Higher Mean Length Of Stay Research Articles

Economic Implications of Dural Tears in Lumbar Microdiscectomies: A Retrospective, Observational Study

Study DesignRetrospective cohort study. Level of Evidence Level III.Dural tears (DT) are a frequent complication after lumbar spine surgery. With this study we sought to determine the incidence of DT and the related impact on healthcare expenditures after lumbar discectomies. All patients with first-time single level lumbar discectomies at our institution that underwent minimally-invasive surgery from 2015 to 2019 were reviewed. Age, sex, weight, height, body mass index (BMI), costs, revenues, length of stay (LOS), American Society of Anesthesiology (ASA) score, Charlson Comorbidity Index (CCI) and operation time (OT) were assessed. Exclusion criteria were age < 18 years, previous spine surgery, multiple or traumatic disc herniations but also malignant and infectious diseases. The follow-up time was at least 12 months postoperatively. 358 patients with lumbar discectomies were identified and 230 met the inclusion criteria. The DT incidence was 3.5%. The mean costs (p < 0.001), the loss (p < 0.01) and the operation time (p < 0.0001) were found to be significantly higher in the DT group when compared to the control group of patients without a DT. The revenues were not statistically different between both groups (p > 0.05). Further analysis of the control group by profit and loss revealed significantly higher BMI (p < 0.05), LOS (p < 0.0001) and OT (p < 0.0001) in the loss group. DT represent a significant socioeconomic burden in lumbar spine surgery and cause severe secondary complications. The DT-related impact on healthcare expenses is primarily based on significantly higher OT and a higher mean LOS.

Risks and Outcomes of Tumor Lysis Syndrome in Patients Admitted with Diffuse Large B Cell Lymphoma; A Nationwide Analysis

Background: Tumor lysis syndrome (TLS) is a feared complication particularly among patients of diffuse large B cell lymphoma (DLBCL) with bulky lymphadenopathy. We conducted a national wide retrospective analysis to determine the impact of TLS on hospitalization among patients admitted for treatment of DLBCL. Methods: The data for this study was obtained from the National Inpatient Sample Database. Using the relevant International Classification of Diseases (1CD) 10 codes, hospitalizations with the primary diagnosis of DLBCL from 2015-19 were subclassified into cases with and without TLS. Univariate analysis was conducted using the chi-square and T-test to compare categorical and continuous variables, respectively between the two groups. Thereafter, propensity score matching (PSM) was performed to match the two groups for patient demographics, and comorbidities. Cochran-Mantel-Haenzel test was used for determining the odds ratio between the endpoints of interest. A p value of &amp;lt;0.05 was considered significant. The primary endpoint was the difference in all-cause mortality between the two matched cohorts. Other secondary endpoints included important hospitalization complications like acute kidney injury (AKI), cardiac arrhythmias (CA), renal failure requiring hemodialysis (HD), and respiratory failure requiring mechanical ventilation (MV). We also performed cost analysis to determine the difference in length of stay (LOS) and adjusted cost of stay between the two groups. Results: A total of 67910 weighted hospitalizations with a primary diagnosis of DLBCL were recorded from 2015-2019. Among these 3910 (5.8) hospitalizations had TLS.Cases with TLS were more likely to be male (61.5% vs57.1; p&amp;lt;0.01) and black (9.4% vs 8.7%, p&amp;lt;0.01). There was a higher proportion of patients with comorbid conditions in the TLS cohort compared to the no TLS cohort, notably history of coagulopathy (22% vs 10.6%), chronic kidney disease (21.9% vs 13.1%), congestive heart failure (15.6% vs 9.5%), diabetes (25.2% vs 23.4%), liver disease (10.4% vs 6.9%), and hypertension (57.0% vs 54.9%) (all p&amp;lt;0.01) (Table 1). After PSM adjusted for these baseline differences, 680 cases of TLS were matched with 680 cases without TLS. Hospitalizations with TLS had higher odds of all-cause mortality (Odds Ratio [OR] = 2.89, 95% confidence interval [CI]: 1.87-4.46; p&amp;lt;0.01). Patients with TLS also had higher odds of AKI (OR = 5.77, 95% CI: 4.53-7.35; p&amp;lt;0.01), HD (OR = 3.63, 95% CI: 1.79-7.40; p &amp;lt;0.01), and MV (OR = 3.79, 95% CI: 2.28-6.30; p&amp;lt;0.01). Though there was a trend towards higher odds of CA, the difference was not statistically significant. Patients with TLS also had a higher mean LOS (12.2 vs 10.8 days, p&amp;lt;0.01), and mean adjusted cost of hospitalization ($53933 vs $36958, p&amp;lt;0.01) (Table 2). Conclusions: Patients with DLBCL that develop TLS are at a higher risk of all-cause mortality and morbidity. Preventive strategies like generous hydration and early detection of TLS are pivotal to improve outcomes.

