Complications In Patients Research Articles

Inpatient care cost, duration, and acute complications associated with BMI in children and adults hospitalized for COVID-19.

ObjectiveThis study aimed to assess the association of BMI with inpatient care cost, duration, and acute complications among patients hospitalized for COVID‐19 at 273 US hospitals.MethodsChildren (aged 2–17 years) and adults (aged ≥18 years) hospitalized for COVID‐19 during March 2020–July 2021 and with measured BMI in a large electronic administrative health care database were included. Generalized linear models were used to assess the association of BMI categories with the cost and duration of inpatient care.ResultsAmong 108,986 adults and 409 children hospitalized for COVID‐19, obesity prevalence was 53.4% and 45.0%, respectively. Among adults, overweight and obesity were associated with higher cost of care, and obesity was associated with longer hospital stays. Children with severe obesity had higher cost of care but not significantly longer hospital stays, compared with those with healthy weight. Children with severe obesity were 3.7 times (95% CI: 1.4–9.5) as likely to have invasive mechanical ventilation and 62% more likely to have an acute complication (95% CI: 39%–90%), compared with children with healthy weight.ConclusionsThese findings show that patients with a high BMI experience significant health care burden during inpatient COVID‐19 care.

Impact of Heart Disease History on Safety of Telemedicine Cardiac Clearance Appointments.

The objective of this study was to compare complication, readmission, mortality, and cancellation rates between patients who had either an in-person or telemedicine preoperative cardiac clearance visit before spine surgery. A retrospective review was conducted on patients who underwent a spine procedure at a single tertiary academic center from February 1, 2020, to June 30, 2021. Cancellations, inpatient complications, 90-day readmissions, and inpatient and 90-day mortality rates were compared between in-person and telemedicine cardiac clearance visits. Secondary analysis included multiple logistic regression to determine independent predictors of case cancellations and complications. Alpha was set at P < 0.05. A total of 1,331 consecutive patients were included, with 775 patients (58.2%) having an in-person cardiac clearance visit and 556 (41.8%) having telemedicine clearance. Overall, the telemedicine cohort did not have more cancellations, complications, or readmissions. Regardless of the type of clearance, patients with a history of cardiac disease had more inpatient complications (15.8% versus 6.9%, P < 0.001) and higher 90-day mortality rates (2.3% versus 0.4%, P = 0.005). Subgroup analysis of patients with a history of cardiac disease showed that patients who had telemedicine visits had more cancellations (4.6% versus 10.9%, P = 0.036) and higher 90-day mortality rates (1.4% versus 4.4%, P = 0.045). On regression analysis, telemedicine visits were not independent predictors of preoperative cancellation rates (P = 0.173) but did predict greater preoperative cancellations among patients with cardiac history (odds ratio 2.73, P = 0.036). Patients with cardiac disease who undergo preoperative telemedicine visits have greater preoperative surgical cancellation rates and postoperative 90-day mortality rates. Although preoperative telemedicine visits may be appropriate for most patients, a history of cardiac disease should be a contraindication.

Pediatric traumatic renal artery thrombosis: A single institution experience

Traumatic renal artery thrombosis (RAT) is a rare injury that results in loss of ipsilateral renal perfusion. While described in adult populations, pediatric traumatic RAT has sparsely been investigated. We aimed to present 4 cases of pediatric traumatic RAT. All patients presented with unilateral RAT after blunt trauma with severe concurrent traumatic injuries. No patients received surgical or endovascular intervention or had any inpatient or outpatient complications related to RAT. One patient was discharged with anticoagulation (81mg aspirin) after initial presentation to an adult trauma center. Only one patient required anti-hypertensives in the setting of severe intracranial hemorrhage for 1 day in the ICU. Pediatric traumatic unilateral RAT in this cohort was not associated with hypertension or renal failure and did not require intervention, but more follow-up data is required to observe for longer term RAT-associated sequelae. • Pediatric traumatic renal artery thrombosis (RAT) is an uncommon traumatic injury. • RAT was unilateral and associated with severe concurrent traumatic injuries. • No patients developed complications from unilateral RAT. • No patients required interventions for RAT.

Assessment of Healthcare Delivery Systems in Orthopaedic Surgery: A Large Retrospective Cohort Evaluation.

