In-hospital Outcomes In Patients Research Articles

Comparison of In-Hospital Outcomes in Patients Transferred for Left Ventricular Assistance Device vs Those With in-House Support in STEMI Complicated by Cardiogenic Shock.

Comparison of In-Hospital Outcomes in Patients Transferred for Left Ventricular Assistance Device vs Those With in-House Support in STEMI Complicated by Cardiogenic Shock.

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

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

Relationships between sex and in-hospital outcomes of patients with acute cardiogenic shock receiving mechanical circulatory support

BackgroundCardiovascular disease is the leading cause of mortality in women. Despite this there is a paucity of data on the impact of sex on utilization and outcomes of temporary mechanical circulatory support (tMCS) in patients hospitalized with Acute Myocardial Infarction (AMI) Cardiogenic Shock (CS). MethodsWe examined the 2016–2019 National Inpatient Sample database to identify cases of AMI-CS. Men were used as our control group, while women comprised our cohort. The primary outcome was in-hospital mortality. Secondary outcomes included the use of tMCS including; left ventricular assist device (LVAD) use, Impella use, and Intra-Aortic Balloon Pump (IABP) use, length of stay (LOS) and total hospitalization cost (THC). Multivariate linear and logistic regression models were used to adjust for confounders. ResultsAmong patients hospitalized for AMI (N = 2,622,939), 37.7 % were Female. A Female sex was associated with a higher inpatient mortality (adjusted OR [aOR] 1.06, p < 0.001), a lower likelihood of LVAD use (2.3 % vs. 2.9 % and p < 0.001), IABP use (3.0 % vs. 4.4 % and p < 0.001), Impella use (1.0 % vs. 1.5 % and p < 0.001), a longer mean LOS (4.4 vs 4.3 days and p < 0.001) and lower THC ($88,097 vs. $104,101, p < 0.001) compared to male patients for AMI-CS. ConclusionFemale patients admitted for AMI-CS were less likely to receive tMCS despite a higher mortality rate and a slightly longer LOS compared to male patients. Further studies are necessary to confirm these findings and elucidate clearer causality for such disparities.

Association between stress hyperglycemia ratio and in-hospital outcomes: findings from the improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) Project.

Stress hyperglycemia ratio (SHR) could provide accurate information on the acute status of hyperglycemia. The relationship between SHR and acute coronary syndrome (ACS) prognosis remains unclear. This study was conducted to identity the association between SHR and in-hospital outcomes in patients with ACS. A total of 12,010 patients were eventually enrolled in the study. The relationship between SHR and in-hospital major adverse cardiovascular events (MACEs) was then modeled by restricted cubic spline (RCS) curves, and all patients were divided into three groups according to the results. The multivariate logistic regression analysis was used to determine the associations between the SHR and in-hospital outcomes, described as odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses were also performed on different diseases. The median age of this cohort was 63 (54, 71) years old, and 8942 (74.5%) were male. Group 1 was defined as SHR < 0.6 (n = 426), Group 2 was defined as SHR between 0.6 and 1 (n = 5821), and Group 3 was defined as SHR > 1 (n = 5763). Compared with Group 2, Group 1 (OR = 1.891, 95% CI: 1.028-3.479, P < 0.001) and Group 3 (OR = 1.868, 95% CI: 1.434-2.434, P < 0.001) had higher risks of suffering from in-hospital MACEs. SHR was associated with higher risks of in-hospital MACEs in the subgroups of DM [OR = 2.282, 95% CI: 1.477-3.524). Both low and high SHR levels were independently associated with in-hospital MACEs. Young males with DM, hypertension, and decreased renal function had much higher risks of suffering from SHR-correlated MACEs.

