Increased Charlson Comorbidity Index Research Articles

Decisions about the limitations of life-sustaining treatment for acutely admitted older patients: a retrospective study of a Danish patient cohort.

Life-sustaining therapy, including heart and lung resuscitation and transfer to the intensive care department, is demanding for patients and relatives and utilizes large amounts of healthcare resources. For older patients acutely admitted to the hospital, very sparse data exist on decision making about life-sustaining therapy. Retrospective data were extracted from patients ≥ 70 years old who were acutely admitted to the hospital. Age, sex, clinical frailty scale score and Charlson comorbidity index were manually extracted from patients' files. Furthermore, data about life-sustaining treatment decisions were extracted. This was further divided into decisions documented within 24h from admission or during the hospital stay. Data were extracted for 200 patients with a median age of 80 years. Patients had a Charlson Comorbidity Index of 6 (5-8 IQR) and a Clinical Frailty Scale (CFS) score of 5 (3-6 IQR). During the first 24h, 61 patients (30.5%) had a written decision about heart and cardiopulmonary resuscitation (CPR), and 52 patients (26%) had written information about intensive care therapy. A total of 93 patients (46.5%) had a written decision about cardiopulmonary resuscitation (CPR), intensive care therapy or both during their hospital stay. With increasing Charlson Comorbidity Index and Clinical Frailty Scale scores, more patients had decisions about limitations in therapy documented in their files. Within the first 24h, 30.5% of the patients had a written decision about cardiopulmonary resuscitation (CPR), and 26% had written information about intensive care therapy. These numbers increased to 46.5% of patients who had a decision made during their hospital stay whether they were candidates for either cardiopulmonary resuscitation (CPR), intensive care therapy or both. These data suggest that further work should be done to determine the limitations of therapy early on the admission for all older frail acutely admitted patients.

Multidimensional Assessment of Sarcopenia and Sarcopenic Obesity in Geriatric Patients: Creatinine/Cystatin C Ratio Performs Better than Sarcopenia Index.

The serum creatinine/cystatin C ratio (CCR) and the sarcopenia index (SI) are novel indicators for sarcopenia, but their accuracy may depend on various confounders. To assess CCR and SI diagnostic accuracy, we studied the clinical and biophysical parameters associated with sarcopenia or sarcopenic obesity. A total of 79 elderly patients (65-99 yrs, 33 females) underwent clinical, anthropometric, body composition, geriatric performance, and blood chemistry evaluation. The CCR and SI accuracy were assessed to identify sarcopenia. Sarcopenia was confirmed in 40.5%, and sarcopenic obesity in 8.9% of the subjects. Sarcopenic patients showed an increased Charlson comorbidity index, cardiovascular disease (CVD) rates and frailty, and decreased physical performance than non-sarcopenic subjects. Patients with sarcopenic obesity had increased body fat and inflammatory markers compared to obese subjects without sarcopenia. Sarcopenia was associated with a decreased CCR and SI. However, when the logistic regression models were adjusted for possible confounders (i.e., age, gender, Charlson comorbidity index, presence of CVD, and frailty score), a significant OR was confirmed for the CCR (OR 0.021, 95% CI 0.00055-0.83) but not for the SI. The AUC for the CCR for sarcopenia discrimination was 0.72. A higher performance was observed in patients without chronic kidney diseases (CKD, AUC 0.83). CCR, more than the SI, is a useful, non-invasive, and cost-effective tool to predict sarcopenia, irrespective of the potential confounders, particularly in subjects without CKD.

#1638 Long-term mortality trends in IgA nephropathy: a study of an Eastern European cohort

