Diagnosis Procedure Research Articles

The impact of financial incentives promoting biosimilar products in oncology: A quasi-experimental study using administrative data

Background Biosimilars have the potential to save a significant amount of money in cancer treatment costs. However, barriers exist in the adoption of biosimilar products. Japan introduced a new health policy in 2022 to promote the use of biosimilars in oncology by offering financial incentives to eligible hospitals. This study aims to examine the association between these financial incentives and prescription patterns. Methods The study analyzed Diagnosis Procedure Combination (DPC) data to assess the impact of the new health policy on the use of biosimilar products in oncology. The policy provided an additional fee for hospitals using biosimilar products. The study included patients with specific types of cancer and analyzed the proportion of monthly biosimilar prescriptions using the number of prescriptions of reference and biosimilar products. A generalized synthetic control method was used for analysis. Results From April 2020 to March 2023, the study involved 27,737 patients in 114 hospitals, with 63 eligible hospitals receiving financial incentives. The average number of prescriptions of the drugs (rituximab, trastuzumab, and bevacizumab) increased gradually in both eligible and ineligible hospitals. The financial incentives were associated with a significant increase in the proportion of biosimilar product prescriptions, with a monthly increase of 0.092 per month (95% CI, 0.040–0.145) [9.2%, 95% CI, 4.0–14.5] compared to ineligible hospitals. Conclusion Our study indicates that providing financial incentives to hospitals to utilize biosimilar products increased their prescriptions. Japan’s recent health policy of moderate financial incentives is an effective approach to increasing prescriptions of biosimilar products.

Nationwide database study of postoperative sequelae and in-hospital mortality in super-elderly hip fracture patients.

The risk of postoperative sequelae and in-hospital mortality in Japanese patients aged 90years and older with hip fractures is unexplored. This study aims to use a comprehensive medical claims database in Japan to compare super-elderly patients aged 90years and older with elderly aged 65-89 and clarify the risk of sequelae and in-hospital mortality in super-elderly patients. We retrospectively analyzed the Diagnosis Procedure Combination (DPC) database for all of Japan from April 2016 to March 2022. Medical records from approximately 1100 DPC-related hospitals were provided with consistent consent during this period. In this study, we focused on super-elderly patients and examined the association with the risk of postoperative pneumonia, pulmonary embolism, myocardial infarction, urinary tract infection, acute renal dysfunction, subsequent cognitive dysfunction, and in-hospital mortality after one-to-one propensity score matching. After performing propensity score matching based on sex and comorbidities, 129,953 pairs of patients were identified. These pairs were compared to elderly and super-elderly patients. The results of this study showed that compared with hip fractures in the elderly, hip fractures in the super-elderly were associated with an increased risk of pneumonia, urinary tract infection, acute renal dysfunction, subsequent cognitive dysfunction, and in-hospital mortality after adjustment for confounders. The odds ratio of in-hospital mortality was 2.190 (95% CI 2.062-2.325). As it has been shown that super-elderly patients with hip fractures are at greater risk of respiratory and urinary tract infections and increased in-hospital mortality, careful attention should be required for perioperative management.

Emergency Care Efficiency vs. Quality: Uncovering Hidden Consequences of Fast-Track Routing Decisions

Problem definition: This work aims to examine the role of emergency department (ED) operational status related to congestion in fast-track (FT) routing decisions and the subsequent effects on patient outcomes. Methodology/results: In this paper, we utilize a two-year data set from two hospital EDs in Alberta, Canada, and adopt an instrumental variable approach to examine the effects of FT routing decisions on patient outcomes. Based on the empirical findings, we utilize a data-calibrated simulation to compare the performance of different routing policies. First, our study reveals that FT routing decisions are not purely clinically driven, and ED operational status is also associated with FT routing decisions. Second, being routed to FT can improve ED efficiency by reducing the average length of stay and left without being seen rates. However, this efficiency improvement comes at the cost of potential quality decline. In particular, being routed to the FT leads to an 8.2% increase in the 48-hour revisit rate for the high-complexity group and a 2.3% increase for the medium-complexity group. Third, we delve into the mechanisms behind observed patient outcomes and find that physicians in the FT area may prioritize expediting patient flow by simplifying patient diagnosis and treatment procedures. Consequently, the quality of care may be compromised for high- and medium-complexity patients. Finally, our simulation findings highlight the importance of selecting the “right” patients to be routed to the FT unit. To this end, the complexity-based classification method and dynamic routing policies emerge as promising avenues. Managerial implications: Our findings call for immediate attention from healthcare practitioners to carefully balance the trade-off between emergency care efficiency and quality, emphasizing the necessity of selecting the right patients for routing. Funding: This study is partially supported by the Hong Kong Research Grants Council [Grants GRF 11508921 and CRF C7162-20G]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0440 .

