Comorbidity Data Research Articles

A Cross-Sectional Study of Psychiatric Comorbidity in Croatian Homeland War Veterans Who Were Held as Prisoners of War and Are Affected by Posttraumatic Stress Disorder.

As a extremely traumatic experience, captivity may cause other mental disorders in addition to posttraumatic stress disorder, which is highly prevalent among ex-prisoners of war, and which often occurs in comorbidity with at least one other mental disorder. This objective of this study is to identify the incidence of comorbid mental disorders in Homeland war veterans ex-prisoners of war affected by posttraumatic stress disorder, as well as to identify the factors that influenced psychiatric comorbidity. The study sample comprised 264 subjects, all of whom were Croatian Homeland War veterans with combat experience in the defence of the Republic of Croatia, and all of whom fulfilled clinical criteria for posttraumatic stress disorder at the time of the study. The subjects were divided into two groups: the experimental group was composed of ex-prisoners of war, and the control group of veterans who had never been prisoners of war. The methods of sociodemographic questionnaire, posttraumatic stress disorder self-report checklist and the Harvard Trauma Questionnaire were used in the study. Psychiatric comorbidity data were retrieved from the subjects' anamnesis and medical records. The results showed that ex-prisoners of war were exposed to a statistically much higher number of traumatic events, and had a significantly higher total number of psychiatric comorbidities (p<0.01) than the control group. The incidence of acute and transient psychotic disorders, generalized anxiety disorders and psychological and behavioural factors associated with disorders or diseases classified elsewhere was significantly higher among ex-prisoners of war. There was no statistically significant difference in overall posttraumatic stress disorder intensity between the two groups (p<0.05). The results of the study confirm our hypothesis that the incidence of psychiatric comorbidity is higher in ex-prisoners of war.

Risk factors of postoperative hydrocephalus following decompressive craniectomy for spontaneous intracranial hemorrhages and intraventricular hemorrhage.

Introduction:Hydrocephalus is a complication of spontaneous intracerebral hemorrhage; however, its predictive relationship with hydrocephalus in this patient cohort is not understood. Here, we evaluated the incidence and risk factors of hydrocephalus after craniectomy.Methods:Retrospectively studied data from 39 patients in the same hospital from 2016/01 to 2020/12 and analyzed risk factors for hydrocephalus. The clinical data recorded included patient age, sex, timing of surgery, initial Glasgow Coma Scale score, intracerebral hemorrhage (ICH) score, alcohol consumption, cigarette smoking, medical comorbidity, and blood data. Predictors of patient outcomes were determined using Student t test, chi-square test, and logistic regression.Results:We recruited 39 patients with cerebral herniation who underwent craniectomy for spontaneous supratentorial hemorrhage. Persistent hydrocephalus was observed in 17 patients. The development of hydrocephalus was significantly associated with the timing of operation, cigarette smoking, and alcohol consumption according to the Student t test and chi-square test. Univariate and multivariate analyses suggested that postoperative hydrocephalus was significantly associated with the timing of surgery (P = .031) and cigarette smoking (P = .041).Discussion:The incidence of hydrocephalus in patients who underwent delayed operation (more than 4 hours) was lower than that in patients who underwent an operation after less than 4 hours. nonsmoking groups also have lower incidence of hydrocephalus. Among patients who suffered from spontaneous supratentorial hemorrhage and need to receive emergent craniectomy, physicians should be reminded that postoperative hydrocephalus followed by ventriculoperitoneal shunting may be necessary in the future.

Prevalence of use and characteristics of users of home-based medical care in Medicare Advantage.

Home-based medical care (HBMC) is longitudinal medical care provided by physicians, advanced practice providers, and, often, inter-professional care teams to patients in their homes. Our objective is to determine the prevalence of HBMC among older adults (≥65) insured by a Medicare Advantage (MA) plan and compare characteristics of those who receive HBMC to those who do not. Study used de-identified medical claims and enrollment records for MA beneficiaries during calendar years 2017 and 2018 linked with socioeconomic status data in the OptumLabs Data Warehouse. We defined a cohort of MA beneficiaries age ≥65 receiving HBMC for at least 2 months during 2017-2018, described the cohort using demographic, utilization, and comorbidity data and compared it to a 5% random sample of a population of MA beneficiaries age ≥65 not receiving HBMC (No HBMC). Overall, 1.45% of the study cohort age ≥65 received HBMC. Compared to No HBMC (n= 132,147), those receiving HBMC (n= 38,800) were more likely to be: older (46.6% vs. 11.9% age 85+); female (70.8% vs. 58.5%); Black (12.3% vs. 11.3%); urban (90.3% vs. 81.3%); experience hospitalization (38.0% vs. 13.3%), emergency department visit (58.3% vs. 26.9%), ambulance trip (44.1% vs. 9.6%), skilled nursing facility (37.6% vs. 6.4%), or hospice care admission (21.1% vs. 3.5%). They also were more likely to experience a wide range of chronic conditions including dementia (58.1% vs. 5.2%), morbidity burden (Charlson score 3.4 vs. 1.8), and serious illness (77.1% vs. 29.5%). All comparisons p< 0.0001. MA beneficiaries who received HBMC are older, experience greater chronic and serious illness burden, and higher levels of facility-based care than those who did not receive HBMC. MA plans need strategies to identify patients that would benefit from HBMC and develop approaches to deliver such care to this impactful, often invisible population.

