Hospital Outcomes Research Articles

2346 Modified hospital frailty risk score (mHFRS) as a tool to identify frail hospitalised older adults

Abstract Introduction Frailty is common in hospitalised older adults. This study compared efficacy of a modified Hospital Frailty Risk Score (mHFRS) to standard HFRS and Clinical Frailty Scale (CFS) to determine whether mHFRS can be used to identify frail hospitalised patients. Methods Anonymised retrospective review of Electronic Health Records was undertaken in patients = > 65 years old attending the Emergency Department (ED) and admitted to hospital 1st July 2022 to 31st March 2023. mHFRS utilises 2 prior emergency admissions within 2 years to generate a frailty risk score, whereas HFRS requires an index admission plus 2 prior emergency admissions. Hospitalisation outcomes and predictive models were evaluated with correlation and measures of agreement between CFS and HFRS, CFS and mHFRS using Spearman’s rank correlation and Cohen’s kappa. Results Of 3042 patients, CFS categorised 1635 patients as non-frail (CFS 1–4) and 1407 as frail (CFS 5–9). Using mHFRS, only 1623 patients could be categorised and of these, 608 were deemed low, 657 intermediate and 358 high risk of frailty. Frail patients were older (81.8 years, SD 8.41 vs 75.3 years, SD 7.20, p = <.001), had significantly longer LOS (52.5% % vs 31.5%, p = <0.001), higher 30-day unplanned hospital readmissions (18.5% vs 9.9%, p = <0.001), and higher in-patient (6.1% vs 2.0%, p < 0.001), 30-day (9.1% vs 2.3%, p < 0.001), and 90-day (15.8% vs 5.1%, p < 0.001) mortality. mHFRS achieved comparable association with hospitalisation outcomes compared to CFS & HFRS. Cohens’s kappa, showed fair agreement across HFRS and mHFRS, κ of 0.235 0.243 respectively. mHFRS was less sensitive at identifying frail patients but had better specificity to identify non frail patients. Conclusion mHFRS is a comparable frailty screening tool that doesn’t require clinical assessment but is standardised and easy to use in those who can be scored.

Comparison of Oral Anticoagulant Users with Non-users Admission Laboratory Parameters, Length of Hospital Stay and Outcomes in COVID-19 Infection

Comparison of Oral Anticoagulant Users with Non-users Admission Laboratory Parameters, Length of Hospital Stay and Outcomes in COVID-19 Infection

Changes in use and hospital outcomes of bariatric surgery in Spain (2016–2022): analysis of the role of type 2 diabetes using propensity score matching

IntroductionThe objectives of this study were to examine temporal trends in the incidence of bariatric surgery (Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG)) in patients with and without type...

Real-world effectiveness of the CoronaVac vaccine in a retrospective population-based cohort in four Colombian cities (2021-2022)

ObjectivesThe National Vaccination Plan against SARS-CoV-2/COVID-19 was launched by the Ministry of Health and Social Protection on 14 February 2021. The main objective of this study was to evaluate the effectiveness of the CoronaVac in preventing the three clinical outcomes of infection, hospitalisation, or death, in a real-world scenario. DesignThis was a population-based retrospective dynamic cohort study using a multivariate Cox model to calculate hazard ratios to estimate vaccine effectiveness from 17 February 2021 to 30 June 2022. The data were collected from surveillance systems for 12 months for each individual. Four cities were selected on the basis of the reliability of their data bases. ResultsThe rates of CoronaVac effectiveness were 32% (95% confidence interval [CI] 31-33) for preventing infection, 55% (95% CI 54-56) for hospitalisation, and 90% (95% CI 89-90) for death, at the end of follow-up. These findings were more consistent during the first 4 months. Compared with the unvaccinated group, homologous booster doses appeared to increase effectiveness in preventing hospitalisation, whereas heterologous booster doses increased protection for both hospitalisation and death. Booster doses did not improve effectiveness among those already vaccinated with CoronaVac, even when they received heterologous boosters. ConclusionsCoronaVac demonstrated effectiveness in preventing death and hospitalisation during the first year of follow-up, but its effectiveness in preventing infection was lower, decreasing rapidly after the first 4 months of follow-up. The effectiveness was higher among children aged between 3 and 12 years, and among adults aged ≥60 years. Booster doses did not improve effectiveness among those already vaccinated with CoronaVac.

