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Author(s):  
Agam Bansal ◽  
Paul C. Cremer ◽  
Wael A. Jaber ◽  
Penelope Rampersad ◽  
Venu Menon

Background The data on the differential impact of sex on the utilization and outcomes of valve replacement surgery for infective endocarditis are limited to single‐center and small sample size patient population. Methods and Results We utilized the National Inpatient Sample database to identify patients with a discharge diagnosis of infective endocarditis from 2004 to 2015 to assess differences in the characteristics and clinical outcomes of patients hospitalized with infective endocarditis stratified by sex. We also evaluated trends in utilization of cardiac valve replacement and individual valve replacement surgeries in women versus men over a 12‐year period, and compared in‐hospital mortality after surgical treatment in women versus men. A total of 81 942 patients were hospitalized with a primary diagnosis of infective endocarditis from January 2004 to September 2015, of whom 44.31% were women. Women were less likely to undergo overall cardiac valve replacement (6.92% versus 12.12%), aortic valve replacement (3.32% versus 8.46%), mitral valve replacement (4.60% versus 5.57%), and combined aortic and mitral valve replacement (0.85% versus 1.81%) but had similar in‐hospital mortality rates. From 2004 to 2015, the overall rates of cardiac valve replacement increased from 11.76% to 13.96% in men and 6.34% to 9.26% in women and in‐hospital mortality declined in both men and women. Among the patients undergoing valve replacement surgery, in‐hospital mortality was higher in women (9.94% versus 6.99%, P <0.001). Conclusions Despite increased utilization of valve surgery for infective endocarditis in both men and women and improving trends in mortality, we showed that there exists a treatment bias with underutilization of valve surgeries for infective endocarditis in women and demonstrated that in‐hospital mortality was higher in women undergoing valve surgery in comparison to men.


Author(s):  
George Gill ◽  
Jignesh K. Patel ◽  
Diego Casali ◽  
Georgina Rowe ◽  
Hongdao Meng ◽  
...  

Background Factors associated with poor prognosis following receipt of extracorporeal membrane oxygenation (ECMO) in adults with cardiac arrest remain unclear. We aimed to identify predictors of mortality in adults with cardiac arrest receiving ECMO in a nationally representative sample. Methods and Results The US Healthcare Cost and Utilization Project's National Inpatient Sample was used to identify 782 adults hospitalized with cardiac arrest who received ECMO between 2006 and 2014. The primary outcome of interest was all‐cause in‐hospital mortality. Factors associated with mortality were analyzed using multivariable logistic regression. The overall in‐hospital mortality rate was 60.4% (n=472). Patients who died were older and more often men, of non‐White race, and with lower household income than those surviving to discharge. In the risk‐adjusted analysis, independent predictors of mortality included older age, male sex, lower annual income, absence of ventricular arrhythmia, absence of percutaneous coronary intervention, and presence of therapeutic hypothermia. Conclusions Demographic and therapeutic factors are independently associated with mortality in patients with cardiac arrest receiving ECMO. Identification of which patients with cardiac arrest may receive the utmost benefit from ECMO may aid with decision‐making regarding its implementation. Larger‐scale studies are warranted to assess the appropriate candidates for ECMO in cardiac arrest.


Author(s):  
Muhammad Zia Khan ◽  
Salman Zahid ◽  
Muhammad U. Khan ◽  
Asim Kichloo ◽  
Shakeel Jamal ◽  
...  

2021 ◽  
Vol 429 ◽  
pp. 117665
Author(s):  
Justin Lapow ◽  
Alis Dicpinigaitis ◽  
Rajkumar Pammal ◽  
Griffin Coghill ◽  
Osher Rechester ◽  
...  

Author(s):  
Pious D. Patel ◽  
Katherine A. Kelly ◽  
Heidi Chen ◽  
Amber Greeno ◽  
Chevis N. Shannon ◽  
...  

OBJECTIVE Rural-dwelling children may suffer worse pediatric traumatic brain injury (TBI) outcomes due to distance from and accessibility to high-volume trauma centers. This study aimed to compare the impacts of institutional TBI volume and sociodemographics on outcomes between rural- and urban-dwelling children. METHODS This retrospective study identified patients 0–19 years of age with ICD-9 codes for TBI in the 2012–2015 National Inpatient Sample database. Patients were characterized as rural- or urban-dwelling using United States Census classification. Logistic and linear (in log scale) regressions were performed to measure the effects of institutional characteristics, patient sociodemographics, and mechanism/severity of injury on occurrence of medical complications, mortality, length of stay (LOS), and costs. Separate models were built for rural- and urban-dwelling patients. RESULTS A total of 19,736 patients were identified (median age 11 years, interquartile range [IQR] 2–16 years, 66% male, 55% Caucasian). Overall, rural-dwelling patients had higher All Patient Refined Diagnosis Related Groups injury severity (median 2 [IQR 1–3] vs 1 [IQR 1–2], p < 0.001) and more intracranial monitoring (6% vs 4%, p < 0.001). Univariate analysis showed that overall, rural-dwelling patients suffered increased medical complications (6% vs 4%, p < 0.001), mortality (6% vs 4%, p < 0.001), and LOS (median 2 days [IQR 1–4 days ] vs 2 days [IQR 1–3 days], p < 0.001), but multivariate analysis showed rural-dwelling status was not associated with these outcomes after adjusting for injury severity, mechanism, and hospital characteristics. Institutional TBI volume was not associated with medical complications, disposition, or mortality for either population but was associated with LOS for urban-dwelling patients (nonlinear beta, p = 0.008) and cost for both rural-dwelling (nonlinear beta, p < 0.001) and urban-dwelling (nonlinear beta, p < 0.001) patients. CONCLUSIONS Overall, rural-dwelling pediatric patients with TBI have worsened injury severity, mortality, and in-hospital complications, but these disparities disappear after adjusting for injury severity and mechanism. Institutional TBI volume does not impact clinical outcomes for rural- or urban-dwelling children after adjusting for these covariates. Addressing the root causes of the increased injury severity at hospital arrival may be a useful path to improve TBI outcomes for rural-dwelling children.


Author(s):  
Chintan Trivedi ◽  
Kaushal Shah ◽  
Zeeshan Mansuri ◽  
Mounica Thootkur ◽  
Ramu Vadukapuram ◽  
...  

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A1073
Author(s):  
Tien-Chan Hsieh ◽  
Guangchen Zou ◽  
Gin Yi Lee ◽  
Kaiqing Lin ◽  
Yee Hui Yeo

2021 ◽  
Vol 429 ◽  
pp. 117817
Author(s):  
Aiden Lui ◽  
Eric Feldstein ◽  
Kevin Clare ◽  
Alis Dicpinigaitis ◽  
Medha Reddy ◽  
...  

Author(s):  
David Romero Funes ◽  
David Gutierrez Blanco ◽  
Liang Hong ◽  
Emanuele Lo Menzo ◽  
Samuel Szomstein ◽  
...  

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A1116
Author(s):  
Tien-Chan Hsieh ◽  
Guangchen Zou ◽  
Pramuditha Rajapakse ◽  
Gin Yi Lee

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