Trends in the prevalence of infiltrative cardiomyopathy among patients with in-hospital cardiac arrest – insight from the US national inpatient sample database

Abstract Background Sarcoidosis, amyloidosis, hemochromatosis and scleroderma are the most common systemic disorders leading to infiltrative cardiomyopathy (InCM). Each of them has been associated with conduction abnormalities and sudden cardiac death. In patients who undergo in-hospital cardiac arrest, a high index of suspicion is required to rule out InCM as an underlying contributor. Purpose We aimed to analyse the temporal trend in the prevalence of InCM among patients with in-hospital cardiac arrest and identify factors associated with increased mortality in this population. Methods We analysed data from the National Inpatient Sample (NIS), which is the largest publicly available database of in-hospital patients in the Unites States. Using ICD-10 coding, we identified patients who were hospitalized across 10 years from 2010–2019. Patients with diagnosis codes for both cardiac arrest and a subtype of InCM were included. Demographic characteristics and co-morbidity data were collected. Statistical analysis was performed using STATA. Results The total number of patients with a diagnosis of in-hospital cardiac arrest was 19,34,260. Of these, the total number with InCM was 14,803 (0.77%), which comprised our study population. Mean age was 63 years. The overall prevalence of InCM across the years ranged between 0.75 to 0.9%, with a significant temporal increase (p&amp;lt;0.01). Prevalence of females ranged between 51% to 62% and significantly outnumbered males across the time period. (p=0.011). Incidence of in-hospital mortality ranged between 61% to 76% for females and 30 to 38% for males. Race based analysis showed that prevalence of Caucasians ranged from 51% to 62% while that of African Americans (AA) ranged from 57% to 73%. The incidence of mortality was similar in both populations. Sarcoidosis was the most prevalent form of InCM, accounting for nearly two-fifths of all cases while amyloidosis and scleroderma both accounted for nearly 20% each. Haemochromatosis was present in 10% of the population. Overall mortality rate in our study population was 60.6%. The following co-morbidities were more prevalent in patients with InCM than those without: history of heart failure, chronic obstructive pulmonary disease (COPD), chronic kidney disease, anaemia, malignancy, coagulopathy, ventricular tachycardia, acute kidney injury and stroke. The following factors were independent predictors of in-hospital mortality-age (p=0.001), female gender (p=0.016), Hispanic race (p=0.039), history of COPD (p&amp;lt;0.001) and presence of malignancy (p=0.042). Conclusion The prevalence of infiltrative cardiomyopathy in patients with in-hospital cardiac arrest is increasing. Females, older patients and Hispanic population are at an increased risk of mortality. Sex and race based disparities in the prevalence of InCM in patients with in-hospital cardiac arrest is an area of further research. Funding Acknowledgement Type of funding sources: None.

Characterisation of pulmonary arterial hypertension patients with cardiovascular comorbidities treated with selexipag: real-world evidence from the EXPOSURE study

Abstract Background A recent post-hoc analysis of the GRIPHON randomised controlled trial [1] showed that selexipag reduces the risk of a morbidity/mortality event versus placebo in pulmonary arterial hypertension (PAH) patients, irrespective of comorbidity burden. Real-world evidence is needed on the management of PAH patients with cardiovascular comorbidities receiving selexipag. Purpose To describe characteristics, treatment patterns and outcomes of PAH patients with cardiovascular comorbidities receiving selexipag in the real world. Methods EXPOSURE is an ongoing, multicentre, prospective, observational study of PAH patients initiating a PAH-specific therapy in Europe and Canada. Patients initiating selexipag were grouped by number of cardiovascular comorbidities present prior to or at therapy initiation: BMI ≥30 kg/m2, systemic hypertension, diabetes mellitus, and coronary artery disease. Results As of November 2020, 382 selexipag-treated patients had follow-up and comorbidity data available: 44% (n=169) had 0, 30% (n=114) had 1, 18% (n=70) had 2, and 8% (n=29) had ≥3 comorbidities. At selexipag initiation, patients with comorbidities were older, more likely to have idiopathic/heritable PAH and had worse functional capacity (lower median 6-minute walk distance, higher proportion in WHO functional class III/IV) vs those without comorbidities (Table 1). Overall, haemodynamic parameters were similar across groups (Table 1). Patients with a higher comorbidity burden were more likely to be at high-risk of 1-year mortality (COMPERA method) vs those with a lower comorbidity burden (Table 1). Patients predominantly initiated selexipag as part of triple combination therapy (mainly in addition to an endothelin receptor antagonist and phosphodiesterase type 5 inhibitor), regardless of comorbidity burden (76–79% across groups). The duration of exposure and the median selexipag maintenance dose were similar across groups (Table 2). The proportion of patients hospitalised and the proportion who discontinued selexipag during the exposure period are shown in Table 2. 5% (n=8) of patients in the 0 comorbidities group, 12% (n=14) in the 1 comorbidity group, 0% in the 2 comorbidities group, and 10% (n=3) in the ≥3 comorbidities group died during the exposure period. Conclusions These real-world data from Europe and Canada suggest that more than 50% of patients who initiated selexipag had ≥1 cardiovascular comorbidity. Patients with comorbidities had more severe functional impairment vs those without. Overall haemodynamic profiles reflected Group 1 Pulmonary Hypertension and were similar across groups. Selexipag was initiated predominantly as part of triple combination therapy in all groups and most patients remained on selexipag, regardless of comorbidity burden. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson &amp; Johnson

