Comparing hospital-resource utilization by an enhanced pneumonia surveillance programme for COVID-19 with pre-pandemic pneumonia admissions – a Singaporean hospital’s experience

Introduction. During the early days of coronavirus disease 2019 (COVID-19) in Singapore, Tan Tock Seng Hospital implemented an enhanced pneumonia surveillance (EPS) programme enrolling all patients who were admitted from the Emergency Department (ED) with a diagnosis of pneumonia but not meeting the prevalent COVID-19 suspect case definition. Hypothesis/Gap Statement. There is a paucity of data supporting the implementation of such a programme. Aims. To compare and contrast our hospital-resource utilization of an EPS programme for COVID-19 infection detection with a suitable comparison group. Methodology. We enrolled all patients admitted under the EPS programme from TTSH’s ED from 7 February 2020 (date of EPS implementation) to 20 March 2020 (date of study ethics application) inclusive. We designated a comparison cohort over a similar duration the preceding year. Relevant demographic and clinical data were extracted from the electronic medical records. Results. There was a 3.2 times higher incidence of patients with an admitting diagnosis of pneumonia from the ED in the EPS cohort compared to the comparison cohort (P<0.001). However, there was no significant difference in the median length of stay of 7 days (P=0.160). Within the EPS cohort, stroke and fluid overload occur more frequently as alternative primary diagnoses. Conclusions. Our study successfully evaluated our hospital-resource utilization demanded by our EPS programme in relation to an appropriate comparison group. This helps to inform strategic use of hospital resources to meet the needs of both COVID-19 related services and essential ‘peace-time’ healthcare services concurrently.

Mycoplasma infection and ocular surface diseases: a nationwide cohort study

Whether patients with Mycoplasma infection have an increased risk of ocular surface ulcers. Using a nation-wide database, we identified patients with a new diagnosis of Mycoplasma infection between 1997 and 2013, and compared them with age-, sex-, and index year-matched subjects without the infection. Cox proportional regression was performed to compare the risk of corneal diseases between the two cohorts. The incidence of corneal diseases was significantly higher in the 4223 patients with Mycoplasma infection than in the 16,892 patients without (7.28 vs. 5.94 per 1000 person-years, P < 0.01). The adjusted hazard ratio for the risk of corneal diseases in the study cohort was 1.21 times higher (95% CI 1.02–1.44) than that in the comparison cohort. Mycoplasma infection might be a predisposing factor for patients with keratitis.

Results of Acetabular Microfracture in Patients undergoing FAI surgery are Strongly Correlated with Age (142)

Objectives: Full-thickness cartilage injury is not uncommon in patients undergoing primary treatment of Femoroacetabular impingement (FAI). Treatment of these lesions with microfracture is commonly performed. However, the outcomes of these procedures relative to other patients undergoing FAI surgery is not well established and the literature on this topic is limited to small, retrospective single surgeon studies. The purpose of the present study was to evaluate outcomes of patients who underwent concurrent FAI correction and acetabular microfracture and to identify predictors treatment failure. Methods: A prospective multicenter cohort study of the treatment of FAI was performed. A total of 760 hips undergoing primary FAI surgery were enrolled. Inclusion criteria were primary FAI surgery, Tonnis 0 or 1 osteoarthritis grade, and age between 16 and 55 years. A total of 61 hips underwent treatment of full-thickness acetabular cartilage lesions with microfracture, with 55 (90.2%) having follow-up greater than 1 year (mean 4.0 years). This group had a mean age of 35.0+10.1 years, BMI of 27.2+4.2, and included 81.8% (45/55) males. A comparison cohort of 492 hips undergoing primary FAI surgery without treatment of acetabular full-thickness cartilage was utilized. Baseline, intraoperative, and follow-up data was recorded including the modified Harris hip score (mHHS) and HOOS domains of pain, ADLs, sports and recreation, symptoms, and quality of life. Composite failure was characterized by reoperation [total hip arthroplasty (THA) or revision surgery] or clinical failure (failure to meet either MCID or PASS for mHHS). Age was assessed in 5 year intervals. Students t-test was used for continuous variables and chi squared were used for categorical variables. A p value less than 0.05 was considering significant. Results: Hips undergoing acetabular microfracture were more likely (compared to comparison cohort) to be male (81.8% vs. 40.9%, p<.001) older (35.0 vs. 29.9 years, p=0.001), had higher BMI (27.2 vs. 25.0, p=.001), and greater alpha angle (69.6 vs. 62.3, p<.001). In the microfracture cohort, 12.7% of patients progressed to THA (compared to 3.0% in comparison cohort, p=.001), while the rate of composite failure was similar to the comparison cohort (29.1% vs. 26.0%, p=.618). Age was highly correlated with the risk of THA and composite failure. The rate of THA for patients <35, 35-40*, and >40 years* of age was 0%, 20.0%, and 22.7% p=.016*), while the rate of composite failure in these groups was 17.4%, 20.0% and 45.5%, respectively (p=.029*). Hips greater than 35 years of age demonstrated inferior HOOS outcomes for domains of pain, ADLs, sports and recreation, QOL, and symptoms and SF-12 physical component scores(Table 1). Conclusions: The results of acetabular microfracture in patients undergoing FAI surgery at a mean follow-up of 4.0 years postoperatively are strongly correlated with age. Patients under 35 years of age demonstrate excellent outcomes with low rates of revision or progression to THA. Acetabular microfracture should have a limited to absent role in patients over the age of 40.