Abstract Background and Aims IgA Nephropathy (IgAN), recognized as the most prevalent form of primary glomerulonephritis, has been thoroughly researched in terms of renal outcomes. However, there is a scarcity of data regarding patient survival, especially in Eastern Europe. Our study focuses on exploring the long-term survival rates of IgAN patients and identifying associated risk factors within an Eastern European population. Method In our retrospective study, we analyzed 215 patients with biopsy proven IgAN (median age 44 years, 71% male, median eGFR 40.9 mL/min/1.73 m2, median proteinuria 1.24g/g) diagnosed at a tertiary center in Romania from 2010 to 2017. Our study primarily focused on all-cause mortality and secondarily on the development of ESKD (start of kidney replacement therapy or renal transplantation). The follow-up for patients continued until they reached either of these endpoints or until January 1, 2022, whichever came first. Results During a median follow-up of 7.3 years, 20% of the patients died. The main causes of death were cardiovascular diseases (60%), followed by infectious (19%), gastroenterological (12%), and neoplasia (9%) diseases. Mean survival of the entire cohort was 117.5 months (95% CI: 111.2, 123.8) and mean kidney survival was 98.4 months (95% CI: 90.5, 106.2). Survival rates at 1 year, 5 years and 10 years were 93%, 84% and 77% respectively, and kidney survival rates at 1 year, 5 years and 10 years were 87%, 72% and 58% respectively. When compared to the survivors, deceased patients were significantly older (60 vs 42 years, p 0.001) and had an increased prevalence of diabetes mellitus (26 vs 4%, p 0.001) and higher Charlson comorbidity index (5 vs 2, p 0.001). Deceased patients also had significantly higher serum creatinine levels (3.3 vs 1.6 mg/dL, p 0.001), lower eGFR (18 vs 46 mL/min, p 0.001), and more haematuria (230 vs 183cells/HPF, p 0.01). There was no significant difference in proteinuria between the two groups (1.1 vs 1.2g/g, p 0.3). In the univariate Cox regression analysis, all-cause mortality was significantly associated with several factors: advancing age (HR 1.08, 95% CI: 1.05, 1.11), an increased Charlson comorbidity index (HR 1.60, 95% CI: 1.42, 1.80), the presence of diabetes mellitus (HR 5.13, 95% CI: 2.57, 10.25), lower eGFR (HR 0.95, 95% CI: 0.93, 0.97), increased proteinuria (HR 1.12, 95% CI: 1.00, 1.25), the presence of haematuria (HR 1.26, 95% CI: 1.03, 1.53), lower serum albumin (HR 0.35, 95% CI: 0.22, 0.56), higher MEST-C score (HR 1.38, 95% CI 1.13, 1.69) and absence of renin-angiotensin-system inhibitors (RASI) (HR 0.32, 95% CI 0.17, 0.60). However, in the multivariate analysis, only an increased Charlson comorbidity index (HR 1.31, 95% CI: 1.09, 1.57), lower eGFR (HR 0.98, 95% CI: 0.96-1.00) and absence of RASI (HR 0.21, 95% CI: 0.15, 0.28) retained their statistical significance. Conclusion We report a 20% mortality rate in our Eastern European IgAN cohort, primarily due to cardio-vascular diseases. Death correlates with increased age, comorbidity burden, decreased renal function at diagnosis, and absence of RASI use. RASI treatment may potentially improve survival, highlighting its importance in managing IgAN.

Determinants of pressure injury development in patients with COVID-19.

Pressure injuries (PIs) often develop in critically ill patients due to immobility, and underlying comorbidities that decrease tissue perfusion and wound healing capacity. This study sought to provide epidemiological data on determinants and current managements practices of PI in patients with COVID-19. A US national insurance-based database consisting of patients with coronavirus or COVID-19 diagnoses was used for data collection. Patients were filtered by International Classification of Diseases (ICD) codes corresponding to coronavirus or COVID-19 diagnosis between 2019-2020. Diagnosis of PI following COVID-19 diagnosis was queried. Demographic data and comorbidity information was compared. Logistic regression analysis was used to determine predictors for both PI development and likelihood of operative debridement. A total of 1,477,851 patients with COVID-19 were identified. Of these, 15,613 (1.06%) subsequently developed a PI, and 8074 (51.7%) of these patients had an intensive care unit (ICU) admission. The average and median time between diagnosis of COVID-19 and PI was 39.4 and 26 days, respectively. PI was more likely to occur in patients with COVID-19 with: diabetes (odds ratio (OR): 1.39, 95% confidence interval (CI): 1.29-1.49; p<0.001); coronary artery disease (OR: 1.11, 95% CI: 1.04-1.18, p=0.002), hypertension (OR: 1.43, 95% CI: 1.26-1.64; p<0.001); chronic kidney disease (OR: 1.18, 95% CI: 1.10-1.26; p<0.001); depression (OR: 1.45, 95% CI 1.36-1.54; p<0.001); and long-term non-steroidal anti-inflammatory drug use (OR: 1.21, 95% CI: 1.05-1.40; p=0.007). They were also more likely in critically ill patients admitted to the ICU (OR: 1.40, 95% CI: 1.31-1.48; p<0.001); and patients requiring vasopressors (OR:1.25, 95% CI: 1.13-1.38; p<0.001), intubation (OR: 1.21, 95% CI 1.07-1.39; p=0.004), or with a diagnosis of sepsis (OR: 2.38, 95% CI 2.22-2.55; p<0.001). ICU admission, sepsis, buttock and lower back PI along with increasing Charlson Comorbidity Index (CCI) (OR: 1.04, 95% CI 1.00-1.08; p=0.043) was associated with surgical debridement. The vast majority of patients with COVID-19 did not undergo operative debridement or wound coverage. PIs are widely prevalent in patients with COVID-19, especially in those who are critically ill, yet the vast majority do not undergo operative procedures. The authors have no conflicts of interest to declare.