Differences in Hospital Length of Stay and Cost of Hospitalization Between Income Levels in Patients Hospitalized for Shoulder Arthroplasty

Introduction There has been an increase in volume and cost of total shoulder arthroplasty (TSA). Performing procedures in high-volume inpatient centers and outpatient centers can help limit costs while preserving quality. This study aims to identify whether a difference in length of stay (LOS) and cost exists between income levels in patients hospitalized for TSA and reverse TSA (R-TSA) to identify potential disparities. Methodology NIS data defined by ICD-10 codes for patients diagnosed with primary shoulder osteoarthritis undergoing TSA or R-TSA between 2016 and 2019 were collected. Demographic, social, and comorbidity data were collected and stratified by income quartile. Results Patients had R-TSA (n = 173,695) more frequently than TSA (n = 149,075). The mean age was greater for R-TSA (71.8) than TSA (67.0) and increased by income quartile (P &lt; 0.0001). Among TSA, LOS (days) decreased Q1 (1.50) to Q2 (1.40) and then remained consistent Q2–Q4. Among R-TSA, LOS decreased Q1 (1.67) to Q2 (1.64) to Q3 (1.62) and then increased in Q4 (1.65) (P = 0.03). The lowest income quartile had the highest cost in R-TSA and the second highest in TSA (P &lt; 0.0001). By location, the percentage of urban teaching hospitals increased by income quartile, while the percentage of rural hospitals decreased by quartile (P &lt; 0.0001). Conclusion Low-income shoulder arthroplasty patients had the longest LOS, high costs, and account for vast majority of rural cases. R-TSA had higher costs and LOS across income quartiles than TSA. Continued attention needs to be placed on the disparities in resource utilization for upper extremity arthroplasty among patients of different socioeconomic status.

S661 Impact of Non-Alcoholic Fatty Liver Disease on In-Patient Outcomes in Non-Variceal Upper Gastrointestinal Bleeding: A Nationwide Analysis

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is the leading cause of liver disease globally with an estimated prevalence of 25%. The clinical and economic burden of NAFLD is expected to keep increasing. Upper gastrointestinal bleeding (UGIB) occurs in ∼100 out of 100,000 people per year. Our aim with this study is to determine the impact of NAFLD on mortality, in-patient complications, and utilization of resources in patients with UGIB. Methods: Using de-identified data from the National Inpatient Sample (NIS) database 2016-2019, we identified patients with non-variceal UGIB and then stratified them into those with and without NAFLD. Patient demographics, length of stay, hospital charges, comorbidities, complications and mortality outcome data were analyzed. Mann-Whitney tests with Bonferroni corrections were used for testing differences in continuous variables, while chi-squared tests with Bonferroni corrections were used for testing homogeneity of categorical variables. Multivariate logistic regression was conducted to analyze the relationship between mortality and NAFLD, while controlling for relevant covariates. Bidirectional stepwise regression was utilized to build the final model. All statistical analysis and hypothesis tests were performed at significance level, with p-value set at < 0.05. Analyses were conducted using R software (v. 4.0.4). Results: Multivariate logistic regression analysis (MLRA) was conducted, controlling for the multiple covariates.The primary outcome of interest, mortality, was found to be significantly higher in patients with NAFLD and GI bleeding [aOR: 1.88 (1.68-2.1)]. Secondary outcomes of interest, shock [aOR: 1.15 (1.07-1.22)], acute respiratory failure [aOR:1.28 (1.15-1.42)] and acute liver failure [aOR:5.58 (4.48-6.69)] were all more likely to occur in this cohort. Patients with NAFLD were also more likely to incur higher hospital charges [$2174 ($1677-$2618)] and have a longer length of stay [0.28 days (0.17-0.38)]. Interestingly, in our study the patients with NAFLD were less likely to suffer from acute myocardial infarction [aOR: 0.73 (0.64-0.85)]. Patients with NAFLD were not more likely to suffer AKI, shock requiring vasopressors, sepsis, blood transfusion, intubation or dialysis. Conclusion: Our analysis showed that patients with non-variceal UGIB have higher mortality, increased complications, longer length of stay and higher hospital charges pointing to the increased morbidity and economic burden of NAFLD.Figure 1.: A. Comparison of demographic and co-morbidities data between non-variceal UGIB with and without NAFLD.Figure 1B.: Forest Plot showing relation between presence of NAFLD with GI bleeding and co-variates.

