scholarly journals Spinal Fractures in Ankylosing Spondylitis: Patterns, Management, and Complications in the United States – Analysis of Latest Nationwide Inpatient Sample Data

Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 786-797
Author(s):  
Sandeep Kandregula ◽  
Harjus S. Birk ◽  
Amey Savardekar ◽  
William Chris Newman ◽  
Robbie Beyl ◽  
...  
Keyword(s):  
United States ◽  
Ankylosing Spondylitis ◽  
Nationwide Inpatient Sample ◽  
Spinal Fractures ◽  
The United States ◽  
Complication Rates ◽  
Comorbidity Score ◽  
Thoracic Level ◽  
The Mean ◽  
Cervical Level

Objective: Ankylosing spondylitis (AS) is a rheumatic inflammatory disease marked by chronic inflammation of the axial skeleton. This condition, particularly when severe, can lead to increased risk of vertebral fractures attributed to decreased ability of the stiffened spinal column to sustain normal loads. However, little focus has been placed on understanding the locations of spinal fractures and associated complications and assessing the correlation between these. In this review, we aim to summarize the complications and treatment patterns in the United States in AS patients with spinal fractures, using the latest Nationwide Inpatient Sample (NIS) database (2016–2018).Methods: We analyzed the NIS data of years 2016–2018 to compare the fracture patterns and complications.Results: A total of 5,385 patients were included. The mean age was 71.63 years (standard deviation [SD], 13.21), with male predominance (83.8%). The most common population is Whites (77.4%), followed by Hispanics (7.9%). The most common fracture level was thoracic level (58.3%), followed by cervical level (38%). Multiple fracture levels were found in 13.3% of the patients. Spinal cord injury (SCI) was associated with 15.8% of the patients. The cervical level had a higher proportion of SCI (26.5%), followed by thoracic level (9.2%). The mean Elixhauser comorbidity score was 4.82 (SD, 2.17). A total of 2,365 patients (43.9%) underwent surgical treatment for the fractures. The overall complication rate was 40.8%. Respiratory complications, including pneumonia and respiratory insufficiency, were the predominant complications in the overall cohort. Based on the regression analysis, there was no significant difference (p = 0.45) in the complication rates based on the levels. The presence of SCI increased the odds of having a complication by 2.164 times (95% confidence interval, 1.722–2.72; p ≤ 0.001), and an increase in Elixhauser comorbidity score predicted the complication and in-hospital mortality rate (p ≤ 0.001).Conclusion: In conclusion, AS patients with spinal fractures have higher postoperative complications than the general population. The most common fracture location was thoracic in our study, although it differs with few studies, with SCI occurring in 1/6th of the patients.

scholarly journals Total elbow arthroplasty in the United States: evaluation of cost, patient demographics, and complication rates

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Hanbing Zhou ◽  
Nathan D. Orvets ◽  
Gabriel Merlin ◽  
Joshua Shaw ◽  
Joshua S. Dines ◽  
...  
Keyword(s):  
United States ◽  
Direct Cost ◽  
Complication Rate ◽  
Readmission Rate ◽  
The United States ◽  
Total Elbow Arthroplasty ◽  
Complication Rates ◽  
Patient Demographics ◽  
Elbow Arthroplasty ◽  
The Mean

Total elbow arthroplasty (TEA) is utilized in the treatment of rheumatoid and post-traumatic elbow arthritis. TEA is a relatively low volume surgery in comparison to other types of arthroplasty and therefore little is known about current surgical utilization, patient demographics and complication rates in the United States. The purpose of our study is to evaluate the current practice trends and associated inpatient complications of TEA at academic centers in the United States. We queried the University Health Systems Consortium administrative database from 2007 to 2011 for patients who underwent an elective TEA. A descriptive analysis of demographics was performed which included patient age, sex, race, and insurance status. We also evaluated the following patient clinical benchmarks: hospital length of stay (LOS), hospital direct cost, inhospital mortality, complications, and 30-day readmission rates. Our cohort consisted of 3146 adult patients (36.5% male and 63.5% female) with an average age of 58 years who underwent a total elbow arthroplasty (159 academic medical centers) in the United States. The racial demographics included 2334 (74%) Caucasian, 285 (9%) black, 236 (7.5%) Hispanic, 16 (0.5%) Asian, and 283 (9%) other patients. The mean LOS was 4.2±5 days and the mean total direct cost for the hospital was 16,300±4000 US Dollars per case. The overall inpatient complication rate was 3.1% and included mortality <1%, DVT (0.8%), re-operation (0.5%), and infection (0.4%). The 30-day readmission rate was 4.4%. TEA is a relatively uncommon surgery in comparison to other forms of arthroplasty but is associated with low in-patient and 30-day perioperative complication rate. Additionally, the 30-day readmission rate and overall hospital costs are comparable to the traditional total hip and knee arthroplasty surgeries.

