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

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. Level of Evidence Retrospective comparative study.

Download Full-text

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

10.21203/rs.2.22737/v3 ◽

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.

Download Full-text

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

10.21203/rs.2.22737/v2 ◽

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.

Download Full-text

Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Sub-Saharan Africa

10.21203/rs.2.22737/v1 ◽

2020 ◽

Author(s):

Sarah Peiffer ◽

Anna E. Ssentongo ◽

Laura Keeney ◽

Forster Amponsah-Manu ◽

Richard Yeboako ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Perioperative Complications ◽

Gastrointestinal Surgery ◽

Sub Saharan Africa ◽

Morbidity And Mortality ◽

Surgical Trauma ◽

Potential Cost ◽

Surgical Infection ◽

Sub Saharan

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 in eastern Ghana. Methods This is a retrospective review of perioperative morbidity and mortality in children <18 years at Eastern Regional Hospital (ERH) in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study and secondary analysis was performed. Results We analyzed 468 patients <18 years of age with a median length of stay (LOS) of 3 days. The readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19%) and appendectomy (15%). Major procedures, gastrointestinal surgery, surgical trauma, surgical infection and having insurance were significantly associated with prolonged LOS. Age and male gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. Conclusions Malaria infection is a significant and actionable risk factor for readmission in the pediatric surgical population in sub-Saharan Africa. Preventing readmission in patients with malaria could reduce readmission rates by 74%, leading to potential cost-savings and reductions in morbidity.

Download Full-text

Impact of pre-operative chemoradiotherapy on post-esophagectomy morbidity and mortality

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.4025 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 4025-4025

Author(s):

N. P. Rizk ◽

M. Bains ◽

R. Flores ◽

B. Park ◽

B. Minsky ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Univariate Analysis ◽

Morbidity And Mortality ◽

Hospital Length Of Stay ◽

Categorical Variables ◽

Operative Morbidity ◽

Significant Difference ◽

Chi Square Analysis ◽

Procedure Type

4025 Background: While multimodality therapy prior to surgical resection for locally advanced esophageal cancer is increasingly utilized, there remains the perception in the literature that its use may contribute to increased peri-operative morbidity and mortality. The purpose of this study was to compare our experience with the use of pre-operative chemoradiation with surgery (CRT) to patients who underwent surgery alone (S). Methods: We performed a retrospective review of a prospectively maintained database of all patients in our institution who underwent either (S) or (CRT) between 1/96 and 5/05. Data collected included demographics (age, sex), co-morbidities (cardiac, pulmonary, diabetes), pre-operative treatment details (chemotherapy type, radiation dose), procedure type, post-operative complications (pneumonia, anastomotic leak), length of stay (LOS), and hospital mortality. Statistical analysis included chi-square analysis for categorical variables and analysis of variance for continuous variables, and multivariate analyses was done using a logistic regression model. Results: There were 701 patients who were appropriate for this analysis, 332 (47.3%) (CRT) and 369 (52.7%) (S). 76% of CRT patients received 5040cGy of radiation and 90% received concurrent cisplatin based chemotherapy. CRT patients were younger (p<0.001) and more often male (p=0.003). Univariate analysis indicated a similar incidence of pneumonia (p=0.78), leak rate (p=0.41), hospital length of stay (0.97), and hospital mortality (0.48). Multivariate analysis, controlling for demographics, co-morbidities, procedure type, and tumor location showed no significant difference in hospital mortality (p=0.84). Conclusions: The use of CRT does not appear to result in increased peri-operative morbidity or mortality. No significant financial relationships to disclose.

Download Full-text

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

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101496 ◽

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.

Download Full-text

Thirty-day postoperative morbidity and mortality after temporal lobectomy for medically refractory epilepsy

Journal of Neurosurgery ◽

10.3171/2016.12.jns162096 ◽

2018 ◽

Vol 128 (4) ◽

pp. 1158-1164 ◽

Cited By ~ 5

Author(s):

Panagiotis Kerezoudis ◽

Brandon McCutcheon ◽

Meghan E. Murphy ◽

Kenan R. Rajjoub ◽

Daniel Ubl ◽

...

