Clinical Classification Software Code Research Articles

Comparing emergency department visits 10-year apart at a tertiary care center in Lebanon.

Presentations to the emergency department (ED) are growing worldwide. With the increasing risk factors of non-communicable disease (NCD) and communicable diseases (CD) in low- and middle-income countries, it is crucial to understand how ED presentations are changing with time to meet patients' needs and allocate acute care resources. The aim of this study is to compare the changes in patient and diseases characteristics over 2 time periods 10 year apart at the largest tertiary care center in Lebanon. This was a retrospective descriptive study of patients presenting to the ED at a large tertiary care center in 2009/2010 and 2018/2019. The discharge diagnoses were coded into Clinical Classification Software codes. We used descriptive statistics, odds ratios (OR), and non-parametric test to compare the different diagnoses. The total number of ED visits increased by 33% from 2009/2010 to 2018/2019. The highest increase rate was among patients older than 65 years (2.6%), whereas the percentage of pediatric patients decreased from 30.8% to 25.3%. ED presentations shifted from NCD to CD. A shift in the discharge diagnoses was also noted within age groups, specifically a shift in cardiovascular diseases to a younger age. Our study suggests that the role of the ED is changing and moving towards treating the aging population and CD. There is a need to invest and mitigate CD, better allocate resources to accommodate the aging population, focus on awareness campaigns targeting early detection of cardiovascular diseases and modifying its risk factors.

Patients Undergoing Elective Inpatient Major Therapeutic Procedures in Florida Had No Significant Change in Hospital Mortality or Mortality-Related Comorbidities Between 2007 and 2019.

In a recent study, rapid response team implementation at 1 hospital was associated with only a 0.1% reduction in inpatient mortality from 2005 to 2018, characterized in the accompanying editorial as a "tepid" improvement. The editorialist postulated that an increase in the degree of illness of hospitalized patients might have masked a larger reduction that otherwise might have occurred. Impressions of greater patient acuity during the studied period might have been an artifact of efforts to document more comorbidities and complications, possibly facilitated by the change in diagnosis coding from the International Classification of Diseases , Ninth Revision ( ICD-9 ) to the Tenth Revision ( ICD-10 ). We used inpatient data from every nonfederal hospital in Florida from the last quarter of 2007 through 2019. We studied hospitalizations for major therapeutic surgical procedures with lengths of stay ≥2 days. Using logistic regression with clustering by the Clinical Classification Software (CCS) code of the primary surgical procedure, we evaluated the trends for decreased mortality, changes in the prevalence of Medicare Severity Diagnosis Related Groups (MS-DRG) with complications or comorbidities (CC) or major complications or major comorbidities (MCC), and changes in the van Walraven index (vWI), a measure of patient comorbidities associated with increased inpatient mortality. Also incorporated in the modeling was the change from ICD-9 to ICD-10 . There were 3,151,107 hospitalizations comprising 130 distinct CCS codes and 453 MS-DRG groups among 213 hospitals. Despite a progressive increase of 4.1% per year in the odds of a CC or MCC ( P = .001), there were no significant changes in the marginal estimates of in-house mortality over time (net estimated decrease, 0.036%; 99% confidence interval [CI], -0.168% to 0.097%; P = .49). There was also absence of a significantly greater fraction of discharges with vWI >0 attributable to the year of the study (odds ratio, 1.017 per year; 99% CI, 0.995-1.041). The changes in MS-DRG to those with CC or MCC were not increased significantly from either the ICD-10 coding change or the number of years after the change. Consistent with the previous study, there was at most a small decrease in the mortality rate over a 12-year period. We found no reliable evidence that patients undergoing elective inpatient surgical procedures were any sicker in 2019 than in 2007. There were substantively more comorbidities and complications documented over time, but this was unrelated to the change to ICD-10 coding.

Burden of Mental Illness among Primary HIV Discharges: A Retrospective Analysis of Inpatient Data.

Background: Empirical evidence demonstrates the substantial burden of mental illness among people living with HIV and AIDS (PLWHA). Current literature also notes the co-morbidity of these two illnesses and its impact on quality of life and mortality. However, little evidence exists on patient outcomes, such as hospital length of stay or post-discharge status. Methods: A retrospective analysis of National Inpatient Sample data was conducted. The study population was defined as discharges having a primary diagnosis of HIV based on International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes in primary diagnosis field. Clinical Classification Software (CCS) codes are used to identify comorbid mental illness. Length of stay was defined as number of days between hospital admission and discharge. Disposition (or post-discharge status) was defined as routine versus not routine. Patient and hospital characteristics were used as control variables. All regression analyses were survey-weighted and adjusted for control variables. Results: The weighted population size (N) for this study was 26,055 (n = 5211). Among primary HIV discharges, presence of any mental illness as a secondary discharge was associated with 12% higher LOS, when compared to a lack of such comorbidity (incidence rate ratio [IRR] = 1.12, 95% confidence interval [CI] = 1.05, 1.22, p < 0.01). Likewise, among primary HIV discharges, those with mental illness had a 21% lower routine disposition, when compared to those without any mental illness (OR = 0.79, 95% CI = 0.68, 0.91, p < 0.001). Conclusion: Our results highlight the need for improved mental health screening and coordinated care to reduce the burden of mental illness among HIV discharges.

Impact of history of mental disorders on short-term mortality among hospitalized patients with sepsis: A population-based cohort study.

