scholarly journals Outcomes in Hospitalizations for Patients Admitted With Hyperosmolar Hyperglycemic State and Obesity: Analysis of National Inpatient Sample

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A428-A429
Author(s):  
Hafeez Shaka ◽  
Genaro Velazquez ◽  
Hernan Gerardo Marcos-Abdala ◽  
Ehizogie Edigin ◽  
Iriagbonse Asemota ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Adverse Outcomes ◽  
Hospital Charges ◽  
Obese Patients ◽  
Secondary Diagnosis ◽  
Total Hospital ◽  
Significant Difference

Abstract Introduction: Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHS) is a highly lethal disease with an estimated mortality rate of up to 20%. Although mortality has decreased in recent years, its incidence has increased in the setting of a higher prevalence of underlying conditions that have been previously well described, such as uncontrolled diabetes, Obesity, and a high-carbohydrate diet. All these comorbidities usually overlap with acute complications such as infections or dehydration, which incite the onset of HHS. Currently, limited literature exists for the role of obesity in mortality, hospital stay, and other adverse outcomes in patients with HHS. It is important to know which underlying conditions truly affect outcomes for patients being treated for this condition so further studies can be done, and treatment optimized. Objective: We aim to prove if obesity plays a role in increasing mortality and secondary adverse outcomes in patients with HHS compared to non-obese patients. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. 42,740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of Obesity as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders. Results: Out of the 42 740 hospitalizations with HHS, 9,630 had Obesity. The in-hospital mortality for patients with HHS was 45 overall, out of which 45 patients had Obesity as a secondary diagnosis. Compared with patients without Obesity, non-obese patients had similar in-hospital mortality (OR 0.77, 95% CI 0.39–1.52, p=0.45) when adjusted for patient and hospital characteristics. Patients with HHS and Obesity had similar lengths of hospital stay, total hospital charges, rate of Sepsis, Septic Shock, and ARF in comparison to patients without Obesity; however, non-obese patients had higher odds of developing AKI throughout hospitalization. Conclusion: Although it is known and described that being obese plays a significant role in the onset of diabetes, and consequently HHS, there is no statistically significant difference in mortality or most other adverse outcomes compared to patients that are not obese and develop HHS. Although being obese plays a major role in inciting HHS in the general population, there is no need for a different approach to treatment, and outcomes are similar to non-obese patients with HHS.

scholarly journals In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A426-A426
Author(s):  
Genaro Velazquez ◽  
Hafeez Shaka ◽  
Mukunthan Murthi ◽  
Iriagbonse Asemota ◽  
Sujitha Velagapudi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Secondary Diagnosis ◽  
Total Hospital ◽  
Mortality And Morbidity ◽  
Lower Odds ◽  
Hyperosmolar Hyperglycemic State

Abstract Background: In patients hospitalized with Hyperosmolar hyperglycemic state (HHS) the presence of comorbid conditions including hypertension, heart disease, stroke, and dementia have been variably reported to be associated with higher mortality. HTG is increasingly prevalent in patients with DM, especially those with poor glycemic control who are more likely to suffer from HHS. Elevated triglyceride levels have independently been associated with higher mortality in certain conditions like coronary artery disease and acute pancreatitis. However, data on the effect of Hypertriglyceridemia (HTG) on mortality and morbidity in hospitalized patients with HHS is sparse. Objective: We wanted to compare the outcomes for HHS hospitalizations for patients with and without HTG. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of HTG as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders. Results: Out of the 42 740 hospitalizations with HHS, about 17 040 had HTG. The in-hospital mortality for patients with HHS was 305 overall, out of which 70 patients had HTG as secondary diagnosis. Compared with patients without HTG, patients with HTG had lower odds of in- hospital mortality (0.30, 95% CI 0.157–0.56, p<0.005) when adjusted for patient and hospital characteristics. Patients with HHS and HTG had decreased length of hospital stay, less total Hospital charges, lower odds of Sepsis and Septic Shock, but similar odds of AKI and ARF in comparison to patients without HTG. Conclusion: Our study shows that HTG is associated with lower odds of in-hospital mortality in patients with HHS, even though the odds of AKI and ARF was same in both groups. A similar inverse relationship has already been reported between TG levels and mortality in stroke patients. Though the mechanism of this effect is unclear, one possible explanation could be that patients with HTG are more likely to be treated with statins and fibrates which have known anti-inflammatory effects. Further studies are required to evaluate this possible positive prognostic effect of TG.

