Health Care Utilization Project Research Articles

Changes in adverse obstetrical and neonatal outcomes over time in American women with polycystic ovary syndrome: an 11-year study of a population database.

To determine whether the prevalence in American demographic and resultant adverse obstetric outcomes changed in women with polycystic ovary syndrome between the years of 2004-2014 inclusively, based on data derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database. This is a retrospective population-based study using data derived from the HCUP-NIS database from the years of 2004-2014, inclusively. Within this group, all pregnancies to women with PCOS were identified and separated by year, creating 11 groups. Risk factors including non-Caucasian race, lower socioeconomic status, andrates of obesity and thyroid disease increased over time.The rates of gestational diabetes mellitus demonstrated a slight decrease, (21.3% in 2004 to 18.0% in 2014, P = 0.01). The number of women with preterm premature rupture of membranes decreased from 3.0% in 2004 to 2.0% in 2014 (P = 0.04). Rates of preterm delivery decreased from 14.8% in 2004 to 9.8% in 2014 (P < 0.001). Rates of cesarean section decreased from 57.3% in 2004 to 45.7% in 2014 (P < 0.001), while rates of spontaneous vaginal delivery increased from 37.4% in 2004 to 50.1% in 2014 (P < 0.001). The rate of wound complications decreased from 2.1% in 2004 to 0.4% in 2014 (P < 0.001). However, the rate of congenital anomalies increased from 0.5% in 2004 to 1.2% in 2014 (P = 0.001). In spite of increases in demographic risk factors associated with increased pregnancy complications, we hypothesize that the interventions made to minimize the risks of cesarean section and manage metabolic complications in women with PCOS during the period of study have resulted in improved pregnancy outcomes during the period of study.

Obstetric and perinatal outcomes in women with cerebrovascular accident vs. transient ischemic attack: an evaluation of a population database.

Cerebrovascular accidents (CVAs) and transient ischemic attacks (TIAs) are uncommon neurologic events in women of childbearing age. We aimed to compare pregnancy, delivery, and neonatal outcomes between women who suffered from a CVA and those who experienced a TIA. A retrospective population-based cohort study was performed using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. Included were all pregnant women who delivered or had a maternal death in the US between 2004 and 2014. We compared women with an ICD-9 diagnosis of a CVA before or during pregnancy to those diagnosed with a TIA before, during the pregnancy, or during the delivery admission. Pregnancy and perinatal outcomes were compared between the two groups, using multivariate logistic regression to control for confounders. Among 9,096,788 women in the database, 898 met the inclusion criteria. Of them, 706 women (7.7/100,000) had a CVA diagnosis, and 192 (2.1/100,000) had a TIA diagnosis. Women with a CVA, compared to those with a TIA, had a higher rate of pregnancy-induced hypertension (aOR 3.82,95%CI 2.14-6.81, p < 0.001); preeclampsia (aOR 2.6,95%CI 1.3-5.2, p = 0.007), eclampsia (aOR 13.78,95% CI 1.84-103.41, p < 0.001); postpartum hemorrhage (aOR 4.52,95%CI 1.31-15.56, p = 0.017), blood transfusion (aOR 5.57,95%CI 1.65-18.72, p = 0.006), and maternal death (54 vs. 0 cases, 7.6% vs. 0%), with comparable neonatal outcomes. Women diagnosed with a CVA before or during pregnancy had a higher incidence of myriad maternal complications, including hypertensive disorders of pregnancy, postpartum hemorrhage, and death, compared to women with a TIA diagnosis, with comparable neonatal outcomes, stressing the different prognoses of these two conditions, and the importance of these patients' diligent follow-up and care.

Stroke Risk After Emergency Department Treat-and-Release Visit for a Fall.

Previous cohort studies of hospitalized patients with a delayed diagnosis of ischemic stroke found that these patients often had an initial emergency department (ED) diagnosis of a fall. We sought to evaluate whether ED visits for a fall resulting in discharge to home (ie, treat-and-release visits) were associated with increased short-term ischemic stroke risk. A case-crossover design was used to compare ED visits for falls during case periods (0-15, 16-30, 31-90, and 91-180 days before stroke) and control periods (equivalent time periods exactly 1 year before stroke) using administrative data from the Healthcare Cost and Utilization Project on all hospital admissions and ED visits across 10 states from 2016 to 2020. To identify ED treat-and-release visits for a fall and patients hospitalized for acute ischemic stroke, we used previously validated International Classification of Diseases, Tenth Revision, Clinical Modification codes. Odds ratios and 95% CIs were calculated using conditional logistic regression. Among 90 592 hospitalized patients with ischemic stroke, 5230 (5.8%) had an ED treat-and-release visit for a fall within 180 days before their stroke. Patients with an ED treat-and-release visit for a fall were older (mean age, 74.7 [SD, 14.6] versus 70.8 [SD, 15.1] years), more often female (61.9% versus 53.4%), and had higher rates of vascular comorbidities than other patients with stroke. ED treat-and-release visits for a fall were significantly more common in the 15 days before stroke compared with the 15-day control period 1 year earlier (odds ratio, 2.7 [95% CI, 2.4-3.1]). The association between stroke and a preceding ED treat-and-release visit for a fall decreased in magnitude with increasing temporal distance from stroke. ED treat-and-release visits for a fall are associated with significantly increased short-term ischemic stroke risk. These visits may be opportunities to improve stroke diagnostic accuracy and treatment in the ED.