Thai Guideline for Nuclear Medicine Investigations of Neurocognitive Disorders: Nuclear Medicine Society of Thailand, the Neurological Society of Thailand, and Thai Medical Physicist Society Collaboration

Nuclear medicine investigations play a significant role in diagnosing dementia, mainly using imaging techniques such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). By providing functional and molecular data via brain imaging, nuclear medicine investigations offer valuable insights that complement clinical evaluations and structural imaging in the early detection, diagnosis, and differentiation of various types of dementia, leading to more accurate diagnosis and personalized treatment planning. Therefore, the Nuclear Medicine Society of Thailand, the Neurological Society of Thailand, and the Thai Medical Physicist Society have collaborated to establish these practical nuclear medicine investigation guidelines aiming to (1) identify the role of nuclear medicine studies in patients with neurocognitive disorders; (2) assist referrers in requesting the most appropriate procedure for diagnosis of each type of neurocognitive disorders; and (3) identify scientific evidence that is useful to assisting nuclear medicine professionals in recommending, performing, interpreting, and reporting the results of nuclear medicine investigations in patients with neurocognitive disorders.

Time trends of outcome and treatment options for disseminated intravascular coagulation from 2010 to 2021 in Japan: A nationwide observational study

IntroductionMortality and changes in treatment options for disseminated intravascular coagulation (DIC) are trending downward. This study investigated temporal trends in mortality and treatment preferences of several anticoagulants in Japan. MethodsThis retrospective observational study used the Japanese Diagnosis Procedure Combination inpatient database containing data from >1500 acute-care Japanese hospitals. All adult patients diagnosed as having DIC from July 2010 to March 2022 were sorted by predefined underlying conditions: sepsis, solid cancer, leukemia, trauma, or obstetric. We evaluated in-hospital mortality and clinical status of anticoagulant use for DIC treatment. ResultsBaseline characteristics of the 443,098 DIC patients showed increased age, worsened comorbid conditions, and higher illness severity over time. Over the 12 years, in-hospital mortality for overall DIC patients declined by 17 % from 42.0 % (95 % CI 41.4–42.5 %) to 34.7 % (95 % CI 34.1–35.3 %) (Ptrend < 0.001). This downward decrease was more evident in patients with sepsis (17 %), solid cancer (18 %), and leukemia (22 %) but was not clinically meaningful in trauma and obstetrics patients. The trend in treatment preferences of anticoagulants for DIC patients also changed. Recombinant thrombomodulin administration increased dramatically from 2011 to 2015 and remained high through 2021. Only 7 % of DIC patients were administered antithrombin and recombinant thrombomodulin concomitantly, and its use continues to decline. ConclusionsAll-cause in-hospital mortality for DIC patients clearly decrease by 17 % over the study period. Anticoagulant therapy for patients with DIC has been decreasing, possibly due to recent published clinical evidence.

Hospitalization of patients with Down syndrome in acute care hospitals in Japan

AbstractBackgroundDown syndrome is the most common genetic disorder, and the life expectancy of patients with Down syndrome has increased over the decades. However, the diseases and social problems experienced by patients with Down syndrome remain unknown in Japan. Therefore, we aimed to investigate the disease status of such patients admitted to acute care hospitals in Japan.MethodsThis observational study was conducted using the Diagnosis Procedure Combination data from 2016 to 2021 to evaluate routes of admission, principal diagnoses, comorbidity of dementia, orthopedic surgeries for limb fractures, and discharge destinations of patients with Down syndrome (International Classification of Diseases, Tenth Revision code: Q90).ResultsOverall, 26,195 individuals with Down syndrome were included, of whom 5195 were ≥20 years of age. As the age increased, the number of admissions from home decreased and that from nursing homes increased. Pneumonia was the most common principal diagnosis, with the incidence of aspiration pneumonia increasing in patients &gt;40 years of age. We observed an increase in the incidence of dementia and surgery for limb fractures after 40 years of age. The number of discharges to home decreased with increasing age, whereas that to nursing homes increased with increasing age.ConclusionsThese results suggest that patients with Down syndrome are often hospitalized because of pneumonia and that the incidence of aspiration pneumonia, dementia, and limb fractures increases after 40 years of age. Therefore, a system to prevent pneumonia, especially aspiration pneumonia, and limb fractures in patients with Down syndrome is needed.

