Elevated Charlson Comorbidity Index Research Articles

Significance of Charlson co-morbidity index as predictive factor for post-op complications after radical nephrectomy.

The current study planned to explore the correlation between an elevated Charlson Comorbidity Index score and post-operative complications following radical nephrectomy in patients with renal cell carcinoma. A total of 70 patients aged 30-80 years undergoing radical nephrectomy were categorised into low Charlson Comorbidity Index score <4 group A and high score >4 group B. Post-operatively, complications were noted in 21(30%) patients, with higher grades more prevalent in the group B patients (relative risk: 1.96, p=0.004). The finding underscored the importance of considering comorbidities in assessing the risk of complications following radical nephrectomy.

Utility of a Third Heplisav-B Dose in Patients With Inflammatory Bowel Disease Without Immunity After 2-Dose Heplisav-B Vaccination.

Hepatitis B virus (HBV) vaccination is recommended in patients with inflammatory bowel disease (IBD). Although the 2-dose Heplisav-B vaccine has proven effective, more than 20% of patients with IBD do not seroconvert. We prospectively evaluated the effectiveness of a third Heplisav-B dose in patients with IBD lacking HBV immunity despite 2-dose vaccination. Adults with IBD who had received 2-dose Heplisav-B vaccination between 2018 and 2023 were identified. Seroconversion was defined as hepatitis B surface antibody (HBsAb) ≥ 10 IU/L measured at ≥4 weeks after vaccination. Patients who did not seroconvert were prospectively offered a third Heplisav-B dose, followed by repeat HBsAb measurement. Demographic, clinical, medication, and vaccination data were compared between those who did and did not seroconvert. Of 192 patients identified, 71.9% (138/192) seroconverted after 2-dose Heplisav-B vaccination. The 54 patients (28.1%) who did not seroconvert were more likely to be male, have diabetes, chronic kidney disease, or elevated Charlson Comorbidity Index. Of the 54 patients, 30 (55.6%) elected to receive a third Heplisav-B dose, with 56.7% (17/30) achieving seroconversion (median HBsAb titer 376 IU/L, IQR 47-1,000 IU/L) despite a median intervaccination time of 416 days (IQR 90.8-667.8). No differences were noted between patients who did vs did not seroconvert after third-dose vaccination. In patients with IBD lacking HBV immunity despite 2-dose Heplisav-B vaccination, administration of a third dose resulted in a 56.7% seroconversion rate. Our results suggest that administration of an additional Heplisav-B dose may be an effective strategy in patients lacking immunity despite primary 2-dose vaccination.

Treatment and Outcomes of Fungal Prosthetic Joint Infections: A Systematic Review of 225 Cases

BackgroundFungal prosthetic joint infections (PJIs) after a total joint arthroplasty are a rare, yet severe, occurrence not often reported in the literature. Unlike in bacterial PJIs, no clear consensus exists on fungal PJI optimal management. MethodsA systematic review was performed using the PubMed and Embase databases. Manuscripts were assessed for inclusion and exclusion criteria. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was applied for quality assessment. Individual demographic, clinical, and treatment information was retrieved from included manuscripts. ResultsSeventy one patients who had a PJI of the hip and 126 of the knee were included. Infection recurrence occurred in 29.6% and 18.3% of patients with hip or knee PJI, respectively. Patients who had knee PJIs recurrence had a significantly higher Charlson Comorbidity Index (CCI). For knee PJIs, infection recurrence was more common in patients with Candida albicans (CA) PJIs (P = .022). Two-stage exchange arthroplasty was the most common procedure in both joints. Multivariate analysis found that CCI ≥ 3 was associated with an 18.5-fold increase in the risk of knee PJI recurrence (Odds ratio [OR] = 18.57). Additional risk factors for recurrence in the knee included CA etiology (OR = 3.56) and C-reactive protein at presentation ≥ 6 (OR = 6.54). Compared to debridement, antibiotics, and implant retention, 2-stage procedure was a protective factor for PJI recurrence in the knee (OR = 0.18). No risk factors were found in patients who had hip PJIs. ConclusionTreatment of fungal PJIs varies widely, but 2-stage revision is the most common. Risk factors for knee fungal PJI recurrence include elevated CCI, infection by CA, and high C-reactive protein at presentation.