A National Database Study on Racial Disparities in Route of Hysterectomy with a Surrogate Control for Uterine Size: A Proposed Quality Metric for Benign Indications

Study ObjectiveTo investigate the association between race and route of hysterectomy among patients undergoing hysterectomy for abnormal uterine bleeding in the absence of uterine fibroid disease and excluding malignancy. DesignA cross-sectional cohort study utilizing the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and National Ambulatory Surgical databases to compare abdominal to minimally invasive route of hysterectomy. SettingHospitals and hospital-affiliated ambulatory surgical centers participating in the Healthcare Cost and Utilization Project in 2019 Patients75,838 patients who had undergone hysterectomy for abnormal uterine bleeding excluding uterine fibroids and malignancy. Interventionsn/a Measurements and Main ResultsOf the 75,838 hysterectomies performed for abnormal uterine bleeding in the absence of uterine fibroids and malignancy, 10.1% were performed abdominally and 89.9% minimally invasively. After adjusting for confounders, Black patients were 38% more likely to undergo abdominal hysterectomy compared to White patients (OR 1.38, CI 1.12-1.70 p=0.002). Black race thus is independently associated with open surgery. ConclusionDespite excluding uterine fibroids as a risk factor for an abdominal route of hysterectomy, Black race remained an independent predictor for abdominal versus minimally invasive hysterectomy and Black patients were found to undergo a disproportionately higher rate of abdominal hysterectomy compared to White patients.

Diabetic Ketoacidosis and Adverse Outcomes Among Pregnant Individuals With Pregestational Diabetes in the United States, 2010-2020.

To assess the frequency of, risk factors for, and adverse outcomes associated with diabetic ketoacidosis (DKA) at delivery hospitalization among individuals with pregestational diabetes (type 1 and 2 diabetes mellitus) and secondarily to evaluate the frequency of and risk factors for antepartum and postpartum hospitalizations for DKA. We conducted a serial, cross-sectional study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmissions Database from 2010 to 2020 of pregnant individuals with pregestational diabetes hospitalized for delivery. The exposures were 1) sociodemographic and clinical risk factors for DKA and 2) DKA. The outcomes were DKA at delivery hospitalization, maternal morbidity (nontransfusion severe maternal morbidity (SMM), critical care procedures, cardiac complications, acute renal failure, and transfusion), and adverse pregnancy outcomes (preterm birth, hypertensive disorders of pregnancy, and cesarean delivery) and secondarily DKA at antepartum and postpartum hospitalizations. Of 392,796 deliveries in individuals with pregestational diabetes (27.2% type 1 diabetes, 72.8% type 2 diabetes), there were 4,778 cases of DKA at delivery hospitalization (89.1% type 1 diabetes, 10.9% type 2 diabetes). The frequency of DKA at delivery hospitalization was 1.2% (4.0% with type 1 diabetes, 0.2% with type 2 diabetes), and the mean annual percentage change was 10.8% (95% CI, 8.2-13.2%). Diabetic ketoacidosis at delivery hospitalization was significantly more likely among those who had type 1 diabetes compared with those with type 2 diabetes, who were younger in age, who delivered at larger and metropolitan hospitals, and who had Medicaid insurance, lower income, multiple gestations, and prior psychiatric illness. Diabetic ketoacidosis during the delivery hospitalization was associated with an increased risk of nontransfusion SMM (20.8% vs 2.4%, adjusted odds ratio [aOR] 8.18, 95% CI, 7.20-9.29), critical care procedures (7.3% vs 0.4%, aOR 15.83, 95% CI, 12.59-19.90), cardiac complications (7.8% vs 0.8%, aOR 8.87, 95% CI, 7.32-10.76), acute renal failure (12.3% vs 0.7%, aOR 9.78, 95% CI, 8.16-11.72), and transfusion (6.2% vs 2.2%, aOR 2.27, 95% CI, 1.87-2.75), as well as preterm birth (31.9% vs 13.5%, aOR 2.41, 95% CI, 2.17-2.69) and hypertensive disorders of pregnancy (37.4% vs 28.1%, aOR 1.11, 95% CI, 1.00-1.23). In secondary analyses, the overall frequency of antepartum DKA was 3.1%, and the mean annual percentage change was 4.1% (95% CI, 0.3-8.6%); the overall frequency of postpartum DKA was 0.4%, and the mean annual percentage change was 3.5% (95% CI, -1.6% to 9.6%). Of 3,092 antepartum hospitalizations among individuals with DKA, 15.7% (n=485) had a recurrent case of DKA at delivery hospitalization. Of 1,419 postpartum hospitalizations among individuals with DKA, 20.0% (n=285) previously had DKA at delivery hospitalization. The above risk factors for DKA at delivery hospitalization were similar for DKA at antepartum and postpartum hospitalizations. The frequency of DKA at delivery hospitalization and antepartum hospitalizations for DKA increased between 2010 and 2020 among deliveries in individuals with pregestational diabetes in the United States. Diabetic ketoacidosis is associated with an increased risk of maternal morbidity and adverse pregnancy outcomes. Risk factors for DKA at delivery were similar to those for DKA during the antepartum and postpartum periods.

Evidence Against a Traumatic Brain Injury "July Effect": An Analysis of 3 160 452 Patients From the National Inpatient Sample.