BackgroundMental disorders are associated with markedly reduced life expectancy, in part due to an increased risk of death due to infection, likely reflecting sepsis-associated mortality. Patients with mental disorders are at an increased risk of sepsis, but data on the prognostic impact of mental disorders in sepsis are sparse, showing conflicting findings.MethodsWe used statewide data to identify hospitalizations aged ≥18 years with sepsis in Texas during 2014–2017. Mental disorders, including mood, anxiety, psychosis, and personality disorders were identified using Clinical Classification Software codes. Multilevel, multivariable logistic regression with propensity adjustment (primary model), with propensity score matching, and multivariable logistic regression as alternative models, were used to estimate the association between mental disorders and short-term mortality (defined as in-hospital mortality or discharge to hospice). Additional models were fitted for sensitivity analyses and to estimate the prognostic associations of individual categories of mental disorders.ResultsAmong 283,025 hospitalizations with sepsis, 56,904 (20.1%) had mental disorders. Hospitalizations with vs without mental disorders were younger (age 18–44 years 12.2% vs 10.6%), more commonly white (61.0% vs 49.8%), with lower burden of comorbidities (mean [SD] Deyo comorbidity index 2.53 [2.27] vs 2.73 [2.47]), and with lower need for organ support (mechanical ventilation 32.8% vs 36.0%); p<0.0001 for all comparisons. Crude short-term mortality among sepsis hospitalizations with and without mental disorders was 25.0% vs 32.8%, respectively. On adjusted analyses, mental disorders remained associated with lower odds of short-term mortality (adjusted odds ratio 0.792 [95% CI 0.772–0.812]). This finding was consistent on the alternative modeling approaches, sensitivity analyses, and examination of individual categories of mental disorders.ConclusionsMental disorders were associated, unexpectedly, with markedly lower risk of short-term mortality in sepsis. Further studies to examine the mechanisms underlying these findings may inform future efforts to improve sepsis outcomes.

Predictors of new persistent opioid use after benign hysterectomy in the United States

Despite substantial reductions in the past decade, prescription opioids continue to cause widespread morbidity and mortality in the United States. Little is known regarding patterns and predictors of opioid use among women undergoing benign hysterectomy. This study aimed to identify the incidence and predictors of new persistent opioid use after benign hysterectomy among opioid-naïve women from a set of demographic, operative, and opioid prescription characteristics of patients. In this retrospective cohort study, we identified women undergoing benign hysterectomy from 2011 to 2016 using a validated national insurance claims database (IBM MarketScan Commercial Database). After excluding women with prevalent opioid use (from 365 to 31 days preoperatively), we identified patients who received a perioperative opioid prescription (30 days before to 14 days after hysterectomy) and evaluated them for new persistent opioid use, defined as at least 1 prescription from 15 to 90 days and at least 1 prescription from 91 to 365 days postoperatively. Multivariate logistic regression was used to examine demographic, clinical, operative, and opioid prescription-related factors associated with new persistent use. International Classification of Diseases, Ninth and Tenth Revisions, and Clinical Classification Software codes were used to identify hysterectomies, preoperative pain and psychiatric diagnoses, surgical indications, and surgical complications included as covariates. We identified 114,260 women who underwent benign hysterectomy and were not prevalent opioid users, of which 93,906 (82.2%) received at least 1 perioperative opioid prescription. Of 93,906 women, 4334 (4.6%) developed new persistent opioid use. Logistic regression demonstrated that new persistent use odds is significantly increased by younger age (18-34 years; adjusted odds ratio, 1.97; 95% confidence interval, 1.69-2.30), southern geographic location (adjusted odds ratio, 2.03; 95% confidence interval, 1.79-2.27), preoperative psychiatric and pain disorders (anxiety: adjusted odds ratio, 1.20 [95% confidence interval, 1.09-1.33]; arthritis: adjusted odds ratio, 1.30 [95% confidence interval, 1.21-1.40]), >1 perioperative prescription (adjusted odds ratio, 1.53; 95% confidence interval, 1.24-1.88), mood disorder medication use (adjusted odds ratio, 1.51; 95% confidence interval, 1.40-1.64), tobacco smoking (adjusted odds ratio, 1.65; 95% confidence interval, 1.45-1.89), and surgical complications (adjusted odds ratio, 1.84; 95% confidence interval, 1.69-2.00). Although statistically nonsignificant, total morphine milligram equivalent of ≥300 in the first perioperative prescription increased persistent use likelihood by 9% (95% confidence interval, 1.01-1.17). Dispensing of a first perioperative prescription before the surgery, as opposed to after, increased new persistent use odds by 61% (95% confidence interval, 1.50-1.72). Each additional perioperative day covered by a prescription increased the likelihood of persistent use by 2% (95% confidence interval, 1.02-1.03). In contrast, minimally invasive hysterectomy (laparoscopic: adjusted odds ratio, 0.89 [95% confidence interval, 0.71-0.88]; vaginal: adjusted odds ratio, 0.82 [95% confidence interval, 0.72-0.93]) and a more recent surgery year (2016 vs reference 2011: adjusted odds ratio 0.58; 95% confidence interval, 0.51-0.65) significantly decreased its likelihood. New persistent opioid use after hysterectomy was associated with several patient, operative, and opioid prescription-related factors. Considering these factors may be beneficial in counseling patients and shared decision-making about perioperative prescription to decrease the risk of persistent opioid use.

Perioperative Stroke and Thirty-Day Hospital Readmission After Cardiac Surgeries: State Inpatient Database Study.