scholarly journals Impact of Atrial Fibrillation on In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State: Analysis of National Inpatient Sample

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A425-A426
Author(s):  
Genaro Velazquez ◽  
Hafeez Shaka ◽  
Mukunthan Murthi ◽  
Hernan Marcos-Abdala ◽  
Sujitha Velagapudi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Septic Shock ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Secondary Diagnosis ◽  
Total Hospital ◽  
Hospital Outcomes ◽  
Hyperosmolar Hyperglycemic State

Abstract Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia and its negative prognostic impact on the morbidity and mortality of hospitalized patients has been well described. In patients with Hyperosmolar hyperglycemic state (HHS), mortality rates can reach up to 20% and poor outcomes have been reported in people with older age, presence of comorbid conditions and concurrent infections. However, the impact of atrial fibrillation on the hospital outcomes of patients admitted with HHS has not been well documented. Objective: We wanted to compare the outcomes for HHS hospitalizations for patients with and without Atrial fibrillation. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of Atrial Fibrillation as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders. Results: Out of the 42 740 hospitalizations with HHS, about 3 295 had Atrial Fibrillation. The in-hospital mortality for patients with HHS was 305 overall, out of which 60 patients had Atrial Fibrillation as secondary diagnosis. Compared with patients without Atrial Fibrillation, patients with Atrial Fibrillation had a similar in- hospital mortality (aOR 0.77, 95% CI 0.39–1.52, p=0.45) when adjusted for patient and hospital characteristics. Patients with HHS and Atrial Fibrillation had similar length of hospital stay, total Hospital charges, rate of Sepsis, Septic Shock, AKI, and ARF in comparison to patients without Atrial Fibrillation. Conclusion: Our study suggests that the presence of atrial fibrillation in hospitalized HHS patients is not associated with increased mortality or longer duration of hospital stay. This data is essential since it helps identify HHS patients with increased risk of complications. As previous reports have suggested that AF, especially of new onset in critically ill patients is a marker of increased disease severity, the lack of such impact in patients with HHS requires further studies.

scholarly journals Effect of Chronic Kidney Disease on Outcomes of Adult Patients Admitted With Hyperosmolar Hyperglycemic State: Analysis of National Inpatient Sample

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A424-A425
Author(s):  
Hafeez Shaka ◽  
Genaro Velazquez ◽  
Sujitha Velagapudi ◽  
Ehizogie Edigin ◽  
Mukunthan Murthi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
Volume Overload ◽  
Fluid Replacement ◽  
Hospital Charges ◽  
Secondary Diagnosis ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Secondary Outcomes