C-20 | Higher Amputation Rates Among Patients Admitted to United States Teaching Hospitals in the Month of July: The July Effect

Every year, teaching hospitals in the United States experience a turnover in trainees. Several studies have shown an increase in adverse outcomes and higher resource utilization during the beginning of academic year compared to end academic year. We hypothesized that patient hospitalizations during the month of July would have poorer outcomes compared to those in May. National Inpatient Sample 2018 was queried with ICD-10-CM codes to identify patient admissions during the months of July and May. Outcomes of interest including inpatient mortality, amputation rates and mean length of stay (LOS) were compared between the two groups. A multivariate logistic regression analysis was performed while adjusting for confounders to analyze our outcomes of interest and calculate adjusted odds ratio (aOR) with corresponding 95% confidence interval (CI). A total of 5,560 weighted hospitalizations during the months of July (48.1%) and May (51.9%) were identified. Average age was 70 years and 37.8% were females. Hospital admissions during the month of July were associated with higher amputation rates (aOR 1.33; 1.01 - 1.75, p=0.04), particularly major amputations (aOR 1.50; 1.08-2.1, p=0.02) compared to those in May. There was a non-statistically significant trend towards a higher mean LOS (+0.77 days; -0.58 - 1.59, p=0.07) with July admissions. No difference was found in inpatient mortality rates between the two groups. Hospital admissions during the month of July were associated with higher amputation rates compared to admissions in May. No such July effect was observed in terms of mortality.

Abstract P412: The Effect of Targeted Therapeutic Management in ST-Elevation Myocardial Infarction Cardiac Arrest

Introduction: ST-elevation myocardial infarction (STEMI) is a known cause of cardiac arrest (CA). Little is known about the impact of targeted therapeutic management in CA patients with STEMI (SCA). Our aim was to investigate the effect of TTM on SCA. Methods: This was a retrospective cohort study using the 2019 Nationwide Inpatient Sample database to identify admissions in adults with diagnoses of CA and STEMI. Regression models were adjusted for demographic variables. Primary outcome was mortality, and secondary outcomes were length of stay (LOS) and total charge in USD. Results: Out of 13895 admissions with SCA, 440 underwent TTM. Compared to Non-TTM-SCA cohort, TTM-SCA cohort had fewer females (18.18% vs 31.03,p&lt;0.05), more males (81.82% vs 68.97,p&lt;0.05), lower mean age (62.17 vs 64.57,p&lt;0.05), more Native American (2.27% vs 0.63%,p&lt;0.05), less South region hospitals (25.00% vs 39.95%,p&lt;0.05), less acute respiratory failure with hypercapnia (0.47% vs 8.53%,p&lt;0.05), acute respiratory failure with hypoxia (1.94% vs 38.90%,p&lt;0.001), history of cardiac arrest (0.11% vs 0.61%,p&lt;0.01), ventricular fibrillation (2.27% vs 50.59%,p&lt;0.001), cerebral infarction (0.29% vs 4.28%,p&lt;0.05), more alcohol abuse (12.50% vs 4.72%,p&lt;0.001), and more persistent vegetative state (1.14% vs 0.15%,p&lt;0.05). Compared to Non-TTM-SCA, TTM-SCA group had similar mortality rates (38.64% vs 42.96%,p=0.3940), mortality OR 1.04 (95%CI 0.66-1.62,p=0.869), higher mean LOS 10.69 vs 6.25 days (95%CI 2.39-6.17,p&lt;0.001), and higher mean total hospitalization charge $238960.90 vs $179880.10 (95%CI 18772.87-98404.78,p&lt;0.01). Conclusion: In SCA patients, TTM presence had no difference in mortality rate, odds of mortality, but had higher mean LOS and total hospitalization charge. TTM was associated with fewer females, more males, lower mean age, more Native Americans, less acute respiratory failure, history of cardiac arrest, ventricular fibrillation, cerebral infarction, and more alcohol abuse and persistent vegetative state.

