Inpatient Hospital Admissions Research Articles

The effect on women's health of extending parental leave: a quasi-experimental registry-based cohort study.

Parental leave policies have been hypothesized to benefit mothers' mental health. We assessed the impact of a 6-week extension of parental leave in Denmark on maternal mental health. We linked individual-level data from Danish national registries on maternal sociodemographic characteristics and psychiatric diagnoses. A regression discontinuity design was applied to study the increase in parental leave duration after 26 March 1984. We included women who had given birth between 1 January 1981 and 31 December 1987. Our outcome was a first psychiatric diagnosis following the child's birth, ascertained as the first day of inpatient hospital admission for any psychiatric disorder. We presented cumulative incidences for the 30-year follow-up period and reported absolute risk differences between women eligible for the reform vs not, in 5-year intervals. In all, 291 152 women were followed up until 2017, death, emigration or date of first psychiatric diagnosis. The median follow-up time was 29.99 years, corresponding to 10 277 547 person-years at risk. The cumulative incidence of psychiatric diagnoses at 30 years of follow-up was 59.5 (95% CI: 57.4 to 61.6) per 1000 women in the ineligible group and 57.5 (95% CI: 55.6 to 59.4) in the eligible group. Eligible women took on average 32.85 additional days of parental leave (95% CI: 29.20 to 36.49) and had a lower probability of having a psychiatric diagnosis within 5 years [risk difference (RD): 2.4 fewer diagnoses per 1000 women, 95% CI: 1.5 to 3.2] and up to 20 years after the birth (RD: 2.3, 95% CI: 0.4 to 4.2). In subgroup analyses, the risk reduction was concentrated among low-educated, low-income and single women. Longer parental leave may confer mental health benefits to women, in particular to those from disadvantaged backgrounds.

Associations between pregnancy complications and incident cardiovascular disease: a nationwide data linkage study in Wales

Abstract Background Previous studies have associated pregnancy complications with a higher risk of cardiovascular disease. However, previous studies have not sufficiently evaluated the impact of broad range of pregnancy complications or common cardiovascular conditions individually. Furthermore, most previous studies have relied on data from hospital admission records only, which may not have adequately accounted for conditions that may not result in an inpatient hospital admission, such as atrial fibrillation. Purpose To examine the risk of ischemic heart disease (IHD), stroke, atrial fibrillation or heart failure among women after their first pregnancy with a history of pregnancy complications compared to women without pregnancy complications in a large nationwide study using linked routinely collected data. Methods A retrospective cohort study was conducted using the Secure Anonymised Information Linkage (SAIL) Databank and included women aged 16–45 years who had their first pregnancy between 2000 and 2018 in Wales. Data were extracted from various sources such as Office for National Statistics (ONS) birth and death extracts, hospital admission, outpatient, emergency department and General Practice data sources, and pregnancy related data such as maternal indicators and national community child health. Survival analyses were conducted using Cox proportional hazard regression models adjusted for hypertension, diabetes, hyperlipidaemia, congenital and valvular heart diseases, multifetal pregnancy ethnicity, maternal age, calendar year of first birth and index of multiple deprivation. Results A total of 298,515 women were included in the study, of which 74,832 (25.1%) had a history of any pregnancy complication during their first pregnancy. During a median of 9.7 years follow-up time, 2,484 women developed at least one cardiovascular condition. Among women with a history of pregnancy complication in their first pregnancy, IHD had the highest incidence rate at 4.94 (95% confidence interval (CI) 4.44–5.49) per 10,000 person-years, and atrial fibrillation was the lowest at 1.92 (95% CI 1.62–2.28). The history of any pregnancy complication during the first pregnancy was associated with a higher risk of all cardiovascular conditions examined, including heart failure [hazard ratio (HR) 1.93 95% CI 1.61–2.31)], IHD [HR 1.82 (95% CI 1.58–2.10)], stroke [HR 1.39 (95% CI 1.20–1.61)] and atrial fibrillation [HR 1.33 (95% CI 1.08–1.65) (Figure 1). Conclusion This population-scale study used anonymised individual-level linked data from multiple routinely collected data sources. A history of pregnancy complications during first pregnancy was associated with a higher risk of incident cardiovascular conditions, including heart failure, ischaemic heart disease, stroke and atrial fibrillation. Applying primary preventive measures and risk assessments for cardiovascular disease after the first pregnancy may mitigate the higher risk among these women. Funding Acknowledgement Type of funding sources: Other.

