Elixhauser Comorbidity Measure Research Articles

Revisiting the Obesity Paradox: Insights from Pulmonary Embolism Patient Outcomes

Background: Obesity is an epidemic in the US and has been associated with increased incidence and severity of cardiovascular disease and increased risk for pulmonary embolism (PE). However, the evidence of its effect on outcomes in PE patients remains equivocal. We aimed to investigate the impact of obesity on adverse in-hospital outcomes in PE. Methods: This study conducted a comprehensive analysis of the National Inpatient Sample (NIS) database, focusing on adult patients (aged ≥18 years) with a discharge diagnosis of PE (ICD-10 code: I26) from 2016 to 2020. We specifically identified obese patients using the Elixhauser comorbidity measure within NIS and compared them to non-obese patients in terms of adverse in-hospital outcomes. Results: Between 2016 and 2020, there were 1,940,294 discharges for PE, with 436,505 patients (22%) identified as obese. A rising trend of obesity among PE patients was observed, increasing from 21.5% in 2016 to 24.3% in 2020. Obese patients, when compared to their non-obese counterparts, were more female (57.4% vs 49.1%, p<0.001), younger (mean age 58.4 ± 15.1 years vs 64.0 ± 17.1 years, p<0.001), and African American (21.2% vs 17.5%, p<0.001). They also had higher rates of comorbid conditions like CHF (25.1% vs 21.2%, p<0.001), hypertension (70.6% vs 58.2%, p<0.001), diabetes (37.2% vs 21.5%, p<0.001), and renal failure (16.2% vs 14.7%, p<0.001). Obese patients were more likely to receive systemic thrombolytics (3.80% vs. 2.31%, p<0.001), undergo surgical thrombectomy or embolectomy (0.24% vs. 0.16%, p<0.001), and receive catheter-directed thrombectomy or thrombolysis (3.04% vs. 1.37%, p<0.001). Paradoxically, despite these comorbidities and complications, obese patients demonstrated lower mortality rates (4.58% vs 7.60%, p<0.001), mechanical intubation (7.71% vs 8.90%, p<0.001), and shock requiring pressor support (1.73% vs 2.14%, p<0.001). After adjusting for demographic factors, all comorbidities, and reperfusion therapies, the analysis consistently showed a reduced adjusted odds ratio for in-hospital mortality among obese patients (OR 0.63, 95% CI 0.61-0.65, p<0.001). Conclusions: Analyzing nearly two million inpatient cases of PE, our study revealed an intriguing association between obesity and reduced in-hospital mortality rates in PE patients. Notably, despite a higher prevalence of comorbidities and more frequent need for reperfusion interventions, obese patients exhibited lower mortality rates and fewer complications, such as the need for mechanical intubation and shock. This survival advantage in obese individuals persisted even after adjusting for potential confounders. These findings align with a similar study conducted on the German nationwide inpatient database and reflect the broader concept of the ‘obesity paradox,’ previously observed in cardiovascular diseases and chronic obstructive pulmonary diseases. However, whether these results indicate a true protective effect of obesity, a ‘lean paradox,’ or are due to unidentified confounders remains a subject for further investigation.

Inferior Outcomes for Patients Transferred Between Surgical Stages for Knee Periprosthetic Joint Infection

BackgroundPeriprosthetic joint infection (PJI) in total knee arthroplasty may result in 2-stage revision surgery. There are limited data describing outcomes when the first stage is completed at an outside hospital and the patient is referred to a tertiary center. We hypothesized that patients have greater success when both surgeries occur at a single center. MethodsThere were 25 knee PJI patients who presented with an antibiotic spacer and had a minimum 2-year follow-up who were retrospectively identified at a single tertiary referral center from 2014 to 2021. A cohort matched for age, sex, body mass index, Elixhauser comorbidity measure, spacer type, infectious organism, and year of surgery was established with patients who had both stages completed at the investigating institution. Modified Delphi success criteria of no subsequent surgery or reinfection with any species were compared. ResultsThe transferred group demonstrated a treatment success of 40% compared to 84% in the continuous group (P < .01). The transferred group was more likely to have an additional procedure between stages (44 versus 8%, P < .01), with a higher number of surgeries after primary total knee arthroplasty (4.8 versus 3.0, P < .01), between stages (1.4 versus 0.2, P < .01), and after second stage (0.8 versus 0.2, P = .03). The transferred group had longer durations between stages (20.1 versus 7.0 weeks, P < .01). ConclusionPatients who have PJIs transferred between stages demonstrated higher treatment failure. Surgeons should consider transfer early with a goal of continuous management by a single institution.

Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study

BackgroundHand infections are heterogeneous, and some may undergo successful outpatient management. There are no strict guidelines for determining which patients will likely require inpatient admission for successful treatment, and many patients succeed with outpatient therapy. We sought to determine risk factors for failed outpatient management of cellulitic hand infections.MethodsWe performed a retrospective review of patients who presented to the Emergency Department (ED) for hand cellulitic infections over five years, from 2014 to 2019. Vital signs, lab markers, Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Measure (ECM), and antibiotic use were investigated. Discharge from the ED without subsequent admission was considered an outpatient success, while admission within 30 days of the prior visit was considered a failure. Continuous variables were compared with Welch's t test, and categorical data with Fisher's exact tests. Multivariable logistic regression was performed on comorbidities. Multiple testing adjustment was performed on p-values to generate q-values.ResultsOutpatient management was attempted for 1,193 patients. 31 (2.6%) infections failed treatment, and 1,162 (97.4%) infections succeeded. Attempted outpatient treatment was 97.4% successful. Multivariable analysis demonstrated higher odds of failure with renal failure according to both CCI (OR 10.2, p < 0.001, q = 0.002) and ECM (OR 12.63, p = 0.003, q = 0.01) and with diabetes with complications according to the CCI (OR 18.29, p = 0.021, q = 0.032).ConclusionsOutpatient treatment failure was higher in patients with renal failure and complicated diabetes. These patients require a high index of suspicion for outpatient failure. These comorbidities should influence consideration for inpatient therapy though most patients can undergo successful treatment as outpatients.Level of evidenceLevel III.

Effects of bariatric surgery on cardiovascular-related acute care use in patients with hypertrophic cardiomyopathy.

Prior studies have suggested causal relationships between obesity and acute cardiovascular events. It has been also known that the risk of acute cardiovascular events is reduced by bariatric surgery. However, little is known about whether bariatric surgery lowers the risk of acute cardiovascular events in patients with obesity and hypertrophic cardiomyopathy (HCM). In this context, we aimed to investigate whether bariatric surgery is associated with a reduced risk of cardiovascular-related acute care use in patients with HCM. In this population-based study, the bariatric surgery group consisted of patients with HCM who underwent bariatric surgery from January 2004 to December 2014. The control group included those who have obesity and HCM and received non-bariatric elective intra-abdominal surgery during the same period. The outcome was cardiovascular-related acute care use (i.e. emergency department (ED) visits or unplanned hospitalizations for cardiovascular disease) during a 1-year post-surgery period. We used the SPARCS database, a population-based ED and inpatient database in New York State. We constructed logistic regression models with generalized estimating equations to compare the risk of the outcome events during sequential 6-month post-surgery periods. We adjusted for age, sex, number of ED visits and hospitalizations for cardiovascular disease within 2years before the index surgery, and the Elixhauser co-morbidity measures. We also performed propensity score (PS)-matching and inverse probability treatment weighting analyses using these variables. The analytic cohort consisted of 207 adults with obesity and HCM, including 147 patients who underwent bariatric surgery and 60 in the control group. The risk was not significantly different in the 1-6months post-surgery period. By contrast, in the 7-12months post-surgery period, the risk of cardiovascular-related acute care use was significantly lower in the bariatric surgery group (adjusted odds ratio 0.23; 95% CI 0.068-0.71; P=0.01) compared with the control group. In the PS-matched cohort, there were no significant differences in the baseline characteristics. The PS-matched analysis demonstrated lower risk of the outcome event in the bariatric surgery group in the 7-12months post-surgery period. The inverse probability treatment weighting analysis replicated the findings. Bariatric surgery was associated with a lower risk of cardiovascular-related acute care use in the 7-12months post-surgery period in this population-based study.

