Analysis Of National Database Research Articles

Hemoglobin A1c in Intracerebral Hemorrhage: A Cross-sectional Analysis of a Large National Database. (P5.3-043)

Hemoglobin A1c in Intracerebral Hemorrhage: A Cross-sectional Analysis of a Large National Database. (P5.3-043)

Role of Anti-Platelets & Anti-coagulants in Intracerebral hemorrhage: Analysis of a Large National Database (P5.3-042)

Role of Anti-Platelets & Anti-coagulants in Intracerebral hemorrhage: Analysis of a Large National Database (P5.3-042)

Congestive Heart Failure is Strongly Associated with Hereditary Hemorrhagic Telangiectasia (HHT): Analysis of a Large National Database (P5.3-018)

Congestive Heart Failure is Strongly Associated with Hereditary Hemorrhagic Telangiectasia (HHT): Analysis of a Large National Database (P5.3-018)

In-hospital mortality after knee replacement in China: analysis of a large national database

In-hospital mortality after knee replacement in China: analysis of a large national database

A national trauma database analysis of alcohol- associated injuries.

Knowledge of the pattern of alcohol-associated injury (AAI) is lacking in Singapore. We aimed to determine the local demographic pattern, injury mechanism, injury severity and outcomes of AAI. Data on trauma cases presenting to emergency departments in 2012-2013 was extracted from the National Trauma Registry. Cases with missing data fields and those aged 1-15 years were excluded. Patients were classified as alcohol positive (A+) or negative (A-) based on clinical assessment. The two groups' demographics, injury mechanism, injury severity, mortality and disposition were compared. Logistic regression analysis was used to determine independent associations with mortality. 105,468 trauma cases met the inclusion criteria. 3.9% were A+ and their peak age range was 25-44 years. The A+ group had more Indian males (p < 0.001), and significantly more assaults, self-harm and falls (p < 0.001). Injuries in the A+ group were more common in public areas and less common in homes, recreational facilities and workplaces. Outcomes in the A+ group showed higher mean Injury Severity Score and mortality (p < 0.001). Significantly more A+ patients were admitted to hospital but had shorter mean length of stay (p < 0.001). Multivariate logistic regression revealed age > 44 years and male gender as independent predictors of mortality. AAI in Singapore is associated with more severe injuries and resource utilisation. Using data from the registry, 'at risk' demographic groups are identified for targeted injury prevention. However, alcohol use is not an independent predictor of mortality in trauma cases.

Postoperative Pulmonary Complications Following Brain Tumor Resection: A National Database Analysis

There is sparse literature that investigates the adverse effects of postoperative pulmonary complication (PPCs) specifically in postcraniotomy tumor patients. In this study, we describe the rate of PPCs, determine predictive factors, and delineate associations with adverse outcomes. The National Surgical Quality Improvement Program (2006-2016) database was queried for patients who underwent craniotomy for brain tumors. A total of 28,700 eligible patients were identified. Univariate tests and/or multivariate logistic regression were used to determine predictors of PPC and associations with adverse outcomes. A total of 19 predictors of PPC across 14 different categories were identified: age 65-79 years (odds ratio [OR] 1.6; P < 0.001), age ≥80 years (OR 2.3; P<0.001), male sex (OR 1.3; P < 0.001), operative time ≥360 minutes (OR 4.3; P < 0.001), operative time 300-359 minutes (OR 2.5; P < 0.001), operative time 240-299 minutes (OR 1.8; P < 0.001), operative time 180-239 minutes (OR 1.3; P<0.001), total functional dependence (OR 3.8; P < 0.001), partial functional dependence (OR 1.7; P < 0.001), insulin-dependent diabetes (OR 1.5; P < 0.001), preoperative dyspnea (OR 1.3; P= 0.01), chronic steroid use (OR 1.4; P<0.001), chronic obstructive pulmonary disease (OR 1.8; P<0.001), preoperative leukocytosis (OR 1.4; P < 0.001), anemia (OR 1.2; P < 0.001), American Society of Anesthesiologists (ASA) classification ≥3 (OR 2.0; P < 0.001), emergency case status (OR 2.0; P < 0.001), and infratentorial lesions (OR 1.4; P < 0.001). PPCs were significantly associated with higher reoperation, readmission, and mortality rates as well as longer length of stay (univariate). There are several predictive factors of PPCs in patients that undergo surgical resection of brain tumors, and PPC development is associated with numerous adverse outcomes. It is critically important to understand and, if possible, mitigate controllable circumstances that may reduce morbidity and mortality associated with PPCs.