A Standard-Based Citywide Health Information Exchange for Public Health in Response to COVID-19: Development Study.

BackgroundDisease surveillance is a critical function of public health, provides essential information about the disease burden and the clinical and epidemiologic parameters of disease, and is an important element of effective and timely case and contact tracing. The COVID-19 pandemic demonstrates the essential role of disease surveillance in preserving public health. In theory, the standard data formats and exchange methods provided by electronic health record (EHR) meaningful use should enable rapid health care data exchange in the setting of disruptive health care events, such as a pandemic. In reality, access to data remains challenging and, even if available, often lacks conformity to regulated standards.ObjectiveWe sought to use regulated interoperability standards already in production to generate awareness of regional bed capacity and enhance the capture of epidemiological risk factors and clinical variables among patients tested for SARS-CoV-2. We described the technical and operational components, governance model, and timelines required to implement the public health order that mandated electronic reporting of data from EHRs among hospitals in the Chicago jurisdiction. We also evaluated the data sources, infrastructure requirements, and the completeness of data supplied to the platform and the capacity to link these sources.MethodsFollowing a public health order mandating data submission by all acute care hospitals in Chicago, we developed the technical infrastructure to combine multiple data feeds from those EHR systems—a regional data hub to enhance public health surveillance. A cloud-based environment was created that received ELR, consolidated clinical data architecture, and bed capacity data feeds from sites. Data governance was planned from the project initiation to aid in consensus and principles for data use. We measured the completeness of each feed and the match rate between feeds.ResultsData from 88,906 persons from CCDA records among 14 facilities and 408,741 persons from ELR records among 88 facilities were submitted. Most (n=448,380, 90.1%) records could be matched between CCDA and ELR feeds. Data fields absent from ELR feeds included travel histories, clinical symptoms, and comorbidities. Less than 5% of CCDA data fields were empty. Merging CCDA with ELR data improved race, ethnicity, comorbidity, and hospitalization information data availability.ConclusionsWe described the development of a citywide public health data hub for the surveillance of SARS-CoV-2 infection. We were able to assess the completeness of existing ELR feeds, augment those feeds with CCDA documents, establish secure transfer methods for data exchange, develop a cloud-based architecture to enable secure data storage and analytics, and produce dashboards for monitoring of capacity and the disease burden. We consider this public health and clinical data registry as an informative example of the power of common standards across EHRs and a potential template for future use of standards to improve public health surveillance.

Non-steroidal anti-inflammatory drugs (NSAIDs) in cancer pain: A database analysis to determine recruitment feasibility for a clinical trial

Background: Insufficient evidence exists to support or refute use of NSAIDs for managing cancer pain. Palliative physicians support a placebo-controlled trial of NSAIDs as strong opioid adjuncts for cancer-induced bone pain as the most pragmatic design to benefit clinical practice. Aim: We aimed to determine patient numbers receiving palliative radiotherapy for cancer-induced bone pain, estimate the suitability of NSAID prescription and determine survival, guiding future trial feasibility. Design: A retrospective observational database analysis was undertaken using 5 years of routinely collected regional radiotherapy and healthcare data, filtered to achieve a cohort with cancer-induced bone pain. Demographics and survival were linked to available serology and co-morbidity data. Setting/participants: Data was sourced from the regional Leeds Cancer Centre, a tertiary care setting. Patients who underwent palliative single fraction 8 gray (Gy) radiotherapy treatment for cancer-induced bone pain were included, totalling 2411 over 5 years. Results: A mean of 478 patients received palliative radiotherapy for cancer-induced bone pain annually. Median age (IQR) was 70 (62–77); negatively skewed (−0.69). 65.3% died within 1 year of radiotherapy; 48.0% within 6 months. Age was not associated with survival on univariable analysis (HR 0.999 (95% CI 0.996–1.003)). Serology from 1063 patients (44.2%) were available; eGFR was ⩾60 mL/min/1.73 m2 in 83.0%. From available data (1352 pts; 51.6% of sample), 20.2% had a coded co-morbidity contra-indicating NSAIDs. Combining serology and co-morbidities, 68.5% could be considered for NSAID prescription. Conclusions: Patient numbers at a regional radiotherapy centre support the feasibility of trial recruitment. Available serology and co-morbidity data suggest two-thirds may be suitable for NSAID prescription.

Comorbidities in patients with Unverricht-Lundborg disease(EPM1).

