scholarly journals Treatment Outcomes in Septic Arthritis of the Foot and Ankle in People Who Inject Drugs

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142092889
Author(s):  
Margaret V. Shields ◽  
Alexander Toppo ◽  
Mariano E. Menendez ◽  
David Tybor ◽  
Peter Dewire ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Nationwide Inpatient Sample ◽  
People Who Inject Drugs ◽  
The United States ◽  
Demographic Characteristics ◽  
Hospital Charges ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
National Trends ◽  
To Receive

Background: Although injection drug use (IDU) is a known risk factor for septic arthritis (SA) of the foot and ankle (F&A), disease and hospitalization outcomes are poorly characterized. We evaluated national trends, demographic characteristics, and hospitalization outcomes of SA of the F&A in people who inject drugs vs those who do not. Methods: Using the Nationwide Inpatient Sample, we identified all patients aged 15-64 with a principal discharge diagnosis of SA of the F&A from 2000 to 2013 and evaluated if they were related or unrelated to IDU. We assessed differences in demographic characteristics and in-hospital outcomes in these groups. Results: From 2000 to 2013, there were an estimated 14,198 hospitalizations for SA of the F&A in the United States, and 11% were associated with IDU (SA-IDU). Compared to SA unrelated to IDU, people with SA-IDU were significantly more likely to be younger, black, and have Medicaid or no insurance. People with SA-IDU were significantly more likely to leave against medical advice (9.7% vs 1.4%, P < .001), have a longer length of stay (9.2 vs 6.8 days, P < .001), and incur increased hospital charges ($58 628 vs $38 876, P = .005). People with SA-IDU were significantly less likely to receive an arthroscopy (1.5% vs 6.5%, P < .001) or arthrotomy (2.2% vs 11.0%, P < .001) of the foot. Conclusion: People with SA-IDU of the F&A had suboptimal hospitalization outcomes with greater costs. Recognizing risk factors and proactively addressing potential complications of substance use disorder in the hospital should be prioritized by the orthopedic community. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Patients with History of Intravenous Drug Use (IDU) with Septic Arthritis of the Foot and Ankle Have Suboptimal Hospitalization Outcomes Compared to Patients Without IDU

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0038
Author(s):  
Margaret Shields ◽  
Alex Toppo ◽  
Mariano Menendez Furrer ◽  
Peter Dewire ◽  
Matthew Salzler
Keyword(s):  
Drug Use ◽  
Septic Arthritis ◽  
Insurance Coverage ◽  
Length Of Hospital Stay ◽  
Demographic Characteristics ◽  
Intravenous Drug ◽  
Hospital Charges ◽  
Intravenous Drug Use ◽  
Foot And Ankle ◽  
History Of

Category: Infection Introduction/Purpose: Although intravenous drug use (IDU) is a known risk factor for septic arthritis of the foot and ankle (F&A), little is known about its influence on hospitalization outcomes. This study evaluated differences in demographic characteristics and hospitalization outcomes of septic arthritis of the F&A according to IDU status. Methods: Using the Nationwide Inpatient Sample for the years 2000 to 2013, we identified all patients aged 15-64 with a principal discharge diagnosis of septic arthritis of the F&A. Applying previously published algorithms, septic arthritis of the F&A was classified as related or unrelated to IDU. We assessed differences in demographic characteristics and in-hospital outcomes including length of hospital stay (LOS), leaving against medical advice (AMA), hospital charges, and presence or absence of surgical intervention. Results: Of the 14,198 hospitalizations, 11% were associated with IDU. Patients with IDU were more likely to be younger, black, and have Medicaid or no insurance coverage. Patients with IDU were more likely to leave AMA (9.7% vs 1.4%, p<0.001), have longer LOS (9.2 vs 6.8 days, p<0.001), and incur increased hospital charges ($58,628 vs $38,876, p=0.005). In addition, patients with IDU were significantly less likely to receive an arthroscopy (1.5% vs 6.5%, p<0.001) or arthrotomy (2.2% vs 11.0%, p<0.001) of the foot. Conclusion: IDU-related septic arthritis of the foot and ankle is associated with suboptimal hospitalization outcomes and greater resource use. Given the disparity in outcomes, there is potential to improve outcomes of septic arthritis of the foot and ankle in patients with IDU via enhanced physician communication skills among disenfranchised patient populations and proactively addressing substance abuse issues early during hospital admission.

scholarly journals Laparoscopic Appendectomy Trends and Outcomes in the United States: Data from the Nationwide Inpatient Sample (NIS), 2004–2011