Keyword(s):

Mortality Rate ◽

Length Of Stay ◽

Refractory Epilepsy ◽

Significant Risk ◽

Intractable Epilepsy ◽

Major Complication ◽

Morbidity And Mortality ◽

Temporal Lobectomy ◽

National Database ◽

Medically Refractory Epilepsy

OBJECTIVETemporal lobectomy is a well-established treatment modality for the management of medically refractory epilepsy in appropriately selected patients. The aim of this study was to assess 30-day morbidity and mortality after temporal lobectomy in cases registered in a national database.METHODSA retrospective cohort analysis was conducted using a multiinstitutional surgical registry compiled between 2006 and 2014. The authors identified patients who underwent anterior temporal lobectomy and/or amygdalohippocampectomy for a primary diagnosis of intractable epilepsy. Univariate and multivariable analyses with regard to patient demographics, comorbidities, operative characteristics, and 30-day outcomes were applied.RESULTSA total of 216 patients were included in the study. The median age was 38 years and 46% of patients were male. The median length of stay was 3 days and the 30-day mortality rate was 1.4%. Fourteen patients (6.5%) developed at least one major complication. Return to the operating room was observed in 7 patients (3.2%). Readmission within 30 days and discharge to a location other than home were available for 2011–2014 (n = 155) and occurred in 11% and 10.3% of patients, respectively. Multivariable regression analysis revealed that increasing age was an independent predictor of discharge disposition other than home and that male sex was a significant risk factor for the development of a major complication. Interestingly, the presence of the attending neurosurgeon and a resident during the procedure was significantly associated with decreased odds of prolonged length of stay (i.e., > 75th percentile [5 days]) and discharge to a location other than home.CONCLUSIONSUsing a multiinstitutional surgical registry, 30-day outcome data after temporal lobectomy for medically intractable epilepsy demonstrates a mortality rate of 1.4%, a major complication rate of 6.5%, and a readmission rate of 11%. Temporal lobectomy is an extremely effective therapy for seizures originating there—however, surgical intervention must be weighed against its morbidity and mortality outcomes.

Download Full-text

Medical and Economic Burden of Heparin-Induced Thrombocytopenia: Data from the National Inpatient Sample 2009-2011

Blood ◽

10.1182/blood.v126.23.3272.3272 ◽

2015 ◽

Vol 126 (23) ◽

pp. 3272-3272

Author(s):

Ranjan Pathak ◽

Smith Giri ◽

Madan Raj Aryal ◽

Paras Karmacharya ◽

Anthony Donato ◽

...

Keyword(s):

