Hospital Frailty Risk Score and Healthcare Resource Utilization After Surgery for Primary Spinal Intradural/Cord Tumors

Objective The Hospital Frailty Risk Score (HFRS) is a metric that measures frailty among patients in large national datasets using ICD-10 codes. While other metrics have been utilized to demonstrate the association between frailty and poor outcomes in spine oncology, none have examined the HFRS. The aim of this study was to investigate the impact of frailty using the HFRS on complications, length of stay, cost of admission, and discharge disposition in patients undergoing surgery for primary tumors of the spinal cord and meninges. Methods A retrospective cohort study was performed using the Nationwide Inpatient Sample database from 2016 to 2018. Adult patients undergoing surgery for primary tumors of the spinal cord and meninges were identified using ICD-10-CM codes. Patients were categorized into 2 cohorts based on HFRS score: Non-Frail (HFRS<5) and Frail (HFRS≥5). Patient characteristics, treatment, perioperative complications, LOS, discharge disposition, and cost of admission were assessed. Results Of the 5955 patients identified, 1260 (21.2%) were Frail. On average, the Frail cohort was nearly 8 years older ( P < .001) and experienced more postoperative complications ( P = .001). The Frail cohort experienced longer LOS ( P < .001), a higher rate of non-routine discharge ( P = .001), and a greater mean cost of admission ( P < .001). Frailty was found to be an independent predictor of extended LOS ( P < .001) and non-routine discharge ( P < .001). Conclusion Our study is the first to use the HFRS to assess the impact of frailty on patients with primary spinal tumors. We found that frailty was associated with prolonged LOS, non-routine discharge, and increased hospital costs.

Pregnancy, delivery and neonatal outcomes among women living with Down syndrome. A matched cohort study, taken from a population database.

Objectives: Women with Down syndrome (DS) suffer from several health issues, however, their fecundity is not affected. Despite that, there are no studies in the literature to address pregnancy, delivery, or neonatal outcomes among women with DS. Design: We conducted a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample Database over 11 years from 2004 to 2014. Methods: A delivery cohort was created using ICD-9 codes. ICD-9 code 758.0 was used to extract the cases of maternal DS. Pregnant women with DS (study group) were matched based on age and health insurance type to women without DS (control) at a ratio of 1:4. A multivariant logistic regression model was used to adjust for statistically significant variables (P-value < 0.5). Results: There were a total of 9,096,788 deliveries during the study period. Of those, 185 pregnant women were found to have DS. The matched control group was 740. Maternal pregnancy risks mostly did not differ between those with and without DS including pregnancy-induced PIH, gestational diabetes, preeclampsia, PPROM, chorioamnionitis, cesarean section, operative vaginal delivery, or blood transfusion (P >0.05, all). However, they were at extremely increased risk of delivering prematurely (aOR 3.86, 95% CI 1.25-11.93), and to have adverse neonatal outcomes such as small for gestational age (aOR 13.13, 95% CI 2.20-78.41), intrauterine fetal demise (aOR 20.97, 95% CI 1.86-237.02), and congenital anomalies (aOR 9.59, 95% CI 1.47-62.72). Conclusion: Women with DS should be counseled about their increased risk of premature delivery and adverse neonatal outcomes.

Incidence and Risk Factors of In-hospital Prosthesis-Related Complications Following Total Shoulder Arthroplasty

