Database Study Research Articles

The epidemiology of spinal fractures: A nationwide data-based study in Iran.

Blunt trauma is a physical injury to a part of the body, mainly caused by road accidents, direct blows, attacks, sports injuries, and falls in elderly people. Spinal fractures are observed only in a small percentage of injured patients. Accordingly, the present study was conducted on collected data between 2018 and 2022 to determine the frequency of spinal fractures in blunt trauma in Iran while also considering the mechanism of injury as a secondary outcome of interest. In this retrospective study, blunt trauma patients with spinal fractures, regardless of age were included by the census sampling method. Data were obtained from the National Trauma Registry of Iran. Means and standard deviations were used for continuous variables, and the chi-square test was used to assess the relationship between the variables. Among 25,986 cases of all-cause trauma patients, 1,167 cases (4.5%) of blunt trauma and spinal fracture were included in the study. Gender, the severity of injury, and the cause of trauma showed a significant difference among different age groups (p < 0.05). Significant differences were found in the injury mechanisms across various spine regions (p < 0.05). The majority of patients (68.2%) had lumbar spinal fractures. Road traffic collisions were the most common cause of spinal cord injuries, accounting for 58.3% of cases, followed by falls (36.1%). The injury severity score was higher in younger patients (under 18 years old), with a mean of 4.4 ± 3.5, and in patients with cervical injuries. The majority of injuries occurred in the lumbar area (68.2%), followed by the thoracic area. Furthermore, notable variations existed in Emergency Room (ER) stay duration, overall hospitalization, Intensive Care Unit (ICU) stay duration, and injury severity levels, all influenced by the spinal regions (p < 0.05). Distinctively, ICU stay durations and ER stay duration showed significant differences, particularly in relation to injuries in the lumbar and thoracic regions (p < 0.05). According to the results of the present study, trauma is more severe, and cervical injuries are more common in young people, which is a critical finding that underscores the need for targeted interventions to mitigate the severity of trauma in this age group. Additionally, the majority of cervical injuries occurred in young people, which is a particularly concerning finding given the potential for long-term disability and impact on quality of life. Our findings suggest that strategies to reduce cervical injuries, such as speed control, seat belt use, and phone-free driving, are crucial interventions for mitigating the severity of trauma and promoting patient outcomes in young people.

6374 Prevalence and risk factor of complications in patients with adult growth hormone deficiency: A retrospective database study

Abstract Disclosure: H. Fukuoka: None. S. Fujio: None. T. Endo: Employee; Self; Novo Nordisk. Stock Owner; Self; Novo Nordisk. S. Tsuboi: Employee; Self; Novo Nordisk. Stock Owner; Self; Novo Nordisk. Though adult growth hormone deficiency (AGHD) is known to lead to increased prevalence of complications, large database studies on AGHD have not been conducted. We investigated the clinical characteristics and prevalence of AGHD-related complications in Japanese patients. We identified 8,809 GH-untreated patients with AGHD from Medical Data Vision claims database between April 2008 and September 2022. In 2020, 3,420 AGHD patients were identified, and their prevalence of complications adjusted for sex and age was higher than that of Japanese general population, 9.3% vs 3.6% for diabetes mellitus (DM), 4.8% vs 1.3% for osteoporosis, and especially 22.0% vs 3.9% for dyslipidemia. We explored the risk factors for the onset of complications using Cox proportional hazard model. Age was significant risk factor for most complications and being female was significant risk factor for osteoporosis. DM was a significant risk factor for dyslipidemia, ischemic heart disease, cerebrovascular disease, and all cause death. AGHD increases the overall risk of metabolic complications, risk factors of these complications were similar to those in general population. Comprehensive treatment approach needs to be considered to alleviate the risk of complications. Presentation: 6/3/2024

Impact of Antibiotic Choice at the Time of Sacral Neuromodulation Implantation on Rates of Surgical Site Infection.

To evaluate the efficacy of specific antibiotic regimens in preventing infection following sacral neuromodulation. This is a retrospective cohort study utilizing the Premier Healthcare Database. Patients who underwent sacral neuromodulation placement between January 2016 and March 2020. The patients were grouped by those who received dual antibiotic therapy per 2019 AUA guidelines (Gram positive + broad Gram negative coverage), first- or second-generation cephalosporins or any other regimen. Comparison between groups was performed using Kruskal-Wallis and χ2 tests for continuous and categorical variables, respectively. Inverse probability of treatment weighted (IPTW) analysis was used to estimate the average treatment effect of AUA guidelines regimens versus the use the first- or second-generation cephalosporins alone. The sample included 14 179 patients, with 2211 patients receiving prophylaxis that followed the AUA guideline recommendations. There was no significant difference in surgical site infection rates within 3 months (p = 0.28) or within 12 months (p = 0.53) between the groups. On IPTW, the probability of an infection at 3 months was lower with the AUA guideline regimens compared to those who received first- or second-generation cephalosporins alone, but this difference was not statistically significant (OR = 0.73, 95% CI: [0.43, 1.24]). In the absence of allergies to cephalosporins or penicillin, first- or second-generation cephalosporins alone may be a sufficient preoperative antibiotic regimen for prevention of infection at the time of sacral neuromodulation. Not applicable due to being a database study.