23 Burns in Octogenarians: 80 is the New 60

Geriatric trauma patients (age≥65 years) with burn injuries have a 5x higher mortality rate compared to younger adults. Although the LD50 for children and younger adults has improved significantly over the past decade, it remains at 35% total-body surface area (TBSA) for geriatric patients. Due to an aging population, the proportion of octogenarians (80–89 years) suffering burns are increasing. An analysis from over a decade ago using the National Burn Repository demonstrated a linear increase in mortality for patients older than 65-years. We hypothesized that octogenarians with burn injuries would have a higher rate of in-hospital complications as well as mortality, compared to patients aged 65–79 years. The Trauma Quality Improvement Program (2010–2016) was queried for patients with any burn injuries. Two groups were compared: age 65–79 vs 80–89. A multivariable logistic regression model was used to determine risk for mortality. From 282 patients, 209 (74.1%) were aged 65–79 and 73 (25.9%) were 80–89. Both groups had a similar median injury severity score (ISS) (p=0.81), TBSA (p=0.30) and rate of comorbidities except for higher rate of smoking (12.9% vs. 4.1%, p=0.04) and lower rate of hypertension (52.2% vs. 65.8%, p=0.04) in the age 65–79 group. Octogenarians had a similar rate of complications (acute kidney injury, acute respiratory distress syndrome, deep vein thrombosis, pneumonia) (p>0.05) as well as mortality (15.1% vs. 10.5%, p=0.88), compared to those aged 65–79. On multivariable logistic regression, octogenarians were not associated with increased risk of mortality (p=0.67). Compared to patients aged 65–79 with burn injuries, octogenarians have a similar rate of complications and risk of mortality. This differs from a previous national database analysis. Octogenarians are making up a larger proportion of patients admitted for burn injuries than ever before. Among patients ≥65 years, age in of itself is not a significant predictor of mortality. Future research on alternative methods to prognosticate mortality in elderly burn patients, such as development of a burn-related frailty index appears warranted.

Screening and surgery for foramen magnum stenosis in children with achondroplasia: a large, national database analysis.

OBJECTIVE The goal of this study was to determine the rates of screening and surgery for foramen magnum stenosis in children with achondroplasia in a large, privately insured healthcare network. METHODS Rates of screening and surgery for foramen magnum stenosis in children with achondroplasia were determined using de-identified insurance claims data from a large, privately insured healthcare network of over 58 million beneficiaries across the United States between 2001 and 2014. Cases of achondroplasia and screening and surgery claims were identified using a combination of International Classification of Diseases diagnosis codes and Current Procedural Terminology codes. American Academy of Pediatrics (AAP) practice guidelines were used to determine screening trends. RESULTS The search yielded 3577 children age 19 years or younger with achondroplasia. Of them, 236 met criteria for inclusion in the screening analysis. Among the screening cohort, 41.9% received some form of screening for foramen magnum stenosis, whereas 13.9% of patients were fully and appropriately screened according to the 2005 guidelines from the AAP. The screening rate significantly increased after the issuance of the AAP guidelines. Among all children in the cohort, 25 underwent cervicomedullary decompression for foramen magnum stenosis. The incidence rate of undergoing cervicomedullary decompression was highest in infancy (28 per 1000 patient-years) and decreased with age (5 per 1000 patient-years for all other ages combined). CONCLUSIONS Children with achondroplasia continue to be underscreened for foramen magnum stenosis, although screening rates have improved since the release of the 2005 AAP surveillance guidelines. The incidence of surgery was highest in infants and decreased with age.

Extremity Arterial Thromboses in Hospitalized Children: A National Database Analysis of Prevalence and Therapeutic Interventions.