The purpose of this study was to assess how quality and volume of common orthopaedic care varies across private, municipal, and federal healthcare delivery systems (HDSs). Hip and knee arthroplasty, knee and shoulder arthroscopy, and hip fracture repair were audited over a two-year period. Electronic medical records were reviewed for demographics, diagnosis, lengths of stay (LoSs), surgical wait times, inpatient complication, readmission, and revision surgery rates. Multivariate regression controlled for differences in age, sex, diagnosis, and Charlson Comorbidity Index to determine how HDS correlated with surgical wait time, length of stay, complication rates, readmission, and revision surgery. The 5,696 included patients comprise 87.4% private, 8.6% municipal, and 4.0% federal HDSs. Compared with private HDS for arthroplasty, federal surgical wait times were 18 days shorter (95% CI = 9 to 26 days, P < 0.001); federal LoS was 4 days longer (95% CI = 3.6 to 4.3 days, P < 0.001); municipal LoS was 1 day longer (95% CI = 0.8 to 1.4, P < 0.001); municipal 1-year revision surgery odds were increased (odds ratio [OR] = 2.8, 95% CI = 1.3 to 5.4, P = 0.045); and complication odds increased for municipal (OR = 12.2, 95% CI = 5.2 to 27.4, P < 0.001) and federal (OR = 12.0, 95% CI = 4.5 to 30.8, P < 0.001) HDSs. Compared with private HDS for arthroscopy, municipal wait times were 57 days longer (95% CI = 48 to 66 days, P < 0.001) and federal wait times were 34 days longer (95% CI = 21 to 47 days, P < 0.001). Compared with private HDS for fracture repair, municipal wait times were 0.6 days longer (95% CI = 0.2 to 1.0, P = 0.02); federal LoS was 7 days longer (95% CI = 3.6 to 9.4 days, P < 0.001); and municipal LoS was 4 days longer (95% CI = 2.4 to 4.8, P < 0.001). Only private HDS fracture repair patients received bone health consultations. The private HDS provided care for a markedly larger volume of patients seeking orthopaedic care. In addition, private HDS patients experienced reduced surgical wait times, LoSs, and complication odds for inpatient elective cases, with better referral patterns for nonsurgical orthopaedic care after hip fractures within the private HDS. These results may guide improvements for federal and municipal HDSs.

The Effects of COVID-19 on Geriatric Hip Fracture Management and 1-Year Mortality in Beijing.

ObjectivesConcerns about the coronavirus disease 2019 (COVID‐19) pandemic resulted in unprecedented challenges to the management of geriatric hip fractures. We aimed to evaluate the effects of the COVID‐19 surge on the time to surgery and 1 year mortality in geriatric patients with hip fracture at a large, urban Level 1 trauma center in Beijing, and to guide the management of geriatric hip fracture patients throughout the COVID‐19 pandemic.MethodsThis single‐center retrospective study included consecutive patients aged ≥65 years and injured 3 weeks prior to admission. Demographic and surgical data were collected between January 20 and May 31, 2020, and from the same period in 2019. Mortality data and functional status were collected at follow‐up of 1‐year after surgery. The primary outcomes were time to surgery and 1 year mortality.ResultsThere were no significant differences in sex, fracture type, and surgical pattern between the 2020 (n = 261) and 2019 time‐matched (n = 307) cohorts. The time from admission to surgery was significantly delayed in the 2020 cohort compared with that in the 2019 cohort (48.9 h vs 20.5 h, p < 0.001). Fewer patients underwent surgery within 48 h in the 2020 cohort (65.5% vs 87.6%, p < 0.001). Surgical delay was also associated with an increased risk of inpatient complications (30.2% vs 20.8%, p = 0.010), however there was no significant difference in the 1‐year mortality rate, nor between pre‐injury and 1 year follow‐up mobility as assessed by Parker score. Only approximately half of the patients in both groups completely returned to their pre‐injury mobility levels.ConclusionsThe COVID‐19 pandemic has significantly increased the surgery waiting time for geriatric patients with hip fractures, which resulted in increased inpatient complications without a higher mortality rate within 1 year. This reinforces the importance of maintaining timely and protocolized care for geriatric hip fractures throughout any subsequent waves of the pandemic.

