Charlson Comorbidity Index Research Articles

Risk factors for SARS-CoV-2 pneumonia among renal transplant recipients in Omicron pandemic—a prospective cohort study

BackgroundThe coronavirus disease (COVID-19) pandemic is a global health emergency, and SARS-CoV-2 pneumonia poses significant challenges to health systems worldwide. Renal transplant recipients (RTRs) are a special group and are more vulnerable to viral pneumonia. However, few studies have elucidated the risk factors of SARS-CoV-2 pneumonia in RTRs infected with COVID-19. This study aimed to build a risk prediction model for SARS-CoV-2 pneumonia among RTRs based on demographic and clinical information.MethodsWe conducted a prospective cohort study among 383 RTRs (age ≥ 18 years) diagnosed with COVID-19 from December 21, 2022, to March 26, 2023. Patients’ demographic and clinical information was collected through a questionnaire survey combined with electronic medical records. A stepwise logistic regression model was established to test the predictors of SARS-CoV-2 pneumonia. We assessed the diagnostic performance of the model by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) and calibration using the Hosmer–Lemeshow (HL) goodness-of-fit test.ResultsOur study showed that the incidence of SARS-CoV-2 pneumonia among RTRs was 31.1%. Older age (OR = 2.08–3.37,95%CI:1.05–7.23), shorter post-transplantation duration (OR = 0.92,95% CI: 0.87,0.99), higher post-transplant Charlson Comorbidity Index (CCI) (OR = 1.84, 95%CI: 1.14,2.98), pulmonary infection history (OR = 3.44, 95%CI: 1.459, 8.099, P = 0.005), fatigue (OR = 2.11, 95%CI: 1.14, 3.90), cough (OR = 2.03, 95%CI: 1.08, 3.81), and lower estimated glomerular filtration rate (eGFR) at COVID-19 diagnosis (OR = 0.98, 95%CI:0.97,0.99) predicted a higher risk for SARS-CoV-2 pneumonia. The model showed good diagnostic performance with Chi-Square = 10.832 (P > 0.05) and AUC = 0.839 (P < 0.001).ConclusionsOur study showed a high incidence of SARS-CoV-2 pneumonia among RTRs, and we built a risk prediction model for SARS-CoV-2 pneumonia based on patients’ demographic and clinical characteristics. The model can help identify RTRs infected with COVID-19 at high risk of SARS-CoV-2 pneumonia to inform timely, targeted, and effective prevention and intervention efforts.

Etiology and therapy of pharyngeal perforations.

The primary aim of this study is to evaluate the impact of diagnostic procedures and treatment interventions performed at our medical institution on the final outcomes and survival rates of patients with iatrogenic and traumatic pharyngeal perforation (PP). We reviewed the medical records of 36 patients with iatrogenic and trauma-induced PP who were treated at the Quaternary Medical Center of Otorhinolaryngology between 2010 and 2020. Comorbidities were classified according to the Age-adjusted Charlson Comorbidity Index (ACCI) scoring system, and postoperative complications were classified according to the Clavien and Dindo scoring system. Of the 36 patients, 15 (41.7%) were male and 21 (58.3%) were female. The median age was 73 years, and PP was typically diagnosed within one day. Notably, the perforation site was identified in the hypopharynx in 29 (80.5%) patients. The median ACCI score was 4, with the most frequent ACCI score observed being 5. During the treatment course, 17 patients (47.2%) experienced complications, with 9 of these patients experiencing grade IV complications according to the Clavien and Dindo classification. Our study showed that patients with hypopharyngeal perforations have an almost 42-fold higher risk of mortality during hospitalization compared to those with epipharyngeal or oropharyngeal perforations, though results are limited by the small sample size and the variable dates. Additionally, neurosurgery of the cervical spine, transesophageal echocardiography, and diverticular surgery emerged as procedures carrying the highest risk for pharyngeal perforations. Within our patient cohort, 4 patients (11.11%, all female) died during the treatment course.

Perioperative Complications and In-Hospital Mortality in Radical Nephroureterectomy Patients with Heart Valve Replacement.