The "July Effect" hypothesizes increased morbidity and mortality after the addition of inexperienced physicians at the beginning of an academic year. However, the impact of newer members on neurosurgical teams managing patients with traumatic brain injury (TBI) has yet to be examined. This study conducted a nationwide analysis to evaluate the existence of the "July Effect" in the setting of patients with TBI. The Healthcare Cost and Utilization Project Central Distributor's National Inpatient Sample data set was queried for patients with TBI using International Classification of Diseases (ICD)-9 and ICD-10 codes. Discharges were included for diagnoses of traumatic epidural, subdural, or subarachnoid hemorrhages. Only patients treated at teaching hospitals were included to ensure resident involvement in care. Patients were grouped into July admission and non-July admission cohorts. A subgroup of patients with neurotrauma undergoing any form of cranial surgery was created. Perioperative variables were recorded. Rates of different complications were assayed. Groups were compared using χ2 tests (qualitative variables) and t-tests or Mann-Whitney U-tests (quantitative variables). Logistic regression was used for binary variables. Gamma log-linked regression was used for continuous variables. The National Inpatient Sample database yielded a weighted average of 3 160 452 patients, of which 312 863 (9.9%) underwent surgical management. Patients admitted to the hospital in July had a 5% decreased likelihood of death (P = .027), and a 5.83% decreased likelihood of developing a complication (P < .001) compared with other months of the year. July admittance to a hospital showed no significant impact on mean length of stay (P = .392) or routine discharge (P = .147). Among patients with TBI who received surgical intervention, July admittance did not significantly affect the likelihood of death (P = .053), developing a complication (P = .477), routine discharge (P = .986), or mean length of stay (P = .385). The findings suggested that there is no "July Effect" on patients with TBI treated at teaching hospitals in the United States.

Racial and Ethnic Disparities in Sacrocolpopexy Approach.

Racial inequity elevates risk for certain diagnoses and health disparities. Current data show disparities for Black women when comparing open versus minimally invasive hysterectomy. It is unknown if a similar disparity exists in surgical management of pelvic organ prolapse. The objective of this study was to determine whether racial or ethnic disparities exist for open abdominal versus minimally invasive sacrocolpopexy. Cross-sectional data of the Healthcare Cost and Utilization Project National Inpatient Sample and the Nationwide Ambulatory Surgery Sample for the year 2019 was used. Bivariate analysis identified demographic and perioperative differences between abdominal versus minimally invasive sacrocolpopexy, which were compared in a multivariable logistic regression. Forty-one thousand eight hundred thirty-seven patients underwent sacrocolpopexy: 35,820 (85.6%), minimally invasive sacrocolpopexy, and 6,016, (14.4%) abdominal sacrocolpopexy. In an unadjusted analysis, Black patients were more likely to undergo an abdominal sacrocolpopexy compared to non-Hispanic White patients (OR 2.14, 95% CI 1.16-3.92, P <0.01). Hispanic patients were more likely to undergo abdominal sacrocolpopexy compared to non-Hispanic White patients (OR 1.69, 95% CI 1.26-2.26, P <0.001). Other factors associated with abdominal sacrocolpopexy are zip code quartile, payer status, composite comorbidity score, hospital control, and hospital bed size. In the regression model, Black patients remained more likely to undergo abdominal sacrocolpopexy compared to those who identified as White (aOR 2, 95% CI 1.26-3.16, P < 0.003). Hispanic patients were more likely to undergo abdominal sacrocolpopexy compared to those who identified as White (aOR 1.73, 95% CI 1.31-2.28, P < 0.001). Abdominal sacrocolpopexy was more likely to occur in patients who identified as Black or Hispanic.

Factors influencing disparities in epilepsy surgery: analysis of the National Inpatient Sample and Kids' Inpatient Database.

Despite the proven efficacy of surgical intervention for achieving seizure freedom and improved quality of life for many epilepsy patients, this treatment remains underutilized. In this study, the authors assessed sociodemographic trends in epilepsy surgery in the National Inpatient Sample (NIS) and the Kids' Inpatient Database (KID) and sought to determine whether disparities in surgical intervention for epilepsy may be attributed to insurance and comorbidity status. This cross-sectional study utilized data from the NIS database and KID from the Healthcare Cost and Utilization Project between the years 2012 and 2018. Outcomes of interest were rates of neurosurgical intervention, including resection, neuromodulation, or laser ablation. The authors utilized logit regression models to test the association between rates of neurosurgical intervention and the variables of interest and calculated the adjusted mean proportion of patients who received surgery using marginal effects. Of 336,015 admissions with intractable epilepsy in the NIS, 6.1% were patients who underwent neurosurgical treatment. Of 39,655 admissions from KID, 5.0% received surgical treatment. Private insurance was associated with a greater odds of surgical intervention compared with Medicaid (NIS: OR 1.63, KID: OR 1.62; p < 0.001). Patients assigned White race had an increased odds ratio of undergoing surgery when compared with those assigned Black race, adjusted for comorbidity burden (NIS: OR 1.59, p < 0.001; KID: OR 1.44, p = 0.027). Patients with an Elixhauser Comorbidity Index score of 0 or 1 were associated with a lower likelihood of surgery when compared to their higher scoring counterparts who had 4 or more comorbidities (NIS: OR 0.74, KID: OR 0.62; both p < 0.001). This study demonstrates that marginalized patients and those with Medicaid had decreased odds of neurosurgical intervention for epilepsy. Results of this research support the need for increased attention toward epilepsy patients from marginalized groups. Further investigation into the root cause of socioeconomic inequities in epilepsy surgery is necessary.

