Hospital wastewater as a hotspot for environmental dissemination of a carbapenem representative and enzyme inhibitors: insights from a multi-hospital study.

RF35. Hospital Characteristics, Not State Economics, Drive National Disparities in CABG Value

Trends in Bunnell and Huber Abductorplasty are Driven by Differences in Patient Age, Geographical Region, and Surgical Training.

Financial characteristics of private equity-affiliated freestanding psychiatric hospitals in the U.S

Transvaginal ultrasound-guided oocyte retrieval is required for assisted reproductive technology. This is a short and minimally invasive, but painful procedure. There are no clinical guidelines on optimal pain management. We aimed to identify risk factors for acute post-procedural pain to help target individualized prevention strategies. We conducted a one-year retrospective cohort study (June 30, 2023 to June 30, 2024) at Montpellier University Hospital (France), comparing clinical and procedural characteristics with post-procedural pain. Data were classified as patient-, anesthesia-, and procedure-related variables. The primary outcome was post-procedural pain, defined as a maximal NRS>3 or requirement for rescue analgesia within 4h. The secondary outcome was moderate to severe post-procedural pain, defined as a maximal NRS>5 or morphine consumption within 4h. A total of 1000 oocyte retrieval procedures were included. Post-procedural pain was observed in 608 of 986 patients (61.66%) and moderate to severe pain in 227 of 982 patients (23.12%), based on available outcome data. Independent risk factors for post-procedural pain (n=969) were age (OR 0.96, P=0.020), pre-procedural pain (OR 5.84, P<0.001) and procedure duration (OR 1.07, P<0.001). For moderate to severe pain (n=816), independent risk factors were pre-procedural pain (OR 4.12, P<0.001), endometriosis (OR 2.23, P<0.001), anti-Mullerian hormone levels (OR 1.11, P=0.009) and procedure duration (OR 1.05, P=0.001). Younger age, pre-procedural pain, procedure duration, endometriosis and high basal anti-Mullerian hormone levels are risk factors and should prompt prophylactic strategies for post-procedural pain management.

Risk Factors for Pediatric Deep Neck Infection Revisit After Emergency Department Discharge for Pharyngitis or Localized Neck Symptoms.

Association Between Hospital Ownership Type and ST-Segment Elevation Myocardial Infarction Outcomes: Insights from the National Readmission Database, 2016-2022.

Background: Accurate diagnosis and management of neonatal seizures are critical to ensure interventions that improve survival and long-term neurological outcomes. Electroencephalography is crucial for diagnosing and managing neonatal neurologic disorders. In Low- and middleincome countries where the burden of neonatal neurologic disorders, such as birth asphyxia, is very high, the availability and use of electroencephalography are unknown.Aim: To determine the availability, use, and expertise on the use of EEG by Nigerian neonatal medical providers and to evaluatemanagement protocol, drug treatment, and post-discharge followup for babies managed for seizures in the neonatal intensive care unit(NICU).Methods: Participants were recruited at a national pediatric conference. Semi-structured questionnaires were administered to assessEEG availability. Associations between EEG availability in NICUs and hospital characteristics were evaluated using the chisquare test. A p-value of &lt; 0.05 was used to determine significance.Results:135 participants representing 52 neonatal intensive care units (NICUs) were surveyed. There were 103 (76.3%) females, only 7.7% of 52 NICUs surveyed had access to EEG equipment, and four (3 %) respondents had formal training on EEG use. Phenobarbitone was the most used first-line drug for neonatal seizures (61.5%), followed by diazepam (26.7%), phenytoin (5.9%), and midazolam (5.9%). 76.9%of the facilities had neurodevelopmental follow-up clinics, but most hospitals discharged patients by 6 months of neonatal clinic followup.Conclusion: Critical deficiencies still exist in neonatal seizure monitoring, management, and follow-up. The availability of EEG in Nigerian Neonatal facilities is unacceptably poor.