2014 ◽  
Vol 80 (10) ◽  
pp. 1074-1077 ◽  
Author(s):  
Hossein Masoomi ◽  
Ninh T. Nguyen ◽  
Matthew O. Dolich ◽  
Steven Mills ◽  
Joseph C. Carmichael ◽  
...  
Keyword(s):  
United States ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Conversion Rate ◽  
Nationwide Inpatient Sample ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
The United States ◽  
Hospital Charges ◽  
Nationwide Inpatient Sample Database

Laparoscopic appendectomy (LA) is becoming the standard procedure of choice for appendicitis. We aimed to evaluate the frequency and trends of LA for acute appendicitis in the United States and to compare outcomes of LA with open appendectomy (OA). Using the Nationwide Inpatient Sample database, we examined patients who underwent appendectomy for acute appendicitis from 2004 to 2011. A total of 2,593,786 patients underwent appendectomy during this period. Overall, the rate of LA was 60.5 per cent (children: 58.1%; adults: 63%; elderly: 48.7%). LA rate significantly increased from 43.3 per cent in 2004 to 75 per cent in 2011. LA use increased 66 per cent in nonperforated appendicitis versus 100 per cent increase in LA use for perforated appendicitis. The LA rate increased in all age groups. The increased LA use was more significant in male patients (84%) compared with female patients (62%). The overall conversion rate of LA to OA was 6.3 per cent. Compared with OA, LA had a significantly lower complication rate, a lower mortality rate, a shorter mean hospital stay, and lower mean total hospital charges in both nonperforated and perforated appendices. LA has become an established procedure for appendectomy in nonperforated and perforated appendicitis in all rates exceeding OA. Conversion rate is relatively low (6.3%).

Venous Thromboembolism: Regional Differences in the Nationwide Inpatient Sample, 1993 to 2000

Vascular ◽  
2004 ◽  
Vol 12 (6) ◽  
pp. 374-380 ◽  
Author(s):  
Mary C. Proctor ◽  
Reid M. Wainess ◽  
Peter K. Henke ◽  
Gilbert R. Upchurch ◽  
Thomas W. Wakefield
Keyword(s):  
Public Health ◽  
Venous Thromboembolism ◽  
Regional Differences ◽  
Nationwide Inpatient Sample ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Geographic Region ◽  
Public Health Care ◽  
Hospital Charges ◽  
Health Care Planning

Venous thromboembolism (VTE) is a costly complication of hospitalization. The sequelae make it a concern for public health planners. The Nationwide Inpatient Sample (NIS) contains data for hospital discharges in the United States. These data were reviewed to determine their suitability for health policy planning. International Classification of Diseases, Ninth Revision, Clinical Modification codes for VTE were applied to the NIS data. The sample was queried for demographic information, mortality, length of hospital stay, diagnosis, and treatment. The rates were standardized for geographic region and disease acuity. Statistical analysis included descriptive reporting of means and event rates; analysis of variance and logistic regression were used for regional effects and modeling of mortality. Between 1993 and 2000, 636,814 discharges involved VTE (1.2%). This rate was consistent over time and within regions. Regional differences existed in the acceptance of new technology and hospital charges. Mortality varied from 6.3% (Midwest) to 7.9% (Northeast) and was associated with admission type, comorbidities, pulmonary embolism, and discharge from the Northeast region. White race, chronic venous insufficiency, and female gender were protective variables. The NIS data report a consistent mortality rate despite improved therapy. Regional diagnostic, treatment, and economic differences exist. The data are useful for the purposes of public health care planning and stimulating clinical trial questions.

scholarly journals Inverse National Trends in Decompressive Craniectomy Versus Endovascular Thrombectomy for Stroke

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Nicolas K Khattar ◽  
Beatrice Ugiliweneza ◽  
Mayur Sharma ◽  
Enzo Fortuny ◽  
Shawn William Adams ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Recent Decade ◽  
The United States ◽  
Hospital Charges ◽  
Utilization Rate ◽  
Study Cohort ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
National Trends