O-228 Do myomectomies decrease third trimester pregnancy complications when compared to women without myomectomies and uterine fibroids in situ? A study of an American population database

Abstract Study question Myomectomies are performed to decrease pregnancy complications, among other indications, however, do myomectomies decrease third trimester pregnancy complications? Summary answer Post-myomectomy, pregnancies experienced more complications including hypertensive disorders, premature-pre-term-rupture of membranes, preterm-delivery, placenta-previa, cesareans, uterine ruptures, wound complications, transfusions, and small for gestational age infants. What is known already Patients with fibroid uterus experience reduced fertility rates and increased in obstetrical complications compared to patients without fibroids. If the removal of fibroids improves fertility is controversial for intramural fibroids, it is recommended for submucosal fibroids by the American College Of Gynaecology guidelines. It is a common, untested belief that myomectomies may reduce the risks of certain obstetrics complications. While rates of mal-placentation and hypertensive disorders may increase post-myomectomy as shown by the literature comparing myomectomy vs. control groups without fibroids, other complications may be anticipated to decrease. However, no population-based studies have attempted to answer this question. Study design, size, duration Retrospective cohort study, using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample between 2004 and 2014, inclusively, based on International Classification of Diseases, 9th edition, diagnoses (ICD-9). Data collected from 48 states and the District of Columbia, representing 20% of annual hospital admissions in the United States. Population-based study, including 89,025 with uterine fibroids: 7508 pregnancies with previous abdominal myomectomy (AM) or laparoscopic myomectomy (LM), and 81,517 controls with uterine fibroids in-situ, without myomectomies. Participants/materials, setting, methods We included patients delivery discharge diagnoses or maternal deaths, and with either uterine fibroids (ICD-9 codes 218.0, 218.1, 218.2, 218.9) or AM or LM prior to the pregnancy, (ICD-9 codes 68.29 and 68.19 or CPT procedure code 58140, 58145, 58146, 58545 and 58546). Binomial logistic regression was used and adjusted for age, race, income quartiles, smoking, previous cesarean section, chronic and pregnancy-induced hypertension, obesity, multiple gestations, pre-gestational and gestational diabetes mellitus. Main results and the role of chance The myomectomy group was characterized by older patients, higher rates of Caucasian race, chronic hypertension, previous cesarean delivery, and multiple gestations, and lower, income quartiles, rates of obesity, compared to the fibroid in-situ group (P &amp;lt; 0.05). There was no difference for rates of medical insurance plan type, tobacco smoking, pregestational diabetes, illicit drug use, thyroid disease, or in vitro fertilization use (P &amp;gt; 0.05, all). The myomectomy group had increased rates of pregnancy-induced hypertension (adjusted odd ratios(aOR)-1.15, 95% confidence intervals(CI):1.06-1.26), preeclampsia (aOR:1.25 95%CI:1.12-1.41), preterm delivery (aOR:1.4, 95%CI:1.27-1.53), preterm premature rupture of membranes (aOR:1.29, 95%CI:1.05-1.58), placenta previa (aOR:1.59, 95%CI:1.32-1.92), cesarean delivery (aOR:37.1, 95%CI:27.35-50.4), uterine rupture (aOR:2.1, 95%CI:1.06-4.16), blood transfusion (aOR:1.21, 95%CI:1.68-2.24), wound complications (aOR:1.44, 95%CI:1.1-1.9), disseminated intravascular coagulation (aOR:1.58, 95%CI:1.1-2.27), and small for gestational age (SGA) infants (aOR:0,19, 95%CI:1.05-1.39) compared to the fibroid in-situ group. The myomectomy group had a lower rate of gestational diabetes mellitus (aOR:0,88, 95%CI:0,79-0,97), chorioamnionitis (aOR:0,74, 95%CI:0,6-0,93), maternal infection (aOR:0.79, 95%CI:0.65-0.95), spontaneous (aOR:0.03, 95%CI:0.02-0.04) and operative vaginal delivery (aOR:0.87, 95%CI:0.75-0.99), and postpartum hemorrhage (aOR:0.73, 95%CI:0.62-0.87). There was no significant differences for rates of gestational hypertension, eclampsia, preeclampsia or eclampsia superimposed on pre-existing hypertension, abruptio placenta, hysterectomy, maternal death, deep venous thrombosis, pulmonary embolism and venous thromboembolism events (P &amp;gt; 0.05, all). Limitations, reasons for caution The retrospective nature of the study may mask undetected bias. Moreover, although the rate of uterine rupture was increased in the myomectomy group, it was rare and requires confirmation. Further prospective studies are needed to evaluate the outcomes in pregnancy after myomectomy. Wider implications of the findings The complications seen after myomectomies were likely related to uterine-incisions and alteration of myometrial vascularization, impairing trophectoderm invasion and leading to hypertensive disorders, mal-placentation, and abnormalities of fetal growth. Patients should be counselled regarding these potential risks. Increased understanding of the role of myomectomies on reproductive outcomes needs further study. Trial registration number not applicable

P-625 Association between advanced maternal age in women with polycystic ovary syndrome and adverse obstetric outcomes

