Health Care Utilization Project Nationwide Research Articles

A comparison of obstetric and neonatal outcomes in polycystic ovary syndrome and congenital adrenal hyperplasia: a retrospective analysis of a population database

To investigate potential differences in pregnancy, delivery, and neonatal outcomes between 2 hyperandrogenic conditions in reproductive-aged women: polycystic ovary syndrome (PCOS) and congenital adrenal hyperplasia (CAH). Retrospective population-based study with data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample Database from 2004-2014. Not applicable. A total of 14,881 women with PCOS and 298 women with CAH. Not applicable. Gestational diabetes mellitus, placenta previa, pregnancy-induced hypertension (HTN), gestational HTN, preeclampsia, eclampsia, preeclampsia and eclampsia superimposed on HTN, preterm birth, preterm premature rupture of membrane, abruptio placenta, chorioamnionitis, mode of delivery, maternal infection, hysterectomy, blood transfusion, venous thromboembolism (deep vein thrombosis and pulmonary embolism during pregnancy, intrapartum, or postpartum), maternal death, chorioamnionitis, septicemia during labor, postpartum endometritis, septic pelvic, peritonitis, small for gestational age, congenital anomalies, and intrauterine fetal demise. After adjusting for potential confounders, we found that women with PCOS were at increased risk of developing pregnancy-induced HTN (adjusted odds ratio [OR] = 1.76; 95% confidence interval [CI]: 1.12-2.77) and gestational diabetes (adjusted OR = 1.68; 95% CI: 1.12-2.52) when compared with women with CAH. Contrary women with CAH were at increased risk for delivery via cesarean section (adjusted OR = 0.59; 95% CI: 0.44-0.80) and small for gestational age neonates (adjusted OR = 0.32; 95% CI: 0.20-0.52). To our knowledge, this study is the first to directly compare obstetric and neonatal outcomes between patients with PCOS and CAH. Despite the similar phenotypes and some common hormonal and biochemical profiles, such as insulin resistance, hyperinsulinemia, and hyperandrogenism, our results suggest the existence of additional metabolic pathways implicated in the pathogenesis of pregnancy complications.

How does the need for IVF affect pregnancy complications among multiple gestations? The study of a large American population database including almost 100,000 multiple gestations

ObjectiveThis study’s aim is to compare pregnancy outcomes in multifetal gestations that were conceived spontaneously compared to in vitro fertilization (IVF). Few population-based studies have addressed this topic. Study designThis is a retrospective cohort study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database. Our study cohort included 90,552 multifetal gestations conceived spontaneously and 3219 IVF conceptions, from 2008 to 2014, inclusively. Multivariate logistic regression analyses were performed comparing maternal and neonatal outcomes, whilst adjusting for confounding variables. Subject was conducted using ICD-9 codes for multifetal gestation: 651. X and 76.1 and ICD-9 code for IVF: 23.85. Each pregnancy was included once. Results and conclusionIVF multifetal gestations had increased risk of pregnancy-induced hypertension (aOR 1.31, 95 % CI 1.20–1.43), gestational hypertension (aOR 1.21, 95 % CI 1.04–1.41), preeclampsia (aOR 1.31, 95 % CI 1.19–1.45), gestational diabetes (aOR 1.26, 95 % CI 1.13–1.41) and placenta previa (aOR 1.7, 95 % CI 1.32–2.19). IVF delivery outcomes were more likely complicated by cesarean section (aOR 1.21, 95 % CI 1.10–1.33), preterm premature rupture of membranes (aOR 1.33, 95 % CI 1.16–1.52), chorioamnionitis (aOR 1.71, 95 % CI 1.37–2.14), postpartum hemorrhage (aOR 1.44, 95 % CI 1.26–1.63) and transfusions (aOR 1.48, 95 %CI 1.26–1.74). IVF neonatal outcomes were more likely complicated by small for gestational age (aOR 1.26, 95 % CI 1.12–1.41) and congenital anomalies (aOR 1.82, 95 % CI 1.29–2.57). IVF was not found to increase risks of eclampsia, preterm delivery, operative vaginal delivery, hysterectomy, or intrauterine fetal demise.IVF increased the risk of pregnancy, delivery, and neonatal outcomes in multifetal pregnancies with risks increased from 20 % to 70 %. The role of infertility versus the need for IVF and the type of IVF protocol used should be further evaluated.

Gender, BMI, Patient Comorbidities, and Hospital Characteristics Influence 30-Day Readmission Following Vertical Sleeve Gastrectomy.