Readmission after transcatheter aortic valve implantation according to frailty

Abstract Background Readmissions and time spent hospitalized following transcatheter aortic valve implantation (TAVI) are important parameters of patient autonomy, particularly for frail patients with limited life-expectancy. Yet, such data remain scarce. Purpose To investigate actual time spent hospitalized the first year after TAVI. Secondly, to investigate time spent hospitalized according to frailty risk. Methods Through Danish, nationwide registries, we included all patients undergoing TAVI and alive at discharge between January 2008 and June 2020. From discharge, patients were followed until death, emigration, end of study period, or one year of follow-up, whichever came first. During follow-up, all in-patient hospital admissions were identified according to ICD-10 diagnosis codes. Length of stay was calculated, and cumulative numbers of days hospitalized was presented. Further, the proportion of patients dying within one year of follow-up was calculated. Using The Hospital Frailty Risk Score, a validated frailty risk assessment tool, patients were categorized as low, intermediate, and high frailty risk. We then evaluated the time spent hospitalized stratified by frailty risk group. Results The study population comprised 5,464 patients undergoing first-time TAVI with a median age of 81 years among whom 55.2% were males. After one year, 445 (8.1%) patients had died. In total, 2,452 (44.9%) of TAVI patients survived one year and were never admitted, whereas 3,012 (55.1%) patients were admitted at least once or died within one year of TAVI. Of these, 1,200 (21.9%) patients were admitted for more than two weeks or died within one year of TAVI (Figure 1). Regarding frailty, 3,296 (60.3%), 1,965 (36.0%), and 203 (3.7%) patients were classified as low, intermediate, and high frailty risk, respectively. In the low frailty risk group, 6.2% of patients died within one year and 50.4% survived one year without a hospital admission. By contrast, 16.7% of patients in the high frailty risk group died within one year and only 24.6% survived one year without a hospital admission. Further, 17.1% of patients in the low frailty risk group were admitted for more than two weeks or died within one year of TAVI compared with 47.3% in the high frailty risk group (Figure 2). Conclusion Readmissions in the first year after transcatheter aortic valve implantation were common and time spent hospitalized after transcatheter aortic valve implantation was significant. Our results were clearly related to frailty, which should be considered for future prevention strategies. Funding Acknowledgement Type of funding sources: None.

Long-term non-cardiovascular morbidity risk remains elevated following myocardial infarction: a nationwide cohort study

Abstract Introduction Risk of cardiovascular events following myocardial infarction (MI) is high, and secondary preventive treatment is largely focused on reducing future cardiovascular risk. As gradual implementation of guideline-based treatments successfully leads to improved survival, long-term non-cardiovascular morbidity is likely of rising importance following MI. Purpose To determine the long-term risk of non-cardiovascular morbidity in a contemporary MI population with the aim of informing the need for and scope of prolonged surveillance. Methods We included all patients with a first-time MI in Denmark from 2001–2018 matched on age, sex, and date of discharge with up to 4 general population controls. We used the Aalen-Johansen estimator to estimate 1-year and 5-year risk of non-cardiovascular morbidity with death as a competing risk. Non-cardiovascular morbidity was defined as an in-patient hospital admission for any primary cause excluding cardiovascular diagnoses (International classification of diseases, 10th revision codes: I00–99). We also calculated 2-year and 6-year risks of non-cardiovascular morbidity in a stable population of post-MI patients and matched controls, i.e., participants alive with no hospital admissions for 1 full year following study entry. Finally, we estimated 1-year and 5-year risks of cause-specific non-cardiovascular morbidity. Results A total of 124,072 patients with MI who survived to hospital discharge were matched with 496,277 general population controls. Median age was 68 years and 35.5% were female. The 1-year and 5-year risk of non-cardiovascular morbidity was elevated for patients with MI compared to controls: 38.6% (95% confidence interval: 38.3–38.9) vs 15.3% (15.2–15.4) and 64.8% (64.6–65.1) vs 45.8% (45.7–45.9), respectively (Figure 1). Regarding cause-specific morbidity, risks of respiratory disease, gastrointestinal disease, and infectious disease particularly were high (Figure 2). For example, 1-year risk of infection was 4.5% for patients with MI and 1.8% for controls and 5-year risk of respiratory disease was 16.3% for patients with MI and 9.7% for controls. Furthermore, in the stable population (patients with MI, n=50,144; controls, n=159,467, median age 64 years, 33.0% female), risk of non-cardiovascular morbidity remained elevated at 2 years (17.2% [16.8–17.5] vs 11.3% [11.1–11.5]) and 6 years (49.2% [48.7–49.7] vs 39.8% [39.6–40.1]) post MI (Figure 1). Conclusions Risk of non-cardiovascular morbidity was high in patients following myocardial infarction, particularly for respiratory disease, gastrointestinal disease, and infectious disease. The risk remained elevated during long-term follow up. The study highlights the importance of additional focus on non-CV morbidity to further improve outcomes. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Danish Heart Foundation

