California State Inpatient Database Research Articles

Impact of COVID-19 on total hip arthroplasty: results from California state inpatient database

Background: COVID-19 pandemic has significantly affected orthopedic surgery, resulting in postponements and cancellations. The aim of this study is to determine the possible effects of COVID-19 on the number of total hip arthroplasty (THA) hospitalizations and hospital outcomes using a large database. Methods: We conducted a retrospective analysis of data gathered and stored in the California State Inpatient Database (SID) during 2019 and 2020. All THA hospitalizations ≥18 yr that occurred in 2019 and 2020 and COVID-19 hospitalizations that occurred in 2020 were used for the analysis. The primary outcomes of the study were trends in THA hospitalizations between 2019 and 2020. Secondary outcomes were mortality, surgical, medical, and other complications, and prolonged length of stay. Results: A total of 36,760 and 20,243 THA hospitalizations occurred during 2019 and 2020, respectively. Trends in THA hospitalizations during 2019 and 2020 showed that the rates of these hospitalizations were substantially lower throughout 2020. Logistic regression analysis showed that the odds of mortality (odds ratio [OR], 2.77; 95% CI, 1.38-5.53), surgical complications (OR,1.61; 95% CI, 1.36-1.89), medical complications (OR,1.27; 95% CI, 1.20-1.33), other complications (OR,1.42; 95% CI, 1.19-1.69), and prolonged length of stay (OR,1.10; 95% CI, 1.05-1.16) were significantly higher during 2020. Conclusions: Our findings show that during COVID-19 pandemic THA hospitalizations were prioritized based on case severity. By the end of 2020 THA hospitalizations did not steeply decrease in numbers compared to the advent of the pandemic, indicating that orthopedic surgeons and other healthcare professionals functioned optimally even during the COVID-19 pandemic.

Gender Differences in Hospital Outcomes among COVID-19 Hospitalizations.

Many epidemiological studies have shown that coronavirus disease 2019 (COVID-19) disproportionately affects males, compared with females, although other studies show that there were no such differences. The aim of the present study was to assess differences in the prevalence of hospitalizations and in-hospital outcomes between the sexes, using a larger administrative database. We used the 2020 California State Inpatient Database for this retrospective analysis. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code U07.1 was used to identify COVID-19 hospitalizations. These hospitalizations were subsequently stratified by male and female sex. Diagnosis and procedures were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. The primary outcome of the study was hospitalization rate, and secondary outcomes were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit (ICU) admission. There were 95,180 COVID-19 hospitalizations among patients 18 years and older, 52,465 (55.1%) of which were among men and 42,715 (44.9%) were among women. In-hospital mortality (12.4% vs 10.1%), prolonged length of hospital stays (30.6% vs 25.8%), vasopressor use (2.6% vs 1.6%), mechanical ventilation (11.8% vs 8.0%), and ICU admission rates (11.4% versus 7.8%) were significantly higher among male compared with female hospitalizations. Conditional logistic regression analysis showed that the odds of mortality (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.38-1.44), hospital lengths of stay (OR 1.35, 95% CI 1.31-1.39), vasopressor use (OR 1.59, 95% CI 1.51-1.66), mechanical ventilation (OR 1.62, 95% CI 1.47-1.78), and ICU admission rates (OR 1.58, 95% CI 1.51-1.66) were significantly higher among male hospitalizations. Our findings show that male sex is an independent and strong risk factor associated with COVID-19 severity.

Complications and outcomes of hospitalizations for patients with and without Parkinson disease.

To examine complications and outcomes of hospitalizations for common indications for hospitalization among patients with Parkinson disease (PD). We identified and selected the ten most common indications for hospitalization among individuals ≥65 years of age using principal diagnoses from the California State Inpatient Database, 2018-2020. Patients with comorbid PD were identified using secondary diagnosis codes and matched one-to-one to patients without PD based on principal diagnosis (exact matching), age, gender, race and ethnicity, and Elixhauser comorbidity index (coarsened exact matching). We identified potentially preventable complications based on the absence of present on admission indicators among secondary diagnoses. In the matched cohort, we compared inpatient complications, early Do-Not-Resuscitate (DNR) orders (placed within 24 h of admission), use of life-sustaining therapies, new nursing facility requirement on discharge, and death or hospice discharge for patients with and without PD. We identified 35,457 patients with PD among the ten leading indications for hospitalization in older adults who were matched one-to-one to patients without PD (n = 70,914 in total). Comorbid PD was associated with an increased odds of developing aspiration pneumonia (OR 1.17 95% CI 1.02-1.35) and delirium (OR 1.11 95% CI 1.02-1.22) during admission. Patients with PD had greater odds of early DNR orders [placed within 24 h of admission] (OR 1.34 95% CI 1.29-1.39). While there was no difference in the odds of mechanical ventilation (OR 1.04 95% CI 0.98-1.11), patients with PD demonstrated greater odds of tracheostomy (OR 1.41 95% CI 1.12-1.77) and gastrostomy placement (OR 2.00 95% CI 1.82-2.20). PD was associated with greater odds of new nursing facility requirement upon discharge (OR 1.58 95% CI 1.53-1.64). Patients with PD were more likely to die as a result of their hospitalization (OR 1.11 95% CI 1.06-1.16). Patients with PD are at greater risk of developing aspiration pneumonia and delirium as a complication of their hospitalization. While patients with PD more often have early DNR orders, they have greater utilization of life-sustaining therapies and experience worse outcomes of their hospitalization including new nursing facility requirement upon discharge and greater mortality.