Risk Factors Associated With Quadriceps Tendon Extensor Mechanism Disruption Following Total Knee Arthroplasty

BackgroundQuadriceps tendon extensor mechanism disruption is an infrequent but devastating complication after total knee arthroplasty (TKA). Our knowledge of specific risk factors for this complication is limited by the current literature. Thus, this study aimed to identify potential risk factors for quadriceps tendon extensor mechanism disruption following TKA. MethodsA retrospective cohort analysis was performed using the PearlDiver Administrative Claims Database. Patients undergoing TKA without a prior history of quadriceps tendon extensor mechanism disruption were identified. Quadriceps tendon extensor mechanism disruption included rupture of the quadriceps tendon, patellar tendon, or fracture of the patella. Patients who had a minimum of 5 years of follow-up after TKA were included. A total of 126,819 patients were included. Among them, 517 cases of quadriceps tendon extensor mechanism disruption occurred (incidence 0.41%). Hypothesized risk factors were compared between those who had postoperative quadriceps tendon extensor mechanism disruption and those who did not. ResultsOn multivariate analysis, increased Charlson Comorbidity Index (odds ratio (OR): 1.10, 95% confidence interval (CI) [1.07 to 1.13]; P < .001), obesity (OR: 1.49, 95% CI [1.24 to 1.79]; P < .001), and fluoroquinolone use any time after TKA (OR: 1.24, 95% CI [1.01 to 1.52]; P = .036) were significantly associated with quadriceps tendon extensor mechanism disruption. ConclusionsOur study identified the incidence of quadriceps tendon extensor mechanism disruption following TKA as 0.41%. Identified risk factors for quadriceps tendon extensor mechanism disruption after TKA include an increased Charlson Comorbidity Index, obesity, and use of fluoroquinolones postoperatively.

Dexamethasone Suppression Testing in a Contemporary Cohort with Adrenal Incidentalomas in Two U.S. Integrated Healthcare Systems.

Autonomous cortisol secretion (ACS) from an adrenal adenoma can increase the risk for comorbidities and mortality. The dexamethasone suppression test (DST) is the standard method to diagnose ACS. A multi-site, retrospective cohort of adults with diagnosed adrenal tumors was used to understand patient characteristics associated with DST completion and ACS. Time to DST completion was defined using the lab value and result date; follow-up time was from the adrenal adenoma diagnosis to the time of completion or censoring. ACS was defined by a DST > 1.8 µg/dL (50 nmol/L). The Cox proportional hazards regression model assessed associations between DST completion and patient characteristics. In patients completing a DST, a logistic regression model evaluated relationships between elevated ACS and covariates. We included 24,259 adults, with a mean age of 63.1 years, 48.1% obese, and 28.7% with a Charlson comorbidity index ≥ 4. Approximately 7% (n = 1768) completed a DST with a completion rate of 2.36 (95% CI 2.35, 2.37) per 100 person-years. Fully adjusted models reported that male sex and an increased Charlson comorbidity index were associated with a lower likelihood of DST completion. Current or former smoking status and an increased Charlson comorbidity index had higher odds of a DST > 1.8 μg/dL. In conclusion, clinical policies are needed to improve DST completion and the management of adrenal adenomas.

Graft failure within 2years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears.

A debilitating complication following anterior cruciate ligament reconstruction is a secondary meniscus tear. Currently, the literature is mixed regarding the risk factors associated with the incidence of secondary meniscus tears. The aim of this study was to investigate risk factors associated with meniscus tears following an isolated primary anterior cruciate ligament reconstruction. ACL graft failure was hypothesized to be the strongest risk factor for secondary meniscal injury occurrence. A retrospective cohort analysis was performed using the PearlDiver Database. Patients with a primary anterior cruciate ligament reconstruction were identified in the database. Patients with concomitant knee ligament injury or meniscus injury present at the time the index procedure were excluded. Patients were grouped to those who had a secondary meniscus tear within 2years following anterior cruciate ligament reconstruction and those who did not. Univariate analysis and multivariable regression analysis was conducted to identify significant risk factors for a secondary meniscus tear. There were 25,622 patients meeting criteria for inclusion in this study. Within 2years from the primary anterior cruciate ligament reconstruction, there were 1,781 patients (7.0%) that experienced a meniscus tear. Graft failure had the highest odds of having a postoperative meniscus tear within 2years (OR: 4.1; CI 3.5-4.8; p < 0.002). Additional significant risk factors included tobacco use (OR: 2.0; CI 1.0-3.1; p < 0.001), increased Charlson Comorbidity Index (OR: 1.2; CI 1.1-1.4), male gender (OR: 1.1; CI 1.1-1.2; p < 0.001), obesity (OR: 1.1; CI 1.1-1.2; p < 0.001), delayed surgery (OR:1.1; CI 1.1-1.2; p < 0.002), and patients age 30 and older (OR: 1.0; CI 1.0-1.0; p < 0.001). This study found that anterior cruciate ligament graft failure is the strongest predictor of post-operative meniscus tears. Other risk factors, including tobacco use, increased CCI, male gender, obesity, delayed surgery, and age 30 and older, were established, with several being modifiable. Therefore, targeted preoperative optimization of modifiable risk factors and postoperative protocols may reduce the risk of secondary meniscus tears. Level III, prognostic trial.

