.2 versus 5.1 d P &lt; 0.001). CONCLUSION: The association between elderly age and adverse outcome after meningioma resection suggests a note of caution before proceeding to surgery with these patients.

scholarly journals Total numbers and in-hospital mortality of patients with myocardial infarction in Germany during the FIFA soccer world cup 2014

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Karsten Keller ◽  
Lukas Hobohm ◽  
Volker H. Schmitt ◽  
Martin Engelhardt ◽  
Philip Wenzel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Environmental Stress ◽  
Nationwide Inpatient Sample ◽  
Hospital Admissions ◽  
Patient Characteristics ◽  
World Cup ◽  
National Team ◽  
Comparison Period

AbstractEnvironmental stress like important soccer events can induce excitation, stress and anger. We aimed to investigate (i) whether the FIFA soccer world cup (WC) 2014 and (ii) whether the soccer games of the German national team had an impact on total numbers and in-hospital mortality of patients with myocardial infarction (MI) in Germany. We analyzed data of MI inpatients of the German nationwide inpatient sample (2013–2015). Patients admitted due to MI during FIFA WC 2014 (12th June–13th July2014) were compared to those during the same period 2013 and 2015 (12th June–13th July). Total number of MI patients was higher during WC 2014 than in the comparison-period 2013 (18,479 vs.18,089, P < 0.001) and 2015 (18,479 vs.17,794, P < 0.001). WC was independently associated with higher MI numbers (2014 vs. 2013: OR 1.04 [95% CI 1.01–1.07]; 2014 vs. 2015: OR 1.07 [95% CI 1.04–1.10], P < 0.001). Patient characteristics and in-hospital mortality rate (8.3% vs. 8.3% vs. 8.4%) were similar during periods. In-hospital mortality rate was not affected by games of the German national team (8.9% vs. 8.1%, P = 0.110). However, we observed an increase regarding in-hospital mortality from 7.9 to 9.3% before to 12.0% at final-match-day. Number of hospital admissions due to MI in Germany was 3.7% higher during WC 2014 than during the same 31-day period 2015. While in-hospital mortality was not affected by the WC, the in-hospital mortality was highest at WC final.

Abstract WP314: Renal Insufficiency Worsens Outcomes in Cerebrovascular Disease

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Sea mi Park ◽  
Shouri Lahiri ◽  
Asma Moheet ◽  
Konrad Schlick ◽  
Shlee Song ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Renal Insufficiency ◽  
Cerebrovascular Disease ◽  
Nationwide Inpatient Sample ◽  
Negative Impact ◽  
Care Facility ◽  
Length Of Hospital Stay ◽  
Female Gender ◽  
Outcome Parameters ◽  
Nationwide Inpatient Sample Database

Introduction/Hypothesis: We were interested in studying patient outcomes with acute cerebrovascular disease (ACVD) who had concomitant acute or chronic renal insufficiency (RI). Methods: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (1998-2009) and identified 1,760,415 adult ACVD patients among 92,848,710 patients enrolled. Using SAS 6.4 and applying SPSS 22 the outcome variables mortality, length of hospital stay (LOS), HC (HC) >$20,000, and disposition (home or any care facility) were selected. Logistic regression analyses were performed adjusting for the covariates hypertension (HTN), diabetes mellitus (DM), age, race, sex, number of comorbidities, and care complexity (numbers of inpatient procedures) among all ACVD with and without RI. Results: Mean age was 71 years (SD 15) with 76% >65 years old; 54% female gender; 55% Whites, 11% Blacks, 6% Hispanics. Among all ACVD, 66% had HTN, 28% DM, RI 9%, LOS 7.6 days (SD 9.8), in-patient mortality 12%; disposition home 42% and facility 44%, and mean HC $36,010 (SD $63,331). After covariate adjustment, the mortality rate of ACVD patients with RI was 24% vs 11% (P<0.001) for those without RI; LOS ≥7 days 50% vs 29% (P<0.001); and facility discharge 62% vs 51% (P<0.001). In subgroup analysis, adjusted HC were significantly greater in patients with acute RI (78% vs 43%; P<0.001). The frequency of hemodialysis (HD) in all ACVD patients was 2.3%. Notably, HD was associated with LOS ≥7 days (61% vs 30%; p<0.001), increased mortality rate (25% vs 12%; p<0.001), and HC (76% vs 44%; p<0.001). However, there was no difference in disposition to facility (57% vs 52%; p<0.350). Conclusions: Acute or chronic RI was present in 9% of patients with ACVD. RI was associated with significantly greater risks of in-patient mortality, LOS, and discharge to a facility. In subgroup analyses, the overall HC were greater in patients with acute RI. Patients undergoing HD experienced a similar negative impact on all outcome parameters except for disposition status. The negative impact of RI on vital outcome parameters in ACVD patients should be considered, i.e., when indicating the administration of contrast for imaging.

