Healthcare Cost And Utilization Project Nationwide Inpatient Sample Research Articles

The effects of smoking on pregnancy risks in women with polycystic ovary syndrome: a population-based study.

Is there is an association between smoking and pregnancy complications in pregnant women with polycystic ovarian syndrome (PCOS)? There is an increased risk of developing gestational diabetes mellitus (GDM) among women with PCOS who smoke. Smokers are at increased risk of developing Type 2 Diabetes Mellitus (DM). Given the common pathophysiology and shared risk factors between type 2 DM and GDM, we sought to assess whether an association between smoking and the development of GDM exists. This is a retrospective population-based study utilizing data from the HCUP-NIS over 11 years from 2004 to 2014. Pregnant women with PCOS who did smoke were compared to pregnant women with PCOS who did not smoke. A second comparison was made between pregnant smokers with and without PCOS. Of the 443 590 women who smoked during pregnancy and the 14 882 women with PCOS, 631 women were both smokers and diagnosed with PCOS. The Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) is the largest inpatient sample database in the USA and is composed of hospital inpatient stays submitted by hospitals throughout the entire country. Each year, the database provides information relating to 7 million inpatient stays, including patient characteristics, diagnosis and procedures. The data are representative of ∼20% of admissions to US hospitals across 48 states and the District of Columbia. There were no differences in the risks of preterm delivery (aOR1.2; CI 0.8-1.9), placental abruption (aOR1.1; CI 0.4-3.2), pregnancy induced hypertension (aOR1.0; CI 0.7-1.5), rate of operative vaginal delivery (aOR1.5; CI 0.9-2.5) and rates of cesarean section (C/S) (aOR1.0; CI 0.7-1.3) between smoking and non-smoking women with PCOS. A significant association between smoking and GDM was observed in women with PCOS (aOR1.5; CI1.01-2.1). The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. Data regarding smoking and PCOS diagnosis could be skewed due to patients' underreporting, lack of documentation and documentation differences. The public health implications of confirming smoking as a risk for GDM among women with PCOS are many. This can lead to earlier screening in pregnancy of smokers for GDM. Earlier initiation of interventions could decrease fetal complications and possibly have an impact on the life and long-term health of the offspring. Future studies are needed in order to assess whether smoking cessation during pregnancy decreases the risk of GDM in that gestation. No external funding was used. The authors report no competing interests. N/A.

Percutaneous Coronary Interventions in Patients Supported with Left Ventricular Assist Devices

<h3>Purpose</h3> More than half of patients with advanced heart failure (HF) requiring left ventricular assist device (LVAD) support have severe ischemic cardiomyopathy, yet the incidence, indications, and outcomes of coronary interventions in the LVAD population are unknown. The objective of this study was to describe outcomes of percutaneous coronary interventions (PCI) in LVAD patients. <h3>Methods</h3> Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS), we identified LVAD patients who underwent diagnostic coronary angiography from 2015-2017. The index admission for LVAD implantation was excluded. Baseline characteristics and in-hospital outcomes of those who underwent PCI vs. diagnostic catheterization only were described. <h3>Results</h3> A total of 33,456 admissions for LVAD patients were identified. Coronary catheterization was performed in 3,830 admissions (11.5%) and 260 of these resulted in PCI (6.8%). Overall, patients were more commonly men (77.3%), white (62.3%), with a high burden of comorbidities based on Elixhauser index ≥3 (99.3%). Acute myocardial infarction (AMI) (83%) was the most common indication for PCI; 35.6% were identified as a ST-elevation MI and 40% presented with or developed cardiogenic shock. Among patients undergoing PCI, the median length-of-stay was 6 days (IQR 4-10) and in-hospital mortality was 15.4%. Among patients undergoing diagnostic catheterization only, the median length-of-stay was 10 days (IQR 5-18) and in-hospital mortality was 4.3%. Other in-hospital outcomes are described in <b>Table 1</b>. <h3>Conclusion</h3> Although PCI procedures are uncommon in LVAD patients, they may be appropriately performed in severe AMI cases. PCI in LVAD patients is associated with significantly high in-hospital mortality. Further studies are warranted to better characterize the risk and outcomes of CAD progression in LVAD patients, as well as the utility of PCI in this complex population.

Anxiety Linked to Hypertensive Disorders in Pregnancy

Back to table of contents Previous article Next article Clinical & ResearchFull AccessAnxiety Linked to Hypertensive Disorders in PregnancyTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:12 Jan 2021https://doi.org/10.1176/appi.pn.2021.12a11AbstractRates of comorbid anxiety and preeclampsia increased nearly sixfold over 10 years.Pregnant women who have anxiety may be at increased risk for hypertensive disorders of pregnancy such as gestational hypertension, preeclampsia, and eclampsia, suggests a study in the Journal of Affective Disorders.Women should be screened for mental disorders in the first trimester of pregnancy, says Tuong-Vi Nguyen, M.D., M.Sc.McGill University“Mental health screening should be considered in the first trimester of the pregnancy if it is to be used prospectively to prevent hypertensive disorders of pregnancy and mental health disorders in the postpartum period,” study researcher Tuong-Vi Nguyen, M.D., M.Sc., told Psychiatric News. She is an assistant professor and a reproductive psychiatrist at McGill University in Montreal.The researchers analyzed data from a population-based retrospective study involving nearly 9.1 million pregnant women using Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) data from 2004 through 2014. This database samples 20% of all discharges from community hospitals in the United States except for long-term care and rehabilitation facilities. For their analysis, the researchers used ICD-9 codes for gestational hypertension, preeclampsia, and eclampsia and categorized mental disorders as bipolar disorder, depression, mood disorder, and anxiety disorder as well as mental disorders of mother, antepartum condition, or complication.The rapid increase in rates of comorbid mental health disorders and hypertensive disorders in pregnancy are a call to action for health care professionals, says Eva Suarthana, M.D., Ph.D.McGill UniversityPregnant women who had anxiety had a 32% greater risk of gestational hypertension, a 52% greater risk of preeclampsia, and an 81% greater risk of eclampsia compared with pregnant women who did not have anxiety. The rate of pregnant women with anxiety disorder and gestational hypertension increased from 1.75 per 10,000 women in 2004 to 12.99 per 10,000 women by 2014. At the same time, the rate of pregnant women with anxiety and preeclampsia increased from 2.21 to 12.85 per 10,000 women.“In the past decade people have become more aware of and open about mental health problems, so I personally expected to see an increasing trend,” said senior author Eva Suarthana, M.D., Ph.D., an adjunct professor in the Obstetrics and Gynecology Department at McGill University and a researcher at McGill University Health Center in Montreal. “Nevertheless, I was still surprised to see such a remarkable increase and thought that health care professionals need to do something about this concerning trend.”The researchers found that having depression did not consistently increase the risk of hypertensive disorders in pregnancy. Pregnant women with depression had a 15.6% greater risk of gestational hypertension and a 25.5% greater risk of preeclampsia than those who did not have depression, but they did not appear to have an increased risk of eclampsia.The medical literature supports actively treating pregnant women with psychiatric disorders to wellness, says Jennifer Payne, M.D.Rouse Photography Group LLCJennifer Payne, M.D., an associate professor of psychiatry and behavioral sciences and the director of the Women’s Mood Disorders Center at Johns Hopkins Medicine, said there is no harm in psychiatrists screening their pregnant patients who have anxiety for hypertension.“Technically, the patients’ OB-GYNs are screening them regularly, [but] it never hurts to have more screening, particularly if a psychiatrist is prescribing a medication that can raise blood pressure,” said Payne, who was not involved in the research.Payne emphasized the importance of psychiatric treatment in this population.“In general the literature currently supports actively treating pregnant women with psychiatric disorders, including anxiety, to wellness. Untreated psychiatric disorders are not benign in pregnancy,” Payne said.This study was supported in part by the Academic Enrichment Fund of the Department of Obstetrics and Gynecology at McGill University. ■“Pregnancy Hypertension and Its Association With Maternal Anxiety and Mood Disorders: A Population-Based Study of 9 Million Pregnancies”. ISSUES NewArchived