BackgroundReadmission rates are an important metric for evaluating healthcare quality. Stroke is a major complication following cardiac surgery. Our study aimed to evaluate the frequency and predictors of 30-day unplanned hospital readmission after cardiac surgeries and to evaluate the impact of perioperative stroke on readmission.MethodsSurgical discharge records spanning the years of 2008 through 2011 were analyzed utilizing California State Inpatient Database. International Classification of Diseases, ninth revision-Clinical Modification (ICD-9-CM) codes and Clinical Classification Software (CCS) codes were used to identify surgeries and variables of interest. Surgical records were then followed up for 30 days through linking admission records. Perioperative stroke was defined as brain infarction of ischemic or hemorrhagic etiology that occurred during or within 30 days after surgery.ResultsBaseline characteristics associated with increased readmission rates were female gender, age above 65, non-white race, lower income, and increased number of comorbidities. Among 199,617 hospitalizations for cardiac surgeries, 1,817 (0.91%) patients developed perioperative stroke. The rate of readmission in perioperative stroke patients was 21.89%. They had a longer length of hospital stay and their discharge was vastly non-routine (84%). Our univariate analysis yielded significant association between stroke and readmission rates (odds ratio: 1.82, 95% confidence interval: 1.63 - 2.04). This association failed to remain significant upon controlling for other variables in our multivariate analysis.ConclusionBaseline patient characteristics and perioperative complications are significant predictors of readmission. More than one in five patients who develop a stroke after cardiac surgery are readmitted to the hospital within 30 days of discharge.

Distribution, management and outcomes of AMI according to principal diagnosis priority during inpatient admission.

In recent years, there has been a growing interest in outcomes of patients with acute myocardial infarction (AMI) using large administrative datasets. The present study was designed to compare the characteristics, management strategies and acute outcomes between patients with primary and secondary AMI diagnoses in a national cohort of patients. All hospitalisations of adults (≥18years) with a discharge diagnosis of AMI in the US National Inpatient Sample from January 2004 to September 2015 were included, stratified by primary or secondary AMI. The International Classification of Diseases, ninth revision and Clinical Classification Software codes were used to identify patient comorbidities, procedures and clinical outcomes. A total of 10864598 weighted AMI hospitalisations were analysed, of which 7186261 (66.1%) were primary AMIs and 3678337 (33.9%) were secondary AMI. Patients with primary AMI diagnoses were younger (median 68 vs 74years, P<.001) and less likely to be female (39.6% vs 48.5%, P<.001). Secondary AMI was associated with lower odds of receipt of coronary angiography (aOR 0.19; 95%CI 0.18-0.19) and percutaneous coronary intervention (0.24; 0.23-0.24). Secondary AMI was associated with increased odds of MACCE (1.73; 1.73-1.74), mortality (1.71; 1.70-1.72), major bleeding (1.64; 1.62-1.65), cardiac complications (1.69; 1.65-1.73) and stroke (1.68; 1.67-1.70) (P<.001 for all). Secondary AMI diagnoses account for one-third of AMI admissions. Patients with secondary AMI are older, less likely to receive invasive care and have worse outcomes than patients with a primary diagnosis code of AMI. Future studies should consider both primary and secondary AMI diagnoses codes in order to accurately inform clinical decision-making and health planning.

In Hospital Burden of Venous Thromboembolism in Cancer: A 13 Year Analysis

Introduction:Patients with malignancies tend to develop a hypercoagulable state which predisposes them to thromboembolic events such as deep vein thrombosis (DVT) and pulmonary emboli (PE). Cancer increases the risk of venous thrombosis several fold with varying degree of relative risks (range 4-7). Various factors including tumor type, location, stage and time since diagnosis influence such incidence. The hospital burden of venous thromboembolism (VTE) associated with cancer has yet to be determined, as well as it's impact on cost, length of stay and mortality. The purpose of this study was to identify the annual trend in incidence, cost, and length of stay of VTE among patients with a diagnosis of cancer as well as determine the associated in-hospital mortality based on cancer origin.Methods:Data on inpatient hospitalizations was collected using the National Inpatient Sample (NIS) for years 2002 to 2014. VTE was identified using the clinical classification software code in conjunction with ICD 9 codes for acute pulmonary embolus. Annual trends for incidence, length of stay, and cost of admission were assessed with a linear regression analysis. Associated cancer type and mortality due to PE was evaluated using univariate logistic regression analysis.Results:During the years between 2002 and 2014 a weighted estimate of total admissions for VTE among cancer patients is 903,610. This represents 23% of all admissions for VTE. A trending increase in annual admissions is seen from 61,614 in 2002 to 69,585 in 2014. This increase is primarily driven by a primary diagnosis of acute pulmonary embolus, as these admissions increased from an annual 23,042 to 38,780, while admissions with a primary diagnosis of DVT decreased from 38,571 to 30,805. The total cost of admission increased from $19,380 to $40,105 (p<0.001) while the total length of stay decreased from 6.15 to 4.81 (p<0.001). Mortality among patients with PEs with and without cancer are 2.9% vs 5.6% respectively (p<.0001). Notably, patients with a history of esophageal, gastric, liver, pancreatic and lung cancers all had a more than two-fold increase in the likelihood of mortality.Conclusion:Among patients admitted between 2002 and 2014, VTE remains a source of mortality and morbidity, VTE associated with cancer significantly more so. Admissions for VTE are increasing, and this is primarily driven by an increase in acute pulmonary emboli. On the other hand admissions for acute DVT is decreasing which could imply that these are being managed more frequently in the outpatient setting. The mortality from pulmonary emboli doubles with a history of cancer. More specifically mortality in this population is most associated with esophageal, gastric, liver, pancreatic, and lung cancers. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