Demographic predictors of treatment and complications for adult spinal deformity: An analysis of the national inpatient sample

PurposeTo examine the role of demographics on surgical management and inpatient complications in patients with spinal deformity between 2010 and 2014 via retrospective analysis. MethodsData were obtained from the National Inpatient Sample (NIS). International Classification of Diseases 9th revision codes were used to identify patients with a primary diagnosis of adult spinal deformity (ASD). Multivariable Poisson regression analyses were used to determine whether any individual demographic variables were predictive of surgical management, surgical complexity, postoperative complications and revision operations. Results17,433 patients were identified for analysis. Surgical intervention was performed for 94.5% of patients with a primary diagnosis of ASD. Patients at urban teaching hospitals were the most likely to receive surgery (OR= 2.13; 95% CI 1.51–2.95; p < 0.001) relative to rural patients. Female patients were the majority undergoing surgery and were more likely to receive a complication or require a revision when controlling for surgical complexity. Medicare patients were the least likely to undergo surgery and the most likely to receive complex fusion when undergoing an operation. Medicare patients were the least likely to experience complications (OR=0.89; 95% CI 0.80–0.98; p = 0.022) after adjusting for surgical complexity. With regards to race and ethnicity, Hispanics had a decreased likelihood of receiving a revision surgery. ConclusionThere were substantial differences in rates of surgical management, postoperative complications, and revisions among individuals of different demographics including sex, insurance status, ethnicity and hospital teaching status. Further research evaluating the effect of demographics in spine surgery is warranted to fully understand their influence on patient outcomes.

Length of Stay, Cost, and Outcomes related to Traumatic Subdural Hematoma in inpatient setting in the United States

ABSTRACT Objective In the US, the prevalence of traumatic subdural hematoma (TSDH) continues to increase. Using a nationally representative sample of discharge records of patients with TSDH, the study objectives were to estimate trend in number of TSDH cases, surgical management, inpatient cost, length of stay (LOS), mortality rate, and complication rate; and to identify the association of sociodemographic, clinical and hospital characteristics with complications and mortality. Method We identified patients with a primary diagnosis of TSDH from the National Inpatient Sample (NIS) database from 2010 to 2017. Quarterly and monthly trends were estimated using interrupted time series design. Multivariate logistic regressions measured association between various factors and inpatient death and complications. Results Number of cases, mean LOS, rate of complication increased. Proportion of patients undergoing surgery, mean inpatient cost, inpatient mortality decreased. Mean inpatient cost was $23,182.40 and LOS was 6.41 days. Odds of inpatient death and complications increased with injury severity score and comorbid conditions requiring use of anticoagulants. Odds of inpatient death were highest among those ≥85 years old and in south and northeast region. Conclusion Given the increase in prevalence of TSDH in USA, additional resources should be allocated toward improving patient outcomes and lowering healthcare costs.

