Hospital Outcomes Research Articles

Can We Predict 30-day Readmission Following Hip Fracture?

To determine the most common reason for 30-day readmission following hospitalization for hip fractures. Design: A retrospective review. Single academic medical center that includes a Level 1 Trauma Center. Included were all patients operatively treated for hip fractures (OTA 31) between October 2014 and November 2023. Patients that died during their initial admission were excluded. Patient demographics, hospital quality measures, outcomes and readmission within 30-days following discharge for each patient were reviewed. 30-day readmission reason was recorded and correlation analysis was performed. A total of 3,032 patients were identified with a mean age of 82.1 years and 70.5% of patients being female. The 30-day readmission cohort was 2.6 years older (p<0.001) and 8.8% more male patients (p=0.027), had 0.5 higher CCI (p<0.001), 0.3 higher ASA class (p<0.001) and were 9.2% less independent at the time of admission (p= 0.003). Hemiarthroplasty procedure (32.7% vs. 24.1%) was associated with higher 30-day readmission compared to closed percutaneous screw fixation (4.5% vs. 8.8%) and cephalomedullary nail fixation (52.2% vs. 54.4%, p<0.001). Those readmitted by 30-days developed more major (16.7% vs. 8.0%) (p<0.001) and minor (50.5% vs. 36.4%) (p<0.001) complications during their initial hospitalization and had a 1.5 day longer LOS during their first admission (p<0.001). Those discharged home were less likely to be readmitted within 30-days (20.7% vs. 27.6%, (p=0.008). Multivariate regression revealed increasing ASA class (O.R. 1.47, p=0.002) and pre-injury ambulatory status (O.R. 1.42, p=0.007) were most associated with increased 30-day readmission. The most common reason for readmission was pulmonary complications (17.1% of complications) including acute respiratory failure, COPD exacerbation and pneumonia. Thirty-day readmission following hip fracture was associated with older, sicker patients with decreased pre-injury ambulation status. Hemiarthroplasty for femoral neck fracture was also associated with readmission. The most common reason for 30-day readmission following hip fracture was pulmonary complications. Prognostic Level III.

Older Adults' Experiences of Emergency Department Admission Decisions: A Qualitative Study in a Public Safety Net Hospital.

Hospital admission is a significant event in the healthcare trajectory of older adults (age 60 +). Numerous harms such as delirium, falls, and adverse medication events can arise that outweigh the benefits of admission. Little is known about how older adults feel about being hospitalized or what they think admission will achieve for them. These issues are particularly important to understand in socioeconomically disadvantaged patients, who have poor access to outpatient care and higher hospitalization rates. We performed semi-structured interviews with emergency department (ED) patients aged 60 and older who were being admitted. The study site was a public hospital serving a socioeconomically disadvantaged, predominantly Hispanic and Black patient population. Interviews focused on experiences of the admission decision, expectations of hospitalization, and health outcome goals. We coded data using an inductive approach. Twenty-seven older adults were interviewed about their experiences. Most participants belonged to minoritized racial or ethnic groups (70%, n = 19), and 41% (n = 11) spoke Spanish as their primary language. Approximately one-third were admitted for ambulatory care-sensitive conditions, i.e., conditions that can be managed in the outpatient setting to prevent hospitalization. Four themes emerged: (1) participants felt that clinicians made admission decisions for, rather than with, them; (2) participants sought to avoid admission due to family caregiving and work obligations; (3) participants with chronic conditions viewed their admission as resulting from poor access to care over the longer term; (4) participants expected hospitalization to improve their chronic symptom burden, mobility, and abilities to perform activities of daily living. Older adults' expectations of hospitalization exceed stabilization of acute illness. Hospital admission of older adults presents an opportunity for shared decision-making and communication about likely outcomes of hospitalization. Incorporating patient-centered outcomes into admission decisions may help align care with older adults' priorities in the ED.