Mortality Rates by Age Group and Intubation Status in Hospitalized Adult Patients From 21 United States Hospital Systems During Three Surges of the COVID-19 Pandemic

Mortality Rates by Age Group and Intubation Status in Hospitalized Adult Patients From 21 United States Hospital Systems During Three Surges of the COVID-19 Pandemic

Discriminative Ability for Adverse Outcomes in Traumatic Ankle Fracture: A Comparison of the Modified Charlson Comorbidity Index, Elixhauser Comorbidity Measure, and Modified Frailty Index

Category: Trauma; Ankle Introduction/Purpose: The modified Charlson Comorbidity Index (mCCI), Elixhauser comorbidity measure (ECM), and 5- factor modified Frailty Index (mFI-5) have been validated for the purpose of outcome prediction in foot and ankle orthopedic care. However, from the perspective of clinical utility, no study has sought to compare the predictive performance of these measures specifically following traumatic ankle fracture. The present study compares the discriminative ability of the mCCI, ECM, and mFI-5, as well as various demographic characteristics, such as age, gender, and race, to predict in-hospital mortality and complications after the surgical management of traumatic ankle fracture. Methods: We performed a retrospective cohort study of adult patients registered in the National Trauma Data Bank (NTDB) 2011-2016 experiencing ankle trauma as malleolar fracture and undergoing surgical management. Patients missing baseline or comorbidity information, dead on arrival, or with a pilon fracture or stress fracture were excluded. Enhanced ICD-9 algorithms were used to calculate mCCI, ECM, and mFI-5 as has been done in prior orthopedic literature. The discriminative ability of the indices for adverse outcomes was assessed using area under the curve analysis from receiver operating characteristic curves. Outcomes included death, severe adverse events (death, deep surgical site infection (SSI), myocardial infarction (MI), cardiac arrest, deep vein thrombosis (DVT), pulmonary embolism (PE), sepsis, stroke, compartment syndrome), minor adverse events (acute kidney injury (AKI), pneumonia, superficial SSI, urinary tract infection (UTI)), infectious events (deep SSI, organ/space SSI, superficial SSI, pneumonia, UTI, catheter-related bloodstream infection, osteomyelitis, sepsis), and any adverse event. Results: In total, 171,097 patients met inclusion criteria. The median age was 50 years and 49% of patients were male. Compared to ECM and mFI-5, mCCI had the largest discriminative ability for the outcome of in-hospital mortality (P=0.02 versus ECM, P&lt;0.001 versus mFI-5, Table I). ECM, however, had a larger discriminative ability for major adverse event, minor adverse event, infectious event, and any complication during the hospitalization (P&lt;0.001, all comparisons). In an analysis of demographic factors, age demonstrated higher discriminative ability for in-hospital mortality compared to gender (P&lt;0.001) and race (P&lt;0.001). Race had sole or shared inferior discriminative ability for all outcomes. The most discriminative comorbidity index (ECM) outperformed the most discriminative demographic factor (age, gender) for any complication, minor adverse event, and infectious events. A combination analysis of the most predictive comorbidity index and the most predictive demographic factor resulted in discriminative improvements in all five outcome variables. Conclusion: Among comorbidity indices, the mCCI demonstrated significantly greater discriminative ability for mortality and the ECM demonstrated significantly greater discriminative ability for multiple adverse events during hospitalization. The use of these indices in conjunction with easily accessible demographic factors, such as age, resulted in further improvements in discrimination ability. These findings suggest that increased use of the mCCI and ECM may assist in the identification and management of patients at risk of death and postoperative complications, respectively, and thereby help optimize risk stratification, inform patient expectations, and guide outcomes-based reimbursements in the management of traumatic ankle fracture.

Heart failure ejection fraction class conversions: impact of biomarkers, co‐morbidities, and pharmacotherapy