Racial difference in mortality among COVID-19 hospitalizations in California

In the US, racial disparities in hospital outcomes are well documented. We explored whether race was associated with all-cause in-hospital mortality and intensive care unit (ICU) admission among COVID-19 patients in California. This was a retrospective analysis of California State Inpatient Database during 2020. Hospitalizations ≥ 18 years of age for COVID-19 were included. Cox proportional hazards with mixed effects were used for associations between race and in-hospital mortality. Logistic regression was used for the association between race and ICU admission. Among 87,934 COVID-19 hospitalizations, majority were Hispanics (56.5%), followed by White (27.3%), Asian, Pacific Islander, Native American (9.9%), and Black (6.3%). Cox regression showed higher mortality risk among Hispanics, compared to Whites (hazard ratio, 0.91; 95% CI 0.87–0.96), Blacks (hazard ratio, 0.87; 95% CI 0.79–0.94), and Asian, Pacific Islander, Native American (hazard ratio, 0.89; 95% CI 0.83–0.95). Logistic regression showed that the odds of ICU admission were significantly higher among Hispanics, compared to Whites (OR, 1.70; 95% CI 1.67–1.74), Blacks (OR, 1.70; 95% CI 1.64–1.78), and Asian, Pacific Islander, Native American (OR, 1.82; 95% CI 1.76–1.89). We found significant disparities in mortality among COVID-19 hospitalizations in California. Hispanics were the worst affected with the highest mortality and ICU admission rates.

Prevalence and effects of acute myocardial infarction on hospital outcomes among COVID-19 patients.

Acute myocardial infarction (AMI) is one of the most lethal complications of COVID-19 hospitalization. In this study, we looked for the occurrence of AMI and its effects on hospital outcomes among COVID-19 patients. Data from the 2020 California State Inpatient Database was used retrospectively. All COVID-19 hospitalizations with age ≥ 18 years were included in the analyses. Adverse hospital outcomes included in-hospital mortality, prolonged length of stay (LOS), vasopressor use, mechanical ventilation, and ICU admission. Prolonged LOS was defined as any hospital LOS ≥ 75th percentile. Multivariate logistic regression analyses were used to understand the strength of associations after adjusting for cofactors. Our analysis had 94 114 COVID-19 hospitalizations, and 1548 (1.6%) had AMI. Mortality (43.2% vs. 10.8%, P < 0.001), prolonged LOS (39.9% vs. 28.2%, P < 0.001), vasopressor use (7.8% vs. 2.1%, P < 0.001), mechanical ventilation (35.0% vs. 9.7%, P < 0.001), and ICU admission (33.0% vs. 9.4%, P < 0.001) were significantly higher among COVID-19 hospitalizations with AMI. The odds of adverse outcomes such as mortality (aOR 3.90, 95% CI: 3.48-4.36), prolonged LOS (aOR 1.23, 95% CI: 1.10-1.37), vasopressor use (aOR 3.71, 95% CI: 3.30-4.17), mechanical ventilation (aOR 2.71, 95% CI: 2.21-3.32), and ICU admission (aOR 3.51, 95% CI: 3.12-3.96) were significantly more among COVID-19 hospitalizations with AMI. Despite the very low prevalence of AMI among COVID-19 hospitalizations, the study showed a substantially greater risk of adverse hospital outcomes and mortality. COVID-19 patients with AMI should be aggressively treated to improve hospital outcomes.

