Inpatient Database Years Research Articles

Bariatric Surgery Lowers Rates of Spinal Symptoms and Spinal Surgery in a Morbidly Obese Population.

Retrospective analysis of New York State Inpatient Database years 2004-2013. Assess rates of spinal diagnoses and procedures before and after bariatric surgery (BS). BS for morbid obesity helps address common comorbidity burdens and improves quality of life for patients. The effects of BS on spinal disorders and surgical intervention have yet to be investigated. Patients included in analysis if they underwent BS and were seen at the hospital before and after this intervention. Spinal conditions and rates of surgery assessed before and after BS using χ 2 tests for categorical variables. Multivariable logistic regression analysis used to compare rates in BS patients to control group of nonoperative morbidly obese patients. Logistic testing controlled for comorbidities, age, biological sex. A total of 73,046 BS patients included (age 67.88±17.66 y, 56.1% female). For regression analysis, 299,504 nonbariatric, morbidly obese patients included (age 53.45±16.52 y, 65.6% female). Overall, rates of spinal symptoms decreased following BS (7.40%-5.14%, P <0.001). Cervical, thoracic, lumbar spine diagnoses rates dropped from 3.28% to 2.99%, 2.91% to 2.57%, and 5.39% to 3.92% (all P <0.001), respectively. Most marked reductions seen in cervical spontaneous compression fractures, cervical disc herniation, thoracic radicular pain, spontaneous lumbar compression fractures, lumbar spinal stenosis, lumbar spondylosis. Controlling for comorbidities, age and sex, obese nonbariatric patients more likely to have encounters associated with several cervical, thoracic or lumbar spinal diagnoses and procedures, especially for cervical spontaneous compression fracture, radicular pain, lumbar spondylosis, lumbar spinal stenosis, posterior procedures. BS significantly lowered comorbidity burden for many specific factors. BS lowered rates of documented spinal disorders and procedures in a morbidly obese population. These findings provide evidence of additional health benefits following BS, including reduction in health care encounters for spinal disorders and rates of surgical intervention.

16. Discrepancies in the surgical management of central cord syndrome: assessment of nonoperative, surgical, and crossover to surgery patients

BACKGROUND CONTEXT The efficacy of surgical intervention for central cord syndrome (CCS) is shown in the literature; however, it is unclear whether disparities in patient presentation and treatment exist between those who initially undergo operative treatment and those who delay operative treatment. PURPOSE In a population of CCS patients, assess disparities in presentation and treatment between those undergoing immediate surgery and those who delay operative treatment. STUDY DESIGN/SETTING Retrospective analysis of New York State Inpatient Database years 2004-2013. PATIENT SAMPLE A total of 1,301 CCS patients (ICD-9 codes 952.03, 952.08, 952.13, 952.18). OUTCOME MEASURES Time to surgery, length of stay (LOS). METHODS Patient-specific linkage codes allowed longitudinal tracking of inpatient stays within the study period. Demographics, comorbidities (Charlson Comorbidity Index [CCI]), complications, and surgical factors, including Mirza invasiveness score, were compared between CCS patients that initially underwent surgery (Initial) and patients that delayed operative treatment (Delayed) using Chi-squared tests and independent samples t-tests as appropriate. Similar tests assessed differences in demographics and comorbidity burden between nonoperative patients and surgical crossover patients. RESULTS Included: 1,301 CCS patients (62±16 yrs, 27% female). Follow-up rate was 67.3%; mean follow-up time was 515±707 days. By level of CCS injury, 61.0% of patients were injured between C1 and C4, 59.2% between C5-C7, 1.0% between T1-T6, and 0.6% between T7-T12. Overall, 800 (61%) patients underwent surgical treatment (procedural breakdown: 80% fusion, 59% decompression, including 38% discectomy and 23% other decompression of the spinal canal). Of the surgical patients, 621 (78%) had surgery at first recorded hospital visit, while 179 (22%) experienced a delay before surgical treatment. For patients that delayed treatment, mean time to surgery was 203±358 days. Initial and Delayed patients did not differ in sex (p=0.109) or CCI (p=0.894), though Initial patients were younger than Delayed (60±15 yrs vs 63±13, p=0.016) and had lower rates of diabetes and valvular disease (both p 0.05). Patients who delayed operative treatment did not differ from nonop patients in age (63±13 vs 63±17, p=0.802) or CCI (1.04±1.49 vs 1.06±1.49, p=0.923); however, Delayed patients had higher rates of diabetes (26% vs 18%, p=0.037), neurologic disorders (7% vs 1%, p CONCLUSIONS Although patients managed with initial surgical treatment of CCS had longer hospital stays and were treated with more invasive procedures, perioperative complications did not differ. Twenty-two percent of CCS patients crossed over from nonoperative to operative treatment, with a mean time to crossover of 203 days. Patients who crossed over to operative care were more comorbid than patients who remained nonoperative, indicating comorbidity burden may play a role in the decision to operate. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