Obesity impacts 300 million people worldwide and the number continues to increase. Laparoscopic sleeve gastrectomy (LSG) is one of several bariatric procedures offered to help these individuals achieve a healthier life. Here, we report 30-day readmission rates and risk factors for readmission after gastrectomy. We used the US Healthcare Utilization Project's Nationwide Readmission Database (NRD) from 2016 to 2019 for patients who underwent laparoscopic gastrectomy and evaluated 30-day readmission rates, comparing readmitted patients to non-readmitted patients. Confounder adjusted and unadjusted analysis were proceeded to the potential factors. The study population consisted of 235,563 patients, with a 3.0% readmission rate. Factors associated with a higher readmission rate included older age, male gender, higher BMI, Medicare as the primary payer, longer length of stay, higher total charge, higher Charlson Comorbidity Index, higher Elixhauser-Comorbidity Index, lower household income, non-elective admission type, and non-routine disposition. Additionally, larger hospital bed size, and private, invest-own hospital ownership were associated with higher readmission rates. After adjusting for confounders, several comorbidities and complications were found to be significantly associated with readmission, including ileus, abnormal weight loss, postprocedural complications of digestive system, acute posthemorrhagic anemia, and history of pulmonary embolism (all p < 0.001). Patient characteristics including age, BMI, and payment source, as well as hospital characteristics, can impact the 30-day readmission after LSG. Such factors should be considered by CMS when deciding on penalties related to readmission.

Pregnancy, delivery, and neonatal outcomes among women living with Down syndrome: a matched cohort study, utilizing a population database.

We utilized a population database to address the paucity of data around pregnancy outcomes in women with Down syndrome (DS). We conducted a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample Database over 11years, from 2004 to 2014. A delivery cohort was created using ICD-9 codes. ICD-9 code 758.0 was used to extract the cases of maternal DS. Pregnant women with DS (study group) were matched based on age, race, income, and health insurance type to women without DS (control) at a ratio of 1:20. There were a total of 9,096,788 deliveries during the study period. Of those, 184 pregnant women were found to have DS. The matched control group was 3680. After matching, most of the pregnancy and delivery outcomes, such as pregnancy-induced hypertension, gestational diabetes, preterm premature rupture of membrane, chorioamnionitis, cesarean section, operative vaginal delivery, or blood transfusion were similar between participants with and without DS. However, patients with DS were at increased risk of giving birth prematurely (aOR 3.09, 95% CI 2.06-4.62), and having adverse neonatal outcomes such as small for gestational age (aOR 2.70, 95% CI 1.54-4.73), intrauterine fetal demise (aOR 22.45, 95% CI 12.02-41.93), congenital anomalies (aOR 7.92, 95% CI 4.11-15.24), and fetal chromosomal abnormalities. Neonates to mothers with DS are at increased risk of prematurity and other neonatal adverse outcomes. Hence, counseling patients with DS about these risks and increased antenatal surveillance is advised.

O-269 Reproductive and Neonatal Outcomes in Women with Adenomyosis: A Population-based Study

Abstract Study question Does adenomyosis impact reproductive and neonatal outcomes? Summary answer Adenomyosis increases risk of infertility and pregnancy/delivery complications. Increased surveillance may aid in prevention and/or decreasing risk of maternal and neonatal morbidity and mortality. What is known already Patients with adenomyosis experience greater adverse obstetric and gynecological events which include but are not limited to, infertility and preterm delivery, as well as other adverse gynecological conditions such as endometriosis. Currently, existing literature provides a limited guide regarding obstetric and gynecological surveillance and management of patients diagnosed with adenomyosis. The current study aims at providing an in-depth analysis of a population database to expand and provide evidence-based insight on maternal, pregnancy and neonatal outcomes in women with adenomyosis. Study design, size, duration Retrospective population-based study. Data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database (HCUP-NIS) were extracted from 2004 through 2014 using the ICD-9 codes to create a delivery cohort. Code 617.0 was used to identify women with adenomyosis, and reproductive outcomes were then compared to pregnancies without adenomyosis. A multivariate logistic regression model was utilized to adjust for statistically significant variables (P-value &amp;lt;0.05) Participants/materials, setting, methods Data was obtained from HCUP-NIS databse. Delivery records for the study and control groups were extracted using international classification of diseases Clinical Modification diagnostic codes(ICD-9-CM). The study group consisted of patients with adenomyosis and the control was patients without a diagnosis of adenomyosis. Logistic-regression-analysss was conducted to explore associations between adenomyosis and maternal&amp;neonatal obstetrical outcomes through the estimation of odds ratio (OR) and 95%-confidence intervals(CI). The regression models were adjusted for the potential confounding factors. Main results and the role of chance Of the 9,096,788 deliveries in the study period, 2467 women had adenomyosis. Women with adenomyosis were more likely to be older (P &amp;lt; 0.0001), obese (P &amp;lt; 0.0001), have chronic hypertension (P &amp;lt; 0.0001), thyroid disease (P &amp;lt; 0.0001), pre-gestational diabetes mellitus (P &amp;lt; 0.0001), to have had previous caesarean section (P &amp;lt; 0.0001) and in-vitro fertilization (IVF) (P &amp;lt; 0.0001). Patients with adenomyosis had a statistically significant risk of developing pregnancy induced hypertension, preeclampsia, and placenta previa relative to the controls, after controlling for baseline risk factors; aOR 1.55 (95% CI 1.33-1.82), aOR 1.69 (95% CI 1.38-2.08), and aOR 5.86 (95% CI 4.62-7.43), respectively. Moreover, the rates of abruptio placenta, caesarean section, hysterectomy, post-partum hemorrhage, wound complications, blood transfusions and maternal infection were higher in the adenomyosis group relative to the controls, after controlling for confounding factors, aOR 2.17 (95% CI 1.60-2.95), aOR 21.63 (95% CI 17.99-26.02), aOR 6.39 (95% CI 4.22-9.68), aOR 1.97 (95% CI 1.60-2.42), aOR 2.37 (95% CI 1.52-3.69), aOR 2.25 (95% CI 1.71-2.95), and 1.82 (95% CI 1.39-2.39), respectively. At birth 1.5% of neonates born to adenomyosis patients had congenital anomalies, relative to 0.4% within the controls (aOR 2.94 (95% CI 2.02-4.28)). Limitations, reasons for caution Code were utilized to identify patients with adenomyosis. This may present as a limitation given the possibility that a number of adenomyosis patients were grouped within the controls. Inability to differentiate between severity and extent of adenomyosis, presents as a limitation within the HCUP-NIS database. Wider implications of the findings This is the first study of its kind to provide an in-depth analysis with substantial statistical power and over nine-million deliveries, in order to provide clinical guidance for patient surveillance and management. Trial registration number Not applicable