Perioperative complication rates and in-hospital mortality after radical nephroureterectomy (RNU) in patients with a history of heart valve replacement are unknown. Within the National Inpatient Sample (2000-2019), we identified non-metastatic upper urinary tract carcinoma patients treated with RNU according to the presence or absence of a history of heart valve replacement. Propensity score matching (1:10 ratio) and multivariable logistic regression as well as Poisson regression models were used. Of 15,423 RNU patients, 151 (1.0%) harbored heart valve replacement. This proportion increased over the study span from 0.5% to 1.4% (p=0.02). Heart valve replacement patients were older (median 78 vs. 72 years; p<0.001), more frequently male (73 vs. 60%; p=0.002), and more frequently harbored a Charlson Comorbidity Index (CCI) ≥3 (36 vs. 27%; p=0.002). After 1:10 propensity score matching for age, sex, and CCI, the patients exhibited higher rates of perioperative bleeding (7.4 vs. 2.4%; odds ratio [OR] 3.2; p<0.001), blood transfusions (24.0 vs. 17.0%; OR 1.6; p=0.02), and cardiac complications (24.0 vs. 14.0%; OR 2.1; p<0.001). Conversely, heart valve replacement patients did not exhibit higher rates of critical care therapy (OR 1.06; p=0.8), higher rates of in-hospital mortality (OR 0.8; p=0.8), and longer length of stay (OR 1.4; p=0.052) than their RNU counterparts without a history of heart valve replacement. RNU patients with a history of heart valve replacement are at significantly increased risk of perioperative bleeding, blood transfusions, and cardiac complications; however, despite these increased risks, they neither exhibited higher critical care therapy rates or higher in-hospital mortality rates, nor did they require significantly longer hospital stay.

Can Endovascular Repair of Unruptured Intracranial Aneurysms Be Safely Performed in an Outpatient Setting? Lessons Learned from Spine Outcome Control Groups.

The performance of select neurosurgical procedures is being transitioned to an outpatient setting rather than an inpatient setting to increase healthcare cost-effectiveness. Despite numerous technological advancements in the treatment of unruptured intracranial aneurysms (UIAs), the procedures are solely performed in an inpatient setting. We aimed to compare the rate of short-term outcomes associated with inpatient endovascular treatment of UIAs with those for established outpatient neurosurgical procedures, including anterior cervical discectomy and fusions (ACDFs) and lumbar discectomies. We performed a retrospective analysis on the data of healthy (Charlson Comorbidity Index ≤4) adult patients undergoing elective neurosurgical procedures including endovascular repair of UIAs, ACDF, and discectomy between January 1, 2012, and August 31, 2019, at a single tertiary facility. Clinical complications and outcomes data were collected and analyzed. The primary outcome variable was the 30-day readmission rate with subgroup analyses of readmission <48 hours and 48 hours to 30 days. A total of 586 patients and a total of 606 procedures were identified, comprising 205 endovascular UIA treatments, 201 ACDFs, and 200 discectomies. Fourteen UIA procedures were excluded from analysis (n = 191) on the basis of anatomic high-risk features. For the primary outcome, there was no statistically significant difference in 30-day readmission rates among the comparison groups (P = .36). For the subgroup analyses, there were no differences in readmission rates for <48 hours (P = .06) and 48 hours to 30 days (P = .71). In addition, there was no significant difference in intraprocedural complication rates among the groups (P = .19). Inpatient elective endovascular treatment of UIAs had similarly low rates of intraprocedural complications and short-term readmissions compared with the established outpatient spine procedures. We hope that our findings may serve as the foundation for future, prospective studies assessing the safety and utility of performing endovascular procedures for UIAs in an outpatient setting.

Epidemiological and Clinical Characteristics of the Course of COVID-19 Among Vaccinated and Unvaccinated Heart Transplant Recipients in Slovenia