Air pollution and cerebrovascular diseases - retrospective analysis of 10,486 cases of acute ischemic stroke requiring intravenous thrombolysis. A report from the EP-PARTICLES study

Abstract Introduction Air pollution (AP) is becoming an increasingly important non-classical CVD risk factor. Recent years have brought us the introduction of new types of AP, such as ‘Polish smog’, rich in particulate matter (PM) and benzo(alpha)pyrene (B(a)P) - thus far overlooked in scientific research. Acute ischemic stroke (AIS) is an increasing healthcare challenge, with the ageing population and associated presence of atrial fibrillation worldwide. Intravenous thrombolysis (IVT), alongside thrombectomy, is the most effective AIS treatment method. Purpose To analyze the impact of AP on AIS requiring IVT incidence. To our knowledge this is the first study of its kind worldwide. Methods The study covered 500 municipalities inhabited by 5.7 million people in Poland in 2011-2020. AIS requiring IVT incidence data [hospitalizations with ICD-10 diagnosis (I63.X) and concomitant ICD-9 procedure (99.101/99.102/99.103)] and AP concentrations (PM2.5 and B(a)P) were obtained from the National Health Fund and Inspectorate for Environmental Protection, respectively. IVT was administered within 4.5 hours from the onset of AIS symptoms, ensuring accuracy in the timing of exposure. Using the GEM-AQ model we calculated AP levels for all 500 municipalities. To analyze the effects of AP we used quasi-Poisson generalized additive models with covariates such as weather conditions, day of the week, bank holidays, and seasonal trends. Results are presented as relative risks (RRs) and 95% confidence intervals (95% CI) per interquartile range increase in AP on the day of exposure (LAG 0) and the following days (LAG 1, etc). Results In the study period, we recorded 96,122 AIS with a slight predominance of females (52.6%) and median age 76 years old (y.o) [IQR 66-83]; 10,486 (10.9%) were treated with IVT (median age 74 y.o. IQR 65-82), females 51.3%. Mortality rates were lower in patients treated with IVT than overall AIS patients (13.3% vs 15.4%, p&amp;lt;0.001). Exposure to B(a)P was associated with the highest increase in AIS requiring IVT incidence on LAG 0 and this effect persisted for up to 3 days after exposure [Figure 1]. In the overall population, an increase in PM2.5 concentration was associated with an increased risk of AIS requiring IVT on LAG 0, LAG 1, and LAG 3 [Figure 1]. AP increased the risk of AIS requiring IVT in both young and older individuals, as well as in women and men. We recorded no differences between the effects of analyzed air pollutants and AIS requiring IVT depending on age and sex [Figure 2]. Conclusions AP acts as a trigger for AIS requiring IVT with a similar impact regardless of sex and age. Patients undergoing IVT are characterized by better survival. Public health changes should consider efforts to decrease levels of air pollutants. Highly polluted areas should have centers with rapid access to AIS treatments and our study could help to identify high risk areas that require adaptations in local infrastructure.Figure 1.Figure 2.

Evaluating corticosteroid treatment strategies for cardiac sarcoidosis: analysis of the nationwide claims-based JROAD-DPC dataset

Abstract Background Corticosteroid-based immunosuppressive therapy is the cornerstone of treatment for cardiac sarcoidosis (CS), aimed at preventing severe adverse events including death, heart failure and lethal arrhythmic events. Nevertheless, data on the optimal initial dosing, appropriate tapering schedules, suitable maintenance dosages, and the recurrence rates among patients are insufficient. Purpose This study sought to scrutinize real-world data on corticosteroid therapy regimen for CS and to reassess optimal treatment protocols. Methods From the Japanese Diagnosis Procedure Combination database, 6,282 patients with hospitalized CS were identified between 2012 and 2022. Among them, 3,067 CS patients who were initiated on corticosteroid therapy during hospitalization were analyzed. We examined the baseline patient characteristics and treatment strategies for corticosteroid therapy, including starting dose, tapering period, maintenance dose, and their correlation with the onset of adverse events. Results The cohort had a mean age was 63±11 years, and 1,256 patients (41.0 %) were female. The starting dose of corticosteroids was 30.3±6.9 mg, with 88.6% of patients receiving a dose of ≧30 mg/day. The doses of corticosteroids at 30, 60, 90, 120, 150 and 180 days post-discharge were 21.4±9.8, 15.7±6.9, 12.2±5.7, 10.4±5.0, 9.3±4.5 and 9.0±4.6 mg, respectively. By day 180, 83.7% of the patients were maintained on ≦10 mg/day. However, 17.1 % of patients required an increase in corticosteroid dosage during the tapering course, primarily due to exacerbation of sarcoidosis. When analyzing only the group without corticosteroid escalation up to 180 days post-discharge, the average corticosteroid dose was 8.7±3.8 mg, with 95.3% of patients on ≦10 mg/day. We observed 965 re-hospitalization (31.5 %) during follow-up, with 58.8% of these patients having corticosteroid escalation to ≧30 mg, and 12.8% of patients received second-line immunosuppressive therapy, such as methotrexate. Conclusion The majority of CS patients were initiated on a corticosteroid regimen of 30 mg/day, which was subsequently tapered to below 10 mg/day by day 180. However, non-negligible number of patients experienced clinical events or relapse, underscoring the necessity for vigilant follow-up during corticosteroid therapy.Figure