Abstract INTRODUCTION Endovascular thrombectomy (ET) for acute large vessel occlusion reduces infarct size, and it should hypothetically decrease the incidence of major ischemic strokes requiring decompressive craniectomy (DC). The aim of this retrospective cohort study is to determine trends in the utilization of ET versus DC for stroke in the United States over a 10-yr span. METHODS We extracted data from the Nationwide Inpatient Sample (NIS) using ICD-9/10 codes for the time period 2006 to 2016. Patients with a primary diagnosis of stroke and a concurrent procedure code for ET or DC were included. Baseline demographics, outcomes and hospital charges were analyzed. RESULTS The study cohort comprised 187 355 patients diagnosed with stroke who underwent either ET or DC. The number of ET- or DC-treated stroke patients increased by 266% from 2006 to 2016. During the study period, the ET utilization rate increased (2.7% in 2006 to 68.6% in 2016, P < .0001) and the DC utilization rate decreased (97.3% in 2006 to 31.4% in 2016, P < .0001). In 2015, the utilization rate of ET (50.2%) exceeded that of DC (49.8%). ET-treated patients had shorter durations of hospital stay (mean 8.8 vs 16.8 days, P < .0001), decreased mortality (16.2% vs 19.3%), higher likelihood of discharge home (27.1% vs 24.1%, P < .0001), and lower hospital charges (mean $189,724 vs $261,314, P < .0001) CONCLUSION We identified an inverse relationship between national trends in increasing ET and diminishing DC utilization for stroke treatment over a recent decade. Although direct causation cannot be inferred, our findings suggest that ET curtails the necessity for DC.

Financial Impact of Tumor Lysis Syndrome Among Inpatients in the United States

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5966-5966
Author(s):  
Ranjan Pathak ◽  
Smith Giri ◽  
Madan Raj Aryal ◽  
Paras Karmacharya ◽  
Vijaya R. Bhatt ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nationwide Inpatient Sample ◽  
Tumor Lysis Syndrome ◽  
The United States ◽  
Hospital Charge ◽  
Hospital Charges ◽  
Tumor Lysis ◽  
Significant Difference ◽  
The Us ◽  
The Mean

Abstract Background With an estimated 0.1 million cases in 2014, lymphomas and acute leukemias are the leading causes of malignancies in the US. Tumor lysis syndrome (TLS) is a potentially devastating complication associated with hematologic malignancies leading to increased morbidity and mortality. Previous European studies have shown that the financial burden of TLS is high, with an estimated cost of 7,342 Euros ($10,320 US Dollars) per admission. However, there is a paucity of data on the economic impact of TLS among US inpatients. Methods We used the Nationwide Inpatient Sample database to identify hospitalized patients aged ≥18 years with a primary diagnosis of TLS (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 277.88) from the first year the diagnosis code was introduced (2009) to 2011. Nationwide Inpatient Sample is the largest all-payer publicly available inpatient care database in the US. It contains data from five to eight million hospital stays from about 1,000 hospitals across the country and approximates a 20% sample of all US hospitals. We calculated the mean length of stay (LOS) and mean hospital charges per TLS admission and compared them with those of overall inpatient admissions. Given that renal failure occurs in severe cases, we compared the mean LOS and hospital charge between TLS patients with and without RRT (hemodialysis or peritoneal dialysis, ICD-9-CM procedure codes 39.35 and 54.98 respectively). Data analysis was done using STATA version 13.0 (College Station, TX). Results We identified 997 admissions with TLS. Mean age was 67.5 (±3.3) with 62% males and 80.4% whites. Overall mean LOS and hospital charge for TLS during the study period was 8.02 days (SE 0.83) and $ 72,840 (SE 8,083). Both the mean LOS and hospital charge for TLS were significantly higher than overall in-patient admissions (Table 1). A total of 949 patients (95%) underwent RRT. There was no significant difference in mean LOS (9.84 days vs 7.94 days, p=0.28) and mean hospital charge ($ 88,098 vs $ 71,930, p=0.58) in patients with TLS that underwent RRT compared (95.2%, n=949) to patients that did not undergo RRT (4.8%, n=48). Conclusion Our study shows that TLS is associated with a significant economic burden, with a mean cost of $ 72,840 per TLS hospitalization. Although majority of the patients hospitalized for TLS received RRT, its use was not associated with significantly higher costs. Further studies are warranted to determine the ways of optimizing current preventive measures and to explore the drivers of increased in-hospital costs in TLS patients. Table 1 Mean LOS and Hospital Charge in TLS Admissions Compared with Overall Inpatient Admissions, 2009-2011 Year Mean LOS (days) Mean hospital charge (USD) TLS admissions Overall admissions p TLS admissions Overall admissions p 2009 13.94 4.5 0.02 104,235 30,506 0.04 2010 7.62 4.6 <0.001 69,552 32,799 <0.001 2011 7.14 4.5 <0.001 69,222 35,213 <0.001 LOS=Length of Stay; TLS=Tumor Lysis Syndrome; USD=US Dollars Disclosures No relevant conflicts of interest to declare.

scholarly journals Geographic Distribution of Foot and Ankle Orthopedic Surgeons Throughout the United States