The impact of childhood injury and injury severity on school performance and high school completion in Australia: a matched population-based retrospective cohort study

Background Exploring the impact of injury and injury severity on academic outcomes could assist to identify characteristics of young people likely to require learning support services. This study aims to compare scholastic performance and high school completion of young people hospitalised for an injury compared to young people not hospitalised for an injury by injury severity; and to examine factors influencing scholastic performance and school completion. Method A population-based matched case-comparison cohort study of young people aged ≤18 years hospitalised for an injury during 2005–2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalised linear mixed modelling examined risk of performance below the national minimum standard (NMS) on the National Assessment Plan for Literacy and Numeracy (NAPLAN) and generalised linear regression examined risk of not completing high school for injured young people compared to matched peers. Results Injured young people had a higher risk of not achieving the NMS compared to their matched peers for numeracy (ARR: 1.12; 95%CI 1.06–1.17), reading (ARR: 1.09; 95%CI 1.04–1.13), spelling (ARR: 1.13; 95%CI 1.09–1.18), grammar (ARR: 1.11; 95%CI 1.06–1.15), and writing (ARR: 1.07; 95%CI 1.04–1.11). As injury severity increased from minor to serious, the risk of not achieving the NMS generally increased for injured young people compared to matched peers. Injured young people had almost twice the risk of not completing high school at year 10 (ARR: 2.17; 95%CI 1.73–2.72), year 11 (ARR: 1.95; 95%CI 1.78–2.14) or year 12 (ARR: 1.93; 95%CI 1.78–2.08) compared to matched peers. Conclusions The identification of characteristics of young people most likely to encounter problems in the academic environment after sustaining an injury is important to facilitate the potential need for learning support. Assessing learning needs and monitoring return-to-school progress post-injury may aid identification of any ongoing learning support requirements.

Different Influences of Endometriosis and Pelvic Inflammatory Disease on the Occurrence of Ovarian Cancer

To compare the rate and risk of ovarian cancer in patients with endometriosis or pelvic inflammatory disease (PID). A nationwide population cohort research compared the risk of ovarian cancer in 135,236 age-matched comparison females, 114,726 PID patients, and 20,510 endometriosis patients out of 982,495 females between 1 January 2002 and 31 December 2014 and ended on the date of confirmation of ovarian cancer, death, or 31 December 2014. In order to reduce the unbalanced characteristics, propensity score matching (PSM) was performed for 20,478 females in each subgroup. The incidence rate (per 100,000 person–years) of ovarian cancer was 8.74 (95% CI, 7.16–10.66) in comparison, 9.26 (7.54–11.39) in PID, and 28.73 (21.07–39.16) in endometriosis cohorts. The adjusted hazard ratio (aHR) of ovarian cancer was 1.17 (p = 0.296) in PID and 3.12 (p < 0.001) in endometriosis cohorts, compared with the comparison cohort in full cohort, using the multiple Cox regression model. The aHR of ovarian cancer was 0.83 (p = 0.650) in PID and 3.03 (p = 0.001) in endometriosis cohorts, compared with the comparison cohort after performing PSM. In the full cohort and PSM population, the cumulative incidence rate of ovarian cancer was significantly higher in patients with endometriosis than in those with PID or in the comparison cohort (p < 0.001 and p < 0.001). In conclusion, after considering the differences in the impacts of exposure to endometriosis or PID, patients with endometriosis were more likely to develop ovarian cancer.