Unverricht-Lundborg disease (EPM1) typically leads to accumulating disability. Disability may also be caused by comorbidities but there are no data available on these. To investigate the frequency of comorbidities in EPM1. Comorbidity data of a previously described cohort of 135 Finnish patients with EPM1 were retrieved from neurological, surgical (including subspecialities), internal medicine (including subspecialities) and intensive care patient charts of the treating hospitals. Mean follow-up time was 31.4 years (SD 12.4 years, range 6.8-57.8 years), during which at least one comorbidity was observed in 107 patients (79%) and three or more in 53 (39%). The most common diagnostic categories were external injuries, mental and behavioural disorders and endocrine, nutritional and metabolic diseases. The most common single comorbid diagnosis was a fracture of the ankle (in 19% of all patients). The second most common single comorbid diagnosis in the cohort was diabetes (in 13% of all patients), and the third was depression, recorded for 13% of the cohort. Malignancies and cardiovascular end-organ damage were rare, whereas phimosis/paraphimosis appeared more common than in general population. Patients with EPM1 often have comorbidities. Trauma and mental health risks should be especially followed and acted upon. Further studies are needed to more accurately comorbidity risks, characteristics and patient needs.

Ulnar Resection Length: A Risk Factor for Nonunion in Ulnar Shortening Osteotomy.

Nonunion rates following ulnar shortening osteotomy (USO) are reported up to 18% with few known risk factors. While resection length is variable in practice, little is known about the prognostic implications on healing. The purpose of this study was to evaluate whether longer resection lengths increased the odds of nonunion. A retrospective review was performed on patients who underwent an elective USO at a single institution over a 6-year period. Demographic, social, comorbidity, and surgical data were reviewed. Ulnar resection length was obtained from operative notes and dichotomized into smaller (<5.5 mm) and larger (≥5.5 mm) groups. The primary outcome was the rate of nonunion. Univariate analyses and a multivariable logistic regression model were used to assess for significant predictors of nonunion. A total of 87 patients were included with a mean age of 45 years. Patient comorbidities included 12.6% with diabetes, 29.9% with an American Society of Anesthesiologists score of ≥ 3, 5.8% reporting current tobacco use, and 29.9% reporting former tobacco use. There were 55 patients (63.2%) with resection lengths < 5.5 mm and 32 patients (36.8%) with ≥ 5.5 mm resections. Multivariable analysis identified longer resection length (≥5.5 mm) and current tobacco use as independent risk factors for nonunion. Patients with a resection length of ≥ 5.5 mm had 20.2 times greater odds of nonunion compared with patients with smaller resections, and current smokers had 72.2 times greater odds of nonunion compared with nonsmokers. Longer ulnar resection length (≥5.5 mm) significantly increases the risk of nonunion following USO.

Prevalence of depression in amyotrophic lateral sclerosis/motor neuron disease: multi-attribute ascertainment and trajectories over 30 months

Objective: Evidence is equivocal about the prevalence of depression in amyotrophic lateral sclerosis (ALS). This study uses a multi-attribute ascertainment of the prevalence of depression and examines this prevalence over time. Methods: Patients with ALS were recruited into the Trajectories of Outcome in Neurological Conditions (TONiC-ALS) study. Caseness was identified by the Modified-Hospital Anxiety and Depression Scale (M-HADS). In addition, participants provided data on co-morbidities and medication use. A combination of the three was used to derive the estimate for the prevalence of depression, treated or untreated. Longitudinal data were analyzed by trajectory analysis of interval level M-HADS-Depression data. Results: Among 1120 participants, the mean age was 65.0 years (SD 10.7), 60.4% male, and the median duration since diagnosis was 9 months (IQR 4–24). Caseness of probable depression at baseline, defined by M-HADS-Depression, was 6.45% (95%CI: 5.1–8.0). Taken together with antidepressant medication and co-morbidity data, the prevalence of depression was 23.1% (95%CI: 20.7–25.6). Of those with depression, 17.8% were untreated. Trajectory analysis identified three groups, one of which contained the most cases; the level of depression for each group remained almost constant over time. Conclusion: Depression affects almost a quarter of those with ALS, largely confined to a single trajectory group. Prevalence estimates based on screening for current depressive symptoms substantially under-estimate the population experiencing depression. Future prevalence studies should differentiate data based on current symptoms from those including treated patients. Both have their place in assessing depression and the response by the health care system, including medication, depending upon the hypothesis under test.

Occurrence of comorbidity with colorectal cancer and variations by age and stage at diagnosis