1040-P: Survival Models of Diabetes Complications Applied to Different Cohorts

Background: EMRs have enabled the application of machine learning (ML) to characterize disease progression. ML requires large data to produce meaningful results, thus penalizing health systems with small EMRs. Applying models pre-trained on different EMRs is useful but may also suffer from discrepancies between medical sites using different disease codes, procedures, etc. We study the models trained on a large EMR and applied on a smaller one to estimate T2DM complication time using survival models.Method: We trained survival models on a large US insurance claim dataset to create a right-censored cohort (C_1) that includes onset time of T2DM complications, patient profiles, and disease histories. We constructed features using age, sex, and past occurrences of 250 most frequent Clinical Classification Software codes. We trained Random Survival Forest (RSF) models on this cohort. We then created another cohort (C_2) from a smaller EMR from a large Japanese hospital, on which we trained RSF models and also applied models trained on C_1.Results: Table 1 shows a feature importance ranking of trained RSF models and C-indices results. When applying C_1 pre-trained models to C_2, C-indices are high in Nephrology, Hyperosmolar, and Neuropathy. In these cases, common features are highly ranked by both models.Conclusions: This study illustrates the applicability of survival models with disease code covariates on cohorts from different geos.View largeDownload slideView largeDownload slide DisclosureA. Koseki: Employee; Self; IBM, Research Support; Self; Astellas Pharma Inc. M. Makino: None. A. Suzuki: Research Support; Self; Chugai Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Speaker’s Bureau; Self; Eli Lilly Japan K. K. R. Tokumasu: None. P. Chakraborty: None. M. Ghalwash: None. T. Iwamori: None. M. Kudo: Employee; Self; IBM. D. Sow: None. H. Yanagisawa: None. R. Yanagiya: None.

Washington's liquor license system and alcohol-related adverse health outcomes.

In June 2012, Washington state (USA) implemented Initiative 1183, privatizing liquor sales. As a result, off-premises outlets increased from 330 to over 1400 and trading hours lengthened. Increased availability of liquor may lead to increased consumption. This study examines the impact of Initiative 1183 on alcohol-related adverse health outcomes, measured by inpatient hospitalizations for alcohol-related disorders and accidental injuries. It further assesses heterogeneity by urbanicity, because outlets increased most in metropolitan-urban areas. County-by-quarter difference-in-difference linear regression models, estimated statewide and within metropolitan/rural strata. Data are from AHRQ Healthcare Cost and Utilization State Inpatient Database 2010-2014 and HHS Area Health Resource File 2010-2014. Changes in the rates of hospitalizations in the 2.5years following Initiative 1183 in Washington (n=39 counties) are compared with changes in Oregon (n=36 counties). County rates of hospitalizations per 1000 residents, including all records with any-listed ICD-9 Clinical Classification Software code denoting an alcohol-related disorder, and all records with any-listed external cause of injury code denoting an accidental injury. The increase in the rate of accidental injury hospitalizations in Washington's metropolitan-urban counties was on average 0.289 hospitalizations per 1000 county residents per quarter greater than the simultaneous increase observed in Oregon (P=0.017). This result was robust to alternative specifications using a propensity score matched sample and synthetic control methods with data from other comparison states. The evidence did not suggest that Initiative 1183 was associated with differential changes in the rate of hospitalizations for alcohol-related disorders in metropolitan-urban (P=0.941), non-metropolitan-urban (P=0.162), or rural counties (P=0.876). Implementing Washington's Initiative 1183 (privatizing liquor sales) appears to have been associated with a significant increase in the rate of accidental injury hospitalizations in urban counties in that state but does not appear to be significantly associated with changes in the rate of hospitalizations specifically for alcohol-related disorders within 2.5years.