Colorectal Cancer Risk in Patients with Hemorrhoids: A 10-Year Population-Based Retrospective Cohort Study

Colorectal cancer (CRC) is a common disease and one of the leading causes of cancer deaths worldwide. This retrospective cohort study evaluated the risk of developing CRC in people with hemorrhoids. Using Taiwan’s National Health Insurance Research Database, we established three sets of retrospective study cohorts with and without hemorrhoids. The first set of cohorts were matched by sex and age, the second set of cohorts were matched by propensity score without including colonoscopies, and the third set of cohorts were matched by propensity score with colonoscopies, colorectal adenomas, and appendectomies included. In the second set of cohorts, 36,864 persons with hemorrhoids that were diagnosed from 2000 to 2010 and a comparison cohort, with the same size and matched by propensity score, were established and followed up to the end of 2011 to assess the incidence and Cox proportional regression-measured hazard ratio (HR) of CRC. The overall incidence rate of CRC was 2.39 times greater in the hemorrhoid cohort than it was in the comparison cohort (1.29 vs. 0.54 per 1000 person-years), with a multivariable model measured adjusted HR of 2.18 (95% CI = 1.78–2.67) after controlling for sex, age, and comorbidity. Further analysis on the CRC incidence rates among colorectal sites revealed higher incidence rates at the rectum and sigmoid than at other sites, with adjusted HRs 2.20 (95% CI = 1.48–3.28) and 1.79 (95% CI = 1.06–3.02), respectively. The overall incidence rates of both cohorts were similar in the first and second sets of cohorts, whereas the rate was lower in the third set of hemorrhoid cohorts than in the respective comparison cohorts, probably because of overmatching. Our findings suggest that patients with hemorrhoids were at an elevated risk of developing CRC. Colonoscopy may be strongly suggested for identifying CRC among those with hemorrhoids, especially if they have received a positive fecal occult blood test result.

Incidence of pancreatic malignancies in the Russian Federation: a retrospective cohort trial

Background. Pancreatic malignancies pose a challenging medical and social problem. The assessment of oncology care requires an in-depth analysis of morbidity and lethality. At a relatively improved prevalence and lethality in other-locale malignancies, pancreatic cancer remains a disappointing situation. Medical statistics in pancreatic malignancy can be used for the specialty care prediction and implementation of measures to advance diagnostic algorithms and population screening.Objectives. An assessment of the pancreatic malignancy incidence and mortality in the adult population of Russian Federation over a six-year period.Methods. A retrospective descriptive cohort trial included statistical data on morbidity and mortality in pancreatic cancer patients (C 25.0-C 25.9) according to the ICD of 10th edition. A comparison cohort sampled patients with all-locale neoplasms (C00-C96) according to the ICD of 10th edition, excluding nosologies C25.0-C25.9. Information was sourced in the Federal Statistical Abstracts for the period of 2014-2019. Inclusion criteria: the study cohort included pancreatic cancer patients diagnosed at the age of 18 years on, and comparison cohort — malignancy patients diagnosed with at 18 years on. The main study indicator were the pancreatic cancer morbidity and mortality figures in Russia.Results. Pancreatic cancer was shown to co-increase main morbidity figures in 2014-2019 compared to malignant neoplasms of other localities. Other-locale malignancies decreased mortality over the study period, which was not the case with pancreatic cancer. The period exhibits more frequent morphologically verified diagnoses and higher population numbers registered with specialty dispensaries. Registered pancreatic cancer figures are significantly higher in the female population. The proportion of advanced pancreatic malignancies at primary diagnosis exceeds that of early stages.Conclusion. The findings expose a demand for improving the system of early pancreatic cancer detection via intensifying preventive measures to capture the patient’s predisposition and screening techniques for early disease diagnosis. An active outpatient surveillance is prerequisite to an effective population involvement in dispensary screening.