Risk Factors and Cardiovascular Disease (CVD) Related Outcomes in Hospitalized Patients with Hemophilia 10 Year Follow up

Introduction: Comprehensive management for patients with hemophilia has drastically improved outcomes, quality of care, and longevity. Because of increases in life span, patients with hemophilia may be at risk for other chronic conditions including cardiovascular disease (CVD). Though initially it was thought that hemophilia might have been protective for cardiovascular disease further research has shown that CVD remains a significant risk for the aging hemophilia population. This study aims to determine the prevalence of risk factors and outcomes for CVD in hospitalized adult and pediatric patients with the discharge diagnosis of Hemophilia A or B compared to patients without Hemophilia. We examine longitudinal changes over the previous decade. WMethods: The Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) was utilized for analysis of years 2007 and 2017. The NIS uses a stratified probability sample of 20% of all inpatient discharges (representing more than 97% of the US population). Hemophilia-A and B were identified using ICD-9 code 286.0 and 286.1, ICD-10 codes D66 and D67 respectively and sampling weights were applied to generate nationally representative estimates. Cardiovascular risk factors and outcomes were determined by evaluating ICD-9 codes for 2007 data and ICD-10 codes for 2017 data. For comparative historical data, 2007 NIS data from a prior published study [Goel et al., Hemophilia (2012), 18, 688-692] were used. The NIS is a de-identified, publicly available data set. This study was deemed exempt from review from the Johns Hopkins Institutional Review Board. This analysis was conducted in accordance with the HCUP data use agreement guidelines. Results: In 2017, there were 10,555 admissions with Hemophilia A or B listed as one of all diagnoses. The mean age of hemophilia patients was 44.31 years compared to 49.57. years for all admissions. The most prevalent risk factor in 2017 was hypertension (32.4% for admissions with hemophilia as compared to 35.3% for all admissions) followed by hyperlipidemia (19.4% compared to 27.5%), diabetes (17.4% compared to 22.8%) and obesity (10.8% compared to 14.4%). CVD outcomes, in descending order of frequency were atherosclerotic coronary artery disease (11.6% for admissions with hemophilia compared to 16.9% for all admissions), heart failure (10.2% compared to 14.2%), acute myocardial infarction (AMI) (2.2% compared to 3.9%), and stroke (2.2% compared to 2.4% respectively). Comparing to 10 year prior data, in 2007, there were 9,737 admissions with Hemophilia A or B listed as one of all diagnoses. The mean age of hemophilia patients was 30.89 years compared to 47.16 years for all admissions. The most prevalent risk factor in 2007 was hypertension (27.0% in admissions with hemophilia compared to 36.7% for all admissions); followed by diabetes (11.2% compared to 18.5%), hyperlipidemia (9.5% compared to 17%), and obesity (3.6% compared to 5.8%). CVD outcomes, in descending order of frequency were, atherosclerotic coronary artery disease (10.1% compared to 16.7%), heart failure (6.6% compared to 10.8%), AMI (2.1% compared to 2.4%), and stroke (2.0% compared to 1.7%). Between 2007 and 2017 the crude prevalence rates of all CVD risk factors as well as CVD outcomes generally increased for admissions with hemophilia as well as all-cause hospitalizations. Conclusions: The frequency of all CVD risk factors (obesity, diabetes, hypertension, and hyperlipidemia) as well as CVD outcomes (atherosclerosis, congestive heart failure, AMI, and stroke) increased between 2007 and 2017 in hospitalized patients both with and without hemophilia. While the unadjusted prevalence rates for all CVD risk factors and CVD outcomes were less in hospitalized patients with hemophilia compared to the general hospitalized population in both 2007 and 2017, CVD remains a significant risk for the hemophilia population. An improved understanding of the various risk factors will help to improve CVD outcomes in the aging hemophilia population. Disclosures Takemoto: Genentech: Membership on an entity's Board of Directors or advisory committees; Novartis: Other: DSMB Aplastic Anemia Trial.

Mortality and Associated Comorbidities Among Patients Hospitalized for Deep Vein Thrombosis and Pulmonary Embolism in the United States: Results from a Nationally Representative Database

