Healthcare Cost And Utilization Project Research Articles

Financial Burden of Acute Cerebrovascular Disease in United States Healthcare During 1993–2019 (P6-5.025)

<h3>Objective:</h3> To determine the financial burden of stroke on the national healthcare system for the past three decades. <h3>Background:</h3> Stroke is a leading cause of morbidity and mortality in the United States and has implications on the financial health of patients, families, and healthcare systems. <h3>Design/Methods:</h3> This is a retrospective study of inpatient subjects from 1993–2019 with cerebrovascular disease that was collected from the Healthcare Cost and Utilization Project (HCUP). Patients were evaluated for demographics, length of stay (LOS), mortality, and hospital charges. Statistical Z-testing was conducted for the analysis. <h3>Results:</h3> During the study period, 17,041,026 stroke subjects were studied, with 52.6% female and mean age of 70.62 (± 0.16) years old. The mean rate of stroke discharges per 100,000 persons was 194.46 (± 3.74), with an increase from 203 to 209 during the study (p = 0.22). The mean percentage of deaths was 9.52% (± 0.17), which decreased from 12.87% to 5.52% (p = 0.00). The mean LOS was 6.63 days (± 0.08), decreased from 9.54 to 6.90 during the study (p = 0.00). During the study period, the aggregated national bill was $710 billion. The mean hospital charges per patient were $43,954.23 (± 1,185.90) with an increase from $14,392.06 to $111,279.50 during the study period (p = 0.00). <h3>Conclusions:</h3> Our data show that the rate, LOS, and mortality of stroke have decreased, but its charges are increasing. The improvement in outcomes could be multifactorial such as establishment of comprehensive stroke centers and evolving treatment modalities. Ironically, the charges-per-patient increased nearly eight-fold with a national bill almost equal to the annual Medicare budget. Thus, the significance of preventive medicine, such as controlling hypertension, diabetes, and smoking cessation, cannot be understated. With such a dramatically increasing financial burden, improvements in mitigating risk factors, educational programs, and access to care may be a more cost-effective option. <b>Disclosure:</b> Miss Lorio has nothing to disclose. Miss Malone has nothing to disclose. Dr. Garcia Rodriguez has nothing to disclose. Ali Seifi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Chiesi. Ali Seifi has received intellectual property interests from a discovery or technology relating to health care.

Association Between Hospital-Ascertained Atrial Fibrillation And Central Retinal Artery Occlusion: A Study Of 12 Million Patients (P2-9.003)

<h3>Objective:</h3> To determine whether hospital-ascertained atrial fibrillation (AF) is associated with subsequent central retinal artery occlusion (CRAO). <h3>Background:</h3> Atrial fibrillation is a major risk factor for cerebral ischemic stroke. However, it is not known whether AF predicts the development of central retinal artery occlusion. <h3>Design/Methods:</h3> A retrospective cohort study was undertaken using data from the California Healthcare Cost and Utilization Project (HCUP) State Inpatient and State Emergency Department Datasets (SID/SEDDs). Patients 18 years and older discharged from non-federal hospitals between 2005 and 2011 who did not have a history of CRAO were analyzed. AF and CRAO were identified using validated ICD-9-CM diagnosis codes. Association between AF and CRAO was modeled using a Fine-Gray method with death as a competing risk with adjustment for age, biological sex, race, and vascular comorbidities. <h3>Results:</h3> A total of 12,181,778 patients were included, 806,397 with AF and 11,375,381 without AF. In total, 309 patients had CRAO. In an unadjusted analysis, there was a higher risk of CRAO in patients with versus without AF (HR 2.24 (95% CI: 1.51 to 3.32)). After adjustment for pre-specified covariates, there appeared to be a lower hazard of CRAO in patients with AF (aHR 0.61 (95% CI: 0.45 to 0.98)). Further analyses including cerebral ischemic stroke (aHR 1.16 (95% CI: 1.14 to 1.18)) and specifically embolic stroke (aHR 4.29 (95% CI 4.10–4.48)) as positive controls argued against overadjustment bias. We present sensitivity analyses including CRAO identified in any position of the ICD list, using different ascertainment windows for AF and using broader categories of retinal ischemia. <h3>Conclusions:</h3> The incidence of CRAO was higher in patients with AF than those without AF, but the hazard of CRAO was not higher for patients with AF after adjustment for measured covariates. Endpoint and exposure ascertainment may have been limited by inclusion only of inpatient and emergency department encounters. <b>Disclosure:</b> Mr. Lusk has received research support from American Heart Association. The institution of Ms. Song has received research support from Research to Prevent Blindness. Ms. Unnithan has nothing to disclose. Dr. Al-Khalidi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medpace. Dr. Al-Khalidi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CSL Behring . The institution of Dr. Al-Khalidi has received research support from NIH/NHLBI. Jonathan Piccini has nothing to disclose. Dr. Xian has nothing to disclose. Dr. O’Brien has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boehringer Ingelheim. The institution of Dr. O’Brien has received research support from Pfizer. The institution of Dr. O’Brien has received research support from BMS. Dr. Mac Grory has nothing to disclose.

