Effect of Weekend Compared to Weekday Stroke Admission on Thrombolytic Use, In-Hospital Mortality, Discharge Disposition, Hospital Charges, and Length of Stay in the Nationwide Inpatient Sample Database: 2002–2006

Abstract Background Patients suffering from acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are thought to be at a higher risk of developing venous thromboembolism due to various reasons such as smoking, immobilization and a transient procoagulant state. However, clinical diagnosis of acute pulmonary embolism (PE) in patients with AECOPD is often difficult due to the similarity in the presenting symptoms of the two conditions. Literature regarding the true prevalence of PE among patients with AECOPD and the role of routine screening for PE in these patients with imaging is controversial. Although some studies have suggested prevalence rates to be as high as 20-25%, thus justifying a routine CT pulmonary angiography (CTPA) to evaluate for PE in these patients, other studies have refuted such findings. Methods We used the 2011 Nationwide Inpatient Sample database to identify patients aged ≥18 years admitted with AECOPD (International Classification of Diseases, 9th Revision, Clinical-Modification [ICD-9-CM] code 491.21). Patients with AECOPD with co-existing PE were identified using the ICD-9-CM codes 415.1x and 673.2x. Prevalence of PE in patients with AECOPD was calculated. Similarly, in-hospital mortality, length of stay and mean hospital charge was derived for patient with AECOPD, with and without PE. Statistical analysis was performed using Stata 13.1 (STATA Corp, College Station, TX), which accounted for the complex survey design and clustering of the database. Results A total of 1,187,808 admissions with AECOPD were identified, of which 1.18% (n=13,988) patients were found to have co-existent PE. On Univariate analyses, no differences were seen in the demographic characteristics (mean age, sex, race, primary payer, region, bed-size, teaching status) of AECOPD patients with and without PE. However, diagnosis of concurrent PE in patients with AECOPD was associated with higher in-hospital mortality (10.6% vs. 3.81%, p<0.001), mean length of stay (9.38 vs. 5.92 days, p<0.001) and mean total hospital charges ($74,234 vs. 40,424, p<0.001). Conclusion In this study of large national database, we found the prevalence of PE in patients admitted for AECOPD to be much lower than reported in literature, suggesting that routine imaging to rule out PE is unlikely to be cost effective. Furthermore, routine screening of AECOPD patients for PE with CTPA might actually result in more untoward effects such as incidental pulmonary nodules and PEs with further unnecessary testing and treatment. Disclosures No relevant conflicts of interest to declare.

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Abstract 14634: Hospital Teaching Status and Variation in Outcomes: Evidence From Patients Undergoing Multi-vessel Percutaneous Coronary Interventions

Circulation ◽

10.1161/circ.142.suppl_3.14634 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Temitope Ajibawo ◽

◽

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Coronary Intervention ◽

Hospital Charges ◽

Teaching Hospitals ◽

Chi Square ◽

Hospital Outcomes ◽

Nationwide Inpatient Sample Database ◽

Percutaneous Coronary ◽

Teaching Status

Background and Objectives: Evidence suggests variations in medical services provided by hospital teaching status. However, there is limited data on how it affects hospital outcomes. The aim of this study is to examine differences in outcomes among patients who underwent multi-vessel percutaneous coronary intervention (MVPCI) stratified by hospital teaching status. Methods: We queried the 2016 Nationwide Inpatient Sample database and identified patients who underwent MVPCI using ICD-10 procedure codes. Hospital teaching status was classified as urban teaching vs. non- teaching. Chi-square and Wilcoxon rank-sum tests were used to compare the following outcomes between hospitals: patient demographics, clinical outcomes, in-hospital mortality, length of stay (LOS), and total charges. Results: Among the 15,611 MVPCI procedures performed, 73.5% were done in teaching hospitals. 68.4% of the MVPCI in teaching hospitals were in males and 54.1% in patients aged ≥65 years. Teaching hospitals had a lower proportion of whites (74.1% vs 79.5%, p<0.001). Teaching and non-teaching hospitals did not differ significantly in impella use (1.7% vs 1.7%, p=0.9928), IABP use (2.2% vs. 2.3%, p=0.7156) and in-hospital mortality (2.0% vs 2.2% p=0.3399). The incidence of acute renal failure (14.0% vs 13.5%, p=0.3858), cardiogenic shock (4.5% vs 4.7%, p=0.5969), cardiac tamponade (0.2% vs 0.2% p=0.5769), and ventricular fibrillation (2.6% vs 2.9%, p=0.2570) did not differ significantly. However, the median length of stay (LOS) (3 vs 2 days, p=0.0075) and hemorrhage requiring transfusion (HRT) (5.6% vs 4.7%, p=0.0414) were significantly greater in teaching centers. In contrast, total hospital charges ($96,465 vs. $106,711, p<0.0001) was lower in teaching centers. Conclusion: Our analysis did not show any differences with regards to in-hospital deaths, IABP use, impella use and many of the hospital outcomes in MVPCI. In teaching centers, the occurrence of HRT and the mean LOS was increased, but there was no increased financial costs.