Intermediate-term Experience With the STAR Total Ankle in the United States

2018 ◽  
Vol 40 (3) ◽  
pp. 268-275 ◽  
Author(s):  
Evan M. Loewy ◽  
Thomas H. Sanders ◽  
Arthur K. Walling
Keyword(s):  
United States ◽  
Perioperative Complications ◽  
Case Series ◽  
Major Complication ◽  
The United States ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean

Background: Limited intermediate and no real long-term follow-up data have been published for total ankle arthroplasty (TAA) in the United States. This is a report of clinical follow-up data of a prospective, consecutive cohort of patients who underwent TAA by a single surgeon from 1999 to 2013 with the Scandinavian Total Ankle Replacement (STAR) prosthesis. Methods: Patients undergoing TAA at a single US institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination, and radiographs; American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Primary outcomes included implant survivability and functional outcomes scores. Secondary outcomes included perioperative complications such as periprosthetic or polyethylene fracture. Between 1999 and 2013, a total of 138 STAR TAAs were performed in 131 patients; 81 patients were female. The mean age at surgery was 61.5 ± 12.3 years (range, 30-88 years). The mean duration of follow-up for living patients who retained both initial components at final follow-up was 8.8±4.3 years (range 2-16.9 years). Results: The mean change in AOFAS Ankle-Hindfoot scores from preoperative to final follow-up was 36.0 ± 16.8 ( P < .0001). There were 21 (15.2%) implant failures that occurred at a mean 4.9 ± 4.5 years postoperation. Ten polyethylene components in 9 TAAs (6.5%) required replacement for fracture at an average 8.9 ± 3.3 years postoperatively. Fourteen patients died with their initial implants in place. Conclusion: This cohort of patients with true intermediate follow-up after TAA with the STAR prosthesis had acceptable implant survival, maintenance of improved patient-reported outcome scores, and low major complication rates. Level of Evidence: Level IV, case series.

Severe Maternal Morbidity and Hospital Cost among Hospitalized Deliveries in the United States

2018 ◽  
Vol 35 (13) ◽  
pp. 1287-1296 ◽  
Author(s):  
Suneet Chauhan ◽  
Sean Blackwell ◽  
Han-Yang Chen
Keyword(s):  
United States ◽  
Hospital Cost ◽  
Maternal Morbidity ◽  
Nationwide Inpatient Sample ◽  
Hospital Costs ◽  
The United States ◽  
Severe Maternal Morbidity ◽  
The Mean ◽  
Procedure Codes ◽  
Mean Cost

Objective The objective of this study was to estimate the contemporary national rate of severe maternal morbidity (SMM) and its associated hospital cost during delivery hospitalization. Study Design We conducted a retrospective study identifying all delivery hospitalizations in the United States between 2011 and 2012. We used data from the National (Nationwide) Inpatient sample of the Healthcare Cost and Utilization Project. The delivery hospitalizations with SMM were identified by having at least one of the 25 previously established list of diagnosis and procedure codes. Aggregate and mean hospital costs were estimated. A generalized linear regression model was used to examine the association between SMM and hospital costs. Results Of 7,438,946 delivery hospitalizations identified, the rate of SMM was 154 per 10,000 delivery hospitalizations. Without any SMM, the mean hospital cost was $4,300 and with any SMM, the mean hospital cost was $11,000. After adjustment, comparing to those without any SMM, the mean cost of delivery hospitalizations with any SMM was 2.1 (95% confidence interval: 2.1–2.2) times higher, and this ratio increases from 1.7-fold in those with only one SMM to 10.3-fold in those with five or more concurrent SMM. Conclusion The hospital cost with any SMM was 2.1 times higher than those without any SMM. Our findings highlight the need to identify interventions and guide research efforts to mitigate the rate of SMM and its economic burden.