Abstract Study question What is the effect of advanced maternal on the likelihood of experiencing adverse pregnancy, delivery, and neonatal outcomes in pregnant women with PCOS? Summary answer Advanced maternal age in women with polycystic ovary syndrome confers an additional risk of pregnancy induced hypertension, preeclampsia, preterm delivery, c-section, and placenta previa. What is known already Women with PCOS have an increased risk of obstetric complications, including preterm delivery, PROM, hypertensive disorders, gestational diabetes, cesarean section, and placental abruption. Similarly, the impact of advanced maternal age on pregnancy outcomes has been widely studied. Studies have highlighted the association between advanced maternal age and increased risks of preeclampsia, gestational diabetes mellitus, preterm labor, cesarean section, stillbirth, and fetal growth restriction. The role of advanced maternal age on pregnancy complications in PCOS in a population database has not been thoroughly evaluated. Study design, size, duration A retrospective population-based study using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database was performed. All deliveries between 2004 to 2014, inclusively, were studied using ICD-9 codes. Within the study period, 14,846 women had a diagnosis of PCOS, of which 943 (6.35%) were of significant advanced maternal age (38-43 years/old). The study could not be extended since in 2015 ICD-10 codes were used which are not compatible with ICD-9 codes. Participants/materials, setting, methods Chi-squared tests were used for comparison of demographics. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI), controlling for confounding effects. According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available Main results and the role of chance Women with PCOS and advanced maternal age were more likely to develop pregnancy complications, including pregnancy induced hypertension (aOR 1.32; 95% CI: 1.09-1.59; p = 0.004), preeclampsia (aOR 1.51; 95% CI: 1.16-1.98; p = 0.003), and gestational diabetes mellitus (aOR 1.66; 95% CI: 1.40-1.97; p &amp;lt; 0.001), after controlling for confounding demographics. Women with PCOS of advanced maternal age were also at increased risk of delivery by cesarean section (aOR 1.20 95% CI: 1.10-1.43; p &amp;lt; 0.001). Women with PCOS and advanced maternal age were not at an increased risk of preterm delivery, PPROM, placental abruption, chorioamnionitis, operative vaginal delivery, post-partum hemorrhage, wound complications, transfusion, maternal infection, deep vein thrombosis, pulmonary embolism, venous thromboembolism, disseminated intravascular coagulation and eclampsia (p &amp;gt; 0.05 in all cases). Results demonstrated no difference in the rate of women who gave birth to SGA infants, the rate of IUFDs, and the rate of infants with congenital anomalies between the two groups. Limitations, reasons for caution The limitations of our study are its retrospective nature and use of 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. Wider implications of the findings The impact of advanced maternal age on the relationship between PCOS and pregnancy outcomes should be considered when counseling and planning care for pregnant women affected by these conditions. This emphasizes the importance of optimal perinatal care in older women with PCOS as they have higher risks of obstetric complications. Trial registration number NA

Trends in Atrial Fibrillation and Ablation Therapy During the Coronavirus Disease 2019 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic affected many aspects of health care and continues to have an impact as waves of COVID-19 cases re-emerge. Many procedures were negatively impacted by the pandemic, and management was primarily focused on limiting exposure to the virus. We present an analysis of the National Inpatient Sample (NIS) to delineate how COVID-19 affected atrial fibrillation (AF) ablation. The NIS was analyzed from 2017-2020 in order to determine the pre- and intra-pandemic impacts on AF ablation procedures. Admissions were identified using the International Classification of Diseases, 10th Revision, Clinical Modification codes with a primary diagnosis of AF (ICD-10 CM code I48.0, I48.1, I48.2, or I48.91). Admissions were also assessed for the use of cardiac ablation therapy. Comorbidity diagnoses were identified using the Elixhauser comorbidity software (Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Rockville, MD, USA); additional ICD-10 codes for diagnoses and procedures used are also provided. The primary outcome of our study was the trend in ablation therapy during AF admissions. Secondary outcomes included health care disparities, inpatient mortality, and length of stay. Ablation therapy was used in 18,885 admissions in 2020, compared to the preceding 3-year average of 20,103 (adjusted Wald test, P = .002). Multivariate logistic regression revealed a greater likelihood of undergoing ablation therapy (odds ratio, 1.24; 95% confidence interval, 1.10-1.40; P < .001) among 2020 admissions compared to 2017 admissions. Inpatient mortality increased in 2020 compared to the preceding average; however, the difference was not significant. The procedural volume of ablation for AF saw a decrease in 2020; however, surprisingly, more patients were likely to undergo ablation during 2020.

Patient and Hospital Characteristics Associated with Admission Among Patients With Minor Isolated Extremity Firearm Injuries: A Propensity-Matched Analysis.

To quantify the association between insurance and hospital admission following minor isolated extremity firearm injury. The association between insurance and injury admission has not been examined. This was an observational retrospective cohort study of minor isolated extremity firearm injury captured in the Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases in 6 states (New York, Arkansas, Wisconsin, Massachusetts, Florida, and Maryland) from 2016 to 2017 among patients aged 16 years or older. The primary exposure was insurance. Admitted patients were propensity score matched to nonadmitted patients on age, extremity Abbreviated Injury Score, and Elixhauser Comorbidity Index with exact matching within hospital to adjust for selection bias. A general estimating equation logistic regression estimated the association between insurance and odds of admission in the matched cohort while controlling for sex, race, injury intent, injury type, hospital profit type, and trauma center designation with observations clustered by propensity score-matched pairs within hospital. A total of 8151 patients presented to hospital with a minor isolated extremity firearm injury between 2016 and 2017 in 6 states. Patients were 88.0% male, 56.6% Black, and 71.7% aged 16 to 36 years old, and 22.1% were admitted. A total of 2090 patients were matched on propensity for admission. Privately insured matched patients had 1.70 higher adjusted odds of admission and 95% confidence interval of 1.30 to 2.22, compared with uninsured after adjusting for patient and hospital characteristics. Insurance was associated with hospital admission for minor isolated extremity firearm injury.

