In-hospital Morbidity Research Articles

National In-Hospital Outcomes of Mechanical Mitral Valve Replacement in the Pediatric Population.

Background: National data about the outcomes of children undergoing mechanical mitral valve replacement (m-MVR) are scarce. Methods: A retrospective review of hospitalizations from the Kids' Inpatient Database was performed for patients ≤18 years of age in the United States. A total of 500 patients underwent m-MVR in 2009, 2012, 2016, and 2019. Patients with single ventricle physiology were excluded (n = 13). These patients were categorized into three groups according to age: neonates (<1 month, n = 20), infants (1-12 months, n = 76 patients), and children (1-18 years, n = 404). Outcomes were compared between the three groups. Results: The proportion of m-MVR involving children undergoing MV procedures (repair and replacement) has increased from 17.3% in 2009 to 30.8% in 2019 (Ptrend < .01). History of cardiac surgery was present in 256 patients (51.2%). Concomitant procedures were performed in 119 patients (23.8%). Intra- or postoperative extracorporeal membrane oxygenation was required in 19 patients (3.8%). The overall in-hospital mortality was 4.8% and was significantly higher in neonates and infants compared with older children (10% vs 11.8% vs 3.2%, P = .003). The length of hospital stay was longer in the neonatal group (median, 57 days, interquartile range, [24.8-90] vs 29.5 days [15.5-61] vs 10 days [7-18], P < .01). Nonhome discharges were more common in neonates and infants (40% vs 36.8% vs 13.1%, P < .01). Conclusion: Mechanical mitral valve replacement is increasingly performed over time with acceptable in-hospital morbidity and mortality, especially in older children and adolescents. Neonates and infants are associated with worse hospital survival, prolonged hospitalization, and significant rates of nonhome discharges.

Rapid-Response Electroencephalography in Seizure Diagnosis and Patient Care: Lessons From a Community Hospital.

BACKGROUND: Nonconvulsive seizures are a major source of in-hospital morbidity and a cause of unexplained encephalopathy in critically ill patients. Electroencephalography (EEG) is essential to confirm nonconvulsive seizures and can guide patient-specific workup, treatment, and prognostication. In a 208-bed community hospital, EEG services were limited to 1 part-time EEG technician and 1 EEG machine shared between inpatient and outpatient settings. Its use was restricted to typical business hours. A nursing-led quality improvement (QI) project endeavored to enhance access to EEG by introducing a point-of-care rapid-response EEG program. METHODS: For this project, a multidisciplinary protocol was developed to deploy a Food and Drug Administration-cleared, point-of-care rapid-response EEG platform (Ceribell Inc) in a community hospital's emergency department and inpatient units to streamline neurodiagnostic workups. This QI project compared EEG volume, study location, time-to-EEG, number of cases with seizures captured on EEG, and hospital-level financial metrics of diagnosis-related group reimbursements and length of stay for the 6 months before (pre-QI, using conventional EEG) and 6 months after implementing the rapid-response protocol (post-QI). RESULTS: Electroencephalography volume increased from 35 studies pre-QI to 115 post-QI (3.29-fold increase), whereas the median time from EEG order to EEG start decreased 7.6-fold (74 [34-187] minutes post-QI vs 562 [321-1034] minutes pre-QI). Point-of-care EEG was also associated with more confirmed seizure diagnoses compared with conventional EEG (27/115 post-QI vs 0/35 pre-QI). This resulted in additional diagnosis-related group reimbursements and hospital revenue. Availability of point-of-care EEG was also associated with a shorter median length of stay. CONCLUSION: A nurse-led, rapid-response EEG protocol at a community hospital resulted in significant improvements in EEG accessibility and seizure diagnosis with hospital-level financial benefits. By expanding access to EEG, confirming nonconvulsive seizures, and increasing care efficiency, rapid-response EEG protocols can enhance patient care.

Primary spontaneous pneumomediastinum: 237 cases in a single-center experience over a 10-year period and assessment of factors related with recurrence.