The association between systemic immune-inflammation index (SII) and early nosocomial infections after cardiopulmonary bypass surgery in children with congenital heart disease

BackgroundInfections occurring postoperatively in pediatric patients with congenital heart disease (CHD) following cardiopulmonary bypass (CPB) surgery pose a considerable challenge, affecting the duration of hospitalization, financial costs, and patient outcomes. Studies investigating the association between systemic immune-inflammation index (SII) and early infections after CHD surgery are very rare. This study seeks to delineate the link between SII and the occurrence of early nosocomial infections in pediatric patients undergoing CPB surgery for CHD.MethodsA cross-sectional analysis was performed on 325 pediatric patients who underwent CPB surgery for CHD between July 2020 and June 2023. The primary exposure was the SII value on the first postoperative day. The outcome was the occurrence of nosocomial infections within the first week following CPB surgery. Multivariable logistic regression models and subgroup analyses were employed to evaluate the association between SII and the risk of early nosocomial infections.ResultsThe median age of the study cohort was 4.4 years, with a male preponderance of 51.7%. The median SII value was recorded at 0.6 × 10^12/L. The rate of nosocomial infections within the first week post-CPB surgery was 53.5%. An inverse association was observed between SII and the incidence of early nosocomial infections. After controlling for multiple confounders, an increment of 1 × 10^12/L in SII corresponded to a 25% reduction in the likelihood of nosocomial infections (OR = 0.75; 95%CI: 0.57, 0.99; P = 0.044). Subgroup analyses substantiated the consistency of these findings.ConclusionsThe study demonstrated that an elevated SII corresponded to a reduced likelihood of early nosocomial infections after CPB surgery in children with CHD, a finding that merits additional investigation.

Use of a bioactive matrix glove in the treatment of paediatric hand burns: a case series.

Burns to the hand are a common injury in paediatrics and can be traumatic to children, both physically and psychologically. Timely conservative or operative management is critical to maximise healing and minimise long-term complications in these young patients. Here, we present the cases of patients treated with a novel skin substitute formed into a prefabricated glove. The glove (PermeaDerm, Inc., US) is a bioactive matrix composed of a silicone composite membrane embedded with collagen and aloe extract with variable porosity that allows moisture to pass to a secondary dressing. To our knowledge, our group was the first to treat a small set of paediatric patients with hand burns with the glove. A chart review was conducted to analyse hospital course, treatment length, complications and outcomes for each patient. The age range of the five patients included in this case series was seven months to three years. All five patients had scald burns to the hand. Overall, healing with the glove was successful, with little scarring or altered skin pigmentation, and a full range of motion at the affected joints. Hand burns in paediatric patients are traumatic and cumbersome to the patient and their families. This bioactive matrix glove allows for a one-time application, decreases operating room time and need, and reduces the demand for multiple dressing changes. In our set of five patients, the glove showed promising results as a safe and effective noninvasive treatment option for hand burns in paediatric patients.

Association between the lowest level of serum albumin during hospitalization and adverse outcomes in older adults with COVID-19.

Serum albumin on admission has been investigated among inpatients with COVID-19. However, studies on the lowest level of serum albumin during hospitalization and adverse outcomes are limited. This research aimed to explore association between them in older adults with COVID-19. A retrospective study was conducted with 300 patients aged 60 or older with first confirmed COVID-19 from January to February 2023. An adverse outcome was defined as development of acute respiratory failure, shock, or death. Data on demographics, comorbidities, laboratory parameters, the initial phase of COVID-19, coinfection, sepsis, receipt of antiviral treatment and outcomes were gathered from the electronic medical records. The association between the lowest level of serum albumin and adverse outcomes was analyzed using univariate and multivariate regression models, along with generalized additive models. After adjusting potential confounders, nonlinear relationship with an inflection point of 29.1 g/L was detected between the lowest level of serum albumin and adverse outcomes in the elderly. The effect sizes and the confidence intervals on the left and right sides of the inflection point were 0.667 (0.520, 0.856) and 1.171 (0.875, 1.568), respectively. This demonstrated that the lowest level of serum albumin was negatively correlated with adverse outcomes when albumin was <29.1 g/L. A rise of 1 unit in the lowest level of albumin equated to a 33.3% decrease in the risk of adverse outcomes. The correlation between the lowest level of serum albumin and adverse outcomes of COVID-19 is a nonlinear. this study indicates that serum albumin levels should be sustained above the critical inflection point identified to reduce the risk of adverse outcomes.

The Impact of Comorbid Dementia and Diabetes Mellitus on Hospital Patients' Outcomes: A Systematic Review and Meta-analysis.