In-Hospital Outcomes of Patients with Anterior Wall Myocardial Infarction and Right Bundle Branch Block in the Primary PCI Era: Impact and Prognostic Factors

Objective: This study investigates the in-hospital outcomes of patients presenting with Anterior Wall Myocardial Infarction (AWMI) and Right Bundle Branch Block (RBBB) during the primary Percutaneous Coronary Intervention (PCI) era. It aims to assess the impact of primary PCI on these patients and identify factors contributing to poor outcomes. Methodology: A prospective observational study was conducted at the Department of Cardiology, Hayatabad Medical Complex (HMC), Peshawar, Pakistan. The study enrolled 150 patients diagnosed with AWMI and RBBB, undergoing reperfusion therapy. Data on demographics, clinical characteristics, and treatment outcomes were collected and analyzed using IBM SPSS version 21.0. Results: Among the 150 patients included in the study, there was a balanced gender distribution with a mean age of 51.15 years. The majority of patients, 136 (90.7%), survived their hospital stay. Primary PCI was significantly associated with improved survival rates compared to medical management alone. Factors such as TIMI and GRACE risk scores were crucial for risk stratification, highlighting the need for personalized management strategies. Conclusion: The findings underscore the effectiveness of primary PCI in improving in-hospital outcomes for patients with AWMI and RBBB. This study highlights the necessity of timely reperfusion therapy and personalized risk stratification to enhance patient prognosis. By documenting the impact of primary PCI and identifying factors leading to poor outcomes, this research provides valuable insights that aid in the optimization of treatment protocols for this high-risk patient group.

Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020.

Both cancer diagnosis/treatment modality and surgical technique for the spine have been developed recently. Nationwide trends in the surgical treatment for metastatic spinal tumors have not been reported in the last decades. This study aimed to examine recent trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes using nationwide administrative hospital discharge data. The Diagnosis Procedure Combination database from 2012 to 2020 was used to extract data from patients who underwent surgical procedures for spinal metastasis with the number of non-metastatic spinal surgery at the institutions that have performed metastatic spine surgeries at least one case in the same year. Trends in the surgical treatment for spinal metastasis, patients' demographics, and in-hospital mortality/outcomes were investigated. This study analyzed 10,321 eligible patients with spinal metastasis. The surgical treatment for spinal metastasis increased 1.68 times from 2012 to 2020, especially in fusion surgery, whereas the proportion of metastatic spinal surgery retained with a slight increase in the 2%s. Distributions of the primary site did not change, whereas age was getting older. In-hospital mortality and length of stay decreased over time (9.9-6.8%, p < 0.001; 37-30days, p < 0.001). Postoperative complication and unfavorable ambulatory retained stable and slightly decreased, respectively. During the last decade, surgical treatment for spinal metastasis, especially fusion surgery, has increased in Japan. In-hospital mortality and length of stay decreased. Recent advances in cancer treatment and surgical techniques might influence this trend.

In-hospital outcomes of patients with lung cancer with and without superior vena cava thrombosis: A nationwide analysis.

e23322 Background: Malignant superior vena cava syndrome (SVCS) is a clinical problem that results from the obstruction of blood flow in the superior vena cava by an underlying malignancy. It may be caused by external compression or internal obstruction due to a thrombus or direct invasion by tumor cells. Though lung malignancy is the most common cause of SVCS, there is a lack of data on in-hospital outcomes in these patients. Methods: We queried the National Inpatient Sample 2018-2020 to identify hospitalizations with lung cancer including both small cell and non small cell lung cancer. Hospitalizations with diagnosis of acute SVC thrombosis were determined by using ICD-10 codes.Demographics and mortality rates were compared between two groups using chi square for categorical variables and t test for continuous variables. Multivariate regression analysis was further performed to study the impact of SVC thrombosis on mortality, LOS and total hospitalization cost. Results: A total of 2011620 hospitalizations with lung cancer were identified. Of these, 2855 (0.0014%) had acute SVC thrombosis. These patients were younger with a mean age of 63 years. African-Americans and Hispanics were in a higher proportion in the cohort of hospitalizations with SVC thrombus as compared to those without. (Table 1). Multivariate regression analysis revealed higher odds of mortality (OR-1.94; C.I: 1.53-2.47; P &lt; 0.001), LOS (OR 1.66; C.I:1.20- 2.31; P &lt; 0.005) and total hospitalization cost (26211.15; C.I:22183.56- 30238.74; P &lt; 0.001) in lung cancer hospitalizations. Conclusions: Our study shows that SVCT, has higher odds of mortality, length of stay and total hospital cost. Though the general recommendation is to continue anticoagulation, sometimes patients may require endovascular stent placement with/without thrombectomy. Though rare, SCVT can be life threatening and requires prompt attention.[Table: see text]