A nationwide analysis of clinical outcomes among newborns with esophageal atresia and tracheoesophageal fistulas in the United States

BackgroundThe aim of this study was to examine national outcomes in newborn patients with esophageal atresia and tracheoesophageal fistula (EA/TEF) in the United Sates. MethodsKid's Inpatient Database (KID) is designed to identify, track, and analyze national outcomes for hospitalized children in the United States. Inpatient admissions for pediatric patients with EA/TEF for kid's Inpatient Database years 2000, 2003, 2006, and 2009 were analyzed. Patient demographics, socioeconomic measures, disposition, survival and surgical procedures performed were analyzed using standard statistical methods. ResultsA total of 4168 cases were identified with diagnosis of EA/TEF. The overall in-hospital mortality was 9%. Univariate analysis revealed lower survival in patients with associated acute respiratory distress syndrome, ventricular septal defect (VSD), birth weight (BW) < 1500 g, gestational age (GA), time of operation within 24 h of admission, coexisting renal anomaly, imperforate anus, African American race, and lowest economic status. Multivariate logistic regression identified BW < 1500 g (odds ratio [OR] = 4.5, P < 0.001), operation within 24 h (OR = 6.9, P < 0.001), GA <28 wk (OR = 2.2, P < 0.030), and presence of VSD (OR = 3.8, P < 0.001) as independent predictors of in-hospital mortality. Children's general hospital and children's unit in a general hospital were found to have a lower mortality rate compared with not identified as a children's hospital after excluding immediate transfers (P = 0.008). ConclusionsBW < 1500 g, operation within 24 h, GA < 28 wk, and presence of VSD are the factors that predict higher mortality in EA/TEF population. Despite dealing with more complicated cases, children's general hospital and children's unit in a general hospital were able to achieve a lower mortality rate than not identified as a children's hospital.

ECMO hospital volume and survival in congenital diaphragmatic hernia repair

PurposeThis study examined survival in newborn patients after congenital diaphragmatic hernia (CDH) repair. MethodsWe analyzed the Kids' Inpatient Database Years 2000, 2003, and 2006 for patients admitted at fewer than 8 d of age undergoing CDH repair. We analyzed patient demographics, clinical characteristics, socioeconomic measures, hospital type, operative case volume, and survival using Fisher's exact test and a multivariate binary logistic regression model. ResultsOf 847 patients identified, most were male (61%) and white (57%), were treated at urban (99.8%) and teaching (96%) hospitals, and had private insurance (57%). Survival to discharge was 95% in non-extracorporeal membrane oxygenation (ECMO) patients versus 51% for those requiring ECMO (P < 0.0001). Univariate analysis revealed significantly lower survival rates in blacks, Medicaid patients, and patients undergoing repair after 7 d of life. Among ECMO patients, we noted higher survival rates at hospitals conducting four or more ECMO cases per year (66% versus 47%; P = 0.03). Multivariate analysis identified ECMO (hazards ratio [HR] 16.23, P < 0.001), CDH repair at >7 d of age (HR 2.70, P = 0.004), and ECMO patients repaired at hospitals performing <4 CDH ECMO cases per year (HR 3.59, P = 0.03) as independent predictors of mortality. ConclusionsWe conclude that ECMO hospital volume is associated with survival in patients requiring ECMO for CDH repair.