The National Institutes of Health Stroke Scale (NIHSS) quantifies stroke severity, yet variability in its reporting may reflect healthcare disparities and affect outcomes. This study analyzes trends in NIHSS reporting in the National Inpatient Sample (NIS) database and its relationship with patient characteristics and outcomes. This retrospective cross-sectional study used data from the NIS between May 2016 and December 2022. This nationally representative sample included patients in the US hospitalized with acute ischemic stroke (AIS). Primary outcomes include NIHSS reporting rate over time, factors associated with reporting, and subsequent discharge disposition. Propensity score matching (PSM) accounted for patient demographics, hospital characteristics, severity of illness, and use of reperfusion therapy. Among 4,558,909 AIS hospitalizations, NIHSS was reported in 1,930,880 (42.4%). The proportion of hospitalizations with reported NIHSS increased from 14.33% in December 2016 to 56.27% in December 2022. After PSM, reporting of NIHSS was associated with higher odds of routine discharge (Adjusted Odds Ratio = 1.03, 95% CI: [1.01-1.04]; p < 0.001) and lower odds of inpatient mortality (0.650 [0.632-0.668], p < 0.001). Scores were less likely to be reported in females (0.970 [0.961-0.979], p < 0.001) and Black (0.963 [0.939-0.988], p = 0.004) or Hispanic patients (0.960 [0.926-0.996], p = 0.030), as well as in smaller and less urban hospitals. Since the implementation of NIHSS reporting, rates have increased to more than half of all AIS hospitalizations as of December 2022. NIHSS reporting was significantly associated with improved discharge disposition, and patient demographics impacted odds of having a reported NIHSS, highlighting persistent disparities in stroke care.

ABSTRACT Objective To determine the incidence and risk factors associated with postoperative stump complications in diabetic patients who underwent amputation using a nationwide cohort study. Method A retrospective cohort analysis was conducted using the Nationwide Inpatient Sample (NIS) database from 2010 to 2019. Patients were categorized into two groups based on the presence or absence of stump complications. Patient demographics (age, sex, and race), hospital characteristics (admission type, payer status, bed size, teaching status, location, and region), length of stay (LOS), total hospitalization charges, in‐hospital mortality, comorbidities, and perioperative complications were analyzed. Risk factors were identified using multivariate logistic regression analysis, incorporating patient demographics, hospitalization parameters, economic indicators, and comorbidities. Results A total of 101,015 patients were included, of whom 6547 developed stump complications, yielding an overall incidence of 6.5%. Patients with stump complications had longer hospital stays (7 vs. 5 days, p &lt; 0.0001) and higher total hospitalization charges ($52,248 vs. $40,226, p &lt; 0.0001) than those without complications. Multivariable analysis showed that Black race, Hispanic ethnicity, Native American heritage, larger hospital bed size, greater comorbidity burden, weight loss, peripheral vascular disease, blood transfusion, hemorrhage/hematoma, wound dehiscence/non‐healing, and wound infection were independently associated with higher odds of stump complications. Conclusion Several demographic, hospital‐level, and clinical factors were associated with postoperative stump complications in diabetic patients undergoing amputation. These findings may help improve perioperative risk stratification and identify patients who warrant closer postoperative monitoring.