Association of Do-Not-Resuscitate orders and in-hospital mortality among patients undergoing cranial neurosurgery

BackgroundPrevious studies identified pre-existing DNR orders as a predictor of mortality after surgery. We sought to evaluate mortality of patients receiving cranial neurosurgery with DNR orders placed at the time of, or within 24 h of admission. MethodsWe performed a retrospective cohort study using the California State Inpatient Database, January 2018 to December 2020. We used International Classification of Diseases, 10th Revision (ICD-10) codes to identify emergent hospitalizations with principal diagnosis of brain injury, including traumatic brain injury [TBI], ischemic stroke [IS], intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], or malignant brain tumor [mBT]. We used procedure and Diagnosis Related Group codes to identify cranial neurosurgery. Patients with DNR were one-to-one matched to non-DNR controls based on diagnosis (exact matching), age, sex, Elixhauser comorbidity index, and organ failure (coarsened matching). The primary outcome was inpatient mortality. ResultsIn California, 30,384 patients underwent cranial neurosurgery, 2018–2020 (n = 3,112, 10% DNR). DNR patients were older, more often female, more often White, with greater comorbidity and organ system dysfunction. There were 2,505 patients with DNR orders 1:1 matched to controls. Patients with DNR had greater inpatient mortality (56% vs. 23%, p < 0.001; Hazard Ratio 3.11, 95% CI 2.50–3.86), received tracheostomy (Odds Ratio [OR] 0.37, 95% CI 0.24–0.57) and gastrostomy less (OR 0.48, 95% CI 0.39–0.58) compared to controls. Multivariable analysis of the unmatched cohort demonstrated similar results. ConclusionPatients undergoing cranial neurosurgery with early or pre-existing DNR have high inpatient mortality compared to clinically similar non-DNR patients; 1 in 2 died during their hospitalization.

Impact of the COVID-19 Pandemic on Inpatient Utilization for Acute Neurologic Disease.

Background and Objective: The initial months of the Corona Virus 2019 (COVID-19) pandemic resulted in decreased hospitalizations. We aimed to describe differences in hospitalizations and related procedures across neurologic disease. Methods: In our retrospective observational study using the California State Inpatient Database and state-wide population-level estimates, we calculated neurologic hospitalization rates for a control period from January 2019 to February 2020 and a COVID-19 pandemic period from March to December 2020. We calculated incident rate ratios (IRR) for neurologic hospitalizations using negative binomial regression and compared relevant procedure rates over time. Results: Population-based neurologic hospitalization rates were 29.1 per 100,000 (95% CI 26.9-31.3) in April 2020 compared to 43.6 per 100,000 (95% CI 40.4-46.7) in January 2020. Overall, the pandemic period had 13% lower incidence of neurologic hospitalizations per month (IRR 0.87, 95% CI 0.86-0.89). The smallest decreases were in neurotrauma (IRR 0.92, 95% CI 0.89-0.95) and neuro-oncologic cases (IRR 0.93, 95% CI 0.87-0.99). Headache admissions experienced the greatest decline (IRR 0.62, 95% CI 0.58-0.66). For ischemic stroke, greater rates of endovascular thrombectomy (5.6% vs 5.0%; P < .001) were observed in the pandemic. Among all neurologic disease, greater rates of gastrostomy (4.0% vs 3.5%; P < .001), intubation/mechanical ventilation (14.3% vs 12.9%, P < .001), and tracheostomy (1.4 vs 1.2%; P < .001) were observed during the pandemic. Conclusions: During the first months of the COVID-19 pandemic there were fewer hospitalizations to varying degrees for all neurologic diagnoses. Rates of procedures indicating severe disease increased. Further study is needed to determine the impact on triage, patient outcomes, and cost consequences.

Hospital Discharge and Readmissions Before and During the COVID-19 Pandemic for California Acute Stroke Inpatients

BackgroundAcute stroke therapy and rehabilitation declined during the COVID-19 pandemic. We characterized changes in acute stroke disposition and readmissions during the pandemic. MethodsWe used the California State Inpatient Database in this retrospective observational study of ischemic and hemorrhagic stroke. We compared discharge disposition across a pre-pandemic period (January 2019 to February 2020) to a pandemic period (March to December 2020) using cumulative incidence functions (CIF), and re-admission rates using chi-squared. ResultsThere were 63,120 and 40,003 stroke hospitalizations in the pre-pandemic and pandemic periods, respectively. Pre-pandemic, the most common disposition was home [46%], followed by skilled nursing facility (SNF) [23%], and acute rehabilitation [13%]. During the pandemic, there were more home discharges [51%, subdistribution hazard ratio 1.17, 95% CI 1.15-1.19], decreased SNF discharges [17%, subdistribution hazard ratio 0.70, 95% CI 0.68-0.72], and acute rehabilitation discharges were unchanged [CIF, p<0.001]. Home discharges increased with increasing age, with an increase of 8.2% for those ≥85 years. SNF discharges decreased in a similar distribution by age. Thirty-day readmission rates were 12.7 per 100 hospitalizations pre-pandemic compared to 11.6 per 100 hospitalizations during the pandemic [p<0.001]. Home discharge readmission rates were unchanged between periods. Readmission rates for discharges to SNF (18.4 vs. 16.7 per 100 hospitalizations, p=0.003) and acute rehabilitation decreased (11.3 vs. 10.1 per 100 hospitalizations, p=0.034). ConclusionsDuring the pandemic a greater proportion of patients were discharged home, with no change in readmission rates. Research is needed to evaluate the impact on quality and financing of post-hospital stroke care.

