Postoperative Complications Following Ankle Arthrodesis in Patients With Hepatitis C: Matched Propensity Score Analysis

Background: Hepatitis C is associated with increased adverse events following surgery. The goals of this study were therefore to evaluate postoperative outcomes in patients with hepatitis C following ankle arthrodesis. Materials and Methods: A review of Medicare patients was performed to identify patients who underwent ankle arthrodesis. Patients were then divided into those with a preoperative history of hepatitis C and those who did not and were matched using propensity scores. Outcomes of interest were analyzed using multivariate logistic regression. Results: A diagnosis of hepatitis C was associated with a significantly increased risk of myocardial infarction, emergency department visits, and readmission within 90 days following surgery. In addition, hepatitis C is associated with an increased length of stay, cost of hospitalization, and total hospital charge. Conclusions: A diagnosis of hepatitis C was associated with a significant increase in hospital resource utilization during the initial inpatient stay and the immediate post-discharge period. Level of Evidence: III

Comparing patient characteristics and outcomes in type 1 versus type 2 diabetes with diabetic ketoacidosis: a review and a propensity-matched nationwide analysis

Diabetic ketoacidosis (DKA) is a known complication of patients with type 1 diabetes mellitus (T1DM), but less common in type 2 diabetes mellitus (T2DM). The aim of this study was to compare the outcomes of patients admitted to the hospital with DKA in T1DM versus T2DM. This was a population-based, retrospective, cohort study using data from the Nationwide Inpatient Sample. The group of patients hospitalized for DKA was divided based on a secondary diagnosis of either T1DM or T2DM. The primary outcome was inpatient mortality, and the secondary outcomes were rate of complications, length of hospital stay (LOS) and total hospital charge (THC). The inpatient mortality for DKA was 0.27% (650 patients). In T2DM, the adjusted OR (aOR) for mortality was 2.13 (95% CI 1.38 to 3.28, p=0.001) with adjusted increase in mean THC of $6035 (95% CI 4420 to 7652, p<0.001) and mean LOS of 0.5 day (95% CI 0.3 to 0.6, p<0.001) compared with T1DM. Patients with T2DM had significantly higher odds of having septic shock (aOR 2.02, 95% CI 1.160 to 3.524, p=0.013) compared with T1DM. T2DM was associated with higher inpatient mortality, septic shock and increase in healthcare utilization costs compared with T1DM.

Diabetes Does Not Worsen Outcomes of Patients Admitted for Hyperthyroidism: Analysis of the National Inpatient Sample

Introduction: Both diabetes mellitus (DM) and hyperthyroidism are common diseases. However, it is unclear if co-existing DM worsens outcomes in patients with hyperthyroidism. This study aims to compare the outcomes of patients primarily admitted for hyperthyroidism with and without a secondary diagnosis of DM. Methods: Data were extracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalizations for adult patients with hyperthyroidism as principal diagnosis with and without DM as secondary diagnosis using ICD 10 codes. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges and NSTEMI were secondary outcomes of interest. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million hospitalizations in the combined NIS 2016 and 2017 database. Out of 17,705 hospitalizations for hyperthyroidism, 2,160 (15.9%) had DM. Hospitalizations for hyperthyroidism with DM had similar inpatient mortality [0.35% vs 0.50%, AOR 0.25, 95% CI (0.05–1.30), P= 0.101], total hospital charge [$47,001 vs $36,978 P=0.220], LOS [4.50 vs 3.48 days, P=0.050] and NSTEMI compared to those without DM. Conclusion: Hospitalizations for hyperthyroidism with DM had similar inpatient mortality, total hospital charges, LOS and odds of undergoing ablation compared to those without obesity.

Lung involvement in systemic sclerosis is associated with adverse hospital outcomes: insights from the National Inpatient Sample

This study aimed to compare outcomes of systemic sclerosis (SSc) hospitalizations with and without lung involvement. The primary outcome was inpatient mortality while secondary outcomes were hospital length of stay (LOS) and total hospital charge. Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. This database is the largest collection of inpatient hospitalization data in the USA. The NIS was searched for SSc hospitalizations with and without lung involvement as principal or secondary diagnosis using International Classification of Diseases 10th Revision (ICD-10) codes. SSc hospitalizations for patients aged ≥18 years from the above groups were identified. Multivariate logistic and linear regression analysis was used to adjust for possible confounders for the primary and secondary outcomes, respectively. There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 62,930 hospitalizations were for adult patients who had either a principal or secondary ICD-10 code for SSc. 5095 (8.10%) of these hospitalizations had lung involvement. Lung involvement group had greater inpatient mortality (9.04% vs 4.36%, adjusted OR 2.09, 95% CI 1.61 to 2.73, p<0.0001), increase in mean adjusted LOS of 1.81 days (95% CI 0.98 to 2.64, p<0.0001), and increase in mean adjusted total hospital charge of $31,807 (95% CI 14,779 to 48,834, p<0.0001), compared with those without lung involvement. Hospitalizations for SSc with lung involvement have increased inpatient mortality, LOS and total hospital charge compared with those without lung involvement. Collaboration between the pulmonologist and the rheumatologist is important in optimizing outcomes of SSc hospitalizations with lung involvement.