CONSTRICTIVE PERICARDITIS AND ASCITES: A CROSS-SECTIONAL STUDY

SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Constrictive pericarditis is a rare disease with various causes and manifestations. Our study evaluated clinical features, length of stay (LOS) and costs among patients admitted with constrictive pericarditis in a large nationally representative database. METHODS: We conducted a retrospective study of patients who were discharged from the acute care hospitals in the United States from 2012 to 2014. Based on Healthcare Cost and Utilization Project NIS database. ICD-9-CM was used to identify all diagnosis variables. Procedure Clinical Classification Software (CCS) codes were used for all procedures of interest. We compared baseline demographics, hospital characteristics and comorbidities of patients greater than 18 years old with comorbidity of ascites admitted with constrictive pericarditis. We sub-grouped patients with a principal diagnosis of constrictive pericarditis to 2 cohorts with or without ascites during hospitalization. RESULTS: There were 3,415 adult admissions with a principal diagnosis of constrictive pericarditis in the study period, among which 31% were female, 79.1% were Caucasian. The mean age was 59.9. For clinical presentations, 19.3% had a diagnosis of ascites. 9.6% (n=330) had cardiac tamponade, 33.9% had pleural effusion. 36.9% had atrial fibrillation. For constrictive pericarditis related and comorbidities, 57.2% had hypertension, 31.7% had coronary artery disease, 22.1% had chronic kidney disease (CKD), 48% had congestive heart failure, 2% had cirrhosis, 0.4% had tuberculosis, 0.4% had sarcoidosis. 1.3% had systemic lupus erythematosus (SLE). Of all the patients with a principal diagnosis of constrictive pericarditis, 29.7% underwent cardiac catheterization, 10.5% underwent pericardiocentesis. 42.6% (n=1455) underwent pericardiectomy. Among which 485 cases were performed with cardiopulmonary bypass (CPB). Patients with ascites are more likely to be male (78.0% vs. 66.8%, p<0.05), while less likely had cardiac tamponade [(3.8% vs. 11.1%, adjusted odds ratio (aOR) 0.32, 95% CI 0.12- 0.85, p<0.05]. In-patient mortality was 4.9% (n=170). The mean length of stay (LOS) was 10.1 days. The total cost was $35,007. Compare with patients without ascites, patients with ascites had a significantly longer LOS (difference of 4 days, p<0.05) and higher cost (additional $17382, p<0.05) after adjusting for patient and hospital-level confounders. There was no statistical difference in mortality between the two groups. CONCLUSIONS: Patients with ascites are more likely to be male and less likely had cardiac tamponade. Concomitant diagnosis of ascites in patients admitted with constrictive pericarditis as a principal diagnosis is associated with higher length of stay and cost. CLINICAL IMPLICATIONS: Patients with constrictive pericarditis who developed ascites may reflect a later stage of right heart failure. Early recognition and prompt treatment may alleviate the health care burden. DISCLOSURES: No relevant relationships by Si Li, source=Web Response No relevant relationships by Bojana Milekic, source=Web Response No relevant relationships by Fareeha Mubin, source=Web Response No relevant relationships by Pius Ochieng, source=Web Response No relevant relationships by Palakkumar Patel, source=Web Response No relevant relationships by NISHANT SHARMA, source=Web Response No relevant relationships by Yichen Wang, source=Web Response

Economic and Humanistic Burden of Cervical Cancer in the United States: Results from a Nationally Representative Survey.

Objective: To measure the economic and humanistic burden of cervical cancer in the United States.Materials and Methods: This was a retrospective analysis of Medical Expenditure Panel Survey data (2006–2015). Cervical cancer cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification code “180” or clinical classification software code “26”. The control group included women without any cancer diagnosis. Study outcomes included health care resource use (institutional inpatient and outpatient, emergency room, and physician office visits), costs, limitations in activities of daily living, and quality of life (general health status, 12-Item Short Form Health Survey [SF-12] physical and mental component summary [MCS], EuroQol-5D and Short-Form Six-Dimension health utility, and Patient Health Questionnaire-2 depression severity). Generalized linear models, controlling for sociodemographic and clinical covariates, were conducted to compare outcomes between cases and controls.Results: The analytic cohort included 275,246 cervical cancer cases and 146,061,609 noncancer controls. Cases were significantly older (mean age [years]: 42.03 vs. 36.98) and had a higher Charlson comorbidity burden (mean score: 1.06 vs. 0.46) versus controls. Multivariate analyses suggested that compared to controls, cancer cases had significantly higher costs: institutional outpatient ($1,610 vs. $502), physician visit ($2,422 vs. $1,321), and total health care ($10,031 vs. $4,913). Cases were 1.99 (odds ratio [OR]: 1.991; 95% confidence interval [CI]: 1.23–3.22) and 2.56 (OR: 2.562; 95% CI: 1.78–3.68) times as likely to report activity limitations and poor general health versus controls. Cervical cancer patients had significantly lower SF-12 physical and MCS score, health utility, and higher depression severity.Conclusions: Cervical cancer is associated with significant economic burden, activity limitations, and quality of life impairment among ambulatory women in the United States.

PNS158 COMPARISON OF EFFECTIVE ALTERNATIVE ALGORITHMS OF CLASSIFYING ED VISITS TO THE NYU ED ALGORITHM

The New York University (NYU) emergency department (ED) algorithm is being increasingly used to categorize ED care as emergent and non-emergent. However, alternative algorithms are used with publicly available data sources where part of the diagnosis code is masked. The objective of this study was to compare the agreement between the ED visit classification based on all digits of ICD-9 versus using 3-digit ICD-9 code in combination with the clinical classification software (CCS) code. This study used a National Hospital Ambulatory Medical Care Survey (NHAMCS, 2013) and included all ED visits with a valid non-missing primary ICD-9 diagnosis code. The percent agreement (kappa) between the NYU ED and alternative algorithm classification was the primary objective. Furthermore, multivariable logistic regression was conducted to estimate the predictors of agreement between the original NYU ED & alternative algorithms. Our study found 78.25% agreement between classification obtained using ICD-9 CM’s 3-digit+CCS algorithm and NYU ED visit algorithm. Further, the odds of classifying ED visits in concordance with NYU ED algorithm, and using the ICD9 3-digit+CCS algorithm was lower for age>= 18, non-Hispanic blacks, males, follow-up visits, and those with greater number of comorbidities. This study finds that ICD9 3-digit+CCS algorithm provided good agreement between the ED visit classifications based on all digits of ICD-9 versus using ICD 3-digit+CCS algorithm, however, the agreement varies based on sociodemographic factors.