Molecular Weight ◽

High Risk ◽

Length Of Stay ◽

Hospital Mortality ◽

Significant Risk ◽

Hospital Charges ◽

Low Molecular Weight ◽

National Inpatient Sample ◽

Platelet Factor ◽

Heparin Induced Thrombocytopenia

Abstract Background Although generally safe, heparin use can trigger an immune response in which platelet factor 4-heparin complexes set off an antibody-mediated cascade that can result in heparin-induced thrombocytopenia (HIT). Although older studies report incidences as high as 5% in high-risk subgroups of surgical patients, recent studies report a much lower incidence (0.02% of hospital admissions and <0.1-0.4% among patients exposed to heparin). As hospitals transition to the less immunogenic low molecular weight heparins, reassessment of the overall national burden of HIT would help inform needs for monitoring strategies for this potentially fatal complication of anticoagulation. Methods We used the 2009-2011 National Inpatient Sample database to identify patients aged ≥18 years with primary and secondary diagnoses of HIT (International Classification of Diseases, 9th Revision, Clinical-Modification [ICD-9-CM] code 289.84). We derived the prevalence rate of HIT overall as well as among subgroup of patients undergoing 3 types of surgeries (cardiac, vascular and orthopedic surgeries). We compared characteristics of patients diagnosed with versus without HIT, and HIT with thrombosis (HITT) versus those without thrombosis. Statistical analysis was performed using Stata 13.1, which accounted for the complex survey design and clustering. We used a 2-sided p- value of <0.05 to determine statistical significance. Results We identified 72,515 cases of HIT among a total of 98,636,364 hospitalizations (0.07%). Arterial and venous thromboses were identified in 24,880 (34.3%) of cases with HIT. Males were slightly more likely to be diagnosed with HIT (50.12% vs. 49.88%, odds ratio, OR 1.48, 95% CI: 1.46-1.51), but females had higher rates of post-cardiac and vascular surgery-associated HIT (OR: 1.41, 95% confidence interval, CI: 1.26-1.58, p<0.001 and OR 1.42, 95% CI: 1.29-1.57, p<0.001 respectively). Prevalence rates of HIT among cardiac, vascular and orthopedic surgeries were 0.53% (95% CI: 0.51-0.54%), 0.28% (95% CI: 0.28-0.29%) and 0.05% (95% CI: 0.05-0.06%) respectively. Patients with HIT and HITT were significantly more likely to be fatal than cases without diagnosed HIT (9.63% and 12.28% versus 2.19% respectively, p<0.001), and have significantly higher costs ($137401 and $179735 versus $35905) and length of stay (14.07 and 16.51 days versus 4.76 days). Conclusion Although rates of HIT appear lower in the modern era of widespread low molecular weight heparin use, patients undergoing cardiac and vascular surgeries remain at significant risk. Even in recent years, one-third of patients with HIT develop thrombosis, which significantly increases mortality, cost and length of stay. Strategies to monitor and mitigate that risk in high-risk patients appear to be warranted. Table 1. In-hospital mortality, mean LOS and Mean hospital charges for patients with heparin induced thrombocytopenia (HIT) and HIT with thrombosis (HITT) No HIT HIT P HIT without thrombosis HITT P In-hospital mortality 2.19% 9.63% (OR 4.75, 95% CI 4.45-5.08) <0.001 8.24% 12.28% (OR 1.56, 95% CI 1.40-1.74) <0.001 Mean LOS (days) 4.76 (95% CI 4.71-4.82) 14.07 (95% CI 13.67-14.48) <0.001 12.80 (95% CI 12.38-13.23) 16.51 (95% CI 15.96-17.06) <0.001 Mean total hospital charge (USD) 35905 (95% CI 34626- 37185) 137401 (95% CI 129369-145433) <0.001 115456 (95% CI 108251-122661) 179735 (95% CI 168582-190889) <0.001 HIT= Heparin induced thrombocytopenia; HITT= Heparin induced thrombocytopenia with thrombosis; LOS=Length of stay; USD=US Dollars. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Retrospective Analysis of Geriatric Patients Undergoing Hip Fracture Surgery: Delaying Surgery Is Associated With Increased Morbidity, Mortality, and Length of Stay

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318795260 ◽

2018 ◽

Vol 9 ◽

pp. 215145931879526 ◽

Cited By ~ 3

Author(s):

Andrew Bennett ◽

Hsin Li ◽

Aakash Patel ◽

Kevin Kang ◽

Piyush Gupta ◽

...