Pregnancy, delivery and neonatal outcomes among women with diabetic retinopathy

Objectives Diabetic retinopathy is a common microvascular complication of diabetes. Despite that, there are few studies in the literature to address pregnancy, delivery, or neonatal outcomes among women with diabetic retinopathy. Methods We conducted a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample Database over 11 years from 2004 to 2014. A delivery cohort was created using ICD-9 codes. ICD-9 code 250 or 249 was used to extract the cases of maternal diabetic retinopathy. A multivariant logistic regression model was used to adjust for statistically significant variables (p-value ≤ .05). Results There were a total of 9,096,788 deliveries during the study period. Of those, 86 615 pregnant women were found to have Diabetes Mellites (DM). Diabetic retinopathy was present in 1233 of the patients with DM. Diabetic retinopathy increased the likelihood of developing pregnancy-induced HTN (p < .0001), Preeclampsia (p < .0001), and Preeclampsia and eclampsia superimposed on preexisting HTN (p < .0001). In addition, in women with DM, the presence of diabetic retinopathy increased the risk of Preterm delivery (p = .002), cesarean section (p < .0001), requiring transfusion (p < .0001), and undergoing hysterectomy (p = .001), and were less likely to have a spontaneous vaginal delivery (p < .0001). However, the presence of diabetic retinopathy in women with DM did not increase the risk of the fetus being small at delivery, having intrauterine fetal demise, or congenital anomalies. Conclusion Women with diabetic retinopathy should be counseled about their increased risk of pregnancy-induced HTN, preeclampsia, premature delivery, cesarean section, transfusion, and hysterectomy.

O-059 Pregnancy, delivery and neonatal outcomes among women with an arcuate uterus, a large American population based study

Abstract Study question In this study, we evaluated the pregnancy, delivery and neonatal outcomes among women with an arcuate uterus. Summary answer The arcuate uterus is associated with multiple adverse pregnancy outcomes, particularly, increased risk for; cesarean delivery (CS), venous thromboembolism (VTE) and pulmonary embolism (PE). What is known already Congenital uterine anomalies (CUAs) have been associated with poor reproductive outcomes. The arcuate uterus is one of the most common CUAs, however, it is believed to be a variation of normal and should as such have minimal adverse effects on pregnancies. However, the published studies evaluating the effects of arcuate uteri on pregnancy outcomes, involved only small numbers of participants, and were not powered to detect differences, while reporting conflicting results. Study design, size, duration A retrospective population-based study was conducted using data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). Unique in-hospital births occurring between 2010 and 2014 were included. Cases of arcuate uterus were identified using the ICD code 752.36. A total of 3,840,147 control births and 754 in women with an arcuate uterus occurred during the study period. Pregnancies in women with an arcuate uterus were compared to those without CUAs. Participants/materials, setting, methods We assessed hypertensive disorders, gestational diabetes and placenta previa, preterm premature rupture of membranes (PPROM), preterm delivery, placental abruption, chorioamnionitis, delivery mode, bleeding, clotting and wound complications, maternal infections or death. Selected neonatal outcomes included small for gestational age(SGA), intrauterine fetal demise and congenital anomalies. A multivariate logistic regression was used to adjust for confounding effects. IRB approval was not required since the study included only publicly available anonymized data. Main results and the role of chance Women with an arcuate uteri were more likely to be older, Caucasian, with a higher income, and private insurance (P-value &amp;lt; 0.0001 all). They were also more likely to have had a Cesarean in the past, to have pre-gestational diabetes, thyroid disorders, an in-vitro pregnancy and multiple gestations (P-value &amp;lt;0.01 all). Pregnancies associated with the arcuate uterus had higher rates of pregnancy-induced hypertension (PIH) (aOR 1.32, 95% CI 1.03-1.70), preeclampsia (aOR 1.63, 95% CI 1.18-2.24), premature preterm rupture of membranes (PPROM) (aOR 2.86, 95% CI 1.86-4.40), preterm delivery (aOR 1.86, 95% CI 1.45-2.37) and placental abruption (aOR 3.08, 95% CI 1.99-4.77). They also had 10.88 times the odds of delivering via Cesarean (95% CI 8.90-13.30), 4.81 times the odds of suffering from a VTE (95% CI 1.20-19.30) and 15.14 times the odds of having a PE (95% CI 3.76-60.91). Small for gestational age (SGA) neonates were also more common (aOR 2.21, 95% CI 1.58-3.10). Limitations, reasons for caution The database may be affected by recall bias and coding issues. Information on the method of diagnosing arcuate uteri was lacking. However, to our knowledge, this is the largest study looking at the reproductive outcomes with the arcuate uterus. We were powered to adjust results to identified confounding factors. Wider implications of the findings Our study demonstrates that women with an arcuate uterus are at increased risk for certain undesirable pregnancy outcomes. Physicians following these women should be prepared to manage these complications. Since our results differ from those of some smaller cohorts, additional large studies should be undertaken to confirm the results. Trial registration number Not applicable

Patterns in Academic Cosmetic Surgery Practice: Population Differences and Procedure Preferences.