Outcomes of Multiple Myeloma Hospitalization Undergoing Autologous Stem Cell Transplantation with and without CKD: A NIS 2016 to 2020 Database Study

Outcomes of Multiple Myeloma Hospitalization undergoing autologous stem cell transplantation with and without CKD: A NIS 2016 to 2020 database study. Objective: This study aimed to compare hospital outcomes between multiple myeloma patients undergoing autologous stem cell transplantation (ASCT) with and without chronic kidney disease (CKD) using data from the National Inpatient Sample (NIS) from 2016 to 2020. Methods: A retrospective analysis of the NIS database was conducted using International Classification of Diseases (ICD-10) codes to identify hospitalization who underwent ASCT for multiple myeloma. STATA version MP14.2 was used mainly for analysis. We used Fischer's exact test to compare proportions, the student's t-test to compare continuous variables, and multivariate regression analysis to calculate the adjusted odds ratio. Following are included in transplant complications (transplant rejection, failure, transplant infection). Results: Among 31,390 hospitalized, 4,930 had co-existing CKD. The mean age was 61.65 years. The majority were male (64.2%), with an increased Charlson comorbidity index with a majority &amp;gt;6. On multivariant analysis compared to hospitalization without CKD, those with CKD showed a significantly higher risk of transplant complications (adjusted odds ratio [AOR]: 1.90, 95% confidence interval [CI]: 1.21-2.99, P = 0.006), AKI (AOR: 5.43, 95% CI: 4.47-6.59, P &amp;lt; 0.001), AKI requiring dialysis (AOR: 2.16, 95% CI: 2.14-11.94, P &amp;lt; 0.001), blood transfusion (AOR: 1.32, 95% CI: 1.00-1.75, P = 0.048), and in-hospital mortality (AOR: 2.16, 95% CI: 1.13-4.12, P = 0.02). Additionally, there was a non-significant increase in the rate of platelet transfusion and ICU admission. Hence, patients with CKD had a significantly longer average length of hospital stay (18.27 vs. 16.26. p&amp;lt; 0.001) and higher total cost of hospital stay ($217,202 vs. $199,062, P=0.02) compared to those without CKD. Conclusion: Multiple myeloma patients undergoing ASCT with co-existing CKD experienced poorer hospital outcomes, including a higher risk of transplant-related complications, AKI, blood transfusion, and in-hospital mortality resulting in prolonged hospital stays and higher healthcare costs. Since multiple myeloma has a higher incidence of CKD, further studies are warranted to explore interventions based on the stage of CKD to improve the outcomes of ASCT in multiple myeloma patients with CKD.

Machine learning facilitates the prediction of long-term mortality in patients with tricuspid regurgitation

ObjectiveTricuspid regurgitation (TR) is a prevalent valve disease associated with significant morbidity and mortality. We aimed to apply machine learning (ML) to assess risk stratification in patients with ≥moderate TR.MethodsPatients...

Long-term benzodiazepine usage and mortality in patients with chronic non-cancer musculoskeletal pain: A Nationwide cohort study.