Introduction Venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [PE]) is a cause of significant morbidity and mortality. Over the last decade, there has been an increase in awareness and major advances in early diagnosis and treatment of VTE. This study sought to estimate the mortality and associated diagnoses in hospitalized patients with a primary diagnosis of DVT or PE using a nationally representative database. Methods The 2017 Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) was used for analysis. The NIS uses a stratified probability sample of 20% of all inpatient discharges, representing over 97% of the US population. Sampling weights were applied to hospital discharges for DVT and PE using applicable ICD-10 codes to generate nationally representative estimates. Pearson's chi-squared test and the Mann-Whitney U test were used for comparisons to assess statistical significance. Results Of the nearly 36 million hospital admissions in 2017, 579,860 had DVT included in the index list of diagnoses during the hospitalization, and 105,635 had DVT as the primary admission diagnosis. Within the primary DVT admissions (median age (interquartile range (IQR)): 64 years (51-77)), 102,505 were acute DVT, and 3,130 were chronic DVT. There were 376,140 admissions with PE as one of all diagnoses and 188,245 with PE as the primary admission diagnosis. Among primary PE admissions (median age (IQR): 64 years (52-75)), 16,205 (8.6%) were saddle PE (Figure 1a). Overall, there were 826,155 people diagnosed with PE or DVT as one of any diagnoses, and 129,845 were diagnosed with both DVT and PE. Mortality The all-cause mortality in admissions with a primary diagnosis of DVT (0.8%) was significantly lower than for all other NIS admissions at 1.96% (p&amp;lt;0.001) (Figure 1a). Among primary DVT admissions who had in-hospital mortality, the median age (IQR) at death was 72 years (61-82), which was comparable to 73 years (61-83) for all other NIS hospitalizations. The median (IQR) length of stay (LOS) of primary DVT admissions who had in-hospital mortality was 5 days (3-10). For primary PE admissions, the all-cause mortality (3.0%) was significantly higher than all other NIS admissions (p&amp;lt;0.001). Among the PE admissions, mortality in those with saddle PE (4.2%) was significantly higher than all other PE cases (p&amp;lt;0.001) (Figure 1b). The median (IQR) age at death for PE patients was 71 years (60-81) and was comparable to all other NIS hospitalizations. The median (IQR) LOS for deaths in PE admissions was 3 days (1-7). Besides the known cardiovascular disease risk factors such as hypertension, obesity, smoking, Type 2 diabetes mellitus, and hyperlipidemia, the most common diagnoses in those who died with DVT or PE as a primary diagnosis were acute kidney failure, cancer, and chronic kidney disease (CKD) (Table 1). Health Care Utilization The median (IQR) hospital charges for DVT and PE admissions were $27,476 ($15,053-$54,874) and $29,158 ($17,471-$52,636) respectively. These were comparable to all NIS hospitalizations at $26,841 ($12,969-$54,568). For hospitalizations for DVT and PE resulting in death, the median (IQR) hospital charges were $60,689 ($24,775-$137,830), and $55,218.50 ($29,373-$106,313) respectively which were comparable to all NIS deaths at $56,107 ($23,117-$131,768). Discussion/Conclusions In the United States, DVT or PE was listed as one of the discharge diagnoses in approximately 825,000 admissions in 2017 and was the primary reason for admission in 300,000 cases (0.8% of all admissions). PE was seen more often as a primary cause for hospitalization, while DVT was more often seen as a comorbidity. The all-cause mortality among admissions for PE was greater than that for DVT. The subset of PE patients with saddle embolism had the highest mortality rate of all admissions for VTE. Besides cardiovascular risk factors, cancer, acute kidney failure, and CKD were among the most common comorbidities seen in admissions with PE and DVT that had in-hospital mortality. Disclosures Streiff: Bayer: Consultancy, Speakers Bureau; Portola: Consultancy; Boehringer-Ingelheim: Research Funding; NHLBI: Research Funding; PCORI: Research Funding; NovoNordisk: Research Funding; Sanofi: Research Funding; Dispersol: Consultancy; BristolMyersSquibb: Consultancy; Janssen: Consultancy, Research Funding; Pfizer: Consultancy, Speakers Bureau. Takemoto:Novartis: Other: DSMB Aplastic Anemia Trial; Genentech: Membership on an entity's Board of Directors or advisory committees.

Pregnancy hypertension and its association with maternal anxiety and mood disorders: A population-based study of 9 million pregnancies

BackgroundEvidence on whether anxiety or mood disorders increases the risk of hypertensive disorders of pregnancy (HDP) has been conflicting. We aimed to evaluate the prevalence of maternal mental disorders over time and their associations with HDP. MethodsThis was a population-based retrospective study involving 9,097,355 pregnant women using Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) data from 2004 through 2014. We calculated the prevalence of maternal anxiety, depression, bipolar disorder and mood disorder and trends of gestational hypertension, preeclampsia and eclampsia during the study period. Multivariate logistic regression was used to examine the association between each mental disorder and HDP. ResultsMental disorders showed increasing trends among pregnant women, with anxiety showing the greatest increase in rates. Unadjusted associations suggest all mental disorders increase the likelihood of HDP. When adjusted for sociodemographic characteristics and comorbidities, only anxiety showed consistently increased risk of gestational hypertension (adjusted odds ratio (aOR) 1.324, 95% CI 1.255-1.397), preeclampsia (aOR 1.522, 95% CI 1.444-1.604), with the strongest association with eclampsia (aOR 1.813, 95% CI 1.260-2.610). LimitationsInformation on medication use is not available in the HCUP-NIS database and might have been contributory to our findings. ConclusionsRates of maternal psychopathology are rising in the United States. Our study suggests that pregnant women with anxiety are at increased risk of HDP. Targeted screening for mental disorders as possible clinical risk markers may allow for timely prophylaxis and surveillance for the development of HDP.

Nationwide Patterns of Hemorrhagic Stroke among Patients Hospitalized with Brain Metastases: Influence of Primary Cancer Diagnosis and Anticoagulation

Brain metastases can contribute to a decreased quality of life for patients with cancer, often leading to malaise, neurologic dysfunction, or death. Intracerebral hemorrhage (ICH) is an especially feared complication in patients with brain metastases given the potential for significant morbidity and mortality. We aim to characterize patients with cancer and brain metastases admitted to hospitals nationwide and identify factors associated with ICH. The 2016 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) was queried for all patients with cancer hospitalized with a diagnosis of brain metastases. Admissions with a primary or secondary diagnosis of ICH were further identified. Baseline differences in demographic, clinical, socioeconomic, and hospital-related characteristics between patients with and without ICH were assessed by chi-square, Mann-Whitney U, and ANOVA testing. Multivariable logistic regression was used to identify factors associated with ICH. Weighted frequencies were used to create national estimates for all data analysis. In 2016, a total 145,225 hospitalizations were associated with brain metastases, of which 4,145 (2.85%) had a concurrent diagnosis of ICH. Patients with ICH were more likely to have a longer length of stay (median 5 days vs 4 days, p<0.001) and a higher cost of stay (median $14241.14 vs $10472.54, p<0.001). ICH was found to be positively associated with having a diagnosis of melanoma (odds ratio [OR] 5.01; 95% Confidence Interval [CI] 3.50-7.61) and kidney cancer (OR 2.50; 95% CI 1.69-3.72). Patients on long-term anticoagulation had a higher risk of ICH (OR 1.49; CI 1.15-1.91). Approximately 3% of patients hospitalized with brain metastasis also had a diagnosis of ICH, which was significantly associated with longer length of stay and cost. Patients with melanoma, kidney cancer, and on long-term anticoagulation had a higher risk of ICH. Physicians should consider the risks of anticoagulation carefully for patients with brain metastasis, especially those with melanoma and kidney cancer.