Kidney-Pancreas Transplant Recipients Experience Higher Risk of Complications Compared to the General Population after Undergoing Coronary Artery Bypass Grafting

This retrospective analysis aims to identify differences in surgical outcomes between pancreas and/or kidney transplant recipients compared with the general population undergoing coronary artery bypass grafting (CABG). Using Nationwide Inpatient Sample (NIS) data from 2005 to 2014, patients who underwent CABG were stratified by either no history of transplant, or history of pancreas and/or kidney transplant. Multivariate analysis was used to calculate odds ratio (OR) to evaluate in-hospital mortality, morbidity, length of stay (LOS), and total hospital charge in all centers. The analysis was performed for both nonemergency and emergency CABG. Overall, 2,678 KTx (kidney transplant alone), 184 PTx (pancreas transplant alone), 254 KPTx (kidney-pancreas transplant recipients), and 1,796,186 Non-Tx (nontransplant) met inclusion criteria. KPTx experienced higher complication rates compared with Non-Tx (78.3 vs. 47.8%, p < 0.01). Those with PTx incurred greater total hospital charge and LOS. On weighted multivariate analysis, KPTx was associated with an increased risk for developing any complication following CABG (OR 3.512, p < 0.01) and emergency CABG (3.707, p < 0.01). This risk was even higher at transplant centers (CABG OR 4.302, p < 0.01; emergency CABG OR 10.072, p < 0.001). KTx was associated with increased in-hospital mortality following emergency CABG, while PTx and KPTx had no mortality to analyze. KPTx experienced a significantly higher risk of complications compared with the general population after undergoing CABG, in both transplant and nontransplant centers. These outcomes should be considered when providing perioperative care.

Abstract 16225: Protein Energy Malnutrition is Associated With Increased Inpatient Mortality in Patients Admitted for Atrial Fibrillation: Analysis of the National Inpatient Sample

Introduction: Various forms of protein energy malnutrition (PEM) has been shown to affect different heart pathologies through its underlying pathogenesis of unabating chronic inflammation. The effect of PEM on atrial fibrillation (AF) is unclear. Our study sought to estimate the impact of PEM on clinical outcomes of hospitalizations for AF using a national database Methods: We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without PEM as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were hospital length of stay (LOS) and total hospital charge. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,629 AF hospitalizations, 3% had PEM. Hospitalization for AF with PEM had a statistically significant increase in mortality (5.2% vs 0.8%, AOR 2.33, 95% CI 1.96 - 2.78, P<0.0001), with an adjusted increase in mean hospital charge of $15,862 (95% CI 11,999 - 19,725, P<0.0001) and a 2 day increase in LOS (95% CI 2.00 - 2.50, P= <0.0001) compared to those without PEM. Conclusion: In conclusion, PEM resulted in increased mortality, LOS and total hospital charge in patients hospitalized with AF. Nutritional rehabilitation in patients with PEM and concomittant AF may be needed to improve outcomes.

Abstract 16243: Co-existing Amyloidosis is Associated With Increased Inpatient Mortality in Patient Admitted for Atrial Fibrillation: Analysis of the National Inpatient Sample

Introduction: Amyloidosis is associated with conduction disturbances of the heart such as atrial fibrillation (AF). The outcomes of atrial fibrillation in patients with concomitant diagnosis of amyloidosis is not clearly established. This aim of this study is to compare outcomes of AF hospitalization with and without a secondary diagnosis of amyloidosis Methods: We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States (US). The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without a secondary diagnosis of amyloidosis (irrespective of specific organ involvement) using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were total hospital charge, rates of electrical cardioversion, pharmacologic cardioversion, and pacemaker implantation. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,629 AF hospitalizations, 715 (0.09%) had amyloidosis. AF hospitalizations with amyloidosis had higher inpatient mortality (AOR 4.56, CI 2.15-9.68, P<0.001) compared to those without amyloidosis. There was no difference in rates of ablation (AOR 0.59, CI 0.22-1.63, P=0.314), pacemaker implantation (AOR 1.18, CI 0.38-3.70, P=0.780) and electrical cardioversion (AOR 0.91, CI 0.58-1.41, P=0.650) and pharmacologic cardioversion (AOR 0.99, CI 0.97-1.02, P=0.560) compared to those without amyloidosis. Conclusion: Patients admitted primarily for AF with co-existing amyloidosis have increased inpatient mortality compared to those with amyloidosis. Rates of ablation, pacemaker implantation, electrical, and pharmacologic cardioversion were similar in both groups.