42. Are telemedicine cardiac clearance visits safe prior to lumbar fusion?

BACKGROUND CONTEXTSince the start of the coronavirus (COVID-19) pandemic, telemedicine has increased in popularity to deliver health care via a remote setting. Preoperative spine surgery clearance visits are imperative for assessing and stratifying patients based on cardiac risk factors for potential invasive testing prior to surgery. However, it is unclear if moving these visits to a remote setting delivers the same quality of care as in person visits.PURPOSETo compare the rates of complications, readmissions, mortality, and cancellations for all patients who underwent spine procedures based on the setting of the preoperative cardiac clearance.STUDY DESIGN/SETTINGRetrospective cohort.PATIENT SAMPLEPatients >18 years-old who underwent any spine procedure performed by one of our fellowship-trained spine surgeons at a single tertiary academic center from January 1st, 2019 to June 30th, 2021.OUTCOME MEASURESComplications, readmissions, inpatient and 90-day mortality and cancellations.METHODSPatients were split into in-person or telemedicine cohorts based on their preoperative cardiac clearance visit. Patients were also split into cohorts based on their medical cardiac history. Cancellations, inpatient complications, 90-day readmission and inpatient and 90-day mortality were compared between the cohorts. Secondary analysis included multiple logistic regression to determine independent predictors of cancellations, 90-day readmission and 90-day mortality and multiple linear regression for inpatient complications.RESULTSA total of 1,963 patients were included with 1,407 patients having an in-person preoperative cardiac clearance visit and 556 having telemedicine clearance. The two cohorts had similar inpatient complications (0.6 vs 0.6, p=0.812), 90-day readmission (5.2% vs 4.9%, p=0.763), inpatient mortality (0.1% vs 0.2%, p=0.486), and 90-day mortality (0.6% vs 0.9%, p=0.370). The telemedicine cohort had more cancelled surgeries (4.5% vs 6.7%, p=0.048). Patients with a medical cardiac history had more inpatient complications (mean, 0.6 vs 0.8, p=0.011), and higher inpatient (0.0% vs 0.3%, p=0.039) and 90-day mortality (0.4% vs 1.3%, p=0.023). A subgroup analysis of patients with a medical cardiac history showed that patients who had a telemedicine visit had more cancellations (3.9% vs 10.3%, p=0.005) and higher 90-day mortality (0.8% vs 3.4%, p=0.024) than in-person visits. On regression, having a telemedicine visit was an independent predictor of preoperative cancellation (OR 1.57, p=0.039). Similarly, age (OR 1.02, p=0.042) and Elixhauser (OR 1.18, p=0.012) were associated with cancellation. A medical cardiac history (0.16, p=0.005), age (0.005, p=0.002), female sex (0.18, p <0.001), CCI (0.06, p=0.005), surgery in the thoracolumbar region (0.84, p <0.001), anterior approach (ref: posterior, 0.20, p=0.047), and combined approach (ref: posterior, 0.37, p <0.001) were independent predictors of increased inpatient complications while surgery in the cervical region was associated with decreased inpatient complications (ref: lumbar, -0.38, p <0.001). CCI was an independent predictor of 90-day mortality (OR 2.02, p <0.001).CONCLUSIONSPatients with a cardiac history who undergo telemedicine visits have increased cancellations and 90-day mortality. Telemedicine for preoperative cardiac clearance is safe for appropriately selected patients but carries increased risk of case cancellation and in-person visits should be strongly considered for patients with a history of heart disease.FDA DEVICE/DRUG STATUSThis abstract does not discuss or include any applicable devices or drugs.

671 The Effect of Supplementary Simulation-Based Procedural Training: The SIMULATE Randomised Controlled Clinical and Educational Trial

Abstract Aim To evaluate whether surgical trainees undergoing additional simulation, compared to conventional training, are able to achieve proficiency sooner with better patient outcomes. Methods This international, multicentre randomised controlled superiority trial recruited urology trainees (n=94) who had performed ≤10 ureterorenoscopy (URS) cases, as a selected index procedure, with no prior simulation experience. Recruits were randomised to simulation-based training or non-simulation-based training groups, the latter of which is the current standard of training. Training sessions were conducted for the simulation arm, utilising an expert-developed multi-modality training curriculum. The primary outcome was the number of procedures required to achieve proficiency, defined as achieving a score of ≥28 on an OSATS scale, on 3 consecutive operations, without complications. Inpatient surgical complications were also recorded. All participants were followed up for 25 procedures or over 18 months. Results A total of 1140 cases were performed by 65 participants where proficiency was achieved in 21 simulation and 18 conventional participants over a median of 8 and 9 procedures, respectively (HR: 1.41 [95% CI 0.72–2.75]). More participants reached proficiency in the simulation arm in flexible ureterorenoscopy, requiring fewer number of procedures (HR 0.89 [95% CI 0.39–2.02]). Significant differences were observed in overall comparison of OSATS scores between groups (mean difference 1.42 [95% CI 0.91–1.92]; p&amp;lt;0.001), with fewer total complications (15 vs 37; p=0.003) and ureteric injuries (3 vs 9; p&amp;lt;0.001) in the simulation group. Conclusions Simulation-based training demonstrated higher overall proficiency and fewer procedures were required to achieve proficiency in the complex form of the index procedure with surgical complications.

Comorbidities and complications of COVID-19 associated with disease severity, progression, and mortality in China with centralized isolation and hospitalization: A systematic review and meta-analysis.