Abstract Background: Treatment guidelines have been well established in patients with HHS and a normal renal function. The mainstay of treatment for patients with HHS includes intravenous volume replacement, potassium replacement, and blood glucose correction by administering insulin. However, this treatment protocol cannot be directly applied to a patient with decreased GFR as it increases the risk of hypoglycemic episodes due to decreased insulin clearance along with increasing the risk of hyperkalemia and volume overload. Hence titrating insulin, maintaining euvolemia and normokalemia becomes further challenging in a patient with HHS in the setting of CKD. Although the above-mentioned complications are well described in multiple studies, there is not enough evidence demonstrating the association between the inpatient mortality and secondary outcomes in patients with HHS with and without CKD. Objective: To compare the inpatient mortality and secondary outcomes in patients admitted with HHS with CKD vs without CKD. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of CKD as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders. Results: Out of the 42 740 hospitalizations with HHS, about 9 545 had CKD. The in-hospital mortality for patients with HHS was 305 overall, out of which 105 patients had Atrial Fibrillation as a secondary diagnosis. Compared with patients without CKD, patients with CKD had similar in-hospital mortality (aOR 0.93, 95% CI 0.48–1.8, p=0.83) when adjusted for patient and hospital characteristics. Patients with HHS and CKD had similar length of hospital stay, total hospital charges, rate of Sepsis, Septic Shock, and ARF in comparison to patients without CKD; however, patients with CKD had higher odds of developing AKI thorough out hospitalization. Conclusion: This study found that patients admitted with HHS and CKD have similar in-hospital mortality when compared to patients without CKD. However, the study group with CKD has higher odds of developing AKI when compared to the group without CKD. Although AKI is common and correctable in HHS, the above-mentioned association is possible due to the judicious IV fluid replacement in an HHS patient with CKD as a concern for volume overload. Further studies are needed to identify contributing risk factors and establishing fluid replacement guidelines in a patient with HHS and CKD.

scholarly journals Path Analysis of the Impact of Obesity on Postoperative Outcomes in Colorectal Cancer Patients: A Population-Based Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2904
Author(s):  
Kuan-Chih Chung ◽  
Ko-Chao Lee ◽  
Hong-Hwa Chen ◽  
Kung-Chuan Cheng ◽  
Kuen-Lin Wu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Path Analysis ◽  
Postoperative Infection ◽  
Digestive System ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Perioperative Outcomes ◽  
Total Hospital

Background: Obesity is adversely affecting perioperative outcomes; however, long-term outcomes do not appear to be affected by excess body weight (the obesity paradox). The purpose of this study is to examine the association between obesity and surgical outcomes in patients with colorectal cancer (CRC) using data from the United States National Inpatient Sample (NIS). Methods: Patients ≥20 years old diagnosed with CRC who received surgery were identified in the 2004–2014 NIS database. Patients who were obese (ICD-9-CM code: 278.0) were matched with controls (non-obese) in a 1:4 ratio for age, sex, and severity of CRC (metastasis vs. no metastasis). Linear regression and path analysis were used to compare outcomes between obese and non-obese patients. A total of 107,067 patients (53,376 males, 53,691 females) were included in the analysis, and 7.86% were obese. Results: The rates of postoperative infection, shock, bleeding, wound disruption, and digestive system complications were significantly different between the obese and non-obese groups. The obesity group had increased incidence of postoperative infection by 1.9% (∂P/∂X = 0.019), shock by 0.25% (∂P/∂X = 0.0025), postoperative bleeding by 0.5% (∂P/∂X = 0.005), wound disruption by 0.6% (∂P/∂X = 0.006), and digestive system complications by 1.35% (∂P/∂X = 0.0135). Path analysis showed that obesity group had higher in-hospital mortality through mentioned above five complications by 66.65 × 10−5%, length of hospital stay by 0.32 days, and total hospital charges by 2384 US dollars. Conclusions: Obesity increases the risk of postoperative complications in patients with CRC undergoing surgery. It also increased in-hospital mortality, length of hospital stay, and total hospital charges. Therefore, patients with obesity might require a higher level of preoperative interventions and complications monitoring to improve outcomes.

scholarly journals Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

2021 ◽  
Vol 8 (1) ◽  
pp. 37-42
Author(s):  
Hasan Ghandhari ◽  
◽  
Ebrahim Ameri ◽  
Mohsen Motalebi ◽  
Mohamad-Mahdi Azizi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Obese Group ◽  
Obese Patients ◽  
Number Of Patients ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

scholarly journals Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Theresa Madaline ◽  
Francis Wadskier Montagne ◽  
Ruth Eisenberg ◽  
Wenzhu Mowrey ◽  
Jaskiran Kaur ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
Rank Test ◽  
P Value ◽  
Analysis Model ◽  
Subdistribution Hazard ◽  
Significant Difference ◽  
The Impact