MP39-20 COST OF URINARY TRACT INFECTIONS WITH AND WITHOUT ANTIBIOTIC RESISTANCE IN THE UNITED STATES FROM 2012-2019

You have accessJournal of UrologyCME1 Apr 2023MP39-20 COST OF URINARY TRACT INFECTIONS WITH AND WITHOUT ANTIBIOTIC RESISTANCE IN THE UNITED STATES FROM 2012-2019 Meera Nagpal, Jacky Chu, and Amy Dobberfuhl Meera NagpalMeera Nagpal More articles by this author , Jacky ChuJacky Chu More articles by this author , and Amy DobberfuhlAmy Dobberfuhl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infections (UTI) are the second most common type of infection in older adults, and serious cases can lead to hospitalization, with severe complications like kidney failure and sepsis. Meanwhile, antibacterial resistance is on the rise, which can impact the severity of hospitalizations and clinical outcomes, as well as hospital costs. In this study, we explore the costs and characteristics associated with UTI hospitalizations with and without multi-drug resistance (MDR). METHODS: Using the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), a longitudinal database of inpatient visits in the United States (US), we conducted a retrospective study of UTI hospitalizations from 2012-2019. Among inpatient visits with UTI as a primary diagnosis, we further examined those with ICD-9 and ICD-10 codes of multi-drug resistance. Demographics associated with inpatient visits were collected, and hospital costs were inflation-adjusted to 2022 US dollars. In addition, we fitted a linear regression model on the variables of sex, race, payment type, length of stay, and age. RESULTS: From 2012 to 2019, the study found an approximately weighted estimate of 23,810 records of UTI hospitalizations, and among those, 595 (2.5%) records had some form of multi-drug resistance. Among UTI records, the mean cost was $7766 and the mean length of stay (LOS) was 4 days. Among UTI with MDR records, the mean cost was $9902 and the mean LOS was 4.8 days. The average cost of UTI hospitalizations increased by 10.2% from 2012 to 2019. Surprisingly, the cost of UTI hospitalizations in multi-drug resistant patients decreased by 45% over this time span. Results from the linear regression model from UTI inpatient visits show that lower costs were most strongly associated with White race (p<0.001), Black race (p<0.001), while higher costs were associated with Asian/Pacific Islander race (p<0.001) and LOS (p<0.001). The linear regression model from UTI with MDR records showed lower costs most robustly correlated with White race (p<0.05), while LOS (p<0.0001) and female sex (p<0.05) correlated with higher costs. CONCLUSIONS: This study found that mean cost of UTI inpatient visits was higher in those with MDR than no MDR. Overall costs have increased over time, and several demographics were associated with varying costs. Future studies should more closely examine the costs associated with MDR and more complicated sequelae of UTIs. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e544 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Meera Nagpal More articles by this author Jacky Chu More articles by this author Amy Dobberfuhl More articles by this author Expand All Advertisement PDF downloadLoading ...

Factors associated with subsequent surgery after septic arthritis of the knee in children.

Septic arthritis of the knee in children is a challenging problem. Surgical debridement is an established treatment, but there is a paucity of literature on long-term prognosis. To determine the rates and factors associated with return to surgery (RTS) and readmission after index surgical debridement for septic arthritis of the knee in children. This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project (HCUP). We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and 2017. Demographic data included age, gender, race, hospital type and insurance type. Clinical data including index admission length of stay (LOS) and Charlson Comorbidity Index (CCI) were available from the HCUP database. Descriptive statistics were used to summarize the data and univariate and multivariate analyses were performed. Nine-hundred thirty-two cases of pediatric septic knee were included. This cohort was 62.3% male, with mean age of 9.0 (± 6.1) years. Approximately 46% of patients were white and approximately half had Medicaid insurance. Thirty-six patients (3.6%) required RTS at a minimum of 2 year after index surgery, and 172 patients (18.5%) were readmitted at any point. The mean readmission LOS was 11.6(± 11.3) d. Higher CCI was associated with RTS (P = 0.041). There were no significant associations in age, gender, race, insurance type, or type of hospital to which patients presented. Multivariate analysis showed that both increased CCI (P = 0.008) and shorter LOS (P = 0.019) were predictive of RTS. Septic arthritis of the knee is an important condition in children. The CCI was associated with RTS at a minimum of 2 years after index procedure. No association was found with age, gender, race, insurance type, or hospital type. Shorter LOS and CCI were associated with RTS in multivariate analysis. Overall, risk of subsequent surgery and readmission after pediatric septic knee arthritis is low, and CCI and shorter LOS are predictive of RTS.

Variability in neurosurgical management and associated comorbidities and complications among preterm patients with posthemorrhagic hydrocephalus in the United States.