In-Hospital Morbidity and Mortality Among Acute Myeloid Leukemia Patients Admitted for Hematopoeitic Stem Cell Transplants between 2002-2014

Introduction: Acute myeloid leukemia (AML) is a disease with poor overall prognosis, about 4.3 per 100,000 men and women per year are diagnosed with AML with a deaths rate of 2.8 per 100,000. The incidence of AML increases with age which leads to an older population with multiple comorbidities and inferior prognosis. Hematopoietic stem cell transplant (HCT) remains the standard of care in most intermediate and high-risk AML patients. However, HCT puts these patients at risk of severe cytopenia, opportunistic infections, acute graft versus host disease and financial stress, especially in the early phases of transplant. The purpose of this study is to identify the annual trends in in-hospital mortality and morbidity associated with patients with AML admitted for HCT and impact of comorbid conditions on the likelihood of death during admission. Method Data was collected from the National Inpatient Sample from the years of 2002 to 2014. Admissions for HCT for acute myeloid leukemia patients were identified using a procedural clinical classification software code for bone marrow transplants in combination with ICD 9 codes for acute myeloid leukemia. Annual trends in mortality, hospital length of stay, and costs of admission were assessed with a linear regression analysis. Univariate logistic regression analysis was used to test for associations between chronic medical conditions and mortality among these patients. Co-morbid conditions were identified using the Agency for Healthcare Research and Quality comorbidity measures for underlying chronic conditions in patients in 2013 to 2014. Results: Between and including the years of 2002 to 2014, a total weighted estimate of transplants for acute myeloid leukemias in the United States totaled 31,811 (N=6,102). Annual transplants increased from 1,761 in 2002 to 3,030 in 2014. In-hospital mortality decreased from 8.4% in 2002 to 4.8% in 2014 (p=0.02). The mean length of stay remained unchanged from 32.8 days in 2002 to 32.7 days in 2014. Costs of admission increased from $226,280 to $474,106. In-hospital mortality in the years 2013 and 2014 were most strongly associated with comorbid conditions of congestive heart failure (Odds ratio (OR)=5.93), weight loss (OR=4.32), coagulopathy (OR=3.84), liver cirrhosis (OR=3.41). Any two of these conditions increased the OR to 8.34. Conclusions: HCTs have traditionally been associated with high upfront including in-hospital mortality. Our data demonstrates that in the last two decades mortality has been reduced by almost 50% while the length of hospital stay has not changed. This could be related to improvements in supportive care and better selection of conditioning regimens for the patients. It also shows that the costs of hospitalization has doubled. Congestive heart failure, weight loss, underlying coagulopathy and liver cirrhosis are most strongly associated with worse outcomes with any combination of these further potentiating risk of death. Careful selection of patients with special attention to the pre-existing comorbidities is the key to improving early outcomes in HCT. Consideration should also be given to expanding infrastructure to perform outpatient transplants to bend the cost curve. Disclosures No relevant conflicts of interest to declare.

2677. Infection-Related Outcomes in Patients With Malignancy-Related Febrile Neutropenia: A National Perspective

BackgroundFebrile neutropenia (FBN) is a life-threatening oncological emergency requiring hospitalization and early treatment with broad-spectrum antibiotics. We aimed to study differences in infection-related outcomes for febrile neutropenia in various malignancies.MethodsThe National Inpatient Sample (NIS) data set was queried from 2007 to 2014 to identify all patients with a diagnosis of neutropenic fever (ICD-9: 780.6x and 288.5x or 288.0x or 284.1x). Diagnoses for various cancers were determined via their respective Clinical Classification Software (CCS) codes. Diagnoses of pneumonia (481.x, 482x), bacterial meningitis (320.x), Clostridium difficile (008.45), infectious colitis due to neoplastic agents (009.x), urinary tract infection (599.0x), pyelonephritis (590.1x, 590.80), skin and soft-tissue infection (682.x, 684.x, 686.8x, 686.9x), mucositis (528.01), influenza (CCS 487), sepsis (995.91), severe sepsis (995.92), septic shock (785.52), E. coli septicemia (038.42), Pseudomonas septicemia (038.43), MRSA septicemia (038.12) and Streptococcal septicemia (038.0) were identified using their respective ICD/CCS codes. Variables were analyzed via multivariate analysis using the program SAS.ResultsWe studied 381,043 patients with FBN. Leukemia was the most common malignancy associated with FBN (140,190, patients, 36.8%). Meningitis was found to be significantly associated with brain cancer, while other infections were associated with a range of malignancies. (Table.1) Methicillin-resistant Staphylococcus aureus was associated with cancers of the bone, breast, uterus and non- hodgkins lymphoma, while other microorganisms varied across different malignancies (Table 2). Septic Shock was associated with cancer of the pancreas, lung, bone, breast, leukemia, bladder, kidney, thyroid, myeloma, prostate, testis, cervix, brain, melanoma, non-hodgkins lymphoma, compared with other malignancies (Table 3).ConclusionPathogen-specific and targeted antibiotic therapy is the cornerstone of treatment in FBN. Our study provides evidence of specific presentations and organisms causing infections in various malignancies. We hope that further outcomes-based research will provide objective evidence of certain high-risk infections, improving patient outcomes and minimizing redundant testing. Disclosures All authors: No reported disclosures.