The interaction effect between comorbidity and venous thromboembolism on mortality rates after venous thromboembolism: A 5-year cohort study

Background: Comorbidity influences venous thromboembolism (VTE) mortality, but it is unknown whether this is due to comorbidity alone or whether biological interaction exists. Objectives: We examined whether comorbidity and VTE interact to increase VTE mortality beyond their individual effects. Methods: This register-based 5-year cohort study included all VTE patients ≥18 years during 2000–2016, and an age-, sex-, and comorbidity-matched comparison cohort of individuals without VTE. We computed age-standardized mortality rates and examined interaction on the additive scale via interaction contrasts (difference in rate differences). Results: After 30-day follow-up, the mortality rate per 1000 person-years among individuals with no comorbidity was 419 (95% confidence interval [CI]: 391–447) in the VTE and 16 (95% CI: 13–18) in the comparison cohort (rate difference: 403). The corresponding mortality rate increased to 591 (95% CI: 539–643) in the VTE cohort and 38 (95% CI: 33–44) in the comparison cohort among individuals with low comorbidity (rate difference: 553). The interaction contrast (150) showed that 25% (150/591) of mortality was explained by the interaction in individuals with low comorbidity. This percentage increased to 56% for moderate and 63% for severe comorbidity. Interaction effects were largest within 30-day follow-up, for provoked VTE, and in young individuals. Dose-response patterns between comorbidity and interaction effects were also observed after 31–365-day and >1–5-year follow-up (p<0.0001). Interaction effects varied between individual comorbidities. Conclusion: Biological interaction between comorbidity and VTE explains a substantial proportion of VTE mortality, and this interaction effect increases with comorbidity burden.

Risk of Inflammatory Bowel Disease Following Appendectomy in Adulthood

Background: The appendix has a complicated immune function, and appendectomy may derange the immune system. Studies on the relationship between appendectomy and subsequent inflammatory bowel disease (IBD) have been inconsistent. We conducted a nationwide cohort study consisting of individuals who underwent appendectomy to evaluate the incidence and risk of ulcerative colitis (UC) and Crohn's disease (CD).Methods: We identified patients aged &gt;20 years who underwent appendectomy between 2000 and 2012 from inpatient claims of the National Health Insurance Research Database (NHIRD) and assigned them to the appendectomy cohort. Then, we randomly selected patients without appendectomy in the NHIRD and assigned them to the comparison cohort in a frequency-matched 1:1 ratio based on sex, age, and index year. We tracked down all participants until IBD diagnosis, death, or the end of 2013. Cox models were used to estimate the hazard ratio (HR), and 95% confidence intervals (CIs) were used to compare the IBD risk between the appendectomy and comparison cohorts.Results: The appendectomy and comparison cohorts in the study consisted of 246 562 patients each. The appendectomy cohort exhibited a 2.23- and 3.48-fold higher risk of UC (adjusted HR = 2.23, 95% CI = 1.59-3.12) and CD (adjusted HR = 3.48, 95% CI = 2.42-4.99), respectively, than did the comparison cohort. UC and CD risks significantly increased in the appendectomy cohort regardless of whether appendicitis was present.Conclusions: Our study suggests that appendectomy increases UC and CD risks irrespective of appendicitis.

Pyogenic Liver Abscess Risk in Patients With Newly Diagnosed Type 2 Diabetes Mellitus: A Nationwide, Population-Based Cohort Study

Background: To date, no comprehensive epidemiological study exists on pyogenic liver abscess (PLA) risk in patients with newly diagnosed type 2 diabetes mellitus (T2DM) worldwide.Methods: We conducted a retrospective cohort study by using data from Taiwan National Health Insurance Research Database (NHIRD) to examine the association between newly diagnosed T2DM and PLA. The T2DM cohort included patients newly diagnosed as having T2DM (ICD-9-CM:250) from 2000 to 2009, with follow-up until December 31, 2011. The comparison cohort was then recruited through 1:4 random frequency matching with the T2DM cohort. Finally, the adjusted hazard ratios for PLA were compared between the T2DM and comparison cohorts, which included 44,728 patients with T2DM and 178,912 patients without DM respectively.Results: In T2DM cohort, 166 patients were diagnosed as having PLA (incidence rate = 5.87 per 10,000 person-years) and in comparison cohort, 238 patients were diagnosed as having PLA (incidence rate = 2.06 per 10,000 person-years). The T2DM cohort exhibited higher PLA risk than did the comparison cohort (hazard ratio = 2.83, 95% confidence interval = 2.32–3.46). Furthermore, the adjusted hazard ratio for PLA risk in T2DM cohort was the highest in those who were younger, man and with duration of DM &lt;2 years. In the T2DM cohort, the most common PLA causative agent was Klebsiella pneumonia (KP). In addition, PLA risk was high in T2DM patients with gallstone and cholecystitis. Compared with comparison cohort, patients with T2DM prescribed acarbose has a lower PLA risk, however glyburide significantly increased PLA risk in T2DM cohort.Conclusion: In patients with newly diagnosed T2DM, PLA risk was high and acarbose might reduce PLA risk.