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110035
Author(s):  
Matthew Fanelli ◽  
Coleman Cush ◽  
Hui Zhang ◽  
Benjamin Wagner ◽  
Amanda J. Young ◽  
...  
Keyword(s):  
United States ◽  
Geographic Distribution ◽  
Census Data ◽  
Pearson Correlation ◽  
Negative Relationship ◽  
The United States ◽  
Foot And Ankle ◽  
Congressional District ◽  
Level Of Evidence ◽  
Congressional Districts

Background: At present, the geographic distribution of orthopedic foot and ankle (OFA) surgeons in the United States is poorly defined. The purpose of this investigation is to determine the geographic distribution of OFA surgeons in the United States. We hypothesize that there will be differences in OFA surgeon density throughout the United States and that economic factors may play a role in access to subspecialty OFA care. Methods: A current membership list was obtained from the American Orthopaedic Foot & Ankle Society (AOFAS). Active members were categorized relative to states and US congressional districts, using publicly available census data. The relationship between income and surgeon density was determined using a Pearson correlation. Results: We identified a list of 1103 active AOFAS members. There was an average of 0.38 and 0.40 OFA surgeons per 100 000 people in each state and congressional district, respectively. We found a weak negative relationship demonstrating that regions with higher levels of poverty had fewer OFA surgeons, with a Pearson correlation coefficient of –0.14 (95% CI: –0.24, –0.04), P = .008. Conclusion: There is wide geographic variation of OFA surgeon density throughout the United States. Regions with higher levels of poverty were weakly associated with decreased population density of OFA surgeons compared to regions with lower poverty levels. Understanding these trends may aid in developing both recruitment and referral strategies for complex foot and ankle care in underserved regions. Level of Evidence: Level V.

scholarly journals Late Presentation of a Retained Stingray Spine in the Plantar Medial Hindfoot

2019 ◽  
Vol 4 (3) ◽  
pp. 247301141986402
Author(s):  
David P. Falk ◽  
Sreenivasulu Metikala ◽  
Viviana Serra Lopez ◽  
Matthew Stein ◽  
Karim Mahmoud ◽  
...  
Keyword(s):  
The United States ◽  
Late Presentation ◽  
Tarsal Tunnel ◽  
Delayed Presentation ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Acute Injuries ◽  
Operative Exploration ◽  
Magnetic Resonance Imaging Mri

In the United States, approximately 2000 stingray injuries occur annually. The majority of reports on stingray injuries to the foot and ankle reflect acute injuries. Delayed presentation after stingray injury to the foot and ankle has not been reported. We present a case of a 29-year-old female who sustained a stingray injury to the left plantar medial hindfoot 14 months prior to presenting to our clinic with new-onset posteromedial ankle redness and swelling along the tarsal tunnel. Magnetic resonance imaging (MRI) revealed multiple linear foreign bodies at the quadratus plantae and tarsal tunnel. The patient underwent operative exploration with removal of multiple retained stingray spines. At her most recent follow-up at 3 months, she was able to resume her usual activities. Level of Evidence: Level V, case report.

scholarly journals National trends in cerebral bypass for unruptured intracranial aneurysms: a National (Nationwide) Inpatient Sample analysis of 1998–2015

2019 ◽  
Vol 46 (2) ◽  
pp. E15 ◽  
Author(s):  
Mayur Sharma ◽  
Beatrice Ugiliweneza ◽  
Enzo M. Fortuny ◽  
Nicolas K. Khattar ◽  
Noberto Andaluz ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Primary Diagnosis ◽  
Hospital Charges ◽  
Unruptured Intracranial Aneurysms ◽  
Number Of Patients ◽  
Cerebral Bypass ◽  
Median Hospital ◽  
Flow Diverters