scholarly journals Does inappropriate initial antibiotic therapy affect in-hospital mortality of patients in the emergency department with Escherichia coli and Klebsiella pneumoniae bloodstream infections?

2020 ◽  
Vol 34 ◽  
pp. 205873842094237
Author(s):  
Fu-Cheng Chen ◽  
Yu-Ni Ho ◽  
Hsien-Hung Cheng ◽  
Chien-Hung Wu ◽  
Meng-Wei Change ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Emergency Department ◽  
Logistic Regression ◽  
Mortality Rate ◽  
Klebsiella Pneumoniae ◽  
Hospital Mortality ◽  
Multiple Logistic Regression ◽  
E Coli ◽  
Time To Antibiotics ◽  
Qsofa Score

Extended-spectrum β-lactamase (ESBL)-positive bloodstream infection (BSI) is on the rise worldwide. The purpose of this study is to evaluate the impact of inappropriate initial antibiotic therapy (IIAT) on in-hospital mortality of patients in the emergency department (ED) with Escherichia coli and Klebsiella pneumoniae BSIs. This retrospective single-center cohort study included all adult patients with E. coli and K. pneumoniae BSIs between January 2007 and December 2013, who had undergone a blood culture test and initiation of antibiotics within 6 h of ED registration time. Multiple logistic regression was used to adjust for bacterial species, IIAT, time to antibiotics, age, sex, quick Sepsis Related Organ Failure Assessment (qSOFA) score ⩾ 2, and comorbidities. A total of 3533 patients were enrolled (2967 alive and 566 deceased, in-hospital mortality rate 16%). The patients with K. pneumoniae ESBL-positive BSI had the highest mortality rate. Non-survivors had qSOFA scores ⩾ 2 (33.6% vs 9.5%, P < 0.001), more IIAT (15.0% vs 10.7%, P = 0.004), but shorter mean time to antibiotics (1.70 vs 1.84 h, P < 0.001). A qSOFA score ⩾ 2 is the most significant predictor for in-hospital mortality; however, IIAT and time to antibiotics were not significant predictors in multiple logistic regression analysis. In subgroup analysis divided by qSOFA scores, IIAT was still not a significant predictor. Severity of the disease (qSOFA score ⩾ 2) is the key factor influencing in-hospital mortality of patients with E. coli and K. pneumoniae BSIs. The time to antibiotics and IIAT were not significant predictors because they in turn were affected by disease severity.

scholarly journals Infective endocarditis at a tertiary care hospital in South Korea

Heart ◽  
2020 ◽  
Vol 107 (2) ◽  
pp. 135-141 ◽  
Author(s):  
Jung Ho Kim ◽  
Hi Jae Lee ◽  
Nam Su Ku ◽  
Seung Hyun Lee ◽  
Sak Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
South Korea ◽  
Hospital Mortality ◽  
Care Hospital ◽  
Multivariable Logistic Regression ◽  
Long Term Prognosis

ObjectiveThe treatment of infective endocarditis (IE) has become more complex with the current myriad healthcare-associated factors and the regional differences in causative organisms. We aimed to investigate the overall trends, microbiological features, and outcomes of IE in South Korea.MethodsA 12-year retrospective cohort study was performed. Poisson regression was used to estimate the time trends of IE incidence and mortality rate. Risk factors for in-hospital mortality were identified with multivariable logistic regression, and model comparison was performed to evaluate the predictive performance of notable risk factors. Kaplan-Meier survival analysis and Cox regression were performed to assess long-term prognosis.ResultsWe included 419 patients with IE, the incidence of which showed an increasing trend (relative risk 1.06, p=0.005), whereas mortality demonstrated a decreasing trend (incidence rate ratio 0.93, p=0.020). The in-hospital mortality rate was 14.6%. On multivariable logistic regression analysis, aortic valve endocarditis (OR 3.18, p=0.001), IE caused by Staphylococcus aureus (OR 2.32, p=0.026), neurological complications (OR 1.98, p=0.031), high Sequential Organ Failure Assessment score (OR 1.22, p=0.023) and high Charlson Comorbidity Index (OR 1.11, p=0.019) were predictors of in-hospital mortality. Surgical intervention for IE was a protective factor against in-hospital mortality (OR 0.25, p<0.001) and was associated with improved long-term prognosis compared with medical treatment only (p<0.001).ConclusionsThe incidence of IE is increasing in South Korea. Although the mortality rate has slightly decreased, it remains high. Surgery has a protective effect with respect to both in-hospital mortality and long-term prognosis in patients with IE.