To evaluate the precipitating factors and symptoms of primary spontaneous pneumomediastinum (PSPM) and to assess the factors related with recurrent spontaneous pneumomediastinum (RSPM). From 2010 to 2021, 237 PSPM patients were included in this retrospective study. Clinical information including in-hospital periods, morbidity, mortality, presenting symptoms, precipitating events, smoking, and asthma history was obtained. The patients with smoking history were subdivided into "ex-smoker" or "current smoker". The severity of asthma was categorized into "mild intermittent", "mild persistent", "moderate persistent", or "severe persistent". During follow-up, patients with RSPM were classified into "recurrence" group and the others were into "no recurrence" group. Multivariate regression analysis was used to elucidate the associated factors with RSPM. The mean age of study patients (men: women = 222: 15) was 23.4 years and mean period of hospital stay was 7.5 days. There was no mortality and morbidity. Most frequent symptom and precipitating factor were acute chest pain (n = 211, 89.0%) and cough (n = 72, 30.4%), respectively. RSPM occurred in 11 patients (4.6%). The proportion of patients with smoking (72.8% vs. 37.1%, p = 0.010) or asthma (81.8% vs. 39.8%, p<0.001) was significantly higher in "recurrence" group than "no recurrence" group. On multivariate analysis, asthma was the only factor associated with RSPM (mild intermittent/persistent, OR = 7.092, p = 0.047; moderate persistent, OR = 8.000, p = 0.011). PSPM is a benign disease with no morbidity and mortality. Asthma may be the associated factor with RSPM; thus, despite the low rate of recurrence, patients with asthma should be informed about the chance of RSPM.

Comparison of intravenous ceftriaxone and ciprofloxacin in prevention of infection in cirrhosis patients with variceal bleeding

Background: Patients with variceal gastrointestinal bleeding are very susceptible to bacterial infections. This study was designed to examine the effectiveness of ciprofloxacin and ceftriaxone in controlling in-hospital morbidity, mortality, and infection in variceal bleeding patients. Methods: From August 2010 to August 2012, an interventional randomized controlled clinical trial was conducted in the Department of Gastroenterology, East Medical Ward, Mayo Hospital, Lahore. Adult patients who were diagnosed to have gastroesophageal variceal bleeding after endoscopic examination were included. These patients were randomly distributed to 2 groups. Group ceftriaxone: receiving injection Ceftriaxone 1000 mg intravenously 12 hourly for 7 days, Group ciprofloxacin: receiving injection ciprofloxacin 200 mg intravenously 12 hourly for 7 days. Results: Most common viral etiology was Hepatitis C in both the study groups. It was observed that in the ceftriaxone group, 4.8% had rebleeding, while in the ciprofloxacin group 5.6% had rebleeding (p=0.77), one case each had porto-systemic encephalopathy (p=0.99), 0.8% in ceftriaxone group and 3.2% in ciprofloxacin group had spontaneous bacterial peritonitis (p=0.39) and 4.8% in ceftriaxone group and 8% in ciprofloxacin group had systemic inflammatory response syndrome (p=0.31). No patients died during one week follow up. Conclusions: From our study, it was concluded that ciprofloxacin and ceftriaxone had same efficacy when used intravenously for prevention of bacterial infection and improvement in mortality and morbidity in patient of variceal bleeding. Future multicentric studies are required with a longer patient follow to support our findings.

Outcomes Following Laparoscopic Versus Open Surgery for Pediatric Intussusception: Analysis Using a National Inpatient Database in Japan

BackgroundLaparoscopic surgery for pediatric intussusception has recently become more common as an alternative to open surgery. However, the differences in outcomes between laparoscopic and open surgery remain unclear. Thus, this study aimed to compare short-term surgical outcomes and recurrence rates between patients treated with laparoscopic and open surgery for pediatric intussusception. MethodsPatients aged <18 years who underwent laparoscopic (n = 192) and open (n = 416) surgery for intussusception between April 2016 and March 2021 were retrospectively identified using a Japanese nationwide inpatient database. Propensity-score overlap weighting analyses were conducted to compare the outcomes between the laparoscopic and open surgery groups. The outcomes included in-hospital morbidity, reoperation, readmission for intussusception, bowel resection, the diagnosis of Meckel's diverticulum, duration of anesthesia, postoperative length of hospital stay, and total hospitalization costs. ResultsThe laparoscopic surgery group was older, heavier, and had fewer congenital malformations and emergency admissions than the open surgery group did. Overlap weighting analyses showed no significant differences in in-hospital morbidity (odds ratio [95% confidence interval], 0.88 [0.35−2.23]), reoperation (1.88 [0.24−14.9]), readmission for intussusception within 30 days (0.80 [0.12−5.30]) and 1 year (0.90 [0.28−2.93]), bowel resection (0.69 [0.46–1.02]), the diagnosis of Meckel's diverticulum (0.97 [0.50−1.90]), duration of anesthesia (difference, 11 [-1−24] minutes), postoperative length of stay (difference, −1.9 [-4.2−0.4] days), or total hospitalization costs (difference, 612 [ −746−1970] US dollars) between the groups. ConclusionsIn this large nationwide cohort, no significant differences in outcomes were observed between laparoscopic and open surgery. Laparoscopic surgery is an acceptable treatment option for pediatric intussusception. Levels of EvidenceLevel III.