Posthemorrhagic hydrocephalus (PHH) remains a major morbidity of premature birth resulting from intraventricular hemorrhage (IVH). National consensus guidelines for the timing of surgical interventions are lacking, which leads to considerable variations in management among neonatal intensive care units (NICUs). Early intervention (EI) has been shown to improve outcomes, but the authors hypothesized that the timing from IVH to intervention affects the comorbidities and complications associated with PHH management. The authors used a large national inpatient care data set to characterize comorbidities and complications associated with PHH management in premature infants. The authors used hospital discharge data from the 2006-2019 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) to conduct a retrospective cohort study of premature pediatric patients (weight < 1500 g) with PHH. The predictor variable was the timing of the PHH intervention (EI ≤ 28 days vs late intervention [LI] > 28 days). Hospital stay data included hospital region, gestational age, birth weight (BW), length of stay (LOS), PHH treatment procedures, comorbidities, surgical complications, and death. Statistical analysis included chi-square and Wilcoxon rank-sum tests, Cox proportional hazards regression, logistic regression, and a generalized linear model with Poisson and gamma distributions. Analysis was adjusted for demographic characteristics, comorbidities, and death. Of the 1853 patients diagnosed with PHH, 488 (26%) had documented timing of surgical interventions during their hospital stay. More patients had LI than EI (75%). The patients in the LI group of patients had younger gestational age and lower BW. There were significant regional differences in the timing of treatment: hospitals in the West performed EI, whereas hospitals in the South performed LI, even after adjustment for gestational age and BW. The LI group was associated with longer median LOS and more total hospital charges compared with the EI group. More temporary CSF diversion procedures occurred in the EI group, whereas more permanent CSF-diverting shunts were placed in the LI group. Shunt/device replacement and complications did not differ between the two groups. The LI group had 2.5-fold higher odds of sepsis (p < 0.001) and almost 2-fold higher odds of retinopathy of prematurity (p < 0.05) than the EI group. The timing of PHH interventions differs by region in the United States, whereas the association of potential benefits with treatment timing suggests the importance of national consensus guidelines. Development of these guidelines can be informed by data regarding treatment timing and patient outcomes available in large national data sets, which provide insights into comorbidities and complications of PHH interventions.

Biliary colic in the emergency department: A state-wide analysis of one-year costs and clinical outcomes

ImportanceApproximately 335,000 cases of biliary colic present to US emergency departments (EDs) annually, and most patients without complications are discharged from the ED. It is unknown what are the subsequent surgery rates, subsequent complications of biliary disease, ED revisits, repeat hospitalizations and cost; and, how does the ED disposition decision (admission versus discharge) affect long-term outcomes. ObjectiveTo determine whether there is a difference in one-year surgery rates, complications of biliary disease, ED revisits, repeat hospitalizations, and cost in ED patients with uncomplicated biliary colic who are admitted to the hospital versus those that are discharged from the ED. Design, setting, and participantsA retrospective observational study was conducted using records collected from the Maryland Healthcare Cost and Utilization Project (HCUP) in the Ambulatory Surgery, the Inpatient, and the ED setting between 2016 and 2018. After applying inclusion criteria, 7036 ED patients with uncomplicated biliary colic were followed for one year after their index ED visit for repeat healthcare utilization across multiple settings. A multivariable logistic regression study was performed to asses for risk factors for surgery allocation and hospital admission. Medicare Relative Value Units (RVUs) and HCUP Cost-Charge Ratio files were used to estimate direct costs. ExposuresEpisodes of biliary colic were ascertained using ICD-10 codes at the index ED visit. Main outcomes and measuresThe primary outcome was the one-year surgery rate, defined as a cholecystectomy. Secondary outcomes included the rate of new acute cholecystitis or other related complications, ED revisits, hospital admission and costs. Associations with hospital admission and surgeries were measured using adjusted odds ratios (ORs) with 95 % CIs. ResultsOf the 7036 patients analyzed, 793 (11.3 %) were admitted and 6243 (88.7 %) were discharged on their initial ED visit. When comparing the groups who were initially admitted versus discharged, we observed similar one-year cholecystectomy rates (42 % versus 43 %, mean difference 0.5 %, 95 % CI −3.1 %–4.2 %; P < 0.001), lower rates of new cholecystitis occurrences (18 % versus 41 %, mean difference 23 %, 95 % CI, 20 %–26 %; P < 0.001), lower rates of ED revisits (96 vs 198 per 1000 patients, mean difference 102, 95 % CI, 74–130; P < 0.001) and higher costs ($9880 versus $1832, mean difference 8048, 95 % CI, 7478–8618; P < 0.001). Initial ED hospital admission was associated with increased age (adjusted odds ratio [aOR], 1.44; 95 % CI, 1.35–1.53; P < 0.001), obesity (aOR, 1.38; 95 % CI, 1.32–1.44; P < 0.001), ischemic heart disease (aOR, 1.39; 95 % CI, 1.30–1.48; P < 0.001), mood disorders (aOR, 1.18; 95 % CI, 1.13–1.24; P < 0.001), alcohol-related disorders (aOR, 1.20; 95 % CI, 1.12–1.27; P < 0.001), hyperlipidemia (aOR, 1.16; 95 % CI, 1.09–1.23; P < 0.001), hypertension (aOR, 1.15; 95 % CI, 1.08–1.21; P < 0.001), and nicotine dependence (aOR, 1.09; 95 % CI, 1.03–1.15; P = 0.003) but not associated with race (P > 0.9), ethnicity (P > 0.9), or income-stratified zip code (aOR, 1.04; 95 % CI, 0.98–1.09; P = 0.17). Conclusions and relevanceIn our analysis of ED patients with uncomplicated biliary colic from a single state, the majority of patients do not receive a cholecystectomy within one year and hospital admission at the initial visit was not associated with an overall change in rates of cholecystectomy but was associated with increased costs. These findings inform our understanding of the long-term outcomes and are important considerations when communicating care options with ED patients with biliary colic.