Social determinants of health and their associations with outcomes in pediatric out-of-hospital cardiac arrest: A national study of the NEMSIS database

BackgroundSocial determinants of health (SDOH) impact health disparities, though little is known about the effects of SDOH on pediatric out-of-hospital cardiac arrest (POHCA). MethodsThis cross-sectional study utilized the NEMSIS Database to obtain nationwide POHCA data from 2021 to 2023. Outcomes included performance of bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) usage, and obtainment of return of spontaneous circulation (ROSC). SDOH data was obtained from the US Census Bureau and included minority race/ethnicities status, poverty levels, and educational attainment of the community where POCHAs occurred. Multivariable logistic regression and Cochran-Armitage trend tests were used to assess associations between SDOH and POHCA outcomes. ResultsQuery of the NEMSIS Database yielded 27,137 POHCAs. The odds of CPR performance and obtainment of ROSC were significantly higher (p < 0.001) in communities with lower levels of minority races/ethnicities. The odds of bystander CPR, AED usage, and obtainment of ROSC all increased significantly (p < 0.001) in the wealthiest communities compared to the poorest communities. The odds of bystander AED usage (p = 0.001) and ROSC (p = 0.003) were significantly higher in communities with the highest educational attainment. As the minority status and poverty level of the community increased and educational attainment decreased, there was a significant decreasing trend (p < 0.001) in performance of bystander CPR, AED usage, and obtainment of ROSC. ConclusionsCommunity-level SDOH, including increasing community minority status, poverty levels, and decreasing educational attainment, are associated with less bystander CPR, AED usage, and ROSC obtainment in POHCAs. Understanding SDOH offers opportunities for public health interventions addressing disparities in POHCA outcomes.

"Projekt TyreRoadNoise" -- Data-based study of effects on controlled and real drive noise emission

Road traffic noise affects the quality of life of many citizens. In particular, the noise emitted by electric vehicles is mainly caused by tyre-road contact. There are many conflicts of interest between the performance characteristics of tyres and road surfaces. Therefore, more accurate prediction models are needed to exploit the potential for reducing tyre-road noise emissions during development. To this end, the TyreRoadNoise project team is developing a physics- and data-based tyre-road noise prediction model over a three-year period. A multi-manufacturer fleet of vehicles will collect extensive data on tyre-road noise emissions and their influencing parameters using simple measurement methods. AI methods will be used to estimate relevant parameters and correlations, which will be validated by measurements in controlled environments. The model should make it possible to extrapolate emissions on other routes from appropriate measurements on a specific road and to derive mitigation measures. Data and models will be made publicly available for future use. This article identifies the research needs, gives a brief overview of the project and describes the tyre-road noise measurement techniques used. Interested parties are invited to discuss and participate in the project.

Undiagnosed Periprosthetic Infections in First-Time Aseptic Revision Hip Arthroplasties.

Background: Unexpected infections diagnosed after intraoperative cultures in aseptic revision hip arthroplasties are infrequent, but the features and outcomes of culture-positive cases are still poorly understood. A single-center retrospective study was conducted to assess the following: (1) the incidence, (2) the profile of the cases, and (3) the outcomes of the revision hips performed for presumed aseptic reasons that became septic after intraoperative cultures. Methods: Instances of first-time aseptic revision hips (a retrospective cohort study) in the hospital database were reviewed. The revisions with the isolation of two phenotypically identical microorganisms in the intraoperative cultures were selected. The profile (bacteria, pre-operative markers) and the outcomes of the revisions (survival rates, complications, reasons for re-revision) were assessed. Results: Out of 424 cases of presumed aseptic revision hip arthroplasty, 19 patients (4.48%) were classified as septic. Staphylococcus epidermidis (9, 47.37%) was the most frequent microorganism. In three patients (15.8%), C-reactive protein and erythrocyte sedimentation rate values were higher, and in only one case (5.26%), C-reactive protein values and the white blood cell count were elevated. An antibiotic therapy was administered in every case. At a mean follow-up of 3.72 ± 2.18 years, three patients (15.79%) experienced complications (dislocation, pain without loosening, chronic suppressive antibiotic therapy) and two patients (10.53%) required re-revision for septic relapse (same microorganisms). The survival rate of the cohort was 89.47% (95% CI: 64.08-97.26) at 2 and 4 years. Conclusions: Missed periprosthetic infections rarely occurred in presumed aseptic revision hips. However, the outcomes are fair, and septic relapses are not uncommon.