Evaluating the Impact of Protocol-Driven Treatment for COVID-19 in an Emergency Department Observation Unit.

Background Hospital overcrowding and operating above capacity have occurred frequently throughout the COVID-19 pandemic. Both phenomena can lead to worsened patient outcomes; thus, it is imperative to find solutions that tackle both. Our goal was to create a treatment protocolfor a subset of patients with mild to moderate COVID-19 infection that would combat inpatient overcrowding by diverting these patients to an emergency department (ED) observation unit (EDOU). This protocol was based on dynamic treatment guidelines and required regular updates to allow our team to provide the most up-to-date care throughout the pandemic. Methods This study is a retrospective chart review of all adult patients seen at twolarge suburban EDs for symptoms related to COVID-19 from April 2020 to January 2022. We subsequently identified adult patients who met the criteria for treatment with our COVID-19 protocol and were placed in our observation unit. These patients were identified using a flag for the protocol orderset within our electronic medical record. Primary outcomes include the need for hospital admission, bounce back rate, and death rate. Results A total of 2,417 patients were treated in our ED observation units using our COVID-19 protocol. Our study population was evenly divided by gender, while a majority self-identified as white (76%). Five hundred two patients (20.8%) required admission to the hospital, and of these, 55 (11%) patients required intensive care unit (ICU) level of care. A total of 27 (1.1%) patientsdied. No deaths occurred for patients that remainedwithin our ED observation units. Bounce back rates at the 48-hour, 72-hour, and seven-day marks were 3.6%, 4.6%, and 7.9%, respectively. Finally, we calculated a total of 284 inpatient days saved with the implementation of our protocol. Conclusion This study shows that our newly created protocol is effective in that it reduces the need for inpatient hospital admissions and results in low bounce back rates. Protocol-driven care in ED observation units can be a powerful tool against hospital overcrowding. Creating such protocols offers opportunities for hospital systems to provide efficient care at a significant cost savings without sacrificing quality of care. Our COVID-19 treatment protocol can be replicated by other hospital systems within their own ED observation units should any future similar outbreaks occur.

Understanding the impacts of health information systems on patient flow management: A systematic review across several decades of research.

Patient flow describes the progression of patients along a pathway of care such as the journey from hospital inpatient admission to discharge. Poor patient flow has detrimental effects on health outcomes, patient satisfaction and hospital revenue. There has been an increasing adoption of health information systems (HISs) in various healthcare settings to address patient flow issues, yet there remains limited evidence of their overall impacts. To systematically review evidence on the impacts of HISs on patient flow management including what HISs have been used, their application scope, features, and what aspects of patient flow are affected by the HIS adoption. A systematic search for English-language, peer-review literature indexed in MEDLINE and EMBASE, CINAHL, INSPEC, and ACM Digital Library from the earliest date available to February 2022 was conducted. Two authors independently scanned the search results for eligible publications, and reporting followed the PRISMA guidelines. Eligibility criteria included studies that reported impacts of HIS on patient flow outcomes. Information on the study design, type of HIS, key features and impacts was extracted and analysed using an analytical framework which was based on domain-expert opinions and literature review. Overall, 5996 titles were identified, with 44 eligible studies, across 17 types of HIS. 22 studies (50%) focused on patient flow in the department level such as emergency department while 18 studies (41%) focused on hospital-wide level and four studies (9%) investigated network-wide HIS. Process outcomes with time-related measures such as 'length of stay' and 'waiting time' were investigated in most of the studies. In addition, HISs were found to address flow problems by identifying blockages, streamlining care processes and improving care coordination. HIS affected various aspects of patient flow at different levels of care; however, how and why they delivered the impacts require further research.