Abstract WP168: Percutaneous Left Atrial Appendage Closure Device For Patients With Atrial Fibrillation In New York

Introduction: Trials have shown that WATCHMAN left atrial appendage closure (LAAC) for stroke is noninferior to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). Since the approval of WATCHMAN, real world clinical outcome of LAAC is still limited. We performed a state wide analysis to evaluate clinical outcomes for AF patients undergo LAAC. Methods: Using the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database, we included New York state adult patients, who had AF diagnosis with and without LAAC procedure from 2011 to 2017. Patients who had acute ischemic stroke (AIS) or history of AIS prior or during index admission were excluded. AF, AIS and other diagnosis were identified based on standard ICD-9 CM and ICD-10 CM codes. We compared rates of AIS, intracranial hemorrhage (ICH) and death between patients with and without LAAC. We also constructed a Cox regression model to determine hazard ratios (HR) of LAAC associated with each outcome. Results: Of the 627,972 patients with AF admitted, the mean age was 75.8 and 33.1% were female, and 773 (0.1%) underwent LAAC. AIS readmission occurred in 0.030% of AF patients without LAAC while it occurred in 0.012% of patients underwent LAAC. In the Cox regression model, LAAC had similar AIS readmission (HR 0.84, 95% CI 0.44-1.62, P = 0.602) and ICH readmission (HR 1.688, 95% CI 0.63-4.50, P = 0.296), but LAAC was associated with less death (HR 0.295, 95% CI 0.20-0.43, P &lt; 0.001). These outcomes remained the same despite adjustment with common risk factors and insurance type, or adjustment with CHADS 2 VASC 2 scores. In sensitivity analysis, after restricting to patients that had ICH prior to index admission, LAAC again had similar AIS readmission (HR 1.884, 95% CI 0.26-13.46, P = 0.528) compared to non-LAAC group but still marginally associated with less death (HR 0.289, 95% CI 0.07-1.16, P = 0.080). Conclusion: In New York state, AF patients underwent LAAC procedural are less likely to have death during follow up despite adjustment of common risk factors or CHADS 2 VASC 2 score, while AIS and ICH readmission appears to be similar. However, given potential underlying confounding by treatment indication, these findings need confirmation by ongoing randomized control trials.

Abstract 30: Association Between Hospital-ascertained Atrial Fibrillation And Central Retinal Artery Occlusion: A Study Of 12 Million Patients

Introduction: Atrial fibrillation (AF) is a major risk factor for cerebral ischemic stroke. However, it is not known whether AF predicts the development of central retinal artery occlusion (CRAO), a form of ischemic stroke affecting the retina. Methods: A retrospective cohort study was undertaken using data from the California Healthcare Cost and Utilization Project (HCUP) State Inpatient and State Emergency Department Datasets (SID/SEDDs). Patients 18 years and older discharged from non-federal hospitals between 2005 and 2011 who did not have a history of CRAO were analyzed. The exposure variable was AF and the endpoint was CRAO, each identified using validated ICD-9-CM diagnosis codes. Association between AF and CRAO was modeled using a Fine-Gray method with death as a competing risk with adjustment for age, biological sex, race, and vascular co-morbidities. Results: A total of 12,181,778 patients were included, among these 806,397 with AF and 11,375,381 without AF. In total, 309 patients had CRAO. In an unadjusted analysis, there was a higher risk of CRAO in patients with versus without AF (HR 2.24 (95% CI: 1.51 to 3.32)). After adjustment for pre-specified covariates, there appeared to be a lower hazard of CRAO in patients with AF (aHR 0.61 (95% CI: 0.45 to 0.98)). Further analyses including cerebral ischemic stroke (aHR 1.16 (95% CI: 1.14 to 1.18)) and specifically embolic stroke (aHR 4.29 (95% CI 4.10-4.48)) as positive controls argued against overadjustment bias. We present sensitivity analyses including CRAO identified in any position of the discharge ICD list, using different ascertainment windows for AF and using broader categories of retinal ischemia. Conclusion: The incidence of CRAO was higher in patients with AF than those without AF, but the hazard of CRAO was not higher for patients with AF after adjustment for measured covariates. Endpoint and exposure ascertainment may have been limited by inclusion only of inpatient and emergency department encounters.