The purpose of this study was to evaluate the prevalence, demographics, predisposing conditions, therapeutic interventions, and outcomes of extremity arterial thrombosis in hospitalized children. Retrospective cohort study. National discharge database analysis. Cases of extremity arterial thrombosis in children and neonates were extracted from the Kids' Inpatient Database 2012. These were analyzed and compared with other discharges for prevalence, demographics, treatments, outcomes, and further analyzed by age group and select predisposing conditions. A total of 961 children with extremity arterial thrombosis (prevalence of 2.35/10,000 discharges) were included in our analysis. The median age of extremity arterial thrombosis patients was significantly lower when compared with other pediatric discharges (1 yr [interquartile range, 0-15 yr) vs 3 yr [interquartile range, 0-16 yr]; p < 0.0001). The proportion of females with extremity arterial thrombosis was lower (41.4% vs 53.3%; odds ratio, 0.62; 95% CI, 0.55-0.70) with no racial/ethnic variation in the prevalence of extremity arterial thrombosis. An upper extremity was involved in 18.1% and a lower extremity in 83.3%. Arterial cannulation and cardiac catheterization were much more common in the younger age groups. External trauma was documented in 13.2% of all patients with extremity arterial thrombosis and was more frequent in older age groups. A systemic thrombolytic medication was administered to 5.7% of the patients, thromboembolectomy was performed in 11.8% of the cases, and 3.1% of the patients required amputation. There was a significant variation in the use of thrombolysis, thrombectomy/embolectomy, or requirement for amputation limb based on age groups and underlying predisposing condition. The study describes the national prevalence of extremity arterial thrombosis in hospitalized children. The management strategies of extremity arterial thrombosis vary with age and underlying predisposing factors.

Realization of Industry Export Potential in the Republic of Belarus: Trends, Factors, Perspectives

Main development trends and complex of internal and external factors influencing on export potential of the industrial sector in the Republic of Belarus have been revealed and determined on the basis of the analysis of national and international statistical databases and method for expert assessment. Relevance of the research is to demonstrate that industry creates a significant part of commodity exports in the small open economy of the Republic of Belarus which has adopted a course to post-industrialization as a national strategy. Absolute figures of the Belarusian export of services are 3.4 times lower than values of the commodity export, 92.4 % of which is provided by manufacturing industry. It is in the sphere of industrial production that we should look for the reasons of long-term trend to reducing physical and cost volumes of Belarusian export, deterioration of its commodity and geographical structure, negative balance of trade and account of current operations. Main positions of the Belarusian commodity exports which form 70 % of its volume to non-CIS countries are raw materials exposed to unstable price environment in the world market, although the mining industry accounts for only 1.2 % while the manufacturing industry creates 85.6 % of the sector’s gross output. The study refutes the conclusion that problems associated with implementation of an export potential of domestic industry should be explained by the crisis of industrial production, proving that post-industrialization, accompanied by a reduction, curtailment or cross-border transfer of industrial production, is not so clear and does not bring the expected macroeconomic results. Reindustrialization, achievement of a breakthrough in the use of information technologies for a new quality of industrial production, which involves reorientation of IT-sector in Belarus operating on the basis of an outsourcing model from external to domestic market and solution of problems concerning system modernization of industry must become a national strategy aimed at the development and implementation of the industry’s export potential.

Adjuvant chemotherapy with or without sequential radiation in resected pancreatic adenocarcinoma: Who will win RTOG 0848?