AimsTemporal conversions among ejection fraction (EF) classes can occur across the heart failure (HF) spectrum reflecting amended structural and functional outcomes unaccounted for by current taxonomy. This retrospective study aims to investigate the differences in serum laboratory values, guideline‐directed medical therapy (GDMT), and co‐morbidity burden across EF conversion groups.Methods and resultsHeart failure patients at least 18‐year‐old who obtained at least two echocardiograms between January 2018 and January 2020 were identified using ICD‐10 codes. Analysis of variance, chi‐square tests, and analysis of means for proportions were used as appropriate to identify associations with class conversion groups. A total of 874 patients who underwent 1748 echocardiograms on unique visits were categorized according to initial EF as HF with preserved EF (HFpEF) (n = 531, 61%), HF with mildly reduced or midrange EF (HFmrEF) (n = 132, 15%), or HF with reduced EF (HFrEF) (n = 211, 24%). In accordance with follow‐up EF, class conversions were categorized into HF with improved EF (HFiEF) (n = 143, 16%), HF with worsened EF (HFwEF) (n = 171, 20%), or HF with stable EF (HFsEF) (n = 560, 64%). The average age was 75 ± 13 years old; 54% were male, 85% were Caucasian, 11% were African American, and 4% other. The mean time between EF assessments was 208.6 ± 170.2 days. Serum sodium levels were greater in HFwEF (139 ± 3 mmol/L) when compared with HFsEF (138 ± 4 mmol/L) (P = 0.05). Pro‐BNP levels were higher in HFiEF (12 150 ± 19 554 pg/mL) versus HFsEF (6671 ± 10 525 pg/mL) (P = 0.007). Angiotensin receptor‐neprilysin inhibitors (ARNI) were more frequently ordered on index visit in HFiEF (P = 0.03), but no other significant differences in GDMT were identified. Despite similar Elixhauser Co‐morbidity Measure (ECM) scores, ECM categorical analysis revealed that HFwEF was more likely to have an established diagnosis of depression (P = 0.03) and a spectrum of psychiatric illnesses (P = 0.03) on preliminary visit. HFsEF was less likely to have an established diagnosis of blood loss anaemia (P = 0.04). Metastatic cancer was more likely to have been diagnosed in HFiEF and less likely in HFsEF (P = 0.002).ConclusionsDespite similar ECM scores, EF class conversion groups demonstrated salient differences in average serum sodium and pro‐BNP levels. Inpatient ARNI orders, psychiatric, hematologic, and oncologic co‐morbidity patterns were also significantly different. Findings demonstrate blood‐based biomarker patterns and targetable co‐morbid conditions which may play a role in future EF class conversion. Dedicated studies evaluating measurements related to GDMT dose‐titration, quality of life, and functionality are the next steps in this field of HF.

Longitudinal Ejection Fraction Class Conversion In Heart Failure: Impact Of Biomarkers, Comorbidities, And Pharmacotherapy

<h3>Introduction</h3> Temporal conversions among ejection fraction (EF) classes can occur across the heart failure (HF) spectrum reflecting amended structural and functional outcomes unaccounted for by current taxonomy. This retrospective study aims to investigate the differences in laboratory biomarkers, guideline-directed medical therapy (GDMT), and comorbidity burden across EF conversion groups. <h3>Methods</h3> HF patients at least 18-year-old who obtained at least two echocardiograms between January 2018 and January 2020 were identified using ICD-10 codes. Analysis of variance, chi-square test, and analysis of means for proportions were used as appropriate to identify associations with class conversion groups. <h3>Results</h3> A total of 874 patients who underwent 1,748 echocardiograms on unique visits were categorized according to initial EF as HF with preserved EF (HFpEF) (n=531, 61%), HF with midrange EF (HFmrEF) (n=132, 15%), or HF with reduced EF (HFrEF) (n=211, 24%). In accordance with follow-up EF, class conversions were categorized into HF with improved EF (HFiEF) (n=143, 16%), HF with worsened EF (HFwEF) (n=171, 20%), or HF with stable EF (HFsEF) (n=560, 64%). The average age was 75±13 years old; 54% were male, 85% were Caucasian, 11% were African American, and 4% other. Mean time between EF assessments was 208.6±170.2 days. Biomarker analysis demonstrated significantly higher average baseline Pro-BNP levels (12,150 pg/mL) in HFiEF versus HFsEF (6,671 pg/mL) (p=0.01). Angiotensin receptor-neprilysin inhibitor (ARNI) orders on index visit were more likely to be seen in the HFiEF group, but no other significant differences in GDMT were identified. Despite similar Elixhauser Comorbidity Measure (ECM) scores, ECM categorical analysis revealed that HFwEF was more likely to have an established diagnosis of depression (p=0.04) and a spectrum of psychiatric illnesses inclusive of diagnosis codes such as schizoaffective disorder and bipolar disorder (p=0.04) on preliminary visit compared to HFsEF or HFiEF. HFsEF was less likely to have an established diagnosis of blood loss anemia versus HFiEF or HFwEF (n=874, p=0.04). <h3>Conclusions</h3> Salient differences in baseline Pro-BNP levels as well as psychiatric and hematologic comorbidity patterns were observed across the EF class conversion spectrum despite similar baseline comorbidity burden, GDMT, and laboratory data. Findings demonstrate biomarker patterns associated with future EF improvement and targetable comorbid conditions which likely play a role in EF class conversion. Dedicated study evaluating measurements related to quality of life, functionality, hospital readmissions, and mortality are next steps in this field of HF.

Can extant comorbidity indices identify patients who experience poor outcomes following total joint arthroplasty?