Abstract Objective Severe sepsis and septic shock (SS/SS) treatment bundles reduce mortality, and early infectious diseases (ID) consultation also improves patient outcomes. We retrospectively examined whether early ID consultation further improves outcomes in Emergency Department (ED) patients with SS/SS who complete the sepsis bundle. Method We included 248 adult ED patients with SS/SS who completed the 3-hour bundle. Patients with ID consultation within 12 hours of ED triage (n = 111; early ID) were compared with patients who received standard care (n = 137) for in-hospital mortality, 30-day readmission, length of hospital stay (LOS), and antibiotic management. A competing risk survival analysis model compared risks of in-hospital mortality and discharge alive between groups. Results In-hospital mortality was lower in the early ID group unadjusted (24.3% vs 38.0%, P = .02) and adjusted for covariates (odds ratio, 0.47; 95% confidence interval (CI), 0.25–0.89; P = .02). There was no significant difference in 30-day readmission (22.6% vs 23.5%, P = .89) or median LOS (10.2 vs 12.1 days, P = .15) among patients who survived. A trend toward shorter time to antibiotic de-escalation in the early ID group (log-rank test P = .07) was observed. Early ID consultation was protective of in-hospital mortality (adjusted subdistribution hazard ratio (asHR), 0.60; 95% CI 0.36–1.00, P = .0497) and predictive of discharge alive (asHR 1.58, 95% CI, 1.11–2.23; P-value .01) after adjustment. Conclusions Among patients receiving the SS/SS bundle, early ID consultation was associated with a 40% risk reduction for in-hospital mortality. The impact of team-based care and de-escalation on SS/SS outcomes warrants further study.

scholarly journals Morbid Obesity Does Not Impact Mortality, Rate of Endoscopy in Patients With Biliary Acute Pancreatitis: A US Nationwide Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A34-A35
Author(s):  
Hafeez Shaka ◽  
Emmanuel Palomera-Tejeda ◽  
Ikechukwu Achebe ◽  
Jennifer Chiagoziem Asotibe ◽  
Garima Pudasaini ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Septic Shock ◽  
Acute Pancreatitis ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Morbidly Obese ◽  
Nationwide Inpatient Sample Database ◽  
Significant Difference ◽  
Biliary Acute Pancreatitis ◽  
The Impact

Abstract Introduction: Morbid obesity (MO) is associated with increased mortality in various conditions including acute pancreatitis. Interventions are challenging in patients with MO due to higher prevalence of comorbidities that may affect airway and cardiopulmonary management. Biliary acute pancreatitis (BAP) is the most common etiology for acute pancreatitis in the US. Population-based studies on the effect of obesity on biliary acute pancreatitis are lacking. This study aimed to assess the impact of MO on outcomes of patients with BAP. Methods: Data was obtained from the Nationwide Inpatient Sample database for 2016 and 2017. Hospital discharges of patients 18 years and over with a principal diagnosis of BAP were included. This cohort was divided based on BMI into nonobese patients (BMI &lt;30) and morbidly obese (MO) patients (BMI &gt;/=40.0). Patients with BMI between 30.0–39.9 were excluded. Primary outcome was inpatient mortality. Secondary outcomes included rate of endoscopic procedures, length of hospital stay (LOS), total hospital charges (THC), discharge diagnoses of hypocalcemia, septic shock, acute renal failure (AKI) and acute respiratory failure (ARF). Multivariate regression analysis was used to adjust for patients’ sociodemographic factors, Charlson comorbidity index as well as hospital characteristics as confounders. Results: A total of 128995 hospitalizations were principally for BAP, with 75.7% and 12.0% of these patients classified as nonobese and MO respectively. There was a significantly higher proportion of females (66.1 vs 54.5%, p&lt;0.001) and lower mean age (50.1 vs 58.7 years, p&lt;0.001) in patients with MO. There was no significant difference in adjusted odds of mortality (aOR=1.34, 95% CI: 0.88 - 2.03, p=0.174), or rate of endoscopy (aOR 1.00 95% CI: 0.91 - 1.11, p=0.958), in MO compared with patients who were nonobese. However, MO patients had increased mean LOS of 0.8 days (95% CI: 0.5 - 1.0, p&lt;0.001), increased mean THC of $10760 (95% CI: 7077 - 14442, p&lt;0.001), increased odds of hypocalcemia (aOR=1.60, 95% CI: 1.22 - 2.09, p=0.001), septic shock (aOR=2.13, 95% CI: 1.39 - 3.25, p&lt;0.001), and AKI (aOR=1.48, 95% CI: 1.30 - 1.68, p&lt;0.001). Conclusion: Even though we did not find any significative difference in mortality, patients with MO appear to have and increased LOS and THC, as well as more complications like septic shock, AKI, and hypocalcemia. This calls for a greater recognition of this association for further research studies and to recognize this potential association during clinical practice.