BackgroundCoronavirus disease 2019 (COVID-19) causes life-threatening with the high-fatality rates and spreads with high-infectious disease worldwide. We aimed to systematically review the comorbidities and complications of COVID-19 that are associated with various disease severity, progression, and mortality in China, to provide contemporary and reliable estimates in settings with centralized isolation and hospitalization.MethodsIn this systematic review and meta-analysis, we searched four main English language databases, and four main Chinese language databases for observational studies published from inception to January 2022, to identify all the related comorbidities and complications of COVID-19, in the China region with centralized isolation and hospitalization, with disease severity, progression, and mortality. Literature search, data extraction, and quality assessment were independently conducted by two reviewers. We used the generalized linear mixed model to estimate pooled effect sizes for any comorbidities and complications, and subgroup in gender ratio was done to further address the potential heterogeneity.ResultsOverall, 187 studies describing 77,013 patients, namely, 54 different comorbidities and 46 various complications of COVID-19, were identified who met our inclusion criteria. The most prevalent comorbidities were hypertension [20.37% 95% CI (15.28–26.63), 19.29% (16.17–22.85), 34.72% (31.48–38.10), and 43.94% (38.94–49.06)] and diabetes [7.84% (5.78–10.54), 8.59% (7.25–10.16), 17.99% (16.29–19.84), and 22.68% (19.93–25.69)] in mild, moderate, severe, and critical cases. The most prevalent complications were liver injury [10.00% (1.39–46.72), 23.04% (14.20–35.13), and 43.48% (39.88–47.15)] in mild, moderate, and severe cases, and acute respiratory distress syndrome [ARDS; 94.17% (20.78–99.90)] and respiratory failure [90.69% (28.08–99.59)] in critical cases. Renal insufficiency [odds ratio (OR) 17.43 (6.69–45.43)] in comorbidities and respiratory failure [OR 105.12 (49.48–223.33)] in complications were strongly associated in severe/critical than in mild/moderate cases. The highest estimated risk in intensive care unit (ICU) admission, progression, and mortality was an autoimmune disease, nervous system disease, and stroke in comorbidities, shock, and ARDS in complications.ConclusionComorbidities and complications in inpatients with COVID-19 were positively associated with increased risk in severe and critical cases, ICU admission, exacerbation, and death during centralized isolation and hospitalization. Prompt identification of comorbidities and complications in inpatients with COVID-19 can enhance the prevention of disease progression and death and improve the precision of risk predictions.

Factors associated with inpatient complications among patients with obesity and COVID-19 at an urban safety-net hospital: A retrospective cohort study.

ObjectiveObesity increases morbidity and mortality from Coronavirus disease 2019 (COVID‐19). This study characterized inpatient complications among patients with obesity and COVID‐19—including myocardial infarction, renal failure requiring dialysis, stroke, secondary bacterial infection, and venous thromboembolism—and identified factors associated with developing at least one inpatient complication at a safety‐net hospital with a diverse cohort.MethodsA retrospective review was performed of all patients admitted for ≥3 days with COVID‐19 between 16 March 2020, and 8 April 2020. Logistic regression identified factors associated with developing at least one COVID‐19‐related complication among patients with obesity (body mass index ≥30 kg/m2).Results374 patients were included; 53.7% were classified as having obesity, 43.9% identified as Black, and 38.5% identified as Latino or Hispanic. Obesity was not associated with having at least one inpatient complication on multivariable analysis, but increased age (aOR 1.02, [95% CI 1.01–1.04], p = 0.010) and obstructive sleep apnea (aOR 2.25, [1.08–4.85], p = 0.034) were associated with this outcome.ConclusionsObesity was not associated with specified inpatient complications among patients with COVID‐19 admitted to a health system caring for diverse patients. Future studies should incorporate larger cohorts and reflect newer treatment protocols.

Infection after ureteroscopy for ureteric stones: analysis of 71 305 cases in the Hospital Episode Statistics database.

To investigate the burden of infectious complications following ureteroscopy (URS) for ureteric stones on a national level in England using data from the Hospital Episodes Statistics (HES) data warehouse. A retrospective cohort was identified and followed up in HES during the period April 2013 to March 2020 for all procedure codes relating to ureteroscopic stone treatment (M27.1, M27.2, M27.3). Treatment episodes relating to the first URS ('index ureteroscopy') for each patient were further analysed. All subsequent admissions within 30 days were also captured. The primary outcome was diagnosis of urinary tract infection (UTI; including all codes relating to a UTI/sepsis within the first 30 days of index URS). Secondary outcomes were critical care attendance, attendance at the accident and emergency department (A&E) within 30 days, and mortality. A total of 71 305 index ureteroscopies were eligible for analysis. The median age was 55 years, and 81% of procedures were elective and 45% were undertaken as day-cases. At the time of index URS, 16% of patients had diabetes, 0.5% had coexisting neurological disease and 40% had an existing stent/nephrostomy. Overall, 6.8% of the cohort (n = 4822) had a diagnosis of UTI within 30 days of index URS (3.9% immediately after surgery). A total of 339 patients (0.5%) required an unplanned stay in critical care during their index URS admission; 8833 patients (12%) attended A&E within 30 days. Overall mortality was 0.18% (60 in-hospital, 65 within 30 days); 40 deaths (0.056%) included infection as a contributing cause of death. We present the largest series evaluating infectious complications after ureteroscopic stone treatment. The procedure is safe, with low inpatient infective complication and critical care admission rates.