OBJECTIVEThe development and recent widespread dissemination of flow diverters may have reduced the utilization of surgical bypass procedures to treat complex or giant unruptured intracranial aneurysms (UIAs). The aim of this retrospective cohort study was to observe trends in cerebral revascularization procedures for UIAs in the United States before and after the introduction of flow diverters by using the National (Nationwide) Inpatient Sample (NIS).METHODSThe authors extracted data from the NIS database for the years 1998–2015 using the ICD-9/10 diagnostic and procedure codes. Patients with a primary diagnosis of UIA with a concurrent bypass procedure were included in the study. Outcomes and hospital charges were analyzed.RESULTSA total of 216,212 patients had a primary diagnosis of UIA during the study period. The number of patients diagnosed with a UIA increased by 128% from 1998 (n = 7718) to 2015 (n = 17,600). Only 1328 of the UIA patients (0.6%) underwent cerebral bypass. The percentage of patients who underwent bypass in the flow diverter era (2010–2015) remained stable at 0.4%. Most patients who underwent bypass were white (51%), were female (62%), had a median household income in the 3rd or 4th quartiles (57%), and had private insurance (51%). The West (33%) and Midwest/North Central regions (30%) had the highest volume of bypasses, whereas the Northeast region had the lowest (15%). Compared to the period 1998–2011, bypass procedures for UIAs in 2012–2015 shifted entirely to urban teaching hospitals (100%) and to an elective basis (77%). The median hospital stay (9 vs 3 days, p < 0.0001), median hospital charges ($186,746 vs $66,361, p < 0.0001), and rate of any complication (51% vs 17%, p < 0.0001) were approximately threefold higher for the UIA patients with bypass than for those without bypass.CONCLUSIONSDespite a significant increase in the diagnosis of UIAs over the 17-year study period, the proportion of bypass procedures performed as part of their treatment has remained stable. Therefore, advances in endovascular aneurysm therapy do not appear to have affected the volume of bypass procedures performed in the UIA population. The authors’ findings suggest a potentially ongoing niche for bypass procedures in the contemporary treatment of UIAs.

scholarly journals COVID-19 Vaccine Acceptability and Inequity in the United States: Results from a nationally representative survey

2021 ◽  
Author(s):  
Dustin Gibson ◽  
Smisha Agarwal ◽  
Ankita Meghani ◽  
Rupali J. Limaye ◽  
Alain Labrique
Keyword(s):  
United States ◽  
Influenza Vaccine ◽  
Online Survey ◽  
The United States ◽  
Demographic Characteristics ◽  
Third Party ◽  
Sample Population ◽  
Nationally Representative ◽  
To Receive ◽  
Racial Ethnic

AbstractBackgroundAt the time of this survey, September 1st, there were roughly 6 million COVID-19 cases and 176,771 deaths in the United States and no federally approved vaccine. The objective of this study was to explore the willingness to accept a COVID-19 vaccine in the United States and describe variability in this acceptability by key racial, ethnic and socio-demographic characteristics.MethodsThis was a cross-sectional digital survey that sampled participants from a nationally-representative panel maintained by a third party, Dynata. Dynata randomly sampled their database and emailed web-based surveys to United States residents ensuring the sample was matched to US Census estimates for age, race, gender, income, and Census region. Participants were asked how willing or unwilling they would be to: 1) receive a COVID-19 vaccine as soon as it was made publicly available, and 2) receive the influenza vaccine for the upcoming influenza season. Participants could respond with extremely willing, willing, unwilling, or extremely unwilling. For those who reported being unwilling to receive a COVID-19 vaccine, reasons for this hesitancy were captured. All participants were asked about where they obtain vaccine-related information, and which sources they trust most. Univariable and multivariable logistic regressions were conducted to examine the association of all demographic characteristics with willingness to receive COVID-19 vaccine.FindingsFrom September 1st to September 7, 2020, 1592 respondents completed the online survey. Overall, weighted analyses found that only 58.9% of the sample population were either willing or extremely willing to receive a COVID-19 vaccine as soon as it was made publicly available. In comparison, 67.7% of the respondents were willing or extremely willing to take the influenza vaccine. By gender, 66.1% of males and 51.5% of females were willing to receive a COVID-19 vaccine. Males were significantly more willing to receive a COVID-19 vaccine (adjusted odds ratio (OR)=1.98, 95% CI: 1.56, 2.53; p<0.001) than females. Blacks were the least willing racial/ethnic group (48.8%) Blacks, (aOR=0.59, 95%CI: 0.43, 0.80; p<0.001) were significantly less willing, than whites, to receive a COVID-19 vaccine. There were numerous reasons provided for being unwilling to receive a COVID-19 vaccine. The most common reason was concern about the vaccine’s safety (36.9%), followed by concerns over its efficacy (19.1%).InterpretationIn conclusion, we found that a substantial proportion (41%) of United States residents are unwilling to receive a COVID-19 vaccine as soon as one is made publicly available. We found that vaccine acceptance differs by sub-populations. In addition to sub-group differences in willingness to receive the vaccine, respondents provided a variety of reasons for being unwilling to receive the vaccine, driven by various sources of vaccine information (and misinformation). This compounds the challenge of delivering a safe and efficacious COVID-19 vaccine at a population level to achieve herd immunity. A multi-pronged and targeted communications and outreach effort is likely needed to achieve a high level of immunization coverage.

Sign in / Sign up

Export Citation Format

Share Document