Association between Glycemic Gap at Admission and In-Hospital Outcome in Patients with Diabetes with Acute Myocardial Infarction

Background: Acute hyperglycemia predicts adverse outcomes in patients with acute myocardial infarction (AMI), but it has a major disadvantage because the association is diminished in patients with diabetes mellitus (DM). Recent studies introduced a more accurate predictor, the glycemic gap (the difference between admission blood glucose and the estimated average glucose), that could anticipate adverse outcomes in patients with diabetes with AMI. Aims: This study aimed to determine the association between glycemic gap and clinical outcome in diabetic patients presenting with AMI to a tertiary hospital in Bangladesh. Methods: Two hundred twenty diabetic patients hospitalized with AMI were included in this study from the Department of Cardiology of Chittagong Medical College Hospital from March 2023 to February 2024. Admission blood glucose and HbA1c were measured, and the glycemic gap was calculated. Patients were prospectively followed during their hospital stay to obtain data regarding major adverse cardiac events (MACEs). Results: The mean (±SD) age of the patients was 56.5 (±10.1) years and 63.6% of them were male. MACEs included in-hospital death, cardiac arrest, cardiogenic shock, arrhythmia and left ventricular failure were observed in 6.4%, 3.6%, 19.5%, 5.5%, and 30.5% of the patients, respectively. Ninety-nine (45%) patients had one or more MACEs. Median (IQR) glycemic gap values were 38.5 (31.9-47.3) and 71.0 (61.0-84.3) in patients without any MACEs and patients with one or more MACEs, respectively (p&lt;0.001). Median (IQR) glycemic gap values were 90.6 (86.0-97.9) and 52.6 (36.1-69.3) in expired and survived patients, respectively (p&lt;0.001). The area under the receiver operating characteristics curve (AUROC) for admission glycemic gap values to predict in-hospital mortality was 0.895[95% confidence interval (CI) 0.768-1.000, p&lt;0.001] and with the best cut-off value of 80.16, glycemic gap had sensitivity and specificity of 92.9% and 89.8%, respectively.The Area Under ROC for admission glycemic gap values to predict MACEs was 0.926 (95% CI 0.874-0.958) and with the best cut-off value of 53.19, glycemic gap had a sensitivity and specificity of 94.9% and 84.3%, respectively. Glycemic gap was an independent predictor of MACEs [odds ratio (OR): 1.11, 95% CI 1.08-1.14, p &lt;0.001] and in-hospital mortality (OR: 1.09, 95% CI 1.05-1.14, p &lt;0.001). Conclusions: Elevated glycemic gap was significantly associated with an increased in-hospital mortality and other MACEs. So, glycemic gap can be used to assess the prognosis of hospitalized AMI patients with diabetes.

The Gender Spectrum of In-hospital Survival Post Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction: Exploring Age-driven Trends.

The study was aimed to evaluate gender difference and age & gender specific interaction of in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). This was a prospective cohort study of 1748 patients with STEMI undergoing primary PCI. The study was dichotomised according to gender to evaluate the difference in the outcome. The study was further stratified based on an age cut-off of 75 years to examine the age-specific gender relationship in survival outcomes. Independent variables for in-hospital mortality were analysed through logistic regression. There were 314 (17.96%) females with an average age of 60.80 years and 1434 (82.03%) males with an average age of 54.87 years. The prevalence of diabetes (24.8% vs. 13.2%) and hypertension (33.1% vs. 12.9%) was significantly higher in female patients compared to male patients, whereas the significantly higher number of male patients were smokers. On multivariate analysis, odds of female gender OR = 3.54 (1.37-9.17), killip class >2 OR = 3.05 (1.97-4.71) and baseline creatinine OR = 2.27 (1.22-4.23) were found as significant predictors of in-hospital mortality. The crude odds ratio of 2.35 (1.49-3.72) and adjusted OR of 2.05 (1.27-3.30) for female mortality was significant among patients aged <75-years. While patients with ≥75-years of age, the mortality difference was insignificant. Although the incidence of STEMI was higher in male compared to female patients, female patients had two-fold higher in-hospital mortality than male. Female gender was an independent predictor for in-hospital mortality in patients <75-years of age.