Although growth in cosmetic surgery remains constant in the private setting, academic cosmetic surgery practices are often underdeveloped. Our study aims to determine which patient populations access academic cosmetic surgery services. The 2018 Health Care Utilization Project Nationwide Ambulatory Surgery Sample database was used for data analysis. Encounters for the following American Society of Plastic Surgery top 5 procedures for 2020 were selected: blepharoplasty, breast augmentation, liposuction, rhinoplasty, and rhytidectomy. Patient encounter data were collected because it relates to median income, geographic location, and primary payer status. The 2018 Nationwide Ambulatory Surgery Sample data set contained 44,078 encounters at academic surgical centers for the procedures listed previously. Low-income patients account for 13.7% of academic cosmetic surgery encounters compared with 37.9% for high-income patients. Breast augmentation rates are higher among low-income patients (20.5% vs 17.2%, P < 0.001), and high-income patients undergo rhytidectomy more frequently (5.7% vs 3.0%, P < 0.001). In the academic setting, patients from large metropolitan areas encompass the majority of cosmetic encounters (71.0%), and these patients are more likely to proceed with rhinoplasty, rhytidectomy, and liposuction procedures (P < 0.001). Patients from smaller metropolitan areas undergo blepharoplasty more frequently compared with those from larger metropolitan areas (56.4% vs 41.8%, P < 0.001). Self-pay and privately insured patients comprise the majority of academic cosmetic surgery encounters (40.8% and 29.9%, respectively). Eighty-eight percent of Medicare patients within this cohort underwent blepharoplasty, whereas self-pay patients accessed breast augmentation, liposuction, and rhytidectomy more often than other insured patients. Income status, patient location, and primary payer status play an important role in academic cosmetic surgery access rates and procedure preferences. Academic cosmetic practices can use these insights to tailor their services to the populations they serve.

Incidence and risk factors of bladder injury during cesarean delivery: a cohort study.

To identify risk factors associated with bladder injury during cesarean delivery, and to determine the frequency of associated morbidities. Data obtained from the United States' Health Care Cost and Utilization Project-Nationwide Inpatient Sample were used to conduct a retrospective population-wide cohort study. ICD-9 codes were used to identify women who underwent a cesarean delivery between 1999 and 2015. Subsequently, women were classified based on whether or not they experienced a bladder injury during delivery. Multivariate logistic regression was used to determine predictors of bladder injury in cesarean deliveries and to examine the associated morbidities while adjusting for baseline maternal demographics and clinical characteristics. Of 4,169,681 cesarean deliveries identified, there were 7,627 (0.2%) bladder injuries for an overall incidence of 18 per 10,000. Women ≥ 35years were at greater risk of bladder injury 1.5 (1.4-1.6), as were women with endometriosis 2.0 (1.5-2.7) and Crohn's disease 2.7 (1.7-4.2). Risk of bladder injury increased if the cesarean delivery was associated with placenta previa 2.2 (1.9-2.4), previous cesarean delivery 4.3 (4.1-4.6), failed instrumental delivery 4.1 (3.5-4.8), fetal distress 1.7 (1.6-1.8), failed trial of labor after cesarean delivery 1.3 (1.2-1.4), and labor dystocia 1.7 (1.6-1.8). Cesarean hysterectomies presented the greatest risk for bladder injury 37.0 (33.7-40.6). Bladder injury was associated with an increased frequency of sepsis, venous thromboembolism, peritonitis, blood transfusions and longer hospital stays. Bladder injury during cesarean deliveries is a rare outcome but it is more common among women with certain demographic and clinical characteristics. Among these cases, strategies to prevent sepsis and venous thromboembolism should be considered.

Reproductive and neonatal outcomes in women with unicornuate uterus: a population-based study