Effect of preoperative ivabradine on hemodynamics during elective off-pump CABG.

Ivabradine is a specific heart rate (HR)-lowering agent which blocks the cardiac pacemaker If channels. It reduces the HR without causing a negative inotropic or lusitropic effect, thus preserving ventricular contractility. The authors hypothesized that its usefulness in lowering HR can be utilized in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. To study the effects of preoperative ivabradine on hemodynamics (during surgery) in patients undergoing elective OPCAB surgery. Fifty patients, New York Heart Association (NYHA) class I and II, were randomized into group I (control, n = 25) and group II (ivabradine group, n = 25). In group I, patients received the usual anti-anginal medications in the preoperative period, as per the institutional protocol. In group II, patients received ivabradine 5 mg twice daily for 3 days before surgery, in addition to the usual anti-anginal medications. Anesthesia was induced with fentanyl, thiopentone sodium, and pancuronium bromide as a muscle relaxant and maintained with fentanyl, midazolam, pancuronium bromide, and isoflurane. The hemodynamic parameters [HR and mean arterial pressure (MAP)] and pulmonary artery (PA) catheter-derived data were recorded at the baseline (before induction), 3 min after the induction of anesthesia at 1 min and 3 min after intubation and at 5 min and 30 min after protamine administration. Intraoperatively, hemodynamic data (HR and MAP) were recorded every 10 min, except during distal anastomosis of the coronary arteries when it was recorded every 5 min. Post-operatively, at 24 hours, the levels of troponin T and brain natriuretic peptide (BNP) were measured. This trial's CTRI registration number is CTRI/005858. The HR in group II was lower when compared to group I (range 59.6-72.4 beats/min and 65.8-80.2 beats/min, respectively) throughout the study period. MAP was comparable [range (78.5-87.8 mm Hg) vs. (78.9-88.5 mm Hg) in group II vs. group I, respectively] throughout the study period. Intraoperatively, 5 patients received metoprolol in group I to control the HR, whereas none of the patients in group II required metoprolol. The incidence of preoperative bradycardia (HR <60 beats/min) was higher in group II (20%) vs. group I (8%). There was no difference in both the groups in terms of troponin T and BNP level after 24 hours, time to extubation, requirement of inotropes, incidence of arrhythmias, in-hospital morbidity, and 30-day mortality. Ivabradine can be safely used along with other anti-anginal agents during the preoperative period in patients undergoing OPCAB surgery. It helps to maintain a lower HR during surgery and reduces the need for beta-blockers in the intraoperative period, a desirable and beneficial effect in situations where the use of beta-blockers may be potentially harmful. Further studies are needed to evaluate the beneficial effects of perioperative Ivabradine in patients with moderate-to-severe left ventricular dysfunction.

In-Hospital and Medium-Term Morbidity and Mortality Outcomes of 12,526 Patients Who Underwent Surgical Versus Transcatheter Aortic Valve Replacement: An Australian-Statewide Population-Linkage Cohort Study

In-Hospital and Medium-Term Morbidity and Mortality Outcomes of 12,526 Patients Who Underwent Surgical Versus Transcatheter Aortic Valve Replacement: An Australian-Statewide Population-Linkage Cohort Study

Long-Term Outcomes of Bovine versus Porcine Mitral Valve Replacement: A Multicenter Analysis.