Nationwide Patterns of Hemorrhagic Stroke among Patients Hospitalized with Brain Metastases: Influence of Primary Cancer Diagnosis and Anticoagulation

Brain metastases can contribute to a decreased quality of life for patients with cancer, often leading to malaise, neurologic dysfunction, or death. Intracerebral hemorrhage (ICH) is especially feared complication in patients with brain metastases given the potential for significant morbidity and mortality. We aim to characterize patients with cancer and brain metastases admitted to hospitals nationwide and identify factors associated with ICH. The 2016 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) was queried for all patients with cancer hospitalized with a diagnosis of brain metastases. Admissions with a primary or secondary diagnosis of ICH were further identified. Baseline differences in demographic, clinical, socioeconomic, and hospital-related characteristics between patients with and without ICH were assessed by chi-square, Mann-Whitney U, and ANOVA testing. Multivariable logistic regression was used to identify factors associated with ICH. Weighted frequencies were used to create national estimates for all data analysis. In 2016, a total 145,225 hospitalizations were associated with brain metastases, of which 4,145 (2.85%) had a concurrent diagnosis of ICH. Patients with ICH were more likely to have a longer length of stay (median 5 days vs 4 days, p < 0.001) and a higher cost of stay (median $14241.14 vs $10472.54, p < 0.001). ICH was found to be positively associated with having a diagnosis of melanoma (odds ratio [OR] 5.01; 95% Confidence Interval [CI] 3.50-7.61) and kidney cancer (OR 2.50; 95% CI 1.69-3.72). Patients on long-term anticoagulation had a higher risk of ICH (OR 1.49; CI 1.15-1.91). Approximately 3% of patients hospitalized with brain metastasis also had a diagnosis of ICH, which was significantly associated with longer length of stay and cost. Patients with melanoma, kidney cancer, and on long-term anticoagulation had a higher risk of ICH. Physicians should consider the risks of anticoagulation carefully for patients with brain metastasis, especially those with melanoma and kidney cancer.

Outcomes and Utilization of Therapeutic Hypothermia in Post-Cardiac Arrest Patients in Teaching Versus Non-Teaching Hospitals: Retrospective Study of the Nationwide Inpatient Sample Database (2016).

BackgroundUsing therapeutic hypothermia (TH) reduces the core body temperature of survivors of cardiac arrest to minimize the neurological damage caused by severe hypoxia. The TH protocol is initiated following return of spontaneous circulation (ROSC) in non-responsive patients. Clinical trials examining this technique have shown significant improvement in neurological function among survivors of cardiac arrests. Though there is strong evidence to support TH use to improve the neurologic outcomes in shockable and nonshockable rhythms, predictors of TH utilization are not well-characterized. Our study tried to evaluate TH utilization, as well as the effect of the teaching status of hospitals, on outcomes, including mortality, length of stay, and total hospitalization charges.MethodWe conducted a retrospective analysis of the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) database. Patients with an admitting diagnosis of cardiac arrest, as identified by the corresponding International Classification of Disease, 10th Revision (ICD-10) code for the year 2016 were analyzed. In addition, we identified TH using the ICD-10 procedure code. A weighted descriptive analysis was performed to generate national estimates. Groups of patients admitted to teaching hospitals were compared to those admitted in non-teaching hospitals. Patients were stratified by age, sex, race, and demographic and clinical data, including the Charlson Comorbidity Index (CCI), for these two groups, and statistical analysis was done for the primary outcome, in-hospital mortality, as well as the secondary outcomes, including length of stay (LOS) and total hospitalization charges. Fisher’s exact test was used to compare proportions and student’s t-test for continuous variables. Statistical analysis was completed by linear regression analysis.ResultsA total of 13,780 patients met the inclusion criteria for cardiac arrest admission. The number of patients with cardiac arrest admitted to a teaching hospital was 9285. A total of 670 patients received TH, with 495 admissions to teaching hospitals. The population of females in the hypothermia group was 270. The mean age of patients received TH was 59.4 years. In patients who received TH, 65% were Caucasians followed by Hispanics (16%), with no significant statistical racial differences in groups (p=0.30). The majority of patients with TH in both groups (teaching vs. non-teaching admissions) had Medicare (58.8% vs 49.5%; p=0.75). Hospitals in the southern region had the most admissions in both groups (45.7% and 31.3%), with the northeast region having the least non-teaching hospital admissions (8.5%) and approximately similar teaching hospital admissions in other regions (~22%) (p=0.27). The total number of deaths in this group was 510, out of which 370 were in a teaching hospital. After adjusting for age, sex, race, income, the CCI, hospital location, and bed size, mortality was not significantly different between these two groups (p=0.797). We found increased LOS in patients admitted to teaching hospitals (p=0.021). With a p-value of 0.097, there were no differences in total hospitalization charges in both groups.ConclusionThere were no significant differences in mortality or total hospitalization charge between patients admitted with cardiac arrest to a teaching hospital and received TH as compared to a non-teaching hospital although patients admitted to teaching hospitals stayed longer.

Associations between polycystic ovary syndrome and adverse obstetric and neonatal outcomes: a population study of 9.1 million births.