S11 Impact of Marijuana in Ulcerative Colitis With Nstemi Hospitalizations: Insights From National Inpatient Sample 2016-2019.

Background: Marijuana use is increasingly prevalent in patients with ulcerative colitis (UC). Clinical symptoms such as abdominal pain, reduced appetite, and diarrhea improve in some patients after marijuana use; partly due to its psychotropic, neuromodulatory, and immunomodulatory effects via the endocannabinoid pathway. Marijuana use and underlying UC can lead to adverse cardiovascular outcomes, and we aim to study its impact on NSTEMI hospitalizations. Methods: A retrospective analysis of the 2016-2019 NIS was conducted to identify hospitalization (Age ≥18 & non-elective) with acute NSTEMI and concomitant history of UC using ICD-10 codes. Variables were screened with univariate regression, intermediate, co-linear variables were removed before a multivariable regression analysis model was built and performed to calculate the odds ratio. Discharge-level weight analysis was used to produce a national estimate. Results: Out of 142,420,378 hospitalizations, only 7,010 had acute NSTEMI and underlying UC. Only 0.78% of these hospitalizations also reported marijuana use. The mean age of patients who used marijuana was 57.55 yrs vs 70.58 yrs for those who did not. A total of 560 (7.99%) hospitalizations had fatal outcomes; however, the difference in deaths between those who used marijuana vs those who did not was statistically insignificant (9.09% vs 7.99%, P 0.89). Upon multivariate analysis, marijuana is not a risk factor for mortality in UC + NSTEMI (OR 1.11, P 0.907). Factors associated with increased mortality were shock (OR 5.88, P 0.00), AKI (OR 3.44, P 0.00), mech ventilation > 24h (OR 3.44, P 0.00). Marijuana use is also not associated with increased hospital resource utilization (-22557.46$, P 0.42). Factors associated with increased total charges of hospitalization are urban teaching hospital location (rural -48272.37$ p 0.00, urban non-teaching -23378.35$, P 0.00), mech ventilation >24 hr (+170339.6$, P 0.00), HF (+25197.46$, P 0.00), CABG (+152736.6$, P 0.00), and shock (+50532.01$, P 0.000). Marijuana, however, is associated with a lower mean length of stay (LOS) by 3.4 days (P 0.02). Factors associated with higher mean LOS are elixhauser comorbidity (+0.48d, P 0.00), mech ventilation > 24h (+7.35d, P 0.00), shock (+1.72d, p 0.01), ventricular arrhythmias (+1.90d, P 0.02), ESRD on HD (+5.20d, P 0.04), AKI (+2.11d, P 0.00), CABG (+5.62d, P 0.000), and anemia (+1.09d, P 0.02). Conclusion(s): Marijuana is not associated with increase in mortality or total charges of hospitalization in UC patients admitted for acute NSTEMI. Additionally, it is associated with reduced LOS in these hospitalizations, likely due to the lower mean age resulting in quicker recovery and discharge.