Recent national guidelines recommending mitral valve replacement (MVR) for severe secondary mitral regurgitation have resulted in an increased utilization of mitral bioprosthesis. There is a paucity of data on how longitudinal clinical outcomes vary by prosthesis type. We examined long-term survival and risk of reoperation between patients having bovine vs. porcine MVR. Study Design. A retrospective analysis of MVR or MVR + coronary artery bypass graft (CABG) from 2001 to 2017 among seven hospitals reporting to a prospectively maintained clinical registry was conducted. The analytic cohort included 1,284 patients undergoing MVR (801 bovine and 483 porcine). Baseline comorbidities were balanced using 1 : 1 propensity score matching with 432 patients in each group. The primary end point was all-cause mortality. Secondary end points included in-hospital morbidity, 30-day mortality, length of stay, and risk of reoperation. In the overall cohort, patients receiving porcine valves were more likely to have diabetes (19% bovine vs. 29% porcine; p < 0.001), COPD (20% bovine vs. 27% porcine; p=0.008), dialysis or creatinine >2 mg/dL (4% bovine vs. 7% porcine; p=0.03), and coronary artery disease (65% bovine vs. 77% porcine; p < 0.001). There was no difference in stroke, acute kidney injury, mediastinitis, pneumonia, length of stay, in-hospital morbidity, or 30-day mortality. In the overall cohort, there was a difference in long-term survival (porcine HR 1.17 (95% CI: 1.00-1.37; p=050)). However, there was no difference in reoperation (porcine HR 0.56 (95% CI: 0.23-1.32; p=0.185)). In the propensity-matched cohort, patients were matched on all baseline characteristics. There was no difference in postoperative complications or in-hospital morbidity and 30-day mortality. After 1 : 1 propensity score matching, there was no difference in long-term survival (porcine HR 0.97 (95% CI: 0.81-1.17; p=0.756)) or risk of reoperation (porcine HR 0.54 (95% CI: 0.20-1.47; p=0.225)). In this multicenter analysis of patients undergoing bioprosthetic MVR, there was no difference in perioperative complications and risk of reoperation of long-term survival after matching.

Postoperative acute kidney injury after thoracic endovascular aortic repair for acute type B aortic dissection

BackgroundThoracic endovascular aortic repair (TEVAR) has evolved as the standard for treating complicated acute type B aortic dissection (ATBAD). Acute kidney injury (AKI) is a common complication in critically ill patients and is commonly observed in patients with ATBAD. The purpose of the study was to characterize AKI after TEVAR. MethodsAll patients who underwent TEVAR for ATBAD from 2011 through 2021 were identified using the International Registry of Acute Aortic Dissection. The primary end point was AKI. A generalized linear model analysis was performed to identify a factor associated with postoperative AKI. ResultsA total of 630 patients presented with ATBAD and underwent TEVAR. The indication for TEVAR was complicated ATBAD in 64.3%, high-risk uncomplicated ATBAD in 27.6%, and uncomplicated ATBAD in 8.1%. Of 630 patients, 102 (16.2%) developed postoperative AKI (AKI group) and 528 patients (83.8%) did not (non-AKI group). The most common indication for TEVAR was malperfusion (37.5%). In-hospital mortality was significantly higher in the AKI group (18.6% vs 4%; P < .001). Postoperatively, cerebrovascular accident, spinal cord ischemia, limb ischemia, and prolonged ventilation were more commonly observed in the AKI group. The expected mortality was similar at 2 years between the two groups (P = .51). Overall, the preoperative AKI was observed in 95 (15.7%) in the entire cohort consisting of 60 (64.5%) in the AKI group and 35 (6.8%) in the non-AKI group. A history of CKD (odds ratio, 4.6; 95% confidence interval, 1.5-14.1; P = .01) and preoperative AKI (odds ratio, 24.1; 95% confidence interval, 10.6-55.0; P < .001) were independently associated with postoperative AKI. ConclusionsThe incidence of postoperative AKI was 16.2% in patients undergoing TEVAR for ATBAD. Patients with postoperative AKI had a higher rate of in-hospital morbidities and mortality than those without. A history of CKD and preoperative AKI were independently associated with postoperative AKI.

Primary anastomosis with diverting loop ileostomy versus Hartmann's procedure for acute complicated diverticulitis: analysis of the National Inpatient Sample 2015-2019.

