Charlson Comorbidity Index Research Articles

Mixing Metals During Operative Fixation and Reconstruction in the Appendicular Skeleton: Does Theoretical In Vivo Galvanization Cause Clinically Detrimental Outcomes?

Traditional training and teaching have advised against mixing varying metal types to avoid the potential for in vivo galvanization and corrosion. The objective of this study was to retrospectively analyze patients who have undergone operative reconstruction with mixed metal (MM) constructs to report any related complications. Design: Retrospective case series. Single Level II Trauma Center. Patients that underwent trauma and/or arthroplasty surgery at a single level II trauma center between 2017-2022 with 'mixed' fixation defined as contact and proximity within the bone (≤10mm) with complete radiographs and medical records and minimum 1 year follow-up was eligible for study inclusion. The primary outcome measure were incidence of corrosion directly related to hardware related complications causing unplanned reoperation. The final analysis included 56 patients (67.9% female), with a mean age of 62.0±16.6 years, mean BMI of 28.9±8.4 kg/m2, and mean Charlson Comorbidity Index (CCI) of 2.5±1.8. Seventy-three percent of the MM implants had direct metal on metal contact, and the average distance between non contacting metals was 0.32±0.28cm. The most common combination of metals was titanium+stainless steel (69.6%). At an average postoperative follow-up of 25.9±19.6 months, hardware-related complications were observed in 15 (26.8%) of patients, with reoperation due to hardware-complications in 12 (21.4%) within 18.5±15.8 months. No evidence of metal-on metal galvanic corrosion was observed on radiographic evaluation at an average of 25.9±19.6 months. Patients who received mixed metal implants showed no radiographic or clinical signs of corrosion. While theoretical concerns exist regarding use of mixed metal implants, these findings suggest that the consequence of such combinations in clinical practice may not be as significant. IV, Retrospective case series.

Fournier’s Gangrene Severity Index and Charlson Comorbidity Index Predict Mortality, Intensive Care Unit Admission, and Length of Hospital Stay in Patients With Fournier’s Gangrene: An Analysis of 264 Consecutive Patients

Fournier’s Gangrene Severity Index and Charlson Comorbidity Index Predict Mortality, Intensive Care Unit Admission, and Length of Hospital Stay in Patients With Fournier’s Gangrene: An Analysis of 264 Consecutive Patients

Trial eligibility, treatment patterns and outcome for venetoclax-based therapy in AML: a prospective cohort study.

Venetoclax (Ven) plus hypomethylating agents are considered standard-of-care for patients with acute myeloid leukemia (AML) judged ineligible for intensive chemotherapy (IC). Real-world studies complement clinical trials, since patterns of patient selection, treatment-exposure and post-remission management may vary. This prospective observational multi-center study included 209 newly diagnosed IC-ineligible patients with a median age 75 years (interquartile range, 71-81 years). A high proportion of patients had secondary AML (53.7%), adverse-risk disease (35.3%), and complex karyotype (15.5%). At a median follow-up of 22.5 months (range 0.1-43), median overall-survival (mOS) was 11.7 months (95% Confidence Interval [CI] 9.9,15.4). Composite complete remission (CRc) was achieved in 65.2% (CR 44.4%; CRi 20.8%). Of responding patients, 21.1% underwent stem-cell transplantation. When stratified based on VIALE-A original eligibility criteria, mOS was 17.8 months for patients meeting eligibility criteria and 10.7 months for patients who did not (p=0.027). AML ontogeny (p=0.024), reduced kidney function (p=0.001), Charlson co-morbidity index (CCI; p=0.0017), ELN-risk (p=0.01) and body-mass index (p=0.0298) were significantly associated with OS. Multivariant Cox-regression analysis confirmed independent association of OS with AML ontogeny (p=0.012), CCI (p=0.033) and ELN-risk (p=0.019). Patients enrolled in the latter half of the study period demonstrated improved OS compared to those enrolled earlier (p=0.026). This prospective observational study highlights outcomes of patient subgroups, including those excluded from registration trials. (clinicaltrials.gov: #NCT03987958).