Economic burden and economic impact associated with non-communicable diseases among countries of the World Health Organization South-East Asia Region: a systematic review protocol.

The objective of this systematic review is to synthesize studies on the economic burden and economic impact of non-communicable diseases in the World Health Organization South-East Asia Region (WHO SEAR) countries. WHO SEAR countries represent 8.6% of the world's population, and 75% of all deaths in this region are attributable to non-communicable diseases. In addition, there is a pattern of low government spending on health in SEAR countries, leading to a high proportion of health financing by patients, risking impoverishment for households. We will consider observational (cross-sectional, cohort, and case-control) and interventional (either single arm or comparative) studies that report the economic burden (direct and indirect costs, out-of-pocket expenditure) and economic impact (catastrophic health expenditure, hardship financing, impoverishment, and gross domestic product impact) at the individual, household, and/or country levels. This includes government surveys, surveillance, and secondary data analyses for one or more non-communicable diseases prevalent in the WHO SEAR. We will conduct a comprehensive search for relevant studies in databases, including MEDLINE (PubMed), Embase (Ovid), Scopus, Web of Science, Google Scholar, and gray literature, with no date limits. Two reviewers will independently screen titles and abstracts, followed by full-text screening. Included studies will be critically appraised for quality. Data will be extracted accordingly and, if possible, random effects meta-analyses will be conducted on the pooled data for resource utilization and costs (including burden and impact), presenting the degree of variation between studies. The characteristics and results of the included studies will be narratively summarized with accompanying tables. PROSPERO CRD42023421302.

Quantifying corticosteroid burden in chronic rhinosinusitis with nasal polyps: A retrospective US database study

BackgroundReal-world burden data on systemic corticosteroid (SCS) use in chronic rhinosinusitis with nasal polyps (CRSwNP) are limited. ObjectiveThis study's objective was to describe the real-world burden of SCS in CRSwNP. MethodsThis retrospective cohort study included commercial/Medicare Advantage with Part D health plan members from the Optum Research Database with a first medical claim (index) for CRSwNP (January 2015 to July 2020). Primary outcomes/variables included SCS use, healthcare resource utilization (HCRU) and costs during the 12-month follow-up period. Outcomes were analyzed overall (N=21,172) and stratified by baseline comorbid asthma status and sinus surgeries during follow-up. ResultsOverall, 64.7% and 41.0% of patients used all-cause and CRSwNP-related SCS respectively, and 36.0% had ≥1 oral corticosteroid (OCS) burst (≥20 mg for 3–28 days); SCS use was higher in patients with asthma and those with a NP-related surgery (1, 2, ≥3) versus without. The mean (SD) all-cause cumulative OCS dose was 303.3 (675.0) mg/year and 23.5% had a cumulative annual dose ≥400 mg; these values were higher (p<0.001) in patients with versus without comorbid asthma (514.9 [956.1] vs. 247.5 [567.0]; 36.9% vs. 19.9%). All-cause and CRSwNP HCRU and costs increased with increasing number of surgeries; mean (SD) all-cause total medical costs were $14,472 (38,915), $26,909 (40,800), $29,816 (41,677), and $31,558 (37,143) with 0, 1, 2, and ≥3 surgeries, respectively. ConclusionThese data highlight the significant burden of SCS use in CRSwNP, particularly in patients with comorbid asthma and suggest a need to reduce SCS exposure.

Monitoring Pregnancies Exposed to Galcanezumab for Migraine in a United States Administrative Claims Database.

Galcanezumab is a calcitonin gene-related peptide monoclonal antibody indicated for migraine prevention in adults. Due to the long half-life of galcanezumab and the prevalence of migraine in women of childbearing age, galcanezumab exposure may occur during pregnancy. However, real-world use and safety of galcanezumab during pregnancy has not been fully described. To help fill this gap, galcanezumab has two ongoing pregnancy safety studies, one of which is an insurance claims database study. This database study is actively identifying and following pregnancies exposed to galcanezumab using commercial claims from the Healthcare Integrated Research Database (HIRD). Patient accrual is planned from September 2018 to June 2026, with a final study report planned for December 2027. This study requires 430 galcanezumab-exposed pregnancies with linked infants to reach power for comparative analysis of major congenital malformations. Recent monitoring of patient accrual, including data from 28 September 2018 to 31 January 2023, identified 207 galcanezumab-exposed pregnancies in women with migraine in the HIRD, of which 110 were live births and 73 of which were linked to an infant. This represents an annual accrual rate of approximately 17 pregnancies linked to infants, which is substantially lower than the 55 required annually to reach target size within current regulatory-committed study timelines. The accrual of a sufficient number of galcanezumab-exposed pregnancies represents a substantial, but not uncommon, barrier to conducting comparative analyses in pregnancy studies. Potential solutions that would allow for timely dissemination of important safety information to patients and providers may be available.