Diabetes affects 20%-25% of surgical patients, but whether elective surgery should be deferred for patients with diabetes absent clinically recognized hyperglycemia remains unclear. We evaluated perioperative risk by glycemic status in adults undergoing elective surgery. Retrospective cohort study of the National Inpatient Sample, 2016-2022. Adults undergoing elective joint arthroplasty, lumbar spine fusion, cholecystectomy, colectomy, cardiac surgery, or hysterectomy were classified as no diabetes, diabetes without hyperglycemia, or diabetes with hyperglycemia using ICD-10-CM codes. The primary endpoint was composite major adverse events (mortality, acute kidney injury, sepsis, myocardial infarction, ischemic stroke, or venous thromboembolism). Survey-weighted multivariable logistic regression adjusted for demographics, payer, procedure type, year, hospital characteristics, and Elixhauser comorbidities. Among 2,104,338 hospitalizations (~10.5 million weighted), 1,641,797 (78.0%) had no diabetes, 398,095 (18.9%) had diabetes without hyperglycemia, and 64,446 (3.1%) had diabetes with hyperglycemia. Adjusted major adverse event probability was 5.31% for no diabetes, 5.85% for diabetes without hyperglycemia, and 9.16% for diabetes with hyperglycemia. Diabetes without hyperglycemia was associated with modestly increased odds of major adverse events (adjusted odds ratio [aOR] 1.13; 95% CI, 1.11-1.15; absolute risk difference 0.55%; number needed to harm 183) and ranked 16th of 17 surgical risk factors examined. Diabetes with hyperglycemia was associated with substantially higher risk (aOR 2.00; 95% CI, 1.94-2.05; absolute risk difference 3.85%; number needed to harm 26). Diabetes without clinically recognized hyperglycemia was a comparatively weak risk factor, whereas clinically recognized hyperglycemia identified substantially higher perioperative risk. These findings suggest glycemic status may better inform elective surgical risk stratification than diabetes diagnosis alone.

Little is known about the sources of financing to offset the costs associated with operating hospital-based trauma centers (TCs). Research has documented separate trauma activation charges in hospital transparency databases, but the amounts that TCs bill to third-party payors have not been studied. We examined the association between trauma activation fees, an additional facility fee charged by TCs for trauma care, and the overall billed hospital charges between 2019 and 2022 using commercial administrative claims data for injury patients. Average hospital charges were US$41,601 (p < .001) higher for trauma injury patients relative to nontrauma injury patients. After controlling for patient, clinical, and hospital characteristics, the differential decreased to US$31,613 (p < .001) and further to US$12,793 (p < .001) after excluding the facility charge for trauma activation. Our findings indicate that TCs bill more for trauma injury patients - a premium that cannot be fully explained by patient case mix or the trauma activation charge.

Abstract Introduction The SYNERG-IE research programme aims to address the unmet needs of patients with Sjögren’s disease (SjD) and Sjögren’s associated with additional autoimmune rheumatic diseases (AIRDs), which are chronic, multisystemic conditions that frequently lead to significant morbidity and health service utilization.[1,2] Despite their clinical complexity, there is limited population-based evidence describing hospitalisation patterns among patients with AIRDs in Ireland. Understanding these trends is essential to inform service planning, identify changing patterns of disease burden, and optimise inpatient management strategies. Aim To examine trends and characteristics of hospitalisations related to autoimmune rheumatic diseases in Ireland by analysing the Hospital In-patient Enquiry (HIPE) database. Methods Data were obtained from the HIPE database and included all inpatient discharges with AIRDs listed as the principal diagnosis between 2015–2019 and 2022–2023. AIRDs were identified using the International Classification of Diseases (ICD)-10 codes and included Rheumatoid Arthritis (RA, M05/M06), Systemic Lupus Erythematosus (SLE, M32), SjD (M35.0), Systemic Sclerosis (SSc, M34), Myositis (including Polymyositis/Dermatomyositis, M33), and Mixed/Undifferentiated Connective Tissue Diseases (MCTD/UCTD, M35.1/M35.8/M35.9). Analyses focused on temporal trends in hospitalisations, and descriptive statistics were used to summarise patient characteristics, length of stay (mean, standard deviation), admission type, discharge status, and clinical specialty. Comorbidities (excluding AIRDs) were identified from additional diagnosis records to assess their frequency and distribution. Results Overall, 3942 inpatient hospitalisations were recorded, with RA (65.6%) being the commonest coded condition, followed by SLE (14.1%), and SSc (8.9%). Trend analyses showed overall number of hospitalisations per year remained relatively stable, with a decreasing trend in RA, more marked declines in SjD, and a slight upward trend in SSc, SLE, and myositis. Compared to RA, patients with other AIRDs had significantly longer hospitals stays (mean 5.4 vs 10.4 days), with the longest mean duration of admissions for myositis at 16 days. Prolonged hospitalisations (&amp;gt;90 days) were more commonly observed in patients with myositis and SjD. Patients with SLE and myositis were significantly more likely to have emergency admissions compared to their counterparts. SjD (24.7%) and SLE (27.7%) patients were significantly less likely to be admitted under a rheumatologist. Nephrology and orthopaedics were common specialties to care for hospitalised SLE (22.1%) and RA (21.9%) patients, respectively. We observed significantly higher rates of neurological admissions in SjD patients in comparison to all other AIRDs (24% vs 1.5%). Conclusion This study used comprehensive, national administrative dataset capturing all hospital discharges in Ireland for AIRDs, providing robust population-level estimates; however, the use of routinely coded data limits clinical detail and may be subject to coding variability. We observed a reduction in RA-related admissions over time potentially due to earlier diagnosis and access to advanced therapies. This was offset by increased rates of admission with SSc, SLE, and myositis, and patients with these AIRDs often required prolonged hospital stay. Access to new therapies for AIRD patients as they become available may improve outcomes. High rates of neurological admission in SjD patients warrant prospective evaluation.