In-hospital outcomes of anterior versus non-anterior st elevation myocardial infarction complicated with complete atrioventricular block

Abstract Background Complete atrioventricular block (CAVB) is an infrequent complication of acute ST-elevation myocardial infarction (STEMI), and information on its outcomes is scarce. We aimed to address the characteristics and in-hospital outcomes of patients with anterior versus non-anterior STEMI complicated with CAVB in a contemporary, nationwide, all-comer registry, in the U.S. Methods Using the National Inpatient Sample (NIS) database, we identified patients who were hospitalized with STEMI, complicated with CAVB between 2016- 2019. Patients with any cardiac implantable electronic device (CIED) in-situ were excluded. Baseline characteristics, in-hospital procedures and outcomes including time to temporary or permanent pacemaker (PPM)/implantable cardioverter defibrillator (ICD) implantation, length of stay and mortality were collected. Results A total of 17470 patients, were hospitalized with a primary diagnosis of STEMI and concomitant diagnosis of CAVB, 2755(15.8%) with Anterior and 14715(84.2%) with non-anterior STEMI. Non-anterior STEMI patients included more women, had higher prevalence of hypertension, dyslipidemia, smoking history and chronic pulmonary disease, while anterior STEMI patients had higher prevalence of chronic kidney disease and ischemic cardiomyopathy. Anterior STEMI patient had significantly higher rate of in hospital death [955 (35%) vs 2220 (15%), p&amp;lt;0.001], CPR, VT/VF, cardiac arrest, acute heart failure, respiratory failure, mechanical ventilation &amp;gt;96 hours and acute kidney injury. In both groups 40% received temporary pacemaker, but mean time to implantation was longer in anterior STEMI patients [1.1±3.3 vs 0.3±1.2 days, p&amp;lt;0.001]. Rate of any permanent CIED implantation was also significantly higher in the anterior STEMI patients with longer time to PPM implantation, [3.3±3.5 vs 2.8±2.8 days, p&amp;lt;0.001]. Use of mechanical circulatory support devices was significantly higher in anterior STEMI patients. Conclusion In STEMI patients complicated with CAVB, in-hospital outcomes of anterior STEMI were worse comparing to non-anterior STEMI, with significantly higher rates of in-hospital death, in-hospital complications and CIED implantations.

Trends and outcomes of hospitalized patients with priapism in Germany: results from the GRAND study.

We aimed to provide evidence on the trends and in-hospital outcomes of patients with low- and high-flow priapism through the largest study in the field. We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2008-2021), and performed multiple patient-level analyses. We included 6,588 men with low-flow and 729 with high-flow priapism. Among patients with low-flow priapism, 156 (2.4%) suffered from sickle cell disease, and 1,477 (22.4%) patients required shunt surgery. Of them, only 37 (2.5%) received a concomitant penile prosthesis implantation (30 inflatable and 7 semi-rigid prosthesis). In Germany, the total number of patients with low-flow priapism requiring hospital stay has steadily increased, while the number of patients with high-flow priapism requiring hospital stay has decreased in the last years. Among patients with high-flow priapism, 136 (18.7%) required selective artery embolization. In men with low-flow priapism, sickle cell disease was associated with high rates of exchange transfusion (OR: 21, 95% CI: 14-31, p < 0.001). The length of hospital stay (p = 0.06) and the intensive care unit admissions (p = 0.9) did not differ between patients with low-flow priapism due to sickle cell disease versus other causes of low-flow priapism. Accordingly, in men with high-flow priapism, embolization was not associated with worse outcomes in terms of length of hospital stay (p > 0.9), transfusion (p = 0.8), and intensive care unit admission (p = 0.5). Low-flow priapism is an absolute emergency that requires shunt surgery in more than one-fifth of all patients requiring hospital stay. On the contrary, high-flow priapism is still managed, in most cases, conservatively.