Objective: To investigate reproductive and neonatal outcomes in women with unicornuate uterus. Study design: Data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database were extracted from 2010 through 2014 to create a delivery cohort using ICD-9 codes. Code 752.33 was used to identify cases with unicornuate uterus and reproductive outcomes were compared to pregnancies without unicornuate uterus. A multivariate logistic regression model was used to adjust for statistically significant variables (P-value&lt;0.05). Results: Among 3,850,226 deliveries during the study period, 802 women had unicornuate uterus. Patient with unicornuate uterus were more likely to be older (P&lt;0.001), have thyroid disease (P&lt;0.001), previous Caesarean section (P&lt;0.001), and to have had in-vitro fertilization (IVF) (P&lt;0.001). The risk of gestational diabetes, pregnancy induced hypertension, gestational hypertension and preeclampsia were significantly greater in the unicornuate uterus group relative to controls, after controlling for baseline risk factors; aOR 1.32 [95% CI 1.03–1.71], aOR 1.46 [95% CI 1.16–1.85], aOR 1.16 [95% CI 1.22-2.28] and aOR 1.70 [95% CI 1.24-2.32], respectively. Also, the rates of preterm delivery, preterm premature rupture of membranes and caesarean section were higher in the unicornuate uterus group compared to controls after controlling for confounding factors, aOR 3.83 (95% CI 3.19–4.6), aOR 5.11 (95% CI 3.73–7.14) and aOR 11.38 (95% CI 9.16–14.14) respectively. At birth, 11.1% and 2.6% of neonates were small for gestational age in the unicornuate uterus and the control groups, respectively, aOR 4.90, (95% CI 3.87-6.21). Conclusion: Women with unicornuate uterus are at higher risk for pregnancy complications, preterm delivery and having small for gestation age neonates. Women with known unicornuate uterus may benefit from increased surveillance to prevent and/or decrease maternal and neonate morbidity and mortality.

The effect of Cushing's syndrome on pregnancy complication rates: analysis of more than 9 million deliveries

Purpose The purpose of this study to evaluate the risk of Cushing’s syndrome (CS) and maternal and fetal complications using the American Nationwide Inpatient Sample database. Materials and methods This is a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database from 2004 to 2014. We compared pregnancies with CS versus non-CS regarding pregnancy, delivery, and neonatal outcomes using multivariate logistic regression. Results We identified 9,096,788 pregnancies during the study period. Cushing’s syndrome complicated 135 pregnancies at a rate of 1–2 cases per 100,000 births. Cushing’s syndrome subjects were more likely to be older, obese, have private insurance, chronic hypertension, and pre-gestational diabetes (p<.001). The maternal mortality rate was 0.7 and 0.007% in Cushing’s syndrome and control groups, respectively, although due to small numbers of cases, this should be interpreted with caution. Preeclampsia was higher in CS compared to controls after controlling for confounding variables, aOR 2.20. Operative vaginal delivery and blood transfusion rates were higher in CS patients than controls after controlling for confounding factors, aOR 6.49 and 3.09, respectively. The rates of preterm delivery (8.9 versus 7.2%) and gestational diabetes (8.1 versus 5.8%) were not statistically different between CS and control groups. Conclusion Cushing’s syndrome patients begin pregnancies often with maladies making them more at risk for complications including, preeclampsia, blood transfusion, and operative vaginal delivery. These patients might benefit from prevention methods for preeclampsia, and increased surveillance to decrease maternal morbidity and mortality. However, the nature of the database and its limitations, including the lack of information about CS activity and treatments received by patients, warrant careful interpretation of these results.

P–634 The effect of bariatric surgery on PCOS patients’ obstetrical and neonatal outcomes: A population based study

Abstract Study question Does bariatric surgery (BS) decrease the occurrence of adverse obstetrical and neonatal outcomes in morbidly obese women with polycystic ovarian syndrome (PCOS)? Summary answer Patients with PCOS who underwent BS were at lower risk for gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH), than other women with PCOS. What is known already Studies have shown that PCOS in pregnancy is associated with the occurrence of GDM, preeclampsia, PIH, preterm birth (PTB), cesarean section, miscarriage, hypoglycemia, and neonatal death. Patients with PCOS may have an increased risk of obesity compared to the general population, which magnifies the inherent insulin resistance many fold. PCOS patients who underwent bariatric surgery have a marked improvement in menstrual irregularities, hirsutism, T2DM, hypertension, and dyslipidemia. The benefit of bariatric surgery for PCOS patients and the improvement of pregnancy related complications has not been adequately studied, with most studies being small. Study design, size, duration This is a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database from 2004 to 2014. Using multivariate logistic regression analysis, we compared women with PCOS who underwent BS with a control group consisting of pregnant patients with PCOS of all BMIs who had not had weight reduction operations regarding pregnancy, delivery, and neonatal outcomes. Participants/materials, setting, methods The study group included pregnant PCOS patients who underwent BS and the control group consisted of pregnant patients with PCOS; who delivered between 2004 and 2014. Demographic and clinical characteristics, pregnancy, delivery, and neonatal outcomes were compared. Multivariate logistic regression analysis was performed to control for all statistically different (P &amp;lt; 0.05) confounding effects. Each subject was included once per delivery. Main results and the role of chance We identified 9,096,788 pregnancies during the study period. 141 patients had a history of PCOS and underwent BS. The control group was composed of 14,741 patients with PCOS who didn’t undergo BS. Prevalence of PCOS patients who underwent BS increased from 0/1,000 in 2004 to 14.6/1,000 in 2014(p = 0.001). Those who underwent BS were more likely to be older than 35-years(42.6% vs. 18.7%, p &amp;lt; 0.0001), obese at delivery(44.7% vs. 22%, p &amp;lt; 0.0001) and have a history of previous cesarean sections (24.8% vs. 18.2%, p = 0.045). Differences in pre-gestational diabetes (7.1% vs. 4.1%, p = 0.086) and hypertension (12% vs. 8.4%, p = 0.125) .The BS group was less likely to develop PIH (aOR–0.39, 95%CI–0.21–0.72) and GDM( aOR–0.40, 95%CI–0.23–0.70) when compared to the control group. When comparing the PCOS with and without BS; differences in gestational hypertension(95%CI–0.22–1.30), preeclampsia(95%CI–0.19–1.15), spontaneous vaginal delivery (95%CI 0.58–1.3), operative vaginal delivery (95%CI 0.34–1.8), Cesarean section (95%CI 0.79–1.79), post partum hemorrhage (95%CI–0.12–1.94), transfusion (95%CI–0.1–5.22), preterm delivery (95%CI–0.56–1.75) and maternal infection (95%CI–0.27–2.07) were similar. Regarding neonatal outcomes of PCOS with and without BS: small for gestational age babies (95%CI–0.26–2.68), and congenital anomalies (95%CI–0.09–4.52) were similar. Limitations, reasons for caution Limitations of our study include its retrospective design. Information regarding the time interval between the surgical intervention and pregnancy wasn’t available. Nor was information on the type of gastric bypass performed. Wider implications of the findings: Our study demonstrated an association between bariatric surgery in the setting of PCOS patients and a reduced risk of GDM and PIH. Although no differences were noted in other delivery and neonatal outcomes, data was not compared to a group of strictly obese PCOS controls. Trial registration number Not applicable