It is uncertain if generic comorbidity indices commonly used in orthopedics accurately predict outcomes after total hip (THA) or knee arthroplasty (TKA). The purpose of this study was to determine the predictive ability of such comorbidity indices for: (1) 30-day mortality; (2) 30-day rate of major and minor complications; (3) discharge disposition; and (4) extended length of stay (LOS). The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent elective THA (n = 202,488) or TKA (n = 230,823) from 2011 to 2019. The American Society of Anesthesiologists (ASA) physical status classification system score, modified Charlson Comorbidity Index (mCCI), Elixhauser Comorbidity Measure (ECM), and 5-Factor Modified Frailty Index (mFI-5) were calculated for each patient. Logistic regression models predicting 30-day mortality, discharge disposition, LOS greater than 1 day, and 30-day major and minor complications were fit for each index. The ASA classification (C-statistic = 0.773 for THA and TKA) and mCCI (THA: c-statistic = 0.781; TKA: C-statistic = 0.771) were good models for predicting 30-day mortality. However, ASA and mCCI were not predictive of major and minor complications, discharge disposition, or LOS. The ECM and mFI-5 did not reliably predict any outcomes of interest. ASA and mCCI are good models for predicting 30-day mortality after THA and TKA. However, similar to ECM and mFI-5, these generic comorbidity risk-assessment tools do not adequately predict 30-day postoperative outcomes or in-hospital metrics. This highlights the need for an updated, data-driven approach for standardized comorbidity reporting and risk assessment in arthroplasty.

Bariatric surgery is associated with lower risk of acute cardiovascular events in patients with obesity and hypertrophic cardiomyopathy

Abstract Background Prior studies have suggested causal relationships between obesity and acute cardiovascular events (e.g., acute coronary syndrome, hypertensive crisis, and heart failure exacerbation). It has been known that the risk of cardiovascular events is reduced by bariatric surgery, the most effective method for substantial and sustained weight loss. However, little is known about whether bariatric surgery lowers the risk of acute cardiovascular events in the hypertrophic cardiomyopathy (HCM) population. Purpose To test the hypothesis that patients with obesity and HCM who underwent bariatric surgery have lower risk of developing acute cardiovascular events than those who did not. Methods In this population-based study of adults with obesity and HCM, the bariatric surgery group consisted of patients who underwent bariatric surgery from January 2004 to December 2014, whereas the control group included those who received non-bariatric elective intra-abdominal surgery during the same period. The outcome was an acute cardiovascular event – defined as emergency department (ED) visit or unplanned hospitalization for cardiovascular disease – during a 1-year post-surgery period. We used the SPARCS database, a population-based ED and inpatient database that captures all the ED visits and hospitalizations in New York State. We constructed logistic regression models with generalized estimating equations to compare the risk of the outcome events during sequential 6-month periods. We conducted multivariable analysis, adjusting for age, sex, number of ED visits and hospitalizations for cardiovascular disease within 2 years before the index surgery, and the Elixhauser comorbidity measures. We also performed additional analyses with propensity score (PS)-matching at 2:1 ratio and inverse probability treatment weighting (IPTW) using these variables. Results The analytic cohort consisted of 207 adults with obesity and HCM, including 147 patients who underwent bariatric surgery and 60 who had non-bariatric elective intra-abdominal surgery. In the 7–12 months post-surgery period, the risk of acute cardiovascular event was significantly lower in the bariatric surgery group (adjusted OR 0.23; 95% CI, 0.068–0.71; P=0.01; Figure) compared to the control group. In the PS-matched cohort (n=82 vs. 47), there were no significant differences in the baseline characteristics (P&amp;gt;0.50 for all comparisons). Similar to the main analysis, the PS-matched analysis demonstrated lower risk of the outcome event in the bariatric surgery group in the 7–12 months post-surgery period (OR 0.26; 95% CI, 0.083–0.73; P=0.01). The IPTW analysis also replicated the findings (OR 0.33; 95% CI, 0.16–0.71; P=0.004 during the 7–12 months post-surgery period). Conclusion In this population-based study of 207 adults with obesity and HCM, bariatric surgery was associated with a lower risk of acute cardiovascular events in the 7–12 months post-surgery period in real-world settings. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (USA) and American Heart Association

Reporting of Comorbidities in Total Hip and Knee Arthroplasty Clinical Literature: A Systematic Review.