Thyroidectomy Complications in Patients with Diabetes Mellitus

2019 ◽  
Vol 161 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Sei Y. Chung ◽  
Aparna Govindan ◽  
Archana Babu ◽  
Andrew Tassler
Keyword(s):  
Diabetes Mellitus ◽  
Hospital Mortality ◽  
Vocal Cord ◽  
Thyroid Surgery ◽  
Adverse Outcomes ◽  
Hospital Charges ◽  
Multivariate Techniques ◽  
Vocal Cord Paresis ◽  
Significant Difference ◽  
Patients With Diabetes

Objective To (1) analyze postoperative thyroidectomy outcomes in patients with diabetes mellitus (DM), who are prone to deleterious effects of glucose dysmetabolism, and (2) apply findings to optimize perioperative management of diabetics requiring thyroid surgery. Study Design Retrospective database analysis. Setting University hospital. Subjects and Methods The National Inpatient Sample was queried using International Classification of Diseases, Ninth Revision, Clinical Modification and Procedure Coding System (PCS) codes for patients with benign or malignant thyroid disease who underwent thyroid surgery between 2002 and 2013. An analysis of demographics, comorbidities, and postoperative outcomes was conducted between a DM vs non-DM cohort using bivariate and multivariate techniques. Results In total, 103,842 cases met inclusion criteria; 14.2% were diabetics. Diabetics had significantly higher rates of baseline comorbid chronic pulmonary disease, hypertension, obesity, and anemia. Following thyroidectomy, patients with DM were more likely to have vocal cord paresis or paralysis compared to non-DM patients (2.0% vs 1.3%; P < .001). However, when adjusting for demographics and comorbidities, there was no significant difference in this complication between the 2 groups. Diabetics had independently higher rates of cardiac, pulmonary, and urinary complications, as well as transfusion, reintubation, and in-hospital mortality. Diabetics had longer hospital stays (2.76 vs 1.97; P < .001) with higher incurred hospital charges (32,921 vs 25,198; P < .001). Conclusion Although DM often confers metabolic and ischemic derangements secondary to hyperglycemia such as neuropathy, this comorbidity was not independently associated with higher rates of vocal cord paresis or paralysis following thyroid surgery. However, DM predicted other adverse outcomes, including greater cardiac, pulmonary, and urinary complications, as well as transfusion, reintubation, and in-hospital mortality.

Abstract 325: Acute Pericarditis Associated Hospitalizations in the United States: A Nationwide Analysis From 2003 through 2012

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Nilay Kumar ◽  
Neetika Garg ◽  
Priyank Jain ◽  
Ambarish Pandey
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Cardiac Tamponade ◽  
Metastatic Cancer ◽  
Length Of Hospital Stay ◽  
The United States ◽  
P Value ◽  
Secondary Diagnosis ◽  
Acute Pericarditis ◽  
The Us