Abstract Tu070: Impact of Hypertrophic Cardiomyopathy in Hospitalizations with Aortic Stenosis : A National Inpatient Sample survey

Background: The management of patients with combined aortic stenosis (AS) and hypertrophic cardiomyopathy (HCM) is tricky. HCM causes a dynamic obstruction, while AS causes a fixed obstruction, both causing a hindrance to left ventricular output. We aim to study the outcomes of hospitalizations with co-prevalent HCM and AS. Methods: We queried the National Inpatient Sample 2018-2020 for adult hospitalizations with AS. This sample was stratified based on the prevalence of HCM. Mortality, arrhythmia prevalence, and acute cardiac complications were compared in aortic stenosis hospitalizations with and without AS. A multivariate regression analysis was performed to study the impact of HCM on mortality, arrhythmias, and other complications in patients with AS. Results: In hospitalizations with aortic stenosis (n=2483854), a total of 11820 had underlying HCM (0.47%). The mean age was 76 years and 64% were females. Hospitalizations with AS and HCM as compared to those without HCM had a higher prevalence of arrhythmias including first degree AV block, atrial flutter, atrial fibrillation, ventricular tachycardia and ventricular fibrillation (Table 1). The occurence of cardiogenic shock was also higher in this subgroup. The difference in mortality, acute coronary syndrome, acute heart failure and cardiac arrest was not statistically significant in AS hospitalizations with and without HCM (Table 1). Multivariate regression analysis revealed a higher odds of arrhythmias (OR-1.44; C.I: 1.36-1.62; P<0.001) and cardiogenic shock (OR-1.58; C.I: 1.22-2.06; P<0.001) with HCM in AS hospitalizations. Conclusion: Prior studies have demonstrated worse outcomes in AS patients with pre-existing HCM, especially post TAVI. Our study concludes that HCM was associated with a higher odds of arrhythmias and cardiogenic shock in AS hospitalizations.

Timing of surgical intervention after firearm-related spinal cord injury

Context Surgical management of firearm-related spinal cord injury (SCI) remains controversial, and there are no clear guidelines. Time to surgery, surgical indications, and patient characteristics on initial presentation in this group are not well understood, and these factors may impact the potential for neurologic recovery after operative intervention. Objective To understand the timing and factors affecting the timing of operative intervention after firearm-related SCI Methods In a retrospective cohort study, patients with traumatic SCI from July 2012 to July 2022 (n = 1569) were identified from our level 1 trauma center Trauma Registry. Data was obtained from the trauma registry and chart review. Rates and timing of surgical intervention, initial injury severity measures, and general hospital outcomes were compared between firearm-related SCI and blunt trauma SCI. Results Patients with firearm-related SCI were less likely to undergo surgery compared to other etiologies (24.3% vs. 70.2%, P < 0.0001). Time to surgery for firearm-related SCI was longer than for other etiologies (49.2 ± 92.9 vs. 30.6 h ± 46.0, P = 0.012). Multiple measures of initial injury severity, including Injury Severity Score, Glasgow Coma Score, and emergency department disposition demonstrated more severe injury among patients with firearm-related SCI, and these patients often required other emergent surgeries prior to spine surgery (52%). Conclusions There was a longer time to spine surgery among patients with firearm-related SCI compared to blunt trauma SCI, and patients with firearm-related SCI were more severely injured on initial presentation. Further research is needed to understand the complex relationship between patient injury severity, surgical intervention, surgical timing, and outcomes after firearm-related SCI.

Implications of surgical infection on surgical and hospital outcomes after spine surgery: A NSQIP study of 410,930 patients