Characteristics of COVID-19 vaccinated and unvaccinated patients admitted to Careggi University Hospital, Florence, Italy

More than 11.5 billion COVID-19 vaccine doses have been administered around the world. Although vaccine effectiveness for severe infections is reported to be 89.0%, breakthrough infections are common and may lead to severe outcome in fragile population. We conducted a real-world observational study on 420 COVID-19 admitted patients from July 2021 to January 2022 in a tertiary level Italian hospital. We collected patient’s vaccination and SARS-CoV-2 serological status, SARS-CoV-2 treatments, oxygen supports, intensive (ICU) and subintensive (sub-ICU) care unit admissions, length of staying (LoS) and in-hospital mortality. One-hundred-seventy-two vaccinated and 248 unvaccinated patients were admitted during the study period. Vaccinated group (Vg) had a significantly more elevated Charlson Comorbidity Index than Unvaccinated group (UVg), and no statistical differences were found in terms of in-hospital mortality, LoS or ICU and sub-ICU admissions. Among Vg, anti-S antibodies were detected in 86.18% of patients (seropositives). Vaccinated seronegative patients’ in-hospital mortality was significantly higher than vaccinated seropositive patients (33.33% vs 10.69%, p = 0.0055): in particular, mortality rate in 45–69 years old population was higher in vaccinated seronegative group, and comparable in patients ≥ 70 years old. No differences in terms of outcome were registered between Vg and UVg, taking into account that Vg was considerably older and with more comorbidities. In line with other recent observations, higher mortality rate was evidenced for seronegative vaccinated patients. Primary prophylaxis and early treatments result to be necessary, especially for older and immunosuppressed populations.

Severe mitral regurgitation in nonagenarians: Impact of symptomatic status, frailty and etiology on management and outcomes

BackgroundData regarding mitral regurgitation (MR) in extremely elderly patients are limited. The aim of the present study was to assess symptomatic status, frailty, etiology and outcomes for nonagenarians with severe MR. MethodsSingle-center cohort study of patients ≥90 years of age with at least 3+ MR on echocardiography between September 2010 and August 2018. Out of a total of 11,998 patients with at least 3+ MR, 267 patients were included in the present study. ResultsThe average age was 93.5 ± 2.6 years, and 57% were female. At baseline, 88% were symptomatic, with mean Charlson co-morbidity index of 6 ± 2 points, and mean frailty score of 2.9 ± 1.4 points. Primary MR was present in 50%, secondary in 47%, and prosthetic valve dysfunction in 3%. Among patients with primary MR, the most common etiology was mitral annular calcification (58%). In comparison, the most common etiology of secondary MR was atrial functional MR (52%). Of all, 95% were treated conservatively, and 5% underwent interventional management. Among 253 patients who had follow-up data with a median follow-up of 14 months (25th–75th interquartile range: 3–31 months), 191 patients (75%) died. Mortality trended higher in the conservative group versus the interventional group (60% vs. 22%, log-rank P = 0.063). ConclusionsMost nonagenarians with significant MR were symptomatic at presentation, had elevated Charlson co-morbidity index and frailty scores. Etiologies of MR were almost equally distributed between primary and secondary causes. The vast majority of nonagenarians with significant MR were conservatively managed.

1848. Predictors of 6-Month Mortality in Staphylococcus aureus Bacteremia: A Population-Based Study in Olmsted County, Minnesota, from 2006 to 2020

Abstract Background Staphylococcus aureus has high mortality rates, which is influenced by several factors related to the host-pathogen interaction. The current study aims to provide a contemporary evaluation of predictors of 6-month mortality rate in a population-based cohort of incident Staphylococcus aureus bacteremia (SAB) cases. Methods Retrospective population-based study of 541 adult residents of Olmsted County, MN with monomicrobial SAB from January 1, 2006 through December 31, 2020. The study’s primary outcome was 6-month mortality rate, and a survival analysis was prepared by the Kaplan-Meier method. Multivariable Cox regression was used to investigate risk factors associated with 6-month mortality. Results The median (IQR) age of 541 patients with SAB was 66.8 (54.4-78.5) years and 39.6% were female. The median Charlson Comorbidity Index (CCI) was 2 (1-4). SAB cases were healthcare-associated in 49.2% and 56.2% were methicillin-susceptible. Twenty percent of SAB cases had an unknown infection source and 38.3% had complicated bacteremia. There were 7 relapses within the first 12 weeks of follow-up, corresponding to a cumulative incidence rate of 1.3%. There were no re-infections through the remainder of the 6-month follow-up, although there were 2 recurrences after 7 months. Eighty-nine (16.5%) patients died within 1 month of SAB diagnosis and 144 (26.7%) patients died during the 6-month follow-up period. In a multivariable analysis, older age, elevated CCI, unknown source of SAB, and intensive care unit (ICU) admission were significant predictors of an increased 6-month mortality rate. In contrast, presence of diabetes mellitus was significantly associated with a decreased 6-month mortality rate; also, undergoing infectious diseases consultation was associated with reduced mortality in the first 2 weeks, but not for the remainder of the 6-month follow-up period. Conclusion To our knowledge, the current investigation represents the only contemporary population-based study determining significant predictors of mortality in SAB patients, namely, older age, higher CCI, unknown source of SAB, and ICU admission. This study also described one of the lowest 30-day mortality rates reported over the past 2 decades. Figure 1.Survival and reinfection rates of patients with SAB over 6 months. Abbreviations: SAB, Staphylococcus aureus bacteremia. Foot notes: The overall survival curve was derived by the Kaplan-Meier estimator, while the curve for reinfection was estimated by the cumulative incidence function taking into account the competing risk of death. Disclosures Larry M. Baddour, M.D., Boston Scientific: Advisor/Consultant|Botanix Pharmaceuticals: Advisor/Consultant|Roivant Sciences: Advisor/Consultant|UpToDate, Inc.: Royalty payments - authorship duties.