Association between the quality of primary care, insurance coverage, and diabetes-related health outcomes in a cohort of older adults in China: results from the China Health and Retirement Longitudinal Study

ObjectiveThis study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary care in a cohort of older Chinese adults.Design and settingData...

A Case of Neurofibromatosis Type 1 with Severe Mood and Behavioral Symptoms

INTRODUCTION: Neurofibromatosis type 1 (NF1) is a genetic disorder caused by a mutation in the NF1 gene. In addition to physical manifestations, complications such as cognitive and behavioral deficits have been described. CLINICAL FINDINGS: We describe a case of a 14-year-old male with a past psychiatric history of obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and multiple suicide attempts, who presented with suicidal ideation and command hallucinations. The patient became aggressive, physically assaulting hospital staff, and required sedative medication and physical restraints for several days. He required inpatient hospital admission due to rhabdomyolysis. Throughout his admission, the patient was intermittently verbally and physically abusive to people around him. They described his outbursts as impulsive and thought to be out of motivation to get what he wants. He preferred to keep to himself and did not have relationships with people at his home. CONCLUSION: This case report provides insight into the behavioral characterization of children diagnosed with NF1. While the mechanism of how NF1 relates to behavioral issues is unknown, the association between NF1 and behavioral issues should be carefully considered in NF1 patients presenting with aggression.

Racial Disparities in Psychiatric Decisional Capacity Consultations.

In this study, the authors examined potential disparities and biases in the placement and outcomes of decisional capacity evaluations across races, controlling for patient characteristics. The authors reviewed 181 patient decisional capacity consultations requested for the consultation-liaison psychiatry service at a tertiary care medical center from 2018 to 2019. The racial distribution of patients in these consultations was compared with the racial distribution of hospital inpatient admissions from 2018 to 2019. The authors analyzed patient outcomes by using logistic regression that controlled for race, gender, age, education, primary insurance, type of capacity assessment, and psychiatric diagnosis. Decisional capacity consultations were placed disproportionately for Black (43% of consultations vs. 18% of total admissions) and Hispanic patients (26% of consultations vs. 21% of admissions) compared with White and Asian patients. Among 130 patients with a capacity determination, 95 (53% of total sample) were determined not to have capacity, an outcome that did not differ by race but was more likely to occur among patients diagnosed as having delirium. Sixty-seven patients with no capacity (37% of total sample) experienced a change in treatment, an outcome that was less likely to occur among Hispanic patients in the univariable analysis. Significant racial disparities were observed during the placement of a decisional capacity consultation. These findings reveal the potential biases introduced with both the initial challenge to a patient's capacity and the subsequent outcomes of the consultation. As such, the balance of risk versus benefit or utility of these consultations in certain populations must be carefully considered.

Examining the incidence of acute stress in pediatric trauma patients

ObjectivePediatric patients can be significantly impacted emotionally by exposure to acute trauma which may negatively impact long-term functioning and lead to an increase in overall distress. This study reports on...