BackgroundThe occurrence of prosthesis-related complications after total shoulder arthroplasty is devastating and costly. The purpose was to determine the incidence and risk of in-hospital prosthesis-related complications after total shoulder arthroplasty utilizing a large-scale sample database.MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample from 2010 to 2014. Patients who underwent total shoulder arthroplasty were included. Patient demographics, hospital characteristics, length of stay, economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated.ResultsA total of 34,198 cases were capture from the Nationwide Inpatient Sample database. There were 343 cases of in-hospital prosthesis-related complications after total shoulder arthroplasty and the overall incidence was 1%, with a more than 2.5-fold decrease from 2010 to 2014. Dislocation was the most common category among prosthesis-related complications (0.1%). The occurrence of in-hospital prosthesis-related complications was associated with significantly more total charges and slightly longer length of stay while less usage of Medicare. Risk factors of prosthesis-related complications were identified including younger age (<64 years), female, the native American, hospital in the South, alcohol abuse, depression, uncomplicated diabetes, diabetes with chronic complications, fluid and electrolyte disorders, metastatic cancer, neurological disorders, and renal failure. Interestingly, advanced age (≥65 years) and proprietary hospital were found as protective factors. Furthermore, prosthesis-related complications were associated with aseptic necrosis, rheumatoid arthritis, rotator cuff tear arthropathy, Parkinson’s disease, prior shoulder arthroscopy, and blood transfusion.ConclusionsIt is of benefit to study risk factors of prosthesis-related complications following total shoulder arthroplasty to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.

Temporal Trends in the Microbiological Characteristics of Sepsis in the United States: A Population Based Study

Background Epidemiologic studies are needed for monitoring population-level trends in sepsis. This study examines sepsis-causing microorganisms from 2006 to 2014 in the United States using data from the Nationwide Inpatient Sample database. Methods 7 860 686 adults hospitalized with sepsis were identified using a validated ICD-9 coding approach. Associated microorganisms were identified by ICD-9 code and classified by major groups (Gram-positive, Gram-negative, fungi, anaerobes) and specific species for analysis of their incidence and mortality. Results The rate of sepsis incidence has increased for all four major categories of pathogens, while the mortality rate decreased. In 2014, Gram-negative pathogens had a higher incidence than Gram-positives. Anaerobes increased the fastest with an average annual increase of 20.17% (p < 0.001). Fungi had the highest mortality (19.28%) and the slowest annual decrease of mortality (−2.31%, p = 0.006) in 2013, while anaerobic sepsis had the highest hazard of mortality (adjusted HR 1.60, 95% CI 1.53-1.66). Conclusions Gram-negative pathogens have replaced Gram-positives as the leading cause of sepsis in the United States in 2014 during the study period (2006-2014). The incidence of anaerobic sepsis has an annual increase of 20%, while the mortality of fungal sepsis has not decreased at the same rate as other microorganisms. These findings should inform the diagnosis and management of septic patients, as well as the implementation of public health programs.

Incidence, Risk Factors and Outcomes of Pulmonary Embolism in Philadelphia Negative Myeloproliferative Neoplasms: A Population Based Study