Efficacy of Bedside Index for Severity In Acute Pancreatitis (Bisap) Score As Predictor of In-Hospital Outcome in Acute Pancreatitis

Background: Acute pancreatitis is a potentially life-threatening condition characterized by inflammation of the pancreas. Early identification of patients at risk of severe disease is crucial for devising appropriate management strategies and improving outcomes. The aim of the study was to investigate the efficacy of BISAP score as predictor of in-hospital outcome in patients with acute pancreatitis. Methods: This was a longitudinal study conducted in Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka from January 2023 to December 2023. After ethical approval, a total 107 subjects were included in this study based on inclusion and exclusion criteria. Severity of the disease was assessed by BISAP score. Theoutcome determinants were length of hospital stay, complete recovery, partial recovery with complication, transfer to ICU and mortality. Chi Square test, Binominal Regression analysis and Receiver operator characteristic (ROC) curve analysis were performed as applicable. p value &lt;0.05 was considered as the level of significance. Results: The mean BISAP score among 107 study participants was 2.00 ± 0.76. Patients with BISAP score ³3 had significantly increased odds of prolonged hospital stay (OR: 11.226; 95% CI: 2.985- 42.222; p&lt;0.001), higher rate of partial recovery with complications (OR: 7.302; 95.325% CI: -20.997; p&lt;0.001). &lt;0.001), and greater likelihood of intensive care unit (ICU) transfer (OR: 1.136; 95% CI: 0.968-1.333; p=0.004). A BISAP score cutoff value of ³3 was associated with increased length of hospital stay (sensitivity 91.3%, specificity 97.6%, AUC=0.945), partial recovery with complications (sensitivity 83.3%, specificity 96.4%, AUC=0.899), and ICU transfer (sensitivity 75%, specificity 80.6%, AUC=0.778).Conclusion: It can be concluded that increased BISAP score can be served as an independent predictor of in-hospital in patients with acute pancreatitis (AP). Bangladesh J Medicine 2024; 35: 88-92

Long-term prognostic significance of stress hyperglycemia in patients with ST-elevation myocardial infarction

Abstract Funding Acknowledgements None. Background/aim Stress hyperglycemia is defined as hyperglycemia that occurs in critically ill patients without diabetes mellitus (DM). It is associated with adverse in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI). The aim of the present study is to evaluate short- and long-term prognostic impact of stress hyperglycemia in STEMI patients. Method We analysed 2505 consecutive STEMI patients treated with successful primary PCI (pPCI) without previous DM and without cardiogenic shock at admission. Successful pPCI was defined as post-procedural flow TIMI 3. Stress hyperglycemia was defined as plasma glucose level above 7.8mmol/L at any time during hospitalization. The follow-up period was 6 years. Results Stress hyperglycemia at admission was registered in 685 (27.3%) patients. Compared with patients without stress hyperglycemia, patients with stress hyperglycemia were older and presented more often with heart failure (Killip class II and III); they were more likely to have hypertension, chronic kidney disease, three vessel coronary disease (at initial angiogram) and lower predischarge left ventricular ejection fraction (EF). In-hospital, 30-day and 6-year mortality were significantly higher in patients with stress hyperglycemia vs patients without stress hyperglycemia: 7.1% vs 1.5%, 7.5% vs 1.7% and 12.5% vs 4.6% (p&amp;lt;0.001), respectively as shown in Figure 1. In Cox regression analysis stress hyperglycemia was an independent predictor for in-hospital, 30-days and 6-year mortality- HR 2.19 (95% 1.49-3.94), p=0.018, HR 1,58(95%CI 1.15-2.85), p=0.020 and HR 1.52 (95%CI 1.32-2.17), p=0.030, respectively. Conclusion In STEMI patients without diabetes mellitus treated with successful primary PCI stress hyperglycemia is an independent predictor for short- and long-term mortality (up to 6-years). These findings emphasize the importance of close monitoring of blood glucose level in STEMI patients regardless of diabetic status.

In-Hospital Outcomes in Patients With Non-ST Segment Elevation Myocardial Infarction and Concomitant Neurodevelopmental Disorders in the United States: Insights From the National Inpatient Sample 2011-2020.