Plasmapheresis in hypertriglyceridemia-induced acute pancreatitis

The study involved hospitalizations with a diagnosis of hypertriglyceridemia-induced acute pancreatitis (HTGAP). This cohort was grouped into plasmapheresis and nonplasmapheresis groups using ICD-10 codes (6A550Z3 and 6A551Z3). Information was obtained on inpatient mortality, length of stay, total hospital charges, as well as the occurrence of comorbid systemic immune response syndrome, sepsis, septic shock, acute respiratory failure, acute respiratory distress syndrome, kidney failure, hypocalcemia, and need for transfusion of blood products. The study identified independent predictors of plasmapheresis. The plasmapheresis group had a higher proportion of patients with diabetes mellitus and obesity. Inpatient mortality was higher in the plasmapheresis group (0.86% vs 0.57%), and plasmapheresis was also associated with longer length of stay and higher total hospital charges. Overall, plasmapheresis was associated with higher proportions of inpatient complications. Patients with HTGAP had higher odds of undergoing plasmapheresis if they were in an urban location (adjusted odds ratio [aOR] 6.14, 95% confidence Interval [CI] 1.86–20.28, P = 0.003), larger hospital (aOR 3.37, 95% CI 2.14–5.29, P < 0.001), and teaching hospital (aOR 2.01, 95% CI 1.39–2.92, P < 0.001). Black patients were less likely to undergo plasmapheresis than white patients (aOR 0.42, 95% CI 0.23–0.78, P = 0.006). Patients with HTGAP who receive plasmapheresis may be at higher risk of numerous in-hospital complications, including death, compared to those who do not receive plasmapheresis. Black and older patients were less likely to undergo plasmapheresis.

TU4.10 Short term outcomes of patients undergoing transanal total mesorectal excision versus robotic low anterior resection

Abstract Introduction Robotic Low anterior resection has a potential benefit because of its technical difficulty to access the narrow pelvic cavity. The aim of the study was to compare short-term outcomes of patients who underwent TaTME versus Robotic TME for low rectal cancers. Methods Retrospective analysis of cases from a single institution was undertaken. Data including demographics, operative details, inpatient complications, and clinical outcomes were collected from patients' notes. Comparative analysis between the two groups was performed using non-parametric statistical tests. Results The total sample size was 35 patients who underwent low anterior resection at a single center. Of the 17 patients who had Laparoscopic Transanal Total mesorectal excision (LLAR), (15 LLAR + 2 RLAR converted to LLAR), and Robotic Low anterior resection (RLAR) was performed in 18 patients. Mean age in both groups was comparable (66.5±9.93). There was no significant difference in patient demographics in both groups including Gender (Males 88.2% vs 61.1%), ASA grade, BMI (29.4), and WHO status. There was a statistically significant difference in tumor height from anal verge between both groups, mean LLAR 13.78cm, RLAR 7.5cm (p-value 0.04). There was no difference in circumferential resection margins (p-value 0.366) and number of lymph nodes harvested (mean LLAR 17 vs RLAR 20). Post-operative margins (R0) were positive in 3/17 patients in LLAR group and 1/18 patients in RLAR group (p-value 0.261). There was no difference in post-operative calvin-dindo complication rate and hospital readmission rate. Conclusion There was no significant difference identified in clinical and short term oncological outcomes between the two groups

Complications and predictors of morbidity for hip fracture surgery in patients with chronic liver disease.