Survival of Elderly Patients on Peritoneal Dialysis: Retrospective Study of 292 Patients, from 1982 to 1999

2002 ◽  
Vol 22 (1) ◽  
pp. 73-81 ◽  
Author(s):  
François Vrtovsnik ◽  
Raphaël Porcher ◽  
Catherine Michel ◽  
Gilles Hufnagel ◽  
Guillaume Queffeulou ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Retrospective Study ◽  
Mortality Rate ◽  
Sex Ratio ◽  
Elderly Patients ◽  
Poor Prognosis ◽  
Patient Survival ◽  
University Hospital ◽  
Initiation Of Dialysis ◽  
Comorbidity Index

Background Dialysis is becoming increasingly frequent in patients over 75 years of age. Age is a superimposed comorbid factor commonly associated with poor prognosis in these patients. Objective To analyze the survival of 292 patients aged over 75 years on initiation of peritoneal dialysis (PD) from September 1982 to September 1999. Design Retrospective study. Setting Nephrology department in a University Hospital. Results Mean age was 81.5 years (range 75 – 92 years); 178 patients were over 80 years and 60 patients were over 85 years. Sex ratio was 136F/156M. Ninety-day mortality rate was 12%. Excluding the first 3 months, median patient survival was 21.6 months; 226 patients died on PD and 24 were shifted to hemodialysis. Survival was inversely correlated with the Charlson combined comorbidity index (CCI), but independent of predialysis hemoglobin and serum albumin levels. Over three selected periods, 1982 – 1989, 1989 – 1995, and 1995 – 1999, an increase was found in mean age (79.7 ± 3.3, 82.6 ± 3.9, and 81.8 ± 4.4 years; p < 0.001), CCI (7.6 ± 1.59, 8.0 ± 1.52, and 8.5 ± 1.63; p = 0.01), and predialysis creatinine clearance (6.2 ± 2.3, 6.4 ± 2.4, and 9.8 ± 3.8 mL/minute; p < 0.001). Median survival was similar in the various selected periods (21.0, 21.5, and 25.4 months). The incidence of peritonitis decreased from 0.63 to 0.21 episodes per patient year. Conclusion From 1982 to 1999, mean age and comorbidity increased on initiation of dialysis in elderly patients, with no increase in mortality. Survival in elderly patients on PD was related to the age–comorbidity index.

scholarly journals 146. Infective Endocarditis in South Korea: a 12-year Single-Center Experience of 419 Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S100-S101
Author(s):  
Jung Ho Kim ◽  
Hi Jae Lee ◽  
Woon Ji Lee ◽  
Hye Seong ◽  
Jin young Ahn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
South Korea ◽  
Hospital Mortality ◽  
Incidence Rate ◽  
Logistic Regression Analysis