Effect of COVID-19 pandemic on outcomes in intracerebral hemorrhage.

Patients with severe intracerebral hemorrhage (ICH) often suffer from impaired capacity and rely on surrogates for decision-making. Restrictions on visitors within healthcare facilities during the pandemic may have impacted care and disposition for patient with ICH. We investigated outcomes of ICH patients during the COVID-19 pandemic compared to a pre-pandemic period. We conducted a retrospective review of ICH patients from two sources: (1) University of Rochester Get With the Guidelines database and (2) the California State Inpatient Database (SID). Patients were divided into 2019-2020 pre-pandemic and 2020 pandemic groups. We compared mortality, discharge, and comfort care/hospice. Using single-center data, we compared 30-day readmissions and follow-up functional status. The single-center cohort included 230 patients (n = 122 pre-pandemic, n = 108 pandemic group), and the California SID included 17,534 patients (n = 10,537 pre-pandemic, n = 6,997 pandemic group). Inpatient mortality was no different before or during the pandemic in either cohort. Length of stay was unchanged. During the pandemic, more patients were discharged to hospice in the California SID (8.4% vs. 5.9%, p<0.001). Use of comfort care was similar before and during the pandemic in the single center data. Survivors in both datasets were more likely to be discharged home vs. facility during the pandemic. Thirty-day readmissions and follow-up functional status in the single-center cohort were similar between groups. Using a large database, we identified more ICH patients discharged to hospice during the COVID-19 pandemic and, among survivors, more patients were discharged home rather than healthcare facility discharge during the pandemic.

Hospital Outcomes Among Covid-19 Hospitalizations With Myocarditis: Results From California State Inpatient Database

Hospital Outcomes Among Covid-19 Hospitalizations With Myocarditis: Results From California State Inpatient Database

The impact of the Coronavirus disease 2019 on hospitalizations for coronary artery revascularization: results from California State Inpatient Database.

Coronavirus disease 2019 (COVID-19) outbreak has negatively impacted routine cardiovascular care. In this study, we assessed the impact of COVID-19 pandemic on percutaneous coronary artery intervention (PCI) and coronary artery bypass grafting (CABG) hospitalizations and outcomes using a large database. The current study was a retrospective analysis of California State Inpatient Database (SID) during March-December of 2019 and 2020. All adult hospitalizations for coronary artery revascularization were included for the analysis. ICD-10-CM diagnosis and procedure codes were used for identifying hospitalizations and procedures. The primary outcome was inhospital mortality, and secondary outcomes were hospital length of stay, stroke, acute kidney injury, and mechanical ventilation. Propensity score match analysis was done to compare adverse clinical outcomes. PCI hospitalizations (relative decrease, 15.0%, P for trend <0.001) and CABG hospitalizations (relative decrease, 16.4%, P for trend <0.001) decreased from 2019 to 2020, while viral pneumonia hospitalizations increased (relative increase, 1751.6%, P for trend <0.001). Monthly PCI and CABG hospitalization showed decreasing trends from January 2019 to December 2020. Propensity score match analysis showed that the odds of inhospital mortality (OR, 1.12; 95% CI, 1.01-1.24), acute kidney injury (OR, 1.12; 95% CI, 1.06-1.17), and ARDS (OR, 1.89; 95% CI, 1.18-3.01) were higher among patients who received PCI in 2020. Results of our study indicate that initiatives such as encouraging patients to receive treatments and controlling the spread of COVID-19 should be instituted to improve PCI and CABG hospitalizations.

Abstract TP104: Discharge Disposition Before And During The Covid-19 Pandemic For Acute Stroke Inpatients Admitted To California Hospitals