The effects of comorbid disease remain an area of interest. Concurrent diagnoses not only affect clinical outcomes but also affect health-care reimbursement. As the rate of arthroplasty increases, consistent risk stratification is imperative. Therefore, our aim was to ascertain how comorbidities have been reported in the recent total hip arthroplasty (THA) and total knee arthroplasty (TKA)-related literature; we also wanted to quantify the use of comorbidity scores for the assessment of comorbid disease in arthroplasty research. A systematic review of the recent THA and TKA literature that was published between January 1, 2019, and September 21, 2020, was performed using the PubMed and MEDLINE databases. Clinical studies that provided data on comorbidities were evaluated for method of comorbidity reporting. The prevalence of comorbidity reporting was assessed, and the manner of reporting was analyzed. Among 659 articles, a total of 207 studies (31.4%) reported comorbidities and met our inclusion criteria. Of the 207 studies that reported comorbidities, only 57% used a comorbidity index to report comorbid disease. Of all of the indices, the American Society of Anesthesiologists (ASA) Physical Status Classification System was the score that was most commonly used (TKA, 86.2%; THA, 83.3%). Additional scores were used at varying frequencies. For TKA, the scores included the Charlson Comorbidity Index (CCI) (15.5%); the New York Heart Association (NYHA) Functional Classification (3.4%); and the CCI-Deyo (adapted by Deyo et al.), the age-adjusted CCI, the Cumulative Illness Rating Scale (CIRS), and the Readmission Risk Assessment Tool (RRAT) (1.7% each). For THA, the scores included the CCI (16.7%), the Elixhauser Comorbidity Measure (ECM) (6.7%), and the CCI-Deyo (1.7%). Considering the impact of comorbid disease on outcomes, complications, and, ultimately, reimbursement, standardized risk stratification in arthroplasty is necessary. Current studies demonstrate inconsistent comorbidity reporting, making it challenging to further characterize the impact of comorbidities on outcomes. Future research should target the development of a standardized data-driven model for comorbidity assessment in the orthopaedic patient population.

CORR Insights®: Does a Prescription-based Comorbidity Index Correlate with the American Society of Anesthesiologists Physical Status Score and Mortality After Joint Arthroplasty? A Registry Study.

CORR Insights®: Does a Prescription-based Comorbidity Index Correlate with the American Society of Anesthesiologists Physical Status Score and Mortality After Joint Arthroplasty? A Registry Study.

Validity of comorbidity adjustment scores in estimating in-hospital mortality in individual subgroups of race/ethnicity.

Aim: To examine the validity of race/ethnicity-specific comorbidity adjustment scores in estimating in-hospital mortality. Materials & methods: Using 2007-2014 data from the State Inpatient Databases (SID), we compared the performance of derived race/ethnicity-specific composite scores to the existing scores and binary Elixhauser comorbidity measures at estimating in-hospital mortality. Results: In the overall validation sample (N=9,564,277), our index (c=0.80;95%CI: 0.79-0.80) discriminated better than the van Walraven score (c=0.79;95% CI: 0.79-0.79), SID 29 (c=0.78;95% CI: 0.78-0.79)and SID 30 (c=0.78;95% CI: 0.78-0.78), but was not superior to the binary indicators (c=0.80;95% CI: 0.80-0.80). Similar findings were observed in individual populations of White and Black patients. All models showed weak calibration. Conclusion: Race/ethnicity-specific indexes discriminated slightly better than existing composite measures at modeling in-hospital mortality in individual subgroups of race/ethnicity.

Physical Comorbidity According to Diagnoses and Sex among Psychiatric Inpatients in South Korea

People with mental disorders are susceptible to physical comorbidities. Mind–body interventions are important for improving health outcomes. We examined the prevalence of physical comorbidities and their differences by diagnoses and sex among psychiatric inpatients. The dataset, from National Health Insurance claims data, included 48,902 adult inpatients admitted to psychiatric wards for at least 2 days in 2016 treated for schizophrenia, schizotypal and delusional disorders, or mood disorders. We identified 26 physical comorbidities using the Elixhauser comorbidity measure. Among schizophrenia-related disorders, other neurological disorders were most common, then liver disease and chronic pulmonary disease. Among mood disorders, liver disease was most common, then uncomplicated hypertension and chronic pulmonary disease. Most comorbid physical diseases (except other neurological disorders) were more prevalent in mood disorders than schizophrenia-related disorders. Male and female patients with schizophrenia-related disorders showed similar comorbidity prevalence patterns by sex. Among patients with mood disorders, liver disease was most prevalent in males and third-most in females. In both diagnostic groups, liver disease and uncomplicated diabetes mellitus were more prevalent in males, and hypothyroidism in females. Mental health professionals should refer to a specialist to manage physical diseases via early assessments and optimal interventions for physical comorbidities in psychiatric patients.