Testing trends and co-testing patterns for HIV, hepatitis C and sexually transmitted infections (STIs) in Emergency departments

BackgroundMany underserved populations use Emergency Department (EDs) as primary sources of care, representing an important opportunity to provide infectious disease testing and linkage to care. We explored national ED testing trends and co-testing patterns for HIV, hepatitis C, and sexually transmitted infections (STIs). MethodsWe used 2010–2019 Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample data to estimate ED visit testing rates for HIV, hepatitis C, chlamydia, gonorrhea, and syphilis infections, identified by Current Procedural Terminology codes. Trends and co-testing (visit with tests for > 1 infection) patterns were analyzed by sociodemographic, hospital, and visit characteristics. Trends were evaluated as the average annual percentage change (AAPC) using the Joinpoint Regression. ResultsDuring 2010–2019, testing events per 1000 visits (AAPCs) increased for HIV from 1.3 to 4.2 (16.3 %), hepatitis C from 0.4 to 2.2 (25.1 %), chlamydia from 9.1 to 16.0 (6.6 %), gonorrhea from 8.4 to 15.7 (7.4 %), and syphilis from 0.7 to 2.0 (12.9 %). Rate increases varied by several characteristics across infections. The largest AAPC increases were among visits by groups with lower base rate testing in 2010, including persons aged ≥ 65 years (HIV: 36.4 %), with Medicaid (HIV: 43.8 %), in the lowest income quintile (hepatitis C: 36.9 %), living in the West (syphilis: 49.4) and with non-emergency diagnoses (hepatitis C: 44.1 %). Co-testing increased significantly for all infections except hepatitis C. ConclusionsHIV, hepatitis C, and STI testing increased in EDs during 2010–2019; however, co-testing patterns were inconsistent. Co-testing may improve diagnosis and linkage to care, especially in areas experiencing higher rates of infection.

Endovascular Aneurysm Repair-First Strategy for Ruptured Abdominal Aortic Aneurysm Might Not Be Applicable to all Cases

We evaluate the relationship between the hospital case volume (HCV) and mortality outcomes after open aortic repair (OAR) and endovascular aortic repair (EVAR) of intact (i) and ruptured (r) abdominal aortic aneurysm using a contemporary administrative database. The Healthcare Cost and Utilization Project Database for New York (2016) and New Jersey/Maryland/Florida (2016-2017) were queried using International Classification of Disease-10th edition to identify patients who had undergone OAR and EVAR. The hospitals were categorized into quartiles (Q) per overall (EVAR+OAR) volume, OAR-alone volume and EVAR- alone volume. Cox regression adjusted for confounding factors was used to estimate hazard ratios (HR) for mortality. A total of 8825 patients (mean age, 73.5±9.5 years; 6861 male [77.7%]) had undergone 1355 OARs and 7470 EVARs. Overall HCV had no impact on in-hospital mortality across quartiles after iEVAR (range, 0.7%-1.4%, p=.15), rEVAR (range, 20.5%-29.6%, p=.63) and iOAR (range, 4.9%-8.8%, p=0.63). However, the rOAR mortality rates in highest-volume (Q4) hospitals were significantly lower than those in the three lower quartile hospitals (23.1% vs 44.7%, p<.001). When analyzed per OAR-alone volume, the same findings were observed (22.0% for Q4 vs 41.6% for Q1-3, p<.001). Furthermore, in Q4 hospitals per the OAR-alone volume analysis, the mortality hazard was greater for rEVAR (39.0%) than for rOAR (22.0%) (HR=2.3, 95% confidence interval, 1.02-5.34, p<.05). The mortality rates for iEVAR, rEVAR and iOAR were independent of HCV. However, after rOAR, mortality rates in high OAR volume hospitals were lower than those in the lower quartile hospitals, and, at least comparable to those of rEVAR. EVAR-first strategy for ruptured AAA might not be applicable to all cases. Patent-specific, individualized treatment should be the gold standard, For patients requiring rOAR, transfer to a regional center of excellene, when clinical safe, should be encouraged. deferred to high-volume aortic OAR centers whenever feasible.