Real-world characteristics and outcomes of patients with high-risk and non-high-risk smoldering multiple myeloma using the Flatiron Health database

This study aimed to provide real-world evidence on progression risk in patients with high-risk smoldering multiple myeloma (SMM). This retrospective, observational study leveraged data from the Flatiron Health database. Eligible patients had SMM and relevant measures to apply Mayo 2018, International Myeloma Working Group (IMWG) 2020, and AQUILA trial risk criteria. Time to progression to active MM (TTP), progression or death (PFS), and death or progression on first-line MM therapy (PFS2) were evaluated using Kaplan–Meier methods and multivariate Cox regression models adjusted for age, Charlson Comorbidity Index, and time from SMM diagnosis to risk classification date. Across the three risk models (Mayo 2018, IMWG 2020, and AQUILA trial), high-risk patients with SMM had 3.0–4.0 times the risk of TTP, 2.1–3.5 times the risk of PFS, and 1.7–3.2 times the risk of PFS2 versus non-high-risk patients (p < 0.001 for all comparisons). Similar results were observed when patients with early treatment, early progression, and/or bone disease were excluded. This study demonstrates that high-risk patients with SMM have worse prognoses than non-high-risk patients, regardless of the criteria used, and highlights a need for early intervention testing.

Rising challenges in periprosthetic joint infections: a focus on rare pathogens and their clinical implications.

The study aimed to evaluate differences in clinical characteristics and treatment outcomes of periprosthetic joint infection (PJI) attributed to rare versus common pathogens. Data on PJI patients who underwent hip or knee arthroplasty at our center from April 2013 to December 2022 were retrospectively collected. Among the 219 enrolled patients, we compared 32 cases of PJI caused by rare pathogens with 187 controls of PJI caused by common pathogens, analyzing demographic information, clinical characteristics, and treatment outcomes. In demographic data, the Charlson comorbidity index and preoperative invasive procedures were identified as risk factors for rare pathogen PJI. Clinically, the rare pathogen cohort exhibited a significantly higher rate of sinus tract formation compared to those with common bacteria PJI. In terms of laboratory findings, the mean serum C-reactive protein (CRP) was significantly lower in the rare pathogen group. This cohort also had a significantly lower culture positivity rate and a higher rate of polymicrobial co-infections. The median hospital stay was statistically longer for rare pathogen PJI cases than for those with common bacteria PJI. Furthermore, the rare pathogen group required longer antibiotic treatments and had higher rates of antibiotic-related adverse events, although reinfection rates did not significantly differ. PJI caused by rare pathogens exhibits distinct clinical presentations. With advances in diagnostic techniques such as metagenomic next-generation sequencing (mNGS), optimized culture methods, and an interdisciplinary approach facilitating early targeted treatment, rare pathogen PJIs may achieve outcomes comparable to those of typical cases.

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.

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.

Predictive Factors of Short Inpatient Stay Following Total Knee Replacement.

Enhanced Recovery after Surgery (ERAS) protocols adopt a multidisciplinary approach in perioperative care to reduce Length of Stay (LOS). This study aims to identify predictive factors resulting in short-stay following TKR with an ERAS programme. Retrospective analysis was performed on a consecutive series of patients who underwent unilateral TKR by a single surgeon in a tertiary institution between August 2019 and December 2021. Patient demographics, comorbidities and length of stay were collected using Electronic Medical Records. Short-stay was defined as LOS within 1day or less, while standard-stay was defined as LOS exceeding 2days or more. Statistical analysis was performed using R version 4.3.1. Logistic regression was performed for multivariate analysis. Ninety-nine patients were included in the study, comprising 45 short-stay patients and 54 standard-stay patients. Short-stay patients were significantly younger (mean 66.1, 95% CI [64.5, 67.7], p=0.0212) than standard-stay patients (mean 69.2, 95% CI [67.1, 71.2]). There was a significantly lower mean BMI among short-stay patients (26.98, 95% CI [25.52, 28.45], p=0.021) than among standard-stay patients (29.31, 95% CI [27.96, 30.66]). A significantly higher proportion of short-stay patients (84.4%, 95% CI [73.4, 95.5], p=0.00132) were premorbid community ambulant without aids than standard-stay patients (51.9%, 95% CI [38.1, 65.6]). There was no significant difference in sex, race, smoking, American Society of Anaesthesiologists score and Charlson Comorbidity Index (p>0.05). Multivariate logistic regression revealed the following significant factors: Age<75 (p=0.0293), BMI<25 (p=0.00688), and premorbid community ambulant without aids (p=0.0402). In conclusion, predictive factors for short-stay after TKR include age<75, BMI<25 and being premorbid community ambulant without aids.