Background: Patients receiving heart transplantation require lifelong immunosuppression and compared to the general population, they have a more than five times higher chance of acquiring COVID-19, and their mortality rates are higher. The aim of the present study was to estimate the epidemiological and clinical characteristics of COVID-19 in heart transplant recipients (HTRs) in Slovenia to estimate the vaccination rate and evaluate possible vaccination-hesitant subgroups. Methods: All SARS-CoV-2-positive HTRs (N = 79) between 1 March 2020 and 31 December 2023 at the Infectious Diseases Department, University Medical Centre Ljubljana, Slovenia, were included retrospectively. Demographic, clinical and vaccination data were extracted from medical documentation and a statistical evaluation was performed. Results: The observed vaccination rate was 63.3%, but among patients who received transplants before the pandemic, it was statistically significantly higher (p = 0.027). Vaccinated HTRs were statistically significantly older (p = 0.004) and had a significantly higher Charlson Comorbidity Index (p = 0.018). Our results indicate no significant differences between vaccinated and unvaccinated HTRs regarding acute respiratory insufficiency (p = 0.135), length of hospital stay (p = 0.106), intensive care unit admission (0.414) and in-hospital mortality (p = 0.317), but we observed statistically more frequently an asymptomatic course in those vaccinated (p = 0.050), and a longer length of stay in vector vaccine recipients (p = 0.011) and in those not re-vaccinated (p = 0.030). There was a significantly higher re-vaccination rate in males (p = 0.005). Conclusions: An asymptomatic course of COVID-19 was more often observed in vaccinated HTRs. Our findings suggest statistically significant differences in COVID-19 vaccine acceptance rates; younger HTRs and those transplanted after the pandemic are more hesitant to vaccinate, while females accept booster doses less frequently.

Socioeconomic deprivation is predictive of incomplete postoperative follow-up in patients with tibial shaft fractures.

Patients who sustain tibial shaft fractures are at risk for delayed recognition of complications with inadequate postoperative follow-up. Area Deprivation Index (ADI) is a surrogate which may be used to analyze the effects of socioeconomic deprivation on postoperative follow-up rates. The purpose of this study was to determine if ADI is associated with incomplete postoperative follow-up after intramedullary (IM) nailing for fractures of the tibial diaphysis. 263 patients who underwent IM nailing of extra-articular tibia fractures were retrospectively reviewed. Predictors of incomplete follow-up that were assessed included ADI, Charlson Comorbidity Index (CCI), length of stay (LOS), and discharge disposition. Additional potential predictors included age, sex, race, history of substance abuse, insurance coverage and the presence of polytrauma. ADI was categorized into terciles with T1 (ADI: 1-68; n = 88), T2 (ADI: 69-89; n = 87), and T3 (ADI: 90-100; n = 88) representing the least deprived, intermediate, and most deprived terciles, respectively. Incomplete follow-up was defined as no follow-up after discharge from the hospital or partial follow-up without clearance from orthopaedic care. Terciles did not differ significantly for LOS (p = 0.351), rates of discharge to home (p = 0.728), differences in CCI (p = 0.972) or health insurance coverage (p = 0.369). ADI was the sole significant predictor of incomplete postoperative follow-up (p < 0.001). Compared to T1, there was a significantly higher risk of incomplete follow-up in both T2 (RR = 1.75, 95% CI: 1.20-2.56) and T3 (RR = 1.88, 95% CI: 1.30-2.74). There was only a marginal difference between T2 and T3 for incomplete follow-up risk (RR = 1.08, 95% CI: 0.82-1.42). Patients from areas of higher socioeconomic deprivation are more likely to have incomplete postoperative follow-up after IM nailing of tibial shaft fractures. Allocation of resources towards these patients to improve postoperative follow-up may allow earlier detection of newly developing complications, and avoidance of the cost and morbidity associated with late treatment. III.

Blood Transfusion Utilization in Patients with Severe Coronavirus Disease 2019 in the Republic of Korea: A Nationwide Population-Based Study

Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly affected both supply and demand for blood transfusion. This study aimed to investigate the prescription patterns of blood products and identify the risk factors for blood transfusion in patients with severe COVID-19. Methods: This nationwide population-based cohort study was performed in the Republic of Korea between January 2021 and December 2021. Adult patients (≥19 years) with severe COVID-19 who received oxygen therapy were examined. Data were obtained from the National Health Insurance Service database. Results: During the study period, 41,203 patients developed severe COVID-19. The overall transfusion rate was 7.11%, with 14,477 units of packed red blood cells, 4501 units of fresh frozen plasma, 20,532 units of platelet concentrates, and 1875 units of cryoprecipitate. Blood transfusion was independently associated with 90-day mortality (hazard ratio: 1.36, 95% confidence interval: 1.21–1.53, p &lt; 0.001). Multivariate logistic regression analysis identified underlying chronic kidney disease; exposure to surgery, thrombolysis, or thrombectomy; renal replacement therapy; mechanical ventilation; and extracorporeal membrane oxygenation as significant risk factors for blood transfusion in patients with severe COVID-19. Conversely, underlying cerebrovascular diseases, a Charlson Comorbidity Index score of ≥6, admission to intensive care units, and anticoagulant use were identified as protective factors. Conclusions: This study provides an overview of blood transfusion patterns in patients with severe COVID-19. Understanding these patterns may help optimize the stockpiling of medical resources.