Comprehensive geriatric assessment of older patients and associated factors of admission to Emergency Departments in pre-covid 19 Era – A Portuguese study

ObjectivesIdentifying frequent users’ (≥3admissions/year) associated factors in an emergency department (ED), using a comprehensive geriatric assessment (CGA), describing the characteristics of patients over 65 years of age. MethodsA cross-sectional study was performed between August 2017 and June 2018 in an ED in Lisbon, Portugal. CGA was applied and completed with clinical records. Clinical, functional, mental and social scores were created based in Portuguese Society of Internal Medicine, and a statistical model was developed. ResultsCGA was applied to 426 patients over 64 years old in an ED. The mean age was 79.3, 84.7% had multimorbidity. 51.2%, 75.6%, and 40% had dependence on basic, instrumental, and walking activities, respectively. 52% had depressive symptoms, 65.7% had cognitive impairment, 63% were undernourished/at risk for malnutrition. 33.1% were socially at risk. Polypharmacy was present with a use on average of 6.5 drugs daily. Social, clinical, functional, and mental scores were unfavourable in 48.6%, 79.6%, 54.9% and 83.1% of the population, respectively. There were 2.7 hospital admissions/year and 39.9% were frequent ED users (≥3/year). The logistic regression model was weak, but showed that patients with polypharmacy, elevated Charlson Comorbidity index and an impairment nutritional status presented higher risk of being frequent users. ConclusionsThis study showed that 97.1% of patients had needs that would justify an interventional care plan. This intervention should be extended to primary care and nursing homes. While not providing a robust model, our study has indicated nutritional problems, polypharmacy, and an elevated Charlson index as the features with more weight in frequent users’ admissions.

Factors Associated with 90-Day Mortality in Invasively Ventilated Patients with COVID-19 in Marseille, France.

Objectives: To describe clinical characteristics and management of intensive care units (ICU) patients with laboratory-confirmed COVID-19 and to determine 90-day mortality after ICU admission and associated risk factors. Methods: This observational retrospective study was conducted in six intensive care units (ICUs) in three university hospitals in Marseille, France. Between 10 March and 10 May 2020, all adult patients admitted in ICU with laboratory-confirmed SARS-CoV-2 and respiratory failure were eligible for inclusion. The statistical analysis was focused on the mechanically ventilated patients. The primary outcome was the 90-day mortality after ICU admission. Results: Included in the study were 172 patients with COVID-19 related respiratory failure, 117 of whom (67%) received invasive mechanical ventilation. 90-day mortality of the invasively ventilated patients was 27.4%. Median duration of ventilation and median length of stay in ICU for these patients were 20 (9–33) days and 29 (17–46) days. Mortality increased with the severity of ARDS at ICU admission. After multivariable analysis was carried out, risk factors associated with 90-day mortality were age, elevated Charlson comorbidity index, chronic statins intake and occurrence of an arterial thrombosis. Conclusion: In this cohort, age and number of comorbidities were the main predictors of mortality in invasively ventilated patients. The only modifiable factor associated with mortality in multivariate analysis was arterial thrombosis.