Pregnancy, delivery, and neonatal outcomes among women with irritable bowel syndrome (IBS) an evaluation of over 9 million deliveries

Objective Evaluate the associations between irritable bowel syndrome (IBS) and pregnancy, delivery, and neonatal outcomes, using a population database cohort. Methods We conducted a retrospective analysis utilizing the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database over 11 years from 2004 to 2014. A delivery cohort was created using ICD-9 codes. ICD-9 code 564.1 was used to extract the cases of IBS. Pregnant women with IBS (study group) were compared to pregnant women without IBS (control). A multivariate logistic regression model was used to adjust for statistically significant variables (p value <.05). Results There were a total of 9,096,788 deliveries during the study period. Of those, 8962 pregnant women were found to have IBS. The prevalence of IBS increased from 47.96 to 172.68 per 100,000 women during the study period. Compared to the control group, women with IBS were more likely to be Caucasian, older, have higher incomes and private insurance plans (p < .0001, in all cases). In addition, they were more likely to be obese, smokers, hypertensive, IVF pregnancies, have multiple gestations, thyroid disorders, chronic interstitial cystitis, fibromyalgia and have psychiatric disorders (p < .0001 in all cases). Women with IBS were more likely to experience pregnancy-induced hypertension (aOR 1.11, 95% CI 1.02–1.21), preeclampsia (aOR 1.23, 95% CI 1.09–1.38), deep venous thrombosis (aOR 2.26, 95% CI 1.12–4.57), and gestational diabetes (aOR 1.1, 95% CI 1.002–1.22) compared to the non-IBS group. Congenital anomalies were encountered in 1.7% of the IBS group compared to 0.4% in the control group (aOR 2.57, 95% CI 2.13–3.09). Conclusion When controlling for confounding effects, IBS is associated with an increased risk for preeclampsia, DVT and increased risk for congenital malformation.

Pregnancy, delivery and neonatal outcomes among women with congenital adrenal hyperplasia: a study of a large US database

Research questionWhat is the association between congenital adrenal hyperplasia (CAH) and pregnancy, delivery and neonatal outcomes, using a population database cohort. DesignRetrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database from 2004–2014. ICD-9 code 255.2 was used to extract the cases of CAH. Pregnancies complicated with CAH were compared with the other pregnancies. All confounding variables were adjusted using multivariate logistic regression, based on any significant differences between the two groups. ResultsA total of 9,096,788 deliveries occurred during the study period. Two hundred and ninety-nine pregnant women had CAH. Chorioamnionitis was higher in CAH compared with controls after controlling for risk factors (adjusted OR 2.67, 95% CI 1.17 to 6.06). The rates of caesarean section and maternal infection were also higher in CAH than controls (adjusted OR 2.10, 95% CI 1.44 to 3.07 and adjusted OR 2.63, 95% CI 1.22 to 5.63, respectively). Risk of gestational diabetes and pregnancy-induced hypertension rates were not significantly different in CAH (adjusted OR 1.53, 95% CI 0.91 to 2.58 and adjusted OR 0.87, 95% CI 0.49 to 1.56, respectively). At birth, 8% and 2.2% of the neonates were found to be small for gestational age in the CAH and the control groups, respectively (adjusted OR 3.37, 95% CI 1.86 to 6.11). Congenital anomalies were encountered in 2.7% and 0.4% in the CAH and control groups, respectively (adjusted OR 5.24, 95% CI 2.31 to 11.90). ConclusionsWomen with CAH were at risk of complications and fetal anomalies. Expected increases in rates of hypertension and gestational diabetes were not encountered. These patients will benefit from surveillance to decrease morbidity.