Despite the fact that patients with chronic liver disease (CLD) are at increased risk of complications after a fracture of the hip, there remains little information about the risk factors for acute postoperative complications and their overall outcome.The aim of this study was to describe inpatient postoperative complications and identify predictors of postoperative morbidity. Patients with CLD who had been treated for a fracture of the hip between April 2005 and August 2019 were identified from a retrospective search of an intramural trauma registry based in the Northeastern United States. Medical records were reviewed for baseline demographics, preoperative laboratory investigations, and outcomes. The trauma registry contained 110 patients with CLD who had undergone surgery for a fracture of the hip. Of these, patients with a platelet-count of ⩽100,000/µL were 3.81 (95% CI, 1.59-9.12) times more likely to receive a transfusion than those with a platelet-count of >100,000/µL. Those with a Model for End-stage Liver Disease (MELD) score of >9 were 5.54 (2.33-13.16) times more likely to receive a transfusion and 3.97 (1.06-14.81) times more likely to develop postoperative delirium than those with a MELD score of ⩽9.Of patients without chronic kidney disease, those with a creatinine of ⩾1.2 mg/dL were 6.80 (1.79-25.87) times more likely to develop acute renal failure (ARF) than those with a creatinine of <1.2 mg/dL. In a multivariable model, as MELD score was increased, the odds of developing a composite postoperative complication, which included transfusion, ARF, delirium, or deep wound infection, were 1.29 (1.01-1.66). Other tools used to assess surgical risks, Charlson Comorbidity Index, Elixhauser, and American Society of Anesthesiologist scores, were not predictive. Patients with CLD who undergo surgery for a hip fracture have a high rate of postoperative complications which can be predicted by the preoperative laboratory investigations identified in this study and MELD scores, but not by other common comorbidity indices.

Transcatheter and Surgical Aortic Valve Replacement in Patients With Bicuspid Aortic Valve Stenosis

BackgroundTranscatheter aortic valve replacement (TAVR) is not widely used in patients with bicuspid aortic valve (BAV) disease and has not yet been studied in randomized clinical trials. We characterized the rate of use and outcomes of TAVR and surgical aortic valve replacement (SAVR) in patients with BAV. MethodsAdults with BAV stenosis receiving SAVR or TAVR procedures were abstracted from the 2012 to 2019 Nationwide Readmissions Database (NRD). Risk-adjusted analyses were performed with NRD-provided weights and inverse probability of treatment weights (IPTW) to examine the association of treatment strategy on inpatient mortality, complications, and hospitalization resource utilization. Nonelective readmissions within 90 days of discharge and reintervention at the first readmission were also examined. ResultsOf an estimated 56 331 patients with BAV requiring aortic valve replacement, 6.8% underwent TAVR. Unadjusted analysis demonstrated higher index hospitalization mortality for TAVR compared with SAVR. Upon risk adjustment using NRD-provided weights, the odds of pacemaker implantation remained significantly higher for TAVR patients compared with SAVR, with no significant difference in mortality. When NRD-provided survey weights were applied, TAVR had higher rates of 90-day readmission. Adjustment with inverse probability of treatment weights resolved these differences between the 2 groups. Regardless of the risk-adjustment method, the odds of reintervention were consistently higher among BAV TAVR patients compared with SAVR. ConclusionsThe present analysis demonstrates comparable in-hospital mortality and morbidity for TAVR and SAVR patients in the moderate-risk era. With increasing TAVR use in BAV, surgeons must further refine selection criteria with consideration of concomitant aortopathy and implications of reintervention.

Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study.

Background: Some research indicated that hypothyroidism has huge adverse effects for the metabolic, cardiovascular, respiratory, and immune systems. However, there is no confirmed conclusion for the effect of cardiovascular surgery. This cohort study aims to investigate the prognosis of hypothyroidism patient at the age under 65-year-old after coronary artery bypass grafting (CABG) surgery. Method: From the National Health Insurance Research Database of Taiwan, 1586 patients with hypothyroidism who underwent elective CABG surgery were selected, along with 6334 patients who underwent surgery in a ratio of 1:4 sex-, age- and index year-matched controls, who were out of hypothyroidism. We used Cox proportional hazard analysis to compare the rate of 30-day, 5-year mortality, post-operative atrial fibrillation, respiratory complication during an average of 10-year follow-up. Result: Post-CABG patients had more hospital days, which was associated with hypothyroidism, male, DM and higher CCI_R (p < 0.001). Post-CABG patients had more inpatient respiratory complications, which was associated with hypothyroidism (p = 0.041), DM and CCI_R (p < 0.001, p = 0.046), and there was no difference in 1-year respiratory complication, tracheostomy in the same hospital course and within 1 year, repeated PCI, Af, CVVH, cerebral infarction, 30-day and 5-year mortality rate. Conclusions: Hypothyroidism correlates to post-CABG ventilator-related complications and pneumonia, and prolonged hospital days, but no effect on 30-day, 5-year mortality, post-operative atrial fibrillation and cerebral infarction rate. Thyroid function survey might include routinely preoperative survey for CABG outcome prognosis.