Up to 50% of patients with acute complicated diverticulitis require operative management on their index admission. There is ongoing debate as to whether primary anastomosis with diverting ileostomy versus a Hartmann's procedure is the optimal surgical approach for these patients. This study aims to compare postoperative complications in patients undergoing either Hartmann's procedure or primary anastomosis and diverting ileostomy for perforated diverticulitis using recent National Inpatient Sample data. Patients who underwent either primary anastomosis with diverting ileostomy or Hartmann's procedure for acute complicated diverticulitis from the 2015 to 2019 NIS database sample were included. Primary outcomes were postoperative in-hospital mortality and morbidity. Secondary outcomes were postoperative cause-specific complications, total admission cost, and length of stay (LOS). Univariate and multivariate regression were utilized to compare the two operative approaches. Overall, 642 patients underwent primary anastomosis with diverting ileostomy and 4,482 patients underwent Hartmann's procedure. There was no difference in in-hospital mortality (OR 0.93, 95%CI 0.45-1.92, p = 0.84) or in-hospital morbidity (OR 1.10, 95%CI 0.90-1.35, p = 0.33). Adjusted analysis suggested shorter postoperative LOS for patients undergoing Hartmann's procedure (MD 0.79days, 95%CI 0.15-1.43days, p = 0.013) and decreased total admission cost (MD $4,893.99, 95%CI $1,425.04-$8,362.94, p = 0.006). The present study supports that primary anastomosis with diverting ileostomy is safe for properly selected patients presenting with complicated diverticulitis. Primary anastomosis with diverting ileostomy is associated with greater total hospitalization costs and LOS.

Obesity paradox: a myth or reality, time to reveal the fact in a South Asian cohort presenting with STE-ACS undergoing primary percutaneous coronary intervention

ObjectivesObesity is a globally well-established risk factor for atherosclerotic cardiovascular diseases; however, some studies have witnessed survival benefits among obese patients and this phenomenon is termed ‘the obesity paradox’. Our...

In-Hospital and One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients Requiring Supplemental Home Oxygen Use.

There have been limited reports with inconsistent results on the impact of long-term use of oxygen therapry (LTOT) in patients treated with transcatheter aortic valve replacement (TAVR). We compared in-hospital and intermediate TAVR outcomes in 150 patients requiring LTOT (home O2 cohort) with 2,313 non-home O2 patients. Home O2 patients were younger, and had more comorbidities including chronic obstructive pulmonary disease (COPD), diabetes, carotid artery disease, lower forced expiratory volume (FEV1) (50.3±21.1% vs. 75.0±24.7%, P < 0.001), and lower diffusion capacity (DLCO, 48.6±19.2% vs. 74.6±22.4%, P < 0.001). These differences represented higher baseline Society of Thoracic Surgeons (STS) risk score (15.5±10.2% vs. 9.3±7.0%, P < 0.001) and lower pre-procedure Kansas City Cardiomyopathy Questionnaire (KCCQ-12) scores (32.5 ± 22.2 vs. 49.1 ± 25.4, P < 0.001). The home O2 cohort required higher use of alternative TAVR vascular access (24.0% vs. 12.8%, P = 0.002) and general anesthesia (51.3% vs. 36.0%, P < 0.001). Compared to non-home O2 patients, home O2 patients showed increased in-hospital mortality (5.3% vs. 1.6%, P = 0.001), procedural cardiac arrest (4.7% vs. 1.0%, P < 0.001), and postoperative atrial fibrillation (4.0% vs. 1.5%, P = 0.013). At 1-year follow-up, the home O2 cohort had a higher all-cause mortality (17.3% vs. 7.5%, P < 0.001) and lower KCCQ-12 scores (69.5 ± 23.8 vs. 82.1 ± 19.4, P < 0.001). Kaplan-Meir analysis revealed a lower survival rate in the home O2 cohort with an overall mean (95% confidence interval (CI)) survival time of 6.2 (5.9 - 6.5) years (P < 0.001). Home O2 patients represent a high-risk TAVR cohort with increased in-hospital morbidity and mortality, less improvement in 1-year KCCQ-12, and increased mortality at intermediate follow-up.