BackgroundWhile age and stage at diagnosis are known to affect treatment choices and survival from colorectal cancer (CRC), few studies have investigated the extent to which these effects are influenced by comorbidity. In this study, we describe the occurrence of comorbidity in CRC cases in South Australia and associations of comorbidity with age, stage and the age-stage relationship. Furthermore, we report on the association of individual comorbidities with age and stage at diagnosis. MethodsThe South Australian Cancer Registry (SACR) provided CRC data (C18-C20, ICD-10) for 2004–2013 diagnoses. CRC data were linked with comorbidity data drawn from hospital records and health insurance claims. Logistic regression was used to model associations of comorbidity with age and stage. ResultsFor the 8462 CRC cases in this study, diabetes, peptic ulcer disease, and previous cancers were the most commonly recorded co-existing conditions. Most comorbidities were associated with older age, although some presented more frequently in younger people. Patients at both ends of the age spectrum (<50 and 80 + years) had an increased likelihood of CRC diagnosis at an advanced stage compared with other ages (50–79 years old). Adjusting for comorbidities moderated the association of older age with advanced stage. Conditions associated with advanced stage included dementia (OR = 1.25 (1.01–1.55)), severe liver disease (OR = 1.68 (1.04–2.70)), and a previous cancer (OR = 1.18 (1.08–1.28)). ConclusionComorbidities are prevalent with CRC, especially in older people. These comorbidities differ in their associations with age at diagnosis and stage. Dementia and chronic heart failure were associated with older age whereas inflammatory bowel disease and alcohol access were associated with younger onset of the disease. Severe liver disease and dementia were associated with more advanced stage and rheumatic disease with less advanced stage. Comorbidities also interact with age at diagnosis and appear to vary the likelihood of advanced-stage disease. CRC patient have different association of age with stage depending on their comorbidity status.

Predictors of Nonadherence to Colorectal Cancer Screening among Hospitalized Women.

Despite proven mortality benefit, disparities in colorectal cancer (CRC) screening utilization persist, especially among younger women, minorities, and low-income women, even those who are insured. The purpose of the present study is to evaluate and estimate the effects of sociodemographic and clinical variables associated with nonadherence to CRC screening among hospitalized women. A cross-sectional bedside survey was conducted to collect sociodemographic and clinical comorbidity data believed to affect CRC screening adherence of hospitalized women aged 50 to 75 years who were cancer free (except skin cancer) at enrollment. Logistic regression models were used to assess the association between these factors and nonadherence CRC screening. In total, 510 women were enrolled for participation in the study. After adjustment for sociodemographic and clinical predictors, only two variables were found to be independently associated with nonadherence to CRC screening: age younger than 60 years (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.58-4.33) and nonadherence to breast cancer screening (OR 3.72, 95% CI 2.29-6.04). By contrast, hospitalized women at high risk for CRC were more likely to be compliant with CRC screening (OR 0.14, 95% CI 0.04-0.50). Both younger age and behavior toward screening remain barriers to CRC screening. Hospitalization creates an environment where patients are in close proximity to healthcare resources, and strategies could be used to capitalize on this opportunity to counsel, educate, and motivate patients toward this screening that is necessary for health maintenance. Seizing on this opportunity may help improve CRC screening adherence.

P124. Does simultaneous decompression above a fusion lead to progressive adjacent segment disease requiring revision surgery?

<h3>BACKGROUND CONTEXT</h3> Degenerative spondylolisthesis (DS) is a condition that often requires surgical treatment. This treatment varies based on surgeon preference and the extent of lumbar pathology seen on imaging. There is controversy regarding the surgical management of segments adjacent to the level of DS that require decompression. While it is understood that decompression and fusion of affected levels is necessary, it is unclear how best to treat levels adjacent to the level of DS. Some surgeons will always fuse any additional levels that require decompression while others will decompress adjacent segments without extending the fusion. Each technique has its own theoretical risks, but analysis of adjacent segment disease (ASD) and need for repeat surgery has not been extensively studied. <h3>PURPOSE</h3> The primary aim is to identify the rate of and risk factors related to progression of ASD and the need for revision surgery in patients with surgically treated DS. The secondary aim is to analyze the efficacy of decompressing adjacent levels without fusion. <h3>STUDY DESIGN/SETTING</h3> All patients treated surgically for DS at a tertiary care medical center over a 5-year period were retrospectively reviewed. Patients were divided into two cohorts consisting of those patients who were fused at all decompressed levels versus those who were not fused at all decompressed levels. <h3>PATIENT SAMPLE</h3> Adult patients who had decompression and fusion of affected levels with decompression of adjacent levels and at least 1 year of followup were included. There were 137 such patients identified. <h3>OUTCOME MEASURES</h3> Patient demographics, level(s) of DS at presentation, ASD rates and reoperation rates were measured and analyzed. Rates of ASD were measured based on clinical presentation, radiographic results and/or need for reoperation. <h3>METHODS</h3> Descriptive statistics were used to summarize demographic and comorbidity data. Relative risks were calculated and two proportion z-test was used to compare rates of adverse events in the two surgical cohorts. Odds ratios were calculated for risk factors associated with adverse events. <h3>RESULTS</h3> Of the 137 patients, 86 (63%) were female and 51 (37%) were male. The average followup was 19.9 months. There were 119 (87%) patients with single level DS and 18 (13%) with DS at two adjacent levels. The most common level for DS was L4-5 (100, 73%). Thirty-four patients underwent a multilevel decompression and fusion only at the level of the DS, while 103 had a fusion at all the decompressed levels. Twelve patients (9%) had progression of ASD requiring extension of their construct; 11 of these patients were female (92%), however female sex was not a statistically significant risk factor for ASD (p = 0.06). Of the 12 patients, 3 had DS at L3-4, 9 at L4-5 and 2 at L5-S1. Two patients were decompressed more levels than fused, and 10 were fused at all levels decompressed. Neither level of DS nor surgical technique correlated with increased risk of ASD. <h3>CONCLUSIONS</h3> Progression of ASD requiring revision surgery is a risk after surgery for DS. The data demonstrates that there is no additional risk of ASD if adjacent levels are decompressed without fusion. This is the first study to our knowledge that shows equal efficacy of decompression without fusion of adjacent levels for the treatment of lumbar DS. The researchers will next compare radiographic and patient-reported outcome data between patients treated with decompression of adjacent segments only versus those treated with decompression and fusion of adjacent segments. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Correlation of Patient Reported Satisfaction With Adverse Events Following Elective Posterior Lumbar Fusion Surgery: A Single Institution Analysis