Objectives: The COVID-19 pandemic impacted acute inpatient care for stroke patients resulting in less acute therapy and limitations in rehabilitation services. We sought to characterize differences in acute stroke disposition and readmissions during the COVID-19 pandemic compared to a pre-pandemic period. Materials and Methods: We used the California State Inpatient Database in this retrospective observational study of acute stroke, including ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). The pre-pandemic period was January 2019 to February 2020, and the pandemic period was March 2020 to December 2020. We compared discharge disposition across the two periods using cumulative incidence functions (CIF) to account for competing risks. We compared re-admission rates across the two periods using a chi-squared test. Results: There were 63,120 stroke hospitalizations in the pre-pandemic period and 40,003 stroke hospitalizations during the pandemic period. Both periods included 81% IS, 15% ICH, and 4% SAH. Baseline demographics were similar in both periods. In the pre-pandemic period, the most common disposition was home [46%], followed by skilled nursing facility (SNF) [23%], and acute rehabilitation [13%]. During the pandemic, disposition shifted to increasing proportions of discharges home [51%], and decreasing discharges to SNF [17%], while discharges to acute rehabilitation were unchanged [CIF, p&lt;0.001]. The increase in home discharges and decrease in SNF discharges were driven by older ages (&gt;85 years). The 30-day readmission rate for acute stroke before the pandemic was 12.7 per 100 hospitalizations compared to 11.6 per 100 hospitalizations during the pandemic [p&lt;0.001]. The readmission rate for those discharged to home (11.0 vs. 10.9 per 100 hospitalizations, p=0.738) was unchanged. However, readmission rate for those discharged to SNF (18.4 vs. 16.7 per 100 hospitalizations, p=0.003) and acute rehabilitation (11.3 vs. 10.1 per 100 hospitalizations, p=0.034) decreased during the pandemic. Conclusions: We observed an increase in the proportion of patients discharged to home, and no change in readmission rates for these patients, suggesting improvement in triage during the pandemic period.

Summarizing multiple networks based on their underlying clustering structure to guide joint clustering of hospitals admissions

Healthcare services planning and regulation involve finding patterns in hospitals admission to detect their needs in a timely manner. Admission patterns for certain diseases are more precise than a general pattern including all diseases. Towards the objective of clustering hospitals based on their monthly admission behavior for different diseases, this study investigates the similarity among multiple disease-specific hospital networks to guide a joint clustering of hospitals. In this paper, the disease super network is generated from health records data using graph matching instead of relying on biomedical literature that is used in the previous work. The health records-based disease network is constructed using more than 7 million discharge records that are extracted from the California State Inpatient Database between 2009 and 2011. Comparison of the disease network results obtained using health records of different years shows consistency in clustering structure despite temporal changes in admission data. We show that the joint clustering guided by the health records-based similarity improves clustering group homogeneity measures as compared to the clustering guided by literature-based similarity (average homogeneity 53% vs 41%, respectively). The code used to conduct this work is available at https://github.com/Nouf-Barakati/JointCLusteringofHospitals.

Abstract C002: The effect of ACA and Medicaid expansion on hysterectomy procedures among women in Florida and California

Abstract Introduction: Disparities in healthcare reflect varying access to quality care, and the reception of quality care increases survival. Multiple factors can contribute to disparities in health care. Although the Affordable Care Act (ACA) offered the health disparities reduction by promoting access to equitable and more efficient health care, however there is still a wide gap in healthcare access, quality, and outcomes. One important factor is the lack of Medicaid expansion (ME) in all states of the US. In this study, the effect of ME is compared in California and Florida, the states with and without ME respectively, by looking into hysterectomy procedures (HP) done in these two states. Methods: We used 2009 and 2011 Florida and California State Inpatient Database (SID) of the Healthcare Cost and Utilization Project (HCUP). Our included population (n=3,043,460) were female portion of the database. The outcome variable was hysterectomy identified by ICD-9 codes. Patient-level factors including race/ethnicity, age, insurance type, income level, and other comorbidities were analyzed as explanatory variables. Logistic regression analyses were used to identify independent predictors of hysterectomy. Statistical analysis was conducted using SAS Version 9.4. Results: Among the Florida subjects, highest rate of HP is observed in Caucasian women (57.26%) followed by black women (21.85%). Also, the likelihood of HP is increased in women who are age 36-45 (39.83%) followed by age 46-55 (34.95%), and belong to the 1st and 2nd income levels (49.51%). Among the California subjects, highest rate of HP is in Caucasian women (52.35%) followed by Hispanics (29.09%), and women age 46-55 (39.69%) followed by age 36-45 (36.31%), and belong to 2nd and 3rd income levels (51.13%). Logistic regression analysis demonstrates that the odds of hysterectomy had a higher increase in Florida women in 2011 vs. 2009 (OR=1.238, 95% CI: 1.214-1.262), comparing to California (OR=1.124, 95% CI:1.107-1.141) respectively. Also, odds of HP had a higher increase among Florida women during 2011 Vs 2009 in comparison to that of California women. The increased odds were seen among the 2 lowest income levels, and insurance types. Conclusions: We found that likelihood of HP were seen more in Florida than California during years of 2009 and 2011. Also, we observed the reduction of likelihood of HP among California women during 2011 post-ACA when comparing to 2009, due to ME. However, the likelihood of HP was higher in Florida during 2011where the lack ME was a factor. Findings from this study highlights the importance of protective and preventable healthcare access for everyone regardless of races/ethnicities and other socio-economic factors, thus, brings better management of chronic diseases and improves women’s health at large. The provisions of important structures of ACA, such as Medicaid expansion, and health insurance exchange, in all states may reduce the health disparity among Medicaid holders, and self-pay patients. Citation Format: Zahra Bahrani-Mostafavi, Susan Rucker. The effect of ACA and Medicaid expansion on hysterectomy procedures among women in Florida and California [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C002.