334 Background: The current role of adjuvant radiation in the management of resected pancreatic adenocarcinoma (PC) is controversial. A prospective trial, RTOG 0848, is currently in process to determine optimal adjuvant therapy, comparing adjuvant chemotherapy (CT) with or without radiation (RT). We determined outcomes in this population using the National Cancer Database (NCDB). Methods: Patients with non-metastatic PC diagnosed from 2004 to 2015 were identified from the NCDB. Patients who underwent surgery and adjuvant chemotherapy were included. Patients who received RT were only included if RT began at least 4 months after CT, to emulate RTOG 0848 schema. A 6 month landmark analysis was performed. Overall survival (OS) was compared using log-rank Kaplan-Meier for univariate analysis (UVA), and Cox proportional hazards for multivariate analysis (MVA). Logistic regression was used to determine predictors of RT utilization and generate propensity scores. Results: We identified 16075 patients. Median follow-up was 30 months, 37 months for survivors. Patients received sequential RT in 9.5% of cases. On UVA, sequential RT demonstrated OS benefit compared to adjuvant chemotherapy alone (3-year OS 44.6% vs 35.3%, p &lt; 0.001). RT utilization was more likely with diagnosis after 2010, age ≤ 65 years, private insurance, higher income, ≤ 10 miles to treatment facility, treatment in the northeast, node positive disease, positive margins, and head of pancreas primary. On MVA, benefit to RT on OS was maintained (HR 0.68, 95% CI 0.63-0.73, p &lt; 0.001). Other factors that improved OS included diagnosis after 2010, no comorbidity, non-government insurance, higher income, and treatment at academic facility. Factors that predicted for worse OS included increasing pathologic tumor and nodal staging, positive margins, and CA 19-9 above a cut-off of 90. After propensity-adjustment, OS benefit was maintained for RT (HR 0.68, p &lt; 0.001). Conclusions: In a large national database analysis, sequential RT improves survival in patients who receive at least 4 months of adjuvant chemotherapy following upfront resection for pancreatic adenocarcinoma. The results of RTOG 0848 are awaited to confirm these findings.

Human Rabies Still Exists in Urban and Peri-Urban Areas in Mali—National Data-Base Analysis of the Capital of Mali from 2007 to 2017

From 2007 to 2017 sixty-three (63) new cases of human rabies have been identified in Mali on an estimated total population in 2017 of 17,650,195 inhabitants. This is an incidence of 0.32 cases for 100,000 inhabitants. All these cases occurred in urban areas and involved the two sexes. The age group most affected was the one less than 20 years old. The majority of the victims (73.1%) were pre-schools, school-aged pupils and housewives. In 97% of the cases, the animal in question was a dog and the type of exposure of the bite. Eighty-two percent (82%) of the victims had received no local medical treatment or the post exposure quasi prophylaxis treatment. The median duration between the first symptoms and death among the cases of human rabies was 3 to 7 days. The median duration between the occurrence of the first signs and death was four (4) days. No virological confirmation had been conducted on the patients. The rage disease is retained as a priority disease, since the adoption of the strategy of “integrated monitoring of the disease and response” in 2008. However, in spite of the efforts made, progress still remains to be effected to assess the actual impact of rabies in Mali.

High Diagnostic Uncertainty and Inaccuracy in Adult Emergency Department Patients With Dyspnea: A National Database Analysis.

High Diagnostic Uncertainty and Inaccuracy in Adult Emergency Department Patients With Dyspnea: A National Database Analysis.

Survival Following Definitive Surgery or Radiation Therapy for Locally Advanced Squamous Cell Carcinoma of the Larynx: An Analysis of the National Cancer Database

Multiple prospective trials have established that radiotherapy (RT) with platinum-based chemotherapy has equivalent efficacy to total laryngectomy (TL) in the treatment of locally advanced laryngeal squamous cell carcinoma (LSCC). While the use of definitive RT has increased, survival for LSCC has declined. Several analyses of large national databases have shown that RT is associated with worse outcomes than TL in these patients. We hypothesized that these differences may be related to suboptimal RT doses or delivery of RT alone. We aimed to analyze survival in patients treated with full-dose RT with chemotherapy (cRT) compared to TL using a large hospital-based registry. Within the National Cancer Database (NCDB), we identified 16,832 patients with T3-4, N0-3, M0 LSCC with complete data treated with RT between 2004 and 2015. Of those, 7,706 received TL and 9,756 received 70 – 80 Gy of RT with chemotherapy (cRT group). Cox proportional hazards and Kaplan-Meier analyses were used to evaluate overall survival (OS) differences between the TL and cRT groups. All OS percentages reported reflect 5-year OS rates. Overall, the median follow-up was 32 months. Among patients with T3 N0-3 disease, cRT was associated with a benefit in OS (51.4%) relative to TL (46.3%; hazard ratio (HR) = 0.9; 95% confidence interval (CI) = 0.8 – 0.9; p < 0.01). This benefit persisted in both the T3 N0 (56.0% vs 50.7%; HR = 0.8; CI = 0.8 – 0.9; p < 0.01) and T3 N+ (46.6% vs 39.3%; HR = 0.8; CI = 0.8 – 0.9; p < 0.01) populations. Among those with T4 N0-3 disease, cRT (38.0%) was associated with worse OS relative to TL (44.3%; HR = 1.2; CI = 1.1 – 1.2; p < 0.01). Upon analysis by N stage, a statistically significant decrement in OS with cRT was seen only in T4 N0 patients (42.8% vs 49.4%; HR = 1.2; CI = 1.1 – 1.3; p = 0.002) and not in patients with T4 N+ disease (35.1% vs 38.5%, HR = 1.1, CI = 1.0 – 1.2, p = 0.16). These relationships persisted on multivariate analysis, including age, gender, and Charlson-Deyo score. Among patients receiving optimal cRT for LSCC, only those with T4 N0 disease experienced a decrement in OS relative to TL; further, the decrement was small (∼6%). Our findings affirm the results of prior prospective analyses that suggest both cRT and TL are acceptable treatment of LSCC. Strategies to optimize the selection of LSCC for cRT, such as primary tumor volume or neoadjuvant chemotherapy, may help identify patients most likely to have a positive response to cRT.