Clinical evaluation and outcome in patients with heart failure receiving chemotherapy with different anti-cancer agents

Abstract Background Over the last few decades, advances in cancer therapy have prolonged the life expectancies of patients diagnosed with malignancies. Although traditional cytotoxic chemotherapy, molecularly targeted therapy, and immunotherapy have improved survival rates, off-target adverse effects such as complications of the cardiovascular system require attention. The optimal strategy for modern chemotherapy should be based on a comprehensive approach for patients with cancer and cardiovascular diseases. Therefore, cardio-oncology has received increasing attention owing to the cardiotoxic effects of anti-cancer therapies. Purpose To assess the clinical characteristics and outcomes of patients with heart failure (HF) who received chemotherapy compared with those of a matched cohort with HF who did not receive chemotherapy, using real-world HF data. Methods This study used the Diagnosis Procedure Combination database of the Japanese Registry of All Cardiac and Vascular Disease. We identified 1,328,113 patients hospitalized for HF between April 2012 and March 2021. We excluded 14,043 patients with unknown outcomes, non-emergency admissions, and unknown chemotherapy data. The primary endpoint was readmission. Thus, our study included 5,774 patients who received chemotherapy and 39,412 patients who did not. The propensity score (PS) was estimated using a logistic regression model, with chemotherapy as the dependent variable, and clinically score-matched analysis of 11,532 patients with HF with or without chemotherapy. Results Colon, lung, breast, and prostate cancers accounted for &amp;gt; 60% of all cancer types. After PS matching, 62.5% and 19.5% of patients with HF had prostate and breast cancer, respectively. After PS matching, readmission was more frequently observed in patients undergoing chemotherapy than those not undergoing chemotherapy (odds ratio [OR], 1.26; 95% confidence interval [CI] 1.17–1.36, p&amp;lt;0.0001). Treatment with genomic epidermal growth factor receptor tyrosine kinase inhibitors (OR, 1.69; 95% CI 1.39–2.07), taxane (OR, 2.95; 95% CI 2.11–4.12), anthracyclines (OR, 1.86; 95% CI 1.19–2.90), and fluorouracil agents (OR, 1.65; 95% CI 1.18–2.30) resulted in a significant risk of readmission. Moreover, patients treated with endocrine therapy before hospitalization had significantly higher readmission rates than the matched patients who did not receive chemotherapy (aromatase inhibitors: OR, 1.40; 95% CI 1.19–1.65: anti-androgens: OR, 1.39; 95% CI 1.27–1.52: luteinizing hormone-releasing hormone agonists: OR, 1.18; 95% CI 1.08–1.30 and gonadotropin-releasing hormone antagonists: OR, 2.17; 95% CI 1.68–2.79). Conclusions Medical providers need to monitor and follow-up patients with HF, depending on the characteristics of the anticancer agents and types of cancer. Furthermore, close collaboration among oncologists, cardiologists, and healthcare professionals will ensure the delivery of optimal care for patients with HF undergoing chemotherapy.

Comparison of complications during catheter ablation of atrial fibrillation between radiofrequency and cryoballoon ablation: insights from a nation-wide claims-based database