Association between previous health condition and outcome after cardiac arrest

IntroductionOverall survival of patients with out-of-hospital cardiac arrest (OHCA) remains low, even in those with return of spontaneous circulation (ROSC). In addition to usual prognostic characteristics, patients’ medical history may also influence their outcome. This study aimed to investigate the role of pre-arrest comorbidities on hospital survival, neurological outcome and mode of death in OHCA patients with successful ROSC. MethodsFrom Jan 2012 to Sep 2017, all consecutive non-traumatic OHCA adults, admitted with a stable ROSC were included. Utstein characteristics, circumstances of arrest and interventions were prospectively recorded. Prior comorbidities were measured using the Charlson Comorbidity Index (CCI), and the population was divided into 3 groups (CCI 0, CCI 1–3 and CCI ≥ 4). The association of CCI with early and long-term mortality was assessed using logistic regression and association with withdrawal-of-life sustaining treatments (WLST) or another cause of death using multinomial regression. ResultsDuring the study period, 777 patients were analyzed and 483 (62%) died before hospital discharge, with death rate of 49%, 60% and 70% in CCI 0, CCI 1–3 and CCI ≥ 4 respectively. After adjustment, an increase CCI was significantly associated with in-hospital mortality (OR = 2.47 [1.35–4.52], p = 0.001 for CCI 1–3; OR = 2.82 [1.49–5.33], p = 0.003 for CCI ≥ 4; ref = CCI 0). Other independent predictors were non-shockable rhythm (OR = 3.23 [2.08–5]), lack of bystander CPR (OR = 1.96 [1.22–3.13]), epinephrine dose ≥ 2 mg (OR = 5.56 [3.70–8.33]), CA to CPR ≥ 5 min (OR = 1.96 [1.28–3.03]) and CPR to ROSC ≥ 20 min (OR = 2.13 [1.39–3.23]).Using multinomial regression, an increase in CCI was associated with all modes of in-hospital death, particularly with WLST-related death (RRadj = 2.48 [1.26–4.90], p = 0.01 for CCI = 1–3 and 3.75 [1.85−8.7.58], p < 0.001 for CCI ≥ 4, reference CCI = 0). ConclusionAlteration of chronic health status, as assessed by an elevated CCI, was associated with a higher mortality and a worse neurological outcome in OHCA patients. Presence and burden of comorbidities should be considered in the evaluation of the prognosis in patients admitted in hospital after cardiac arrest.

Preexisting Oral Anticoagulant Therapy Ameliorates Prognosis in Hospitalized COVID-19 Patients.

Objective: Altered coagulation parameters in COVID-19 patients is associated with a poor prognosis. We tested whether COVID-19 patients on chronic oral anticoagulants (cOACs) for thromboembolism prophylaxis could receive protection from developing more severe phenotypes of the disease.Approach and Results: We searched the database of the SARS-RAS study (Clinicaltrials.gov: NCT04331574), a cross-sectional observational multicenter nationwide survey in Italy designed by the Italian Society of Hypertension. The database counts 2,377 charts of Italian COVID-19 patients in 26 hospitals. We calculated the Charlson comorbidity index (CCI), which is associated with death in COVID-19 patients. In our population (n = 2,377, age 68.2 ± 0.4 years, CCI: 3.04 ± 0.04), we confirm that CCI is associated with increased mortality [OR: 1.756 (1.628-1.894)], admission to intensive care units [ICU; OR: 1.074 (1.017-1.134)], and combined hard events [CHE; OR: 1.277 (1.215-1.342)]. One hundred twenty-five patients were on cOACs (age: 79.3 ± 0.9 years, CCI: 4.35 ± 0.13); despite the higher CCI, cOACs patients presented with a lower risk of admissions to the ICU [OR 0.469 (0.250-0.880)] but not of death [OR: 1.306 (0.78-2.188)] or CHE [OR: 0.843 (0.541-1.312)]. In multivariable logistic regression, cOACs confirmed their protective effect on ICU admission and CHE. The CCI remains the most important risk factor for ICU admission, death, and CHE.Conclusions: Our data support a mechanism for the continuation of cOAC therapy after hospital admission for those patients who are on chronic treatment. Our preliminary results suggest the prophylactic use of direct cOACs in patients with elevated CCI score at the time of the COVID-19 pandemic even in absence of other risks of thromboembolism.

S0312 Increased Incidence of Sessile Serrated Adenoma/Polyp and Colorectal Cancer Detection in Veterans With Elevated Charlson Comorbidity Index and Positive Fecal Immunochemical Test