Quick Sequential Organ Failure Assessment Score in Recognizing Infected Patients with Organ Dysfunction &amp; Prediction of Mortality: Cohort Study

Objectives: To calculate the q-SOFA for postpartum patients admitted with infection and to correlate this with critical care unit admission &amp; patient outcome. Methods: An observational, prospective cohort hospital-based study. It was conducted in Omdurman Maternity Hospital from October 2018-to March 2019. The study included 59 postpartum patients who were diagnosed with postpartum infection; their q-SOFA score was calculated on admission and then on daily basis, to detect their in-hospital mortality and morbidity. The data was analyzed using SPSS, using Pearson Chi-square which was significant at P value of 0.05. Results: Fifty-nine participants were involved, mean age was 28years.Those who delivered by cesarean section was 54.3%, 33(55.9%) developed surgical site infection. Five patients (8.5%) died and 54 (91.5%) discharged. 17(28.8%) were admitted to critical care unit. q-SOFA score was calculated &amp; correlated to critical care unit admission &amp; fate of the patient using Pearson Chi-square which was found to be significant 0.01 and 0.001, respectively (P value of 0.05). Conclusion: q-SOFA is a useful tool in detecting infected patients at risk of poor outcome and death. If the score≥2 patients need to be, admitted to critical care units and to have further assessment.

Risk of in-hospital Deterioration for Children with Single Ventricle Physiology.

Children with single ventricle physiology (SV) are at high risk of in-hospital morbidity and mortality. Identifying children at risk for deterioration may allow for earlier escalation of care and subsequently decreased mortality.We conducted a retrospective chart review of all admissions to the pediatric cardiology non-ICU service from 2014 to 2018 for children < 18 years old. We defined clinical deterioration as unplanned transfer to the ICU or inpatient mortality. We selected children with SV by diagnosis codes and defined infants as children < 1 year old. We compared demographic, vital sign, and lab values between infants with and without a deterioration event. We evaluated vital sign and medical therapy changes before deterioration events.Among infants with SV (129 deterioration events over 225 admissions, overall 25% with hypoplastic left heart syndrome), those who deteriorated were younger (p = 0.001), had lower baseline oxygen saturation (p = 0.022), and higher baseline respiratory rate (p = 0.022), heart rate (p = 0.023), and hematocrit (p = 0.008). Median Duke Pediatric Early Warning Score increased prior to deterioration (p < 0.001). Deterioration was associated with administration of additional oxygen support (p = 0.012), a fluid bolus (p < 0.001), antibiotics (p < 0.001), vasopressor support (p = 0.009), and red blood cell transfusion (p < 0.001).Infants with SV are at high risk for deterioration. Integrating baseline and dynamic patient data from the electronic health record to identify the highest risk patients may allow for earlier detection and intervention to prevent clinical deterioration.

In-Hospital Clinical Features, Morbidity, and Mortality of Patients with Neurofibromatosis 1 in France: A Nationwide, Population-Based Retrospective Cohort Study

Neurofibromatosis 1 (NF1) is a multisystem disease that can affect nearly every organ system. The aim of our study was to describe the in-hospital population with NF1 in France. We conducted a nationwide retrospective cohort study using the French hospital administrative database. A total of 11,425 patients with NF1 (53.4% female, 19,080 person years) were identified from January 2013 to December 2019. A total of 23% had at least one diagnosis of a comorbidity or NF1-associated complication or disease, and it was highest in the age group of 10-15 years. A total of 2,601 (22.8%) had a diagnosis of cancer. There were 366 (3.2%) in-hospital deaths, and we observed a standardized mortality ratio of 4.14 (95% confidence interval= 3.71-4.56), with a higher standardized mortality ratio in women and in the age group of 10-15 years. The standardized incident ratio (SIR) of cancer was 10.3 (95% confidence interval= 9.6-11.1). We observed high SIR values for cancer in childhood, with a decrease toward that of the general population by age 70 years. We observed high SIRs for NF1-associated cancers: CNS SIR of 195.4 (95% confidence interval= 172.2-220.9) and small intestine SIR of 102.9 (95% confidence interval= 71.7-143.2). The study provides a better understanding of the prognosis in people living with NF1.