Cognitive deficit identified via patient reported outcome measures may be a predictor for post-operative health care utilization (131)

<b>Objectives:</b> As care models become increasingly value-based, understanding healthcare utilization and predictors for high utilization are paramount. Patient Reported Outcome Measurement surveys (PROMs) offer a valuable method to evaluate a patient's clinical course more accurately and gain insight into how they manage at home and with their disease. The purpose of this study was to determine if preoperative PROMs examining social, mental, emotional, and physical health could be used to predict increased healthcare utilization in the postoperative period. <b>Methods:</b> PROMs were collected monthly in all patients undergoing care for gynecologic malignancy between January 1, 2018, and September 1, 2019, as described previously. For patients who underwent surgery, charts were reviewed to ascertain the amount of healthcare utilization that occurred in the 90-day postoperative period. Healthcare utilization was grouped into the following categories: phone calls, emails/portal messages, oncology office visits, other office visits, Emergency Department encounters, and inpatient hospital admission. Descriptive statistics, non-parametric tests (Spearman's correlation), and logistic regression were performed where appropriate. <b>Results:</b> A total of 236 patients completed preoperative PROMs. Of all PROMs items, "difficulty remembering things" was strongly associated with postoperative healthcare utilization (see Table 1). This relationship was present even when controlling for other variables (age, body mass index, race, length of stay, disease site, surgery/surgical complications, and ASA class). As difficulty with memory increased, healthcare utilization increased as well (regression coefficient 2.3, p=0.007). When controlling for quality of life measures against one another (i.e., trouble with strenuous activities, depression, treatment interfering with family life, difficulty remembering), memory impairment remained a statistically significant prognostic indicator compared to other variables for total hospital touches (regression coefficient 0.74, p=0.03). <b>Conclusions:</b> Patients who report impairment in memory are significantly more likely to have unplanned re-admissions and office visits postoperatively. Preoperative collection of PROMs can identify this cohort of vulnerable women and suggest that further studies should be done to see if additional support around surgery can mitigate this risk. As healthcare systems move towards more value-based approaches which require risk stratification, attention to memory impairment could help identify patients at higher risk for increased healthcare utilization and adverse outcomes.

Ana o 3 sIgE and diagnostic algorithms reduce cost of cashew allergy diagnosis in children compared with skin prick test: Acost comparison analysis.

In the absence of a clear clinical history of reaction, diagnosis of cashew allergy using skin prick tests (SPT) or cashew-specific IgE requires a high number of oral food challenges (OFC). By using Ana o 3 sIgE alone, or a two-step diagnostic algorithm using cashew sIgE followed by Ana o 3 sIgE, there is a reduced need for OFC. We aimed to perform a cost comparison for both of these approaches compared with cashew SPT alone. Pooled individual-level data from 6 studies were used to determine diagnostic accuracy and OFC rate. Two studies used cashew SPT (n=567, 198 allergic), with 95% positive and negative predictive values of ≥12 mm and <3 mm. Four studies were included in the pathways for Ana o 3 sIgE alone or a 2-step algorithm incorporating cashew and Ana o 3 sIgE (n=271, 156 allergic). Cut-offs used were ≥8.5kUA/L and ≤0.1kUA/L for cashew sIgE and ≥0.35kUA/L and ≤0.1kUA/L for Ana o 3 sIgE. Costs were constructed based on unit prices from hospital inpatient admissions, expenses incurred by families, individual patient data on allergic reaction types and rates, and adrenaline autoinjector carriage, applying a health system perspective. Modeled data through the Ana o 3 pathway resulted in a 46.43% cost reduction (€307,406/1000 patients) compared with using cashew SPT alone (€573,854/1000 patients). The 2-step algorithm resulted in a 44.94% cost reduction compared with SPT alone (€315,952.82/1000 patients). Both the Ana o 3 pathway and 2-step algorithm resulted in a 79%-80% reduction in OFCs compared with SPT. Using Ana o 3 as a standalone test for cashew allergy diagnosis or a 2-step algorithm incorporating cashew sIgE and Ana o 3 sIgE is accurate and results in a large reduction in both OFCs and health system costs compared with cashew SPT alone.