Abstract TMP103: Acute Ischemic Stroke Readmission In Patients With Periprocedural Atrial Fibrillation

Introduction: Anticoagulation therapy are commonly interrupted in patients with atrial fibrillation (AF) for elective procedures. However, risk factors of subsequent stroke during the periprocedural period is uncertain. We performed a nationwide analysis to evaluate risk factors for acute ischemic stroke (AIS) readmission in patients with AF admitted for elective procedure. Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included electively admitted adult patients, who had AF diagnosis and procedural Diagnosis-related group code from 2016 to 2019. AF, AIS and other diagnosis were identified based on standard ICD-10 CM codes. Patients who had history of stroke or stroke during the index admission were excluded. We constructed a Cox regression model to determine hazard ratios (HR) of demographic, clinical factors and procedural type associated with AIS readmission. Results: Of the 1,048,422 patients with AF admitted for elective procedure, the mean age was 71.5 and 39.1% were female, and 1625 (0.15%) had AIS readmission within 30 days of discharge. In the adjusted Cox regression model, age (adjusted HR 1.05, 95% CI 1.04-1.06, P &lt; 0.001), female sex (aHR 1.22, 95% CI 1.05-1.41, P = 0.009), cancer (aHR 1.45, 95% CI 1.89-1.76, P &lt; 0.001), congestive heart failure (aHR 1.22, 95% CI 1.03-1.44, P = 0.021), diabetes (aHR 1.33, 95% CI 1.14-1.55, P &lt; 0.001), neurological surgery (aHR 2.27, 95% CI 1.69-3.06, P &lt; 0.001), cardiovascular surgery (aHR 1.59, 95% CI 1.32-1.91, P &lt; 0.001). Furthermore, higher CHADS 2 VASC 2 score (aHR 1.29 by one point, 95% CI 1.22-1.37, P &lt; 0.001) were associated with AIS readmission. Conclusion: AF patients with higher CHADS 2 VASC 2 score and those undergoing cardiac or neurological surgeries are at higher risk of perioperative stroke. Studies are needed to tailor anticoagulation management during the perioperative time to reduce perioperative AIS risk in such patients.

Perioperative complication rates of colpocleisis performed with or without concomitant hysterectomy: a large population-based study.

We aimed to compare perioperative complications for women who underwent colpocleisis with and without concomitant hysterectomy, and report the rate of concomitant hysterectomy. We conducted a retrospective study using the Healthcare Cost and Utilization Project (HCUP) - Nationwide Inpatient Sample 2004 to 2014. We used International Classification of Diseases, Ninth Revision (ICD-9) codes to identify women with pelvic organ prolapse (POP) who underwent colpocleisis with or without concomitant hysterectomy. Trend over time of each procedure type was created. We calculated odds ratios (ORs) to determine the risk of perioperative complications with or without concomitant hysterectomy. ORs were adjusted for age, race, income, insurance plan, and hypertension. Of 253,100 adult women who underwent POP repair, 7,431 had colpocleisis. Colpocleisis with concomitant hysterectomy was performed in 1,656 (22.2%) and 5,775 (77.7%) underwent colpocleisis alone (2,469 [33.2%] had a previous hysterectomy). Hysterectomy rates among women with POP undergoing colpocleisis remained relatively steady, whereas those undergoing colpocleisis without hysterectomy declined over time. Prevalence of any complications was higher among those with concomitant hysterectomy (11.4% vs 9.5%, p=0.023). Adjusted OR showed that concomitant hysterectomy increased the risk of complications (OR 1.93, 95% CI 1.45-2.57, p<0.001). Our large administrative data analysis suggests an increased risk of complications when performing a hysterectomy at the time of colpocleisis. A concomitant hysterectomy was performed in 22% of cases. Whether or not to include hysterectomy at the time of colpocleisis is based on shared decision making, influenced by individual patients' values, comorbidities, and risk of complications.

Time Series Analysis of Congestive Heart Failure Discharges in Florida (USA) Post Tropical Cyclones.

The aim of this study was to analyze congestive heart failure (CHF) discharges in Florida (USA) post tropical cyclones from 2007 through 2017. This was a retrospective longitudinal time series analysis of hospital CHF quarterly discharges across Florida using the Healthcare Cost and Utilization Project (HCUP) database. The autoregressive integrated moving average (ARIMA) model was used with correlated seasonal regressor variables such as cyclone frequency, maximum cyclone wind speed, average temperature, and reports of influenza-like illness (ILI). A total of 3,372,993 patients were identified, with average age in each quarter ranging 72.2 to 73.9 years and overall mortality ranging 4.3% to 6.4%. The CHF discharges within each year peaked from October through December and nadired from April through June with an increasing overall time trend. Significant correlation was found between CHF discharge and the average temperature (P <.001), with approximately 331.8 less CHF discharges (SE = 91.7) per degree of increase in temperature. However, no significant correlation was found between CHF discharges and frequency of cyclones, the maximum wind speed, and reported ILI. This study suggests that with the current methods and the HCUP dataset, there is no significant increase in overall CHF discharges in Florida as a result of recent previous cyclone occurrences.

The effect of maternal hypertension and maternal mental illness on adverse neonatal outcomes: A mediation and moderation analysis in a U.S. cohort of 9 million pregnancies