1481P - Extra-cost of brain metastases in patients with non-squamous non-small cell lung cancer (NSCLC): A French national hospital database analysis

1481P - Extra-cost of brain metastases in patients with non-squamous non-small cell lung cancer (NSCLC): A French national hospital database analysis

Données épidémiologiques en rapport avec la prise en charge de l’HBP

Epidemiological data concerning benign prostatic hyperplasia are numerous but highly variable depending on the definition of the pathology that is selected and on the source of information used. The objective of this work was to present an inventory of the main epidemiological data available in France and worldwide. A literature review was conducted from the Pubmed database between 1990 and 2018. The MeshTerm "benign prostatic hyperplasia", "epidemiology", "prevalence", and "incidence" were used to identify key articles of interest. These references were analyzed on the basis of the titles and summaries and cross-referenced with the cited references. The main articles selected were discussed by the authors before being summarized in this work. The relationship between BPH, LUTS, OSV and increased prostate volume is difficult to establish. In the context of epidemiological studies, these difficulties have a major impact on the accuracy of the results that are proposed. Nevertheless, we see that global demographics and increased life expectancy are leading to a steady increase in the prevalence of this disease. The corresponding health expenditure is also increasing, but more rapidly, posing major public health issues. The analysis of national health system databases confirms the steady and significant increase in the number of patients medically treated while the number of operated patients remains stable for several years. The number of patients treated for BPH-related LUTS is steadily increasing. The related health expenditures increase exponentially while their efficiency remains poorly assessed from a medico-economic point of view. Given the frequency of this pathology and the resulting financial stakes, improving the quality of life and preventing complications must remain the main objectives of the medical care offered to patients.

Acute Coronary Syndromes in Heart Transplant Recipients (from a National Database Analysis)

With an expanding and aging heart transplant population, the incidence of acute coronary syndromes (ACS) is expected to increase. Our study aims to report current trends in in-hospital management and outcomes in heart transplant recipients presenting with ACS. We conducted an analysis of the National Inpatient Sample (2007 to 2014) to study the trends in hospitalization, in-hospital management, and outcomes in heart transplant recipients with a primary diagnosis of ACS. We included patients with ST elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and those with unstable angina pectoris (UAP). A total of 1,621 ACS (NSTEMI/UAP-76% vs STEMI-24%) hospitalizations were identified. Despite 1,327 (81%) of patients who underwent left heart catheterization, coronary revascularization was performed in only 576 patients (36%). Mortality was significantly higher in patients presenting with STEMI versus NSTEMI/UAP (28% vs 11%, respectively; p <0.05) and those who did not undergo revascularization (19% vs 7%; p <0.05). Cardiogenic shock (CS) was diagnosed in 14.5% patients. Mechanical circulatory support utilization was higher in CS group compared with non-CS group (69% vs 2.8%; p <0.05), as was in-hospital mortality (39% vs 10%; p <0.05). Repeat transplantation during the index hospitalization was done in 4.5% of ACS patients. In conclusion, in heart transplant recipients, ACS is associated with a high incidence of CS and in-hospital mortality. Aggressive treatment strategy that includes revascularization, mechanical circulatory support use (in those developing CS), and urgent retransplantation in suitable candidates seems to lead to better results than a more conservative strategy.