Does polycystic ovary syndrome (PCOS) confer an independent risk for adverse delivery and neonatal outcomes, based on analysis of the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database? After controlling for all potential confounding effects, women with PCOS are at an increased risk of experiencing preterm pre-labour rupture of membranes (PPROM), pre-term delivery (PTD), placental abruption, caesarean section (C/S) delivery, chorioamnionitis and post-partum maternal infections. PCOS may be associated with an increased risk of adverse perinatal outcomes. However, there remain significant gaps in understanding the correlation between PCOS and important delivery and neonatal complications. This is a retrospective population-based cohort study utilising data from the HCUP-NIS over 11 years from 2004 to 2014. A cohort of all deliveries between 2004 and 2014 inclusively was created. Within this group, all deliveries to women with PCOS were identified as part of the study group (n = 14882), and the remaining deliveries were categorised as non-PCOS births and comprised the reference group (n = 9081906). The HCUP-NIS is the largest inpatient sample database in the USA and it is comprised of hospital inpatient stays throughout the entire country. It provides information relating to 7 million inpatient stays per year, includes ∼20% of admissions, and represents over 96% of the American population. After adjustment for all potential confounders, women with PCOS were more likely to experience PPROM (aOR 1.48, 95% CI 1.20-1.83), PTD (aOR 1.37 95% CI 1.24-1.53) and placental abruption (aOR 1.63, 95% CI 1.30-2.05) and were more likely to deliver by C/S (aOR 1.50, 95% CI 1.40-1.61 (all P < 0.001). Women with PCOS more often developed chorioamnionitis (aOR 1.58, 95% CI 1.34-1.86, P < 0.001) and maternal infections (aOR 1.58, 95% CI 1.36-1.84 (both P < 0.001)). With the exception of multiple gestations (aOR 1.27, 95% CI 1.01-1.62, P = 0.04), there was no difference in the number of women who gave birth to small for gestational age (SGA) infants (aOR 0.97, 95% CI 0.82-1.15, P = 0.72) between the women with PCOS and the reference group. Intrauterine foetal deaths (IUFDs) were also comparable between the two groups (aOR 1.03, 95% CI 0.68-1.59, P = 0.88). However, congenital anomalies were more likely to occur in the offspring of women with PCOS (aOR 1.89, 95% CI 1.51-2.38, P < 0.001). This is a retrospective analysis utilising an administrative database which relies on the accuracy and consistency of the individuals coding the data. There are known limitations in how accurately hospital coding is able to capture perinatal conditions and complications, making it difficult to know with certainty that such events are accurate. Women with PCOS are more likely to experience adverse delivery and neonatal outcomes. It is important to additionally consider the risk of all other co-existing conditions frequently encountered in PCOS women, as these risks are additive and place women with PCOS at significantly increased risk of adverse pregnancy outcomes. No specific funding was obtained for this study. The authors have no conflicts of interest to disclose.

Nationwide patterns of hemorrhagic stroke among patients hospitalized with brain metastases: influence of primary cancer diagnosis and anticoagulation

Brain metastases can contribute to a decreased quality of life for patients with cancer, often leading to malaise, neurologic dysfunction, or death. Intracerebral hemorrhage (ICH) is an especially feared complication in patients with brain metastases given the potential for significant morbidity and mortality. We aim to characterize patients with cancer and brain metastases admitted to hospitals nationwide and identify factors associated with ICH. The 2016 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) was queried for all patients with cancer hospitalized with a diagnosis of brain metastases. Admissions with a primary or secondary diagnosis of ICH were further identified. Baseline differences in demographic, clinical, socioeconomic, and hospital-related characteristics between patients with and without ICH were assessed by chi-square, Mann–Whitney U, and ANOVA testing. Multivariable logistic regression was used to identify factors associated with ICH. Weighted frequencies were used to create national estimates for all data analysis. In 2016, a total 145,225 hospitalizations were associated with brain metastases, of which 4,145 (2.85%) had a concurrent diagnosis of ICH. Patients with ICH were more likely to have a longer length of stay (median 5 days vs 4 days, p < 0.001) and a higher cost of stay (median $14,241.14 vs $10,472.54, p < 0.001). ICH was found to be positively associated with having a diagnosis of melanoma (odds ratio [OR] 5.01; 95% Confidence Interval [CI] 3.50–7.61) and kidney cancer (OR 2.50; 95% CI 1.69–3.72). Patients on long-term anticoagulation had a higher risk of ICH (OR 1.49; CI 1.15–1.91). Approximately 3% of patients hospitalized with brain metastases also had a diagnosis of ICH, which was significantly associated with longer length of stay and cost. Patients with melanoma, kidney cancer, and on long-term anticoagulation had a higher risk of ICH. Physicians should consider the risks of anticoagulation carefully for patients with brain metastases, especially those with melanoma and kidney cancer.

Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.1 million pregnancies.

Does polycystic ovary syndrome (PCOS) confer an independent risk for the development of gestational diabetes mellitus (GDM), gestational hypertension (GHTN) and preeclampsia (PEC) based on analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database. After controlling for all potential confounding effects, women with PCOS are at a 2-fold higher risk of developing GDM, a 50% increased risk for the development of GHTN and a 30% increased risk of developing PEC than women without PCOS. Currently, there is evidence of an increased prevalence of maternal pregnancy complications in women with PCOS. However, there remain significant gaps in understanding how PCOS affects the development of GDM, GHTN and PEC. This is most likely due to the complex, multifactorial etiology of PCOS, its range of potential confounders for pregnancy complications and the variable methodology of studies that have been conducted. To date, the largest meta-analysis on this subject includes 11565 women with PCOS analyzed for their risk of GDM and 5896 patients analyzed for their risk of PEC. This is a retrospective population-based study utilizing data from the HCUP-NIS over 11 years from 2004 to 2014. A dataset of all deliveries between 2004 and 2014 inclusively was created. Within this group, all deliveries to women with PCOS were identified as part of the study group (n = 14882), and the remaining deliveries were categorized as non-PCOS births and comprised the reference group (n = 9081906). The HCUP-NIS is the largest inpatient sample database in the USA and is comprised of hospital inpatient stays submitted by hospitals throughout the entire country. Each year, the database provides information relating to 7 million inpatient stays, including patient characteristics, diagnosis and procedures. The data are representative of ∼20% of admissions to US hospitals across 48 states and the District of Columbia. At baseline, more pregnant women with PCOS were obese (22.3% vs. 3.5%, P < 0.001), had chronic hypertension (HTN) (8.4% vs. 1.8%, P < 0.001), had pregestational diabetes (4.1% vs. 0.9%, P < 0.001) and had treated thyroid disease (12.6% vs. 2.4%, P < 0.001). Women with PCOS were also more likely to have undergone IVF treatment (2.4% vs. 0.1%, P < 0.001), have multi-gestation pregnancies (5.9% vs. 1.5%, P < 0.001), and more multiple gestations (MGs) in the PCOS group were the result of IVF treatment than the non-PCOS groups (12.3% vs. 2.3%, P < 0.001). In all pregnancies, women with PCOS were more likely to develop gestational diabetes (adjusted odds ratio (aOR) 2.19, 95% CI 2.02-2.37), pregnancy associated HTN (aOR 1.38, 95% CI 1.27-1.50, P < 0.001), GHTN (aOR 1.47, 95% CI 1.31-1.64), PEC (aOR 1.29, 95% CI 1.14-1.45) and superimposed PEC (aOR 1.29, 95% CI 1.04-1.59) after controlling for confounding effects (age, race, income level, insurance type, obesity, IVF use, previous cesarean section, chronic HTN, pregestational diabetes, thyroid disease, MG, smoking and recreational drug use). Odds ratios were comparable between all pregnancies and singleton pregnancies only. In women pregnant with multiple fetuses, PCOS only conferred a statistically significant increased risk of developing GDM (aOR 2.33, 95% CI 1.92-2.83, P < 0.001). However, there was a trend toward an increased risk for developing pregnancy associated HTN (aOR 1.92, 95% CI 0.99-1.42, P = 0.058). This is a retrospective analysis utilizing an administrative database which relies on the accuracy and consistency of the individuals coding the data. There are known limitations in how accurately hospital coding is able to capture perinatal conditions and complications, making it difficult to know with certainty that such events are accurate. Pregnant women with PCOS are at increased risk of adverse complications in pregnancy even when they do not present with other coexisting metabolic conditions. Furthermore, it is important to also consider the risk of all other coexisting metabolic conditions frequently encountered in PCOS women, as these risks are additive and place women with PCOS at significantly increased risk for adverse complications in pregnancy. None.