Abstract 14180: Characteristics and In-Hospital Outcomes of Haemochromatosis in Heart Failure

Introduction: Cardiovascular complications are the main contributors towards morbidity and mortality in hemochromatosis. Iron overload can cause arrhythmias and heart failure (HF). There is a paucity of data on haemochromatosis and the burden of HF and its sequalae. Hypothesis: To determine characteristics of HF patients with and without haemochromatosis, and in-hospital outcomes (mortality, length of stay (LOS), mechanical circulatory support, and cardiac transplantation). Methods: Patients with HF, with and without hemochromatosis, were identified from the Nationwide Inpatient Sample Database. Results: Between 2016-2019, 2,940 (0.06%) of 4,823,994 HF patients had hemochromatosis. The hemochromatosis cohort was younger (mean age, 68 vs 71 years), predominantly men (63% vs 52%), White (77% vs 64%), and had less cardiovascular comorbidity burden (coronary artery disease (41% vs 51%), atrial fibrillation (45% vs 46%), hypertension (20% vs 24%), hyperlipidaemia (44% vs 53%), diabetes (42% vs 49%) and obesity (18% vs 25%), compared with HF patients without hemochromatosis (p&lt;0.01 for all). However, hemochromatosis patients had a higher concomitant third degree atrio-ventricular block (1.2% vs 0.7%), ventricular tachycardia (7.8% vs 5.4%), ventricular fibrillation (0.5% vs 0.3%), chronic liver disease (24% vs 6%) and anemia (51% vs 37%) [p&lt;0.01]. The hemochromatosis patients had a higher mean LOS (6.1 vs 5.4 days, p&lt;0.01), need for mechanical circulatory support (0.9% vs 0.6%, p&lt;0.01) and cardiac transplantation (0.2% vs 0.1%, p&lt;0.01). Mortality (2.0% vs 2.7%, p=0.09) was comparable between the groups. Conclusion: Despite younger age and lower burden of cardiovascular comorbidities, patients with hemochromatosis had a higher burden of arrhythmias, need for mechanical circulatory support and cardiac transplantation and a higher LOS. This warrants the need to devise early management strategies for HF patients with hemochromatosis.

Incidence and Impact of Refeeding Syndrome in an Internal Medicine and Gastroenterology Ward of an Italian Tertiary Referral Center: A Prospective Cohort Study.

Background: Refeeding syndrome (RS) is a neglected, potentially fatal syndrome that occurs in malnourished patients undergoing rapid nutritional replenishment after a period of fasting. The American Society for Parenteral and Enteral Nutrition (ASPEN) recently released new criteria for RS risk and diagnosis. Real-life data on its incidence are still limited. Methods: We consecutively enrolled patients admitted to the Internal Medicine and Gastroenterology Unit of our center. The RS risk prevalence and incidence of RS were evaluated according to ASPEN. The length of stay (LOS), mortality, and re-admission rate within 30 days were assessed. Results: Among 203 admitted patients, 98 (48.3%) were at risk of RS; RS occurred in 38 patients (18.7% of the entire cohort). Patients diagnosed with RS had a higher mean LOS (12.5 days ± 7.9) than those who were not diagnosed with RS (7.1 ± 4.2) (p < 0.0001). Nine patients (4.4%) died. Body mass index (OR 0.82; 95% CI 0.69–0.97), RS diagnosis (OR 10.1; 95% CI 2.4–42.6), and medical nutritional support within 48 h (OR 0.12; 95% CI 0.02–0.56) were associated with mortality. Conclusions: RS incidence is high among clinical wards, influencing clinical outcomes. Awareness among clinicians is necessary to identify patients at risk and to support those developing this syndrome.

Abstract 12858: Outcomes And Healthcare Utilization Among Patients Admitted With Heart Failure On Medicaid Versus Private Insurance