TCT-114 Comparing Effectiveness of Different Atherectomy Device Systems in Occlusive Lower Extremity Peripheral Artery Disease: Analysis of a Large National Database

The use of atherectomy devices to assist endovascular treatment of occlusive lower extremity peripheral artery disease (OLEPAD) is rapidly growing. There are no good data to compare the performance of these treatment systems. In this study we compared procedural and longterm outcomes between

Extra cost of brain metastases (BM) in patients with non-squamous non-small cell lung cancer (NSCLC): a French national hospital database analysis

PurposeTo assess the incremental cost associated with the management of patients with primary non-squamous non-small cell lung cancer (NSCLC) with brain metastases at the time of diagnosis.MethodsData were extracted from the French Hospital medical information database (Programme de Médicalisation des Systèmes d’Information (PMSI)). Patients with non-squamous NSCLC were identified through a diagnosis of lung cancer and a prescription of bevacizumab or pemetrexed. All such patients hospitalised with lung cancer for the first time in 2013 and with metastases identified at the first hospitalisation were eligible. Two cohorts were identified, one with brain metastases (group B: n=971) and one with metastases at other sites (group A: n=1529). For each patient, total in-hospital medical resource consumption associated with the initial hospitalisation in 2013 and with any follow-up stays in the following 24 months was documented. Costs were attributed from official French national tariffs and expressed in 2017 euros.ResultsThe mean number of hospitalisations per patient in the 24-moth follow-up period was 17 in group A and 21 in group B. >99% of patients in both groups received chemotherapy. 58% of patients in group B and 13% in group A were managed by radiotherapy. 37% in group B and 24% in group A received palliative care. The associated cost was €2979 per patient-month for patients in group B and €2426 for patients in group A, representing a differential cost of €553 per month. Radiotherapy (+€164/month) and palliative care (+€130/month) were the principal drivers of the incremental cost.ConclusionsThe presence of brain metastases at the time of diagnosis of non-squamous NSCLC carries a significant burden, and ways of lowering this burden are needed.

Patient, Procedure, and Endoscopist Risk Factors for Perforation, Bleeding, and Splenic Injury After Colonoscopies

We investigated perforations, bleeding, and splenic injuries after screening or diagnostic colonoscopies to identify patient-, procedure-, endoscopist-, and facility-associated risk factors. We analyzed data from the SNIIRAM-PMSI national claims databases in France. A total of 4,088,799 patients, 30 years or older, undergoing a first screening or diagnostic colonoscopy from 2010 through 2015 were identified. Rates of severe adverse events (SAEs) were estimated using stringent and broad definitions. Risk factors associated with perforations and major bleeding were estimated using multilevel logistic regression models, adjusted for patient, colonoscopy, and endoscopist characteristics. Perforation rates ranged from 3.5 (stringent definition) to 7.3 (broad definition) per 10,000 procedures, bleeding rates ranged from 6.5 to 23.1 per 10,000 procedures, and splenic injury rates ranged from 0.20 to 0.34 per 10,000 procedures. Rates of 30-day mortality were 13.2 per 1000 bleeds, 29.2 per 1000 perforations, and 36.1 per 1000 splenic injuries (stringent definitions). Patient characteristics associated with SAEs were increasing age (especially for perforation), cancer, and cardiovascular comorbidities. Procedure characteristics associated with SAEs included polypectomy-especially of polyps larger than 1 cm with an increased risk of perforation (odds ratio, 4.1; 95% CI, 3.4-5.0) and bleeding (odds ratio, 13.3; 95% CI, 11.7-15.1). Less-experienced endoscopists and endoscopists who performed a smaller number of colonoscopies were independently associated with a risk of SAEs. In an analysis of national claims databases in France, we found SAEs related to screening and diagnostic colonoscopies to be more frequent in older patients, in patients with comorbidities, and with less-experienced endoscopists. Patients at risk of SAE should be identified and colonoscopies should be performed or supervised by experienced endoscopists.