BackgroundWhile hypertensive disorders of pregnancy (HDP) coexist with maternal anxiety and depression, it is unclear how these conditions affect neonatal outcomes. We evaluated the prevalence as well as associations and potential mechanisms between HDP, maternal anxiety and depression, preterm birth (PTB), and small for gestational age (SGA). MethodsWe conducted a retrospective population-based study using the Healthcare Cost and Utilization Project (HCUP) database from 2004 to 2014. Preterm birth (<37 weeks), SGA (<10th percentile for gestational age and sex), HDP, and mental disorders (anxiety and depression) were extracted using the International Classification of Diseases, Ninth Revision (ICD-9). Mediation and moderation models were constructed separately to evaluate potential mechanisms between maternal anxiety and depression, HDP, and adverse neonatal outcomes. Multivariate logistic regressions were used to determine their associations. ResultsOf 9,097,355 pregnant women, the prevalence of HDP was 6.9 %, anxiety 0.91 %, depression 0.36 %, preterm birth 7.2 %, and SGA 2.1 %. Anxiety increased the probability of having HDP (OR = 1.242, 95 % CI 1.235–1.250), and HDP mediated the association between anxiety and preterm birth (mediation effect = 0.048, p-value<0.001). Depression significantly moderated the effect of HDP on preterm birth (moderation effect = −0.126, p-value = 0.027). HDP also mediated the association between anxiety and SGA (mediation effect = 0.042, p-value<0.001), but depression did not moderate the association between HDP and SGA (p-value = 0.29). ConclusionOur study suggests that women with anxiety are more likely to have HDP, and HDP mediates the associations between anxiety and adverse neonatal outcomes. Depression moderates associations between HDP and preterm birth but not between HDP and SGA.

Traumatic brain injuries in paediatric patients: individual vs. team sports-related hospitalizations

ABSTRACT Paediatric sport participation continues to increase in the United States, with a corresponding increase in sports-related concussions or traumatic brain injuries (TBIs). It is important to recognize which sports are at elevated risk and identify risk factors for hospital admission and length of stay (LOS). Paediatric patients (ages 5–18) from 2008 to 2014 were identified from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS). Eight hundred and ninety-four patients included those who were hospitalized with a TBI resulting from participation in an individual (451 patients) or team (443 patients) sport. We evaluated the differences in LOS and total charges between individual and team sports and found that compared to team sports, TBI patients in individual sports had significantly longer hospital stays compared to team sports (1.75 days versus 1.34 days, p < 0.001) and costlier ($27,333 versus $19,069, p < 0.001) hospital stays. This may be due to reduced awareness and reduced compliance with return-to-play protocols in individual sports. Safety education information at a young age, increased awareness of TBIs, and additional medical support for individual sports as well as team sports may help mitigate these findings.

Trends in Venous Thromboembolism Readmission Rates after Ischemic Stroke and Intracerebral Hemorrhage.

Venous thromboembolism (VTE) is a life-threatening complication of stroke. We evaluated nationwide rates and risk factors for hospital readmissions with VTE after an intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS) hospitalization. Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included patients with a principal discharge diagnosis of ICH or AIS from 2016 to 2019. Patients who had VTE diagnosis or history of VTE during the index admission were excluded. We performed Cox regression models to determine factors associated with VTE readmission, compared rates between AIS and ICH and developed post-stroke VTE risk score. We estimated VTE readmission rates per day over a 90-day time window post-discharge using linear splines. Of the total 1,459,865 patients with stroke, readmission with VTE as the principal diagnosis within 90 days occurred in 0.26% (3,407/1,330,584) AIS and 0.65% (843/129,281) ICH patients. The rate of VTE readmission decreased within first 4-6 weeks (P<0.001). In AIS, cancer, obesity, higher National Institutes of Health Stroke Scale (NIHSS) score, longer hospital stay, home or rehabilitation disposition, and absence of atrial fibrillation were associated with VTE readmission. In ICH, longer hospital stay and rehabilitation disposition were associated with VTE readmission. The VTE rate was higher in ICH compared to AIS (adjusted hazard ratio 2.86, 95% confidence interval 1.93-4.25, P<0.001). After stroke, VTE readmission risk is highest within the first 4-6 weeks and nearly three-fold higher after ICH vs. AIS. VTE risk is linked to decreased mobility and hypercoagulability. Studies are needed to test short-term VTE prophylaxis beyond hospitalization in high-risk patients.

In Response to: Dicpinigaitis AJ, Ogulnick JV, Mayer AS, Gandhi CD, Al‐Mufti F. Increase in Ruptured Cerebral Arteriovenous Malformations and in the United States: Unintended Consequences of the ARUBA Trial? Stroke Vasc Interv Neurol . 2022;0:e000442. https://doi.org/10.1161/SVIN.122.000442

In Response to: Dicpinigaitis AJ, Ogulnick JV, Mayer AS, Gandhi CD, Al‐Mufti F. Increase in Ruptured Cerebral Arteriovenous Malformations and in the United States: Unintended Consequences of the ARUBA Trial? <i>Stroke Vasc Interv Neurol</i> . 2022;0:e000442. https://doi.org/10.1161/SVIN.122.000442

Predicting risk factors for pediatric mortality in clinical trial research: A retrospective, cross-sectional study using a Healthcare Cost and Utilization Project database.