The impact of benzodiazepine use on mortality in patients with chronic non-cancer pain (CNCP) has not been identified. We aimed to examine the factors associated with benzodiazepine use among patients with CNCP and examine whether long-term benzodiazepine usage is associated with mortality in patients with CNCP. This study was conducted using data from the National Health Insurance Service database of South Korea. We selected 2.5% of all adult patients diagnosed with musculoskeletal diseases (MSD) in South Korea from 2010 to 2019 using a stratified random sampling technique and included them in the analysis as patients with CNCP. The risk of 10-year all-cause mortality in patients with CNCP was investigated using the 2010 cohort of patients with CNCP. The proportion of the study population that used benzodiazepine during the 10-year study period was 2.1% (390,683/18,770,234). Multivariable logistic regression showed that old age; increased Charlson comorbidity index (CCI); opioid, gabapentin or pregabalin, paracetamol, non-steroidal anti-inflammatory drugs, and Z-drugs usage; and underlying psychiatric comorbidities were associated with increased benzodiazepine use. In addition, benzodiazepine use was associated with increased 10-year all-cause mortality (adjusted hazard ratio: 1.03, 95% confidence interval: 1.01, 1.06; p < 0.001). Benzodiazepine was prescribed to 2.1% of the patients with CNCP in South Korea from 2010 to 2019. Old age, increased CCI, underlying psychiatric comorbidities, and use of certain drugs are associated with increased use of benzodiazepines. In addition, benzodiazepine use is associated with 10-year all-cause mortality in patients with CNCP.

Patient Characteristics and Clinical and Economic Outcomes Associated with Unplanned Medical and Surgical Intensive Care Unit Admissions: A Retrospective Analysis.

To characterize medical and surgical patient characteristics, as well as clinical and economic outcomes, associated with unplanned intensive care unit (ICU) admissions. This was a retrospective matched cohort analysis that utilized the PINC AITM Healthcare Database, which collects deidentified data from 25% of United States (US) hospital admissions. Discharge records were assessed for medical and surgical admissions in 2021. An unplanned ICU admission was defined as direct transfer from a medical, surgical, or telemetry unit to the ICU. Patients with and without an unplanned ICU admission were 1:1 propensity score matched. Differences between patients with and without unplanned ICU admissions were assessed using two-sample t-tests for continuous measures and Chi-square tests for categorical measures. A total of 3,807,124 qualifying admissions were identified. Medical admissions with unplanned ICU transfers were more likely to be urgent/emergent (odds ratio [OR] 2.9, 95% confidence interval [CI 2.7-3.0], p<0.0001), with patient characteristics including male sex (1.4, [1.4-1.4], p<0.0001), obesity (1.7, [1.6-1.7], p<0.0001), and increased Charlson Comorbidity Index (CCI=1: 1.8, [1.8-1.9], p<0.0001; CCI≥5: 3.2, [3.1-3.3], p<0.0001). Surgical admissions with unplanned ICU transfers were more likely to be urgent/emergent (3.1, [2.9-3.2], p<0.0001) and with patients of higher CCI (2.5, [2.3-2.6], p<0.0001 to a CCI of≥5 (7.9, [7.4-8.4], p<0.0001). Between matched medical patients, mean differences in length of stay, cost, and mortality were 4.1 days (p<0.0001), $13,424 (p<0.0001), and 21% (p<0.0001), respectively. Between matched surgical patients, mean differences in these outcomes were 6.4 days (p<0.0001), $21,448 (p<0.0001), and 14% (p<0.0001), respectively. Emergency care in patients with a higher co-morbid burden is more likely to lead to unplanned ICU admission, putting patients at a significantly increased chance of mortality, longer length of stay, and increased costs. Improving care and monitoring of patients outside the ICU may help detect early changes in pathophysiology and enable early intervention.

Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States.

Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p=0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.

Effect of Instrumented Spine Surgery on Length of Stay

Total joint arthroplasty studies have identified that surgeries that take place later in the week have a longer length of stay compared with those earlier in the week. This has not been demonstrated in studies focused on anterior cervical diskectomy and fusions or minimally invasive lumbar laminectomies. All-inclusive instrumented spine surgeries, however, have not been analyzed. The purpose of this study was to determine whether day of surgery affects length of stay and whether there are predictive patient characteristics that affect length of stay in instrumented spine surgery.All instrumented spine surgeries in 2019 at a single academic tertiary center were retrospectively reviewed. Patients were categorized for surgical day and discharge disposition to home or a rehabilitation facility. Differences by patient characteristics in length of stay and discharge disposition were compared using Kruskal-Wallis and chi square tests along with multiple comparisons.Seven hundred six patients were included in the analysis. Excluding Saturday, there were no differences in length of stay based on the day of surgery. Age older than 75 years, female, American Society of Anesthesiology (ASA) classification of 3 or 4, and an increased Charlson Comorbidity Index were all associated with a notable increase in length of stay. While most of the patients were discharged home, discharge to a rehabilitation facility stayed, on average, 4.7 days longer (6.8 days compared with 2.1 days, on average) and were associated with an age older than 66 years old, an ASA classification of 3 or 4, and a Charlson Comorbidity Index of 1 to 3.Day of surgery does not affect length of stay in instrumented spine surgeries. Discharge to a rehabilitation facility, however, did increase the length of stay as did age older than 75 years, higher ASA classification, and increased Charlson Comorbidity Index classification.