Abstract 15598: Sexual Dimorphism in Hospital Outcomes Among COVID-19 Hospitalizations

Introduction: According to recent global estimates there are nearly 530 million cases and 6.3 million deaths due to novel coronavirus disease 2019 (COVID-19) pandemic. Studies have shown that COVID-19 disproportionately affects males than females. In this study we looked at differences in in-hospital outcomes of COVID-19 based on sex using a larger administrative database. Hypothesis: The adverse in-hospital outcomes of COVID-19 will be significantly higher among males. Methods: This was a retrospective analysis of the California State Inpatient Database 2020. All COVID-19 hospitalizations with age 18 years and above were included for the analysis. These hospitalizations were classified into males and females. The main outcomes of the study were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Any length of stay ≥75th percentile value for the entire cohort was considered as prolonged length of stay. Logistic regression analyses after adjusting for covariates were used to compare COVID-19 related outcomes between males and females. Results: A total of 95,180 primary COVID-19 hospitalizations were included for the analysis. Of these 52465 (55.1%) were males and 42715 (44.9%) were females. Among these hospitalizations, mortality (12.4% versus 10.1%, P&lt;0.001), prolonged length of stay (30.6% versus 25.8%, P&lt;0.001), vasopressor use (2.6% versus 1.6%, P&lt;0.001), mechanical ventilation (11.8% versus 8.0%, P&lt;0.001), and ICU admission (11.4% versus 7.8%, P&lt;0.001) were significantly higher among males. Logistics regression analysis showed that males had significantly greater odds for mortality (aOR, 1.38, 95% CI: 1.32-1.44), prolonged length of stay (aOR, 1.35, 95% CI: 1.31-1.39), vasopressor use (aOR, 1.59, 95% CI: 1.51-1.66), mechanical ventilation (aOR, 1.62, 95% CI: 1.47-1.78), and ICU admission (aOR, 1.58, 95% CI: 1.51-1.66). Conclusions: Adverse outcomes such as mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission were independently associated with male sex. These findings could be due differences to both biological and social factors between the sexes. Future studies should explore these factors to efficiently control COVID-19.

Abstract 15868: Prevalence and Effects of Acute Myocardial Infarction on Hospital Outcomes Among COVID-19 Patients

Introduction: In the US, there are approximately 84 million cases of COVID-19 accounting for 1 million deaths. Though there are not many studies, acute myocardial infarction (AMI) is one of the most lethal complications of COVID-19. In this study, we looked for occurrence of AMI and its effects on hospital outcomes among COVID-19 patients. Hypothesis: AMI among COVID-19 hospitalizations could worsen the levels of adverse in-hospital outcomes. Methods: Data from the 2020 California State Inpatient Database was used retrospectively. All COVID-19 hospitalizations with age ≥18 years were included in the analyses. Adverse hospital outcomes included in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Prolonged length of stay included any hospital length of stay ≥75th percentile. We explored for differences in adverse hospital outcomes between those with and without AMI. Multivariate logistic regression analyses were used to understand the strength of these associations after adjusting for cofactors. Results: Our analysis had a total of 94,114 COVID-19 hospitalizations and 1548 (1.6%) had AMI. Adverse hospital outcomes such as mortality (43.2% versus 10.8%, P&lt;0.001), prolonged length of stay (39.9% versus 28.2%, P&lt;0.001), vasopressor use (7.8% versus 2.1%, P&lt;0.001), mechanical ventilation (35.0% versus 9.7%, P&lt;0.001), and ICU admission (33.0% versus 9.4%, P&lt;0.001) were significantly higher among COVID-19 hospitalizations with AMI. The odds of adverse outcomes such as mortality (aOR, 3.90, 95% CI: 3.48-4.36), prolonged length of stay (aOR, 1.23, 95% CI: 1.10-1.37), vasopressor use (aOR, 3.71, 95% CI: 3.30-4.17), mechanical ventilation (aOR, 2.71, 95% CI: 2.21-3.32), and ICU admission (aOR, 3.51, 95% CI: 3.12-3.96) were significantly more prevalent among COVID-19 hospitalizations with AMI. Conclusions: In spite of very low prevalence of AMI among COVID-19 hospitalizations, we observed a substantially greater risk of adverse hospital outcomes and mortality. The hyperinflammatory response of COVID-19 could additionally worsen the factors precipitating mortality among AMI. COVID-19 patients with AMI should be aggressively treated to improve hospital outcomes.