Aim: The treatment of wide-necked unruptured intracranial aneurysms (UIA) remains clinically challenging. Stent-assisted coiling (SAC) is a commonly used treatment modality for UIAs. The objective of this study was to examine the differences in 180-day all-cause inpatient readmissions, UIA-related inpatient readmission, and retreatment among UIA patients treated with the laser cut nitinol ENTERPRISE® 2 stent versus the braided nitinol LVIS™ stent during SAC procedures. Materials & methods: Using Premier Healthcare Database (PHD), a US nationwide hospital database, UIA patients aged ≥18years old undergoing SAC were identified. Patients were then classified into ENTERPRISE 2 and LVIS cohorts based on the stent used. Study outcomes, including 180-day all-cause and UIA-related inpatient readmissions, and UIA-related retreatment, were compared between the two cohorts. Inverse probability of treatment weighting of propensity score approach was used to balance covariates (i.e., patient demographic, clinical characteristics and hospital characteristics) between the two study groups. Chi-square test and weighted generalized estimating equation (GEE) model was used to assess outcomes among the weighted ENTERPRISE 2 and LVIS cohorts. Results: A total of 249 patients were included after applying study inclusion and exclusion criteria (with 130 in the ENTERPRISE 2 cohort and 119 in the LVIS cohort). Patient characteristics were well balanced after weighting. Bivariate analysis revealed that patients undergoing stent-assisted endovascular coiling using ENTERPRISE 2 stent had a significantly lower rate of 180-day all-cause inpatient readmissions (9.1% vs 24.3%, chi-square p=0.016) and a significantly lower rate of 180-day UIA-related inpatient readmission (2.6% vs 12.4%, chi-square p=0.036) compared with those treated with LVIS stent. GEE regression model indicated that patients in the ENTERPRISE2 stent cohort were 69% less likely to have 180-day all-cause inpatient readmissions (odds ratio: 0.31, 95% CI: 0.12-0.82, GEE p=0.018) versus the LVIS cohort. However, no significant difference in 180-day UIA-related inpatient readmission and 180-day UIA-related retreatment was observed in GEE analysis. Conclusion: Patients who were treated with the laser-cut ENTERPRISE 2 stent during endovascular coiling were observed to have significantly lower risk of all-cause inpatient readmissions compared with those treated with the braided LVIS stent. No significant differences were observed for 180-day UIA-related readmission and retreatment among the study cohorts.