Abstract Background Few large-scale, real-world studies have compared the safety of radiofrequency (RF) catheter ablations (CA) with that of cryoballoon ablations of atrial fibrillation (AF), especially in east Asian countries. Methods This retrospective, cross-sectional study used a nationwide administrative claims database, to compare complication-incidence rates between patients who underwent RFCA and cryoballoon ablation of AF. We used data from Medical Data Vision Co., Ltd, that is derived from the health claims, Diagnosis Procedure Combination (DPC) system, and flat-fee payment system in Japan. We first extracted hospitalization records with CA with diagnosis of AF. Exclusion criteria were 1) records with diagnoses of atrial flutter or atrial tachycardia, 2) patients aged &amp;lt;20 years old, 3) CA of AF performed other than RFCA or cryoballoon, 4) records with insufficient clinical data, and 5) patients who were prescribed both direct oral coagulants and warfarin. Complications were defined using the following ICD-10 diagnosis codes: major bleeding (I31.9, I97.1, J98.5, J048, J0021); thromboembolism (H342, I24, I269, I740, I741, I744, I748, I749, K550, K868, N280, or T790); ischemic stroke (G45, or I63); cardiac tamponade (I31.9, I97.1, or J98.5); and vascular access complications (hematoma: S701, S801, T140 or T810; and/or pseudoaneurysms: I72.4). Logistic regression analyses were performed to estimate odds ratios and 95% confidence intervals (CI) for major bleeding, systemic thromboembolism, ischemic stroke, and cardiac tamponade. Results Among the 32,797,540 records between June 2011 and August 2020 from 426 hospitals, 41,347 records who underwent CA of AF (Median 68 [60–74] years old, 30.2 % women) were included in the study. A total of 36,729 RFCA (88.8%) and 4,618 cryoballoon ablation (11.2%) cases were included in the cohort. Major bleeding, systemic thromboembolism, ischemic stroke, cardiac tamponade, and vascular access complications occurred in 194 (0.5%), 193 (0.5%), 116 (0.3%), 414 (1.0%) and 115 (0.3%) patients, respectively. As a result of logistic regression analysis, when cryoballoon ablation was used as a reference, RFCA was associated with higher risk of cardiac tamponade (OR 1.54, 95% CI 1.09–2.25, P = 0.02), while it was not associated with higher or lower risk of other complications (major bleeding OR [95% CI ]1.21 [0.77–2.04]; thromboembolism 1.74 [1.03–3.22]; ischemic stroke 1.88 [0.94–4.47]; vascular access complication; 1.00 [0.58–1.87]). Conclusion Compared to cryoballoon ablations, RFCA was associated with higher risk of cardiac tamponade, using nationwide administrative claims database.

Effectiveness of an Impella versus intra-aortic balloon pump in patients who received extracorporeal membrane oxygenation: a nationwide inpatient database study

Abstract Background/Introduction Previous studies have suggested that left ventricular (LV) unloading with an intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is associated with lower mortality; however, it is unclear which is better. Purpose This study aimed to evaluate the effectiveness of LV unloading with an Impella versus IABP on in-hospital mortality and other clinical outcomes. Methods Using the Japanese Diagnosis Procedure Combination database from September 28, 2016, to March 31, 2022, we identified inpatients who received an Impella or IABP in combination with ECMO (ECPella or ECMO+IABP group, respectively). The primary outcome was in-hospital mortality and the secondary outcomes were the length of hospital stay, length of ECMO, total hospitalization cost, and complications including major bleeding, an ischemic stroke, vascular complications, and renal replacement therapy during hospitalization. Propensity score matching was performed to compare the outcomes between the groups. We performed sensitivity analyses excluding patients who received extracorporeal cardiopulmonary resuscitation. Results Of 14,525 eligible patients, 603 (4.2%) received ECPella and 13,922 (96%) received ECMO+IABP. After propensity score matching, there was no significant difference in in-hospital mortality between the two groups (58.9% versus 56.6%; risk difference, 2.3%; 95% confidence interval, -3.9% to 8.5%). A Kaplan–Meier analysis with the log-rank test showed no significant difference in the 60-day in-hospital mortality between the two groups (P value = 0.114) (Figure 1). The ECPella group had a longer hospital stay (mean 42.8 days versus 33.7 days; risk difference, 9.1 days; 95% confidence interval, 2.6 to 15.6 days), a higher total hospitalization cost (12,573,000 yen versus 6,857,000 yen; risk differences, 5,716,000 yen; 95% confidence interval, 4,439,000 yen to 6,993,000 yen), and more frequent major bleeding (8.1% versus 5.8%; risk difference, 2.0%; 95% confidence interval, 0.007% to 4.0%), vascular complications (4.1% versus 2.2%; risk difference, 2.0%; 95% confidence interval, 0.04% to 3.9%), and renal replacement therapy during hospitalization (50.6% versus 41.1%; risk difference, 9.5%; 95% confidence interval, 3.0% to 15.9%) than the ECMO+IABP group (Figure 2). The results of the sensitivity analyses, excluding 6,360 patients (44%) who received extracorporeal cardiopulmonary resuscitation, showed similar results to those for the main analyses. Conclusions This nationwide inpatient database study showed that ECPella was not associated with a survival benefit but was associated with a longer hospital stay, a higher total hospitalization cost, and more complications than ECMO+IABP.Figure 1Figure 2

Dementia severity and advanced pressure injury procedures and prognosis: A nationwide study in Japan.