Abstract 15798: Prevalence and Effects of Pulmonary Embolism on Hospital Outcomes Among COVID-19 Patients

Introduction: Approximately 531 million cases of coronavirus disease 2019 (COVID-19) has been reported globally, leading to 6.3 million deaths. Many studies have previous studies have reported that PE is a significantly dangerous complication of COVID-19. Therefore, we explored the prevalence of PE among COVID-19 hospitalizations. We also looked for the adverse effects of the coexistence of these two conditions using a large administrative database. Hypothesis: PE among COVID-19 hospitalizations could significantly increased the risk for adverse in-hospital outcomes. Methods: Using a retrospective analysis of the 2020 California State Inpatient Database we identified all COVID-19 hospitalizations and PE using ICD-10-CM codes among patients aged 18 years and above. Several outcomes such as in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission were explored for differences between those with and without PE. Prolonged length of stay was defined as hospital length of stay ≥75th percentile. We used multivariate logistic regression analyses to understand the relationship between PE and adverse hospital outcomes after accounting for cofactors. Results: A total of 94,114 COVID-19 hospitalizations were included for the analysis, of which 1798 (1.9%) had PE. COVID-19 hospitalizations with PE had significantly greater rates of adverse hospital outcomes such as mortality (19.5% versus 11.2%, P&lt;0.001), prolonged length of stay (40.0% versus 28.2%, P&lt;0.001), vasopressor use (4.6% versus 2.1%, P&lt;0.001), mechanical ventilation (20.4% versus 9.9%, P&lt;0.001), and ICU admission (19.6% versus 9.6%, P&lt;0.001). PE significantly increased the odds of for mortality (aOR, 2.34, 95% CI: 2.07-2.65), prolonged length of stay (aOR, 3.51, 95% CI: 3.16-3.91), vasopressor use (aOR, 4.23, 95% CI: 3.78-4.74), mechanical ventilation (aOR, 2.90, 95% CI: 2.38-3.53), and ICU admission (aOR, 4.32, 95% CI: 3.85-4.84). Conclusions: Though very few COVID-19 hospitalizations in our cohort had PE, they had greater risk for adverse hospital outcomes and death. Given these adverse associations, PE among COVID-19 patients should be aggressively treated in order to decrease the disease burden of COVID-19.

Abstract 15653: Impact of Atrial Fibrillation on Hospital Outcomes Among Covid-19 Patients - Insight From the 2020 California State Inpatient Database

Introduction: Recent estimates of COVID-19 in the US include over 84 million cases with over 1 million deaths. The association between new-onset atrial fibrillation (AF) and COVID-19 has been reported, but hospital outcomes has not been studied among COVID-19 patients with AF. Hypothesis: AF among COVID-19 hospitalizations is not associated with higher rates of adverse in-hospital outcomes. Methods: Using data from the 2020 California State Inpatient Database, we conducted a retrospective analysis of all hospitalized COVID-19 patients ≥18 years of age. Primary outcomes were: prolonged length of stay (LOS) [defined as LOS ≥75th percentile of the population], ICU admission, mechanical ventilation, vasopressor use, and in-hospital mortality. We examined the differences in adverse hospital outcomes among those with AF versus those without. Multivariate logistic regression analyses were used to estimate the association between AF and outcomes after adjusting for cofactors. Results: Our analysis had a total of 94,114 COVID-19 hospitalizations and 9,391 (10.0%) had AF. Adverse hospital outcomes such as prolonged LOS (40.0% versus 27.1%, P &lt;0.001), ICU admission (18.4% versus 8.8%, P &lt;0.001), mechanical ventilation (19.0% versus 9.1%, P &lt;0.001), vasopressor use (4.4% versus 1.9%, P &lt;0.001), and mortality (27.2% versus 9.6%, P &lt;0.001) were significantly higher among COVID-19 hospitalizations with AF. The adjusted odds ratio (aOR) of adverse outcomes such as prolonged LOS (aOR, 1.37, 95% CI: 1.31-1.44), ICU admission (aOR, 2.01, 95% CI: 1.88-2.15), mechanical ventilation (aOR, 1.95, 95% CI: 1.72-2.20), vasopressor use (aOR, 1.98, 95% CI: 1.86-2.11), and mortality (aOR, 2.04, 95% CI: 1.92-2.16) were statistically significantly higher among COVID-19 hospitalizations with AF compared to those without AF. Conclusions: In 2020, AF occurred in about 10% of COVID-19 hospitalizations in California, USA, and was associated with significantly greater risk of adverse hospital outcomes and mortality. COVID-19 patients should be closely monitored for development of AF, and promptly managed like contemporary AF. More studies are however needed to understand the best approach to managing AF in COVID-19 patients.