Precocious Rupture of Abdominal Aortic Aneurysms Below Size Criteria for Repair: Risk Factors and Outcomes

Practice guidelines recommend elective repair for abdominal aortic aneurysms (AAA) ≥5.5cm in men and ≥5cm in women to prevent rupture; however, some rupture at smaller diameters. We identify risk factors for rupture (rAAA) below this threshold and compare outcomes following rAAA repair above/below size criteria. The Vascular Quality Initiative (2013-2019) was queried for patients undergoing repair for rAAA and stratified based on diameter into Small and Large cohorts [Small: <5.5cm (men), <5.0cm (women)]. Univariate analysis was performed, and Kaplan-Meier analysis compared overall survival, aneurysm-related mortality, and reintervention at 12-months. 5,162 rAAA were identified. Small rAAA patients [n = 588] were more likely to have hypertension (81.3% vs. 77.0%, p<0.02), diabetes (18.2% vs. 14.9%, p<0.04), and ESRD (2.9% vs. 0.9%, p<0.01), and be on optimal medical therapy (32.1% vs. 26.8%, p<0.01). Women were more likely to rupture at smaller diameters compared to men (p<0.01). Small rAAA patients were more likely to undergo EVAR (70.2% vs. 56.0%, p<0.01), and had lower in-hospital mortality (17.7% vs. 27.7%, p<0.01), and fewer perioperative complications across all categories. At 12-months, small rAAA patients had better overall survival, freedom from aneurysm-related mortality, and freedom from reintervention, largely driven by EVAR approach. More than 11% of patients presenting with ruptured AAA were below the recommended size threshold for repair, and they tended to be younger, non-white, and have hypertension, diabetes and/or renal failure. Patients with small rAAA experienced lower in-hospital morbidity and mortality and improved 1-year survival, and EVAR was associated with better outcomes than open repair. However, women more frequently rupture at smaller diameters compared to men. Given contemporary elective outcomes for women, a randomized controlled trial for EVAR vs. surveillance at a sex-specific size threshold is needed.

Can previous therapy with statin be considered a protective factor in acute coronary syndrome?

Abstract Funding Acknowledgements Type of funding sources: None. Background Statin therapy is nowadays a cornerstone in primary and secondary prevention of cardiovascular events. Purpose This retrospective observational study intends to characterise the influence of previous therapy with statins on clinical and electrocardiographic presentation of acute coronary syndrome (ACS) and on in-hospital morbidity and mortality. Methods We evaluated a population of 746 patients admitted in a Cardiac Care Intensive Unit diagnosed with ACS (D). We then considered two groups: patients with previous therapy with statins (D1) and patients without it (D2). We documented demographic factors, personal history, clinical and electrocardiographic presentation of ACS, coronary angiography and angioplasty. The following in-hospital complications were defined: heart failure (HF), cardiogenic shock, reinfarction, stroke, major bleeding and need for blood transfusion. In-hospital mortality was compared between both groups. Results D1 consisted of 37.5% of the population (N=280). These patients had a higher prevalence of hypertension (90.7% vs 65.4%, p &amp;lt;0.001), diabetes (45.0% vs 27.8%, p &amp;lt;0.001), dyslipidaemia (81.8% vs. 36.6%, p = 0.001), chronic renal failure (18.6% vs 7.6%, p = 0.001), stroke (10.7% vs. 4.5%, p = 0.003), previous myocardial infraction (MI) (45,0% vs 12,6%, p = 0.001) and previous coronary artery bypass graft (13.2% vs. 2.0%, p = 0.001). They also had more frequently smoking habits (37.4% vs 13.9%, p = 0.001). They were less frequently admitted with ST-elevation MI (24.6% vs 49.2%, p = 0.001) and more frequently with non-ST elevation MI (56.1% vs 40, 9%, p = 0.001) and unstable angina (10.7% vs 5.6%, p = 0.02). The rate of coronary angiography was similar, however patients receiving previous statin therapy underwent less angioplasty. During hospitalization, there were no differences in any of the complications considered, nor in in-hospital mortality between the 2 groups. Conclusions In patients with ACS, previous therapy with statins seems to influence the presentation of ACS but it does not affect in-hospital morbidity and mortality. An important percentage of patients with diabetes and of those with previous MI or stroke were not on statins therapy as recommended in the European guidelines.