Study designRetrospective cohort study. ObjectivesSurgical infections are unfortunately a fairly common occurrence in spine surgery, with rates reported as high as 16 %. However, there is a relative paucity of studies that look to understand how surgical infections may impact outcome variables. The aim of this study was to assess the impact of surgical infection on other perioperative complications, extended hospital length of stay (LOS), discharge disposition, and unplanned readmission following spine surgery. MethodsA retrospective cohort study was performed using the 2016–2022 ACS NSQIP database. Adults receiving spine surgery for trauma, degenerative disease, and tumors were identified using CPT and ICD-9/10 codes. Patients were divided into two cohorts: surgical infection (superficial surgical site infection, deep surgical site infection, organ space surgical site infection, or wound dehiscence) and no surgical infection (those who did not experience any infection). Patient demographics, comorbidities, intraoperative variables, postoperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analysis was utilized to identify predictors of AEs, extended hospital length of stay, non-routine discharge, and unplanned readmission. ResultsIn our cohort of 410,930 patients, 7854 (2.2 %) were found to have experienced a surgical infection. Regarding preoperative variables, a greater proportion of the surgical infection cohort was a female (p < 0.001) and had a higher mean BMI (p < 0.001), greater frailty and ASA scores (p < 0.001), and higher rates of all presenting comorbidities included in the study. Rates of AEs (p < 0.001), unplanned readmission (p < 0.001), reoperation (p < 0.001), non-home discharge (p < 0.001), and 30-day mortality were all greater in the surgical infection group when compared to the group without surgical infection. On multivariate analysis, surgical infection was found to be an independent predictor of experiencing postoperative complications [aOR: 6.15, 95 % CI: (5.72, 6.60), p < 0.001], prolonged LOS [2.71, 95 % CI: (2.54, 2.89), p < 0.001], non-routine discharge [aOR: 1.74, 95 % CI: (1.61, 1.88), p < 0.001], and unplanned readmission [aOR: 22.57, 95 % CI: (21.06, 24.19), p < 0.001]. ConclusionsOur study found that surgical infection increases the risk of complications, extended LOS, non-routine discharge, and unplanned readmission. Such findings warrant further studies that aim to validate these results and identify risk factors for surgical infections.

Effects of early surgery for cervical fracture dislocation on 30-day mortality using the Japanese Diagnosis Procedure Combination database.

Retrospective study of data abstracted from the Diagnosis Procedure Combination (DPC) database. This study aimed to investigate the effects of surgery in the early phase. The optimal timing of surgery for cervical fracture dislocation (CFD) remains unclear because only a few clinical studies with approximately 100 patients have been published. This study included 4,653 adult patients with a definitive diagnosis of CFD from the DPC database. The database contains nationwide inpatient data collected from >1,000 acute care hospitals in Japan. The DPC database contains information regarding hospitalization, such as diagnosis, treatment, medical history, complications, and hospitalization outcomes. This study identified 460 pairs of patients after one-to-one propensity-score matching (PSM). Treatment outcomes were compared between patients who underwent surgery for CFD within 72 hours (early group) and later (delayed group) after admission. The main outcomes included 30-day mortality, inhospital death, and major complications. The secondary outcomes were improvement in the Barthel index, length of hospital stay, and discharged home rate. After adjusting for PSM, the early group had a significantly higher 30-day mortality rates than the delayed group (3.0% vs. 0.4%, p=0.006). In the multivariate logistic regression analysis after PSM, the early group was associated with an increased risk of 30-day mortality (odds ratio, 8.05; 95% confidence interval, 2.15-5.26; p=0.007). This study indicated that early surgery for CFD resulted in increased 30-day mortality.

Custo-Efetividade da Oxigenação por Membrana Extracorpórea Venoarterial no Choque Cardiogênico Refratário: Um Estudo na Perspectiva Brasileira

Abstract Background Refractory cardiogenic shock (CS) is associated with high mortality rates, and the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a therapeutic option has generated discussions. Therefore, its cost-effectiveness, especially in low- and middle-income countries like Brazil, remains uncertain.Objectives: To conduct a cost-utility analysis from the Brazilian Unified Health System perspective to assess the cost-effectiveness of VA-ECMO combined with standard care compared to standard care alone in adult refractory CS patients. Methods We followed a cohort of refractory CS patients treated with VA-ECMO in tertiary care centers located in Southern Brazilian. We collected data on hospital outcomes and costs. We conducted a systematic review to supplement our data and utilized a Markov model to estimate incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY) and per life-year gained. Results In the base-case analysis, VA-ECMO yielded an ICER of Int$ 37,491 per QALY. Sensitivity analyses identified hospitalization cost, relative risk of survival, and VA-ECMO group survival as key drivers of results. Probabilistic sensitivity analysis favored VA-ECMO, with a 78% probability of cost-effectiveness at the recommended willingness-to-pay threshold. Conclusions Our study suggests that, within the Brazilian Health System framework, VA-ECMO may be a cost-effective therapy for refractory CS. However, limited efficacy data and recent trials questioning its benefit in specific patient subsets highlight the need for further research. Rigorous clinical trials, encompassing diverse patient profiles, are essential to confirm cost-effectiveness and ensure equitable access to advanced medical interventions within healthcare systems, particularly in socio-economically diverse countries like Brazil.