Patients with neurodevelopmental disorders(NDDs) encounter significant barriers to receiving quality health care, particularly for acute conditions such as non-ST segment elevation myocardial infarction (NSTEMI). This study addresses the critical gap in knowledge regarding in-hospital outcomes and the use of invasive therapies in this demographic. By analyzing data from the National Inpatient Sample database from 2011 to 2020 using the International Classification of Diseases, Ninth Edition (ICD-9) and Tenth Edition (ICD-10) codes, we identified patients with NSTEMI, both with and without NDDs, and compared baseline characteristics, in-hospital outcomes, and the application of invasive treatments. The analysis involved a weighted sample of 7,482,216NSTEMI hospitalizations, of which 30,168 (0.40%) patients had NDDs. There were significantly higher comorbidity-adjusted odds of in-hospital mortality, cardiac arrest, endotracheal intubation, infectious complications, ventricular arrhythmias, and restraint use among the NDD cohort. Conversely, this group exhibited lower adjusted odds of undergoing left heart catheterization, percutaneous coronary intervention, or coronary artery bypass graft surgery.These findings underscore the disparities faced by patients with NDDs in accessing invasive cardiac interventions, highlighting the need for further research to address these barriers and improve care quality for this vulnerable population.

Clinical Outcomes and Resource Utilization in Patients With Peripheral Arterial Disease Hospitalized for Acute Coronary Syndrome

Previous studies have shown an association between acute limb ischemia and higher mortality in patients with Acute Myocardial Infarction. Although Peripheral Artery Disease is a well-known risk factor for development of macrovascular pathology, the effect of its severity is not well investigated in patients hospitalized for Acute Coronary Syndrome (ACS). Using a national cohort of patients with various degrees of Peripheral Arterial Disease, we investigated in-hospital outcomes in patients who were admitted for ACS. Using the 2016-2020 Nationwide Readmissions Database, we queried all patients who were hospitalized for ACS (Unstable Angina, Non ST-Elevation Myocardial Infarction, and ST-Elevation Myocardial Infarction). Patients were further divided into three groups, either No Peripheral Arterial Disease (Non-PAD), Peripheral Arterial Disease (PAD) or Critical Limb Ischemia (CLI). Multivariable models were designed to adjust for patient and hospital factors and examine the association between ACS and PAD severity. Of an approximately 3,834,181 hospitalizations for ACS, 6.4% had PAD, 0.2% had CLI and all other were Non-PAD. Following risk adjustment, in hospital mortality was higher by 24% in PAD (AOR 1.24, 95%CI 1.21-1.28) and 86% in CLI (AOR 1.86, 95%CI 1.62-2.09) compared to Non-PAD. Furthermore, PAD and CLI were linked to 1.23-fold (95%CI 1.20-1.26) and 1.67-fold (95%CI 1.45-1.86) greater odds of cardiogenic shock compared to Non-PAD. Additionally, PAD and CLI were linked with higher odds of mechanical circulatory support usage, cardiac arrest and acute kidney injury compared to Non-PAD. Lastly, duration of hospital stay, hospitalization costs and odds of non-home discharge and 30-day readmissions were greater in patients with PAD and CLI compared to Non-PAD. PAD severity was associated with worse clinical outcomes in patients with ACS, including in hospital mortality and resource utilization.

Symptomatic HIV infection and in-hospital outcomes for patients with acute myocardial infarction undergoing percutaneous coronary intervention from national inpatient sample

