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

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.

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

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

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

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

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

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

scholarly journals Outcomes following operative vs. non-operative management of blunt traumatic pancreatic injuries: a retrospective multi-institutional study

2016 ◽  
Vol 4 ◽  
pp. 1-7 ◽  
Author(s):  
Poppy Addison ◽  
Toni Iurcotta ◽  
Leo I. Amodu ◽  
Geoffrey Crandall ◽  
Meredith Akerman ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Operative Management ◽  
Morbidity And Mortality ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Pancreatic Injuries ◽  
Significant Difference

Abstract Background Traumatic pancreatic injuries are rare, and guidelines specifying management are controversial and difficult to apply in the acute clinical setting. Due to sparse data on these injuries, we carried out a retrospective review to determine outcomes following surgical or non-surgical management of traumatic pancreatic injuries. We hypothesize a higher morbidity and mortality rate in patients treated surgically when compared to patients treated non-surgically. Methods We performed a retrospective review of data from four trauma centers in New York from 1990–2014, comparing patients who had blunt traumatic pancreatic injuries who were managed operatively to those managed non-operatively. We compared continuous variables using the Mann-Whitney U test and categorical variables using the chi-square and Fisher’s exact tests. Univariate analysis was performed to determine the possible confounding factors associated with mortality in both treatment groups. Results Twenty nine patients were managed operatively and 32 non-operatively. There was a significant difference between the operative and non-operative groups in median age (37.0 vs. 16.2 years, P = 0.016), grade of pancreatic injury (grade I; 30.8 vs. 85.2%, P value for all comparisons &lt;0.0001), median injury severity score (ISS) (16.0 vs. 4.0, P = 0.002), blood transfusion (55.2 vs. 15.6%, P = 0.0012), other abdominal injuries (79.3 vs. 38.7%, P = 0.0014), pelvic fractures (17.2 vs. 0.00%, P = 0.020), intensive care unit (ICU) admission (86.2 vs. 50.0%, P = 0.003), median length of stay (LOS) (16.0 vs. 4.0 days, P &lt;0.0001), and mortality (27.6 vs. 3.1%, P = 0.010). Conclusions Patients with traumatic pancreatic injuries treated operatively were more severely injured and suffered greater complications than those treated non-operatively. The greater morbidity and mortality associated with these patients warrants further study to determine optimal triage strategies and which subset of patients is likely to benefit from surgery.

Impact of length of stay on HCAHPS scores following lumbar spine surgery

2019 ◽  
Vol 31 (3) ◽  
pp. 366-371 ◽  
Author(s):  
Gabriel A. Smith ◽  
Steven Chirieleison ◽  
Jay Levin ◽  
Karam Atli ◽  
Robert Winkelman ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Healthcare Providers ◽  
Primary Outcome Measure ◽  
Hospital Length Of Stay ◽  
Categorical Variables ◽  
Lumbar Spine Surgery ◽  
Significant Difference ◽  
Hcahps Survey

OBJECTIVEHospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, completed by patients following an inpatient stay, are utilized to assess patient satisfaction and quality of the patient experience. HCAHPS results directly impact hospital and provider reimbursements. While recent work has demonstrated that pre- and postoperative factors can affect HCAHPS results following lumbar spine surgery, little is known about how these results are influenced by hospital length of stay (LOS). Here, the authors examined HCAHPS results in patients with LOSs greater or less than expected following lumbar spine surgery to determine whether LOS influences survey scores after these procedures.METHODSThe authors conducted a retrospective review of HCAHPS surveys, patient demographics, and outcomes following lumbar spine surgery at a single institution. A total of 391 patients who had undergone lumbar spine surgery and had completed an HCAHPS survey in the period between 2013 and 2015 were included in this analysis. Patients were divided into those with a hospital LOS equal to or less than the expected (LTE-LOS) and those with a hospital LOS longer than expected (GTE-LOS). Expected LOS was based on the University HealthSystem Consortium benchmarks. Nineteen questions from the HCAHPS survey were examined in relation to patient LOS. The primary outcome measure was a comparison of “top-box” (“9–10” or “always or usually”) versus “low-box” (“1–8” and “somewhat or never”) scores on the HCAHPS questions. Secondary outcomes of interest were whether the comorbid conditions of cancer, chronic renal failure, diabetes, coronary artery disease, hypertension, stroke, or depression occurred differently with respect to LOS. Statistical analysis was performed using Fisher’s exact test for the 2 × 2 contingency tables and the chi-square test for categorical variables.RESULTSTwo hundred fifty-seven patients had an LTE-LOS, whereas 134 patients had a GTE-LOS. The only statistically significant difference in preoperative characteristics between the patient groups was hypertension, which correlated to a shorter LOS. A GTE-LOS was associated with a decreased likelihood of a top-box score for the HCAHPS survey items on doctor listening and pain control.CONCLUSIONSHere, the authors report a decreased likelihood of top-box responses for some HCAHPS questions following lumbar spine surgery if LOS is prolonged. This study highlights the need to further examine the factors impacting LOS, identify patients at risk for long hospital stays, and improve mechanisms to increase the quality and efficiency of care delivered to this patient population.