The Effect of Sleep Disorder Diagnosis on Mortality in End-Stage Renal Disease Patients

Increased risk of all-cause mortality not accounted for by traditional cardiovascular risk factors has been linked to chronic kidney disease. This study tested the hypothesis that mortality may be greater in patients with end-stage renal disease (ESRD) and a sleep disorder diagnosis. The United States Renal Data System database was queried to determine the effect of sleep disorder diagnoses on mortality in ESRD patients enrolled between 2004 and 2015. Sleep disorders were identified using International Classification of Diseases-9 and -10 codes. Mortality risk associated with sleep disorders was examined using Cox proportional hazards (CPH) modeling. In the final CPH model, sleep disorder diagnoses were associated with decreased risk of mortality, with hazard ratios (and 95% confidence intervals) for insomnia, hypersomnolence, restless leg syndrome, and obstructive/central sleep apnea of 0.76 (0.75–0.76), 0.81 (0.78–0.84), 0.79 (0.77–0.80), and 0.82 (0.81–0.82), respectively. Black or other race and Hispanic ethnicity, and to a small extent, female sex and increasing Charlson comorbidity index, were also associated with decreased risk, whereas increasing age, hemodialysis (versus peritoneal dialysis) and catheter or graft access type were associated with increased risk. This study suggests that the diagnosis of a sleep disorder may be associated with improved survival in ESRD patients.

MP22-15 POPULATION-BASED ASSESSMENT OF DETERMINING PREDICTORS FOR DISCHARGE DISPOSITION IN PATIENTS WITH BLADDER CANCER UNDERGOING RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP22-15 POPULATION-BASED ASSESSMENT OF DETERMINING PREDICTORS FOR DISCHARGE DISPOSITION IN PATIENTS WITH BLADDER CANCER UNDERGOING RADICAL CYSTECTOMY Raj Kumar, Kian Asanad, Luis Medina, Gus Miranda, Jie Cai, Hooman Djalat, Mihir Desai, Inderbir Gill, Saum Ghodoussipour, and Giovanni Cacciamani Raj KumarRaj Kumar More articles by this author , Kian AsanadKian Asanad More articles by this author , Luis MedinaLuis Medina More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , Hooman DjalatHooman Djalat More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , and Giovanni CacciamaniGiovanni Cacciamani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003247.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) remains the mainstay of treatment for muscle-invasive bladder cancer. Discharge disposition (DD) following RC - either home or to a continued rehabilitation facility (CRF) – is a clinical decision based on several clinical measures. Given that DD can have a dramatic impact on patient expense and recovery, the purpose of this study is to assess predictors of DD after undergoing RC for bladder cancer in the United States. METHODS: This study is a retrospective, cohort study. Patients were divided into two cohorts: those discharged home and those discharged to CRF. We examined patient, surgical, and hospital characteristics. Multivariable logistic regression models were used to control for selected variables. All statistical tests were two-sided. Patients were derived from the Premier Healthcare Database. International classification of disease (ICD)-9 (<2014), ICD-10 (≥ 2015), and Current Procedural Terminology (CPT) codes were used to identify patient diagnoses and encounters. The population consisted of 138,151 patients who underwent RC for bladder cancer between January 1, 2000 and December 31, 2019. RESULTS: A total of 24,922 (18.0%) of patients were admitted to CRFs. Multivariate analysis revealed that older age [Odds Ratio (OR):1.066, 95% Confidence Interval (CI): 1.063-1.068], single/widowed marital status [OR:2.232, 95%CI:2.160-2.307], female gender [OR:1.444, 95%CI:1.392-1.497], increased Charlson Comorbidity Index (CCI) [CCI=1 OR:1.285, 95%CI:1.162-1.421] [CCI≥2 OR:2.123, 95%CI:1.976-2.281], Medicaid [OR:1.949, 95%CI:1.785-2.129], and Medicare insurance [OR:1.870, 95%CI:1.774-2.129] are associated with CRF discharge. Rural hospital location [OR:0.873, 95%CI:0.824-0.925], self-pay status [OR:0.710, 95%CI:0.565-0.891], increased annual surgeon case [OR:0.660, 95%CI:0.624-0.697], and robotic surgical approach [OR:0.777, 95%CI:0.744-0.811] are associated with home discharge. CONCLUSIONS: Several specific patient, surgical, and facility characteristics were identified that may significantly impact DD after RC for bladder cancer. This new information should help with preoperative counseling and shared decision-making. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e302 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raj Kumar More articles by this author Kian Asanad More articles by this author Luis Medina More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Hooman Djalat More articles by this author Mihir Desai More articles by this author Inderbir Gill More articles by this author Saum Ghodoussipour More articles by this author Giovanni Cacciamani More articles by this author Expand All Advertisement PDF downloadLoading ...