Human immunodeficiency virus (HIV) infection increases the risk of acute myocardial infarction (AMI). However, little is known about its association with in-hospital outcomes and temporal trends in patients with AMI undergoing percutaneous coronary intervention (PCI). We queried patients with AMI who underwent PCI from the National Inpatient Sample Database (2003–2015) and stratified them into three groups: symptomatic, asymptomatic, and HIV-negative. After 1:2 case–control matching (CCM), logistic regression analysis was conducted to determine how HIV infection affected in-hospital outcomes. We also evaluated their recent trends from 2003 to 2015. The total weighted national estimate of 2,191,129 AMI cases included 2,178,995 HIV/AIDS-negative, 4994 asymptomatic, and 7140 symptomatic HIV cases. Symptomatic but not asymptomatic patients with HIV suffered more than triple the in-hospital mortality (adjusted odds ratio (aOR) 3.6, 95% confidence interval (CI) 2.5–5.2), over one-fold incidence of acute kidney injury (aOR 2.6 95% CI 1.9–3.4) and cardiogenic shock risk (aOR 1.9, 95% CI 1.3–2.7), a longer length of hospital stay (beta 1.2, 95% CI 1.0–1.5), and had more procedures (beta 1.3, 95% CI 1.2–1.5). These disparities relating to symptomatic HIV infection persisted from 2003 to 2015. In patients with AMI who underwent PCI, symptomatic HIV infection was associated with higher in-hospital mortality and more severe outcomes.

Association Between Chronic Liver Disease and Adverse In-Hospital Outcomes in Patients Undergoing CABG: A Propensity Score-Matched Analysis

Despite a 30% decline in the rate over the last decade, coronary artery bypass graft (CABG) surgery remains a common major surgical procedure with significant morbidity and mortality. Chronic liver disease (CLD) patients, with increased survival rates due to medical advancements, are now frequently being considered for CABG, bearing higher perioperative risks. This study investigates the association between CLD and in-hospital outcomes in CABG patients using retrospective data from the National Inpatient Sample (NIS) database (2016-2020) including 7,945 CLD patients undergoing CABG that were propensity score matched with an equivalent number of patients with no CLD undergoing CABG. Clinical variables were extracted using corresponding ICD-10 codes and multivariable logistic and linear regression models were used to assess in-hospital mortality, complications, and length of stay. The overall mortality rate was 5.5% (8.6% in the CLD group with cirrhosis, 5.9% CLD group without cirrhosis, and 2.8% in the non-CLD group, p<0.001). CLD with cirrhosis was associated with higher odds of mortality (AOR= 4.21, 95% CI [3.61, 4.94]) and length of stay (β = 1.03, 95% CI [1.01, 1.05]). CLD patients with cirrhosis demonstrated higher odds of perioperative cardiac complications (cardiac arrest, ventricular arrhythmias, tamponade, and shock), thromboembolic events, gastrointestinal bleeding, bowel ischemia, acute kidney injury, pneumonia, and sepsis. This study reveals a substantial impact of CLD on adverse outcomes in CABG patients, emphasizing the need for tailored preoperative assessments and postoperative care.

Outcomes of coronary artery bypass grafting (CABG) in patients with OSA-COPD overlap syndrome versus COPD alone: an analysis of US Nationwide Inpatient Sample.

Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are associated with unfavorable outcomes following coronary artery bypass grafting (CABG). The purpose of this study was to compare in-hospital outcomes of patients with COPD alone versus OSA-COPD overlap after CABG. Data of adults ≥ 18 years old with COPD who received elective CABG between 2005 and 2018 were extracted from the US Nationwide Inpatient Sample (NIS). Patients were divided into two groups: with OSA-COPD overlap and COPD alone. Propensity score matching (PSM) was employed to balance the between-group characteristics. Logistic and linear regression analyses determined the associations between study variables and inpatient outcomes. After PSM, data of 2,439 patients with OSA-COPD overlap and 9,756 with COPD alone were analyzed. After adjustment, OSA-COPD overlap was associated with a significantly increased risk of overall postoperative complications (adjusted odd ratio [aOR] = 1.12, 95% confidence interval [CI]: 95% CI: 1.01-1.24), respiratory failure/prolonged mechanical ventilation (aOR = 1.27, 95%CI: 1.14-1.41), and non-routine discharge (aOR = 1.16, 95%CI: 1.03-1.29), and AKI (aOR = 1.14, 95% CI: 1.00-1.29). Patients with OSA-COPD overlap had a lower risk of in-hospital mortality (adjusted odd ratio [aOR] = 0.53, 95% CI: 0.35-0.81) than those with COPD only. Pneumonia or postoperative atrial fibrillation (AF) risks were not significantly different between the 2 groups. Stratified analyses revealed that, compared to COPD alone, OSA-COPD overlap was associated with increased respiratory failure/prolonged mechanical ventilation risks among patients ≥ 60 years, and both obese and non-obese subgroups. In addition, OSA-COPD overlap was associated with increased risk of AKI among the older and obese subgroups. In US adults who undergo CABG, compared to COPD alone, those with OSA-COPD are at higher risks of non-routine discharge, AKI, and respiratory failure/prolonged mechanical ventilation, but a lower in-hospital mortality. No increased risk of AF was noted.