In older adults, pressure injuries (PIs) are common and, despite advancements in PI care, are associated with increased complications in patients with dementia for whom standardized treatments are unavailable. Herein, we aimed to examine the influence of dementia status on the care practice pattern and healing outcomes for PI on discharge. This retrospective cohort study used data from the Diagnosis Procedure Combination database for 2014-2015 and the Annual Report for Functions of Medical Institutions and included patients aged ≥65 years. The DESIGN-R (depth, exudates, size, inflammation/infection, granulation, necrosis and rating) classification system was used to determine PI severity, and the Dementia Scale was used to assess dementia status. The measured outcomes included advanced PI care and healing upon discharge. Multivariable logistic regression, accounting for hospital-related clustering, was used to examine the association of dementia with these outcomes. Among 20 386 patients from 1198 hospitals included in the analysis, 32.5%, 20.1% and 47.3% had no, mild and severe dementia, respectively. After adjustment for patients' and hospital characteristics, compared with those without dementia, patients with severe dementia were significantly less likely to undergo advanced treatments, such as skin grafts (adjusted odds ratio [aOR], 0.62 [95% confidential interval [CI], 0.40-0.97]; P = 0.034) and flap surgeries (aOR, 0.57 [95% CI, 0.42-0.77]; P < 0.001), and had a reduced likelihood of PI healing (aOR, 0.80 [95% CI, 0.72-0.90]; P < 0.001). Severe dementia was associated with poor PI healing outcomes, indicating potential treatment disparities. Thus, PI treatment should be provided according to the severity of dementia. Geriatr Gerontol Int 2024; ••: ••-••.

Current status analysis of the prevalence and regional disparities of robot-assisted laparoscopic prostatectomy in Japan using diagnosis procedure combination data

The introduction of the “da Vinci S HD Surgical System” marked a significant shift towards robotic surgeries in Japan. However, initial high costs and lack of efficacy data posed barriers to its widespread adoption. By 2023, more than 570 da Vinci units were operational in Japan, highlighting the growing acceptance of robotic surgery despite these challenges. This study aimed to investigate the prevalence and regional disparities in the adoption of robot-assisted laparoscopic prostatectomy (RALP) across Japan using diagnosis procedure combination data. This retrospective observational study analyzed data from 2857 urban and 4184 regional hospitals across 47 prefectures in Japan. The study focused on the number of RALP procedures, da Vinci systems, and certified urological surgery proctors. Multiple regression analysis was performed to identify significant factors influencing RALP adoption. Urban areas demonstrated a higher prevalence of RALP procedures and more da Vinci systems compared to regional areas, with urban hospitals performing an average of 937 RALP procedures compared to 195.5 in regional hospitals. The number of certified urological surgeons also showed significant urban-regional disparities, contributing to the overall imbalance. Our findings highlight substantial regional disparities in access to robot-assisted surgery in Japan, with urban areas benefiting from better access to advanced medical technologies and specialist training. Addressing these disparities will require targeted policies to improve the dissemination of robotic surgery systems and enhance training opportunities in regional cities.

Early effect of a financial incentive for surgeries within 48 h after hip fracture on the number of expedited hip fracture surgeries, in-hospital mortality, perioperative morbidity, length of stay and inpatient medical expenses.

To examine the early effects of the financial incentive (FI) implemented in April 2022 in Japan for surgeries within 48 h after hip fracture (HF) in patients aged 75 and older on expedited HF surgery (EHFS), in-hospital mortality, perioperative morbidity, length of stay (LOS) and inpatient medical expenses (IMEs). We conducted a quasi-experimental study and constructed segmented regression models for controlled interrupted time-series analyses, assuming a Poisson distribution, to evaluate the slope changes (SCs) in the outcomes of interest before and after the introduction of the FI. We used Diagnosis Procedure Combination data from the Quality Indicator/Improvement Project database between 1 April 2018 and 31 March 2023. Patients aged 50 years or older who were hospitalized with a diagnosis of HF and underwent surgery for HF were included. A total of 82,163 patients from 183 hospitals were included in the analyses. In the age group of 75 years and older, increasing trends in the number of EHFSs were observed even before the introduction of the FI, while before and after the introduction of the FI, none of the SCs in the monthly number of EHFSs within 2 days, within 1 day, and on the day of admission were statistically significant (incident rate ratio: 1.0043, 95% confidence interval [CI]: [0.9977-1.0111], 1.0068 [0.9987-1.0149], 1.0073 [0.9930-1.0219]). Nor were any of the SCs in in-hospital deaths, perioperative complications, LOS, and IMEs statistically significant. Additionally, there were no statistical differences in the SCs for any of the outcomes between the two age groups. This study suggested that there was no significant, short-term effect of the FI for surgeries within 48 h after HF on any of the outcomes of interest.