Background The term wake-up stroke refers to an acute ischemic stroke with an unknown time of onset, typically discovered when a patient awakens with symptoms. Wake-up strokes account for up to 25% of all acute ischemic strokes. There is limited understanding of how hospitals vary in their evaluation and treatment of these cases, and institutional protocols, imaging strategies, and therapeutic decision-making for wake-up stroke remain inconsistently defined. Methods In this prospective observational study, we surveyed hospitals in Texas and Louisiana to assess institutional approaches to wake-up stroke care including hospital characteristics, imaging protocols, treatment pathways, and decision-making criteria for acute ischemic stroke with unknown onset time. Results Among 54 hospitals in Louisiana (29), and Texas (25), representing 48 unique zip codes, &amp;gt;80% followed a standardized institutional protocol when making decisions for wake-up strokes. Additionally, 75.5% of hospitals ordered MRIs for these cases in the acute setting. Conclusion A coordinated, systems-level approach to wake-up stroke care that integrates a standardized protocol may be valuable in promoting workflow processes.

BackgroundWhile chronic kidney disease (CKD) has been identified as a risk factor for mortality in patients with aortic diseases, its impact on the outcomes of type A aortic dissection (TAAD) repair has not yet been thoroughly investigated. This study aimed to conduct a comprehensive, population-based analysis of the association of CKD with in-hospital outcomes following TAAD repair.MethodsPatients who underwent TAAD repair were identified in National Inpatient Sample from the last quarter of 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients with and without CKD while adjusting for demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status. Additional subgroup analyses compared mild, moderate, and severe CKD patients vs non-CKD patients.ResultsThere were 800 (18.68%) CKD patients and 3482 (81.32%) non-CKD patients who underwent TAAD repair. Patients with and without CKD had comparable in-hospital mortality (aOR = 0.883, 95 CI = 0.671-1.163, P = .38) and there was no difference in the transfer-in status or indication of delay from admission to operation. Patients with CKD had higher risks of major adverse cardiovascular event (MACE; aOR = 1.519, 95 CI = 1.115-2.069, P = .01), myocardial infarction (MI; aOR = 1.693, 95 CI = 1.135-2.524, P = .01), cardiogenic shock (aOR = 1.422, 95 CI = 1.136-1.779, P < 0.01), mechanical ventilation (aOR = 1.346, 95 CI = 1.109-1.634, P < .01), and acute kidney injury (AKI; aOR = 1.933, 95 CI = 1.596-2.343, P < .01). However, CKD patients had a lower rate of pacemaker implantation (aOR = 0.384, 95 CI = 0.167-0.882, P = .02). Subgroup analyses demonstrated that compared to those without CKD, mild-CKD patients had largely comparable outcomes, moderate-CKD patients had higher AKI, and severe-CKD patients had higher cardiac complications.ConclusionCKD is a significant risk factor for postoperative complications following TAAD repair. It is essential to closely monitor and manage organ system complications, particularly cardiac and renal complications, in patients with severe and moderate CKD undergoing TAAD repair.

This study assessed patient safety culture across selected public hospitals in Sierra Leone and explored how perceptions vary by hospital characteristics, including size, location and resource availability, with the aim of identifying practical strategies to strengthen safety culture and improve care quality. A sequential cross-sectional mixed-methods design was employed. Quantitative data were collected from 404 healthcare workers using the Hospital Survey on Patient Safety Culture and analysed using descriptive statistics and logistic regression. Qualitative data from ten key informant interviews were thematically analysed in NVivo-14 to provide contextual insights. The overall patient safety culture score was low at 40.5% (95% CI: 37.4-43.6). Teamwork within units and organizational learning emerged as relative strengths, while incident reporting and management support were identified as major weakness. Most respondents rated patient safety as acceptable, although underreporting of incidents was widely acknowledged, driven by fear of blame, time constraints and unclear reporting procedures. Qualitative findings highlighted leadership gaps, staffing shortages, resource limitations and marked disparities between urban and rural hospitals. Overall, patient safety culture in Sierra Leone hospitals remains underdeveloped, highlighting the need for strengthened leadership accountability, non-punitive reporting systems, improved communication, training, and broader systemic investments to enhance safe and high-quality care.