Previous reviews have demonstrated that dementia and diabetes mellitus, separately, can worsen the hospital outcomes of patients. Unfortunately, there are no systematic evaluations regarding the hospital outcomes of patients with dementia and diabetes mellitus as a comorbidity. Therefore, our review aimed to determine any differences in hospital length of stay, hospital mortality, and hospital readmission between patients with the comorbidity and patients without. Searches were conducted of Medline, CINHAL, EMBASE, PsychINFO, Web of Science and Google Scholar for original studies. All studies were quality assessed using the Joanna Briggs Institute critical appraisal tools. Where possible, studies were pooled in a meta-analysis to generate odds ratios (OR) with 95% confidence intervals (CI). Sixteen studies were included in this review. When comparing patients with the comorbidity to patients with dementia, the difference in length of stay was inconclusive, and there was no difference in the odds of hospital mortality (OR = 0.98, 95% CI 0.91-1.06). However, patients with the comorbidity had increased odds of 30-day readmission compared to patients with dementia alone (OR = 1.20, 95% CI 1.14-1.26). When comparing patients with the comorbidity to patients with diabetes, those with the comorbidity had a longer length of stay and but no difference in the odds of hospital mortality (OR = 1.48, 95% CI 0.84-2.62). Additionally, those with the comorbidity may have worse readmission outcomes than those with diabetes alone. Our findings suggest that patients with comorbid dementia and diabetes mellitus may have worse hospital outcomes. Therefore, we recommend further research to assess these patients' hospital outcomes to resolve the discrepancies found.

"A little bit more challenging, but more rewarding": Medical-surgical nurses' perspectives on caring for adults with intellectual disabilities.

Background: Despite their central role in hospital care, little research has explored medical-surgical nurses' perspectives on the rewarding aspects of and significant influences on caring for adults with intellectual disabilities, even though they are key to understanding this population's inequitable hospital outcomes. Methods: A qualitative descriptive design was used, and interviews were conducted with 13 medical-surgical nurses from the United States. Manifest content analysis was used to analyze the interview transcripts and categorize findings. Results: Five categories of significant influences: Preparedness to Care for People with Intellectual Disabilities, Communication, Caregiver Involvement, Ethical Concerns, and Context of Care, and four categories of rewards: Connecting, Making a Difference, Enjoyment, and Learning Opportunity, were revealed. Conclusion: Medical-surgical nurses derive meaning from connecting with and making a difference in the lives of hospitalized adults with intellectual disabilities, but face barriers to providing high-quality nursing care, resulting in dehumanized, delayed, or missed care.

Epidemiology of healthcare-associated bloodstream infection in South African neonatal units

BackgroundReports of healthcare-associated bloodstream infection (HA-BSI) epidemiology in African neonatal units are limited.MethodsWe conducted a cross-sectional study (2017–2018) in nine neonatal units in the Western Cape Province, South Africa, including central, regional and district hospitals (416 beds) using laboratory and clinical records. Patient demographics, HA-BSI rates, pathogen spectrum, and hospital outcomes and empiric antibiotic coverage rates were determined.ResultsOver two years, 23,748 neonates were admitted with unit occupancy rates ranging from 79 to 93%. 485 HA-BSI episodes occurred, with median onset at 11 (IQR 7–24) days of life. Most HA-BSI episodes (348; 72%) affected very low birth weight neonates (< 1500 g). The overall HA-BSI rate was 2.0/1000 patient days. The highest HA-BSI rate was observed at the central unit with onsite surgery (3.8/1000 patient days). Crude HA-BSI mortality was 31.8% (154/485) with two-thirds of deaths occurring within three days of BSI onset. Higher mortality was observed for Gram-negative/fungal BSI compared to Gram-positive BSI (RR 1.5; 95%CI 1.1-2.0; p = 0.01) and very preterm neonates (gestation < 32 weeks) versus ≥ 32 weeks (RR 1.5; 95%CI 1.1–2.1; p = 0.01). Mean estimated empiric antibiotic coverage rates varied by unit type: 66–79% for piperacillin-tazobactam plus amikacin, 60–76% for meropenem and 84–92% for meropenem plus vancomycin.ConclusionMost HA-BSI events affected preterm neonates at the central hospital with onsite surgery. One-third of patients with HA-BSI died, with highest mortality in preterm infants and Gram-negative/fungal BSI. Empiric antibiotic regimens provide moderate coverage of circulating pathogens but require annual review given increasing carbapenem resistance rates.

Heart failure after left atrial appendage occlusion: Insights from the LAAOS III randomized trial.