ORTHOPTIST LED VISUAL fiELD MONITORING DURING AWAKE CRANIOTOMY OF LOW GRADE GLIOMA: A UK TERTIARY CENTRE EXPERIENCE

Abstract AIMS To describe orthoptist led monitoring of visual function during awake craniotomy for low grade glioma and to retrospectively review visual field outcomes comparing to published results. METHOD Intraoperative visual field monitoring was performed by the same advanced orthoptist, performing fields to confrontation as well as monitoring for observed visual phenomena. Goldman visual fields were performed pre-operatively and approx. 6 weeks post operatively. Results compared to published outcomes. RESULTS 26 awake procedures were attended with 2 being repeat surgeries therefore 28 surgical episodes. Testing was abandoned for 6 (inability to wake sufficiently, inability to cope with the awake procedure or change in diagnosis from low to high grade). Results were retrospectively reviewed over a five year period from 2019 to 2024. Post operative visual fields were found to be unaltered or only mild superior dipping (not precluding driving) in 18 patients, loss of field to a quadrantiopia negating driving requirements in 2, 2 patients with quadrantiopia pre and post op unchanged. CONCLUSION Visual field assessment during awake craniotomy can give surgeons additional confidence to continue the resection. Utilisation of an Orthoptist with minimal equipment as well as no alteration to the surgical positioning has demonstrated comparable visual outcomes to those published. The authors would recommend that other centres consider utilization of specialised allied health professionals to assess and monitor eloquent function during awake procedures; such as orthoptists for visual function.

Comparative retrospective study on surgical outcomes of hand‐sewn anastomosis versus stapling anastomosis for colectomy using a nationwide inpatient database in Japan with propensity score matching

AbstractBackgroundIntestinal anastomosis is performed by two main methods: hand‐sewn anastomosis (HA) and stapling anastomosis (SA). Studies on anastomosis are still being reported and are an ongoing area of interest. The aim of this study was to evaluate the characteristics of each by comparing them with description and statistical analysis using a nationwide inpatient database.MethodsWe collected data for colon cancer patients who underwent colectomy between April 2014 and March 2022 using the Diagnosis Procedure Combination (DPC) database. In the descriptive analysis, we described the background of the study population and the number of each method. In the statistical analysis, we used propensity score matching to achieve balanced covariates and showed the results of the comparative study using risk ratios and risk differences.ResultsA total of 232 155 cases were selected (HA group: 40 764; SA group: 191 391). SA was performed more frequently than HA during the study period, with the proportion of SA increasing over the last few years (~80% in 2015 and 85% in 2021). We obtained 40 760 pairs through propensity score matching. The comparison of postoperative events varied by outcome (reoperation: 517 [1.27%] vs 380 [0.93%]; risk ratio [RR]: 1.36 [95% confidence interval [CI], 1.19 to 1.55], endoscopic intestinal hemostasis: 17 [0.04%] vs 80 [0.20%]; RR: 0.21 [95% CI, 0.13 to 0.36]).ConclusionSA is becoming more common in colectomy. The risk of reoperation could be higher in the HA group, while the risk of postoperative endoscopic intestinal hemostasis could be higher in the SA group.

Clinical characteristics and outcomes of preterm versus term uterine rupture: a nationwide observational study.

To assess and compare the clinical aspects of uterine rupture by dividing the gestational age at uterine rupture occurrence into < 37-week (preterm) and ≥ 37-week (term) groups. This retrospective cohort study analyzed data from 187 acute-care hospitals across Japan and included patients who experienced uterine rupture. Data were sourced from the Diagnosis Procedure Combination inpatient database, spanning July 2010 to March 2022. The patients' characteristics, in-hospital procedures, and outcomes were compared between those with uterine rupture at < 37 and ≥ 37weeks of gestation. The main outcomes were hysterectomy, complications, proportion of blood transfusions, and postoperative length of stay. A total of 298 patients were identified, with 161 in the preterm group and 137 in the term group. Placenta accreta spectrum occurred more frequently in the preterm group than in the term group (18.0% vs. 6.6%, respectively; P = 0.003). Vacuum delivery (19.0% vs. 0.6%, P < 0.001) and uterine fundal pressure (2.9% vs. 0.0%, P = 0.004) were more likely to be applied in the term group. The maternal need for mechanical ventilation (26.3% vs. 12.4%, P = 0.003), the proportion of disseminated intravascular coagulation (40.1% vs. 25.5%, P = 0.009), and the requirement for platelet transfusions (32.8% vs. 15.5%, P < 0.001) were greater in the term. The postoperative hospital stays were also longer in the term group. This study shows that individual characteristics vary with the gestational age at uterine rupture, and maternal morbidity is notably higher in term compared to preterm ruptures.

Relationship Between Participation of In-Hospital Cardiac Rehabilitation and Regional Characteristics in Japan - Insight From the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination.