Nationwide trends and injury patterns associated with ski and snowboard-related hospitalizations.

ABSTRACT Background Cardiogenic shock (CS) remains highly lethal despite advances in care. Preexisting heart failure (HF) is common in CS, but its effect on outcomes and management is unclear. Research design and methods Using the 2016–2019 National Inpatient Sample, we identified adults (≥18 years) hospitalized with CS and categorized them by presence of preexisting HF. The primary outcome was in-hospital mortality; secondary outcomes included pulmonary artery catheterization, mechanical circulatory support (MCS), renal replacement therapy, major bleeding, length of stay, and hospital charges. Multivariable logistic regression adjusted for demographics, comorbidities, and hospital characteristics. Results Of 640,660 CS admissions, 65.4% had HF. They were older, had more comorbidities, and were more often treated in large urban teaching hospitals. HF was associated with lower in-hospital mortality (adjusted odds ratio [aOR] 0.58; 95% CI 0.56–0.60; p < 0.001), but greater use of pulmonary artery catheterization (aOR 1.76), MCS (aOR 1.33), and renal replacement therapy (aOR 1.11). HF patients had longer stays (+1.6 days), higher charges (+$23,197), and less major bleeding (aOR 0.74; p < 0.001). Conclusions Preexisting HF is associated with a distinct CS phenotype, including lower in-hospital mortality and higher resource utilization, highlighting the need for phenotype-specific strategies and refined risk models in CS management.

Social and structural determinants of health influence acute ischemic stroke (AIS) care, yet the effects of treating hospital characteristics are difficult to measure. We assessed the association between hospital socioeconomic status, measured by area deprivation index (ADI), and likelihood of treatment with revascularization therapy among Medicare AIS patients. Retrospective analysis of complete, deidentified Medicare Fee-for-Service data from January 1, 2016-December 31, 2019. AIS admissions were identified by International Classification of Diseases, Tenth Revision, Clinical Modification Codes 163.x in the primary position. Demographic characteristics, comorbidities, treatment characteristics, and outcomes were abstracted. Treating hospital socioeconomic status was measured by ADI (1-100), from lowest to highest deprivation. We performed unadjusted and adjusted logistic regression models testing the associations between hospital deprivation and treatment with intravenous thrombolysis and endovascular thrombectomy (ET), as well as outcomes, in 10-unit ADI increments. There were 951,845 AIS admissions, and ADI was available for 78.6% (n=748,605) of AIS admissions and 70.1% of treating hospitals (n=3,563). Mean treating hospital ADI was 60.7 (SD 26.9). Every 10-unit increase in ADI was associated with 8% lower odds of treatment with thrombolysis (OR 0.92, 95% CI 0.90-0.93, p<0.0001) and 17% lower odds of treatment with ET (OR 0.83, 95% CI 0.77-0.90, p<0.0001). Every 10-unit increase in ADI was associated with 1% lower odds of home discharge (OR 0.99, 95% CI 0.98-1.00, p=0.0006) and 1% greater odds of 30-day mortality (OR 1.01, 95% CI 1.01-1.02, p<0.0001), despite 3% lower odds of inpatient mortality (OR 0.97, 95% CI 0.96-0.99, p<0.0001) and 4% greater odds of 30-day outpatient visit (OR 1.04, 95% CI 1.03-1.05, p<.0001). AIS patients treated at hospitals of lower socioeconomic status are less likely to receive revascularization therapy and face poorer outcomes, though they have lower odds of inpatient mortality. These findings warrant further investigation in the face of increasing hospital consolidation and evolution of stroke systems of care.