The left atrial appendage (LAA) produces natriuretic peptides and its removal or occlusion might increase the risk of heart failure (HF). We aimed to investigate the incidence of HF after LAA occlusion or removal (LAAO) in the Left Atrial Appendage Occlusion Study (LAAOS III). Patients (n = 4811) with atrial fibrillation (AF) and a CHA2DS2-VASc score ≥2, who were having cardiac surgery for another indication, were randomized to undergo surgical LAAO or not. We compared the composite outcome of HF-related hospitalizations and HF death between the two groups. HF assessment required clinical and radiographic evidence of HF. Analyses included a landmark analysis before and after 30 days and subgroups. Mean age was 71.2 years, 67.5% were male and 57.0% had prior HF. Over a mean follow-up of 3.8 years, 396 (8.3%) patients met the composite HF outcome: 209 (8.8%) with LAAO (n = 2379) and 187 (7.8%) without LAAO (n = 2391) (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.92-1.37, p = 0.25). There was no difference between the two groups in the first 30 days (1.6% vs. 1.1%; p = 0.12) and thereafter (7.6% vs. 7.1%; p = 0.57). Subgroups based on age, sex, body mass index, AF type, prior HF, cardiac rhythm or left ventricular ejection fraction showed consistent results. There was no difference in HF outcomes with LAAO between the cut-and-sew (HR 0.93, 95% CI 0.70-1.23, p = 0.62) versus other closure methods (HR 1.05, 95% CI 0.77-1.41, p = 0.77). Left atrial appendage occlusion or removal at the time of cardiac surgery does not appear to alter the risk of HF-related hospitalization or death. ClinicalTrials.gov NCT01561651.

Does race and insurance status play a role in high-grade renal trauma in the pediatric population? - An analysis from the traumatic renal injury collaborative in kids (TRICK) consortium.

We sought to examine the potential role of race and insurance status on the presentation, management, and outcomes of high-grade renal trauma (HGRT) in a large trauma registry. A retrospective cohort study of a large, multi-center registry of high-grade pediatric renal trauma was performed. Patients < 18 years of age with HGRT (grades III, IV, and V) from 2007 to 2020 were included. Patient demographics, presenting characteristics, hospital courses, outcomes, and follow-ups were extracted and compared. A total of 341 patients were initially identified, 32 were excluded. 66.3% were Caucasian(C), 27.5% were African American(AA), and 6.2% were Other races(O). 43.7% had public insurance,49.8% had private insurance and 6.5% were self-pay. Association of Race: AA patients had a higher rate of penetrating trauma (9% AA vs. 4% C, 0% Others, p = 0.002). Those with O and AA races presented at a younger age (9.5 yo O vs. 12.5 yo AA vs. 14 yo C, p = 0.001). However, no differences were found between race groups in the hospital course or outcome. Association of Insurance status: Those with public insurance presented with higher rates of bowel injury and blood transfusion, no differences were found in hospital course or outcome. Private insurance had higher Urology follow up rates (49% Private vs. 34.6% Public vs. 35% Self pay, p = 0.041). Race and insurance status was associated with differences found on the mechanism of injury, transfusion rate and urology follow-up rate; however, they do not influence rates of surgical intervention, post-injury complications or mortality.

Exploring the Role of Patient Engagement in Organisational Performance: Empirical Evidence From Patient and Family Advisory Councils.

Over the past twodecades, patient-centred care has gained global prominence, emphasising collaboration among patients, families, caregivers, and healthcare professionals to improve healthcare delivery. Recognising the foundational role of patient participation in enhancing clinical outcomes, healthcare organisations increasingly integrate patient inputs and resources into their management strategies. Patient and family advisory councils represent a primary form of collective patient engagement at the organisational level. Patient and family advisory councils actively engage in all levels of the hospital system to enhance quality improvement and meet the demands of patients. Despite recognised importance, empirical evidence regarding their roles as strategic resources and impact on hospital performance remains unexplored. Incorporating patient engagement into the social resource-based view, this study addresses how comprehensive strategic resources are associated with a hospital's quality of care and patient satisfaction outcomes. Utilising hospital-level data from 2018 to 2020, a cross-sectional time-series ordered logit analysis examines the quality of care and patient satisfaction models. The findings reveal that patient engagement, physical resources, and human capital are positively associated with hospital quality of care and patient satisfaction. In contrast, a social resource-a minority population-is negatively associated with hospital outcomes. This study contributes theoretical and practical implications. It synthesises patient engagement into the Social Resource-Based approach and provides consistent empirical evidence. In addition, it suggests evidence for practitioners to develop and manage patient engagement as a strategic resource.