Impact of sodium-glucose cotransporter 2 inhibitor on recurrence and cardiovascular outcomes after catheter ablation for atrial fibrillation in patients with heart failure

BackgroundThe impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on atrial fibrillation (AF) recurrence outcomes and adverse cardiovascular outcomes in heart failure (HF) patients after AF ablation is unknown. ObjectiveWe investigated whether SGLT2i reduces the risk of AF recurrence and adverse cardiovascular outcomes in HF patients after AF ablation. MethodsHF patients with AF undergoing catheter ablation between January 2017 and December 2022 from the China-AF Registry were included. Patients were stratified into 2 groups on the basis of the use of SGLT2i at discharge and were 1:1 matched by propensity score, with SGLT2i using (n = 368) and non-SGLT2i using (n = 368) in each group. The primary outcome was AF recurrence after a 3-month blanking period. ResultsDuring a total of 1315 person-years of follow-up, AF recurred in 83 patients (22.6%) in the SGLT2i group and 132 patients (35.8%) in the non-SGLT2i group. SGLT2i was associated with a lower risk of AF recurrence (adjusted hazard ratio, 0.56; 95% CI, 0.43–0.74; P < .001). The composite risk of cardiovascular death, thrombotic events, or cardiovascular hospitalization was significantly lower in the SGLT2i group compared with those without SGLT2i (adjusted hazard ratio, 0.58; 95% CI, 0.41–0.80; P = .001). Although there was a trend toward benefit, the differences in all-cause mortality, cardiovascular death, or thrombotic events were insignificant between the 2 groups. ConclusionThe use of SGLT2i was associated with a lower risk of AF recurrence and the composite outcome of cardiovascular death, thrombotic events, or cardiovascular hospitalization after catheter ablation for AF in patients with HF.

72245 - Hospital surgical volumes and outcomes in ileocaecal resection for Crohn’s disease in Sweden 2000 - 2019. A national cohort study

72245 - Hospital surgical volumes and outcomes in ileocaecal resection for Crohn’s disease in Sweden 2000 - 2019. A national cohort study

Under pressure: symptomatic pulmonary hypertension is a predictor of poor outcome following hip fracture.

Pulmonary hypertension (PHTN) is associated with increased morbidity and mortality in noncardiac surgery and elective surgery. This population of patients has a low physiological reserve and is prone to cardiac arrest as a result. This study aims to identify the impact that PHTN has on outcomes among geriatric hip fracture patients. A 3:1 propensity-score-matched retrospective case (PHTN)-control (no PHTN [N]) study of hip fracture patients from 2014 to 2022 was performed. Patients were matched utilizing propensity score matching of a validated geriatric trauma risk assessment tool (STTGMA). All patients were reviewed for hospital quality measures and outcomes. Comparative univariable and multivariable analyses were conducted between the two matched cohorts. A sub-analysis compared patients across PHTN severity levels (mild, moderate, severe) based on pulmonary artery systolic pressures (PASP) as measured by transthoracic echocardiogram. PHTN patients (n = 67) experienced a higher rate of inpatient, 30-day, and 1-year mortality, major complications, and 90-day readmissions as compared to the N cohort (n = 201). PHTN patients with a PASP > 60 experienced a significantly higher rate of major complications, need for ICU, longer admission length, and worse 1-year functional outcomes. Pulmonary hypertension was found to be independently associated with a 3.5 × higher rate of 30-day mortality (p = 0.016), 2.7 × higher rate of 1-year mortality (p = 0.008), 2.5 × higher rate of a major inpatient complication (p = 0.028), and 1.2 × higher rate of 90-day readmission (p = 0.044). Patients who had a prior diagnosis of pulmonary hypertension before sustaining their hip fracture experienced significantly worse inpatient and post-discharge outcomes. Those with a PASP > 60mmHg had worse outcomes within the PHTN cohort. Providers must recognize these at-risk patients at the time of arrival to adjust care planning accordingly. III.

Clinical profile of patients with non-ST segment elevation acute coronary syndrome: experience of a regional vascular center