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.

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. 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). Freedom from recurrence in less (ADI ≤ 50) vs. more (ADI > 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). 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.

Evaluating Risk Factors for Clinical Failure Among Tigecycline-Treated Patients.

Clinical trials have documented that tigecycline has a higher mortality risk than other treatments; it continues to be widely used for various infections in real-world settings, where its associated risk factors for clinical failure are understudied. This retrospective analysis included a prospective 2019-2021 cohort of tigecycline-treated patients, excluding those with multiple infection sites. We assessed the outcomes on day 28, with clinical failure defined by mortality, persistent initial infection symptoms, or the requirement for continued antimicrobial treatment. Multivariable logistic regression was used for the outcome analysis. Of 253 patients included in the study, 94 experienced clinical failure. The infection foci included pneumonia (46.3%), bloodstream infection (BSI) (25.3%), and skin/soft tissue infections (10.3%). There were no significant differences in high-dose tigecycline administration or monotherapy rates between patients with favorable outcomes and those with clinical failure. A higher Charlson comorbidity index (adjusted odds ratio [aOR] = 1.20, P = 0.001), Pitt bacteremia score (aOR = 1.25, P = 0.007), and BSI (aOR = 3.94, P < 0.001) were significant predictors of clinical failure. Concomitant use of Pseudomonas aeruginosa-active fluoroquinolone (aOR = 1.97, P = 0.03) and carbapenem (aOR = 2.20, P = 0.01) was linked to increased clinical failure. Multiple comorbidities, BSI, and higher Pitt bacteremia scores are associated with increased risk of clinical failure in tigecycline-treated patients. These results suggest clinicians should consider alternatives to tigecycline for patients with these risk factors. When administering tigecycline, vigilant monitoring is indicated to manage potential clinical failures.

Neighborhood Level Socioeconomic Disadvantage and Adherence to Guidelines for the Evaluation of Patients with Incidentally Detected Pulmonary Nodules.

The management of incidental pulmonary nodules is guided by recommendations set forth by the Fleischner Society. While most pulmonary nodules are benign, timely and evidence-based follow-up can reduce morbidity and mortality. There are known socioeconomic disparities for engagement with recommended cancer screenings, however it is unclear whether disparities exist for follow-up of incidentally detected pulmonary lesions. Do patients residing in more socioeconomically deprived neighborhoods have reduced likelihood of adherence to guideline-recommended follow-up of incidentally detected pulmonary nodules? We assembled a retrospective cohort of 32,965 patients within a large, regional integrated healthcare system with a defined membership who had a pulmonary nodule ≤30mm identified on diagnostic CT between 2012 and 2016. Patients with prior history of malignancy were excluded. Participants were subsequently divided into quartiles utilizing the Neighborhood Deprivation Index as a metric for socioeconomic status. Adherence was ascertained utilizing ICD-9 or CPT coded imaging or biopsy to determine if follow-up was performed within an interval specified by 2005 Fleischner Society Guidelines (with a +/-33% margin of error), based on each patient's nodule characteristics. Negative binomial regression was performed to determine the association between neighborhood level deprivation and adherence to guideline-concordant care, with and without adjustment for plausible confounders. Only 49.6% of patients had follow-up imaging or other diagnostic procedure performed within the guideline-recommended timeframe. There was a 3% reduction in adherence to follow-up for patients residing in the most socioeconomically deprived neighborhood quartile (relative risk [RR]=0.97; 95% CI 0.94 to 1.0) compared with the least deprived quartile. Smoking status was also associated with worse adherence (former vs never, RR= 0.67; 95% CI 0.65 to 0.69) current vs never, RR= 0.73; 95% CI 0.70 to 0.76). Multi-morbidity, and CHF in particular, was associated with decreased adherence to guideline-recommended care (Charlson Comorbidity Index of 3 vs 0, RR:0.93; 95% CI 0.89 to 0.97; History of CHF, RR: 0.93; 95% CI 0.90 to 0.97). In the context of poor adherence overall, patients residing in the most socioeconomically deprived neighborhoods were less likely to receive care in concordance with Fleischner Society recommendations for management of incidental pulmonary nodules.

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.