COVID-19 Admission Rates and Changes in Care Quality in US Hospitals

Unprecedented increases in hospital occupancy rates during COVID-19 surges in 2020 caused concern over hospital care quality for patients without COVID-19. To examine changes in hospital nonsurgical care quality for patients without COVID-19 during periods of high and low COVID-19 admissions. This cross-sectional study used data from the 2019 and 2020 Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project State Inpatient Databases. Data were obtained for all nonfederal, acute care hospitals in 36 states with admissions in 2019 and 2020, and patients without a diagnosis of COVID-19 or pneumonia who were at risk for selected quality indicators were included. The data analysis was performed between January 1, 2023, and March 15, 2024. Each hospital and week in 2020 was categorized based on the number of COVID-19 admissions per 100 beds: less than 1.0, 1.0 to 4.9, 5.0 to 9.9, 10.0 to 14.9, and 15.0 or greater. The main outcomes were rates of adverse outcomes for selected quality indicators, including pressure ulcers and in-hospital mortality for acute myocardial infarction, heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, and percutaneous coronary intervention. Changes in 2020 compared with 2019 were calculated for each level of the weekly COVID-19 admission rate, adjusting for case-mix and hospital-month fixed effects. Changes during weeks with high COVID-19 admissions (≥15 per 100 beds) were compared with changes during weeks with low COVID-19 admissions (<1 per 100 beds). The analysis included 19 111 629 discharges (50.3% female; mean [SD] age, 63.0 [18.0] years) from 3283 hospitals in 36 states. In weeks 18 to 48 of 2020, 35 851 hospital-weeks (36.7%) had low COVID-19 admission rates, and 8094 (8.3%) had high rates. Quality indicators for patients without COVID-19 significantly worsened in 2020 during weeks with high vs low COVID-19 admissions. Pressure ulcer rates increased by 0.09 per 1000 admissions (95% CI, 0.01-0.17 per 1000 admissions; relative change, 24.3%), heart failure mortality increased by 0.40 per 100 admissions (95% CI, 0.18-0.63 per 100 admissions; relative change, 21.1%), hip fracture mortality increased by 0.40 per 100 admissions (95% CI, 0.04-0.77 per 100 admissions; relative change, 29.4%), and a weighted mean of mortality for the selected indicators increased by 0.30 per 100 admissions (95% CI, 0.14-0.45 per 100 admissions; relative change, 10.6%). In this cross-sectional study, COVID-19 surges were associated with declines in hospital quality, highlighting the importance of identifying and implementing strategies to maintain care quality during periods of high hospital use.

#688 Major gastrointestinal bleeding in dialysis: influence of age, sex, race &amp; comorbidities

Abstract Background and Aims Gastrointestinal bleeding (GIB) is considered the most common type of bleeding event in the dialysis population [1]. However, studies to date are small and not representative of the dialysis population, and the influence of patient characteristics has not been considered. We used a nationally representative sample of dialysis patients treated in the United States (US) to characterize the rates of major GIB episodes requiring hospitalization overall and by age, sex, race, and history of GIB comorbidity. Method We used data from a kidney care network from Jan 2018 through Mar 2021. We included data from adult dialysis patients (age ≥18 years) who were treated with dialysis for at least 30 days. We excluded patients who started dialysis on or after Jan 2021 to provide a three-month minimum follow up time for outcomes to occur. GIB hospitalizations were identified from international classification of diseases (ICD) diagnosis codes recorded as the primary, secondary, or tertiary discharge reason for hospitalization. ICD clusters defining GIB hospitalizations and lesion location were based on the US Healthcare Cost and Utilization Project [2]. We calculated proportion of patients with one or more GIB hospitalization, and the proportion of GIB observations per patient during the 3.25-year period by patient characteristics (GIB comorbidity, sex, age, race). Results Among 366,839 adult dialysis patients, 6.8% (n = 25,057) experienced one or more GIB hospitalization during the 3.25-year period. In total, there were 36,791 GIB hospitalization observations with 73.5% (n = 18,422) of patients with one GIB hospitalization, 16.8% (n = 4208) with two GIB hospitalizations, and 9.7% (n = 2,427) with three or more GIB hospitalizations. The lesion location was unspecified in diagnosis codes for 64.7% (n = 23,576) of GIB hospitalization observations. Among GIB hospitalization observations with a recorded lesion location, 60.3% (n = 7,968) were an upper GIB and 39.7% (n = 5,247) were a lower GIB. A baseline history of a GIB comorbidity was associated with a 2.9-fold higher rate for the occurrence of one or more GIB hospitalization in a unique patient, and a 3.5-fold higher rate of a GIB hospitalization event considering all observations (Fig. 1A). GIB hospitalization rates were relatively consistent between females and males on both a patient- and observation-level (Fig. 1B). There were positive increases in GIB hospitalization rates with older age categories, with about a 2-fold higher rate among those with an age ≥75 years compared to an age 18-44 years on both a patient- and observation-level (Fig. 2A). GIB hospitalization rates were relatively consistent for race groups, albeit there may be a trend for slightly higher rates among those with a black race, in particular on an observation level that accounts for multiple events per patient (Fig. 2B). Conclusion Major GIB events requiring hospitalization affect about 7% of dialysis patients. It appears about 60% of GIB hospitalizations were for an upper GIB, and about 40% were for a lower GIB. Patients who experienced one GIB hospitalization commonly had multiple GIB events, with more than 25% having two or more GIB hospitalizations during the observation period. Older age and a history of a baseline GIB comorbidity were associated with higher GIB hospitalization rates. Biological sex and race did not appear to be associated to GIB hospitalization rates. Ongoing analysis of GIB incidence accounting for person-years at risk is needed to confirm these observations.

The association between attention deficit hyperactivity disorder and pregnancy, delivery and neonatal outcomes—an evaluation of a population database