Incorporating real-world data using "big data" analysis in healthcare are useful to extract specific information for healthcare delivery system improvement. All-cause mortality is an essential measure to enhance patient safety in clinical trial research, especially for underrepresented pediatric participants. This study aimed to determine the associations between pediatric mortality and patient-specific factors using the Healthcare Cost and Utilization Project (HCUP) database. Data from the 2019 the HCUP Kids' Inpatient Database (KID) were used to conduct a logistic regression analysis to determine associations between pediatric patients' the chance of survival and their demographic and socioeconomic background, discharge records, and hospital information. Total number of diagnoses (OR = 0.84), total number of procedures (OR = 0.86), length of stay (OR = 1.04), age intervals greater than 1 year (OR > 1.0), transfer into the hospital from a different acute care (OR = 0.34), major diagnoses of multiple significant trauma (OR = 0.03) or hepatobiliary system and pancreas (OR = 0.10), region of hospital - west and midwest (OR > 1.0), and medium or larger hospital bed size (OR > 1.0) were all significantly associated with the chance of survival for patients participating in pediatric clinical trials (p < 0.05). Real-world clinical trial data analysis showed the potential improvement area including reallocating trial resources to promote trial quality and safe participation for pediatric patients. Pediatric trials need tools that are developed using user-centered design approaches to satisfy the unique needs and requirements of pediatric patients and their caregivers. Safe intrahospital transfer procedures and active dissemination of successful trial best practices are crucial to trial management, adherence, quality, and safety.

Effect of tracheostomy timing in pediatric patients with traumatic brain injury.

Traumatic brain injury (TBI) is a prevalent cause of disability and death in the pediatric population, often requiring prolonged mechanical ventilation. Patients with significant TBI or intracranial hemorrhage require advanced airway management to protect against aspiration, hypoxia, and hypercarbia, eventually necessitating tracheostomy. While tracheostomy is much less common in children compared to adults, its prevalence among pediatric populations has been steadily increasing. Although early tracheostomy has demonstrated improved outcomes in adult patients, optimal tracheostomy timing in the pediatric population with TBI remains to be definitively established. This retrospective cohort analysis aims to evaluate pediatric TBI patients who undergo tracheostomy and to investigate the impact of tracheostomy timing on outcomes. The Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), collected between in 2016 and 2019, was queried using International Classification of Disease 10th edition (ICD10) codes for patients with traumatic brain injury who had received a tracheostomy. Baseline demographics, insurance status, and procedural day data were analyzed with univariate and multivariate regression analyses. Propensity score matching was performed to estimate the incidence of medical complications and mortality related to early versus late tracheostomy timing (as defined by median=9 days). Of the 68,793 patients (mean age=14, IQR 4-18) who suffered a TBI, 1,956 (2.8%) received a tracheostomy during their hospital stay. TBI patients who were tracheostomized were older (mean age=16.5 vs 11.4 years), more likely to have injuries classified as severe TBIs and more likely to have accumulated more than one indicator of parenchymal injury as measured by the Composite Stroke Severity Scale (CSSS >1) than non-tracheostomized TBI patients. TBI patients with a tracheostomy were more likely to encounter serious complications such as sepsis, acute kidney injury (AKI), meningitis, or acute respiratory distress syndrome (ARDS). They were also more likely to necessitate an external ventricular drain (EVD) or decompressive hemicraniectomy (DHC) than TBI patients without a tracheostomy. Tracheostomy was also negatively associated with routine discharge. Procedural timing was assessed in 1,867 patients; older children (age >15 years) were more likely to undergo earlier placements (p<0.001). Propensity score matching (PSM) comparing early versus late placement was completed by controlling for age, gender, and TBI severity. Those who were subjected to late tracheostomy (>9 days) were more likely to face complications such as AKI or deep vein thrombosis (DVT) as well as a host of respiratory conditions such as pulmonary embolism, aspiration pneumonitis, pneumonia, or ARDS. While the timing did not significantly impact mortality across the PSM cohorts, late tracheostomy was associated with increased length of stay (LOS) and ventilator dependence. Tracheostomy, while necessary for some patients who have sustained a TBI, is itself associated with several risks that should be assessed in context of each individual patient's overall condition. Additionally, the timing of the intervention may significantly impact the trajectory of the patient's recovery. Early intervention may reduce the incidence of serious complications as well as length of stay and dependence on a ventilator and facilitate a timelier recovery.

Abstract C002: The effect of ACA and Medicaid expansion on hysterectomy procedures among women in Florida and California