The effect of prognostic nutritional indices on stroke hospitalization outcomes

ObjectivesStroke is the second leading cause of death and the third leading cause of disability globally, so monitoring inflammation and nutritional levels is essential for the secondary prevention. The impact of the Prognostic Nutritional Index (PNI) on tumor and perioperative outcomes has been demonstrated as an optimal combination of immune and nutritional indicators. However, the role of PNI on hospitalized outcomes in stroke patients remains unknown. This study aimed to investigate the clinical predictive value of PNI on hospitalized outcomes in stroke patients. Materials and methodsIn this study, stroke cases in the Medical Information Mart for Intensive Care IV database were analyzed using two-sample comparisons, proportional hazards model, subgroup analyses, and ROC analyses, and a nomogram was constructed. Results1795 stroke cases were included in this study, including 1537 in the survival group and 258 in the death group. The results showed that PNI was higher in the survival group than in the death group (43.98±0.21 vs. 36.09±0.49, P=0.001). The optimal regression equation obtained after screening variables using COX stepwise regression included age, GCS score, hypertension, PNI, leukocytes, and PT (C-index=0.730). The optimal regression equation showed that each increase in the PNI value was associated with a 6.6 % reduction in patient mortality, holding all other factors constant (HR 0.934, 95 %CI 0.914–0.954, P<0.008). Subgroup analyses showed that the Optimum regression equation was more effective in predicting hospitalized mortality in Hemorrhagic Stroke than in Ischemic Stroke (C-index: 0.803 vs. 0.703). ROC analysis revealed that the cut-off value of PNI for predicting hospital mortality in stroke patients was 37.45. The Kaplan-Meier curves clearly show that patients with PNI>37.45 have a higher survival rate than the low PNI group. ConclusionsHigher PNI is associated with better hospitalization outcomes for stroke patients. PNI can be used as a supplement to existing indicators, which helps predict the survival of stroke inpatients and provides reference value for clinical treatment.

An Updated Assessment of Safety Strategies for Platelet Blood Concentrates (PCs): A Short Review Article

Background: Platelet concentrates (PCs) are one of the most used blood components in blood banks due to their essential role in treating thrombocytopenia, and while viral transmission has been largely addressed, bacterial contamination of platelet concentrates (PCs) are still regarded as a crucial safety concern. Objective: This short review aimed to consolidate current knowledge on the strategies followed in blood banks to maximize the quality and shelf life of platelet concentrates (PCs). Different methods of each strategy were considered, focusing on outcomes related to approved and effective outcomes. Methods: The current study is based on PubMed, Wiley, and Web of Science databases to assess donor selection, bacterial screening, and pathogen reduction technologies utilized for PCs quality. All articles were collected until April 2024. Studies utilizing approved interventions and relevant hospital outcomes were inclusive. However, repetitive data and unapproved methods were among the exclusive criteria. Collected published manuscripts were reviewed. Results: The studies reviewed and referenced in this article consensus that pathogen reduction technologies (PRTs) utilizing Ultraviolet rays (UV) was found to be effective in eliminating various bacterial contamination. Furthermore, the need for donor and bacterial screening is still essential and could not be overlooked. Pathogen reduction technologies (PRTs) remain important and valid despite studies suggesting the reduced platelet concentrates (PCs) quality and the need for frequent transmission of PCs. Some studies even foresee pathogen reduction technologies (PRTs) as replacing the cultural bacterial detection methods. Conclusion:We conclude that preventing bacterial contamination in platelet concentrates (PCs) requires a multifaceted approach. However, future research should focus on optimizing these strategies while minimizing their potential adverse effects on platelet function and safet

Analysis of Prognostic Factors for Mortality in Patients With Gastrointestinal Bleeding: Application of Machine Learning Tools

Introduction: Treatment of upper gastrointestinal bleeding (UGIB) is a complex challenge due to the wide range of causes and factors affecting hospitalization outcomes.Objective: To study the impact of various factors on 30-day hospital outcomes using machine learning (ML) tools.Materials and methods: We compiled a retrospective data set that includes clinical, laboratory, and imaging data of 101 patients. The database was divided into 2 groups by UGIB etiology: ulcer and variceal bleedings. Both etiological groups were processed using ML tools in 2 steps: imputation by the MICE (multiple imputation by chained equations) model and factor importance analysis using the Random Forest model.Results: Analysis revealed that the most prognostically valuable parameters in both groups were well-known mortality predictors and emerging predictive factors, such as creatinine, blood pressure, activated partial thromboplastin time, level of consciousness, urea, lactate, comorbidity status, procalcitonin, ferritin, and total protein.Conclusions: The application of advanced tools confirmed the significance of popular and validated mortality predictors and contributed to the development of predictors, both explored and unexplored ones.