INTRODUCTION: The fecal immunochemical test (FIT) is widely used as a screening method for colorectal cancer (CRC). The Charlson Comorbidity Index (CCI) is the most widely comorbidity index used by researchers. There have been no studies to date correlating colonoscopy findings after positive FIT based on CCI. The primary aim of our study was to determine if CCI influences colonoscopy findings (adenoma or cancer) in patients with a positive FIT from a Veterans Affairs hospital in the Inland Empire of Southern California. METHODS: The VA Loma Linda Healthcare System electronic medical record was queried for all patients having FIT between October 1, 2014 and September 30, 2015. Inclusion criteria were positive FIT and completion of colonoscopy. Data collected included demographic information, endoscopist performing colonoscopy, type and quality of preparation, withdrawal time, Endocuff use, adenoma size and location along with calculated CCI score. Primary outcome measures were adenoma detection rate (ADR), advanced adenoma detection rate (AADR), sessile serrated adenoma/polyps (SSA/P), CRC, preparation quality and duration of colonoscopy based on CCI. Statistical analysis was performed with R software with Mann-Whitney test, chi-square, Fisher’s exact test, logistic regression and linear regression analysis as indicated. RESULTS: During the study period, 7778 FIT tests were distributed. Of those distributed, 638 patients (8%) were positive and met the study criteria. 380 (59.5%) underwent diagnostic colonoscopy, comprising the study group. The average age was 66 years old. The overall prevalence of ADR, AADR, SSA/P, ASSA/P and CRC was 64.4%, 25%, 13.95%, 2.6% and 3.42% respectively. Multivariate analysis showed higher CCI score was associated with higher CRC (OR = 1.2, P = 0.05) and SSAP incidence (OR = 1.16, P = 0.01) respectively. There was no significant difference in CCI observed in any other parameter assessed. CONCLUSION: For every one-unit elevation, CCI score increased the frequency of diagnosis with either a sessile serrated adenoma/polyp or CRC by a minimum of 16%. CCI may be predictive in FIT outcomes at colonoscopy among veteran patients.Table 1Table 2

Hyponatremia is associated with more severe biliary disease.

Sodium level is an important clinical predictor of complex biliary disease. Hyponatremia has been observed in conjunction with biliary disease, however the nature of this association remains unclear. To investigate the association between serum sodium and severe biliary disease. Of 920 patients with gallstone disease treated at the SFVA Hospital from 1989-2019 were studied. We conducted multivariate analyses of correlation between sodium level and biliary disease severity, the presence/location of biliary bacteria, and other factors. Minimum sodium level pre-intervention was collected. Gallstones, bile, and blood (as relevant) were cultured. Illness severity was characterized: (1) None (no infectious manifestations); (2) Systemic inflammatory response syndrome; (3) Severe illness (gangrenous cholecystitis, cholangitis, necrotizing pancreatitis); and (4) Multiple organ dysfunction syndrome (bacteremia, hypotension, organ failure). Comorbidity was defined using the Charlson Comorbidity Index (CCI). Decreased sodium level significantly correlated with worsening illness severity, ascending bacterial infection, gangrenous changes, elevated CCI score, increasing age, male sex, and glucose. On multivariate analysis, all factors, except age, gender and glucose, independently correlated with sodium level and factors were additive. This unique study is the first to explore, with such granularity, the relationship between biliary disease and sodium. No prior studies have examined specific culture and clinical data. It illustrates an inverse, independent correlation between illness severity and sodium. Culture data demonstrate that sodium decreases as infection ascends from gallstone colonization to bactibilia to bacteremia. Patient comorbidity and gangrenous changes also independently correlate with sodium on multivariate analysis. Sodium level is an important clinical indicator of disease severity for patients with biliary disease.

Inappropriate initial urinary catheter placement among older Chinese hospital inpatients: An observational study.

The aim of this study is to evaluate incidences of inappropriate initial urinary catheter placements within an older inpatient cohort. A total of 200 inpatients that received urinary catheterizations within 24 hours of admission were recruited for this observational study. The key demographic and clinical factors were recorded. Adverse outcomes were assessed by examining incidences of catheter-associated urinary tract infection (CAUTI) during hospitalization, after transfer to skilled nursing facilities, second, duration of hospital stay and by scoring changes on the Katz Index of Independence in Activities of Daily Living. Correlative relationships between demographic data and clinical factors with adverse outcomes were analyzed. Inappropriate initial urinary catheterization in our cohort was approximately 39%. This was associated with elevated Charlson comorbidity index scores and increased dependency, with correlations to medical diagnosis. We also observed that the primary rationale for the procedure (inappropriate catheterization) was for neurogenic bladder (where intermittent catheterization was indicated) and in 'convenience-of-care' catheterizations. Inappropriate catheter placement was ultimately associated with an elevated CAUTI at point of discharge, with transfers to skilled nursing facilities and also with an increased duration of hospital stay. Inappropriate catheter placement was prevalence in southwestern China and associated with adverse outcomes.