Complications following bilateral simultaneous versus staged total knee arthroplasty in the Japanese population: a propensity-matched case-control study

Although bilateral simultaneous total knee arthroplasty (BSTKA) is an effective treatment for bilateral knee osteoarthritis, safety concerns and lack of precise patient selection criteria persist. This study aimed to determine the differences in perioperative parameters and complication rates between BSTKA and staged TKA in the Japanese population. We retrospectively reviewed 531 patients who underwent BSTKA or staged TKA between 2012 and 2021. Propensity score matching, performed on a 1:1 nearest neighbor basis for age, BMI, diagnosis, ASA score, and age-adjusted Charlson Comorbidity Index, yielded matched cohorts of 94 patients (188 knees) for each group. Outcome measures included operative time, perioperative blood loss, length of hospital stay, and nonmechanical complications after surgery. The BSTKA group had a shorter median operative time and hospital stay (111 min and 16 days) than the staged TKA group (159 min and 33 days) (p < 0.001). Overall complication rates were higher in the BSTKA group than in the staged TKA group (26% vs. 13%, p = 0.026), with anemia requiring transfusion being the most common. Cardiovascular complications were more frequent in the BSTKA group (4.3% vs. 0%, p = 0.043). These findings emphasize the importance of careful patient selection and risk assessment when considering BSTKA.

Efficacy of fosfomycin-containing regimens in treating severe infections caused by KPC-producing Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii in critically ill patients

IntroductionFosfomycin (FOS) is gaining increasing importance as part of combination therapy for the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) and KPC-producing Klebsiella pneumoniae (KPC-Kp) thanks to its in-vitro synergism with several antibiotics, high tissue distribution and good tolerability.We analyzed the effect on 30-day survival of FOS-containing regimens compared to NO-FOS in critically ill patients admitted to intensive care unit with CRAB or KPC-Kp infections. Secondary objectives were to evaluate clinical cure and microbiologic eradication of FOS versus NO-FOS group. Materials/methodsMonocentric retrospective observational study including SARS-Cov2-negative critically ill patients with KPC-Kp or CRAB infection treated with combination antibiotic therapy with or without FOS for ≥48h (FOS vs NO-FOS groups). Primary outcome was 30-d mortality, secondary outcomes clinical cure and microbiological eradication. ResultsOf the 78 patients analyzed, 26 (33.3%) were men, median (IQR) age and Charlson Comorbidity Index (CCI) were 67 years (53-74) and 4 (2-5), respectively. Septic shock was present in 18 patients (23.1%), 37 (47.4%) were CRAB, 41 (52.6%) KPC-Kp. Compared to NO-FOS, patients receiving FOS had higher clinical cure (89.2%vs65.9%, p=0.017), early (<72h) improvement (78.4%vs52.2%, p=0.018), microbiological eradication (87.5%vs62.2%, p=0.027) and lower 7-, 14- and 30-d mortality (0%vs4.6%, p=0.027, 2.7%vs22%, p=0.016, 13.5%vs34.2%, p=0.039, respectively). This effect was particularly evident for infections sustained by KPC-Kp. At multivariate analysis, receiving FOS was independently associated with survival (HR 0.29, IC95% 0.09-0.93, p=0.038), confirmed after IPTW (HR 0.501 IC95% 0.25-0.98 p=0.042). ConclusionsFOS-containing regimens exhibit higher clinical cure, higher microbiological eradication and reduced mortality than NO FOS-containing regimens in critically ill patients with CRAB and KPC-Kp infections.