COVID-19 and pregnancy: a comprehensive study of comorbidities and outcomes

ObjectivesThis study aimed to investigate the impact of pregnancy and pre-existing comorbidities on COVID-19 infections and associated complications of hospitalisation and mortality in women of reproductive age (WRA). The study also compared the risk of severe COVID-19 complications between pregnant women (PW) and non-pregnant women (NPW) with and without pre-existing comorbidities. Special focus was placed on some understudied comorbidities of immunosuppression, chronic renal disease and chronic obstructive pulmonary disease (COPD).MethodsThe study utilized anonymized patient-related information for a population of 7,342,869 WRA from the Mexican Ministry of Health data repository on COVID-19. Descriptive variables were characterized using frequencies, percentages, means, and standard deviations. Adjusted odds ratios (aORs) were used to assess the associations between risk factors and outcomes of hospitalisation and mortality. The study covered the entire COVID-19 pandemic period from January 30, 2020, to May 5, 2023.ResultsThe findings revealed that PW were not more likely to get COVID-19 infections than NPW. PW with COVID-19 infections were more likely to require hospital admission, intubation treatments, and ICU admission compared to NPW with COVID-19. PW with immunosuppression had an increased odds ratio (aOR) of getting COVID-19 infections compared to NPW (PW: aOR = 1.0396; NPW: aOR = 0.8373). NPW with immunosuppression had higher risk of mortality (all-cause death: aOR = 1.7084; COVID-19-associated death: aOR = 1.4079) and hospitalisation (all-cause hospitalisation: aOR = 4.1328; COVID-19-associated hospitalisation: aOR = 3.0451) than NPW without immunosuppression. Renal disease was identified as a concerning pre-existing condition that increased the risks of COVID-19 associated mortality/hospitalizations and all-cause mortality/hospitalizations for both PW and NPW. NPW with renal disease had much higher odds ratio (aOR) of either COVID-19-associated-hospitalisations (NPW: aOR = 8.639; PW: aOR = 1.7603) or all-cause hospitalisations (NPW: aOR = 8.8594; PW: aOR = 1.786) than PW with renal disease.ConclusionsThis study provides valuable insights into the impact of pregnancy and pre-existing comorbidities on COVID-19 outcomes in WRA. The findings underscore the importance of considering demographic factors and pre-existing comorbidities in the management of PW with COVID-19. The study also highlights the need for further research to understand the unique impacts of different comorbidities, particularly immunosuppression and renal disease, on COVID-19 outcomes in WRA.

BN SO17 - When cholecystectomies go wrong: A single-centre review of post-operative complications over a two year period

Abstract Background Laparoscopic cholecystectomy (LC) is the main treatment for symptomatic gallstone disease with around 70,000 performed in the UK each year. The majority of these are day case procedures and patients recover well, however, there will always be a risk of more serious complication which can have serious negative effects on patients. The Clavien-Dindo classification of surgical complications is the most recognised method of grading post-operative complications by severity. The aim of our study was to identify our rates and severity of post-operative complication and their management. Method All patients who had LC between 1st July 2020 and 30th June 2022 were identified. Patient and operative details were retrieved from their electronic record. A complication was defined as any deviation from the standard post-operative course and was graded according to the Clavien-Dindo classification. 30-day readmission data was collected via hospital episode statistics and outcomes were reviewed on the patient record. Results 974 patients underwent LC. 30-day morbidity = 8.9%, 30-day readmission = 4.8% and 30-day mortality = 0.31%. Clavien-Dindo grade of complication: Grade 1= 44.7%, Grade 2 = 22.4%, Grade 3A = 12.9%, Grade 3B = 11.8%, Grade 4A = 1.2%, Grade 4B = 1.2%; and Grade 5 = 3.5%. 11 patients (1.1%) returned to theatre; bile leak was the most common indication (73%). Two intra-operative bile duct injuries were observed (0.21%) with one managed locally and the other transferred to the regional HPB centre. 7 patients required post-operative ERCP (0.72%), 57% for CBD stones and 43% for persistent bile leak. Conclusion Our study showed that the majority of post-operative morbidity following LC is related to post-operative pain (2.9%) or simple wound infection (1.8%). 2.6% of patients who underwent LC during had a significant complication requiring surgical, endoscopic or radiological intervention or admission to intensive care (Clavien-Dindo &amp;gt; 2). We report a 0.21% risk of bile duct injury and a 0.92% risk of post-operative bile leak. Overall our findings are in keeping with other studies but provide an insight into our local practice and that an area of potential improvement would be better management of post-operative pain.