Abstract Introduction: Disparities in healthcare reflect varying access to quality care, and the reception of quality care increases survival. Multiple factors can contribute to disparities in health care. Although the Affordable Care Act (ACA) offered the health disparities reduction by promoting access to equitable and more efficient health care, however there is still a wide gap in healthcare access, quality, and outcomes. One important factor is the lack of Medicaid expansion (ME) in all states of the US. In this study, the effect of ME is compared in California and Florida, the states with and without ME respectively, by looking into hysterectomy procedures (HP) done in these two states. Methods: We used 2009 and 2011 Florida and California State Inpatient Database (SID) of the Healthcare Cost and Utilization Project (HCUP). Our included population (n=3,043,460) were female portion of the database. The outcome variable was hysterectomy identified by ICD-9 codes. Patient-level factors including race/ethnicity, age, insurance type, income level, and other comorbidities were analyzed as explanatory variables. Logistic regression analyses were used to identify independent predictors of hysterectomy. Statistical analysis was conducted using SAS Version 9.4. Results: Among the Florida subjects, highest rate of HP is observed in Caucasian women (57.26%) followed by black women (21.85%). Also, the likelihood of HP is increased in women who are age 36-45 (39.83%) followed by age 46-55 (34.95%), and belong to the 1st and 2nd income levels (49.51%). Among the California subjects, highest rate of HP is in Caucasian women (52.35%) followed by Hispanics (29.09%), and women age 46-55 (39.69%) followed by age 36-45 (36.31%), and belong to 2nd and 3rd income levels (51.13%). Logistic regression analysis demonstrates that the odds of hysterectomy had a higher increase in Florida women in 2011 vs. 2009 (OR=1.238, 95% CI: 1.214-1.262), comparing to California (OR=1.124, 95% CI:1.107-1.141) respectively. Also, odds of HP had a higher increase among Florida women during 2011 Vs 2009 in comparison to that of California women. The increased odds were seen among the 2 lowest income levels, and insurance types. Conclusions: We found that likelihood of HP were seen more in Florida than California during years of 2009 and 2011. Also, we observed the reduction of likelihood of HP among California women during 2011 post-ACA when comparing to 2009, due to ME. However, the likelihood of HP was higher in Florida during 2011where the lack ME was a factor. Findings from this study highlights the importance of protective and preventable healthcare access for everyone regardless of races/ethnicities and other socio-economic factors, thus, brings better management of chronic diseases and improves women’s health at large. The provisions of important structures of ACA, such as Medicaid expansion, and health insurance exchange, in all states may reduce the health disparity among Medicaid holders, and self-pay patients. Citation Format: Zahra Bahrani-Mostafavi, Susan Rucker. The effect of ACA and Medicaid expansion on hysterectomy procedures among women in Florida and California [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C002.

1413. Regional variation in substance use associated infectious endocarditis in New York State: 2000-2014.

Abstract Background Injection drug use is a significant and growing public health concern in New York State (NYS). Infectious endocarditis (IE) is a serious complication of injection drug use, and is associated with significant morbidity and mortality, prolonged hospitalizations, and high healthcare costs. Methods Data was extracted from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP)’s New York State Inpatient Database (SID) to determine incidence of IE in New York between 2000-2014. The HCUP-SID database includes inpatient discharge records from hospitals across the state regardless of payer and contains information on inpatient healthcare utilization. Regional incidence was then calculated using population values from the 2010 regional census. Cost of hospitalization was derived from the HCUP using the cost to charge ratio (CCR) file to estimate the cost of inpatient hospital stays. Results During the study interval the number of statewide substance use-associated IE cases fluctuated between a low of 262 cases in 2000, and a high of 362 cases in 2007. Approximately 70-80% of the patients with substance use-associated IE in NYS in this study were insured through public programs (Medicare or Medicaid). In-hospital mortality from substance use-associated IE appears to be decreasing slightly, however, there is an accompanying increase in hospital costs, in part due to long average length of hospital stays between 13 and 18 days. The mean cost of hospitalization rose notably from $51,934 to $134,325 over the course of our study. Over 10% of hospitalizations culminated in patient directed discharges. Over the study period New York City’s incidence rates appeared to decrease while other region’s incidence rates appeared to increase, specifically in the Capital District, Central New York, and Southern Tier regions. Trends in substance use associated infectious endocarditis in NYS This figure shows trends in endocarditis in the study period. It shows a rise in cases in substance use associated endocarditis in NYS in less urban areas. Conclusion Between 2000 and 2014 the rates of substance use-associated infective endocarditis in NYS fluctuated but remained fairly constant. Despite the relatively constant statewide rates, there was important regional variation, including decreasing incidence rates of SUIE in New York City and rising incidence rates in non-New York City counties. Disclosures Shashi Kapadia, MD, GIlead: Grant/Research Support.

HAPPS: A Hidden Attribute and Privilege-Protection Data-Sharing Scheme With Verifiability

Data is a key asset in our interconnected and smart city. Especially, in the context of healthcare, healthcare data can facilitate remote diagnosis and medical research. Because of the potentially sensitive nature of healthcare data, privacy is a key consideration for both individuals and organizations. We can broadly categorize privacy considerations into data privacy, attribute privacy, and privilege policy privacy. To support one or more notions of privacy, the potential of solutions, such as fine-grained access control [e.g., those based on attribute-based encryption (ABE)] and blockchain in realizing data sharing has been explored. However, these approaches generally only facilitate access control of data and the traceability of the sharing process, and do not protect the attribute and privilege policy privacy of users. Therefore, in this article, we implement HAPPS, a hidden attribute and privilege-protection data-sharing scheme with verifiability. The three key building blocks of HAPPS are zero-knowledge proof, blockchain, and distributed ABE (DABE). Specifically, in our approach, we propose a new data access control strategy (i.e., attribute-hidden zero-knowledge proof—at-ZKP) to hide user identity and attributes during the authorization process. Our scheme is embedded in the blockchain and built into the decentralized sharing platform to prevent central verifier counterfeiting and support auditing. To demonstrate utility, we prove that HAPPS ensures data, attribute, and privilege policy privacy. Findings of our evaluations implemented on Ethereum and using the data set from the healthcare cost and utilization project (HCUP), we demonstrate that our scheme can share sensitive healthcare records belonging to minors (e.g., children) without the at-ZKP incurring unrealistic cost.