The Financial Burden of Patient Comorbidities on Total Knee Arthroplasty Procedures: A Matched Cohort Analysis of Patients Who Have a High and Non-High Comorbidity Burden

IntroductionRecent literature has suggested a trend toward a higher comorbidity burden in patients undergoing total knee arthroplasty (TKA). However, there is a lack of data on the impact of increased comorbidities on the cost-effectiveness of TKA. The purpose of this study was to compare the financial implications and perioperative outcomes of patients who do and do not have a high comorbidity burden (HCB). MethodsWe retrospectively reviewed 10,647 patients who underwent an elective, unilateral TKA between 2012 and 2021 and had available financial data. Patients were stratified into HCB (Charlson Comorbidity Index [CCI] ≥ 5) and American Society of Anesthesiology [ASA] scores of 3 or 4) and non-HCB groups and were 1:1 propensity-matched based on baseline characteristics. Perioperative data, revenue, costs, and contribution margins (CM) of the inpatient episode were compared between groups. The 90-day readmissions and revisions were also compared. Of the 10,647 patients reviewed (1,186 HCB, 9,461 non-HCB), 1,536 patients were included in the matched analyses (768 per group). ResultsThe HCB patients had significantly greater total (P < 0.001) and direct (P < 0.001) costs, yet hospital revenue did not differ between cohorts (P = 0.638). This resulted in a significantly decreased CM for the HCB group (P = 0.009). The HCB cohort also had a significantly greater length of stay (P < 0.001) and 90-day readmissions (P = 0.005). ConclusionsIncreased inpatient costs for HCB patients undergoing TKA were not met with increased revenue to cover these costs, leading to a decreased CM. Furthermore, greater 90-day readmissions in the HCB cohort add to the already disproportionate financial burden of these patients. The capacity of hospitals to cover indirect expenses might be impacted, jeopardizing the accessibility of care for HCB patients who need TKA. Current reimbursement models should be modified to adequately consider the increased financial burden associated with HCB patients undergoing TKA.

Duration of antimicrobial treatment for uncomplicated streptococcal bacteraemia: another example of shorter is better

ObjectivesDuration of treatment for uncomplicated streptococcal bacteraemia is unknown. The study aims to assess clinical outcomes of patients with uncomplicated streptococcal bacteraemia receiving a short course (5-10 days) of antimicrobial treatment compared to those receiving the traditional, longer duration (11-18 days). MethodsThis retrospective study was conducted at the Lausanne University Hospital, Switzerland and included episodes of uncomplicated streptococcal bacteraemia among adult patients from 2015 to 2023. Clinical failure was defined as mortality, recurrence of bacteraemia by the same streptococcal species and development in bone and joint infection within 120 days. ResultsDuring the study period, 336 episodes of uncomplicated streptococcal bacteraemia were included. The median duration of antimicrobial treatment was 10 days (interquartile range: 7-14); 184 (55%) and 152 (45%) episodes received a short (5-10 days) and long (11-18 days) duration of antimicrobial treatment, respectively. Forty-three (13%) episodes had clinical failure; 120-day mortality was 11% (36 episodes); recurrence of bacteraemia by the same streptococcal species was observed in 8 episodes (2%). No difference in clinical failure was observed between episodes receiving short and long courses of antimicrobial treatment (10% versus 16%; P 0.143). The Cox multivariable regression model found that a Charlson comorbidity index >4 (aHR 4.87, 95% CI 3.08-7.71), and septic shock (1.67, 1.04-2.67) were associated with clinical failure; a short course of antimicrobial treatment was not associated with clinical failure (0.90, 0.57-1.12). ConclusionsThis study has shown that a short duration of antimicrobial treatment for cases of streptococcal bacteraemia is effective and safe.

The Impact of Socioeconomic Status and Comorbidities on Non-Melanoma Skin Cancer Recurrence After Image-Guided Superficial Radiation Therapy