Australian Injury Comorbidity Indices (AICIs) to predict burden and readmission among hospital-admitted injury patients

BackgroundExisting comorbidity measures predict mortality among general patient populations. Due to the lack of outcome specific and patient-group specific measures, the existing indices are also applied to non-mortality outcomes in injury epidemiology. This study derived indices to capture the association between comorbidity, and burden and readmission outcomes for injury populations.MethodsInjury-related hospital admissions data from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia were analyzed. Various multivariable regression models were run and results used to derive both binary and weighted indices that quantify the association between comorbidities and length of stay (LOS), hospital costs and readmissions. The new and existing indices were validated internally among patient subgroups, and externally using data from the states of New South Wales and Western Australia.ResultsTwenty-four comorbidities were significantly associated with overnight stay, twenty-seven with LOS, twenty-eight with costs, ten with all-cause and eleven with non-planned 30-day readmissions. The number of and types of comorbidities, and their relative impact were different to the associations established with the existing Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Measure (ECM). The new indices performed equally well to the long-listed ECM and in certain instances outperformed the CCI.ConclusionsThe more parsimonious, up to date, outcome and patient-specific indices presented in this study are better suited for use in present injury epidemiology. Their use can be trialed by hospital administrations in resource allocation models and patient classification models in clinical settings.

Predicting Hospital Outcomes Using the Reported Edmonton Frail Scale-Thai Version

Backgrounds Frailty is a common geriatric condition leading to poor surgical outcomes. Having a valid frailty measure has the potential to improve surgical care quality. Objectives To test the ability of the Reported Edmonton Frailty Scale-Thai version (REFS-Thai) in predicting hospital outcomes compared with the American Society of Anesthesiologists physical status classification (ASA) and the Elixhauser Comorbidity Measure (EMC) in older Thai orthopedic patients. Methods A prospective study was conducted on hospitalized older adults scheduled for elective orthopedic surgery. Multiple Firth logistic regression modeled the effect of frailty on postoperative complications, postoperative delirium (POD), and discharge disposition, while the length of stay (LOS) was examined by Poisson regression. The area under the receiver operating characteristic curve (AUC) and mean squared errors (MSE) were used to compare the predictive ability of the instruments. Results Two hundred participants with mean age of 72 (range 60-94 years) were mostly female, 23% were frail. Adjusting for other variables, frailty was significantly associated with postoperative complications (OR = 2.38, p = 0.049), POD (OR = 3.52, p = 0.034), and prolonged LOS (relative risk [RR] = 1.42, p = 0.043). The REFS-Thai alone shows good performance in predicting postoperative complications (AUC = 0.81, 95% CI = 0.74-0.88) and POD (AUC = 0.81, 95% CI = 0.72-0.90). The combination of REFS-Thai with ASA and EMC demonstrates an improved predictability. Conclusion The REFS-Thai was useful in predicting adverse outcomes in surgical orthopaedic older adults. Integrating the REFS-Thai for preoperative assessment may be useful for enhancing care quality.

Abstract 14301: Effects of Septal Reduction Therapy on Acute Cardiovascular Events and All-cause Mortality in Patients With Obstructive Hypertrophic Cardiomyopathy: Propensity Score-matched Study

Introduction: Septal reduction therapy (SRT) - i.e., septal myectomy and alcohol septal ablation - has been used to treat medically-refractory obstructive hypertrophic cardiomyopathy (HOCM) for a few decades. However, the effects of SRT on the risk of acute cardiovascular (CV) events and all-cause mortality are largely unknown. Hypothesis: SRT is associated with a long-term decrease in acute CV events and a short-term increase in all-cause mortality in patients with HOCM. Methods: We performed a propensity score (PS)-matched study using all-payer databases that capture all hospitalizations and outpatient visits in New York State. We identified patients with HOCM who underwent SRT between January 1, 2007 and December 31, 2014 (i.e., the SRT group) and those who have never had SRT but had at least one hospitalization for HOCM during the same period (i.e., the control group). We performed 1:1 PS matching using age, sex, race/ethnicity, source of payment, season and year of starting event follow-up (i.e., the day of SRT or the index hospitalization), and Elixhauser comorbidity measures. The primary outcomes were (1) acute CV event (i.e., emergency department visit or unplanned hospitalization for CV disease) during 1-360 days and 361-720 days and (2) 7-, 15-, 30-, 180-, and 360-day all-cause mortality. We compared the risk of the outcome event using logistic regression models. Results: The analytic cohort consisted of 690 patients with HOCM (i.e., 345 PS-matched pairs). The SRT group had a lower risk of acute CV event during 361-720 days (OR 0.44; 95% CI, 0.20-0.97; P=0.04) but a higher risk of 7-day mortality (11 vs. 2 in the control group; P=0.03). The SRT group had a non-significant trend towards lower all-cause mortality in longer terms ( Figure ). Conclusion: In this population-based PS-matched study of patients with HOCM, SRT was associated with a reduced risk of acute CV events in the second post-procedure year at the sacrifice of a short-term increase in all-cause mortality.