Nationwide Trends of Bowel Obstruction and Intussusception in Endometriosis Patients [11H

INTRODUCTION: One of the complications of endometriosis rarely described is bowel obstruction (BO). The purpose of our study was to evaluate the incidence of BO among women with endometriosis, the trend and the demographic characteristics. METHODS: We used the data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS). We studied women with endometriosis aged 15 to 55-years from 2005-2014. Those with neoplasms in the genitourinary or gastrointestinal system were excluded. RESULTS: Of a total 278,613 women with endometriosis, 1386 had BO or intussusception resulting in an overall incidence of 0.5%. Although the number of hospital admission related to endometriosis were decreasing, there was a significant increase in the incidence of bowel obstruction/intussusception during the time period from 0.3% to 0.9%. Moreover, women with BO tend to be white and with higher income (P&lt;.05). The incidence of BO in those with endometriosis in the pelvic/peritoneum and the intestine were comparable. Also, those with BO tend to have lower BMI (P&lt;.05). In addition, there was no association between diabetes mellitus, hypertension, dyslipidemia or hospital region, and the incidence of BO. CONCLUSION: Although there is a downtrend in the incidence of hospital admission related to endometriosis, the incidence of endometriosis specifically in the intestine or the rectovaginal wall as well as the incidence of bowel obstruction has been slightly increasing.

Venous Thromboembolism in Pregnancy [39L

INTRODUCTION: Venous thromboembolism is one of the leading causes of pregnancy-related maternal death in developed countries. The incidence rate is much higher during the postpartum period with an overall incidence of 2.5 to 9.9 per 1000 METHODS: The data were obtained from the 1999-2015 Health Care Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) and used to carry out a population-based cohort study. The purpose of our study is to trend the rate of VTE during pregnancy and postpartum period and the assessment of the risk factors using a large population-based administrative database from the United States. Logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence intervals (CIs) of demographic and obstetrical determinants of VTEs. RESULTS: The overall incidence of VTE was in an upward trend until 2015 when it reached 20/10,000 pregnancies, with an average case fatality rate of 1.16%. VTE is associated with maternal age above 25, anemia, heart disease, hypertension, obesity, transfusion, C-section, postpartum hemorrhage and PET. Predictors of VTE fatalities included obesity, hypertension, PET, postpartum hemorrhage, PTB and DM. CONCLUSION: VTE is a condition with an increasing in incidence and is associated with a significant maternal morbidity and mortality. Multiple risk factors associated with VTE with obesity being the most significant in our study. Further research targeting risk factors and prevention in pregnancy is warranted.

Associated Co-Morbidities, Healthcare Utilization, and Mortality in Hospitalized Children and Adults with Hemophilia in the United States: Updated Nationally Representative Estimates and a Comparative Analysis

Introduction Hemophilia is one of the most common inherited bleeding disorders. This study aims to estimate associated diagnoses, healthcare utilization, and mortality in hospitalized pediatric and adult patients with hemophilia A and B and evaluate outcome improvement trends. Methods The 2016 Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) was utilized for the analysis. The NIS uses a stratified probability sample of 20% of all inpatient discharges (representing more than 97% of the US population). We applied sampling weights to represent all hospital discharges for hemophilia identified using ICD-10 codes D66 and D67 and generate nationally representative estimates. For comparative historical data, we used 2007 data from a prior published study [Goel et al., Hemophilia (2012), 18, 688-692]. Results In 2016, there were n=10,840 hospital discharges with hemophilia A or B as one of all listed diagnoses (n=1600 as principal diagnosis). Of these, 2445 were children, and 8395 were adults. The median age (interquartile range) was 52 (33-68) years for adults and 5 (1-11) years for children. Associated Diagnoses (Table 1a) The most common associated diagnoses in adults with hemophilia were hypertension (34.7 ± 1.2%), Type 2 diabetes (21.1 ± 1.2%), and hyperlipidemia (18.8 ± 1.0%). Other noteworthy ones include hepatitis C (16.4 ± 1.1%), coronary artery disease (13.3 ± 0.9%), and congestive heart failure (11.1 ± 0.8%). In pediatric hemophilia cases, central line infection and fever (13.5 ± 1.5%), hemarthrosis (10.4 ± 1.3%), and anemia (8.6 ± 1.3%) were the most common discharge diagnoses. HIV/AIDS and hepatitis C were not reported in children and listed in 5.9 ± 0.6% and 16.4 ± 1.1% of adults, with the youngest age at reported diagnosis being 32 and 21 years, respectively. Mortality (Table 1b) The all-cause in-hospital mortality was 1.9% for hemophilia related admissions, which was comparable to all NIS hospitalizations at 1.9%. The median age at death in years (interquartile range) for hemophilia patients was 72 (57-78) and comparable to 73 (61-83) for all hospitalizations. The most common diagnoses associated with mortality included respiratory failure, "do not resuscitate" status, and sepsis. There was no inpatient mortality reported in children, and the youngest age for in-hospital death was 27 years. Health Care Utilization 96.0% of all hemophilia admissions had insurance coverage with the distribution as follows: Medicare: 33.4%, Medicaid: 28.8%, private insurance: 28.6%. For all NIS hospitalizations, 96.1% had coverage (Medicare: 39.6%, Medicaid: 23.1%, private insurance: 30.1%). The median hospital stay length per hemophilia admission was 3 days (2-6) and was similar to all hospital stays at 3 days (2-5). The median hospital charge per hemophilia admission was $50,662 as compared to $25,261 for all hospital admissions. 2007 Comparison When we compared our data to 2007, serving as a near-decade long follow-up, insurance distribution, inpatient mortality rate, and length of stay were relatively unchanged. Amongst the most common diagnoses for adults with hemophilia were hypertension (up from 28.1% to 34.7%), hepatitis C (down from 21.8% to 16.4%), congestive heart failure (up from 8.1% to 11.1%), and HIV/AIDS (stable at 5.6% and 5.9% respectively). In both 2007 and 2016, there were no HIV or hepatitis C cases amongst children with hemophilia. Notably, in 2007, there were more bleeding related diagnoses, such as hematuria and hemorrhages. There was no inpatient mortality for children in 2016, while there were 15 day of life zero deaths (7% mortality rate) in 2007. The median age at death was also greater in 2016 (72 and 68.3 years). Discussion/Conclusions Adult hemophilia hospitalizations were in large part related to non-bleeding complications and age-related co-morbidities. In contrast, catheter-related infections and bleeding remain the top reasons for pediatric admissions. Most hemophilia patients had insurance coverage. The median hospital charge for those with hemophilia was nearly twice that of all-cause hospitalizations. Advancements in hemophilia treatment and outcomes are continuing, as evidenced by the improved mortality rate and median survival range approaching those from all hospitalizations. These changes all cumulatively demonstrate significant treatment and health care advancements in hemophilia management. Disclosures Takemoto: Genetech: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Other: DSMB for aplastic anemia trial.

