The impact of cirrhosis on the postoperative outcomes of patients undergoing splenectomy: Propensity score matched analysis of the 2011–2017 US hospital database

Background & objective: While splenectomy is performed for various trauma and non-trauma indications, there is little information about the impact of cirrhosis on the post-splenectomy outcomes, despite the intricate physiological and vascular connection between the liver and the spleen. Methods: 2011–2017 National Inpatient Sample was used to select patient cases who underwent the splenectomy procedure, who were further stratified using cirrhosis. The cirrhosis-absent controls were matched to the study cohort using propensity score matching with nearest neighbor matching method. Endpoints included mortality, length of stay, hospitalization costs, and postoperative complications. Results: There were 675 patients with cirrhosis and 675 matched controls identified from the database. Cirrhosis cohort had higher mortality (20.0 vs 7.26%, p < 0.001, OR = 3.19, 95% CI = 2.26–4.52) and hospitalization costs ($210,716 vs $186,673, p = 0.003), but shorter length of stay (11.8 vs 12.5d, p = 0.04). In terms of complications, cirrhosis cohorts had higher postoperative bleeding (7.26 vs 4.3%, p = 0.027, OR = 1.74, 95% CI = 1.09–2.80) and shock (3.7 vs 1.04%, p = 0.002, OR = 3.67, 95% CI = 1.58–8.54), and were more likely to be discharged to short-term hospitals and home with home health care. On multivariate analysis, presence of cirrhosis resulted in higher mortality (p < 0.001, aOR = 3.30, 95% CI = 2.33–4.69). Conclusions: Cirrhosis is an independent risk factor of postoperative mortality in patients undergoing splenectomy; given this finding, further precautious and multidisciplinary care should be rendered in these at-risk patients with cirrhosis in the setting of splenectomy.

Download Full-text

Malnutrition as a risk factor of adverse postoperative outcomes in patients undergoing hepatic resection: analysis of US hospitals

British Journal Of Nutrition ◽

10.1017/s0007114521003809 ◽

2021 ◽

pp. 1-28

Author(s):

David Uihwan Lee ◽

Edwin Wang ◽

Gregory Hongyuan Fan ◽

David Jeffrey Hastie ◽

Elyse Ann Addonizio ◽

...

Keyword(s):

Risk Factor ◽

Postoperative Complications ◽

Length Of Stay ◽

Hepatic Resection ◽

Nearest Neighbor ◽

Postoperative Mortality ◽

Wound Complications ◽

Hospital Death ◽

Study Approach ◽

Hospitalization Costs

Abstract In patients with liver cancer or space-occupying cysts, they suffer from malnutrition due to compression of gastric and digestive structures, liver and cancer-mediated dysmetabolism, and impaired nutrient absorption. As proportion of these patients require removal of lesions through hepatic resection, it is important to evaluate the effects of malnutrition on post-hepatectomy outcomes. In our study approach, 2011-2017 National Inpatient Sample was used to isolate in-hospital hepatectomy cases, which were stratified using malnutrition (composite of malnutrition, sarcopenia, and weight loss/cachexia). The malnutrition-absent controls were matched to cases using nearest neighbor propensity score match method and compared to following endpoints: mortality, length of stay, hospitalization costs, and postoperative complications. There were 2531 patients in total who underwent hepatectomy with matched number of controls from the database; following the match, malnutrition cohort (compared to controls) were more likely to experience in-hospital death (6.60% vs 5.25% p<0.049, OR 1.27 95%CI 1.01-1.61), and were more likely to have higher length of stay (18.10d vs 9.32d p<0.001) and hospitalization costs ($278,780 vs $150,812 p<0.001). In terms of postoperative complications, malnutrition cohort was more likely to experience bleeding (6.52% vs 3.87% p<0.001 OR 1.73 95%CI1.34-2.24), infection (6.64% vs 2.49% p<0.001, OR 2.79 95%CI 2.07-3.74), wound complications (4.5% vs 1.38% p<0.001, OR 3.36 95%CI 2.29-4.93), and respiratory failure (9.40% vs 4.11% p<0.001 OR 2.42 95%CI 1.91-3.07). In multivariate, malnutrition was associated with higher mortality (p<0.028, aOR 1.3 95%CI 1.03-1.65). Thus, we conclude that malnutrition is an independent risk factor of postoperative mortality in patients undergoing hepatectomy.