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Analysis of demographics and outcomes of surgical resection in the CNS of patients with melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21534 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21534-e21534

Author(s):

Achuta Kumar Guddati ◽

Takefumi Komiya ◽

Picon Hector ◽

Allan N. Krutchik ◽

Gagan Kumar

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Hospital Mortality ◽

Surgical Resection ◽

Home Healthcare ◽

Teaching Hospitals ◽

Surgical Interventions ◽

Discharge Disposition ◽

Nationwide Inpatient Sample Database ◽

Significant Difference

e21534 Background: Patients with melanoma frequently develop central nervous system metastases. Oligometastatic disease is often treated either by surgical resection or by stereotactic radiotherapy. This study investigates the trends and clinical outcomes of patients with melanoma who have undergone surgical procedures on the central nervous system during their hospitalization. Methods: A retrospective cohort study was performed based on admissions of adult patients who underwent craniectomy/surgical resection for metastatic melanoma from 2002 -2014 using the Nationwide Inpatient Sample database. The primary outcome measure was all-cause in-hospital mortality. Secondary outcomes included length of hospital stay(LOS) and discharge disposition (home/home with health care and skilled nursing facilities/long term acute care (SNF/LTAC)). Factors associated with in-hospital mortality were examined by multivariable logistic regression. We adjusted for patient and hospital characteristics, payer, and comorbid conditions. We also examined trends of mortality for the study years. P was kept at 0.05. Results: There were an estimated 5972 discharges of patients with melanoma undergoing craniectomy/surgical resection during the study period. Patients undergoing surgical interventions were typically males (69%) and whites (79%). 98% of procedures were performed at teaching hospitals. Unadjusted all-cause in-hospital mortality was 3.1%. There was no significant difference in mortality over 13 years. Age, gender, and race were not associated with increased in-hospital mortality. Median LOS was 5 days (IQR 3-9 days). LOS was longer in elderly and those with higher Charlson co-morbid index. Of the survivors, 76% were discharged to home or with home healthcare while 24% were discharged to SNF/LTAC. Patients with age > 65 (OR 2.9; 95%CI 2.2-3.9, p < 0.001) and those with higher Charlson co-morbid index (OR 1.2; 95%CI 1.1-1.3) had higher odds for being discharged to SNF/LTAC. Conclusions: Patients who undergo craniectomy/surgical resection for melanoma have a low in-hospital mortality rate. One quarter of patients are discharged to SNF/LTAC.

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Abstract 45: Thrombolytic Treatment for In-Hospital Ischemic Strokes in United States

Stroke ◽

10.1161/str.44.suppl_1.a45 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Tenbit Emiru ◽

Malik M Adil ◽

Adnan I Qureshi

Keyword(s):

United States ◽

Ischemic Stroke ◽

Length Of Stay ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Clinical Characteristics ◽