BackgroundAttention deficit hyperactivity disorder (ADHD) is one of the more common neuropsychiatric disorders in women of reproductive age. Our objective was to compare perinatal outcomes between women with an ADHD diagnosis and those without.MethodsA retrospective population-based cohort study utilizing the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) United States database. The study included all women who either delivered or experienced maternal death from 2004 to 2014. Perinatal outcomes were compared between women with an ICD-9 diagnosis of ADHD and those without.ResultsOverall, 9,096,788 women met the inclusion criteria. Amongst them, 10,031 women had a diagnosis of ADHD. Women with ADHD, compared to those without, were more likely to be younger than 25 years of age; white; to smoke tobacco during pregnancy; to use illicit drugs; and to suffer from chronic hypertension, thyroid disorders, and obesity (p < 0.001 for all). Women in the ADHD group, compared to those without, had a higher rate of hypertensive disorders of pregnancy (HDP) (aOR 1.36, 95% CI 1.28–1.45, p < 0.001), cesarean delivery (aOR 1.19, 95% CI 1.13–1.25, p < 0.001), chorioamnionitis (aOR 1.34, 95% CI 1.17–1.52, p < 0.001), and maternal infection (aOR 1.33, 95% CI 1.19–1.5, p < 0.001). Regarding neonatal outcomes, patients with ADHD, compared to those without, had a higher rate of small-for-gestational-age neonate (SGA) (aOR 1.3, 95% CI 1.17–1.43, p < 0.001), and congenital anomalies (aOR 2.77, 95% CI 2.36–3.26, p < 0.001).ConclusionWomen with a diagnosis of ADHD had a higher incidence of a myriad of maternal and neonatal complications, including cesarean delivery, HDP, and SGA neonates.

Characteristics and complications of acute promyelocytic leukemia in children: an analysis of a national database

Acute promyelocytic leukemia (APL) is an uncommon subtype of acute myelogenous leukemia (AML) that was previously one of the most fatal forms of acute leukemia. With advances in diagnosis and treatment, APL has become one of the most curable myeloid leukemias. The major reason for treatment failure in APL is early death after initiation of treatment. We performed a retrospective cross-sectional analysis of the Healthcare Cost and Utilization Project 2016 and 2019 Kids’ Inpatient Database, with the diagnosis of APL or AML not in remission as defined by ICD-10-CM codes. We compared complications and outcomes associated with APL and AML (exclusive of APL) in hospitalized children in the U.S. and described yearly national incidence. The national incidence of APL was 2.2 cases per million children per year. Children with APL were more likely to have cardiopulmonary complications (OR 1.79; CI 1.20–2.67; p = 0.004), coagulation abnormalities or DIC (OR 7.75; CI 5.81–10.34; p < 0.001), pulmonary hemorrhage (OR 2.18; CI 1.49–3.17; p < 0.001), and intracranial hemorrhage (OR 10.82; CI 5.90–19.85; p < 0.001) and less likely to have infectious complications (OR 0.48; CI 0.34–0.67; p < 0.001) compared to children with AML. In-hospital mortality rates were similar in children with APL and AML (4.2% vs 2.6%; OR 1.62; CI 0.86–3.06; p = 0.13), while the median length of stay for children who died from APL was shorter compared to AML (2 (IQR: 1–7) versus 25 (IQR: 5–66) days; p < 0.05). Hemorrhagic complications occur more often, and infectious complications occur less often in hospitalized children with APL compared to AML.

Maternal and Fetal Outcomes Among Pregnant Women With Endometriosis [ID 2683578

INTRODUCTION: Endometriosis, a prevalent disorder affecting around 10% of reproductive-aged women, has been linked to obstetric complications during pregnancy. This study aims to evaluate endometriosis prevalence in pregnancy and its effect on maternal and newborn outcomes. METHODS: A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database from the United States between 1999 and 2019. Multivariate logistic regression analysis, controlling for diverse baseline maternal characteristics, was used to investigate pregnancy and newborn outcomes in births to women diagnosed with endometriosis as compared to those without. RESULTS: The cohort consisted of 16,911,497 births to women without endometriosis and 14,956 pregnant women diagnosed with endometriosis. Over the 20-year period, there was a significant upward trend in prevalence of endometriosis among births, rising from 34.9 to 160.6/100,000 births. Births to women with endometriosis exhibited distinctive demographic characteristics: being of advanced maternal age, predominantly of Caucasian ethnicity, belonging to higher income quartiles, obese, smokers, and having private insurance coverage. Births to women with endometriosis were at heightened risk of experiencing obstetric complications, including gestational diabetes, preeclampsia, preterm birth, and postpartum hemorrhage. Neonates born to mothers with endometriosis also demonstrated an elevated likelihood of growth restriction and congenital anomalies. CONCLUSION: The study highlights the evolving prevalence of endometriosis among pregnant women and establishes a strong connection between endometriosis and adverse maternal and newborn outcomes. These findings emphasize the importance of vigilant monitoring to enhance obstetrical and fetal outcomes in pregnant women with endometriosis.

Rural Hospitals Experienced More Patient Volume Variability Than Urban Hospitals During The COVID-19 Pandemic, 2020-21.

Fluctuations in patient volume during the COVID-19 pandemic may have been particularly concerning for rural hospitals. We examined hospital discharge data from the Healthcare Cost and Utilization Project State Inpatient Databases to compare data from the COVID-19 pandemic period (March 8, 2020-December 31, 2021) with data from the prepandemic period (January 1, 2017-March 7, 2020). Changes in average daily medical volume at rural hospitals showed a dose-response relationship with community COVID-19 burden, ranging from a 13.2percent decrease in patient volume in periods of low transmission to a 16.5percent increase in volume in periods of high transmission. Overall, about 35percent of rural hospitals experienced fluctuations exceeding 20percent (in either direction) in average daily total volume, in contrast to only 13percent of urban hospitals experiencing similar magnitudes of changes. Rural hospitals with a large change in average daily volume were more likely to be smaller, government-owned, and critical access hospitals and to have significantly lower operating margins. Our findings suggest that rural hospitals may have been more vulnerable operationally and financially to volume shifts during the pandemic, which warrants attention because of the potential impact on these hospitals' long-term sustainability.