Download Full-text

The impact of beta-lactam allergy labels on hospitalized children

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.424 ◽

2020 ◽

pp. 1-7

Author(s):

Trahern W. Jones ◽

Nora Fino ◽

Jared Olson ◽

Adam L. Hersh

Keyword(s):

Length Of Stay ◽

Pediatric Patients ◽

The United States ◽

Adverse Outcomes ◽

Hospitalized Children ◽

Beta Lactam ◽

Healthcare Facilities ◽

Antibiotic Allergy ◽

Hospitalization Costs ◽

The Impact

Abstract Background and objectives: Antibiotic allergy labels are common and are frequently inaccurate. Previous studies among adults demonstrate that β-lactam allergy labels may lead to adverse outcomes, including prescription of broader-spectrum antibiotics, increased costs, and increased lengths of stay, among others. However, data among pediatric patients are lacking, especially in the United States. In this study, we sought to determine the impact of β-lactam allergy labels in hospitalized children with regards to clinical and economic outcomes. Method: This retrospective cohort study included pediatric patients 30 days to 17 years old, hospitalized at Intermountain Healthcare facilities from 2007 to 2017, who received ≥1 dose of an antibiotic during their admission. Patients with β-lactam allergies were matched to nonallergic patients based on age, sex, clinical service line, admission date, academic children’s hospital or other hospital admission, and the presence of chronic, comorbid conditions. Outcomes included receipt of broader-spectrum antibiotics, clinical outcomes including length of stay and readmission, and antibiotic and hospitalization costs. Results: In total, 38,906 patients were identified. The prevalence of antibiotic allergy increased from 0.9% among those < 1 year peaked at 10.6% by age 17. Patients with β-lactam allergy received broader-spectrum antibiotics and experienced higher antibiotic costs than nonallergic controls. However, there were no differences in the length of stay, readmission rates, or total number of days of antibiotics between allergic and nonallergic patients. Conclusions: Hospitalized pediatric patients with β-lactam allergy labels receive broader-spectrum antibiotics and experience increased antibiotic costs. This represents an important opportunity for allergy delabeling and antibiotic stewardship.

Download Full-text

Resource Utilization, Costs and Type of Malignancy Associated with Prolonged Length of Stay in Autologous Stem Cell Recipients.

Blood ◽

10.1182/blood.v104.11.5311.5311 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5311-5311

Author(s):

Linda J. Patchett ◽

John M. Hill ◽

Thomas F. Fitzmaurice ◽

Kenneth R. Meehan

Keyword(s):

Stem Cell ◽

Length Of Stay ◽

Resource Utilization ◽

Infection Rate ◽

Stem Cell Transplant ◽

Autologous Stem Cell Transplant ◽

Cell Transplant ◽

Prolonged Length ◽

Hospitalization Costs ◽

The Impact

Abstract In order to contain costs, MDs must first identify the clinical factors contributing to increased resource utilization associated with an autologous stem cell transplant. We performed a retrospective clinical and cost analysis of all autologous transplants performed at Dartmouth- Hitchcock Medical Center over a 30 month period (2002-2004) and identified patients who had a prolonged length of stay > 25 d (PLOS). We pinpointed the clinical characteristics and hospital course of each patient to identify trends. The hospital cost-accounting system highlighted resource utilization and costs of the transplants, allowing a comparison between patients with a PLOS and all other transplant patients. PROLONGED LENGTH OF STAY (PLOS) Results: All Patients LOS < 25 days LOS > 25 days # of patients 87(100%) 58 (67%) 29 (33%) LOS (days) Mean (Median) 24 (22) 20 (20) 31 (31) DISEASE (n = no. of patients) AML 14 9 5 HD/NHL 44 24 20 MM 28 25 3 Other (ITP) 1 1 ENGRAFTMENT (median) ANC > 500 (Platelets > 20K) 12 (18) 11 (16) 13 (27) TRANSFUSIONS UNITS /PT (median) RBC /Platelets > 20 4 (3) 3 (2) 7 (7) PARENTAL NUTRITION (TPN) # of days (median) 9 6 14 TOXICITIES >= GRADE 3 NCI (Common Toxicitity Criteria) Nausea and Vomiting 36% 77% Diarrhea 9% 45% Mucositis 36% 41% Anorexia 57% 83% INFECTION RATE 10% 34% ICU TRANSFER 3% 3% Major contributors to costs included nursing/daily room charge costs (39%), pharmacy (39%), Blood Bank (6%), Laboratory (12%), and other costs (3%). The average daily costs are $4252. The PLOS cohort had grade > 3 toxicity, increased infection rate, engrafted later and required more transfusional support. 1 pt was transferred to the ICU for temporary management. Of the 29 patients identified with PLOS, none died and all were discharged from the hospital. 45% of NHL/HD patients experienced a prolonged LOS, representing 68% of the PLOS cohort. The median LOS<25d is 20d and the median LOS>25d is 30.5d. At an average daily cost of $4252, these additional 10.5 days of hospitalization costs are substantial. Based on these findings, identification of factors underlying PLOS in the NHL/HD cohort may provide the key to minimizing cost of autologous stem cell transplant. Accordingly, we are assessing the impact of age, number of pre-transplant treatment regimens, number of peripheral blood stem cells reinfused, use of IL-2 for post-transplant immune modulation, and the day 15 absolute lymphocyte count on LOS in this population.