Background: Heart Failure is the most common diagnosis for cardiovascular admissions across the US. We undertook this study to assess differences in outcomes and healthcare utilization in patients less than 65 years old, who were admitted for HF, on Medicaid (HF-M) versus Private Insurance (HF-P) using a national sample. Methods: The National Inpatient Sample (NIS) was queried to identify all Medicaid and Private-Insurance admissions in adults &lt;65 years old with a principal admission diagnosis of HF between 2016-2018. We studied socio-demographic differences, medical comorbidities, mortality, length of stay (LOS), total hospital charges (THC). Secondary outcomes included arrythmia, cardiogenic shock, cardiac arrest, respiratory failure, sepsis, septic shock, and acute kidney injury. Statistics were performed using the t-test, linear regression, univariate and multinomial logistic regression using Stata 16 software. Results: We identified 329,755 Medicaid and 247,685 Private-insurance admissions with HF. Compared to HF-P, HF-M patients were significantly younger, more likely to be women, Black or Hispanic, more likely to hail from zip-codes with lowest income quartiles. HF-M patients were also significantly more likely to be treated at large sized and urban teaching hospitals. Rates of diabetes, dyslipidemia, CAD and obesity were higher in HF-P patients while COPD, CKD, dialysis and VTE were higher in HF-M patients. Rates of hypertension, smoking and old stroke were similar between groups. More patients died in HF-P group (1.6% vs 1.2%, p&lt;0.0001) and when adjusted for socio-demographics and medical comorbidities, the aOR for death was 0.75 (95%CI 0.67-0.83, p&lt;0.001) in favor of HF-M group. All secondary outcomes were significantly higher in HF-P group except cardiac arrest. HF-P patients also reported higher mean LOS (5.7 vs 5.5 days, p&lt;0.0001) and higher THC ($72,966 vs $59,384, p&lt;0.0001). Conclusion: Our study shows that HF-M patients perform better as compared to HF-P patients, in terms of mortality and healthcare utilization when admitted to the hospital with a principal diagnosis of HF. In current times, when a healthcare reform is urgently needed, this study adds support if the country explores designing a single payor healthcare system.

Clinical outcomes and healthcare utilization of acute hepatitis A virus infection with acute kidney injury in hospitalized patients.

Patients with acute hepatitis A virus (HAV) infection are at risk of developing acute kidney injury (AKI) which may result in increased healthcare resource utilization and worse clinical outcomes. We investigated the impact of AKI on healthcare utilization and clinical outcomes in patients hospitalized with acute HAV infection utilizing a large database. We queried the National Inpatient Sample (NIS) 2007-2014 to identify acute HAV infection-related hospitalizations with and without AKI. Primary outcomes were prevalence of AKI and its predictors with secondary outcomes included the mean length of stay (LOS), hospitalization cost and mortality in both groups. Out of 68 364 acute HAV infection-related hospitalizations, 47 620 met our study criteria and 7458 (15.7%) had concurrent AKI. HAV patients with AKI were older (62.5 vs. 53.7 years; P value <0.001). A higher mean LOS (10.03 vs. 5.6 days; P value <0.001) and mean total hospitalization cost ($27 171.35 vs. $12 790.26; P value <0.001) were observed in HAV patients with the AKI group. A total of 1032 patients (13.8%) in the AKI group died during the same hospitalization as compared to 681 patients (1.5%) in the non-AKI group, P value <0.001. AKI in HAV was also found to be an independent predictor of mortality [adjusted odds ratio (aOR), 3.28; 95% confidence interval, 2.23-4.84; P value <0.001) after adjusting for the confounding factors. We found that 15.67% of patients hospitalized with acute HAV had AKI which contributed to increased healthcare utilization and higher mortality which is preventable.

Operative treatment for intussusception: Should an incidental appendectomy be performed?

Background/objectivesAn incidental appendectomy is performed by some surgeons during operative treatment for intussusception to eliminate future appendicitis as a diagnostic consideration. However, an appendectomy can increase the risk of infection and other noninfectious complications making an incidental appendectomy controversial. We examined outcomes for surgical intervention for intussusception with appendectomy (SWA) compared to surgical reduction alone (SRA). MethodsThe Pediatric Health Information System database, 8/2008–9/2015, was retrospectively analyzed for patients under the age of five who required an operative intervention for intussusception without bowel resection. Demographic data and postoperative outcomes were analyzed. Available data included need for postoperative enema, subsequent small bowel obstruction, recurrent intussusception, length of stay (LOS), and adjusted total cost (ATC). ResultsFifty-seven percent (748/1312) of patients had appendectomy performed during surgical reduction, 564 (43%) did not. ATC ($10,594 vs. $8939, p < 0.001) and LOS (3.0 vs. 2.48, p < 0.001) are higher in the SWA group. Rates of readmission are similar, but post-operative small bowel obstruction may be higher in the SWA group (1.3% vs. 0.35%, p = 0.06). ConclusionThere is a higher mean LOS and ATC in the SWA group. This study suggests that appendectomy during surgery for uncomplicated intussusception should be reconsidered and requires further investigation. Type of Studyretrospective comparative study. Level of EvidenceIII.

Trends in utilization and perioperative outcomes in live donor nephrectomies: a multi-surgical discipline analysis

We aim to analyze the trends in donor nephrectomy (DN) across three surgical disciplines-urology, general surgery, and transplant surgery, specifically to analyze the surgical techniques and perioperative outcomes. We reviewed all live DN reported in the Statewide Planning and Research Cooperative System database of New York State (NYS) from 1995 to 2015. Surgeons were grouped in their respective disciplines using their state license number and the American Medical Association masterfile. We analyzed the volume of DN performed by each group along with how the surgical approach is, such as open, laparoscopic or robotic. Perioperative outcomes assessed were length of stay (LOS), 30-day and 90-day readmission rates, and complication rates RESULTS: A total of 6803 DN were performed with urologists, transplant surgeons and general surgeons accounting for 42%, 29%, and 29% of them, respectively. Urologists performed a higher case volume with a mean surgical volume of 17.4 ± 6.5 per year (p < 0.0001). During the study period, case volumes for urologists and transplant surgeons trended upward, while those for general surgeons trended downward. Urologists also utilized a minimally invasive surgery (MIS) such as laparoscopy or robotic approach in a higher percentage of their cases (p < 0.0001). Regarding perioperative outcomes, general surgeons had a higher mean LOS (p < 0.0001), while transplant surgeons had higher rates of 30-day and 90-day readmission rates (p < 0.0001). There were no statistically significant differences in complication rates following DN among the groups. Urologists remain vital members of the renal transplantation team as they perform a majority of DN in NYS and are increasingly achieving them via an MIS approach when compared to their general and transplant surgery counterparts. Perioperative outcomes are similar amongst all disciplines; however, general surgeons have higher mean LOS, while transplant surgeons have higher readmission rates.

Evaluating the clinical outcomes associated with a modified prolonged infusion piperacillin–tazobactam protocol: A pilot study

AbstractPurpose: This study evaluated the clinical outcomes of a hospital-wide initiative of a 4-h prolonged infusion piperacillin–tazobactam (pip–tz) vs. a 30-min and a 4-h prolonged infusion. Methods: This retrospective study included patients who received pip–tz by two different infusion models with a documented or suspected Gram-negative infection. Patients can receive a 30-min infusion then a 4-h infusion or a 4-h infusion of pip–tz. The study’s primary outcomes were length of stay (LOS) and 30-day mortality. Findings: Seventy-four patients received both types of infusion (SP) and 275 patients received only the prolonged infusion (PI). Using univariate analysis, the PI group had a higher mortality rate (13%) vs. SP group (4%) (p = 0.033). The PI group had a higher mean LOS (12.6 ± 9.5 days) vs. the SP group (10.3 ± 8.2 days) (p = 0.04). The type of infusion was not a significant predictor of LOS or mortality in multiple regression analysis (p > 0.05). Implications: This preliminary study showed that ...

Economic burden associated with hospital postadmission dehydration.

Development of dehydration after hospital admission can be a measure of quality care, but evidence describing the incidence, economic burden, and outcomes of dehydration in hospitalized patients is lacking. The objective of this study was to compare costs and resource utilization of U.S. patients experiencing postadmission dehydration (PAD) with those who do not in a hospital setting. All adult inpatient discharges, excluding those with suspected dehydration present on admission (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes for dehydration: 276.0, 276.1, 276.5), were identified from the Premier database using ICD-9-CM codes. PAD and no-PAD (NPAD) groups were matched on propensity score adjusting for demographics (age, sex, race, medical, elective patients), patient severity (All Patient Refined Diagnosis-Related Groups severity scores), and hospital characteristics (geographic location, bed size, teaching and urban hospital). Costs, length of stay (LOS), and incidence of mortality and catheter-associated urinary tract infection (CAUTI) were compared between groups using the t test for continuous variables and the χ(2) test for categorical variables. In total, 86,398 (2.1%) of all the selected patients experienced PAD. Postmatching mean total costs were significantly higher for the PAD group compared with the NPAD group ($33,945 vs $22,380; P < .0001). Departmental costs were also significantly higher for the PAD group (all P < .0001). Compared with the NPAD group, the PAD group had a higher mean LOS (12.9 vs 8.2 days), a higher incidence of CAUTI (0.6% vs 0.5%), and higher in-hospital mortality (8.6% vs 7.8%) (all P < .05). The results for subgroup analysis also showed significantly higher total cost and longer LOS days for patients with PAD (all P < .05). The economic burden associated with hospital PAD in medical and surgical patients was substantial.

Does hospital accreditation impact bariatric surgery safety?

To evaluate the impact of hospital accreditation upon bariatric surgery outcomes. Since 2004, the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery have accredited bariatric hospitals. Few studies have evaluated the impact of hospital accreditation on all bariatric surgery outcomes. Bariatric surgery hospitalizations were identified using International Classification of Diseases, Ninth Revision (ICD9) codes in the 2010 Nationwide Inpatient Sample (NIS). Hospital names and American Hospital Association (AHA) codes were used to identify accredited bariatric centers. Relevant ICD9 codes were used for identifying demographics, length of stay (LOS), total charges, mortality, complications, and failure to rescue (FTR) events. There were 117,478 weighted bariatric patient discharges corresponding to 235 unique hospitals in the 2010 NIS data set. A total of 72,615 (61.8%) weighted discharges, corresponding to 145 (61.7%) named or AHA-identifiable hospitals were included. Among the 145 hospitals, 66 (45.5%) were unaccredited and 79 (54.5%) accredited. Compared with accredited centers, unaccredited centers had a higher mean LOS (2.25 vs 1.99 days, P < 0.0001), as well as total charges ($51,189 vs $42,212, P < 0.0001). Incidence of any complication was higher at unaccredited centers than at accredited centers (12.3% vs 11.3%, P = 0.001), as was mortality (0.13% vs 0.07%, P = 0.019) and FTR (0.97% vs 0.55%, P = 0.046). Multivariable logistic regression analysis identified unaccredited status as a positive predictor of incidence of complication [odds ratio (OR) = 1.08, P < 0.0001], as well as mortality (OR = 2.13, P = 0.013). Hospital accreditation status is associated with safer outcomes, shorter LOS, and lower total charges after bariatric surgery.

The Effect Of Microalbuminuria On Duration Of Hospitalization In Adult Sickle Cell Disease Patients With Pain Crisis

Introduction Sickle cell disease (SCD) is a genetic blood disorder of hemoglobin resulting in severe morbidity and early mortality. The prevalence of microalbuminuria and/or proteinuria in children with SCD varies from 18 to 28% and increases with age. However, the exact prevalence in adults in not known. In the general population, the presence of albuminuria has been shown to be associated with all cause mortality. The urine microalbumin to creatinine ratio (MA) is considered to be an early sign of impending sickle cell nephropathy. We sought to investigate the association of MA with various SCD genotypes (HbSS, HbSC, HbS/β-thalassemia) in our clinic and also the length of stay (LOS) in hospitalized SCD patients with acute pain crisis. Methods Twenty-eight consecutive SCD patients diagnosed in our clinic by hemoglobin electrophoresis were included in our study. The patients (pts) age, gender, hemoglobin electrophoresis, and baseline MA were obtained. Based on their MA level they were divided into two groups, abnormal MA (MA ≥ 30 mg/g creatinine) or normal MA (&lt; 30 mg/g creatinine). Eleven of these 28 patients were eventually hospitalized for a sickle cell related pain crisis. Their MA level was obtained within 24-hours of hospital admission and their hospitalization length of stay (LOS) was also recorded. We analyzed the association between the two groups of patients, those with normal or abnormal MA, with the different genetic variants of SCD in both our clinic and hospitalized pts. Furthermore, for hospitalized pts we also assessed an association of MA with their mean LOS. The Chi-square test/Fisher’s exact test was used for categorical variables and the T-test/Mann-Whitney test was used for numerical variables. Results All twenty-eight patients were African American without significant renal impairment, with 11, 10, and 7 pts with SS, SC and S β-thalassemia (Sβ), respectively. Fifteen of these pts had abnormal MA, 12 pts were female. The median age was 35.5 yrs (range, 19 - 59), median LOS was 3.5 days (range, 2-8). The SS pts had higher abnormal MA levels followed by SC and then Sβ (p=0.03) (Table 1). There was no significant difference in gender between the two groups (p=0.2). SCD pts admitted to the hospital for pain crisis with an abnormal MA within 24-hours of admission had a significantly higher mean LOS when compared to pts with normal MA (p=0.0089) (Table 1). Conclusion Microalbuminuria is more prevalent in the severe genotypes of SCD disease such as SS and SC vs. Sβ pts. Thereby, MA might be a useful biomarker of generalized SCD vasculopathy, in addition to a known marker of progressive nephropathy. Furthermore, MA has a significant impact on length of hospitalization. An abnormal MA obtained within the first 24-hrs of hospitalization of a SCD pt in pain crisis was predictive of prolonged hospital duration. Early and more aggressive supportive care symptom management for those patients might be a reasonable option but requires more study. Further large prospective clinical trials are needed to validate our findings. Disclosures: No relevant conflicts of interest to declare.