Abstract Background Infective endocarditis (IE) is a potentially lethal disease that has undergone constant changes in epidemiology and pathogen. Treatment of IE has become more complex with today’s myriad healthcare-associated factors as well as regional differences in causative organisms. Therefore, it is necessary to investigate the overall trends, microbiological features, clinical characteristics and outcomes of IE in South Korea. Methods We performed a retrospective cohort study of patients with the diagnosis of probable or definite IE according to the modified Duke Criteria admitted to a tertiary care center in South Korea between November 2005 and August 2017. Poisson log-linear regression was used to estimate time trends of IE incidence rate and mortality rate. Risk factors for in-hospital mortality were evaluated by multivariate logistic regression analysis including an interaction term. Results There were 419 IE patients (275 male vs. 144 female) during the study period. The median age of the patients was 56 years. The annual incidence rate of IE of our institution was significantly increased. (RR 1.05; 95% CI, 1.02–1.08; P = 0.006) The mortality rate showed trends toward down, but not statistically significant (P = 0.875). IE was related to a prosthetic valve in 15.0% and 21.7% patients developed IE during hospitalization. The mitral valve was the most commonly affected valve (61.3%). Causative microorganisms were identified in 309 patients (73.7%) and included streptococci (34.6%), followed by Staphylococcus aureus (15.8%) and enterococci (7.9%). The in-hospital mortality rate was 14.6%. Logistic regression analysis found aortic valve endocarditis (OR 3.18; P = 0.001), IE caused by staphylococcus aureus (OR 2.32; P = 0.026), a presence of central nervous system embolic complication (OR 1.98; P = 0.031), a high SOFA score (OR 1.22; P = 0.023) and a high Charlson’s comorbidity index (OR 1.11; P = 0.019) as predictors of in-hospital mortality. On the other hand, surgical intervention for IE was found to be a protective factor against mortality. (OR 0.25, P < 0.001) Conclusion Although IE has been increasing, the mortality rate has not yet reduced significantly. Studies on causative organisms of IE and risk factors for mortality are warranted in improving prognosis. Disclosures All authors: No reported disclosures.

scholarly journals Propensity Score-Matched Analysis of Open Surgical and Endovascular Repair for Type B Aortic Dissection

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Michael E. Brunt ◽  
Natalia N. Egorova ◽  
Alan J. Moskowitz
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Nationwide Inpatient Sample ◽  
Open Repair ◽  
Complication Rates ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Nationwide Inpatient Sample Database ◽  
Mortality Difference ◽  
Aortic Dissections

Objective. To identify national outcomes of thoracic endovascular aortic repair (TEVAR) for type B aortic dissections (TBADs).Methods. The Nationwide Inpatient Sample database was examined from 2005 to 2008 using ICD-9 codes to identify patients with TBAD who underwent TEVAR or open surgical repair. We constructed separate propensity models for emergently and electively admitted patients and calculated mortality and complication rates for propensity score-matched cohorts of TEVAR and open repair patients.Results. In-hospital mortality was significantly higher following open repair than TEVAR (17.5% versus 10.8%,P= .045) in emergently admitted TBAD. There was no in-hospital mortality difference between open repair and TEVAR (5.6% versus 3.3%,P= .464) for elective admissions. Hospitals performing thirty or more TEVAR procedures annually had lower mortality for emergent TBAD than hospitals with fewer than thirty procedures.Conclusions. TEVAR produces better in-hospital outcomes in emergent TBAD than open repair, but further longitudinal analysis is required.

scholarly journals Prognostic Accuracy of the qSOFA Score for In-Hospital Mortality in Elderly Patients with Obstructive Acute Pyelonephritis: A Multi-Institutional Study

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2277
Author(s):  
Yudai Ishikawa ◽  
Hiroshi Fukushima ◽  
Hajime Tanaka ◽  
Soichiro Yoshida ◽  
Minato Yokoyama ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Acute Pyelonephritis ◽  
Young Patients ◽  
Area Under The Curve ◽  
Predictive Performance ◽  
Initial Assessment ◽  
Prognostic Accuracy ◽  
Comorbidity Index ◽  
Qsofa Score

Prognostic accuracy of the quick sequential organ failure assessment (qSOFA) score for mortality may be limited in elderly patients. Using our multi-institutional database, we classified obstructive acute pyelonephritis (OAPN) patients into young and elderly groups, and evaluated predictive performance of the qSOFA score for in-hospital mortality. qSOFA score ≥ 2 was an independent predictor for in-hospital mortality, as was higher age, and Charlson comorbidity index (CCI) ≥ 2. In young patients, the area under the curve (AUC) of the qSOFA score for in-hospital mortality was 0.85, whereas it was 0.61 in elderly patients. The sensitivity and specificity of qSOFA score ≥ 2 for in-hospital mortality was 80% and 80% in young patients, and 50% and 68% in elderly patients, respectively. For elderly patients, we developed the CCI-incorporated qSOFA score, which showed higher prognostic accuracy compared with the qSOFA score (AUC, 0.66 vs. 0.61, p < 0.001). Therefore, the prognostic accuracy of the qSOFA score for in-hospital mortality was high in young OAPN patients, but modest in elderly patients. Although it can work as a screening tool to determine therapeutic management in young patients, for elderly patients, the presence of comorbidities should be considered at the initial assessment.

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