The influence of various regional backgrounds on participation in cardiac rehabilitation (CR) remains underexplored. We investigated the regional characteristics that potentially promote CR participation. This was a nationwide cross-sectional cohort study using the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination. This study included a cohort of 2.7 million inpatients hospitalized between April 2012 and March 2021. The CR participation rate for each hospital was calculated as the percentage of eligible patients who underwent CR during their admission. Among all hospitals, those that do not perform CR were defined as No-CR hospitals. The remaining hospitals were categorized into High- and Low-CR hospitals based on the median level of the CR participation rate (41.5%). High-CR hospitals had significantly smaller medical service areas (P<0.0001), a higher number of physicians per population (P<0.0001), higher air temperature (P=0.02), and fewer primary industry workers (P=0.005) than the other 2 groups. Logistic regression analyses revealed that a lower consumer price index was a significant regional factor that characterized High-CR hospitals, and a lower population aged ≥65 years was a factor approaching significance that characterized the region where High-CR hospitals are located. High-CR hospitals were found in regions with a lower consumer price index and a trend towards a lower population aged ≥65 years.

Development and Validation of Claims-based Algorithms for Identifying Hospitalized Patients With COVID-19 and Their Severity in 2020 and 2021.

This study aimed to develop and validate claims-based algorithms for identifying hospitalized patients with coronavirus disease 2019 (COVID-19) and disease severity. We used claims data including all patients at the National Center for Global and Medicine Hospital between January 1, 2020, and December 31, 2021. The claims-based algorithms for three statuses with COVID-19 (hospitalizations, moderate or higher status, and severe status) were developed using diagnosis codes (International Classification of Diseases, 10th revision code: U07.1, B34.2) and relevant medical procedure code. True cases were determined using the COVID-19 inpatient registry and electronic health records. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each algorithm at 6-month intervals. Of the 75,711 total patients, the number of true cases was 1,192 for hospitalizations, 622 for moderate or higher status, and 55 for severe status. The diagnosis code-only algorithm for hospitalization had sensitivities 90.4% to 94.9% and PPVs 9.3% to 19.4%. Among the algorithms consisting of both diagnosis codes and procedure codes, high sensitivity and PPV were observed during the following periods: 93.9% and 97.1% for hospitalization (January-June 2021), 90.4% and 87.5% for moderate or higher status (July-December 2021), and 92.3% and 85.7% for severe status (July-December 2020), respectively. Almost all algorithms had specificities and NPVs of approximately 99%. The diagnosis code-only algorithm for COVID-19 hospitalization showed low validity throughout the study period. The algorithms for hospitalizations, moderate or higher status, and severe status with COVID-19, consisting of both diagnosis codes and procedure codes, showed high validity in some periods.

Aggressiveness evaluation of borderline serous ovarian tumors by analysis of Psammoma bodies present in cancer tissues using micro-FTIR spectroscopy

Borderline ovarian tumor is a type of tumor with generally low malignant potential. However, these tumors pose diagnostic challenges with benign and malignant epithelial ovarian tumors because the clinical symptoms are similar and investigation procedures for specific diagnosis are still debated. In addition, a small number of borderlines transform into high-grade serous ovarian carcinoma with a poor prognosis. Therefore, tools improving a better characterization of high-risk subtypes of borderline tumors to enable understanding of possible unfavorable evolution are essential for patients’ management. Psammoma bodies (PBs) are microcalcifications found both in serous epithelial ovarian cancer and serous borderline tumors with possible correlation with disease progressionIn this work, the chemical composition of PBs found in the tissues of borderline, high-grade and low-grade ovarian tumors was evaluated using micro-FTIR spectroscopy. Applying principal component analysis to spectral data, it was observed that among the borderline tumors analyzed (1-bl,2-bland3-bl), the PBs of3-blshowed a different chemical content from that of the PBs of the high-grade and low-grade tumors, while the PBs of1-bland2-blappeared to have similar chemical content to the PBs of high- and low-grade tumors. The discriminating wavenumbers were found to be those related to carbonate CO32− (1454, 1413 cm−1and 872 cm−1) and phosphate PO43−(1018 cm−1and 960 cm−1) present in microcalcifications. A higher ratio between peak intensities at 1413 cm−1and 1018 cm−1(I1413/I1018) was observed in the PBs of3-blcompared with those of high- and low-grade ovarian carcinoma patients, which correlates with higher CO32− content. On the other hand, the PBs of1-bland2-blshowed a CO32−level close to that of the PBs of high- and low-grade patients. Several studies on microcalcifications in breast carcinoma have reported that increased carbonate content is related to decreased tumor aggressiveness. Therefore, case bl-3 appeared to be the less aggressive. The results obtained from FTIR analysis were in agreement with histopathological tumor classification and molecular analysis for BRAFV600E. The FTIR technique could become a reliable tool for identifying borderline low- and high-risk tumors.