Structured BackgroundWith increasing emphasis on patient satisfaction metrics, such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, hospital reputations and reimbursements are being affected by their results. The purpose of the current study is to determine if post-operative self-reported patient satisfaction differed among patients who experienced any adverse event (AAE) following elective posterior lumbar fusion (PLF) surgery compared to those who did not.MethodsPatients who underwent elective PLF surgery performed at a single institution between February 2013 and May 2020 and returned an HCAHPS survey following discharge were included in the retrospective cohort analysis. Demographic, comorbidity, and HCAHPS survey data were compared between patients who did and did not experience any adverse event (AAE) in the 30-days postoperatively.ResultsOf 5,117 PLF patients, the HCAHPS survey was returned by 1,071 patients, of which 30-day AAE was experienced by 40 (3.73%). Of those that experienced AAE, the survey response rate was significantly lower (13.94% versus 21.35%, p=0.003). Those responding reported lower scores pertaining to if medication side-effects were adequately explained (22.22% versus 52.56%, p=0.002) and if post-discharge care was adequately explained (79.17% versus 93.76%, p=0.005), as well as overall top-box responses (67.62% versus 75.93% survey average, p<0.001).ConclusionsPatients experiencing AAE after elective PLF surgery are less likely to respond to surveys about their hospital experience. For those who did respond, they report less satisfaction with multiple aspects of their hospital care measured by the HCAHPS survey. Understanding how postoperative adverse events impact patients’ perception of healthcare quality provides insight into what patients value and has implications for optimizing their care.

Predictors of Early Mortality for Mechanically Ventilated Spontaneous Intracerebral Hemorrhage Patients.

IntroductionSpontaneous intracerebral hemorrhage (sICH) carries a high mortality burden. Limited data are available on early mortality (EM) and sICH. This study attempted to identify the independent predictors of EM and analyze the mortality characteristics for mechanically ventilated patients with sICHs at a tertiary care hospital over a period of five years.MethodsAn Institutional Review Board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPPA)-compliant retrospective analysis was performed on sICH patients admitted at the University of Mississippi Medical Center Neuroscience Intensive Care Unit between January 1, 2013, to December 31, 2017. Patients were divided into two cohorts: EM cohort (death within seven days of admission) versus survivor cohort (alive more than seven days after admission). Demographic, comorbidity, clinical, and radiographic data were collected for each patient. Outcomes were compared utilizing student t-test or Mann-Whitney U tests for continuous variables. Logistic regression analysis was performed to determine independent predictors of EM.ResultsA total of 204 mechanically ventilated patients with sICHs, with a mean age of 59.73 (SD ±14.30), mostly African American (137, 67%), were included in the study. The characteristics of the two cohorts were comparable except the EM cohort had a lower proportion of patients with hypertension and end-stage renal disease; lower median Glasgow Coma Score (GCS) on admission; lower proportion of surgical evacuation and external ventricular drain (EVD) placement; higher proportion of lobar hemorrhage, brainstem involvement, midline shift, hydrocephalus, intraventricular hemorrhage component, and right-sided intracerebral hemorrhage (ICH); higher median ICH score; and higher ICH volume compared to the survivor cohort.Overall, the mortality of mechanically ventilated sICH patients in this institution was 53% (N=109), with 47% (N=96) not surviving beyond seven days.Logistic regression analysis revealed that ICH volume and brainstem involvement increased the odds of EM, while a history of hypertension, surgical evacuation, and EVD placement decreased the odds of EM.ConclusionsThis study on mechanically ventilated sICH patients identified ICH volume and brainstem involvement as independent predictors of increased EM. History of hypertension, EVD placement, and surgical evacuation decreased its odds. Further studies should be conducted to explore potentially modifiable processes that can improve patient outcomes, most importantly EM, especially in this cohort of patients.

Machine learning prediction of postoperative unplanned 30-day hospital readmission in older adult.