Introduction: Thromboembolism is a well-recognized complication of patients with Philadelphia negative myeloproliferative neoplasms (MPN), potentially due to an endothelial injury caused by the activation of inflammatory cytokines. Among the MPNs, Polycythemia vera (PV) seemed to be the most associated with thrombotic events; however, essential thrombocytosis (ET) and primary myelofibrosis (PMF) are also at higher risk than the general population. Furthermore, arterial and venous thromboembolisms account for higher mortality in this population, causing approximately 45% of all disease-associated fatal events. Previous studies have explored the combined outcomes of venous thromboembolism (VTE) on MPN patients; however, none of them focused primarily on pulmonary embolism (PE). Therefore, we aimed to identify any potential demographic, socioeconomic, or clinical characteristics associated with PE in a large cohort of MPN patients admitted to US hospitals. Methods: We inquired the Nationwide Inpatient Sample database to identify patients diagnosed with MPN from 2016-2018. We used the ICD-10 codes to identify the different types of MPN and compare patients with and without PE. The main outcomes were risk factors associated with PE and in-hospital mortality. We computed the chi-squared test and the Mann-Whitney U-test to compare the outcomes of patients with and without PE. We first conducted a univariate analysis. Clinically relevant characteristics and variables with a significant association (p&lt;0.05) with the development of PE in the univariate analysis were considered for the multivariate model. We identified the risk factors associated with PE using multivariate logistic regression. Our analyses were conducted using Stata Statistical Software version 14 (StataCorp, College Station, TX). Results: Among 82,087 identified patients with MPN, most of them were white (67.4%), female (54.6%), and had a median age of 63 (IQR 49-76). Of them, 1982 (2.4%) had a PE event during admission. There were no significant differences in age and sex between PE patients and non-PE patients. While there were higher proportions of White (68.3% vs. 67.4%) and Black patients (18.6% vs. 17%) in the PE group, there was a lower proportion of Hispanics (8.7% vs. 9.7%; p=0.007). Patients with PE also had a higher median Elixhauser comorbidity index (5 vs. 4, p&lt;0.001). There were fewer Medicare beneficiaries (48.5% vs. 52.4%) and a higher proportion of private insurance usage (26.8% vs. 22.3%; p&lt;0.001) in the PE patients compared to those without PE. In the multivariate analysis, age, sex, race, or income quartile were not significantly associated with PE development. Compared to PV, patients with PMF had a protective effect for developing PE (OR: 0.35; CI 95%: 0.22-0.54). The comorbidities associated with higher odds for having a PE were coagulopathies (OR: 1.99; CI 95%: 1.71-2.30) and obesity (OR: 1.47; CI 95%: 1.29-1.67). See Table 1 for all the variables. Patients with PE had a higher length of stay (6 days vs. 5 days; p&lt;0.001) and higher mortality than the non-PE group (6.1% vs. 2.8%; p&lt;0.001). Conclusions: In this large epidemiological study, we found that patients with MPN and PE had higher mortality than those without PE. Risk factors associated with the development of PE were concomitant obesity and coagulopathy. In addition to the known preventive therapies such as aspirin, phlebotomy, and cytoreductive agents, this study highlights the importance of controlling modifiable factors such as obesity in MPN patients. Future studies should confirm our findings and investigate strategies to prevention PE in this vulnerable population. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Reproductive and neonatal outcomes in women with unicornuate uterus: a population-based study

Objective: To investigate reproductive and neonatal outcomes in women with unicornuate uterus. Study design: Data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database were extracted from 2010 through 2014 to create a delivery cohort using ICD-9 codes. Code 752.33 was used to identify cases with unicornuate uterus and reproductive outcomes were compared to pregnancies without unicornuate uterus. A multivariate logistic regression model was used to adjust for statistically significant variables (P-value<0.05). Results: Among 3,850,226 deliveries during the study period, 802 women had unicornuate uterus. Patient with unicornuate uterus were more likely to be older (P<0.001), have thyroid disease (P<0.001), previous Caesarean section (P<0.001), and to have had in-vitro fertilization (IVF) (P<0.001). The risk of gestational diabetes, pregnancy induced hypertension, gestational hypertension and preeclampsia were significantly greater in the unicornuate uterus group relative to controls, after controlling for baseline risk factors; aOR 1.32 [95% CI 1.03–1.71], aOR 1.46 [95% CI 1.16–1.85], aOR 1.16 [95% CI 1.22-2.28] and aOR 1.70 [95% CI 1.24-2.32], respectively. Also, the rates of preterm delivery, preterm premature rupture of membranes and caesarean section were higher in the unicornuate uterus group compared to controls after controlling for confounding factors, aOR 3.83 (95% CI 3.19–4.6), aOR 5.11 (95% CI 3.73–7.14) and aOR 11.38 (95% CI 9.16–14.14) respectively. At birth, 11.1% and 2.6% of neonates were small for gestational age in the unicornuate uterus and the control groups, respectively, aOR 4.90, (95% CI 3.87-6.21). Conclusion: Women with unicornuate uterus are at higher risk for pregnancy complications, preterm delivery and having small for gestation age neonates. Women with known unicornuate uterus may benefit from increased surveillance to prevent and/or decrease maternal and neonate morbidity and mortality.