Abstract 15686: Prevalence and Effects of Deep Vein Thrombosis on Hospital Outcomes Among COVID-19 Patients

Introduction: Current estimates show that, globally, there are 531 million cases and 6.3 million deaths due to COVID-19. Studies have shown that COVID-19 could lead to deep vein thrombosis (DVT) resulting in increased morbidity and mortality. In this study we sought to estimate the prevalence of DVT among COVID-19 hospitalizations as well as its effects on hospital outcomes using a large administrative database. Hypothesis: The adverse in-hospital outcomes of COVID-19 will be significantly higher among DVT hospitalizations. Methods: We conducted a retrospective analysis of the 2020 California State Inpatient Database. All hospitalizations with age 18 and above and primary diagnosis of COVID-19 were included for the study. They were classified into those with and without DVT. The main outcomes of the study were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Length of stay ≥75th percentile was grouped as prolonged length of stay. Multivariate logistic regressions with covariate adjustments were conducted to compare COVID-19 related outcomes between those with and without DVT. Results: We included a total of 94,114 primary COVID-19 hospitalizations for the analysis. Among them 1575 (1.7%) had DVT. The prevalence of mortality (27.5% versus 11.1%, P&lt;0.001), prolonged length of stay (62.2% versus 27.8%, P&lt;0.001), vasopressor use (7.9% versus 2.1%, P&lt;0.001), mechanical ventilation (36.2% versus 9.7%, P&lt;0.001), and ICU admission (35.7% versus 9.3%, P&lt;0.001) were significantly higher among those with DVT. After adjusting for covariates, regression analysis showed that those with DVT had significantly greater odds for mortality (aOR, 2.34, 95% CI: 2.07-2.65), prolonged length of stay (aOR, 3.51, 95% CI: 3.16-3.91), vasopressor use (aOR, 4.23, 95% CI: 3.78-4.74), mechanical ventilation (aOR, 2.90, 95% CI: 2.38-3.53), and ICU admission (aOR, 4.32, 95% CI: 3.85-4.84). Conclusions: In our cohort, only few COVID-19 hospitalizations had a diagnosis of DVT. However, among those with DVT, the risk for adverse outcomes were significantly higher. Since DVT among COVID-19 is uncommon but associated with adverse hospital outcomes, healthcare providers should promptly monitor for DVT and manage it.

Impact of COVID-19 on Intracranial Meningioma Resection: Results from California State Inpatient Database.

Simple SummaryAll fields of healthcare were adversely affected by the COVID-19 pandemic. In this study, we sought to understand the effects of COVID-19 on hospitalizations for intracranial meningioma resection using a large database. We compared hospitalization rates as well as hospital outcomes such as Clavien–Dindo grade IV complications, in-hospital mortality, and prolonged length of stay for intracranial meningioma resection during 2019 and 2020. Our findings showed that though hospitalization rates decreased slightly during the COVID-19 pandemic, hospital outcomes were not adversely affected. The findings of our study show that with adequate planning and preparations, better hospital outcomes could be sustained even during healthcare emergencies such as COVID-19 pandemic. Our findings assure that neurosurgery practice in the US ensured the best quality of care to their patients even during COVID-19 pandemic.Purpose: To assess the effects of COVID-19 on hospitalizations for intracranial meningioma resection using a large database. Methods: We conducted a retrospective analysis of the California State Inpatient Database (SID) 2019 and 2020. All adult (18 years or older) hospitalizations were included for the analysis. The primary outcomes were trends in hospitalization for intracranial meningioma resection between 2019 and 2020. Secondary outcomes were Clavien–Dindo grade IV complications, in-hospital mortality, and prolonged length of stay, which was defined as length of stay ≥75 percentile. Results: There were 3,173,333 and 2,866,161 hospitalizations in 2019 and 2020, respectively (relative decrease, 9.7%), of which 921 and 788 underwent intracranial meningioma resection (relative decrease, 14.4%). In 2020, there were 94,114 admissions for COVID-19 treatment. Logistic regression analysis showed that year in which intracranial meningioma resection was performed did not show significant association with Clavien–Dindo grade IV complications and in-hospital mortality (OR, 1.23, 95% CI: 0.78–1.94) and prolonged length of stay (OR, 1.05, 95% CI: 0.84–1.32). Conclusion: Our findings show that neurosurgery practice in the US successfully adapted to the unforeseen challenges posed by COVD-19 and ensured the best quality of care to the patients.