Abstract 4128352: Association Between G6PD Deficiency and Congenital Heart Disease Incidence and Hospital Outcomes

Background: G6PD deficiency classically presents with hemolytic anemia, but associations have been described with atherogenesis and coronary artery disease. There are limited data that also suggest a link between G6PD deficiency and the development of congenital heart disease (CHD). Hypothesis: We hypothesize a higher incidence of CHD among individuals with G6PD deficiency as well as worse hospital outcomes for those with CHD and G6PD deficiency. Methods: We reviewed the Vizient® Clinical Data Base (a national, administrative database) from 10/2019-3/2024 for admissions of individuals aged 0-25 years with ICD-10 codes for moderate to severe CHD with and without and G6PD deficiency (D55.0, D75.A) to calculate and compare CHD incidence. Additional data included: demographics, hospital outcomes and costs. Hospital outcomes were compared using t-tests for normally distributed data, Mann-Whitney U test for non-normally distributed data and χ 2 for categorical data. Results: There were 213,708 admissions of individuals with CHD and &lt;1% had G6PD deficiency; findings in Table 1. Of the 6,363 admissions with G6PD, 289 (4.5%) had CHD and of 11,179,670 without G6PD, 213,419 (1.9%) had CHD ( p &lt;0.001). Patients with CHD and G6PD deficiency had male predominance and more Blacks (consistent with known G6PD deficiency epidemiology), longer length of stay and higher hospital costs than those without G6PD deficiency (Table 1). Conclusions: This review of a national database shows a higher incidence of CHD in admissions with G6PD deficiency as well as worse hospital outcomes (longer length of stay, higher costs) for those with CHD and comorbid G6PD deficiency. There were demographic differences, but these reflect the typical inheritance of G6PD deficiency. While there may be potential interplay between race/ethnicity and these outcomes as well, further investigation is needed.

Abstract 4118777: Outcomes Of Patients With Hypertrophic Cardiomyopathy In Academic Versus Non-Academic Centers: Analysis from the National Inpatient Sample Database 2012-2020

Introduction: Hypertrophic Cardiomyopathy (HCM) is an uncommon heart condition associated with serious complications. Advances in medicine have improved its prognosis. Despite this, such potentially life-saving improvements concerning the implementation of best practices are not ubiquitous; guidelines recommend management at specialized centers. Unfortunately, not all hospitals have specialized HCM centers. However, given that a sizeable portion of these specialists are also in academic centers (ACs), we hypothesize that ACs may be better positioned than non-academic centers to provide the highest quality care for HCM patients. Purpose: Our study aimed to assess in-hospital outcomes and healthcare burdens among patient admissions with HCM diagnoses, comparing those treated at academic centers with those receiving care at non-academic centers. We examine all-cause in-hospital mortality, length of stay (LOS), hospital costs, and investigate ethnic differences in patients with HCM. Methods: The National Inpatient Sample database was utilized to obtain HCM patient hospitalizations from 2012 through 2020 in the United States. Patient hospitalizations for which adult patients had a primary diagnosis of HCM were identified. Outcomes included all-cause in-hospital death, LOS, and hospital costs. All-cause in-hospital mortality was evaluated using multivariable logistic regression analysis. Multivariable lognormal regression models were used to estimate LOS and inflation adjusted cost outcomes. Results: All-cause mortality unadjusted rates were 2.2% in non-teaching hospitals compared with 1.7% at teaching hospitals; however, this difference was not statistically significant ( p =.235). Both unadjusted and adjusted hospital LOS were 32% shorter for non-teaching hospitals ( p &lt;.001). Both unadjusted and adjusted hospital costs were 46% lower for non-teaching hospitals compared to teaching hospitals ( p &lt;.001; $37,829 vs $70,216). For both LOS and cost, the overall interaction between race and teaching status was statistically significant ( p &lt; .001.) Conclusion: Our study shows variations in hospital outcomes and costs between teaching and non-teaching hospitals. Non-teaching hospitals displayed shorter stays and lower costs. Additionally, the interaction of race and teaching status significantly impacted length of stay and costs. These results underscore the necessity of tailored interventions to address healthcare delivery and resource inequities, especially in teaching hospitals.