Predicting hospital outcomes with the reported edmonton frail scale-Thai version in orthopaedic older patients.

Aims and objectivesTo test the ability of the Reported Edmonton Frail Scale‐Thai version to predict hospital outcomes compared with standard preoperative assessment measures (American Society of Anesthesiologists physical status classification and the Elixhauser Comorbidity Measure) in older Thai orthopaedic patients.BackgroundFrailty is a common geriatric condition. No previous studies have assessed frailty among orthopaedic patients in Thailand. Effective frailty screening could enhance quality of care.DesignProspective cohort study in a university hospital.MethodsTwo hundred hospitalised patients, aged 60 years or older and scheduled for orthopaedic surgery, participated in the study. Frailty was evaluated using the Reported Edmonton Frail Scale‐Thai version. Multiple Firth logistic regression was used to model the effect of frailty on postoperative complications, postoperative delirium and discharge disposition. Length of stay was examined using Poisson regression. Comparing predictability of the instruments, the area under the receiver operating characteristic curve and mean squared errors were evaluated. The STROBE guideline was used.ResultsParticipants’ mean age was 72 years; mostly were female, frail and underwent knee, spine and/or hip surgery. Poor health outcomes including postoperative complications, postoperative delirium, and not being discharged to the home were commonly identified. The length of stay varied from three days to more than ten weeks. Frailty was significantly associated with postoperative complications, postoperative delirium and prolonged length of stay. The Reported Edmonton Frail Scale‐Thai version revealed good performance for predicting postoperative complications and postoperative delirium and was improved by combining with standard assessments.ConclusionThe Reported Edmonton Frail Scale‐Thai version, alone or combined with standard assessment, was useful for predicting adverse outcomes in older adults undergoing orthopaedic surgery.Relevance to clinical practiceThese findings indicate that nurse professionals should apply culturally sensitive frailty screening to proactively identify patients’ risk of frailty, improve care quality and prevent adverse outcomes.

The Australian Injury Comorbidity Indices (AICIs) to predict in-hospital complications: A population-based data linkage study.

Hospital-admitted patients are at risk of experiencing certain adverse outcomes during their hospital-stay. Patients may need to be admitted to the intensive care unit or be placed on the ventilator while there is also a possibility for complications to develop. Pre-existing comorbidity could increase the risk of these outcomes. The Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Measure (ECM), originally derived for mortality outcomes among general medical populations, are widely used for assessing these in-hospital complications even among specific injury populations. This study derived indices to specifically capture the effect of comorbidity on intensive care unit and ventilator use as well as hospital-acquired complications for injury patients. Retrospective data on injury hospital-admissions from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia was analysed. Results from multivariable regression analysis were used to derive the Australian Injury Comorbidity Indices (AICIs) for intensive care unit and ventilator hours and hospital-acquired complications. The AICIs, CCI and ECM were validated on data from Victoria and two other Australian states. Five comorbidities were significantly associated with intensive care unit hours, two with ventilator hours and fifteen with hospital-acquired complications for hospitalised injury patients. Not all diseases listed in the CCI or ECM were found to be associated with these outcomes. The AICIs performed equally well in terms of predictive ability to the long-listed ECM and in most instances outperformed the CCI. Associations between outcomes and comorbidities vary based on the type of outcome measure. The new comorbidity indices developed in this study provide a relevant, parsimonious and up-to-date method to capture the effect of comorbidity on in-hospital complications among admitted injury patients and is better suited for use in that context compared to the CCI and ECM.

The Multiple Sclerosis Comorbidity Index as a Tool for EDSS Prediction: Comparison to the Charlson Comorbidity Index and Elixhauser Comorbidity Measure (2579)

The Multiple Sclerosis Comorbidity Index as a Tool for EDSS Prediction: Comparison to the Charlson Comorbidity Index and Elixhauser Comorbidity Measure (2579)