757 Machine Learning-Driven Web Application for Enhanced Clinical Decision Support in Thoracolumbar Spinal Cord Injuries

INTRODUCTION: Thoracolumbar spinal cord injuries (tlSCI) can result in negative short-term in-hospital outcomes, underscoring the importance of precise prediction tools. METHODS: This retrospective cohort study included 147,826 patients from the American College of Surgeons Trauma Quality Program database. XGBoost, LightGBM, CatBoost, and Random Forest algorithms were utilized in combination with the Optuna optimization library for hyperparameter tuning. Models were evaluated graphically with receiver operating characteristic (ROC) curves, precision-recall curves, and numerically with precision, recall, F1 score, accuracy, area under ROC (AUROC), and area under PRC. The best-performing models were integrated into an open-access web application for individualized predictions. RESULTS: The best-performing models for each outcome were as follows: for predicting mortality, Random Forest achieved the highest AUROC (0.865, 95% CI 0.848-0.879); in predicting non-home discharges, LightGBM had the highest AUROC (0.801, 95% CI 0.794-0.804); and for predicting major complications, Random Forest performed best with an AUROC of 0.733 (95% CI 0.642-0.808). Algorithms' receiver operator curves for the outcomes: (A) mortality, (B) non-home discharges, and (C) major complications. CONCLUSIONS: This study successfully developed ML models to predict critical in-hospital outcomes for patients with tlSCI. By incorporating the top-performing algorithms into a user-friendly web application, these models have the potential to improve clinical decision-making and management strategies for tlSCI patients, ultimately enhancing patient care and outcomes.

Impact of Off-Hour Admission on In-Hospital Outcomes for Patients With Stroke Receiving Reperfusion Therapy in China.

The structure and staffing of hospitals greatly impact patient outcomes, with frequent changes occurring during nights and weekends. This retrospective cohort study assessed the impact of admission timing on in-hospital management and outcomes for patients with stroke receiving reperfusion therapy in China using data from a nationwide registry. Data from patients receiving reperfusion therapy were extracted from the Chinese Stroke Center Alliance. Hospital admission time was categorized according to day/evening versus night and weekday versus weekend. Primary outcomes were in-hospital death or discharge against medical advice, hemorrhage transformation, early neurological deterioration, and major adverse cardiovascular events. Logistic regression was performed to compare in-hospital management performance and outcomes based on admission time categories. Overall, 42 381 patients received recombinant tissue-type plasminogen activator (r-tPA) therapy, and 5224 underwent endovascular treatment (EVT). Patients admitted during nighttime had a higher probability of receiving r-tPA therapy within 4.5 hours from onset or undergoing EVT within 6 hours from onset compared with those admitted during day/evening hours (adjusted odds ratio, 1.04 [95% CI, 1.01-1.08]; P=0.021; adjusted odds ratio, 1.72 [95% CI, 1.59-1.86]; P<0.001, respectively). However, no significant difference was observed between weekend and weekday admissions for either treatment. No notable differences were noted between weekends and weekdays or nighttime and daytime periods in door-to-needle time for r-tPA or door-to-puncture time for EVT initiation. Furthermore, weekend or nighttime admission did not have a significant effect on the primary outcomes of r-tPA therapy or EVT. Nevertheless, in patients undergoing EVT, a higher incidence of pneumonia was observed among those admitted at night compared with those admitted during day/evening hours (adjusted odds ratio, 1.22 [95% CI, 1.05-1.42]; P=0.011). Patients admitted at nighttime were more likely to receive r-tPA therapy or EVT within the time window recommended in the guidelines. However, patients receiving EVT admitted at night had an increased risk of pneumonia.