Safety and Cost Savings Associated with Reduced Inpatient Hospitalization for Microvascular Decompression

Microvascular decompression (MVD) has grown as a first-line surgical intervention for severe facial pain from trigeminal neuralgia and/or hemifacial spasm. We sought to examine the safety and cost-benefits of discharging patients with MVD within 1 day of admission. We retrospectively reviewed patients undergoing MVD at our institution from 2008 to 2020. Patients were sorted by 1 day, 2 days, or >2 days until discharge and by year from 2008 to 2013, 2014 to 2018, or 2019 to 2020. Patient presenting characteristics, intraoperative measures, and complications were documented. Statistical differences were calculated by one-way analysis of variance and χ2 analyses. Our cohort included 976 patients undergoing MVD, with 231 (23.6%) between 2008 and 2013, 517 (52.9%) between 2014 and 2018, and 228 (23.3%) between 2019 and 2020. Over time, postoperative admission rates to the critical care unit, total inpatient hospital admission times, and Barrow Neurological Institute scores at first follow-up decreased. Postoperative complications, including cerebrospinal fluid leak, decreased significantly. In addition, patients discharged within 1 day of admission incurred a total hospital cost of $26,689, which was $3588 lower than patients discharged within more than 1 day of admission, P< 0.0001. Discharging carefully selected patients who are appropriate for discharge within 1 day of admission could translate to a potential cost-savings of $255,346 per year in our clinical practice. In our experience, MVDs are a safe, elective intervention. Our findings suggest that postoperative day 1 discharge in patients with an uncomplicated postoperative course may be safe while improving hospital resource use.

Hospital inpatient admissions of children of mothers with severe mental illness: A Western Australian cohort study.

Children of parents with mental illness face a number of adversities, potentially contributing to poor health. The aim of this study was to quantify the association between maternal severe mental illness and children's hospital admissions. Record linkage cohort study of 467,945 children born in Western Australia between 1 January 1980 and 31 December 2001. Follow-up was from age 28 days until fifth birthday. Linked registers captured information on potential confounders. Rate ratios and adjusted rate ratios measured relative change in the numbers of admissions and total days of stay, while rate differences measured absolute change in outcomes. Cause-specific increases were calculated for ICD-9 chapters and for 'potentially preventable' conditions. After adjusting for potential confounders, children of mothers with severe mental illness had a 46% relative increased rate in hospital admissions (95% confidence interval = [38%, 54%]) and an absolute increase in 0.69 extra days in hospital per child, per year (95% confidence interval = [0.67, 0.70]). The relative increase in admissions was greatest in the child's first year of life (adjusted rate ratio = 1.76, 95% confidence interval = [1.64, 1.88]; rate difference = 0.32, 95% confidence interval = [0.30, 0.34]). Rates of admissions were increased for a range of causes, particularly injuries, infections and respiratory disease, and for conditions classified as 'potentially preventable'. Children of mothers with severe mental illness have a substantial excess in hospital use compared to children of well mothers. This vulnerable group should be targeted with interventions to avert preventable morbidity and premature mortality in later life.

The impact of an oncology-specific shared savings agreement.

1536 Background: In response to rising healthcare costs, several innovative payment strategies have emerged to improve the value and efficiency of healthcare spending. One of these strategies is a shift from volume-based to value-based care (VBC), resulting in the introduction of alternative payment models, innovative provider contracting and new value frameworks. The purpose of this study is to evaluate the impact of a VBC arrangement on total cost of care for chemotherapy patients, specifically cancer-related drug costs, daily hospital inpatient admissions and emergency room visits. Methods: This is a cohort study of chemotherapy patients, in a single state, enrolled in a large national insurer from January 18, 2021, to September 30, 2021. Oncology patients were divided into two groups; the study group consisted of chemotherapy patients receiving care in a VBC arrangement; the control group consisted of chemotherapy patients receiving care at oncology practices not engaged with the insurer in a VBC agreement. The following levers were employed to improve value: digital symptom tracking, biosimilar or lower-cost drug options and NCCN regimen concordance. We defined cancer-related drug costs as the sum of allowed costs paid for medical and pharmacy claims during the study period. Additionally, we averaged the cost per hospital inpatient day and emergency room visit and compared these by group. Results: This study included 1,574 patients, 733 patients in the study group and 841 in the control group. A reduction of 5.1% (a difference of $441) in cancer-related drug costs per member per treatment month (PMPTM) was observed among patients in the study group. Patients in the study group reported 27.8% fewer inpatient days resulting in a savings of $194 PMPTM. Similarly, patients in the study group reported 70.0% fewer emergency room visits resulting in a savings of $59 PMPTM. Conclusions: In this study, chemotherapy patients participating in a shared savings VBC spent less on cancer-related drug costs, hospital inpatient days and emergency room visits through three value levers. Further studies are needed to assess if these results are similar all types of healthcare coverage and to what degree additional value levers further reduce costs. Additionally, the long-term health outcomes of these patients should be assessed.