National Inpatient Sample Database Reveals Pulmonary Artery Catheter Use Decreases Outcomes but Underused in Women

Cardiogenic shock (CS) continues to have high mortality and the influence of pulmonary artery catheters (PAC) in CS patients on a nationwide scale is yet to be well elucidated. We aim to identify the trends and outcomes in CS patients managed with PAC. We conducted a retrospective analysis of the adults with CS using Healthcare Utilization Project Nationwide Inpatient Sample Database from 2009 through 2014 in the United States. A total of 104,455 patients were identified as having the diagnosis of CS during their index hospitalization. Trend analyses were performed using the Cochran-Armitage test of trend for categorical variables, and survey-specific for linear regression for continuous variables. Interestingly, the in-hospital mortality was lower in patients with PAC (29.7 vs 37.6%; p <0.001). Overall, patients with PAC had increased total hospital charges (292,144 vs 171,673 $; p <0.001) and length of stay (16.94 vs 10.78 days; p <0.001). Trends in use in patients requiring PACs were identified (Figure 1). Furthermore, we found a disparity on the use of PACs in CS in which females had less invasive hemodynamic monitoring than males (Figure 2). There has been an increase in the number of patients with CS from 2009 to 2014, and the use of PAC had decreased. PACs were used less in females than in males, although we saw a possible benefit of PACs with in-hospital mortality in CS (p <0.001).

National Patterns of Emergency Department Use for Women with Endometriosis, 2006-2015.

Introduction: Endometriosis is a burdensome chronic condition for which conservative management is often recommended when indicated. Nonetheless, some women seek care for endometriosis in the emergency department (ED). We evaluated trends in ED visits for endometriosis from 2006 to 2015. Materials and Methods: Nationally representative estimates of ED visits for endometriosis by women aged 18-49 were extracted from the Health Care Utilization Project Nationwide Emergency Department Sample into three cohorts by calendar years 2006-2007, 2010-2011, and 2014-Q3 2015. Visits with a principal diagnosis code of endometriosis (International Classification of Disease, 9th Edition, Clinical Modification, code 617.x) were included. Patient and hospital characteristics were compared across cohorts using analysis of variance. Trends in the proportion of ED visits ending in inpatient admission and in mean charges (2015 USD) were assessed using generalized linear models controlling for patient and hospital characteristics. Results: The annual number of ED visits nationally was stable at ∼15,000 visits per year during 2006-2015. From 2006-2007 to 2014-2015, the composition of ED visits shifted away from private pay (42.0% vs. 35.3%) and uninsured (23.6% vs. 16.6%) to Medicaid (26.7% vs. 40.1%) and became more concentrated in metro-teaching hospitals (33.9% vs. 51.9%) (p < 0.001 for all). Inpatient admission rates declined from 20.1% to 9.2% (p < 0.001). Mean ED charges increased from $2458 to $4953 (p < 0.001). Conclusion: During 2006-2015, the number of ED visits for endometriosis remained stable, the inpatient admission/transfer rate declined by half, and mean charges per visit doubled.

765. Pyomyositis in the United States: Trends and Associations From the Healthcare Utilization Project Nationwide Inpatient Sample Database

BackgroundPyomyositis is a spontaneous infection of skeletal muscle that can lead to abscess formation and sepsis. The purpose of our study was to better describe the characteristics, risk factors, and trends of primary pyomyositis in the United States.MethodsThis study is a retrospective review of data from the Healthcare Utilization Project Nationwide Inpatient Sample Database from 2002 to 2014. We systematically searched ICD-9 codes and included diagnoses of infective myositis and/or tropical pyomyositis and excluded progressive myositis ossificans and/or traumatic myositis ossificans. We compiled lists of codes for co-occurring infections, candidate risk factors, and microbiological data. Each group of related ICD-9 codes was combined into a single composite indicator. SAS studio was utilized for analysis.ResultsThe database included a total of 100,790,900 discharges accounting for 482,872,274 weighted discharges with 13,011 pyomyositis cases accounting for 62,657 weighted cases. The patients with pyomyositis were significantly more likely to be younger, male, and have a longer duration of hospitalization. The proportion of discharges with pyomyositis has steadily risen more than 3-fold from 0.0054% to 0.0209%. Of the cases of pyomyositis, a minority had co-occurring deep tissue infections: 16.9% had osteomyelitis and 8.8% had septic arthritis. We found significantly higher rates of co-occurrence with HIV, diabetes mellitus, organ transplant, alcohol abuse, and chronic kidney disease compared with the general hospitalized population, suggesting these as relevant risk factors. When microorganisms were diagnosed, Staphylococus aureus was most common, followed by Streptococcus spp.ConclusionOur study identified a rapid increase in pyomyositis cases in the United States over our 12-year study period. Our results substantiate risk factors for pyomyositis related to immunosuppression and suggest that diabetes mellitus may be an important risk factor in the United States. Identifying causative organisms is helpful for empiric treatment. It is important that clinicians be aware of this emerging diagnosis relevant in both temperate and tropical areas of the globe. Disclosures All authors: No reported disclosures.