Complications During the Hospital Stay, Length of Stay, and Cost of Care in Parkinson Patients Undergoing Total Knee Arthroplasty: A Propensity Matched Database Study.

Background:Patients with Parkinson disease (PD) undergoing total knee arthroplasty (TKA) can present with a unique subset of challenges during their hospital stay. The literature is limited to single-center studies with a small number of patients. This study was aimed to analyze the inpatient complications, length of stay (LOS), and cost of care (COC) associated after TKA with PD over 4 years (2016 to 2019).Methods:In this retrospective cohort study, we used National Inpatient Sample (NIS) database data from 2016 to 2019 and compared in-hospital complications, LOS, and COC among patients undergoing TKA with and without PD.Results:The National Inpatient Sample database is used to identify 558,371 patients (555,289 without PD and 3,082 with PD) who underwent TKA. After propensity-matching, there was an increased incidence of blood loss anemia (PD group 22.3%, control group 13.5%, P ≤ 0.01), periprosthetic dislocations (1.5% in PD group, 0.4% in control group, P < 0.001), and periprosthetic mechanical complications including but not limited to periprosthetic fractures, knee dislocations, patellar maltracking, and subluxations (1.1% in PD group, 0.6% in control group, P = 0.024) in the PD group. The other in-hospital complications including mortality, acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, deep vein thrombosis, periprosthetic fracture, and wound dehiscence showed no notable differences. The average total incurred charges for the PD group were higher, with a mean of $67,581.58 (SD $44,554.64), than that in the control group, with a mean of $64,795.51 (SD $45,841.25) (P < 0.001). The average LOS was higher in the PD group with a mean of 2.7 days (SD = 1.93) compared with the control group (mean = 2.3, SD = 1.73 days, P < 0.001).Conclusions:An increased incidence of complications such as acute blood loss anemia, periprosthetic mechanical complications, and increased COC, but no difference in LOS was noted in patients undergoing TKA with PD. This information can be useful to make an informed decision regarding patient care and preferred healthcare setup for TKA in patients with PD.

A095 Can Bariatric Surgery Reduce Odds of Inpatient Complications after Hysterectomy? Analysis From a National Database, 2016-2018

A095 Can Bariatric Surgery Reduce Odds of Inpatient Complications after Hysterectomy? Analysis From a National Database, 2016-2018

The Impact of Frailty on Adverse Outcomes in Geriatric Hip Fracture Patients: A Systematic Review and Meta-Analysis.

ObjectiveWith an aging population and advances in medicine, more research focuses on health and longevity in geriatric adults. Recently, frailty has gradually emerged to assess physical conditions. Frailty can be generally described as a multi-dimensional situation of increased vulnerabilities to both endogenous and exogenous stressors. The objective of the review was to evaluate the predictive value of frailty on adverse outcomes in geriatric hip fracture patients.Materials and MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane library for relevant literature about the connection between frailty and poor outcomes in hip fracture elders.ResultsEleven studies involving a total of 45,979 participants were selected in our study. Our results indicated that frailty could significantly predict postoperative and in-patient complications (OR, 1.46; 95% CI, 1.13–1.90; I2 = 77.4%). Frail elders had higher risk of inpatient mortality (OR, 1.68; 95% CI, 1.26–2.25; I2 = 0.0%), 6-month mortality (OR, 1.46; 95% CI, 1.25–1.72; I2 = 0.0%) and ≥1-year mortality (OR, 2.24; 95% CI, 1.66–3.04; I2 = 91.3%). Furthermore, the risk of prolonged hospital stays was 1.15 times more likely in frail patients (95% CI, 1.03–1.28; I2 = 14.8%).ConclusionFrailty can predict adverse outcomes effectively in geriatric hip fracture patients.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails.