Higher Total Hospital Charges Research Articles

Clinical Impact of Obesity on Postoperative Outcomes of Patients With Thyroid Cancer Undergoing Thyroidectomy: A 5-Year Retrospective Analysis From the US National Inpatient Sample.

The clinical impact of obesity on postoperative outcomes of patients undergoing thyroidectomy remains controversial. Patients aged ≥ 18 years who were diagnosed with thyroid malignancy and underwent thyroidectomy between 2016 and 2020 were included, and divided into two groups: patients with body mass index (BMI) < 30 kg/m2 and those with BMI ≥ 30 kg/m2. Patients in the obese group were then subdivided into four groups: Group 1 (BMI 30.0-34.9 kg/m2), Group 2 (BMI 35.0-39.9 kg/m2), Group 3 (BMI 40.0-44.9 kg/m2), and Group 4 (BMI ≥ 45.0 kg/m2) to evaluate the association between degree of obesity and clinical outcomes. We performed propensity score matching, compared outcome variables between the groups, and conducted adjusted multivariate logistic regression analyses of postoperative outcomes. A total of 6778 patients diagnosed with thyroid cancer who underwent thyroidectomy were screened, of whom 1299 (19.2%) patients were obese. Patients in the obese group had higher total hospital charges (p < 0.001) and an increased risk of overall postoperative complications (34.7% vs. 30.5%, p = 0.023). Specifically, patients in the obese group had increased odds of respiratory complication (adjusted odds ratio (aOR) 1.66, 95% confidence interval (CI) [1.26-2.19]), acute renal failure (aOR 1.87, 95% CI [1.13-3.09]), and wound complication (aOR 2.77, 95% CI [1.21-6.37]) than those in the non-obese group. Moreover, trend tests showed that the risks of unfavorable discharge, infection, acute renal failure, and respiratory complication all exhibited an upward trend with increased BMI. Obesity is associated with an increased risk of postoperative complications in patients with thyroid cancer undergoing thyroidectomy. This finding suggests that obese patients should be treated with more caution during postoperative recovery.

Inpatient outcomes of NSTEMI among patients with immune thrombocytopenia: a propensity matched national study.

Patients with immune thrombocytopenia (ITP) admitted for non-ST elevation myocardial infarction (NSTEMI) present a unique therapeutic challenge due to the increased risk of bleeding with antiplatelet and anticoagulation therapies. There is limited evidence studying hospital mortality and complications in this population. The study included a patient cohort from the 2018-2021 National Inpatient Sample database. Propensity score matched NSTEMI patients with and without ITP using a 1:1 matching ratio. Outcomes analyzed were in-hospital mortality, rates of diagnostic angiogram, percutaneous coronary intervention (PCI), acute kidney injury (AKI), congestive heart failure (CHF), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, ventricular tachycardia (VT), ventricular fibrillation (VF), major bleeding, need for blood and platelet transfusion, length of stay (LOS), and total hospitalization charges. A total of 1,699,020 patients met inclusion criteria (660,490 females [39%], predominantly Caucasian 1,198,415 (70.5%); mean [SD] age 67, [3.1], including 2,615 (0.1%) patients with ITP. Following the propensity matching, 1,020 NSTEMI patients with and without ITP were matched. ITP patients had higher rates of inpatient mortality (aOR 1.98, 95% CI 1.11-3.50, p 0.02), cardiogenic shock, AKI, mechanical ventilation, tracheal intubation, red blood cells and platelet transfusions, longer LOS, and higher total hospitalization charges. The rates of diagnostic angiogram, PCI, CHF, VT, VF, and major bleeding were not different between the two groups. Patients with ITP demonstrated higher odds of in-hospital mortality for NSTEMI and need for platelet transfusion with no difference in rates of diagnostic angiogram or PCI.

Graft-versus-host disease in patients with bone marrow transplants: A retrospective study analyzing outcomes and healthcare burden in US hospitals.

Graft-versus-host disease (GVHD) is a recognized complication among individuals undergoing bone marrow transplantation (BMT). There is a requirement for supplementary data regarding the in-patient outcomes of GVHD in individuals who have undergone BMT. Our analysis seeks to assess the healthcare burden and outcomes associated with GVHD in hospitalized patients who have undergone BMT. In this retrospective study, we used data from the National Inpatient Sample (NIS) database spanning from 2016 to 2019. Utilizing ICD-10 codes, we distinguished hospitalizations related to BMT and grouped them into two categories: those with GVHD and those without GVHD. Our areas of focus included in-hospital mortality, length of stay, charges, and associations related to GVHD. Unadjusted odds ratios/coefficients were computed through univariable analysis, followed by adjusted odds ratios (aORs)/coefficients from multivariable analysis that considered potential confounding factors. From 2016 to 2019, data were collected from 13,999 hospitalizations with bone marrow transplants. Among them, 836 had GVHD cases. Patient characteristics showed slight differences in mean age and demographics between the two groups, with GVHD patients having a mean age of 51.61 years and higher percentages of males and whites. Analyzing outcomes, patients with GVHD experienced significantly longer hospital stays (41.4 days vs. 21.3 days) and higher total hospital charges ($824,058 vs. $335,765). Adjusting for confounding factors, GVHD posed a substantial risk. The aOR for mortality in GVHD hospitalizations was 7.20 (95% CI: 5.54-9.36, p < .001). The coefficient for the length of stay was 19.36 days (95% CI: 17.29-21.42, p < .001), and the coefficient for total hospital charges was $453,733 (95% CI: $396,577 to $510,889, p < .001) in GVHD cases. Furthermore, GVHD in patients was associated with elevated risks of various medical conditions. The aORs for sepsis, pneumonia, acute respiratory failure, intubation and mechanical ventilation, Clostridium difficile infection, and acute kidney injury (AKI) in GVHD patients were 2.79 (95% CI: 2.28-3.41, p < .001), 3.30 (95% CI: 2.57-4.24, p < .001), 5.10 (95% CI: 4.01-6.49, p < .001), 4.88 (95% CI: 3.75-6.34, p < .001), 1.45 (95% CI: 1.13-1.86, p = .003), and 3.57 (95% CI: 2.97-4.29, p < .001). GVHD in individuals undergoing BMT is linked to elevated mortality rates, prolonged hospitalization, and higher healthcare costs. Moreover, they face a significantly increased risk of developing complications, such as sepsis, pneumonia, acute respiratory failure, C. difficile infection, and AKI. These results underscore the critical need for vigilant monitoring and effective GVHD management to improve patient outcomes and reduce the complications associated with BMT. Nevertheless, further prospective studies are essential to obtain a more profound understanding and a comprehensive assessment of outcomes in these hospitalized patients.

Impact of opioid-related disorders on complications in patients undergoing bariatric surgery: a propensity score-matched analysis of the national inpatient sample.

The opioid crisis caused a huge health concern in the United States. Despite this, few studies haveexamined the influence of opioid-related disorders (OD) on outcomes after bariatric surgery. The major goal of this study is to determine the impact of OD on in-hospital outcomes for patients undergoing bariatric surgery. The National Inpatient Sample (NIS) database from 2016 to 2020 was used to evaluate patients with OD who underwent bariatric operations including sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. The non-OD comparison group was created using a propensity score match (1:1). Weighted analysis was carried out utilizing NIS-provided weights. The odds ratios were obtained using multivariate logistic regression. A total of 159,455 patients who underwent bariatric surgery were evaluated. Propensity score matching and weighted analysis were used to compare 11,025 in the OD group and 11,025 in the non-OD group. OD was an independent predictor for postoperative complications (odds ratio: 1.29, 95% confidence interval: 1.19-1.39, p < 0.001). Among complications, OD was a predictor for bleeding complications, postoperative nausea and vomiting, anastomotic leak, and mechanical ventilation. In addition, the OD group experienced significantly longer lengths of stay (LOS) and a higher total hospital charges. In patients undergoing bariatric surgery, OD is associated with a significantly higher risk of postoperative complications, as well as increased LOS and total hospital charges. These patients may benefit from further preoperative optimization, including decreasing the opioid dose and closer postoperative monitoring.

Impact of Body Mass Index on Delirious Patients Outcomes: A Nation-Wide Analysis

Background: Delirium is a common serious health problem characterized by abrupt changes in consciousness and cognitive function. It leads to poor prognosis, especially among older adults. Low body mass index (BMI) is an independent risk factor for intensive care unit and postoperative delirium, though the impact of body mass index on the prognosis of delirium has not been well studied. This study aims to examine the correlation of BMI on outcomes of delirium patients. Methods: This cross-sectional study utilized national inpatient sample (NIS) database to examine the association of low BMI (&lt;= 19 kg/m2) termed underweight with patient outcomes among patients admitted with delirium diagnosis between January 1, 2020, and December 31, 2020. This study included adult patients (&gt;18 years old) with delirium as primary and underweight (Z68.1) as secondary diagnosis using International Classification of Diseases (ICD) 10 codes. The study variables included gender, age, race, Charlson Comorbidity Index (CCI), insurance, median household income, hospital region, hospital bed size, teaching hospital status and dementia. We compared baseline characteristics and outcomes for delirium hospitalization. Primary outcome was in-hospital mortality. Hospital length of stay (LOS) and total hospital charges were secondary outcomes. Main determinant variable was BMI status (underweight vs non-underweight). Values were presented as percentages or as mean±standard deviations. Recommended discharge and hospital weights were included to construct national estimates for every analysis. Univariate and multivariate regression analyses were used to find odds ratio and adjusted mean differences. Variables with univariate test with a p &lt; 0.20 was included in multivariable model, along with other variables of known clinical importance. STATA version 18.0 (StataCorp LLC, Texas, USA) was used for statistics, and p &lt; 0.05 was considered statistically significant. Results: About 130,805 patients were hospitalized with delirium as primary diagnosis with 6,605 (5.05%) being underweight patients. Overall, in-hospital mortality among the delirium hospitalization group was 2.2%. Most underweight delirium patients were females (63.1%), mean age of 74 years, Caucasian (71.04%), with a low median household income (29.4%) and Medicare payer type (81.2%). Hospital characteristics for most of these admissions include large bed size (49.5%), urban teaching hospitals (70.9%) and located in southern part of United States (38.4%). In multivariate regression analysis, underweight delirium patients had statistically significant increased risk of in-hospital mortality (adjusted odds ratio, [AOR] 2.03; p &lt; 0.001), higher average LOS (additional 2.28 days; p &lt; 0.001) and higher total hospital charges per stay (additional $10,295.26; p &lt; 0.003) when compared to non-underweight patients after controlling for patient and hospital characteristics, CCI and dementia. Conclusions: Underweight is an independent risk factor for in-hospital mortality, longer LOS, and higher costs among adult delirium patients. This study aims to create awareness about this special subgroup of delirium patients for improving their outcome.

Abstract 2126: Impact Of Pulmonary Hypertension On In-Hospital Outcomes Among Patients With Atrial Fibrillation Undergoing Catheter Ablation: Insights From The National Inpatient Sample Database

Introduction: Catheter Ablation (CA) is a treatment option for patients with Atrial Fibrillation (AF) when medications are intolerable or are unable to control symptoms. Pulmonary hypertension is characterized by elevated pulmonary artery pressure and affects all ages, genders and races. In this study, we examine the impact of pulmonary hypertension (PH) on hospitalized patients with AF undergoing catheter ablation. Methods: Using the International Classification of Diseases, 10th edition, Clinical Modification (ICD-10-CM) diagnosis and procedure codes, we queried the National Inpatient Sample 2016 to 2020 for hospitalizations among patients ≥18 years old diagnosed with PH, and AF who underwent CA procedure. Among this cohort, we identified the percentage of all hospitalizations for AF undergoing CA and stratified this cohort into those with and without PH. Mortality and length of hospital stay were compared between those with and without PH. Results: Our study included 232,150 weighted hospitalizations among patients with atrial fibrillation who underwent catheter ablation. Of these, 28,980 (12.5%) had pulmonary hypertension, and the majority (51.1%) were males. Among this cohort, those with pulmonary hypertension were older compared to those without pulmonary hypertension (mean [SD] age: 70.0 [11.2] vs. 68.2 [11.4] years). Patients with pulmonary hypertension had a higher length of hospital stay (10.2 vs. 6.2 days, p&lt;0.0001) and higher total hospital charges ($241,212 vs. $187,987; p&lt;0.0001) compared to those without pulmonary hypertension. Higher in-hospital mortality was recorded among patients with pulmonary hypertension compared to those without pulmonary hypertension (3.4% vs. 1.2%, p&lt;0.0001 ). Conclusion: Among patients with atrial fibrillation undergoing catheter ablation, pulmonary hypertension was associated with worse outcomes, including higher length of stay and mortality. Further research is needed to better understand the impact of pulmonary hypertension among patients with atrial fibrillation undergoing catheter ablation.

Ulcer Bleeding in the United States: Epidemiology, Treatment Success, and Resource Utilization.

Peptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different treatment modalities in this setting. Retrospective cohort study using the National Inpatient Sample. Non-elective adult admissions with a principal diagnosis of ulcer bleeding were included. The primary outcome was endoscopic, radiologic and surgical hemostasis success rate. Secondary outcomes were patients' demographics, in-hospital mortality and resource utilization. On subgroup analysis, gastric and duodenal ulcers were studied separately. Confounders were adjusted for using multivariate regression analysis. A total of 136,425 admissions (55% gastric and 45% duodenal ulcers) were included. The mean patient age was 67years. The majority of patients were males, Caucasians, of lower income and high comorbidity burden. The endoscopic, radiological and surgical therapy and hemostasis success rates were 33.6, 1.4, 0.1, and 95.1%, 89.1 and 66.7%, respectively. The in-hospital mortality rate was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis, respectively. Duodenal ulcers were associated with lower adjusted odds of successful endoscopic hemostasis, but higher odds of early and multiple endoscopies, endoscopic therapy, overall and successful radiological therapy, in-hospital mortality, longer length of stay and higher total hospitalization charges and costs. The ulcer bleeding endoscopic hemostasis success rate is 95.1%. Rescue therapy is associated with lower hemostasis success and more than a ten-fold increase in mortality rate. Duodenal ulcers are associated with worse treatment outcomes and higher resource utilization compared with gastric ulcers.

The impact of Clostridioides difficile infection on outcomes among kidney transplant recipients

Clostridioides difficile infection (CDI) is a significant cause of morbidity and mortality among hospitalized patients, particularly those who are immunosuppressed. We aim to assess the outcomes of CDI among kidney transplant (KT) recipients. Nationwide Inpatient Sample from 2016 to 2020 was used to identify patients with KT and stratify based on the presence of CDI. Data were collected regarding demographics and comorbidities. Outcomes included in-hospital mortality, acute kidney injury, intensive care unit admission, transplant rejection, transplant failure, length of stay, and total hospitalization charges. The relationships between variables of interest and outcomes were analyzed using multivariate regression. A total of 557,635 KT recipients were included. CDI prevalence was 2.4%. The majority of patients in the CDI group were age >65 (43.6%), female (51%), White (55.3%), and had Medicare insurance (74.9%). On multivariate regression analysis, CDI was associated with increased odds of acute kidney injury (aOR 2.06, p<0.001), intensive care unit admission (aOR 2.47, p<0.001), and mortality (aOR 1.90, p<0.001). CDI was also associated with longer length of stay (9.35 days vs 5.42 days, p<0.001) and higher total hospitalization charges ($110,063 vs $100,006, p<0.001). There was no difference in transplant rejection, complication, failure, or infection among KT recipients with CDI and those without. We found that CDI was associated with worse outcomes and higher costs. KT patients should be monitored closely for signs of CDI in order to initiate appropriate management.

Racial/ethnic disparities in inpatient palliative care utilization and hospitalization outcomes among patients with colorectal cancer.

Research has shown that racial/ethnic disparities exist in outcomes for colorectal cancer (CRC) patients, but there are no studies assessing inpatient palliative care utilization and hospitalization outcomes in this population. We examined racial/ethnic disparities in palliative care utilization and hospitalization outcomes among CRC and early-onset CRC patients. Using National Inpatient Sample (NIS) data collected between 2016 and 2018, cross-sectional analyses were performed. Descriptive analyses were done, stratified by race/ethnicity. Multivariable logistic and linear regression models were used to examine racial/ethnic differences in palliative care utilization, inpatient mortality, chemotherapy/radiotherapy use, length of stay and total hospital charges among hospitalized patients with CRC and early-onset CRC. Blacks had higher odds (AOR: 1.09; 95% CI: 1.03-1.16) of receiving palliative care consultation while Hispanics had lower odds (AOR: 0.90; 95% CI: 0.84-0.96) compared to Whites. Blacks had 1.1 times higher odds (95% CI: 1.01-1.18) of inpatient mortality relative to Whites while Hispanics had 16% (AOR: 0.84; 95% CI: 0.76-0.93) lower odds of inpatient mortality. Compared to Whites, Blacks (AOR: 1.99; 95% CI: 1.64-2.41), Hispanics (AOR: 2.49; 95% CI: 1.94-3.19) and colorectal cancer patients in the other category (AOR: 1.72; 95% CI: 1.35-2.18) were more likely to receive inpatient treatment with chemotherapy/radiotherapy. Furthermore, Black patients were 1.1 times (95% CI: 1.06-1.14) more likely to have a length of stay more than 5 days. Blacks (𝛃: $3,096.7; 95% CI: $1,207.0-$4,986.5) Hispanic (𝛃: $10,237.5; 95% CI: $7,558.2-$12,916.8) and other patients (𝛃: $6,332.0; 95% CI: $2,830.9-$9, 833.2) had higher hospital charges relative to their White counterparts. Among patients with early onset CRC, Blacks had higher palliative care use (AOR: 1.29; 95% CI: 1.10-1.51) and inpatient mortality (AOR: 1.38; 95% CI: 1.06-1.79) while Hispanics reported $5,589.7 (95% CI: $683.2-$10,496.2) higher total hospital charges and were more likely to receive inpatient chemotherapy/radiotherapy (AOR: 2.48; 95% CI: 1.70-3.63). Further research is needed to explore specific cultural, socioeconomic, and political factors that explain these disparities and identify ways to narrow the gap. Meanwhile, the healthcare sector will need to assess what strategies might be helpful in addressing these disparities in outcomes in the context of other socioeconomic and cultural factors that may be affecting the patients.

Outcomes Among Hospitalized Patients with Relapsing Multiple Myeloma Utilizing Palliative Care: A United States Population-Based Cohort Study

Background Multiple myeloma has a limiting effect on quality of life, with pain being a commonly reported symptom secondary to lytic lesions. Palliative care plays an important role in both pain management as well as addressing individualized goals of care. Newer treatment options are often implemented in patients with relapsing multiple myeloma, and have the potential to cause further treatment related adverse effects. The role of palliative care in this subgroup needs further exploration. Methods We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified hospitalized patients who have relapsing multiple myeloma and subsequently had a palliative care encounter using appropriate ICD-10 CM codes. We stratified patients based on whether they had a palliative care encounter during the hospitalization or not. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of &amp;lt;0.05 was considered statistically significant. The aim of this study is to investigate the outcomes among hospitalized patients with relapsing multiple myeloma with an in-patient palliative care encounter looking primarily at the in-hospital mortality, hospital LOS as well as total hospital charges. Results We identified a total of 16,726 hospitalized patients with relapsing multiple myeloma, of which 11.30% (1890/16,726) had an in-patient palliative care encounter. The overall in-hospital mortality among those with multiple myeloma was 9.86% (1040/16,726). Among those who had a palliative care encounter, the overall in-hospital mortality rate was significantly higher at 29.97% (566/1890) (p=&amp;lt;0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, the inpatient palliative care encounter among hospitalized multiple myeloma patients significantly increased the risk for in-hospital mortality (adjusted OR 11.99, 95% confidence interval [CI], 8.03-17.92; p=&amp;lt;0.001), longer hospital LOS (median LOS 7 days versus 5 days, p=&amp;lt;0.001) and higher total hospital charges (median total hospital charge 76131 vs 48855, p=0.002) Conclusion Our analysis revealed a statistically significant increased risk of in-hospital mortality, hospital LOS, and total hospital charges in hospitalized patients with relapsing multiple myeloma who had a palliative care encounter. Caution should be exercised in interpreting these results as they may reflect uncontrolled and more advanced disease in patients utilizing palliative care. Further prospective studies are needed to better understand short and long-term outcomes in this patient population.

Insights regarding in-hospital outcomes of COVID-19 hospitalisations and co-existing premature ventricular contractions : from national inpatient sample 2020

Abstract Introduction Since the emergence of the COVID-19 pandemic, several reports have highlighted COVID-19 infection's arrhythmogenic consequences on the cardiac conduction system (1). SARS-CoV-2 has a well-established predilection to cardiomyocytes and is associated with myocardial injury with worse predicted outcomes. A wide range of electrocardiographic findings was significantly associated with COVID-19 infection (2). However, literature is scarce on the outcomes of such ECG findings, and its implications are yet to be understood. Purpose We sought to illustrate the significant outcomes of patients hospitalised for COVID-19 infection and premature ventricular contractions. Methods The National Inpatient Sample database (NIS) - 2020 was analysed to identify adult hospitalisations with a primary diagnosis of COVID-19 with or without co-existing premature ventricular contractions (PVC) using International Classification of Diseases – 10 Clinical Modification (ICD-10-CM) codes. The primary outcome was inpatient mortality, while secondary outcomes included inpatient morbidity, mean length of stay (LOS), and mean total hospital charge (THC). Multivariate logistic regression and linear regression analyses were used to adjust for possible confounders. Results Out of 1,050,045 COVID-19 hospitalisations, 7,729 (0.73%) had PVCs. Encounters with COVID-19 and co-existing PVCS had higher adjusted odds of inpatient mortality (Adjusted odds ratio [aOR]: 1.18, 95% confidence interval [CI]: 1.014-1.38, p=0.033), longer mean LOS of 1.8 days (95% CI: 1.4-2.3, p &amp;lt;0.001), and higher mean THC of $21,869 (95% CI: $13,902-$29,835, p &amp;lt;0.001) than those without co-existing PVCs. Figure 1 shows a forest plot illustrating the multivariate analysis of in-hospital morbidities when adjusted for patient demographics, comorbidities, and hospital characteristics. Conclusion Among patients hospitalised with COVID-19 infection, those with premature ventricular contractions had worse outcomes regarding in-hospital mortality, sepsis, need for endotracheal intubation, mechanical ventilation, and vasopressors use, in addition to the longer length of hospital stay, and higher total hospital charges. Although PVCs are commonly encountered in hospitalised patients and often require no medical interventions in most cases, they are associated with poor prognosis in patients with COVID-19 infection.Forest plot for adjusted outcomes

Abstract 16506: Effect of COVID-19 on Outcomes of Patients Hospitalized With Takotsubo Cardiomyopathy

Introduction: Takotsubo Cardiomyopathy (TCM), commonly known as stress cardiomyopathy, is a condition characterized by the abrupt occurrence of acute left ventricular dysfunction, triggered by a variety of physical and psychosocial factors. The influence of COVID-19 on the outcomes of TCM hospitalizations remains relatively understudied. Thus, our objective was to investigate the impact of COVID-19 (COVID) on the outcomes of individuals hospitalized with TCM. Methods: The 2019-2020 National Inpatient Sample (NIS) was analyzed to identify adult hospitalizations admitted for TCM with a concurrent diagnosis of COVID-19 using International Classification of Disease 10 Clinical Modification (ICD-10-CM) codes. We compared baseline characteristics using T-test and Chi-square for continuous and categorical variables, respectively and multivariate regression analysis was used to adjust for potential confounders. Results: Out of the 41,324 TCM hospitalizations, 1,665 had a concurrent COVID infection. Hospitalizations with TCM and COVID had statistically significant difference in mortality (adjusted Odds Ratio (aOR) 2.30; Confidence Interval [CI] 1.2-4.5, p = 0.01), longer length of stay (LOS) 4.1 days (CI 2.8-5.5, p &lt; 0.001), and higher mean total hospital charges (THC) of $46,452 (CI 17,711-75203). Figure 1 shows the Forrest plot for multivariate analysis of in-hospital morbidities when adjusted for patient demographics, comorbidities and hospital characteristics. Conclusions: Patients hospitalized for TCM with concurrent COVID 19 infection had increased in-hospital mortality, longer LOS, higher THC and increased odds of cardiogenic shock, cardiac arrest, acute kidney injury (AKI), use of mechanical ventilation and use of vasopressor support.

Maternal and prenatal outcomes of hemochromatosis in pregnancy: A population-based study.

This retrospective study investigated the impact of hemochromatosis on maternal and perinatal outcomes among delivery hospitalizations in the United States between 2010 and 2019, revealing notable trends and associations. Utilizing data from over 36 million delivery hospitalizations, we conducted a comprehensive analysis, focusing on maternal complications, perinatal outcomes, and healthcare utilization among women with hemochromatosis compared to those without. Women with hemochromatosis exhibited a longer length of hospital stay (3.27±0.20 days vs. 2.64±0.04 days) and higher total hospital charges ($21,789.66 ± $1124.41vs. $17,751.63 ± $97.71) compared to those without the condition. There was a significant increase in the prevalence of hemochromatosis among delivery hospitalizations over the studied period, from 1.91 per 100,000 hospitalizations to 8.65 cases per 100,000 hospitalizations. Hemochromatosis patients demonstrated a higher prevalence of hypertensive disorders of pregnancy (aOR: 1.50, 95% CI: 1.03-2.19) and VTE(aOR: 20.35, 95% CI: 5.05-82.05).There were no statistically significant differences in rates of peripartum hemorrhage, C-section, preterm birth, fetal growth restriction, large for gestational age infants, and fetal death between the two groups. Our findings underscore higher hypertensive disorders of pregnancy and VTE among women with hemochromatosis, despite unaffected perinatal outcomes. An increasing trend in hemochromatosis prevalence highlights the need for targeted interventions and cost-effective management strategies. Future research is needed to explore potential racial disparities and understand the rising incidence of hemochromatosis among pregnant women.

The Effects of Malnutrition on Inpatient Outcomes in Patients With Gastroparesis: A Nationwide Analysis.

Introduction Gastroparesis (GP) is a chronic debilitating gastric motility disorder defined as delayed emptying of the stomach content without mechanical obstruction. It can result in nutritional deficiencies, leading to poor overall outcomes. We assessed the impact of malnutrition on in-hospital outcomes in patients with gastroparesis. Methods Patients with a primary discharge diagnosis of GP between January 2016 and December 2019 were included in the National Inpatient Sample (NIS) database. Data on patient demographics, hospital characteristics, the Charlson Comorbidity Index (CCI), and the etiology of gastroparesis were collected. The association between malnutrition and outcomes, including mortality, deep vein thrombosis (DVT), pulmonary embolism (PE), sepsis, acute kidney injury (AKI), length of stay (LOS), and total hospitalization charges (THC), were analyzed using the multivariate regression model. Results A total of 182,580 patients with gastroparesis were included in the analysis. Patients with gastroparesis and malnutrition had a higher risk of mortality (adjusted odds ratio {aOR}, 3.29; p<0.001), sepsis (aOR, 0.43; p<0.001), DVT (aOR, 2.34; p<0.001), and PE (aOR, 2.68; p<0.001) compared to patients with gastroparesis without malnutrition. No significant difference was noted in the rates of AKI. Patients with malnutrition also had a prolonged LOS (2.96 days; p<0.001) and higher THC ($22,890; p<0.001) compared to patients without malnutrition. Conclusion Gastroparesis patients with malnutrition are at a greater risk of worse outcomes than those without malnutrition. The early identification of malnutrition in gastroparesis patients can predict morbidity and mortality and assist in risk stratification to enhance outcomes. Further studies are encouraged to identify factors associated with malnutrition in gastroparesis and the impact of interventions to prevent and treat malnutrition.

FRI045 Impact Of Morbid Obesity On Lupus Hospitalizations: A Nationwide Analysis

Abstract Disclosure: F. Sami: None. S. Sami: None. K.N. Patolia: None. T. Ayub: None. Background: Obesity is a risk factor for Systemic Lupus erythematosus(SLE) and reduces quality of life in SLE patients because of disease activity and damage accrual. We aim to define the epidemiology of obese SLE patients, impact of morbid obesity on lupus hospitalizations &amp; assess healthcare economic burden from obesity. Methods: The National Inpatient Sample (NIS) was used to obtain data. Data was optimized to reflect national estimates. Patients hospitalized with a principal diagnosis of SLE with and without morbid obesity as a comorbidity were obtained from 2016-2019 NIS. Epidemiological characteristics were analyzed. Primary outcomes of mortality, length of hospital stay (LOS), &amp; total hospital charges(THC) were compared for both groups. Univariate logistic analysis was used to identify confounders and adjusted odds ratio was calculated using the multivariate logistic regression model. Results: Of 721,090 SLE hospitalizations, 7.96% had obesity as a comorbidity. For obese SLE patients, mean age was significantly lower than nonobese SLE patients(51.94 years [SD 13.86] vs 52.55 years [SD 17.30]). There were significantly more females (93.1% vs. 88%), were from age group of 40-60 years (47.5% vs 36.3%), were caucasians (50.64% vs 48.62%) and blacks (34.5% vs 30.7%)Obesity was less frequent in Hispanic and Asian lupus patients (odds ratio [OR] 0.79 and 0.33, respectively). It was significantly more in low socioeconomic SLE patients (income $1-$55,999) (38.18% vs. 33.87%) and less prevalent in high socioeconomic class with income &amp;gt; $94000 (13.3% vs 49.56%). Mortality rate was significantly higher for obese SLE patients (1.54 % vs. 1.20%, OR 1.03). Obese group had mean LOS 5.79 days vs. 5.42 days (p-value 0.009) and higher THC ($66265 vs $63742, p-value &amp;lt; 0.001). Charlson comorbidity index was higher for obese SLE (3.33 vs 2.98, p-value &amp;lt; 0.001). Obese SLE patients were significantly more common to have sepsis (10.24% vs 8.67%, OR 1.20), heart failure (6.50% vs 5.05%, OR 1.31) pulmonary embolism/deep vein thrombosis (PE/DVT) (3.86% vs. 2.69%,OR 1.45) and respiratory failure (17.91% vs 12.68%, OR 1.50), with p-value &amp;lt; 0.001 for all.It was not an independent predictor of mortality for SLE patients. Other significant predictors of mortality identified for SLE patients were age (OR 1.02), Charlson comorbidity index (OR 1.06), renal failure (OR 2.75), sepsis (OR 2.74), PE/DVT (OR 2.22), respiratory failure (OR 12.75), and stroke (OR 1.82), most of which were more common with obesity. Conclusion: Obesity with SLE is more widely seen in females, relatively younger age, low socioeconomic class, Caucasians and African-Americans. Obese SLE patients have greater mortality, THC &amp; LOS, reflecting more healthcare burden. Respiratory failure, stroke, sepsis, PE/DVT and heart failure are more common in obese patients. Therefore, weight optimization therapies for SLE may improve outcomes. Presentation: Friday, June 16, 2023

Prevalence and Impact of Malnutrition in Hospitalizations Among Celiac Diseases: A Nationwide Analysis.

Celiac disease (CD) is a T-cell-mediated gluten sensitivity that results in villous atrophy in the small intestine, leading to chronic malabsorption. Patients with celiac disease are prone to malnutrition. We assessed the impact of malnutrition on in-hospital outcomes in patients with CD. Patients with a primary discharge diagnosis of CD between January 2016 and December 2019 were included in the National Inpatient Sample Database. Data were collected on patient demographics, hospital characteristics, the Charlson Comorbidity Index (CCI), and concomitant comorbidities. The association between malnutrition and outcomes, including mortality, deep vein thrombosis (DVT), pulmonary embolism (PE), sepsis, acute kidney injury (AKI), length of stay (LOS), and total hospitalization charges (THC), was analyzed using the multivariate regression model. A total of 187310 patients with CD were included in the analysis. Patients with CD and malnutrition had a higher risk of mortality (adjusted odds ratio [aOR], 2.08; p<0.001), AKI (aOR=1.18, p=0.003), and DVT (aOR=1.53; p<0.001) compared to patients with CD without malnutrition. No significant difference was noted in the rates of sepsis and PE. Patients with malnutrition also had a prolonged LOS (2.89 days; p<0.001) and higher THC ($22252.18; p<0.001) compared to patients without malnutrition. Patients with CD and malnutrition are at high risk of worse outcomes. Early identification of malnutrition in CD can help prevent morbidity and mortality.Even strict adherence to a gluten-free diet has been associated with malnutrition. Further studies identifying factors associated with malnutrition in CD and the impact of interventions to prevent and treat malnutrition are encouraged.

The Impact of Type 2 Myocardial Infarction in Acute Pancreatitis: Analysis of 1.1 Million Hospitalizations and Review of the Literature.

Introduction Acute pancreatitis (AP) is a common inflammatory disorder with acute onset and rapid progression. Studies have reported cardiac injury in patients with AP. It is often thought that stress cardiomyopathy can induce these changes leading to type 2 myocardial infarction (type 2 MI) in AP. Our study aims to assess the prevalence as well as the impact of type 2 MI on outcomes in patients with AP. Methods National Inpatient Sample (NIS) 2016-2020 was used to identify adult patients (age>18) with acute pancreatitis. We excluded patients with STEMI, NSTEMI, pancreatic cancer, or chronic pancreatitis. Patients with missing demographics and mortality were also excluded. Patients were stratified into two groups, based on the presence of type 2 MI. Multivariate logistic regression analysis was performed to assess the impact of concomitant type 2 MIon mortality, sepsis, acute kidney injury (AKI), ICU admission, deep venous thrombosis (DVT), and pulmonary embolism (PE) after adjusting for patient demographics, hospital characteristics, etiology of AP and the Elixhauser comorbidities. Results Of the 1.1 million patients in the study population, only 2315 patients had type 2 MI. The majority of the patients in the type 2 MI group were aged >65 years (49.2%, p<0.001), males (54.6%, p=0.63), White (67.6%, p=0.19), had Medicare insurance (55.5%, p<0.001), and were in the lowest income quartile (34.8%, p=0.12). Patients in the type 2 MI group had a higher incidence of mortality (5.4% vs 0.6%, p<0.001), sepsis (7.1% vs 3.7%, p<0.001), shock (9.3% vs 0.9%, p<0.001), AKI (42.9% vs. 11.8%, p<0.001) and ICU admission (12.1% vs 1.4%, p<0.001). After adjusting for confounding factors, patients in the type 2 MI group were noted to be at higher odds of mortality (aOR=2.4; 95% CI 1.5-3.8, p<0.001). Patients in the type 2 MI group had a longer length of stay (adjusted coefficient=2.1 days; 95% CI 1.4-2.8; p<0.001) and higher total hospitalization charges (adjusted coefficient=$45,088; 95% CI $30,224-$59,952; p<0.001). Conclusion Although the prevalence of type 2 MI in AP is low, the presence of type 2 MI is associated with increased mortality and worse outcomes. Physicians should be aware of this association and these patients should be monitored carefully to prevent worse outcomes.

Trends, predictors and impact of atrial fibrillation on inpatient outcomes among malignant melanoma patients: A 5-year National Inpatient Sample (NIS) study.

e21525 Background: Malignant melanoma (MM), a very aggressive cancer, is associated with the highest mortality rate among dermatologic malignancies. Atrial fibrillation (AF) is the most common cardiac arrhythmia. Very little is reported in the literature on the association between both diseases, and there is marked paucity of studies comparing outcomes in patients with concomitant MM and AF. Methods: Retrospective cohort analyses were performed using the National Inpatient Sample (NIS) data collected between 2016 and 2020. Multivariable logistic and linear regression models were used to examine the predictors of AF and inpatient outcomes among MM patients. Results: Out of 9,760 hospitalizations with a diagnosis of MM, the overall prevalence of AF was 13.3% with an increasing trend from 10.1% in 2016 to 16.4% in 2020. MM patients with AF had similar odds (adjusted odds ratio (AOR) = 0.9; 95% confidence interval (CI) = 0.45–1.61) of inpatient all-cause mortality when compared to those without atrial fibrillation. However, they were more likely to have longer hospital stays (beta coefficient (β) = 1.27; 95% CI = 0.39–2.0) and total hospital charges (β = $12,830; 95% CI: $7041.4–$25426.4) when compared to their counterparts without atrial fibrillation. Furthermore, patients with AF had a double likelihood (AOR: 1.90; 95% CI: 1.25–2.90) of developing an acute kidney injury (AKI). We also found that female MM patients were 50% (AOR: 0.50; 95% CI: 0.36–0.68) less likely to have a diagnosis of AF relative to their male counterparts. Similarly, Hispanic MM patients were significantly less likely (AOR: 0.06; 95% CI: 0.008–0.459) to have AF in comparison to Non-Hispanic White patients. Conclusions: There is an increasing trend of comorbid atrial fibrillation in patients hospitalized for malignant melanoma, and this is associated with longer hospital stays and higher total hospital charges. These findings highlight the need for surveillance to enable early detection of atrial fibrillation in this population.

Racial disparities in hospitalization outcomes among patients with cholangiocarcinoma.

6631 Background: Studies have reported on the rising incidence and mortality outcomes among patients diagnosed with cholangiocarcinoma (CCA) but racial disparities in outcomes among inpatients have not been explored in this population. We examined the racial disparities in outcomes among adult hospitalized patients with a diagnosis of CCA. Methods: Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS), 2016-2020. Multivariate logistic and linear regression models were used to examine the association between race/ethnicity and patient disposition, length of stay, elective admissions, and total hospital charges. Results: In the adjusted analyses, while Black patients had 14% higher odds (95% Confidence Interval (CI): 1.04–1.25) of being discharged to a facility/home with home health care versus routine discharge when compared to their White counterparts, Hispanics had 14% lower odds (95% CI: 0.79–0.95). Black patients had 39% higher risk (95% CI: 1.19–1.63) of death versus routine discharge relative to the White patients. Compared to White patients, Blacks (AOR: 1.23; 95% CI: 1.13–1.34), Hispanics (AOR: 1.15; 1.06–1.25) and other race/ethnicities (AOR: 1.20; 1.10–1.31) were more likely to have a length of hospital stay greater than 5 days relative to 5 days or less. Hispanics (β: $16,789; 95% CI: $11,480–$22,099) were found to have higher total hospital charges when compared to the White CCA patients. Additionally, Black (AOR: 0.68; 95% CI: 0.60–0.78) and Hispanic patients (AOR: 0.87; 95% CI: 0.77–0.99) were less likely to be admitted electively to the hospital. Conclusions: Despite advances made in treatment of patients with CCA, the prognosis remains poor. We report disparities in various hospitalization outcomes among adult patients with a diagnosis of CCA. Health care providers need to be aware that these disparities exist and health policies should be implemented to narrow the gap in existing disparities. [Table: see text]

Frailty as a risk-stratification tool in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS).

The concept of frailty has gained importance, especially in patients with liver disease. Our study systematically investigated the effect of frailty on post-procedural outcomes in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). We used National Inpatient Sample(NIS) 2016-2019 data to identify patients who underwent TIPS. Hospital frailty risk score (HFRS) was used to classify patients as frail (HFRS>=5) and non-frail (HFRS<5). The relationship between frailty and outcomes such as death, post-procedural shock, non-home discharge, length of stay (LOS), post-procedural LOS, and total hospitalization charges (THC) was assessed. A total of 13,700 patients underwent TIPS during 2016-2019. Of them, 5,995 (43.76%) patients were frail, while 7,705 (56.24%) were non-frail. There were no significant differences between the two groups based on age, gender, race, insurance, and income. Frail patients had higher mortality (15.18% vs. 2.07%, p<0.001), a higher incidence of non-home discharge (53.38% vs. 19.08%, p<0.001), a longer overall LOS (12.5 days vs. 3.35,p<0.001), longer post-procedural stay (8.2 days vs. 3.4 days, p<0.001), and higher THC ($240,746.7 vs. $121,763.1, p<0.001) compared to the non-frail patients. On multivariate analysis, frail patients had a statistically significant higher risk of mortality (aOR-3.22, 95% CI-1.98- 5.00, p<0.001). Frailty assessment can be beneficial in risk stratification in patients undergoing TIPS.