PIH55 NATIONAL PATTERNS OF EMERGENCY DEPARTMENT USE FOR WOMEN WITH ENDOMETRIOSIS, 2006-2015

To characterize national trends in emergency department (ED) visits, disposition and charges for endometriosis. ED visits for endometriosis by women aged 18–49 were extracted from the Health Care Utilization Project Nationwide Emergency Department Sample into three cohorts for calendar years 2006–2007, 2010–2011 and 2014–Q3 2015. Visits with a principal diagnosis code of endometriosis (International Classification of Disease, 9th Edition, code 617.x) were included. Visits with a diagnosis of malignant neoplasm of female genital organs were excluded. Patient and hospital characteristics were compared across cohorts using analysis of variance. Trends in the proportion of ED visits ending in inpatient admission or transfer to another hospital and in mean ED charges (2015 US dollars) were assessed using generalized linear models controlling for patient and hospital characteristics. Inpatient admission/transfer was chosen as an outcome representative of potentially preventable admissions. Nationally representative estimates were generated based on survey weights. The annual number of ED visits nationally was stable at approximately 15,000 visits per year during 2006–2015. Mean age was 30 years; 41% of visits were from the South Census region; and 8% had ≥1 Charlson comorbidity. From 2006–07 to 2014–15, the composition of ED visits shifted away from private pay (42.0% vs. 35.3%) and uninsured (23.6% vs. 16.6%) to Medicaid (26.7% vs. 40.1%) and became more concentrated in metro-teaching hospitals (33.9% vs. 51.9%) (p<0.001 for all). Inpatient admission/transfer rates declined from 20.1% to 9.2% (p<0.001). Mean ED charges increased from $2458 to $4953 (p<0.001). Older and privately insured endometriosis patients who visited metro-teaching hospitals were more likely to be admitted/transferred and had higher ED charges. During 2006–2015, the number of ED visits for endometriosis remained stable, the inpatient admission/transfer rate declined by half, and mean charges per visit doubled.

Outcomes of Chronic Pancreatitis in the Emergency Department.

Chronic pancreatitis (CP) is a debilitating chronic illness. We sought to assess the most common reasons patients with CP visit the Emergency Department (ED), the disposition of ED visit [admission, discharge, death], and evaluate predictors of admission and discharge. Within the Health Care Utilization Project Nationwide Emergency Department Sample (NEDS), we focused on patients, 18years and older, presenting to the emergency department with CP (ICD-9 code 577.1) (2006-2009). Model was fitted to predict the likelihood of admission. Overall, a weighted sample of 638,310 patients visits for CP were identified, of which 399,559 (62.6%) were admitted, 228,523 (35.8%) were discharged from the ED, 5572 (0.9%) discharged against medical advice, and 4656 (0.7%) had an unknown destination. Of those admitted, 4370 (0.7%) died during the hospital episode. The most associated diagnoses for ED visit were diabetes (28.8%), abdominal pain (25.4%), acute pancreatitis (22.5%), cardiac complication (11.1%), infection (10.1%), and dehydration (8.8%). Multivariable analyses revealed that older (OR = 1.02 P < 0.001), sicker patients (Charlson Comorbidity Index ≥ 3, OR = 2.28 P < 0.001), patients presenting with C. difficile colitis (OR = 23.85 P < 0.001), alcohol withdrawal (OR = 6.71 P < 0.001), and acute pancreatitis (OR = 6.46 P < 0.001) were associated with increased odds of hospitalization. In this national database, our study demonstrates that diabetes, followed by abdominal pain, acute pancreatitis and cardiac complication, were the most common diagnoses associated with ED visits in patients with chronic pancreatitis. Most patients were admitted following the ED visit. Although C. Difficile colitis was a rare associated diagnosis with an ED visit, it was the strongest predictor of admission.

Emergency Care for Children in the United States: Epidemiology and Trends Over Time

BackgroundThe emergency care system for children in the United States is fragmented. A description of epidemiological trends based on emergency department (ED) volume over time could help focus efforts to improve emergency care for children. ObjectivesTo describe the trends of emergency care for children in the United States from 2006–2014 in EDs across different pediatric volumes. MethodsWe analyzed pediatric visits to EDs using the Health Care Utilization Project Nationwide Emergency Department Sample in a representative sample of 1,000 EDs annually from 2006–2014. We report trends in disease severity, mortality, and transfers based on strata by pediatric volume and other hospital characteristics. ResultsFrom 2006–2014, there were 318,114,990 pediatric ED visits. Pediatric visits remained steady but declined as a percentage of total visits (−3.91%, p = 0.0007). The majority (92.7%) of children were cared for in lower-volume EDs (<50,000 pediatric visits/year), where mortality was higher vs. the highest-volume EDs. Mortality decreased over time (0.34/1,000 to 0.27, p = 0.0099), whereas interhospital transfers increased (p = 0.0020). ED visits increased for children with Medicaid insurance (40.7% to 56.7%, p < 0.0001), whereas rates of self-pay insurance decreased (13.6% to 9.45%, p = 0.0006). The most common reasons for pediatric ED visits were trauma (25.6%); ear, nose, and throat; dental/mouth disorders (21.8%); gastrointestinal diseases (17.0%); and respiratory diseases (15.6%). ConclusionsOverall, pediatric ED visits have remained stable, with lower mortality rates, whereas Medicaid-funded pediatric visits have increased over time. Most children still seek care in lower-volume EDs. Efforts to improve pediatric care could be best focused on lower-volume EDs and interhospital transfers.