58 Prevalence, Trend, and Predictors of Opioid Abuse Among Patients With Chronic Pancreatitis

INTRODUCTION: Opioids are a mainstay of chronic pain management however their continued use has become a public-health crisis with potential for abuse and associated adverse outcomes. Patients with Chronic Pancreatitis (CP) suffer from recurrent debilitating pain and are thus susceptible to opioid abuse. We aimed to determine the prevalence, trends and determinants of Opioid Use Disorder (OUD) among hospitalized patients with CP. METHODS: Patients with OUD were identified in the Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS), 2007–2014 and the temporal trend of OUD was analyzed and compared among patients with and without CP. We then extracted patients with a discharge diagnosis of CP from HCUP-NIS 2012–2014 and identified the characteristics of OUD in these patients. Predictors of OUD was evaluated using multivariate logistic regression models (SAS 9.4). RESULTS: 87,068 patients with a primary diagnosis of CP were identified, of which 3,008 (3.45%) had concomitant OUD. With an average annual increase of 29.4 cases per 10,000 hospitalizations vs. 10.6 cases per 10,000 hospitalizations, the rate of OUD in CP patients is increasing at a steeper rate than patients without CP. Predictors of OUD were young age, females, Medicare or Medicaid insurance, mental health disorders, non-opioid substance abuse and comorbid conditions such as arthritis, back pain and headache. The northeast region, urban and large bed size hospitals also have higher odds of OUD. CONCLUSION: OUD affects a significant proportion of patients with CP and occurs at an increasing rate; almost 3 times the rate of those without CP. A better recognition of predisposing pre-existing demographic and clinical variables among at-risk individuals may help guide the utilization of opioids in this patient group, slowing and potentially reversing the rates of OUD.

COMPARISONS OF OUTCOMES WITH AND WITHOUT HIV IN ATRIAL FIBRILATION

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: With the advent of anti-retroviral therapy, human immunodeficiency virus (HIV) infection is now becoming a chronic disease. At the end of 2015 the prevalence of HIV was estimated to be 1.1 million persons aged 13 or more according to the CDC. Literature has demonstrated that HIV infection is associated with myocardial infarction, heart failure as well as ischemic stroke. It is not as widely represented in literature between the correlation of HIV as well as atrial fibrillation (AF). We propose a study to evaluate and identify patient outcomes of those with HIV infection and AF. METHODS: We conducted a retrospective analysis of the Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS) database. Patients with atrial fibrillation were queried from hospital admissions between 2007 and the September 2015. This was by use of the International Classification of Disease 9th revision (ICD-9) code of ‘472.31’ in all discharge diagnoses. Diagnosis of HIV was queried using the Clinical Classification Software code of ‘5’. Using the statistical software SAS, weighted descriptive analyses were completed to produce national estimates. Variables of hospitalization charges, in-hospital mortality, length of stay, number of procedures during hospitalization, income quartile by zip code and Elixhauser comorbidity index scores were evaluated. SAS was also used for ANOVA with Turkey analysis. RESULTS: Between the years 2007 and September 2015, there was a total of 30,395,295 admissions with AF in the US. Of this, 45,037 patients carried a diagnosis code for HIV. Inpatient mortality for HIV patients was 5% compared to 4.45% without HIV (p<0.05). The mean length of stay for HIV patients was 6.85 vs 5.69 days without HIV (p<0.05). The total charges billed was $62,278 for HIV patients and was $46,293 for without HIV infection (p<0.05). The average number of procedures for those with HIV was higher at 2.12 vs 1.68 for those without (p<0.05). The average household income for those with HIV was 2.04 and those without HIV was 2.45 (p<0.05). Elixhauser mortality index for those with HIV was 8.32 and those without HIV was 7.86 (p<0.05). The mean readmission risk score for those with HIV was 30.41 and those without HIV was 18.73 (p<0.05). CONCLUSIONS: Overall, the outcomes for patients with AF were worse when they had co-infection with HIV. This resulted in longer length of stay, more mortality, higher hospital charges, more procedures along with increased mortality and readmission index scores. It reasonable to say that with HIV becoming a more attributed as a chronic disease, that it may be considered as a risk factor in risk scores such as CHADSVASc. CLINICAL IMPLICATIONS: Further research is needed in the realm of HIV and Atrial Fibrillation to identify the underlying reasons for the above differences and determine if there is a direct pathophysiology between HIV and atrial fibrillation. DISCLOSURES: No relevant relationships by Kathir Balakumaran, source=Web Response No relevant relationships by Anantha Sriharsha Madgula, source=Web Response No relevant relationships by Anand Muthu Krishnan, source=Web Response No relevant relationships by Rudra Ramanathan, source=Web Response No relevant relationships by Varun Tandon, source=Web Response