Long-term surveillance of rotavirus vaccination after implementation of a national immunization program in Finland (2008–2018)

BackgroundRotavirus (RV) vaccination was included in the Finnish National immunization Program (NIP) in 2009. RotaTeq (RV5) has been used exclusively with a national average vaccination coverage rate (VCR) of > 90%. While previous studies have demonstrated that inpatient rotavirus gastroenteritis (RVGE) admissions declined by as much as 96% in Finnish children ≤ 5 years old following RV vaccination introduction, no study has evaluated long-term protection after vaccination in Finland. In this study, we analyze incidence of hospital outpatient visits and inpatient admissions of gastroenteritis in children up to 7 years of age. MethodsWe first describe the incidence of RVGE, viral gastroenteritis (VGE), and acute gastroenteritis (AGE) for all Finnish children born during 2008–2011. Children were stratified by the year of birth into not-eligible, partially eligible and rotavirus vaccine-eligible (born in 2008, 2009, 2010 and 2011, respectively). Hospital inpatient and outpatient data was collected from the National Care Register for all children from birth until December 31st, 2018. We also studied RVGE incidence during 2014–2017 for children<3 years of age in municipalities with VCRs of 90% and above and municipalities with VCRs below 90%. ResultsRVGE incidence decreased significantly soon after implementation of RV vaccination in the NIP. In vaccine-eligible cohorts, no clear peak incidence in the youngest age groups could be observed, and no RVGE cases were observed beyond 6 years after vaccination, in contrast to vaccine ineligible and partially eligible cohorts. Despite an overall high VCR in Finland, regions with high VCR had lower incidence of RVGE than regions with lower VCR. ConclusionIncidence of RVGE has remained low in all age groups during the 10 years following introduction of RV vaccine in the Finnish NIP. Differences in RVGE incidence were observed in regions with high as compared with lower VCR, highlighting the importance of maintaining high vaccination coverage.

Buprenorphine and Cardiac Surgery: Navigating the Challenges of Pain Management

OVER THE LAST 2 decades, buprenorphine has been used for the treatment of pain, opioid addiction, and detoxification. It has unique properties, including partial agonist activity at the mu receptor, while also exhibiting antagonism at the kappa receptor. 1 Goel A Azargive S Lamba W et al. The perioperative patient on buprenorphine: A systematic review of perioperative management strategies and patient outcomes. Can J Anaesth. 2019; 66: 201-217 Crossref PubMed Scopus (32) Google Scholar The half-life is highly variable with each patient, but it may extend up to 60 hours. In addition, even low doses will outcompete other opioids to bind receptors, rendering other opioids ineffective unless very high doses are used. 2 Anderson TA Quaye ANA Ward EN et al. To stop or not, that is the question: Acute pain management for the patient on chronic buprenorphine. Anesthesiology. 2017; 126: 1180-1186 Crossref PubMed Scopus (83) Google Scholar Although this may be advantageous in the outpatient setting, the pharmacokinetic and pharmacodynamic properties of buprenorphine can complicate the perioperative management of pain when these patients present for surgery. Herein, the authors present a case during which a patient who was started on buprenorphine for addiction therapy was referred subsequently for cardiac surgery during the same inpatient hospital admission.

Association Between Real-Time Continuous Glucose Monitor Use and Diabetes-Related Medical Costs for Patients with Type 2 Diabetes.