Background: Non-melanoma skin cancers (NMSCs) are the most common cancers in the United States. Image-guided superficial radiation therapy (IGSRT) is an effective treatment for NMSCs. Patient comorbidities and socioeconomic status (SES) are known contributors to health disparities. However, the impact of comorbidities or SES on the outcomes of IGSRT-treated NMSCs has not yet been studied. This study evaluated freedom from recurrence in IGSRT-treated NMSCs stratified by SES and the number of comorbidities. Methods: This large retrospective cohort study evaluated associations between SES (via Area Deprivation Index (ADI)) or comorbidity (via Charlson Comorbidity Index (CCI)) and 2-, 4-, and 6-year year freedom from recurrence in patients with IGSRT-treated NMSC (n = 19,988 lesions). Results: Freedom from recurrence in less (ADI ≤ 50) vs. more (ADI &gt; 50) deprived neighborhoods was 99.47% vs. 99.61% at 6 years, respectively (p = 0.2). Freedom from recurrence in patients with a CCI of 0 (low comorbidity burden) vs. a CCI of ≥7 (high comorbidity burden) was 99.67% vs. 99.27% at 6 years, respectively (p = 0.9). Conclusions: This study demonstrates that there are no significant effects of SES or comorbidity burden on freedom from recurrence in patients with IGSRT-treated NMSC. This supports the expansion of IGSRT in deprived neighborhoods to increase access to care, and IGSRT should be a consideration even in patients with a complex comorbidity status.

Factors associated with new-onset of mental health disorders in Bell's palsy patients: A MarketScan database study

ObjectiveLimited research exists on mental health disorders (MHDs) in Bell's palsy patients. This study investigates risk factors associated with the development of MHDs in these patients. MethodsMarketScan commercial and Medicare outpatient and prescription drug claims data were utilized to conduct this study on adults with Bell's palsy. Patients were identified using International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification diagnosis codes from 2014 to 2020 data. A one-year washout period was applied where patients did not have any diagnosis of MHD before Bell's palsy diagnosis. Patients were included if they were continuously enrolled for at least two years. The primary outcome was new-onset of any MHDs within one year of diagnosis of Bell's palsy. Descriptive statistics and logistic regression model explored risk factors associated with the development of any MHDs. ResultsOut of 37,166 Bell's palsy patients (mean age 49; 50.4 % female), 8.27 % experienced new-onset MHDs, with anxiety being the most prevalent (3.88 %). Female sex [Adjusted odds ratio (AOR) 1.40, 95 % CI 1.30–1.51, p < 0.0001], increasing Charlson comorbidity index (AOR 1.11, 95 % CI 1.04–1.176, p = 0.001), and symptoms like headache (AOR 1.16, 95 % CI 1.34–1.81, p < 0.0001) and facial pain (AOR 1.71, 95 % CI 1.15–2.52, p = 0.007) were associated with increased odds of new-onset of MHDs. ConclusionBell's palsy patients can develop MHDs within first year of diagnosis, although the incidence of MHDs in this cohort is lower than that of the general population. Several factors are associated with the development of MHDs. These findings underscore the significance of addressing mental health in Bell's palsy patients, offering valuable considerations for clinical care and future research.

Comparing surgical readmission, in-hospital complications, and charges between total hip arthroplasty and hemiarthroplasty for geriatric femoral neck fractures.

For displaced femoral neck fractures (FNFs) in geriatric patients, there remains uncertainty regarding the effect of total hip arthroplasty (THA) compared with hemiarthroplasty (HA) in the guidelines. We aimed to compare 90-day surgical readmission, in-hospital complications, and charges between THA and HA in these patients. The Hospital Quality Monitoring System was queried from 1 January 2013 to 31 December 2019 for displaced FNFs in geriatric patients treated with THA or HA. After propensity score matching, which identified 33,849 paired patients, outcomes were compared between THA and HA using logistic and linear regression models. The HA group had a lower incidence of 90-day surgical readmission than the THA group (odds ratio (OR) 0.75 (95% CI 0.68 to 0.83)). Meanwhile, the HA group had lower incidence of dislocation (OR 0.42 (95% CI 0.33 to 0.52)), aseptic loosening (OR 0.50 (95% CI 0.38 to 0.66)), and joint pain (OR 0.63 (95% CI 0.40 to 0.98)), but a higher incidence of periprosthetic fracture (OR 1.41 (95% CI 1.07 to 1.87)) for readmission, compared to the THA group. The incidence of in-hospital complications did not differ significantly between the two groups. Moreover, the HA group had lower mean charges than the THA group (47,578.29 Chinese Yuan (CNY) (SD 20,069.71) vs 57,641.00 CNY (SD 21,524.07)). When considering 90-day surgical readmission rate, in-hospital complications, and mortality, HA resulted in a significantly lower surgical readmission rate within 90 days compared to THA, despite the patients being older and having a higher Charlson Comorbidity Index.