990 The Association of Obstructive Sleep Apnea and Nonalcoholic Steatohepatitis: A Nationwide Inpatient Sample Analysis

INTRODUCTION: Obstructive sleep apnea (OSA) has been suggested to be a potential contributing factor for nonalcoholic steatohepatitis (NASH). The oxidative stress caused by chronic intermittent hypoxia is known to play a vital role in the pathogenesis of NASH. There is conflicting data in the literature regarding the association of OSA and NASH. The primary purpose of this study was to determine the association of OSA and NASH from a large national inpatient sample database. METHODS: We conducted a retrospective analysis using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). NASH patients were identified by ICD-10-CM code K75.81. Non-NASH patients (control) were randomly selected and matched to each NASH patient 4:1 by age and gender. Weighted logistic regression models were used to calculate the association between OSA and NASH for different comorbidities. RESULTS: A total of 54,169 patients were included in our analysis, 10,740 cases of NASH were matched to 43,429 controls (non-NASH). NASH was significantly higher in the white population (82.12% vs. 76.64%, P &lt; 0.001). The prevalence of NASH among OSA patients was significantly higher compared to the non-OSA group (15.8% vs. 8.9%; adjusted OR: 1.34, 95% CI: 1.14–1.56, P = 0.0003). Celiac disease and Crohn’s disease were significantly higher in patients with NASH (0.7% vs. 0.2%, P &lt; 0.0002 and 1.28% vs. 0.76%, P &lt; 0.0001). Multiple comorbidities were significantly elevated in the NASH group compared to the non-NASH group including diabetes mellitus (36.0% vs. 17.6%, P &lt; 0.0001), obesity (36.4% vs. 18.2%, P &lt; 0.0001) and metabolic syndrome (0.86% vs. 0.06%, P &lt; 0.0001). Mortality rate was significantly higher in the NASH group (3.8% vs. 2.0%, P &lt; 0.0001). CONCLUSION: This is the first study using ICD-10-CM code with a specific search code for NASH. Our large population database results emphasize that there is a significant association between OSA and NASH. This important association should prompt physicians to evaluate for the presence of NASH in OSA patients. Additional studies are needed to evaluate this association and the effect of OSA treatment on NASH.

HEALTHCARE DISPARITIES IN HEART FAILURE BETWEEN CAUCASIAN AND ASIAN POPULATIONS IN THE UNITED STATES

SESSION TITLE: Monday Electronic Posters 2 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Healthcare disparities are a growing public health concern. Literature has shown that 30.6% of direct medical expenditures for African-Americans, Asian-Americans, and Hispanics were excess-costs due to health inequalities. Heart failure (HF) admissions are frequently cited as a prime example of how health inequalities can lead to increased hospitalizations and readmissions. Since HF is a frequent admission diagnosis and there is concern for healthcare disparities, we investigated whether there are cost differences between Caucasians (standard population) and Asians for HF admissions. METHODS: We conducted a retrospective analysis by use of the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) database. Patients with HF were selected from hospital admissions between 2009 and 2004. The clinical classifications software (CCS) code of 108 was used to query all HF hospitalizations, including those with reduced and preserved ejection fraction. Using the statistical software SAS, weighted descriptive analyses were completed to produce national estimates of US hospitalizations. Variables of age, hospitalization charges, in-hospital mortality, length of stay, number of procedures during hospitalization, income quartile by zip code and Elixhauser comorbidity index scores were evaluated. SAS was also used for ANOVA with Tukey analysis. RESULTS: Between 2009 and 2014, there were a total of 5,491,051 HF admissions in the United States. Of this, 3,458,333 patients were Caucasian and 91,700 were Asians. The mean age of hospital admission was 75.76 for Caucasians and 71.4 for Asians (p< 0.05). The total charge billed at the time of discharge was $38,034 for Caucasians and $59,668 for Asians (p<0.05). Inpatient mortality for Caucasians was 3.54% versus 3.01% for Asians (p<0.05). The mean length of stay for Caucasians was 5.16 days versus 5.33 days for Asians (p<0.05). The average number of procedures was 1.02 for Caucasians and 1.36 for Asians (p<0.05). In terms of income, the average quartile by zip code was 2.41 for Caucasians and 2.87 for Asians (p<0.05). Lastly, the average Elixhauser comorbidity score was 5.96 and 6.94 (p<0.05) respectively for Caucasians and Asians. CONCLUSIONS: Overall, there was a 57% increase in cost of HF admissions for Asians than Caucasians. Interestingly, the age of presentation was earlier for Asians and they experienced less mortality. The increased charges may be reflective of a longer length of stay and increased number of procedures. Given the increased Elixhauser mortality score, it is possible that Asians are receiving more advanced therapies and medications not used for typical HF admissions, causing higher costs. CLINICAL IMPLICATIONS: Further research should be done to identify the underlying causes of these cost differences to decrease this healthcare disparity. Additionally, contributing risk factors for HF admissions should be further studied. DISCLOSURES: No relevant relationships by Kathir Balakumaran, source=Web Response No relevant relationships by Andre Gabriel, source=Web Response No relevant relationships by Varun Tandon, source=Web Response No relevant relationships by Aysha Tandon, source=Web Response

Nationwide Patterns of Pathologic Fractures Among Patients Hospitalized with Bone Metastases

Bone metastases can significantly affect quality-of-life, especially if they lead to pathologic fractures. However, it is unclear which patients are more likely to develop pathologic fractures when they have bone metastases. We aim to determine risk factors for pathologic fracture among those who are admitted with bone metastases and to evaluate the association of pathologic fracture with clinical and economic outcomes. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) was queried for all patients hospitalized with bone metastases and pathologic fractures in 2016. Baseline differences in demographic, clinical, socioeconomic, and hospital-related characteristics between patients with and without fractures were assessed by chi-square and ANOVA testing. Multivariable logistic regression was used to identify factors associated with fractures. Weighted frequencies were used to create national estimates for all data analysis. In 2016, 272,275 hospital admissions were associated with a diagnosis of bone metastases, of which 11.1% were found to have a pathologic fracture. Patients with fractures have a longer length-of-hospital-stay (mean 8.2 vs 6.3 days, p<0.001), and higher cost-of-hospital-stay (mean $23,526 vs $15,377, p<0.001) compared to patients without pathologic fractures. On multivariable analysis, primary cancers associated with increased risk of pathologic facture included multiple myeloma (odds ratio [OR] 2.91; 95% CI = 2.40-3.53), liver & intrahepatic bile duct (OR 1.72; 95% CI = 1.37-2.16), and kidney and renal pelvis cancer (OR 1.39; 95% CI = 1.21-1.60). Comorbidities significantly associated with fracture included osteoporosis (OR 1.68; 95% CI = 1.44-1.96), paralysis (OR 1.35; 95% CI = 1.18-1.55), and drug (OR 1.35; 95% CI = 1.09-1.66) and alcohol abuse (OR 1.33; 95% CI = 1.07-1.65). Approximately 11% of hospitalized patients with bone metastases presented with a concomitant pathologic fracture, which was associated with longer inpatient stay and higher cost. Multiple myeloma and osteoporosis were associated with higher risk of pathologic fracture. These groups may benefit from increased outpatient monitoring, prophylactic stabilization, or early irradiation.