COMPARISONS OF OUTCOMES WITH AND WITHOUT HIV IN ATRIAL FIBRILATION

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: With the advent of anti-retroviral therapy, human immunodeficiency virus (HIV) infection is now becoming a chronic disease. At the end of 2015 the prevalence of HIV was estimated to be 1.1 million persons aged 13 or more according to the CDC. Literature has demonstrated that HIV infection is associated with myocardial infarction, heart failure as well as ischemic stroke. It is not as widely represented in literature between the correlation of HIV as well as atrial fibrillation (AF). We propose a study to evaluate and identify patient outcomes of those with HIV infection and AF. METHODS: We conducted a retrospective analysis of the Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS) database. Patients with atrial fibrillation were queried from hospital admissions between 2007 and the September 2015. This was by use of the International Classification of Disease 9th revision (ICD-9) code of ‘472.31’ in all discharge diagnoses. Diagnosis of HIV was queried using the Clinical Classification Software code of ‘5’. Using the statistical software SAS, weighted descriptive analyses were completed to produce national estimates. Variables of hospitalization charges, in-hospital mortality, length of stay, number of procedures during hospitalization, income quartile by zip code and Elixhauser comorbidity index scores were evaluated. SAS was also used for ANOVA with Turkey analysis. RESULTS: Between the years 2007 and September 2015, there was a total of 30,395,295 admissions with AF in the US. Of this, 45,037 patients carried a diagnosis code for HIV. Inpatient mortality for HIV patients was 5% compared to 4.45% without HIV (p<0.05). The mean length of stay for HIV patients was 6.85 vs 5.69 days without HIV (p<0.05). The total charges billed was $62,278 for HIV patients and was $46,293 for without HIV infection (p<0.05). The average number of procedures for those with HIV was higher at 2.12 vs 1.68 for those without (p<0.05). The average household income for those with HIV was 2.04 and those without HIV was 2.45 (p<0.05). Elixhauser mortality index for those with HIV was 8.32 and those without HIV was 7.86 (p<0.05). The mean readmission risk score for those with HIV was 30.41 and those without HIV was 18.73 (p<0.05). CONCLUSIONS: Overall, the outcomes for patients with AF were worse when they had co-infection with HIV. This resulted in longer length of stay, more mortality, higher hospital charges, more procedures along with increased mortality and readmission index scores. It reasonable to say that with HIV becoming a more attributed as a chronic disease, that it may be considered as a risk factor in risk scores such as CHADSVASc. CLINICAL IMPLICATIONS: Further research is needed in the realm of HIV and Atrial Fibrillation to identify the underlying reasons for the above differences and determine if there is a direct pathophysiology between HIV and atrial fibrillation. DISCLOSURES: No relevant relationships by Kathir Balakumaran, source=Web Response No relevant relationships by Anantha Sriharsha Madgula, source=Web Response No relevant relationships by Anand Muthu Krishnan, source=Web Response No relevant relationships by Rudra Ramanathan, source=Web Response No relevant relationships by Varun Tandon, source=Web Response

VTE AND TUMOR LYSIS SYNDROME: A DEADLY DUO

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Tumor Lysis Syndrome has been associated with considerable morbidity and mortality, including a higher risk for prothrombotic states and Disseminated Intravascular Coagulation (DIC). These patients can also have thrombosis of the coronary arteries, venous thromboembolism (VTE) and pulmonary embolism (PE). The mechanism of VTE/PE in TLS is not exactly known but is thought to be related to the release of procoagulant factors from the tumor cells. However, the incidence of VTE/PE in TLS patients remains unclear. We hereby report the incidence of VTE/PE in TLS as well as in-hospital outcomes of patients with TLS presenting with VTE/PE compared to the general population. METHODS: The National Inpatient Sample (NIS) dataset was queried from 2012 to 2015 to identify the diagnosis of VTE/PE with the Clinical Classification Software code 118 among hospitalized patients. Among this patient population, we identified patients with TLS using the International Classification of Disease(ICD)- 9 code 277.88 as a coexisting medical condition. Categorical and continuous variables were tested using Chi-square test and Student t-test respectively. Multivariate regression was used for the analysis of primary outcomes of interest. RESULTS: Among 5,973,975 patients with VTE/PE only 3,795 patients were found to have TLS (0.0006%). The incidence of VTE/PE in TLS patients was found to be significantly greater than general population (11.17% vs. 4.66%, p<0.0001) after matching the two groups. Compared to the general population, patients with TLS were significantly younger (58.3 years vs. 64.1 years, p<0.001), were more likely to be male (62.32% vs 45.67%, p<0.001) and, non-white (31.92% vs. 28.11%,p=0.018). Patients with TLS were found to have a higher prevalence of fluids and electrolyte disorders (70.49% vs 32.6%, p<0.0001), anemia (32.41% vs. 25.47%, p<0.0001), pulmonary circulation disorders (11.07% vs. 6.81%, p<0.0001) and coagulopathy (11.07% vs 6.81%, p<0.0001). In terms of in-hospital outcomes, we found that the mean LOS (19.43 days vs. 6.92, p <0.0001) and cost ($2,40,887.00 vs $65,533.00, p<0.0001) were significantly increased in TLS patients presenting with VTE/PE. Furthermore, the in-hospital mortality rate was higher among patients with TLS with VTE/PE (23.58% vs 3.42%, p<0.0001). Also, patients with TLS who presented with VTE/PE were more likely to be readmitted (Readmit score: 27.98 vs. 20.25%, p<0.0001) compared to the general population. CONCLUSIONS: Patients with TLS have a higher incidence of VTE/PE compared to the general population and worse in-hospital outcomes including cost, LOS and mortality. CLINICAL IMPLICATIONS: Given that patients with TLS have significantly increased cost, LOS and mortality when presenting with VTE/PE, it is imperative that physicians are adept at recognizing this presentation in TLS patients in order to provide effective and timely intervention for better patient outcomes. DISCLOSURES: No relevant relationships by Kathir Balakumaran, source=Web Response No relevant relationships by Aakash Desai, source=Web Response No relevant relationships by Varun Tandon, source=Web Response

Near-universal hospitalization of US emergency department patients with cancer and febrile neutropenia.