The United States ◽

Treated Group ◽

Hospital Charges ◽

Thrombolytic Treatment

BACKGROUND: Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital acute ischemic stroke, there is little data on rates and outcomes of patients receiving thrombolytics for in-hospital ischemic strokes. OBJECTIVE: To determine the rates of in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated with thrombolytics on admission. DESIGN/METHODS: We analyzed a seven-year data (2002-2009) from the National Inpatient Survey (NIS), a nationally representative inpatient database in the United States. We identified patients who had in-hospital ischemic strokes (defined by thrombolytic treatment after one day of hospitalization) and those who received thrombolytics on the admission day. We compared demographics, baseline clinical characteristics, in hospital complications, length of stay, hospitalization charges, and discharge disposition, between the two patient groups. RESULT: A total of 18036 (21.5%) and 65912 (78.5%) patients received thrombolytics for in-hospital and on admission acute ischemic stroke, respectively. In hospital complications such as pneumonia (5.0% vs. 3.4%, p=0.0006), deep venous thrombosis (1.9% vs. 0.6%, p<0.0001) and pulmonary embolism (0.8% vs. 0.4%, p=0.01) were significantly higher in the in-hospital group compared to on admission thrombolytic treated group. Hospital length of stay and mean hospital charges were not different between the two groups. Patients who had in-hospital strokes had had higher rates of in hospital mortality (12.1% vs. 10.6%, p=0.02). In a multivariate analysis, in-hospital thrombolytic treated group had higher in-hospital mortality after adjustment for age, gender and baseline clinical characteristics (odds ratio 0.84, 95% confidence interval 0.74-0.95, p=0.008). CONCLUSION/RELEVANCE: In current practice, one out of every five acute ischemic stroke patients treated with thrombolytics is receiving treatment for in-hospital strokes. The higher mortality and complicated hospitalization in such patients needs to be recognized.

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

The American Surgeon ◽

10.1177/000313481408001035 ◽

2014 ◽

Vol 80 (10) ◽

pp. 1074-1077 ◽

Cited By ~ 44

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%).

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Palliative Care in Ruptured Aortic Aneurysm in the United States: A Retrospective Analysis of Nationwide Inpatient Sample Database

Angiology ◽

10.1177/0003319720917239 ◽

2020 ◽

Vol 71 (7) ◽

pp. 633-640

Author(s):

Tomo Ando ◽

Oluwole Adegbala ◽

Takeshi Uemura ◽

Said Ashraf ◽

Emmanuel Akintoye ◽

...

Keyword(s):

Palliative Care ◽

Aortic Aneurysm ◽

Length Of Stay ◽

Nationwide Inpatient Sample ◽

The United States ◽

Hospitalization Cost ◽

Ruptured Aortic Aneurysm ◽

Nationwide Inpatient Sample Database ◽

The Cost ◽

Repair Group

We assessed the trend of palliative care (PC) referrals and its effect on hospitalization cost and length of stay (LOS) in ruptured aortic aneurysm (rAA). The Nationwide Inpatient Sample from 2005 to 2014 was used to identify admissions with age ≥50 and rAA. A total of 54 134 rAA admissions were identified and 5019 (9.3%) had PC referrals. During the study period, PC referral rate increased from 0.97% to 15.3% ( P trend < .0001). Length of stay (1.7 vs 2.8 days, adjusted mean ratio [aMR] = 0.62, 95% confidence interval [CI]: 0.58-0.66), and cost (US$7778 vs US$13 575, aMR = 0.57, 95% CI: 0.52-0.63) were significantly lower in rAA admissions that did not undergo interventions. In the percutaneous repair group, LOS was similar but the cost was higher (US$61 759 vs US$52 260, aMR = 1.18, 95% CI: 1.05-1.30), whereas in surgical repair group, LOS was shorter (4.6 vs 5.9 days, aMR = 0.77, 95% CI: 0.73-0.82) but the cost was higher (US$59 755 vs US$52 523, aMR = 1.14, 95% CI: 1.02-1.28). Palliative care could shorten LOS and save hospitalization cost in rAA admissions not a candidate for repair. Further studies are required to investigate the variable effects of PC on rAA.