Background and objectives: There are scarce data on the incidence and outcomes of acute pericarditis hospitalizations in the US. We sought to ascertain the burden of acute pericarditis hospitalizations and associated outcomes in the US over a ten-year period. Methods: We used the 2003-2012 Nationwide Inpatient Sample (NIS), the largest database of in-patient hospital stays in the US, to identify hospitalizations with primary or secondary diagnosis of acute pericarditis among patients >=16 years using ICD-9-CM codes 420.0, 420.90, 420.91, 420.99, 420.99, 036.41, 074.21, 093.81, 098.83, 115.xx, 391.0 and 411.0. Outcomes of interest included in-hospital mortality, cardiac tamponade, pericardiocentesis, length of hospital stay (LOS) and inflation adjusted charges. Trends and predictors were computed with Poisson regression, linear regression, logistic regression or chi-squared test as appropriate. Survey analysis techniques with discharge weights were used for all analyses. Results: There were 309,983 hospitalizations (mean age 57 ±18; 41.4% women) for acute pericarditis among adults from 2003 - 2012. Overall rates of primary and secondary hospitalizations related to acute pericarditis declined linearly from 164 cases per million in 2003 to 110 cases per million in 2012 (p-value <0.001, Figure). We also observed a significant temporal decline in in-hospital mortality (6.3% to 4%, p<0.001 Figure) and LOS (7.8 ± 11.0 to 6.5±8.4 days; p<0.001) among these patients during the study period. In contrast, rates of cardiac tamponade increased significantly (10.2% in 2008 to 12.02% in 2012; p<0.001) while that of pericardiocentensis remained stable (9.8% in 2003 to 11.2% in 2012; p=0.30) in the study population. Mean inflation adjusted charges increased from 62,478 USD in 2003 to 73,218 USD in 2012 (p<0.001). Old age, female sex, presence of co-morbidities such as heart failure, renal failure, coagulopathy and metastatic cancer were identified as significant predictors of inpatient mortality. Conclusions: Over the past decade, there has been a significant decline in hospitalization rates, in-hospital mortality and length of hospital stay among patients with primary or secondary diagnosis of acute pericarditis.

Abstract 17081: Outcomes of Percutaneous Coronary Intervention in Cirrhosis: Does the Stent Type Matter?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Juan Daniel Del Cid Fratti ◽  
Miguel Salazar ◽  
Pedro Palacios ◽  
Tauseef Akhtar ◽  
Ezequiel Muñoz
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Coronary Intervention ◽  
Hospital Charges ◽  
Decompensated Cirrhosis ◽  
Metal Stents ◽  
Total Hospital ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Hospitalization Costs

Methods: National Inpatient Sample was queried from 2016-2017 for discharges of adult patients with cirrhosis who underwent percutaneous coronary intervention (PCI) with placement of drug-eluding-stents (DES) and bare-metal-stents (BMS) using ICD-10CM/PCS-codes. Patients were subsequently divided between compensated/decompensated cirrhosis as per the BAVENO Score. The primary outcome was in-hospital mortality. Secondary outcomes were post-procedural complications, length of stay (LOS), total hospital charges/costs. Multivariate logistic regression analysis was performed to adjust for confounders. Results: 899,899 PCIs were identified out of which 0.6% (n=5,983) had concomitant cirrhosis. Patients with compensated and decompensated cirrhosis had higher odds of BMS placement when undergoing PCI when compared with patients without cirrhosis [aOR 1.57; (P<0.01)], [aOR 1.54; (P=0.05) respectively]. There was no significant difference in mortality between BMS and DES in patients with compensated-cirrhosis, and similar results were obtained in patients with decompensated-cirrhosis. DES was associated to higher LOS when compared to BMS in patients with decompensated-cirrhosis [4.93; (P:<0.01)], and higher total hospital costs [16, 031.94; (P:<0.01)]. Patients with decompensated-cirrhosis and DES had higher risk of post-procedure bleeding when compared with BMS [aOR 4.22; (P:<0.01)]. Conclusions: Patients admitted for PCI with decompensated-cirrhosis have higher LOS and total hospitalization costs when DES is placed. Likely driven by higher post-procedural bleeding in this set of patients, requiring further intervention. BMS seemed to be safe when used in patients with cirrhosis and is not associated with higher in-hospital mortality even in patients with decompensated-cirrhosis.

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