ImportanceFebrile neutropenia (FN) is the most common oncologic emergency and is among the most deadly. Guidelines recommend risk stratification and outpatient management of both pediatric and adult FN patients deemed to be at low risk of complications or mortality, but our prior single-center research demonstrated that the vast majority (95%) are hospitalized.ObjectiveFrom a nationwide perspective, to determine the proportion of cancer patients of all ages hospitalized after an emergency department (ED) visit for FN, and to analyze variability in hospitalization rates. Our a priori hypothesis was that >90% of US cancer-associated ED FN visits would end in hospitalization.DesignAnalysis of data from the Nationwide Emergency Department Sample, 2006–2014.SettingStratified probability sample of all US ED visits.ParticipantsInclusion criteria were: (1) Clinical Classification Software code indicating cancer, (2) diagnostic code indicating fever, and (3) diagnostic code indicating neutropenia. We excluded visits ending in transfer.ExposureThe hospital at which the visit took place.Main outcomes and measuresOur main outcome is the proportion of ED FN visits ending in hospitalization, with an a priori hypothesis of >90%. Our secondary outcomes are: (a) hospitalization rates among subsets, and (b) proportion of variability in the hospitalization rate attributable to which hospital the patient visited, as measured by the intra-class correlation coefficient (ICC).ResultsOf 348,868 visits selected to be representative of all US ED visits, 94% ended in hospitalization (95% Confidence Interval [CI] 93–94%). Each additional decade of age conferred 1.23x increased odds of hospitalization. Those with private (92%), self-pay (92%), and other (93%) insurance were less likely to be hospitalized than those with public insurance (95%, odds ratios [OR] 0.74–0.76). Hospitalization was least likely at non-metropolitan hospitals (84%, OR 0.15 relative to metropolitan teaching hospitals), and was also less likely at metropolitan non-teaching hospitals (94%, OR 0.64 relative to metropolitan teaching hospitals). The ICC adjusted for hospital random effects and patient and hospital characteristics was 26% (95%CI 23–29%), indicating that 26% of the variability in hospitalization rate was attributable to which hospital the patient visited.Conclusions and relevanceNearly all cancer-associated ED FN visits in the US end in hospitalization. Inter-hospital variation in hospitalization practices explains 26% of the limited variability in hospitalization decisions. Simple, objective tools are needed to improve risk stratification for ED FN patients.

Patient characteristics associated with treatment of cervical cancer in the United States.

e17020 Background: Treatment options for cervical cancer include surgery, radiation therapy, chemotherapy, and immunotherapy depending upon the disease stage. There is limited real-world evidence providing us with a clinical profile for a treated cervical cancer patient. The objective of this study was to compare cervical cancer patients who were currently receiving treatment versus those not receiving treatment. Methods: This was a retrospective, cross-sectional analysis of Medical Expenditure Panel Survey (MEPS) data (2006-2015). Cervical cancer cases were identified using ICD-9 CM code 180 or clinical classification software code 26. Patients receiving only chemotherapy, radiation therapy, undergoing surgery, or a combination of these treatments in a given year were regarded as “currently receiving treatment”. The comparator cohort included patients “not currently receiving treatment”. The two cohorts were compared in terms of patient clinical characteristics using bivariate analyses. Results: The analytic cohort consisted of 275,246 cervical cancer cases (mean age: 42 years, Caucasian: 88.0%, having private insurance: 55.3%) of which 115,639 (42.01%) were “currently receiving treatment”. The most common treatment option was undergoing surgery only (88.21%), followed by combination therapy (6.82%), chemotherapy only (3.84%), and radiation therapy only (1.12%). The “currently receiving treatment” cohort had a significantly higher proportion of patients having a history of myocardial infarction (4.21% vs 3.50%), congestive heart failure (2.73% vs 1.42%), chronic obstructive pulmonary disorder (29.5% vs 23.2%), connective tissue disease (20.5% vs 11.6%), renal disease (2.49% vs 0.48%), and diabetes (17.7% vs 11.7%) compared to those “not currently receiving treatment”. The latter cohort had a higher proportion of patients with moderate/severe liver disease (0.46% vs 5.32%). Conclusions: The observed real-world patient characteristics and treatment patterns were indicative of a cohort of largely early stage cervical cancer patients. Patients receiving treatment appeared to have a higher comorbidity burden which may subsequently result in poorer quality of life and activity limitations.

Patients with minor diseases who access high-tier medical care facilities: New evidence from classification and regression trees.

Patients in Taiwan's National Health Insurance (NHI) program can choose a medical care facility of any tier for outpatient visits, without a referral. However, this system results in high medical expenditures and costs of outpatient visits. In this study, patients who had only minor diseases but who accessed high-tier medical care facilities were investigated using classification and regression trees. For this study, data were obtained from the Taiwan NHI Research Database. First, 280 diseases, coded according to the Clinical Classification Software (CCS), were examined to determine whether patients chose the most appropriate facility when seeking medical care. After controlling for the CCS codes, an investigation into the types of patients who visit high-tier medical care facilities was conducted. Chronic disease status and CCS code were critical for constructing the classification trees. Male patients living in urban areas and earning a higher income were more likely to access high-tier medical care facilities. However, changes to the NHI copayment policies have significantly reduced the probability of utilizing high-tier medical care facilities. Factors relevant to patients' selection of high-tier medical care facilities were identified. Overall, increasing patients' out-of-pocket payments significantly reduced the probability of accessing high-tier medical facilities.