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Comprehensive analysis of in-hospital delirium after major surgical oncology procedures

Canadian Urological Association Journal ◽

10.5489/cuaj.6030 ◽

2019 ◽

Vol 14 (3) ◽

Author(s):

Marco Bandini ◽

Michele Marchioni ◽

Felix Preisser ◽

Sebastiano Nazzani ◽

Zhe Tian ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Hospital Mortality ◽

Lung Resection ◽

Temporal Trends ◽

Surgical Oncology ◽

Population Based ◽

Hospital Charges ◽

Weighted Estimate ◽

Prolonged Length

Introduction: Very few population-based assessments of delirium have been performed to date. These have not assessed the implications of delirium after major surgical oncology procedures (MSOPs). We examined the temporal trends of delirium following 10 MSOPs, as well as patient and hospital delirium risk factors. Finally, we examined the effect of delirium on length of stay, in-hospital mortality, and hospital charges. Methods: We retrospectively identified patients who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection, or pancreatectomy within the Nationwide Inpatient Sample (2003‒2013). We yielded a weighted estimate of 3 431 632 patients. Multivariable logistic regression (MLR) analyses identified the determinants of postoperative delirium, as well as the effect of delirium on length of stay, in-hospital mortality, and hospital charges. Results: Between 2003 and 2013, annual delirium rate increased from 0.7 to 1.2% (+6.0%; p<0.001). Delirium rates were highest after cystectomy (predicted probability [PP] 3.1%) and pancreatectomy (PP 2.6%) and lowest after prostatectomy (PP 0.15%) and mastectomy (PP 0.13%). Advanced age (odds ratio [OR] 3.80), maleness (OR 1.38), and higher Charlson comorbidity index (OR 1.20), as well as postoperative complications represent risk factors for delirium after MSOPs. Delirium after MSOP was associated with prolonged length of stay (OR 3.00), higher mortality (OR 1.15) and increased in-hospital charges (OR 1.13). Conclusions: No contemporary population-based assessments of delirium after MSOP have been reported. According to our findings, delirium after MSOP has a profound impact on patient outcomes that ranges from prolonged length of stay to higher mortality and increased in-hospital charges.

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Impact of tuberculosis on mortality and healthcare resource utilization in cancer patients: A nationwide inpatient sample analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e13625 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e13625-e13625

Author(s):

Ishaan Vohra ◽

Prasanth Lingamaneni ◽

Vatsala Katiyar ◽

Krishna Rekha Moturi ◽

Sindhu Janarthanam Malapati ◽

...

Keyword(s):

Cancer Patients ◽

Resource Utilization ◽

Nationwide Inpatient Sample ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Health Concern ◽

Hospital Charges ◽

Solid Organ ◽

Nationwide Inpatient Sample Database ◽

Increased Risk

e13625 Background: Tuberculosis (TB) is a major public health concern. Patients with malignancy are at increased risk of developing TB as a result of depressed cellular immunity. The aim of the study is to analyze the prevalence, mortality and healthcare resource utilization of cancer patients with TB. Methods: Adult patients with malignancy and TB (cases) were identified using ICD10 code from Nationwide Inpatient Sample database 2017 and their data was compared to cancer patients without TB (controls). Univariate and multivariable logistic and Poisson regression models were used to analyze mortality and healthcare resource utilization. Results: Among 2,099,294 adult cancer patients admitted in 2017, 1115 were found to have TB. Majority (84%) had pulmonary TB. Mean age of patients was 60.3 years with 65% males and white predominance (33%). Overall prevalence of TB in cancer population was 51.3/100,000 patients, with highest being in Hodgkin lymphoma (182.6/100,000) followed by and MDS/ MPN patients (113.2/100,000) (p < 0.01). Among solid organ malignancies, lung cancer had the highest prevalence of TB (92.1/100,000). After adjusting for the demographic and patient related variables, TB was found to be an independent risk factor for mortality in cancer patients (adjusted HR 1.7, 95% CI 1.13-2.66, p = 0.017). The mortality of cases during inpatient stay was 10.2% compared to 6.2% in controls. The mean length of stay for cases was 12.4 days vs 6.3 days in controls (adjusted coef +6.12, 95% CI 3.64-8.59, P < 0.001) and mean hospital charges in cases was $136,026 vs $67,381 in controls (adjusted coef 68,680, 95% CI 39,053.5-98,306.9, p < 0.001). On multivariate analysis, predictors of mortality in cancer patients with TB were older age, malnutrition, uninsured status, higher Charlson comorbidity score ( = > 3), ICU care, venous thrombo-embolism and Acute renal failure requiring dialysis. Conclusions: TB significantly increases the morbidity and mortality in cancer patients. Widespread TB screening, prompt recognition of infection and treatment can considerably reduce health care costs. [Table: see text]

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