Download Full-text

Neoadjuvant therapy for localized gastrointestinal stromal tumors (GISTs): A propensity score weighted analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e23516 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e23516-e23516

Author(s):

Kathryn E. Marqueen ◽

Erin Moshier ◽

Michael Buckstein ◽

Celina Ang

Keyword(s):

Overall Survival ◽

Logistic Regression ◽

Propensity Score ◽

Survival Benefit ◽

Postoperative Mortality ◽

Phase Iii ◽

R0 Resection ◽

Treatment Groups ◽

Significant Difference ◽

The Impact

e23516 Background: Retrospective and single-arm prospective studies have reported clinical benefit associated with receipt of neoadjuvant imatinib for GISTs. In the absence of randomized phase III data, the impact of neoadjuvant systemic therapy (NAT) on survival, in comparison to upfront resection, remains unknown. Methods: We identified N = 14,402 patients with complete clinical, demographic, treatment and pathologic data within the National Cancer Database (2004-2016) who underwent resection of localized GIST of the stomach, esophagus, small bowel, and colorectum, with or without ≥3 months of NAT. Inverse probability of treatment weighting (IPTW) was used to adjust for covariable imbalance among treatment groups, with the propensity score estimated by logistic regression. The effect of NAT on overall survival was estimated with a weighted time-dependent Cox proportional hazards model. A weighted logistic regression was used to estimate the effect of NAT on 90-day postoperative mortality and R0 resection. Results: 759 (5.3%) patients received NAT followed by resection, compared to 13,643 (94.7%) who underwent upfront resection. Median length of NAT was 6.3 months. 53% of NAT patients were male vs. 49% of UR patients, 68% vs. 66% had primary gastric GIST, and 73% vs 49% were high risk. Patients receiving NAT had larger tumors (p < 0.001) and higher mitotic index (p = 0.003). There was a significant survival benefit associated with receipt of NAT (table). 90-day postoperative mortality rate was 3/759 (0.4%) among NAT patients vs. 307/13,643 (2.3%) UR patients. Receipt of NAT was significantly associated with lower odds of 90-day postoperative mortality (table). Of the 13,562 patients with information on margin status, the R0 resection rate was 635/716 (88.7%) for the neoadjuvant group vs. 11,823/12,846 (92%), with no significant difference between treatment groups (table). Conclusions: After adjustment for imbalance in prognostic and demographic factors, this analysis demonstrates that receipt of NAT for localized GIST is associated with a modest overall survival benefit. Although NAT patients had higher risk features, NAT was associated with a lower risk of 90-day postoperative mortality, with no difference in likelihood of achieving an R0 resection. [Table: see text]

Download Full-text

Safety of a first-day catheter removal after transurethral resection of the prostate (TURP): a propensity score-matched historical control study

Insight Urology ◽

10.52786/isu.a.21 ◽

2021 ◽

Vol 42 (1) ◽

pp. 40-45

Author(s):

Songwut Prasopsuk ◽

◽

Suppadech Tunruttanakul ◽

Keyword(s):