Aim. To identify the main clinical and paraclinical characteristics of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) of various risk groups for adverse ischemic events, as well as to describe the in-hospital outcomes of the disease.Material and methods. The retrospective analysis included 600 patients who were hospitalized at the regional vascular center from January 2019 to January 2021 with a diagnosis of NSTE-ACS.Results. Patients were stratified into very high — 208 (34,7%), high — 196 (32,7%), moderate — 108 (18%) and low — 88 (14,6%) risk groups. In the highand very high-risk groups, patients were older, characterized by a significant comorbidity index, increased bleeding risk, decreased left ventricular ejection fraction and glomerular filtration rate in comparison with patients of other groups (p&lt;0,05). Very highrisk patients were characterized by associated clinical conditions, predominantly infectious diseases and decompensated heart failure. Unfavorable outcome of hospitalization was observed in 44 (7,3%) patients. The death probability in the very high-risk group (33; 15,9%) was higher than in the low-risk group (2; 2,3%) (Odds ratio 8,1 (95% confidence interval: 1,9-34,6); p=0,01). Regardless of the risk degree, there was a high (53,5%) likelihood of completing invasive coronary angiography as a diagnostic procedure. Most of the observed complications as a result of invasive coronary angiography were characteristic of the high(18,3%) and very high-risk groups (21,5%).Conclusion. NSTE-ACS patients at very high/high risk of adverse ischemic events represent a heterogeneous group with cardiac and noncardiac pathologies with high comorbidity and bleeding risks, decreased left ventricular ejection fraction and glomerular filtration rate, and associated clinical conditions.

American Association for Thoracic Surgery Quality Gateway: A surgeon case study of its application in adult cardiac surgery for quality assurance

ObjectiveTo demonstrate the application of American Association for Thoracic Surgery Quality Gateway (AQG) outcomes models to a Surgeon Case Study of quality assurance in adult cardiac surgery. MethodsThe case study includes 6989 cardiac and thoracic aorta operations performed in adults at Cleveland Clinic by a single surgeon between 2001 and 2023. AQG models were used to predict expected probabilities for operative mortality and major morbidity and to compare hospital outcomes, surgery type, risk profile, and individual risk factor levels using virtual (digital) twin causal inference. These models were based on postoperative procedural outcomes after 52,792 cardiac operations performed in 19 hospitals of 3 high-performing hospital systems with overall hospital mortality of 2.0%, analyzed by advanced machine learning for rare events. ResultsFor individual surgeons, their patients, hospitals, and hospital systems, the Surgeon Case Study demonstrated that AQG provides expected outcomes across the entire spectrum of cardiac surgery, from single-component primary operations to complex multicomponent reoperations. Actionable opportunities for quality improvement based on virtual twins are illustrated for patients, surgeons, hospitals, risk profile groups, operations, and risk factors vis-à-vis other hospitals. ConclusionsUsing minimal data collection and models developed using advanced machine learning, this case study shows that probabilities can be generated for operative mortality and major morbidity after virtually all adult cardiac operations. It demonstrates the utility of 21st century causal inference (virtual [digital] twin) tools for assessing quality for surgeons asking “how am I doing?,” their patients asking “what are my chances?,” and the profession asking “how can we get better?”

Mais Complicações em Mulheres após Revascularização do Miocárdio Mesmo com Tempos Cirúrgicos Reduzidos: Atenção por Equidade e Melhoria da Qualidade

Abstract Background Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. Objective To compare adjusted hospital outcomes between men and women undergoing CABG. Methods From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p&lt;0.05. Results After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p&lt;0.001), surgical time (p&lt;0.001), a higher number of distal anastomoses (p&lt;0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p&lt;0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). Conclusions Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement.

Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. To compare adjusted hospital outcomes between men and women undergoing CABG. From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05. After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

Shared Medical Appointments in Heart Failure for Post Acute Care Follow-Up: A Randomized Controlled Trial.

Shared medical appointments (SMAs) in heart failure (HF) are medical visits where several patients with HF meet with multidisciplinary providers at the same time for efficient and comprehensive care. It is unknown whether HF-SMAs can improve overall and cardiac health status for high-risk patients with HF discharged from acute care. A 3-site, open-label, randomized-controlled-trial was conducted. Participants within 12 weeks of HF acute care (emergency-room/hospitalization) requiring intravenous diuretic therapy were randomized to receive either HF-SMA or usual HF clinical care (usual-care) on a 1:1 ratio. The HF-SMA team, which consisted of a nurse, nutritionist, psychologist, nurse practitioner and/or a clinical pharmacist, provided four 2-hour session HF-SMAs that met every other week for 8 weeks. Primary outcomes were the overall health status measured by European Quality of Life Visual Analog Scale and cardiac health status by Kansas City Cardiomyopathy Questionnaire, 180 days postrandomization. Of the 242 patients enrolled (HF-SMA n=117, usual-care n=125, mean age 69.3±9.4 years, 71.5% White patients, 94.6% male), 84% of participants completed the study (n=8 HF-SMA and n=9 usual-care patients died). After 180 days, both HF-SMA and usual-care participants had significant improvements from baseline in Kansas City Cardiomyopathy Questionnaire that were not statistically different. Only HF-SMA participants had significant improvements in European Quality of Life Visual Analog Scale (mean change = 7.2±15.8 in HF-SMA versus -0.4±19.0 points in usual-care, P < 0.001). Both HF-SMA and usual-care in participants with HF achieved significant improvements in cardiac health status, but only a team approach through HF-SMA achieved significant improvements in overall health status. Future larger studies are needed to evaluate hospitalization and death outcomes. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02481921.