The impact of age on the efficacy of radiotherapy in pleural mesothelioma patients receiving trimodality therapy: a population-based study of the SEER database

The impact of age on the efficacy of radiotherapy in pleural mesothelioma patients receiving trimodality therapy: a population-based study of the SEER database

Research Study Characteristics Associated with Media Engagement in Hip and Knee Arthroplasty Database Studies

Objectives: This study identified associations between a study’s Altmetric Attention Score (AAS) and the number of times it was posted on X (formerly Twitter) with article characteristics such as the topic or publishing journal. Design: Retrospective study. Setting: Articles published in the orthopedic literature. Article Selection: A total of 116 eligible articles using administrative databases or clinical registries published in 2020 in four orthopaedic journals were studied. Intervention: None. Main Outcome Measurements: Each of the 116 selected articles was assigned one of the following topics: complications and outcomes, technology, medications and/or anesthesia, logistics, and surgical techniques. AAS and X posts for each article were retrieved. Kruskal-Wallis tests were used to identify differences in the AAS and X posts across journals and topics. Results: Kruskal-Wallis tests revealed a difference between an article’s publishing journal and its AAS (p = 0.034) and number of X posts (p = 0.032), with articles published in the Bone &amp; Joint Journal (BJJ) having the greatest mean AAS (16.27) and X posts (25.73). Kruskal-Wallis tests showed a difference between an article’s topic and its AAS (p = 0.001) and number of X posts (p= 0.027), with articles focused on surgical techniques having the greatest mean AAS (26.50) and X posts (37.00). Conclusions: There is significant variation in the degree of media engagement for hip and knee arthroplasty database studies. The topic of the article (surgical techniques) and journal of publication (BJJ) were associated with a greater level of engagement. Level of Evidence: Level V.

S1197 Early Real-World Patient Characteristics and Treatment Patterns in Upadacitinib-Treated Patients With Ulcerative Colitis: A U.S. Claims Database Study

S1197 Early Real-World Patient Characteristics and Treatment Patterns in Upadacitinib-Treated Patients With Ulcerative Colitis: A U.S. Claims Database Study

S411 Impact of Racial Disparities and Socioeconomic Factors on Tumor Stage at Diagnosis in Early-Onset Colorectal Cancer: A SEER Database Study

S411 Impact of Racial Disparities and Socioeconomic Factors on Tumor Stage at Diagnosis in Early-Onset Colorectal Cancer: A SEER Database Study

Letter to the Editor Regarding “Incidence and Risk Factors of Delirium Following Brain Tumor Resection: A Retrospective National Inpatient Sample Database Study”

Letter to the Editor Regarding “Incidence and Risk Factors of Delirium Following Brain Tumor Resection: A Retrospective National Inpatient Sample Database Study”

S1420 Real World Characteristics and Treatment Patterns of Patients With Crohn’s Disease (CD) Treated With Risankizumab: A US Claims Database Study

S1420 Real World Characteristics and Treatment Patterns of Patients With Crohn’s Disease (CD) Treated With Risankizumab: A US Claims Database Study

Stereotactic radiosurgery practice patterns for treatment of brain metastases: A large national cancer database study.