scholarly journals Seasonal Variation in Autoimmune Hemolytic Anemia: A National Database Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4883-4883
Author(s):  
Srinandan Guntupalli ◽  
Dhara Patel ◽  
Ronak Gajendra kumar Soni ◽  
Sindhupriya Devarashetty ◽  
Richard Preston Mansour
Keyword(s):  
United States ◽  
Seasonal Variation ◽  
Immune System ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
National Database ◽  
Community Hospitals ◽  
The Mean

Abstract Background: Autoimmune hemolytic anemia (AIHA) is a decompensated acquired hemolysis caused by host's immune system acting against its own red cell antigens. Serologically, it can be divided to warm hemolytic anemia, cold hemolytic anemia, paroxysmal cold hemoglobinuria and mixed AIHA. Pathogenesis of AIHA comprises of a series of complex interactions between genetics, environmental either conferring to protective or deteriorating effects. Among these, climatic changes appears to be key as it involves many triggers such as viral infections, temperature and other host factors. We reviewed a large national hospitalization database to determine whether rates of autoimmune hemolytic anemia have a seasonal variation over the past decade. Methods: We examined the Nationwide Inpatient Sample (NIS), a nationally representative survey of hospitalizations conducted by the Healthcare Cost and Utilization Project in collaboration with participating states. It is the largest all-payer inpatient dataset in the United States and includes a 20% sample of United States community hospitals that approximates 20% of all US community hospitals. The Nationwide Inpatient Sample (NIS) database was used to estimate annual number of hospitalizations from 2000 - 2012. Identification of autoimmune hemolytic anemia related hospitalizations was based on the designation of the prior validated International Classification of Diseases (9th Edition) Clinical Modification (ICD-9-CM) diagnosis code 283 as the principal discharge diagnosis. The frequency of hospitalization per month cumulative over 13 years was calculated and divided by number of days in that month to determine the mean hospitalizations per day for each month. All calculations were carried out using the weighted estimates approximating nationwide population estimates. Results: An estimated 48,416 hospitalizations with primary diagnosis of autoimmune hemolytic anemia occurred in the US from 2000 to 2012 as per NIS database. More specifically, the mean number of hospitalizations per day in each month is shown in Fig. 1. The mean number of hospitalizations each day was highest in November (141 per day) and thereafter the hospitalization rate dropped to a nadir in May (122 per day). There was a significant rising trend of admissions from June towards winter months with peaks in November as depicted in the Fig.1. In general, the number of hospitalization was maximum in the winter months and minimum in summer months as demonstrated in Fig.2. Conclusion: We identified for the first time in United States an impressive pattern of seasonal variation in hospitalizations for autoimmune hemolytic anemia with a notable increase in winter and fall and a significant drop during summer months. The seasonal pattern may reflect viral or other triggers for immune system activation. Further efforts need to be made to identify triggers and methods to determine the relationship of these variations and reduce this predictive burden on the overall health care system. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

scholarly journals Longer Residence in the United States is Associated With More Physical Function Limitations in African Immigrant Older Adults

2020 ◽  
pp. 073346482097760
Author(s):  
Manka Nkimbeng ◽  
Yvonne Commodore-Mensah ◽  
Jacqueline L. Angel ◽  
Karen Bandeen-Roche ◽  
Roland J. Thorpe ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Confidence Interval ◽  
Physical Function ◽  
Racial Discrimination ◽  
African Immigrants ◽  
The United States ◽  
African Immigrant ◽  
High Discrimination ◽  
The Mean

Acculturation and racial discrimination have been independently associated with physical function limitations in immigrant and United States (U.S.)-born populations. This study examined the relationships among acculturation, racial discrimination, and physical function limitations in N = 165 African immigrant older adults using multiple linear regression. The mean age was 62 years ( SD = 8 years), and 61% were female. Older adults who resided in the United States for 10 years or more had more physical function limitations compared with those who resided here for less than 10 years ( b = −2.62, 95% confidence interval [CI] = [–5.01, –0.23]). Compared to lower discrimination, those with high discrimination had more physical function limitations ( b = −2.51, 95% CI = [–4.91, –0.17]), but this was no longer significant after controlling for length of residence and acculturation strategy. Residing in the United States for more than 10 years is associated with poorer physical function. Longitudinal studies with large, diverse samples of African immigrants are needed to confirm these associations.

scholarly journals A Retrospective Analysis of Softball-Related Head and Facial Injuries Treated in United States Emergency Departments, 2013-2017

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982566 ◽  
Author(s):  
John S. Strickland ◽  
Marie Crandall ◽  
Grant R. Bevill
Keyword(s):  
United States ◽  
Head Injuries ◽  
The United States ◽  
Weighted Estimate ◽  
Body Parts ◽  
Facial Injuries ◽  
Closed Head Injuries ◽  
Closed Head ◽  
The Mean ◽  
Race Ethnicity

Background: Softball is a popular sport played through both competitive and recreational leagues. While head and facial injuries are a known problem occurring from games, little is known about the frequency or mechanisms by which they occur. Purpose: To analyze head/face injury diagnoses and to identify the mechanisms associated with such injuries. Study Design: Descriptive epidemiological study. Methods: A public database was used to query data related to head/facial injuries sustained in softball. Data including age, sex, race/ethnicity, injury diagnosis, affected body parts, disposition, incident location, and narrative descriptions were collected and analyzed. Results: A total of 3324 head and face injuries were documented in the database over the time span of 2013 to 2017, resulting in a nationwide weighted estimate of 121,802 head/face injuries occurring annually. The mean age of the players was 21.5 ± 14.4 years; 72.1% of injured players were female, while 27.9% were male. The most common injury diagnoses were closed head injuries (22.0%), contusions (18.7%), concussions (17.7%), lacerations (17.1%), and fractures (15.1%). The overwhelming majority of injuries involved being struck by a ball (74.3%), followed by colliding with another player (8.3%), colliding with the ground or a fixed object (5.0%), or being struck by a bat (2.8%). For those injuries caused by a struck-by-ball incident, most occurred from defensive play (83.7% were fielders struck by a hit or thrown ball) as opposed to offensive play (12.3% were players hit by a pitch or runners struck by a ball). Although helmet usage was poorly tracked in the database, female players (1.3%) were significantly more likely to have been wearing a helmet at the time of injury than were male players (0.2%) ( P = .002). Conclusion: The present study demonstrates that a large number of head and face injuries occur annually within the United States as a result of softball play. A variety of injuries were observed, with the majority involving defensive players being struck by the ball, which highlights the need for more focus on player safety by stronger adherence to protective headgear usage and player health monitoring.

scholarly journals Stewart's Wilt Reactions of an International Collection of Zea mays Germ Plasm Inoculated with Erwinia stewartii

Plant Disease ◽  
2000 ◽  
Vol 84 (8) ◽  
pp. 901-906 ◽  
Author(s):  
Jerald K. Pataky ◽  
Lindsey J. du Toit ◽  
Noah D. Freeman
Keyword(s):  
United States ◽  
Germ Plasm ◽  
Sweet Corn ◽  
The United States ◽  
River Valley ◽  
Ohio River ◽  
Ohio River Valley ◽  
The World ◽  
The Mean ◽  
Stewart's Wilt

Maize accessions were evaluated in 1997, 1998, and 1999 to identify additional sources of Stewart's wilt resistance and to determine if reactions differed among accessions collected from various regions of the United States and throughout the world. The distributions of Stewart's wilt reactions rated from 1 (no appreciable spread of symptoms) to 9 (dead plants) were relatively similar among groups of accessions from all regions of the world except for those from the Mid-Atlantic/Ohio River Valley region of the United States, the southern United States, and the northeastern United States. The mean and median Stewart's wilt rating for 1,991 accessions evaluated in 1997 was 4. The mean Stewart's wilt rating for 245 accessions collected from the Mid-Atlantic/Ohio River Valley region was 3.1, which was significantly lower than that for accessions from all other regions. The mean rating for accessions from the southern United States was 3.7, which also was lower than mean ratings for accessions from all other regions. Ratings from trials in 1997 and 1998 were highly correlated (r = 0.87) for 292 accessions and 15 sweet corn hybrid checks evaluated in both years. Of 20 accessions rated below 2 in 1997 and 1998, seven were from Virginia, seven were from the Ohio River Valley or central Corn Belt of the United States, four were from the northern or western Corn Belt of the United States, and two were from Spain. Ratings for these accessions ranged from 1.7 to 3.1 in 1999. Ratings ranged from 2.6 to 3.7 for F1 hybrids of these accessions crossed with one of two susceptible sweet corn inbreds, CrseW30 or Crse16, which were rated 5.7 and 5.4, respectively. Based on the reactions of this collection of germ plasm, it appears that high levels of Stewart's wilt resistance are prevalent only among accessions collected from areas where the disease has been endemic for several years, whereas moderate levels of resistance can be found in accessions collected from nearly everywhere in the world.

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