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

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
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. Level of Evidence Retrospective comparative study.

scholarly journals Effect of anticholinergic burden on the onset of delirium in elderly hospitalized patientsassessed by 3 anticholinergic scales

2021 ◽  
Author(s):  
NGOMBENZALE GOY ◽  
JESSICA EPOUPA ◽  
JEAN-CHRISTOPHE BIER ◽  
GILLES NAEIJE ◽  
LAETITIA BEERNAERT ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Categorical Variables ◽  
Control Group ◽  
Anticholinergic Drugs ◽  
Continuous Variables ◽  
Rater Reliability ◽  
Burden Of Treatment ◽  
Significant Difference ◽  
Anticholinergic Burden

Abstract Background: Several studies have demonstrated the deleterious effects of anticholinergic drugs on the cognitive functions of the elderly. However, their effects on the onset of delirium have produced conflicting results. We assessed the association of the anticholinergic burden of treatment at admission according to 3 anticholinergic scales, the ADS, the modified ADS (mADS) and the Marante Scale on the onset of delirium in elderly hospitalized patients. We also analyzed the inter-rater reliability of the scales and their prognostic value in terms of length of stay and hospital mortality.Methods: This retrospective study included patients over 75 years of age hospitalized in medical and surgical departments between January 2014 and June 2019. Delirium was diagnosed by the Confusion Assessment Method (CAM). The anticholinergic burden was assessed by ADS, mADS and Marante Scale in patients with and without delirium.Results were reported as percentages for categorical variables and mean ± standard deviation (SD) and median [interquartile range] for continuous variables after Kolmogorov- Smirnov distribution test. Descriptive statistics were performed using paired Student t-test or Chi-square test. Spearman’s correlation was run to assess the inter-rater reliability between ADS, mADS and the Marante Scale. Results: Among the 1487 patients included, 26% developed delirium. No statistically significant difference in anticholinergic burden was observed between the delirium group and the control group, regardless of the anticholinergic scale used. The correlation coefficient was respectively 0.35 and 0.33 between ADS, mADS and the Marante Scale, and 0.97 between ADS and mADS (all p<0.001). None of the three scales were associated with length of stay, intra-hospital mortality, or one-year mortality. In multivariate analysis, ADS and mADS scores were independently associated with depression (p=0.003 and <0.0001), drug withdrawal (both p<0.001) and the number of drugs on admission (both p<0.001), and Marante Scale score was independently associated with living in a nursing home (p=0.018) and the number of drugs on admission (p<0.0001).Conclusions: Regardless of the scale used, we did not demonstrate a significant association between the anticholinergic burden of treatment upon admission and the onset of delirium during hospitalization.

scholarly journals African–American and Caucasian mortalities are the same after traumatic injury: pair matched analysis from a national data

2020 ◽  
Vol 5 (1) ◽  
pp. e000436
Author(s):  
Nasim Ahmed ◽  
David Kountz ◽  
Yenhong Kuo
Keyword(s):  
African American ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
African American Patient ◽  
National Data ◽  
Level Ii ◽  
Significant Difference ◽  
Caucasian Patients

BackgroundAfrican–Americans have worse outcomes than Caucasians in many clinical conditions studied, including trauma. We sought to analyze if mortality is different in these groups through analysis of a national data set.MethodsRecent data from the national Trauma Quality Improvement Program were assessed with analysis, including all African–American or Caucasian patients who were brought to level I or level II trauma centers for care. Propensity scores were calculated for each African–American patient using age, sex, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), injury type, insurance information and American College of Surgeons trauma level. The primary outcome of this study was in-hospital mortality, and the secondary outcomes were hospital length of stay and discharge disposition.ResultsA total of 82 150 (13.65%) out of 601 768 patients who qualified for the inclusion in the study were African–American. The remaining 519 618 (86.35%) were Caucasian. The median age (IQR) of the patients was 54 (33 to 72) years old, and approximately two-thirds of the patients were male. The median ISS and GCS score were 12 (9 to 17) and 15 (15 to 15), respectively. More than 90% of patients sustained blunt injuries. Overall, there was no significant difference found in overall in-hospital mortality between Caucasians and African–American patients (3% vs. 2.9%, p=0.2); however, the median (95% CI) hospital length of stay was 1 day longer in African–American patients compared with Caucasian patients (5 (5.5) vs. 4 (4.4), p<0.001). When the discharged destinations between the two groups were compared, a higher proportion of Caucasians were discharged to home without services (66% vs. 33%).ConclusionOur study showed that trauma mortalites among African–American and Caucasians are the same. Efforts to mitigate the ethnic and racial biases in the delivery of healthcare should continue, and these results (no differences in mortality) should be validated in other clinical settings.Level of evidenceLevel II.