Clinical-Epidemiological Profile of COVID-19 Patients Admitted during Three Waves of the Pandemic in a Tertiary Care Center, in Belém, Pará, Amazon Region of Brazil.

Coronavirus disease 2019 (COVID-19) is a disease with a broad clinical spectrum, which may result in hospitalization in healthcare units, intensive care, and progression to death. This study aimed to describe and compare the clinical and epidemiological profile of COVID-19 during the three waves of the disease, in patients admitted to a public hospital in the city of Belém, Pará, in the Amazon region of Brazil. This descriptive, observational, and cross-sectional study was population-based on individuals who were hospitalized with a diagnosis of COVID-19, confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR), and who were interviewed and monitored at the public hospital, from February 2020 to April 2022. The prevalence was male patients, older than 60 years. The most frequent symptoms were dyspnea, cough, and fever. Systemic arterial hypertension was the most prevalent comorbidity followed by diabetes mellitus. Less than 15% of patients were vaccinated. The nasal oxygen cannula was the most used oxygen therapy interface followed by the non-rebreathing reservoir mask. Invasive mechanical ventilation predominated and the median time of invasive mechanical ventilation ranged from 2 to 6 days among waves. As for the hospital outcome, transfers prevailed, followed by deaths and discharges. The presence of comorbidities, advanced age, and male sex were important factors in the severity and need for hospitalization of these patients, and the implementation of the vaccination policy was an essential factor in reducing the number of hospital admissions.

Emergent coronary revascularization with percutaneous coronary intervention and coronary artery bypass grafting in patients receiving extracorporeal cardiopulmonary resuscitation.

Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue for refractory cardiac arrest, of which acute coronary syndrome is a common cause. Data on the coronary revascularization strategy in patients receiving ECPR remain limited. The ECPR databases from two referral hospitals were screened for patients who underwent emergent revascularization. The baseline characteristics were matched 1:1 using propensity score between patients who underwent coronary artery bypass grafting (CABG) and those who received percutaneous coronary intervention (PCI). Outcomes, including success rate of weaning from extracorporeal membrane oxygenation (ECMO), hospital survival, and midterm survival in hospital survivors, were compared between CABG and PCI. After matching, most of the patients (95%) had triple vessel disease. Compared with PCI (n = 40), emergent CABG (n = 40) had better early outcomes, in terms of the rates of successful ECMO weaning (71.1% vs 48.7%, P = 0.05) and hospital survival (56.4% versus 32.4%, P = 0.04). After a mean follow-up of 2 years, both revascularization strategies were associated with favourable midterm survival among hospital survivors (75.3% after CABG vs 88.9% after PCI, P = 0.49), with a trend towards fewer reinterventions in patients who underwent CABG (P = 0.07). In patients who received ECPR because of triple vessel disease, the hospital outcomes were better after emergent CABG than after PCI. More evidence is required to determine the optimal revascularization strategy for patients who receive ECPR.

Epidemiology and outcomes of bacterial meningitis in the neonatal intensive care unit.

Examine pathogen distribution, antibiotic resistance patterns, and hospital outcomes of infants with bacterial meningitis in neonatal intensive care units (NICUs) in the US from 2013-2018. Infants were divided into 2 groups based on age at the time of meningitis: early-onset (0-3 days) and late-onset (>3 days). We compared demographics, clinical characteristics, epidemiology, hospital outcomes, distribution of organisms and resistance, and blood culture timing relative to cerebrospinal fluid culture. From 345 NICUs, 659 infants were diagnosed with bacterial meningitis. The cumulative incidence was 1.1-1.3 cases/1000 NICU discharges. Median gestational age was 33 weeks, median birth weight was 1910 grams, 12% failed hearing screening, and 9% died prior to discharge. Of 141 cases of E. coli meningitis, 53% were resistant to ampicillin. Significant morbidities occur in infants with culture-proven meningitis in NICUs. Culture and subsequent discernment of sensitivity are crucial to guide definitive therapy.