Real-World Evidence: How Long Do Our Patients Fast?-Results from a Prospective JAGO-NOGGO-Multicenter Analysis on Perioperative Fasting in 924 Patients with Malignant and Benign Gynecological Diseases.

Despite the key role of optimized fasting in modern perioperative patient management, little current data exist on perioperative fasting intervals in routine clinical practice. In this multicenter prospective study, the length of pre- and postoperative fasting intervals was assessed with the use of a specifically developed questionnaire. Between 15 January 2021 and 31 May 2022, 924 gynecology patients were included, from 13 German gynecology departments. On average, patients remained fasting for about three times as long as recommended for solid foods (17:02 ± 06:54 h) and about five times as long as recommended for clear fluids (9:21 ± 5:48 h). The average perioperative fasting interval exceeded one day (28:23 ± 14:02 h). Longer fasting intervals were observed before and after oncological or extensive procedures, while shorter preoperative fasting intervals were reported in the participating university hospitals. Smoking, treatment in a non-university hospital, an increased Charlson Comorbidity Index and extensive surgery were significant predictors of longer preoperative fasting from solid foods. In general, prolonged preoperative fasting was tolerated well and quality of patient information was perceived as good. Perioperative fasting intervals were drastically prolonged in this cohort of 924 gynecology patients. Our data indicate the need for better patient education about perioperative fasting.

CRB-65 for Risk Stratification and Prediction of Prognosis in Pulmonary Embolism.

Pulmonary embolism (PE) is accompanied by high morbidity and mortality. The search for simple and easily assessable risk stratification scores with favourable effectiveness is still ongoing, and prognostic performance of the CRB-65 score in PE might promising. The German nationwide inpatient sample was used for this study. All patient cases of patients with PE in Germany 2005-2020 were included and stratified for CRB-65 risk class: low-risk group (CRB-65-score 0 points) vs. high-risk group (CRB-65-score ≥1 points). Overall, 1,373,145 patient cases of patients with PE (76.6% aged ≥65 years, 47.0% females) were included. Among these, 1,051,244 patient cases (76.6%) were classified as high-risk according to CRB-65 score (≥1 points). The majority of high-risk patients according to CRB-65 score were females (55.8%). Additionally, high-risk patients according to CRB-65 score showed an aggravated comorbidity profile with increased Charlson comorbidity index (5.0 [IQR 4.0-7.0] vs. 2.0 [0.0-3.0], p < 0.001). In-hospital case fatality (19.0% vs. 3.4%, p < 0.001) and MACCE (22.4% vs. 5.1%, p < 0.001) occurred distinctly more often in PE patients of the high-risk group according to CRB-65 score (≥1 points) compared to the low-risk group (= 0 points). The CRB-65 high-risk class was independently associated with in-hospital death (OR 5.53 [95%CI 5.40-5.65], p < 0.001) as well as MACCE (OR 4.31 [95%CI 4.23-4.40], p < 0.001). Risk stratification with CRB-65 score was helpful for identifying PE patients being at higher risk of adverse in-hospital events. The high-risk class according to CRB-65 score (≥1 points) was independently associated with a 5.5-fold increased occurrence of in-hospital death.

Trends in Perioperative Magnesium Sulfate Use in Patients Who Underwent Major Cancer Surgery: A Retrospective Population-Based Cohort Study in South Korea.