Association between the Charlson Comorbidity Index and the risk of 30-day unplanned readmission in patients receiving maintenance dialysis

BackgroundPatients receiving maintenance hemodialysis (HD) and peritoneal dialysis (PD) are frequently hospitalized. Reducing unplanned 30-day hospital readmissions is a key priority for improving the quality of health care. The purpose of this study was to assess the association between the Charlson Comorbidity Index (CCI), which has been used to evaluate multi-comorbidities status, and 30-day readmission in patients on HD and PD therapy.MethodsThe Hospital Quality Monitoring System (HQMS), a national administrative database for hospitalized patients in China was used to extract dialysis patients admitted from January 2013 to December 2015. The outcome was the unplanned readmission following the hospital discharge within 30 days. For patients with multiple hospitalizations, a single hospitalization was randomly selected as the index hospitalization. A cause-specific Cox proportional hazard model was utilized to assess the association of CCI with readmission within 30 days.ResultsOf the 124,721 patients included in the study, 19,893 patients (16.0%) were identified as experiencing unplanned readmissions within 30 days. Compared with patients without comorbidity (CCI = 2, scored for dialysis), the risk of 30-day readmission increased with elevated CCI score. The hazards ratio (HR) for those with CCI 3–4, 5–6 and > 6 was 1.01 (95% confidence interval [CI] 0.98–1.05), 1.09 (95% CI 1.05–1.14), and 1.14 (95% CI 1.09–1.20), respectively.ConclusionsOur study indicated that CCI was independently associated with the risk of 30-day readmission for patients receiving dialysis including HD and PD, and could be used for risk-stratification.

The Impact of Comorbidity Burden on Complications, Length of Stay, and Direct Hospital Costs After Minimally Invasive Transforaminal Lumbar Interbody Fusion.

A retrospective cohort. The aim of this study was to determine whether comorbidity as determined by Charlson Comorbidity Index (CCI) is associated with inpatient complication rate, length of stay (LOS), or direct hospital costs after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). In the spine literature, comorbidity burden has been associated with an increased risk for complications, prolonged LOS, and greater hospital costs. Few studies have investigated the influence of comorbidity burden on these outcomes in minimally invasive spine surgery populations. A prospectively maintained surgical registry of patients undergoing primary, single-level MIS-TLIF was retrospectively reviewed. Patients were stratified by CCI and tested for association with preoperative demographics and perioperative characteristics using Chi-squared analysis or one-way analysis of variance for categorical and continuous variables, respectively. Complication rates, LOS, and direct hospital costs were compared between groups using a one-way analysis of variance. Two hundred ninety-eight patients were included. About 19.8% had a CCI of 0, 41.3% had a CCI of 1 to 2, 27.2% had a CCI of 3 to 4, and 11.7% had a CCI ≥ 5. Elevated CCI was associated with older age, smoking, and insurance status. Elevated CCI was significantly associated with a greater total inpatient complication rate. Regarding LOS and total direct hospital costs, there were no associations identified. However, elevated CCI was associated with greater costs accrued in the intensive care unit, laboratory costs, and cardiology-related costs. Greater comorbidity burden as reflected by higher CCI was associated with increased postoperative complication rates following primary, single-level MIS-TLIF. However, this did not lead to prolongations in hospital stay or increased total direct hospital costs. This lack of association may suggest that the limited tissue trauma and operative exposure utilized in minimally invasive approaches may limit the utility of CCI as a predictor of surgical outcomes and costs. 4.

Web-Based, Self-Directed Physical Therapy After Total Knee Arthroplasty Is Safe and Effective for Most, but Not All, Patients

BackgroundRecently, self-directed physical therapy (SDPT) programs have gained popularity following total knee arthroplasty (TKA). This study evaluated the safety and efficacy of the routine use of an SDPT program in a nonselect patient population. MethodsThis is a single-surgeon, retrospective study of 296 consecutive patients from August 2016 to October 2017 discharged home after primary, unilateral TKA and enrolled in a web-based SDPT program. Patients were seen 2 weeks after surgery and outpatient physical therapy (OPPT) was prescribed if flexion was less than 90°, upon patient request, or inability to use the web-based platform. ResultsOverall, 195 of 296 (65.9%) patients did not require OPPT (SDPT-only) while 101 of 296 were prescribed OPPT (34.1%, SDPT + OPPT). In SDPT + OPPT, 66.3% were for flexion <90°, 27.7% by patient request, 5.0% received a prescription but did not attend OPPT, and 1.0% due to inability to use the web-based platform. The rate of manipulation under anesthesia was 2.36% overall (SDPT + OPPT, 6.93%; SDPT-only, 0.0%). Multivariate analysis identified elevated Charlson comorbidity index, elevated body mass index, higher preoperative SF12 mental score, and loss of flexion at 2 weeks as independent predictors associated with the need for OPPT. ConclusionWeb-based SDPT is safe and effective for most patients eligible for home discharge after TKA. It is difficult to preoperatively predict those patients who will require OPPT; therefore, we recommend close follow-up. It is critical to preserve these services for patients who require them after TKA as up to a third of patients required OPPT.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P143. The impact of comorbidity burden on complications, length of stay and direct hospital costs after minimally invasive transforaminal lumbar interbody fusion