Propensity Score ◽

Transurethral Resection ◽

Nearest Neighbor ◽

Intraoperative Complications ◽

Postoperative Bleeding ◽

Safety Data ◽

High Rate ◽

Catheter Removal ◽

Control Group ◽

P Value

Objective: Transurethral resection of the prostate (TURP) is the standard surgical management for patients with benign prostatic hyperplasia (BPH). Postoperative maintenance of bladder catheterization is a routine procedure. However, the timing of catheter removal varies. Our objective is to evaluate the safety of early catheter removal (less than 24 hours) whilst maintaining efficacy, especially in an overcrowded community-based hospital, which has a high rate of preoperative catheterization (47.7%). Materials and Methods: This was a prospective and retrospective observational cohort study of 399 TURP indicated patients from February 2014 to September 2019. Since October 2017, the urological unit protocol has changed the process of removal of the catheter to less than 24 hours after monitoring for safety. Data from 95 patients after October 2017 was prospectively collected as the less than 24 hours group. The information from 2014 to October 2017 was collected and used as the control group. Data was then studied retrospectively for three years. The primary outcome, morbidity, and postoperative stay were compared with a 1:1 nearest neighbor propensity score-matched analysis. Results: After the score was matched and balanced, there was no difference as regards complications between the two groups (Odd ratio (OR): 1, (95% Confidence interval (95% CI): 0.14-7.10, p-value: 1.00). Acute urinary retention and postoperative bleeding were also comparable (OR: 0.5, 95% CI: (0.05-5.51), p-value: 0.57, and p-value: 0.99). The postoperative hospital stay was significantly less in the < 24 hours group (38.1 less hours, 95% CI: (41.82- 34.31), p-value: < 0.01). Conclusion: After TURP early catheter removal was safe even in the hospital with a high preoperative catheterization rate. Experienced surgeons, well-educated and compliant patients without contraindications (neurogenic bladder, urethral stricture, stroke, and some intraoperative complications: urinary bladder perforation, urinary tract infection, prostatic capsule perforation, or intraoperative bleeding) are our recommendation for adopting this protocol.

Download Full-text

Tocilizumab shortens time on mechanical ventilation and length of hospital stay in patients with severe COVID-19: a retrospective cohort study.

10.1101/2020.07.29.20164160 ◽

2020 ◽

Author(s):

Johannes Eimer ◽

Jan Vesterbacka ◽

Anna-Karin Svensson ◽

Bertil Stojanovic ◽

Charlotta Wagrell ◽

...

Keyword(s):

Mechanical Ventilation ◽

Length Of Stay ◽

Propensity Score ◽

Ventilatory Support ◽

Length Of Hospital Stay ◽

Matched Cohort ◽

All Cause Mortality ◽

Secondary Endpoints ◽

The Impact

Background: Hyperinflammation is a key feature of the pathogenesis of COVID-19 with a central role of the interleukin-6 pathway. We aimed to study the impact of the IL-6 receptor antagonist tocilizumab on the outcome of patients admitted to the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) related to COVID-19. Methods: Eighty-seven patients with confirmed SARS-CoV-2 infection and moderate to severe ARDS were included (n tocilizumab = 29, n controls = 58). A matched cohort was created using a propensity score. The primary endpoint was 30-day all-cause mortality, secondary endpoints included ventilation-free days and length of stay. Results: No difference was found in 30-day all-cause mortality in patients treated with tocilizumab compared to controls (17.2% vs. 32.8%, p = 0.2; HR = 0.52 [0.19 - 1.39], p = 0.19). Ventilator-free days were 19.0 (IQR 12.5 - 20.0) versus 9 (IQR 0.0 - 18.5; p = 0.04), respectively. A higher rate of freedom from mechanical ventilation at 30 days was achieved in patients receiving tocilizumab (HR 2.83 [1.48 - 5.40], p < 0.002). Median length of stay in ICU and total length of stay were reduced by 8 and 9.5 days in patients treated with tocilizumab. Similar results were obtained in the analysis of the propensity score matched cohort. Conclusions: Treatment of critically ill patients with ARDS due to COVID-19 with tocilizumab was not associated with reduced 30-day all-cause mortality, but shorter duration on ventilatory support as well as shorter overall length of stay in hospital and in ICU.

Download Full-text

The impact of budesonide inhalation suspension for asthma hospitalization: In terms of length of stay, recovery time from symptoms, and hospitalization costs

Allergology International ◽

10.1016/j.alit.2020.04.003 ◽

2020 ◽

Vol 69 (4) ◽

pp. 571-577

Author(s):

Keima Ito ◽

Yoshihiro Kanemitsu ◽

Kensuke Fukumitsu ◽

Yoshitsugu Inoue ◽

Hirono Nishiyama ◽

...

Keyword(s):

Length Of Stay ◽

Recovery Time ◽

Hospitalization Costs ◽

Asthma Hospitalization ◽

The Impact

Download Full-text

The implications of treatment delays in adjuvant therapy for cholangiocarcinoma patients.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.291 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 291-291

Author(s):

Matthew Parsons ◽

Shane Lloyd ◽

Skyler B Johnson ◽

Courtney L. Scaife ◽

Ignacio Garrido-Laguna ◽

...