Use of inpatient systemic chemotherapy and/or radiotherapy and related predictive factors, healthcare resource utilization, and direct hospitalization costs for metastatic urothelial cancer: findings from a real-world retrospective observational study derived from the national hospital discharge claims database in Italy

BackgroundRecent real-world studies revealed high proportions of patients with metastatic urothelial cancer (mUC) do not receive any systemic therapy. This study describes the demographics, clinical characteristics, treatment rate and related predictive factors, healthcare resource utilization, and direct medical costs of patients with mUC receiving systemic therapy (or not) in the inpatient setting in Italy.MethodsThis retrospective observational study used the national hospital discharge database (Scheda di Dimissione Ospedaliera) to describe incident adult (≥ 18 years) patients with a first hospitalization for mUC (index) from 2017-2018, identified by a combination of ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), medical procedure, and diagnosis-related group codes. A model was fitted to identify factors associated with receiving inpatient chemotherapy and/or radiotherapy.ResultsOf 3674 patients with mUC identified, 1014 (27.6%) were treated with inpatient chemotherapy and/or radiotherapy and 2660 (72.4%) were not treated. The median age at index was 71 and 78 years for treated and untreated patients, and the mean (SD) Charlson Comorbidity Index (CCI) score was 0.3 (0.8) and 0.6 (1.1), respectively. Primary tumor location was the bladder in 87.2% of patients. Cardiovascular disease and renal function impairment were more prevalent in untreated (22.6% and 13.2%) vs treated (16.7% and 7.8%) patients. Older age (odds ratio [p-value]) (0.94 [< 0.001]), female sex (0.82 [0.035]), and higher CCI score (0.82 [< 0.001]) were all associated with a lower likelihood of receiving inpatient systemic treatment. The first year was the costliest: estimated national projected costs during the 36-month follow-up from first hospitalization for mUC were €34.3 million (95% CI, €30.3-€60.0 million) and €31.8 million (95% CI, €28.1-€56.0 million) when estimated after 1 year.ConclusionsOur findings indicate a low rate of inpatient systemic therapy for patients with mUC in Italy (driven by older age, female sex, and high comorbidity burden), with a large economic burden despite a high nontreatment rate. Although this study provides a partial capture of the treatment pathway in Italy, the results are consistent with other European studies with similar designs and highlight the need to better identify the reasons for not administering inpatient systemic chemotherapy and/or radiotherapy.

Angiosome-Guided Revascularization in Local Flap Reconstruction of the Foot and Ankle: Comparable Outcomes With Both Direct and Indirect Revascularization.

Among patients with critical limb ischemia and tissue loss, revascularization is an essential component for limb salvage. Local flaps of the foot and ankle remain a versatile tool in reconstructive limb salvage but is dependent on adequate arterial flow. In patients with arterial occlusive disease requiring revascularization, there is a lack of evidence in the current literature investigating on the necessity of direct arterial flow to the respective angiosome for local flaps reconstruction. Our study thereby compares the outcomes of direct (DR) and indirect (IR) revascularization for local flap success. Patients who received endovascular revascularization (ER) prior to local flap reconstruction for chronic wounds in the foot and ankle were retrospectively reviewed. IR was performed in patients where DR could not be performed. DR was defined as an intervention on the same pedicle used for the local flap. IR was defined as an intervention performed on a different angiosome than the pedicle used for the local flap. Patient demographics, Charlson Comorbidity Index (CCI), angiographic details, postoperative complications, and long-term outcomes were collected. A total of 33 patients underwent 43 local flap reconstruction with preoperative ER: 58.1% (n = 25) received DR and 41.2% (n = 18) received IR. Patients had a mean CCI of 6.7 ± 1.8, with a high prevalence of diabetes mellitus (93.9%), peripheral arterial disease (90.9%), and end-stage renal disease (33.3%) with no significant differences between groups. In the immediate postoperative period (postoperative day 0 to 12), there were no significant differences in immediate flap success (DR: 100% vs IR: 88.9%, P = 0.169) or partial flap necrosis between (DR: 0.0% vs IR: 16.7%, P = 0.066). Rates of major complications from infection (DR: 28.2% vs IR: 22.2%, P = 0.736), ischemia (DR: 4.0% vs IR: 11.1%, P = 0.562), or dehiscence (DR: 8.0% vs IR: 16.7%, P = 0.634) requiring reoperation were similar between 2 groups. Overall limb salvage rate was 84.9%, and comparable between groups (DR: 78.6% vs IR: 89.5%, P = 0.628). DR and IR achieve similar rates of limb salvage and flap success after local flap reconstruction. A multidisciplinary vasculo-plastic approach that incorporates preoperative arteriogram and revascularization should be utilized for this highly comorbid patient population to achieve optimal success and limb salvage.