Predictors and Hospital Outcomes in Pregnant Patients Undergoing Extracorporeal Membrane Oxygenation: A Nationwide Study

(Anesth Analg. 2022;135:1172–1179) Extracorporeal membrane oxygenation (ECMO) use, advanced cardiorespiratory support for patients with decreased cardiac or respiratory function, has been on the rise. ECMO for pregnant women has also become more common, however, studies on ECMO often lack inclusion of parturients. Given a lack of information regarding appropriate timing and indications for ECMO for pregnant women, this study seeks to identify in-hospital mortality and morbidity rates for parturients who underwent ECMO.

Impact of congenital heart disease on outcomes among pediatric patients hospitalized for COVID-19 infection

BackgroundCOVID-19 infection is generally regarded as an acute self-limiting illness in children, but it can cause significant morbidity and mortality in both healthy and high-risk children. There are limited data on the outcomes of children with congenital heart disease (CHD) and COVID-19. This study aimed to examine the risks of mortality, in-hospital cardiovascular and non-cardiovascular complications in this patient population.MethodsWe analyzed data from hospitalized pediatric patients from 2020 using the nationally representative National Inpatient Sample (NIS). Children hospitalized for COVID-19 were included, and weighted data were used to compare in-hospital mortality and morbidities between children with and without CHD.ResultsOut of 36,690 children admitted with a diagnosis of COVID-19 infection(ICD-10 code:U07.1 and B97.29) during calendar year 2020, 1240 (3.4%) had CHD. The risk of mortality in children with CHD was not significantly higher than those without CHD(1.2% vs. 0.8%, p = 0.50), with adjusted OR (aOR) of 1.7 (95% CI: 0.6–5.3). Tachyarrhythmias and heart block were more likely in CHD children with an aOR of 4.2 (95% CI: 1.8–9.9) and aOR of 5.0 (95% CI: 2.4–10.8), respectively. Similarly, respiratory failure [aOR = 2.0 (1.5–2.8)], respiratory failure requiring non-invasive mechanical ventilation [aOR = 2.7 (1.4–5.2)] and invasive mechanical ventilation [aOR = 2.6 (1.6-4.0)], and acute kidney injury [aOR = 3.4 (2.2–5.4)] were all significantly higher among patients with CHD. Median length of hospital stay in children with CHD was longer than those without CHD [5 days (IQR: 2–11) vs. 3 days (IQR: 2–5), p = < 0.001].ConclusionsChildren with CHD hospitalized with COVID-19 infection were at increased risk of serious cardiovascular and non-cardiovascular adverse clinical outcomes. They also had increased length of hospital stay and utilization of healthcare resources.

Impact of cannabis on outcome in patients following traumatic injury

IntroductionOutcomes of trauma patients who tested positive for cannabis at the time of admission showed variable results. Sample size and research methodology that was used in prior studies may have resulted in the conflict. The purpose of the study was to evaluate the impact of cannabis use on outcomes in trauma patients using national data. Our hypothesis was that the use of cannabis will impact outcomes. MethodsThe trauma quality improvement program (TQIP) Participant Use File (PUF) database of the calendar years 2017 and 2018 were accessed for the study. All trauma patients aged 12 years old and above who were tested for cannabis at the time of initial evaluation were included in the study. Variables included in the study were: race, sex, injury severity score (ISS), Glasgow Coma Scale (GCS) Score, Abbreviated Injury Scale (AIS) score of different body regions and comorbidities. Excluded from the study were all patients who were not tested for cannabis or tested for cannabis but were also tested positive for alcohol and other drugs and those suffering from mental conditions. Propensity matched analysis was performed. The outcome of interest was overall in-hospital mortality and complications. ResultsPropensity matched analysis created 28,028 pairs. The analysis showed no significant difference in-hospital mortality between cannabis positive and cannabis negative groups (3.2% vs. 3.2%). The median length of hospital stay in both groups was not significantly different (4 [IQR: 3–8] vs. 4 [IQR: 2–8] days). No significant difference was found between the two groups regarding hospital complications except in pulmonary embolism (PE) with 0.1% less incidence of PE in the cannabis positive group compared to the cannabis negative group (0.4 vs. 0.5%). The incidence of DVT was identical in both groups (0.9% vs. 0.9%). ConclusionCannabis was not associated with overall in-hospital mortality or morbidity. There was a slight decrease in the incidence of PE in the cannabis positive group.