123 Background: Brain metastases (BM) portend high mortality rates. While whole brain radiation therapy (WBRT) is a commonly used treatment strategy for BM, stereotactic radiosurgery (SRS) has less neurocognitive toxicity with comparable survival. The objective of this study was to compare treatment practice patterns for SRS vs WBRT using a large national hospital database. Methods: The National Cancer Database (NCDB) was queried for patients ≥18 years treated with radiotherapy (RT) for a BM diagnosis between 2004-2020 and with known follow-up. Twelve cancers were included based on highest prevalence: breast, colorectal, kidney/bladder, liver, lung, lymphoma, melanoma, oral cavity, pancreas, prostate, and thyroid. Patients were grouped by first course RT modality (SRS vs WBRT) confirmed by fraction number (SRS: 1-5; WBRT: 5-15). Multivariable logistic regression assessed predictors of SRS as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Analyses were adjusted for patient and cancer characteristics. Results: Of 112,232 patients with BM, 30,805 (27%) received SRS. Median age was 64 years. Most patients were White (84%), diagnosed in 2012-2020 (64%), with a higher income (56%), more education (55%), and Medicare/Medicaid (60%). The most common cancer treated with RT for BM was lung (85%). Patients were less likely to be treated with SRS if they were Korean (aOR=0.68; 95%CI=0.47-0.95), lower income (aOR=0.88; 95%CI=0.84-0.91), lower education (aOR=0.88; 95%CI=0.85-0.91), with Medicare/Medicaid (aOR=0.86; 95%CI=0.83-0.89) or no insurance (aOR=0.48; 95%CI=0.44-0.53), at a Midwest hospital (aOR=0.79; 95%CI=0.76-0.83; vs Northeast), and at a community (aOR=0.31; 95%CI=0.28-0.33; vs academic) or comprehensive community cancer program (aOR=0.56; 95%CI=0.54-0.58). Patients were more likely to be treated with SRS if they were Asian Indian or Pakistani (aOR=1.41; 95%CI =1.08-1.85), older (aOR=1.01; 95%CI=1.01-1.01), diagnosed in 2012-2020 (aOR=3.92; 95%CI=3.78-4.07; vs 2004-2011), lived farther from the hospital (aOR=1.00; 95%CI=1.00-1.00), and received chemotherapy (aOR=1.17; 95%CI=1.13-1.21). Conclusions: In one of the largest BM studies with over 110,000 US patients, disparities in SRS treatment patterns were identified. On adjusted analysis, SRS was less likely to be used for patients who were lower income, lower educational attainment, without private insurance, and treated at community centers. The data highlight populations with cancer and BM who may benefit from increased access to SRS.

TCT-328 Race, Percutaneous Coronary Interventions Outcomes for ST-Elevated Myocardial Infarction, and Chronic Kidney Disease: A Propensity Matched National Database Study

TCT-328 Race, Percutaneous Coronary Interventions Outcomes for ST-Elevated Myocardial Infarction, and Chronic Kidney Disease: A Propensity Matched National Database Study

S969 Comparative Analysis of Patients With Upper GI Bleed Undergoing Early versus Late Endoscopy: A National Readmission Database Study

S969 Comparative Analysis of Patients With Upper GI Bleed Undergoing Early versus Late Endoscopy: A National Readmission Database Study

Survival Difference of Colorectal Adenocarcinoma Among Racial and Ethnic Minority Groups: A SEER Database Study.

Despite advances in diagnosis and treatment, racial disparities continue to exist in colorectal cancer (CRC) survival. This study aims to characterize the CRC survival differences among racial and ethnic minority groups. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify adults diagnosed with CRC from 2015 to 2019. Demographics, disease characteristics, surgical treatment, stages, and survival data for individuals who are Hispanic, Black, Southeast Asian, Chinese, American Indian and Alaskan Native (AIAN), Asian Indian and Pakistani (AIP), and Native Hawaiian and Other Pacific Islanders (NHOPI) were extracted. Survival analysis was done using the Kaplan-Meier survival curve. Multivariate analysis was done with the Cox proportional hazard model. There were 40 091 individuals with CRC. NHOPI had the youngest median age of 59 years, while Chinese individuals had the oldest median age of 65 years. From the total sample of their respective subgroups, 43.8% of Black patients and 36.7% of AIAN patients had a median household income of <$60 000, while 55.3% of Southeast Asian patients, 59.7% of Chinese patients, 55.8% of AIP patients, and 65.6% of NHOPI patient had a median household income >$70 000. The 1-year survival rate was lower for patients who were Hispanic (62.0%), Black (60.9%), and AIAN (63.1%). Even after multivariate analysis, Black patients had a significant hazard ratio (HR) of 1.21 (95% confidence interval [95% CI]: 1.05-1.38), while AIP had a HR of 0.68 (95% CI 0.55-0.84), compared to AIAN. Other significant variables that were linked with survival included older age, advanced stage of CRC, a median household income <$60 000, male sex, no surgery, subtotal colectomy/hemicolectomy, and total colectomy. Further studies are needed to elucidate the specific causes of these differences and create appropriate strategies to reduce this survival disparity.

S970 Comparative Analysis of Patients With Lower GI Bleed Undergoing Early versus Late Colonoscopy: A National Readmission Database Study

S970 Comparative Analysis of Patients With Lower GI Bleed Undergoing Early versus Late Colonoscopy: A National Readmission Database Study