BACKGROUND CONTEXT The current health care model emphasizes maximizing patient care through utilization of cost-effective management strategies. Within the field of orthopedic surgery, comorbidity burden has been extensively studied in regards to its association with postoperative outcomes and complication incidence. In the subspecialty spine literature, the presence of comorbidities has been associated with an increased risk for complications, length of inpatient stay and hospital costs. However, few studies have investigated the effect of an elevated comorbidity burden on inpatient complication rate, length of stay or direct hospital costs in minimally-invasive spine surgery populations. PURPOSE To determine if comorbidity burden as determined by Charlson comorbidity Index (CCI) is associated with inpatient complication rate, length of stay or direct hospital costs after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). STUDY DESIGN/SETTING Retrospective analysis of a prospectively managed surgical database. PATIENT SAMPLE A total of 362 patients who underwent a primary, single-level MIS TLIF between 2012 and 2017. OUTCOME MEASURES Rates of complications, length of stay and direct hospital costs. METHODS A prospectively maintained surgical registry of patients undergoing primary, single-level MIS TLIF for degenerative pathology between 2012 and 2017 was retrospectively reviewed. Patients were stratified by CCI group (0, 1, 2, 3, ≥4). CCI was tested for an association with preoperative demographics and perioperative characteristics using chi-squared analysis or one-way analysis of variance for categorical and continuous variables, respectively. Rates of complications were tabulated spanning the inpatient period and compared between groups using a one-way analysis of variance. Differences in length of stay and direct hospital costs between groups were assessed using a one-way analysis of variance. Statistical significance was set at p RESULTS A total of 362 patients underwent single-level MIS TLIF during the study period and were included in the analysis. Of these, 23.2% (84) had a CCI of 0, 22.4% (81) had a CCI of 1, 18.5% (67) had a CCI of 2, 16.6% (60) had a CCI of 3, and 19.3% (70) had a CCI ≥ 4. Elevated CCI was associated with older age (p .05 for each). One-way analysis of variance indicated that elevated CCI was not associated with total direct hospital costs (p=.469); however, greater CCI was associated with greater costs accrued in the intensive care unit (p=.028). CONCLUSIONS CCI as a reflection of comorbidity burden was not associated with complication rate, length of stay or total direct hospital costs after single-level MIS TLIF. The potential to mitigate the risk of complications in patients with elevated CCI may help prevent extended hospital stays and improve cost-effective patient care. This lack of association may suggest that the limited tissue trauma and operative exposure utilized in the minimally invasive approach may limit the effect of CCI on postoperative outcomes. Further investigation of the effect of comorbidity burden on perioperative and postoperative outcomes in minimally invasive spine surgery is required to better elucidate its value as a predictor of postoperative outcomes.

The socioeconomic determinants for transsphenoidal pituitary surgery: a review of New York State from 1995 to 2015.

Prolonged length of stay (pLOS), disease-related complications, and 30-day readmissions are important quality metrics under the Affordable Care Act. The purpose of our study was to investigate the effect of patient-level and hospital-level factors on these outcomes for patients admitted for transsphenoidal pituitary surgery. The Statewide Planning and Research Cooperative System (SPARCS) database was queried to investigate 30-day readmissions and pLOS for transsphenoidal pituitary surgery in New York from 1995 to 2015. Multivariate logistic regression, adjusting for patient and hospital characteristics, was performed to assess the effect of these variables on the outcomes of interest. A total of 9950 patients underwent transsphenoidal pituitary surgery; 7122 (72%), 2394 (24%), and 434 (4%) patients were treated at high-volume, medium-volume, and low-volume centers, respectively. Patient factors associated with treatment at high-volume centers (HVCs) included: top income quartile, private insurance, urban residence, and white or Asian race (p < 0.05). Patient variables associated with treatment at low-volume centers (LVCs) included: age >65 years, elevated Charlson comorbidity index (CCI) scores, bottom income quartile, Medicaid and Medicare insurance, rural residence, black race, and Hispanic ethnicity (p < 0.05). Variables predictive of prolonged hospitalizations in our multivariable model included black race, Hispanic ethnicity, Medicaid insurance, low income, female gender, LVC, and comorbidities (panhypopituitarism, hypothyroidism, diabetes insipidus [DI], visual disturbances, CCI) while predictors of readmissions included Asian race, female gender, and comorbidities (Cushing syndrome, DI, CCI). Patients undergoing transsphenoidal pituitary surgery at HVCs have shorter hospitalizations, fewer postoperative electrolyte abnormalities, and lower charges; however, socioeconomic factors may influence access to quality care.

Pre-existing medical comorbidity is not associated with neurological outcomes in patients undergoing targeted temperature management following cardiac arrest.