Magnesium sulfate is a potential anesthetic adjunct in cancer surgery. However, no definite consensus exists on the use of magnesium sulfate in patients undergoing major cancer surgery. This study aimed to examine the trends and factors associated with magnesium sulfate administration in patients who underwent major cancer surgery in South Korea. In this retrospective and population-based cohort study, we used 5-year health data that were extracted from the National registration database in South Korea from January 1, 2016 to December 31, 2020. All adult patients who underwent major cancer surgery during 2016-2020 in South Korea were included. In total, 253,538 patients were included. Among these patients, 6.6% (16,708/253,538) were administered magnesium sulfate during major cancer surgery. In multivariable logistic regression modeling, older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.02-1.02; P < .001), esophageal cancer surgery (vs lung cancer surgery [OR, 3.04; 95% CI, 2.80-3.30; P < .001]), increased Charlson comorbidity index score (OR, 1.03; 95% CI, 1.02-1.03; P < .001), mild-to-moderate disability (OR, 1.08; 95% CI, 1.03-1.14; P = .003), and severe disability (OR, 1.16; 95% CI, 1.05-1.27; P = .003) were associated with a higher incidence of perioperative magnesium sulfate administration for major cancer surgery. Video-assisted thoracoscopic surgery or laparoscopy (OR, .57; 95% CI, .55-.59; P < .001) and propofol-based total intravenous anesthesia (OR, .86; 95% CI, .82-.89; P < .001) were associated with a lower incidence of perioperative Mg sulfate administration for major cancer surgery. In South Korea, 6.6% of the patients who underwent major cancer surgery were administered magnesium sulfate during surgery. Certain factors, such as old age, thoracic cancer surgery, open laparotomy or thoracotomy, greater comorbid status, and inhalation anesthesia, were potentially associated with magnesium sulfate administration in patients undergoing major cancer surgery.

C-Reactive Protein Levels during High Dose Steroid Treatment for COVID-19 Pneumonia

Objectives: Inflammation is the main cause of systemic damage in SARS-COV2 infections. Steroid treatment has been shown to reduce mortality in COVID-19. However, there is no index to monitor treatment responses to steroids. Here, we evaluated the validity of serial C-reactive-protein (CRP) follow-up for predicting the outcome in the patients receiving steroid therapy. Material and methods: In our retrospective cohort study, four hundred twenty-five patients were included. All patients received dexamethasone 6 mg/day or equivalent dose of steroid as much as needed with the onset of hypoxia (SaO2 ≤ 93%). We divided patients into two groups according to outcome (deceased/discharged). We then compared demographic, clinical and laboratory features between the groups. Lastly, we evaluated the thresholds of CRP decline associated with COVID-19 associated mortality at 3th, 5th days and at the end of treatment. Results: COVID 19 associated mortality rate of the cohort was 6.1% (26/425). In multivariate analysis, in which survival was evaluated, parameters related to death due to COVID-19 in the steroid group were high NEWS-2 score (0.82, CI 95 % 0.68-0.97, p=0.02), increased Charlson comorbidity index (0.68,CI 95% 0.51-0.90,p= 0.007) and absolute CRP level at the end of treatment (0.97,CI 95%, p&lt;0.001). In addition, cut-off levels of CRP reduction related to COVID-19-associated mortality during steroid therapy were found as follows: less than 33% (sensitivity 75%, specificity 64.1%) on day 3, less than 43.5% (sensitivity 81.8%, specificity 70.8%) on day 5 and less than 55% at the end of the treatment (sensitivity 80.7%, specificity 71.8%). Conclusions: Serial CRP measurement from the third day of steroid therapy can be used to predict mortality in COVID-19 patients receiving steroids.

Days alive and out of hospital following primary surgery for oral cavity squamous cell carcinoma

Background Days Alive and Out of Hospital (DAOH) is a recently introduced, readily obtainable postoperative outcome measure method that expresses procedure and disease-associated morbidity and mortality. In this study, we evaluated DAOH with 30- and 365-days follow-up periods after primary surgery (DAOH30 and DAOH365, respectively) for patients with oral cavity squamous cell carcinoma (OSCC). The aim of this study is to identify patient-, procedure- and disease-associated risk factors for patients treated with primary surgery for primary OSCC. Material and methods This retrospective cohort study from a prospective collected database represents patients from Eastern Denmark surgically treated for primary OSCC in the period 2000–2014. DAOH30 and DAOH365 were calculated and associations with patient characteristics including comorbidity, tumor characteristics, clinical outcomes such as length of stay, readmission, and mortality were evaluated. Tests for difference and significance between groups were assessed with Mann–Whitney U test and quantile linear regression. Results We included 867 patients (63% males, median age: 63 years (IQR 56–70 years)). Median DAOH30 and DAOH365 after OSCC surgery were 25 days (IQR 21–27 days) and 356 days (IQR 336–360 days), respectively. Alcohol consumption had a significant association with a lower DAOH365, p < 0.01, but not with DAOH30. Advanced T-stage, adjuvant radiotherapy (RT) and increased Charlson Comorbidity Index (CCI) score was significantly associated with a lower DAOH30 and DAOH365. Conclusion In this population-based study in OSCC patients treated with primary surgery, we found that DAOH after 30 days was 25 days (83%), while DAOH after 365 days was 356 days (98%). Advanced T-stage acts as a predictor for significant DAOH30 and DAOH365 reduction while excessive alcohol consumption predicts a significant DAOH365 reduction. Readmission within 30 days following surgery was associated with further readmission within one year.