A cost analysis of managing cancer-related pain among hospitalized US cancer patients.

7079 Background: Pain is a common symptom of cancer, affecting patients' function and quality of life. It is also a common cause of hospitalization for cancer patients. The aim of this study was to evaluate the cost of in-hospital pain management among US cancer patients. Methods: A retrospective analysis of data from all US hospitals that contributed to the National Inpatient Sample for 2011-2015 was conducted. All cancer patients admitted for pain management were included in the analysis. Main outcomes were factors significantly associated with hospital length of stay, total charge per hospital stay, and in-hospital mortality. Weighted chi-square test was used for categorical covariates and univariate analysis was performed using a logistic model. Results: 122,776 patient discharges were identified. Mean age was 59.3 years and 52.3% were female. 65.9% stayed in the hospital for longer than 72 hours, with a median total hospital charge of $48,156. Conversely, the median total hospital charge for those spending less than 72 hours on admission was $15,966. Median total charge per hospital stay was similar among insured and uninsured/self-pay patients ($32,879 vs. $32,323; p=0.013), but higher in patients without metastatic disease ($33,315 vs. $29,369; p<0.001). It was also higher in those with the highest income quartile when compared with lowest income patients ($38,223 vs. $30,047; p<0.001). Co-morbid medical illnesses were more prevalent in those with longer hospital stay (15 vs. 12; p<0.001) and the overall in-hospital mortality rate was 8.2%. There was no significant difference in median total hospital charges between those who died in, or those discharged from the hospital ($33,746 vs. $32,795; p<0.001). On multivariate analyses, gender, race, insurance status, diagnosis of metastatic cancer, age, number of co-morbid medical illnesses, year of diagnosis, and median income were significant predictors of length of stay. Race, insurance payor, metastatic cancer, age, and number of co-morbid medical illnesses were significant predictors of total hospital charges, after adjusting for other covariates. Conclusions: In-patient pain management of cancer patients is associated with significant health care costs. Optimization of outpatient pain management strategies could significantly lower the cost of care for cancer.

Single-institution analysis of ablations versus partial nephrectomies for small renal masses.

e17074 Background: Renal cell carcinoma (RCC) has the highest mortality rate of the genitourinary cancers with detection rising annually for small ( < 4cm) renal masses (SRM). Nephron-sparing partial nephrectomy (PN) is recommended over other approaches such as ablations (Abl). This study aims to evaluate the outcomes and costs associated with treating patients with SRM RCC that undergo PN, laparoscopic cryoablation (lcryo), or various percutaneous ablations-cryoablation (pcryo), microwave (pmv), and radiofrequency (prf). Methods: A retrospective chart review of 295 patients that had either a PN or Abl from 2010-2019 at Beaumont Hospital- Royal Oak was performed. 189 patients with SRM were analyzed. Data collected included demographics, comorbidities, pathology, 30-day ED readmission, recurrence rate, and hospital-billed costs and charges. Data was analyzed using Mann-Whitney, chi-square, unpaired t-tests, Kruskal Wallis post-test, and Dunn’s multiple comparison test. Results: 133 patients with an index Abl (6 lcryo, 73 pcryo, 44 pmv, and 10 prf) and 56 patients with an index PN were analyzed. Mean tumor size for Abl (2.34cm; 90% biopsy-confirmed RCC) and PN (2.48cm; 87% histology confirmed RCC) was comparable. The populations undergoing PN or Abl were similar for both demographics and comorbidities except for age at index procedure (PN 58, Abl 71, p < 0.01). Length of stay (LOS) following index procedure differed with an avg PN LOS = 2.74 days and Abl LOS 0.52 (p < 0.01). 55% of PN patients presented to the ED within 30 days (38% readmitted) whereas only 8% of Abl patients did (42% readmitted)(p < 0.01). The recurrence rate for PN compared to Abl was 23% to 14%, respectively (p = 0.14), with an average follow-up time of 4.95 years for PN and 2.78 years for Abl (p < 0.01). Total hospital charge analysis showed PN being 1.57 the charge of all Abl types (p < 0.01) while cost analysis demonstrated PN being more costly than Abl as a whole by 2.79x (p < 0.01). When evaluating ablation subtypes, trends were noted lcryo being comparable to PN in both charge and cost while percutaneous interventions pmv, pcryo, and prf displayed lower charge and cost when compared to both PN and lcryo. Conclusions: With treatment decisions for SRM RCC are multifactorial, this single-site study demonstrated similar populations with comparable pathologies undergo both PN and Abl procedures. Complication and readmission rates differ between PN and Abl and consideration should be made for these variables as well as the costs associated with each procedure type when managing SRM RCC.