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Hospital Mortality ◽

Retrospective Analysis ◽

Postoperative Morbidity ◽

Morbidity And Mortality ◽

Time To Surgery ◽

Hip Fracture Surgery ◽

Asa Classification ◽

Fracture Surgery

Introduction: Hip fractures are common in elderly patients. However, this population frequently presents with significant medical comorbidities requiring extensive medical optimization. Methods: This study sought to elucidate optimal time to surgery and evaluate its effect on postoperative morbidity, mortality, and length of stay (LOS). We performed a retrospective analysis of data collected from 2008 to 2010 on 841 patients who underwent hip fracture surgery. Patients were classified based on time to surgery and were also classified and analyzed according to the American Society of Anesthesiologists (ASA) physical classification system. Results: Patients with a delay of greater than 48 hours had a significant increase in overall LOS, postoperative days, and overall postoperative complications. Patients classified as ASA 4 had an odds ratio for postoperative morbidity of 3.32 compared to the ASA 1 and 2 group ( P = .0002) and 2.26 compared to the ASA 3 group ( P = .0005). Delaying surgery >48 hours was also associated with increased in-hospital mortality compared to 24 to 48 hours ( P = .0197). Increasing ASA classification was also associated with significantly increased mortality. Patients classified as ASA 4 had 5.52 times the odds of ASA 1 and 2 ( P = .0281) of in-hospital mortality. Those classified ASA 4 had 2.97 times the odds of ASA 3 ( P = .0198) of an in-house mortality. Anesthetic technique (spinal vs general) and age were not confounding variables with respect to mortality or morbidity. Discussion: Surgical timing and ASA classification were evaluated with regard to LOS, number postoperative days, morbidity, and mortality. Conclusions: Delaying surgery >48 hours, especially in those with increased ASA classification, is associated with an increase in overall LOS, postoperative days, morbidity, and mortality. However, rushing patients to surgery may not be beneficial and 24 to 48 hours of preoperative optimization may be advantageous.

Download Full-text

Mortality Rates in Mechanically Ventilated Patients with COVID-19

Proceedings of IMPRS ◽

10.18060/24573 ◽

2020 ◽

Vol 3 ◽

Author(s):

Jonathan Class ◽

Sikandar Khan ◽

Babar Khan

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Length Of Stay ◽

Hospital Mortality ◽

Significant Risk ◽

Mortality Rates ◽

Study Cohort ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

Background/Objective: High mortality rates among mechanically ventilated COVID-19 intensive care unit (ICU) patients have raised concerns regarding use of mechanical ventilation in management of patients with COVID-19. Additional data is needed in this discussion to better understand treatment strategies for this vulnerable population. We conducted a study to examine length of stay, duration of mechanical ventilation, mortality, and risk factors for death in critically ill patients with COVID-19. Methods: Observational study in patients admitted to Eskenazi Health and Indiana University Health Methodist ICUs. Participants were 18 years and older patients admitted to the ICU from March 1 2020 to April 27, 2020 who tested positive for COVID-19. Primary outcomes for this study were in-hospital mortality, duration of mechanical ventilation, and the length of stay in the ICU. Results: The study cohort was made up of 242 patients. The mortality rate was 19.8% (48/242) for the overall cohort and 20.5% (38/185) for mechanically ventilated patients. Age was a significant risk factor for in-hospital mortality [increased hazard in in-hospital mortality: age 65-74 years (HR: 3.1, 95%Cl=1.2-7.9, p=0.021), age 75+ (HR: 4.1, 95%CI=1.6-10.5, p=0.003) compared to those younger than 65]. In our Cox’s proportional hazard model, ESRD (HR:5.9, 95%CI=1.3-26.9, p=0.021) along with age were the only risk factors with statistical significance. The median duration of mechanical ventilation in the overall cohort was 9.3 days (IQR=-5.7-13.7). In patients that died, median ICU length of stay was 8.7 days (IQR=4.0-14.9), compared to 9.2 days (IQR=4.0-14.0) in those discharged alive. Conclusion/Clinical Impact: We found lower mortality rates and longer length of stays in our cohort than in previous studies. While more data is needed, this study supports continued use of mechanical ventilation ARDS recommendations for treating patients with ARDS from COVID-19. Further, this data potentially shows a benefit to not having a strained healthcare system.

Download Full-text

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

Circulation ◽

10.1161/circ.138.suppl_1.17175 ◽

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.

Download Full-text