Robot-assisted partial nephrectomy of multiple tumors: a multicenter analysis.

Robot-assisted partial nephrectomy (RAPN) is increasingly performed in challenging tumor constellations like multiple renal masses. The objective was to investigate influencing factors on postoperative renal function (PRF) after ipsilateral robot-assisted partial nephrectomy of multiple tumors (iRAPN-MT). In this retrospective multicenter study, perioperative data of 132 trans- or retroperitoneal iRAPN-MT for ≥ two tumors were analyzed focusing on influencing factors on PRF and acute kidney injury including RIFLE and trifecta criteria. The impact of patient-, surgery- and tumor-related factors was investigated via uni- and multivariate regression analyses. The majority of patients had two renal masses, with three or more lesions in 19%. Median operative time was 175 minutes. Eighty-five percent of the tumors were dissected on-clamp with a median cumulative warm ischemia time (WIT<inf>sum</inf>) of 15 minutes. Trifecta criteria were fulfilled in 57%. In regression analyses, WIT<inf>sum</inf>, BMI and preoperative eGFR had an impact on eGFR loss before discharge (median -11.6 mL/min). BMI and Charlson Comorbidity Index were independent predictors for the lowest RIFLE stage during hospitalization. iRAPN-MT for multiple ipsilateral renal masses is feasible with good trifecta rates. While mostly unmodifiable patient-associated parameters were independent predictors on PRF impairment, WIT<inf>sum</inf> was identified as a surgery-related independent parameter.

Factors associated with undiagnosed COPD in patients hospitalised for severe COPD exacerbation

BackgroundStudies suggest that up to 70% of chronic obstructive pulmonary disease (COPD) cases globally are undiagnosed worldwide. Some of these undiagnosed patients may present with severe exacerbation and factors associated...

A Higher Charlson Comorbidity Index Is a Risk Factor for Hip Fracture in Older Adults During Low-Temperature Periods: A Cross-Sectional Study

A Higher Charlson Comorbidity Index Is a Risk Factor for Hip Fracture in Older Adults During Low-Temperature Periods: A Cross-Sectional Study

Associations of the Charlson comorbidity index with depression and mortality among the U.S. adults

BackgroundChronic comorbidities are often associated with higher risks of depression and mortality. This study aims to explore the relationships between the Charlson Comorbidity Index (CCI) and depression, and their combined effect on mortality.MethodsThis study made use of data gathered in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018, including a collective of 23,927 adult participants. According to CCI score distribution, CCI was categorized into three groups (T1 with CCI = 0; T2 with CCI = 1; T3 with CCI ≥ 2). In the CCI ≥ 2 group, patients may have two or more chronic diseases. Multivariable logistic regression models were employed to explore the relationship between CCI and depression. The study utilized the Cox proportional hazards model to investigate the association between CCI, the combination of CCI and depression, and all-cause mortality.ResultsOur analysis revealed that after adjusting for potential confounders, a positive association was found between CCI and depression (OR = 1.25, 95% CI: 1.21, 1.29). Moreover, a greater CCI was found to be closely linked to higher mortality in individuals with depression (HR = 1.14, 95% CI 1.11, 1.18). Stratifying CCI into tertiles, higher tertiles of CCI (T2, T3 vs T1) also showed positive associations with depression and all-cause mortality. For patients with CCI ≥2 (T3) combined with depression, the risk of mortality was significantly elevated compared to those with CCI = 0 (T1) and non-depressed participants (HR = 2.01, 95% CI: 1.60, 2.52).ConclusionThe study findings demonstrate a positive correlation between CCI and the risk of depression, along with an association with increased all-cause mortality among depression patients. Hence, it is important to prioritize the clinical care of patients with a high CCI (≥2) and depression in order to lower the chances of mortality.