Background: Although unplanned hospital readmission is an important indicator for monitoring the perioperative quality of hospital care, few published studies of hospital readmission have focused on surgical patient populations, especially in the elderly. We aimed to investigate if machine learning approaches can be used to predict postoperative unplanned 30-day hospital readmission in old surgical patients. Methods: We extracted demographic, comorbidity, laboratory, surgical, and medication data of elderly patients older than 65 who underwent surgeries under general anesthesia in West China Hospital, Sichuan University from July 2019 to February 2021. Different machine learning approaches were performed to evaluate whether unplanned 30-day hospital readmission can be predicted. Model performance was assessed using the following metrics: AUC, accuracy, precision, recall, and F1 score. Calibration of predictions was performed using Brier Score. A feature ablation analysis was performed, and the change in AUC with the removal of each feature was then assessed to determine feature importance. Results: A total of 10,535 unique surgeries and 10,358 unique surgical elderly patients were included. The overall 30-day unplanned readmission rate was 3.36%. The AUCs of the six machine learning algorithms predicting postoperative 30-day unplanned readmission ranged from 0.6865 to 0.8654. The RF + XGBoost algorithm overall performed the best with an AUC of 0.8654 (95% CI, 0.8484–0.8824), accuracy of 0.9868 (95% CI, 0.9834–0.9902), precision of 0.3960 (95% CI, 0.3854–0.4066), recall of 0.3184 (95% CI, 0.259–0.3778), and F1 score of 0.4909 (95% CI, 0.3907–0.5911). The Brier scores of the six machine learning algorithms predicting postoperative 30-day unplanned readmission ranged from 0.3721 to 0.0464, with RF + XGBoost showing the best calibration capability. The most five important features of RF + XGBoost were operation duration, white blood cell count, BMI, total bilirubin concentration, and blood glucose concentration. Conclusion: Machine learning algorithms can accurately predict postoperative unplanned 30-day readmission in elderly surgical patients.

Floppy eyelid syndrome and obstructive sleep apnea: a unique phenotype?

Floppy eyelid syndrome (FES) is an underdiagnosed condition stereotypically found in obese, middle-aged men, characterized by a lax eyelid tarsus which readily everts without excess mechanical manipulation. Obstructive sleep apnoea (OSA) is the most frequently reported comorbidity in patients suffering from FES. The aim of this study was to determine whether or not individuals with FES present with distinct anthropometric characteristics in comparison to patients without FES suspected of having OSA. A retrospective case-control study in which FES patients and controls all referred for investigation of suspected OSA, matched for sex, ethnicity, residential location, age (± 2years), date of sleep study (± 1month), and type of sleep study were compared for anthropometric, comorbidity, and sleep data differences. OSA prevalence and severity, assessed by apnoea-hypopnea index (AHI), revealed no significant differences between patients with FES (n = 39) and those without (n = 75), (85% vs 88%, p = 0.91 and 31.9 ± 28.7 vs 28.5 ± 16.6, p = 0.81 respectively), despite patients with FES being more obese (p = 0.02). Patients with FES had significantly lower Epworth sleepiness scale (ESS) scores after treatment with CPAP (5.3 ± 4.1 vs 9.4 ± 5.0, p = 0.028). Patients with FES exhibited increased prevalence of hernias (15% vs 4%, p = 0.032), dermatological (41% vs 17%, p = 0.006) and rheumatological (15% vs 3%, p = 0.012) comorbidities. FES patients appear to exhibit a distinct phenotype with increased prevalence of comorbidities related to matrix metalloproteinase dysfunction and significant improvement of daytime hypersomnolence with continuous positive airway pressure (CPAP) treatment.

Abnormal CD13/HLA-DR Expression Pattern on Myeloblasts Predicts Development of Myeloid Neoplasia in Patients With Clonal Cytopenia of Undetermined Significance.

ObjectivesPatients with clonal cytopenia of undetermined significance (CCUS) are at increased risk of developing myeloid neoplasia (MN). We evaluated whether a simple flow cytometry immunophenotyping (FCIP) assay could differentiate the risk of development of MN in patients with CCUS.MethodsBone marrow aspirates were assessed by FCIP panel in a cohort of 80 patients identified as having CCUS based on next-generation sequencing or cytogenetics from March 2015 to May 2020, with available samples. Flow cytometric assay included CD13/HLA-DR expression pattern on CD34-positive myeloblasts; CD13/CD16 pattern on maturing granulocytic precursors; and aberrant expression of CD2, CD7, or CD56 on CD34-positive myeloblasts. Relevant demographic, comorbidity, and clinical and laboratory data, including the type and extent of genetic abnormalities, were extracted from the electronic health record.ResultsIn total, 17 (21%) patients with CCUS developed MN over the follow-up period (median survival follow-up, 28 months [95% confidence interval, 19-31]). Flow cytometry immunophenotyping abnormalities, including the aberrant pattern of CD13/HLA-DR expression, as detected at the time of the diagnosis of CCUS, were significantly associated with risk of developing MN (hazard ratio, 2.97; P = .006). Additional FCIP parameters associated with the development of MN included abnormal expression of CD7 on myeloblasts and the presence vs absence of any FCIP abnormality.ConclusionsA simple FCIP approach that includes assessment of CD13/HLA-DR pattern on CD34-positive myeloblasts can be useful in identifying patients with CCUS at higher risk of developing MN.