Keyword(s):

Propensity Score ◽

Adjuvant Therapy ◽

Adjuvant Treatment ◽

Study Cohort ◽

Time Points ◽

Factors Associated ◽

Post Surgery ◽

Significant Difference ◽

Doubly Robust Estimation ◽

The Impact

291 Background: To understand the factors associated with timing of adjuvant therapy in the management of intrahepatic and extrahepatic cholangiocarcinoma and the impact of delays on overall survival (OS). Methods: Data from the NCDB for patients with pathologically proven non-metastatic adenocarcinoma of the bile ducts from 2004 to 2014 were pooled and screened. Patients were included only if they underwent surgery and adjuvant chemotherapy (CMT) and/or radiotherapy (RT). Patients who underwent neoadjuvant therapy or received CMT or RT with palliative intent were excluded. Pearson’s chi-squared test and multivariate logistic regression analyses were used to assess the distribution of demographic, clinical, and treatment factors. After propensity-score matching with inverse probability of treatment weighting, OS was compared between patients who had initiation of adjuvant therapy past various time points using Kaplan Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling. Results: In total, 7,422 patients in our analysis underwent adjuvant treatment. This represented 43% of the study cohort of 17,123 patients. Of the patients who underwent adjuvant treatment, 3,956 (53%) initiated adjuvant therapy by two months, 6,234 (84%) by 3 months and 6,987 (94%) by four months. High-grade disease, macroscopically positive margins, tumors larger than five centimeters, and unknown LVSI status, were associated with earlier initiation of adjuvant treatment at two months or earlier. Patients who received early adjuvant therapy were also more likely to be treated with a combination of CMT and RT. Factors associated with delay of adjuvant therapy beyond three months post-surgery included Charlson scores of one or greater and Hispanic race. After propensity score weighting, there was no survival difference between groups when comparing initiation of adjuvant therapy before or after two, three or four month time points Conclusions: We identified a number of patient characteristics related to the timing of initiating adjuvant therapy in patients with biliary cancers. There were no significant difference in OS associated with delaying adjuvant therapy beyond two, three or four month time-points. Our findings are relevant in the era of COVID-19 when minimizing patient exposure to health-care settings during a pandemic may need to be considered when deciding on the timing of adjuvant therapy. If a delay is necessary, our results suggest that there is no survival detriment to initiating adjuvant therapy beyond three or four months after surgery for biliary cancers.

Download Full-text

The impact of COVID-19 on tourists’ length of stay and daily expenditures

Tourism Economics ◽

10.1177/13548166211053419 ◽

2021 ◽

pp. 135481662110534

Author(s):

José F Baños-Pino ◽

David Boto-García ◽

Eduardo Del Valle ◽

Inés Sustacha

Keyword(s):

Length Of Stay ◽

Propensity Score ◽

Propensity Score Matching ◽

Inverse Probability Weighting ◽

Probability Weighting ◽

Inverse Probability ◽

Regression Adjustment ◽

The Impact ◽

Spanish Region

This study evaluates the effect of the COVID-19 pandemic on tourists’ length of stay and daily expenditures at a destination. The paper compares detailed microdata for visitors to a Northern Spanish region in the summer periods of 2019 (pre-pandemic) and 2020 (after the pandemic outbreak). We estimate the pandemic-induced impacts on the length of stay and expenditures per person for several categories using regression adjustment, inverse probability weighting regression and propensity score matching. We find clear evidence of a drop in the length of stay of around 1.26 nights, representing a 23.8% decline. We also show that, although total expenditures per person and day have remained constant, there has been a change in the allocations for categories in the tourism budget.

Download Full-text

Causal Inference with Complex Survey Designs

10.1093/oxfordhb/9780190213299.013.4 ◽

2016 ◽

Author(s):

Ines Levin ◽

Betsy Sinclair

Keyword(s):

Propensity Score ◽

Causal Inference ◽

Propensity Score Matching ◽

Nearest Neighbor ◽

Target Population ◽

Population Based ◽

Real World Data ◽

Monte Carlo Simulation Study ◽

Inference Techniques ◽

The Impact

This article discusses methods that combine survey weighting and propensity score matching to estimate population average treatment effects. Beginning with an overview of causal inference techniques that incorporate data from complex surveys and the usefulness of survey weights, it then considers approaches for incorporating survey weights into three matching algorithms, along with their respective methodologies: nearest-neighbor matching, subclassification matching, and propensity score weighting. It also presents the results of a Monte Carlo simulation study that illustrates the benefits of incorporating survey weights into propensity score matching procedures, as well as the problems that arise when survey weights are ignored. Finally, it explores the differences between population-based inferences and sample-based inferences using real-world data from the 2012 panel of The American Panel Survey (TAPS). The article highlights the impact of social media usage on political participation, when such impact is not actually apparent in the target population.

Download Full-text