scholarly journals Outcomes of Neutropenic Patients with Clostridium difficile Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s339-s340
Author(s):  
Roopali Sharma ◽  
Deepali Dixit ◽  
Sherin Pathickal ◽  
Jenny Park ◽  
Bernice Lee ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Treatment Failure ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
End Point ◽  
Neutropenic Patients

Background: Data from Clostridium difficile infection (CDI) in neutropenic patients are still scarce. Objective: To assess outcomes of CDI in patients with and without neutropenia. Methods: The study included a retrospective cohort of adult patients at 3 academic hospitals between January 2013 and December 2017. The 2 study arms were neutropenic patients (neutrophil count <500/mm3) and nonneutropenic patients with confirmed CDI episodes. The primary outcome evaluated the composite end point of all-cause in-hospital mortality, intensive care unit (ICU) admissions, and treatment failure at 7 days. The secondary outcome evaluated hospital length of stay. Results: Of 962 unique cases of CDI, 158 were neutropenic (59% men) and 804 were nonneutropenic (46% men). The median age was 57 years (IQR, 44–64) in the neutropenic group and 68 years (IQR, 56–79) in the nonneutropenic group. The median Charlson comorbidity score was 5 (IQR, 3–7.8) and 4 (IQR, 3–5) in the neutropenic and nonneutropenic groups, respectively. Regarding severity, 88.6% versus 48.9% were nonsevere, 8.2% versus 47% were severe, and 3.2% versus 4.1% were fulminant in the neutropenic and nonneutropenic groups, respectively. Also, 63% of patients (60.9% in nonneutropenic, 65.2% in neutropenic) were exposed to proton-pump inhibitors. A combination CDI treatment was required in 53.2% of neutropenic patients and 50.1% of nonneutropenic patients. The primary composite end point occurred in 27% of neutropenic patients versus 22% of nonneutropenic patients (P = .257), with an adjusted odds ratio of 1.30 (95% CI, 0.84–2.00). The median hospital length of stay after controlling for covariates was 21.3 days versus 14.2 days in the neutropenic and nonneutropenic groups, respectively (P < .001). Complications (defined as hypotension requiring vasopressors, ileus, or bowel perforation) were seen in 6.0% of the nonneutropenic group and 4.4% of the neutropenic group (P = .574), with an adjusted odds ratio of 0.61 (95% CI, 0.28–1.45). Conclusions: Neutropenic patients were younger and their cases were less severe; however, they had lower incidences of all-cause in-hospital mortality, ICU admissions, and treatment failure. Hospital length of stay was significantly shorter in the neutropenic group than in the nonneutropenic group.Funding: NoneDisclosures: None

30-Day Outcomes for Total Ankle Arthroplasty in Patients With Anemia

2021 ◽  
pp. 107110072110175
Author(s):  
Jordan R. Pollock ◽  
Matt K. Doan ◽  
M. Lane Moore ◽  
Jeffrey D. Hassebrock ◽  
Justin L. Makovicka ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Univariate Analysis ◽  
Hospital Length ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
Preoperative Anemia ◽  
Improvement Project ◽  
Average Hospital ◽  
Ankle Arthroplasty ◽  
Reoperation Rates

Background: While anemia has been associated with poor surgical outcomes in total knee arthroplasty and total hip arthroplasty, the effects of anemia on total ankle arthroplasty remain unknown. This study examines how preoperative anemia affects postoperative outcomes in total ankle arthroplasty. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from 2011 to 2018 for total ankle arthroplasty procedures. Hematocrit (HCT) levels were used to determine preoperative anemia. Results: Of the 1028 patients included in this study, 114 patients were found to be anemic. Univariate analysis demonstrated anemia was significantly associated with an increased average hospital length of stay (2.2 vs 1.8 days, P < .008), increased rate of 30-day readmission (3.5% vs 1.1%, P = .036), increased 30-day reoperation (2.6% vs 0.4%, P = .007), extended length of stay (64% vs 49.9%, P = .004), wound complication (1.75% vs 0.11%, P = .002), and surgical site infection (2.6% vs 0.6%, P = .017). Multivariate logistic regression analysis found anemia to be significantly associated with extended hospital length of stay (odds ratio [OR], 1.62; 95% CI, 1.07-2.45; P = .023) and increased reoperation rates (OR, 5.47; 95% CI, 1.15-26.00; P = .033). Anemia was not found to be a predictor of increased readmission rates (OR, 3.13; 95% CI, 0.93-10.56; P = .066) or postoperative complications (OR, 1.27; 95% CI, 0.35-4.56; P = .71). Conclusion: This study found increasing severity of anemia to be associated with extended hospital length of stay and increased reoperation rates. Providers and patients should be aware of the increased risks of total ankle arthroplasty with preoperative anemia. Level of Evidence: Level III, retrospective comparative study.

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

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

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

Sign in / Sign up

Export Citation Format

Share Document