Acute Myeloid Leukemia in the Elderly: Longitudinal Outcomes and Hospital Charges in Chemotherapy and Non-Chemotherapy Patients.

Background: Patients with acute myeloid leukemia (AML) have an estimated median age of 65 to 70 years (J Clin Oncol 1999; 17:3569–76). The overall incidence of the disease increases with increasing age. The five-year survival rate for AML is 2% among elderly patients (Arch Intern Med 2002; 162:1597–1603). Treatment includes cytotoxic chemotherapy [e.g., the “7+3” regimen consisting of cytarabine and daunorubicin or idarubicin (Leukemia 1996; 10:389–95)], which can be associated with serious morbidity and is often not tolerated by older patients. Over 80% of Medicare payments for treating AML are attributable to hospitalization costs (Arch Intern Med 2002; 162:1597–1603).Methods: A longitudinal cohort design was employed using an inpatient database containing information on over three million individuals from 28 hospitals in the US. The study population included patients aged 60 years and older with initial AML diagnosis between January 2000 and June 2003. Patients were followed across multiple admissions, from first inpatient encounter through last discharge from hospital. Descriptive statistics (demographics and hospital characteristics), comorbidities, chemotherapies, outcomes, resource utilization, and charges were examined; multivariate linear regressions were performed.Results: 275 patients were identified and included in these analyses. The mean age upon first AML admission was 74.3 years (SD=8.1) and 46.6% of patients were female. On first admission, the mean length of stay (LOS) was 14.7 days (SD=14.3), 37.8% of patients received chemotherapy, and one quarter of all patients (25.3%) died. Patients incurred a mean total charge of $70,305 on first admission, while the median was $17,640; patients on chemotherapy had mean and median total charges of $113,118 and $74,689, respectively, versus $43,999 and $9,784, respectively, for non-chemotherapy patients. Chemotherapy patients also had a higher mean LOS than non-chemotherapy patients (23.0 vs. 6.7 days, respectively). 44.4% of patients had a least one re-admission with a mean of 36.4 days (SD=62.1) between the first and second admissions. For re-admissions, the mean LOS and charges were 8.9 days (SD=15.3) and $38,785 (median $13,936), respectively. Across all admissions, 41.4% of patients received chemotherapy and 40.7% of patients died in-hospital. Over the entire study period, patients incurred a mean total charge of $115,471 with a median charge of $49,168. In multivariate analyses, after adjustment for covariates, chemotherapy was found to be a significant predictor (p<0.0001) of admission charges, LOS, and total days of stay.Conclusion: Elderly patients with AML incurred substantial charges and inpatient mortality. The highest charges and the majority of deaths occurred during first admission. Current chemotherapy regimens in these patients were associated with substantially increased charges.