Abstract 4138242: Association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with procedural complications and in-hospital outcomes from left atrial appendage occlusion (LAAO) device implantation in elderly (&gt;80 yrs) patients with atrial fibrillation (AF)

Background: LAAO has been used as an alternative strategy for stroke prevention in selected patients with AF, however there is very limited data about the outcomes in elderly patients with kidney disease. Methods: The National Inpatient Sample was queried for LAAO in the US between 2015–2020. Hospital outcomes were assessed for elderly patients undergoing LAAO in three cohorts; no CKD, CKD and ESRD. Results: A total of 31,360 elderly patients undergoing LAAO were identified in the study period; 23,250 (74.1%) had no CKD, 7,610 (24.2%) had CKD, and 500 (1.5%) had ESRD. CKD and ESRD were independently associated with higher odds of in-hospital mortality [aOR 3.06, 95 % CI (1.805-5.207), p &lt;0.001)] &amp; [ aOR 9.69 ,95% CI (3.52-26.64), p &lt;0.001], cardiovascular complications [ aOR 1.43 ,95% CI (1.208-1.696), p &lt;0.001] &amp;[ aOR 3.41 ,95% CI (2.12-5.48), p &lt;0.001], p &lt;0.001], neurological complications [aOR 1.2 ,95% CI (1.05-1.36), p=0.006] &amp;[aOR 1.58 ,95% CI (1.07-2.33), p=0.019], gastrointestinal and hematological complications [aOR 1.22 ,95% CI (1.06-1.39), p=0.003] &amp;[ aOR 1.71 ,95% CI (1.16-2.52), p &lt;0.001] respectively when compared to patients with no CKD. CKD was independently associated with higher odds of renal complications compared to patients with no CKD [aOR 5.34 ,95% CI (4.532-6.303), p &lt;0.001]. In comparison to patients with ESRD, patients with CKD had significantly higher odds of renal complications [aOR 8.01 ,95% CI (3.28-19.57), p &lt;0.001] with no significant difference in the odds of in-hospital mortality [aOR 0.4 ,95% CI (0.14-1.12), p=0.08]. In terms of resource utilization, length of stay didn’t differ with different kidney functions (1(1-1) for the three cohorts). However the ESRD cohort had the highest hospitalization costs compared to the CKD and no CKD cohorts ($26.113 ($19.728 -$34.362) vs. $25.799 ($20.231-$32.943) vs. $24.894 ($19.641-$31.373), p &lt;0.001). Conclusion: The prevalence of CKD and ESRD was around 25.7% in elderly patients with AF undergoing LAOO. CKD and ESRD were independently associated with higher odds of in-hospital mortality compared to patients with no CKD while CKD was independently associated with higher odds of renal complications after LAAO.

Abstract 4113885: Impact of Sodium-glucose Cotransporter 2 Inhibitor on Recurrence and Cardiovascular Outcomes after Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure

Background: Catheter ablation for Atrial fibrillation (AF) has been proven to improve the prognosis in patients with heart failure (HF), while it remains a high risk for AF recurrence and adverse cardiovascular outcomes. The impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on these outcomes in HF patients after AF ablation is unknown. Method: HF 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 based on 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. Results: During a total of 1315 person-year follow-ups, AF recurrence occurred 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 HR = 0.56, 95% CI: 0.43-0.74, P&lt;0.001). The composite risk of cardiovascular death, thrombotic events, or cardiovascular hospitalization was significantly lower in the SGLT2i group compared with those without SGLT2i (adjusted HR = 0.58, 95%CI: 0.41-0.80, p = 0.001). Although there was a tendency towards benefits, significant differences in all-cause mortality (adjusted HR = 0.76, 95%CI: 0.35-1.63, p = 0.480), cardiovascular mortality (adjusted HR = 0.62, 95%CI: 0.24-1.57, p = 0.312) and thrombotic events (adjusted HR = 0.40, 95%CI: 0.16-1.03, p = 0.056) were not noted between groups. Conclusion: The 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.