The prognostic significance of chronic medical illness in comatose survivors of cardiac arrest who undergo targeted temperature management (TTM) remains largely unknown. We sought to assess the association between overall burden of pre-existing medical comorbidity and neurological outcomes in survivors of cardiac arrest undergoing TTM. We analyzed a prospectively collected cohort of 314 patients treated with TTM following cardiac arrest at a tertiary care hospital between 2007 and 2014. Overall burden of medical comorbidity was approximated with the use of the Charlson Comorbidity Index (CCI). Poor neurological outcome at hospital discharge, defined as a cerebral performance category (CPC) score >2, was the primary outcome. Secondary outcomes included death prior to hospital discharge and at 1year following cardiac arrest. Multivariable logistic regression was used to assess the association between CCI scores and outcomes. A poor neurological outcome at hospital discharge was observed in 193 (61%) patients. One hundred and seventy-nine (57%) patients died prior to hospital discharge and a total of 195 (62%) patients had died at 1-year post-arrest. In multivariable logistic regression, elevated CCI scores were not associated with increased odds of poor neurological outcomes (OR 1.04, 95% CI 0.90-1.19, p=0.608) or death (OR 0.99, 95% CI 0.86-1.13, p=0.816) at hospital discharge. No association was seen between CCI scores and death at 1-year post-arrest (OR 1.09, 95% CI 0.95-1.26, p=0.220). Increasing burden of medical comorbidity, as defined by CCI scores, is not associated with neurological outcomes or survival in patients treated with TTM.

MP35-09 SPERM ANEUPLOIDY IS ASSOCIATED WITH WORSE GENERAL HEALTH IN INFERTILE MEN

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II1 Apr 2017MP35-09 SPERM ANEUPLOIDY IS ASSOCIATED WITH WORSE GENERAL HEALTH IN INFERTILE MEN Taylor P. Kohn, Alexander W. Pastuszak, Katherine M. Rodriguez, Zachary J. Solomon, Matthew F. Cherches, Dolores J. Lamb, and Larry I. Lipshultz Taylor P. KohnTaylor P. Kohn More articles by this author , Alexander W. PastuszakAlexander W. Pastuszak More articles by this author , Katherine M. RodriguezKatherine M. Rodriguez More articles by this author , Zachary J. SolomonZachary J. Solomon More articles by this author , Matthew F. CherchesMatthew F. Cherches More articles by this author , Dolores J. LambDolores J. Lamb More articles by this author , and Larry I. LipshultzLarry I. Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1099AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Numerous studies have examined the relationship between male infertility and men′s health but most have not investigated specific causes of infertility and their health impact. Here we examine the relationship between general male health and sperm aneuploidy. METHODS We used the Charlson Co-Morbidity Index (CCI) to assess and compare the health status of men with abnormal sperm aneuploidy to five groups of men who received care at an academic infertility clinic: men with normal sperm ploidy (normal FISH), men with genetic abnormalities that may cause infertility (genetic infertile), men presenting for infertility with varicocele (varicocele), men with idiopathic infertility (idiopathic) and proven-fertile men. Sperm ploidy was assessed using fluorescence in situ hybridization (FISH). Genetic infertile men had proven Y chromosome microdeletions or abnormal karyotype. CCI for men with sperm FISH results was completed via telephone survey and CCI for genetic infertile men was extracted from intake forms. Men who were diagnosed with a varicocele or idiopathic infertility had not conceived after 12 months. Men with varicoceles, men with idiopathic infertility, and fertile controls completed the CCI in clinic. Fertile controls included men who presented for vasectomy and had fathered a child in the past 5 years. RESULTS 402 men were included in this analysis: 92 with an abnormal sperm FISH results, 7 with a normal sperm FISH test, 49 genetic infertile men, 85 men with idiopathic infertility, 86 infertile men with varicocele, and 83 fertile controls. Mean age, semen density, and CCI of all groups are described in Table 1. Of note, malignancy was common in our cohort, exceeding rates in the SEER database for comparable age (Table 1). Controlling for age, we explored infertility groups as a predictor of elevated CCI score, and found that only men with abnormal sperm FISH (p=0.002) had increased risk of a higher CCI score. Age also increased the risk for a higher CCI score, with each additional year raising the CCI by 0.0117 points (p=0.009). CONCLUSIONS Men with elevated sperm aneuploidy have nearly double the prevalence of general health issues, particularly malignancy, when compared with men with infertility of other etiologies. These findings further support the relationship between genetic causes of male infertility and general health. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e460-e461 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Taylor P. Kohn More articles by this author Alexander W. Pastuszak More articles by this author Katherine M. Rodriguez More articles by this author Zachary J. Solomon More articles by this author Matthew F. Cherches More articles by this author Dolores J. Lamb More articles by this author Larry I. Lipshultz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...