Little is known about the impact of real-time continuous glucose monitoring (rtCGM) on diabetes-related medical costs within the type 2 diabetes (T2D) population. A retrospective analysis of administrative claims data from the Optum Research Database was conducted. Changes in diabetes-related health care resource utilization costs were expressed as per-patient-per-month (PPPM) costs. A total of 571 T2D patients (90% insulin treated) met study inclusion criteria. Average PPPM for diabetes-related medical costs decreased by -$424 (95% confidence interval [CI] -$816 to -$31, P = 0.035) after initiating rtCGM. These reductions were driven, in part, by reductions in diabetes-related inpatient medical costs: -$358 (95% CI -$706 to -$10, P = 0.044). Inpatient hospital admissions were reduced on average -0.006 PPPM (P = 0.057) and total hospital days were reduced an average of -0.042 PPPM (P = 0.139). These findings provide real-world evidence that rtCGM use was associated with diabetes-related health care resource utilization cost reductions in patients with T2D.

P071 A case series of rheumatic disease patients diagnosed with COVID-19 Feb 2020 to March 2021 at the hospital that reported London’s index case of COVID-19

Background/AimsThe aim of this study is to describe demographics features and outcomes of patients with rheumatic diseases diagnosed with COVID-19 in a single hospital.MethodsPatients with rheumatic diseases and COVID-19 were identified via rheumatology outpatient and inpatient hospital admissions between February 2020 and March 2021. Data was collected retrospectively using the electronic medical records system and in-person and telephone consultations. The data was entered into the COVID-19 Global Rheumatology Alliance (GRA) Registry. Data collected included age, gender, ethnicity, smoker status, rheumatic disease, co-morbidities, drug history and vaccine status. Patient outcome was recorded as mortality, recovered (including days to recovery) or symptoms persisting over 90 days (>90). Requirement for hospital admission was also recorded. Comparison was made to the published GRA Registry data.ResultsForty-three patients were identified; 33 Female (77%),10 (23%) male. Median age 52. 22 Caucasian, 12 Black, 3 mixed race, 2 Asian, 2 Hispanic and 5 unknown. Rheumatoid arthritis (14 patients; 33%) was the most common disease. Other diagnoses included psoriatic arthritis (6; 14%), systemic lupus erythematosus (4: 9%), Sjogrens syndrome (4: 9%) and ankylosing spondylitis (4; 9%). The most common disease modifying antirheumatic drug (DMARD) was methotrexate (35%) followed by hydroxychloroquine (33%). Eight patients were taking steroids (19%). Factors associated with hospitalisation were older age (57% age ≥ 52 vs 40% < 52), multiple co-morbidities (71% ≥ 2 co-morbidities vs 35% < 2 co-morbidities) and black ethnicity (75% black vs 26% of caucasian). These risk factors for morbidity are similar to the UK background population and published COVID-19 GRA data. There was no increased risk of hospitalisation between different DMARDs (53% on methotrexate required admission vs 50% on hydroxychloroquine). 71% of patients on steroids required admission. The overall study cohort had a 49% hospital admission rate. Similar risk factors were identified for persistence of symptoms > 90; 27% of black patients vs 5% of caucasian and 24% of patients with > 2 co-morbidities vs 10% of patients with < 2 co-morbidities. Age did not follow the same trend as hospitalisation; 10% of patients age ≥ 52 vs 20% of patients < 52 had symptoms > 90. 15% on methotrexate had a recovery time > 90 vs 7% on hydroxychloroquine and 14% on steroids. The overall cohort had a 17% rate of patients having symptoms > 90. Mortality rate within the cohort was 5% (2 patients).ConclusionA case-series of 43 patients with rheumatic diseases and COVID-19 was conducted. The risk factors for hospitalisation, mortality and persistence >90 were similar to other studies. Most significantly the findings show a correlation between black ethnicity and increased risk of all mortality, hospitalisation and symptoms > 90. There was no difference in hospitalisation and different DMARDs.Disclosure J. Pilcher: None. G. Yanni: None. P. Lutalo: None. L. Pollard: None.

SARS-CoV-2 Vaccination and Myocarditis in a Nordic Cohort Study of 23 Million Residents

Reports of myocarditis after SARS-CoV-2 messenger RNA (mRNA) vaccination have emerged. To evaluate the risks of myocarditis and pericarditis following SARS-CoV-2 vaccination by vaccine product, vaccination dose number, sex, and age. Four cohort studies were conducted according to a common protocol, and the results were combined using meta-analysis. Participants were 23 122 522 residents aged 12 years or older. They were followed up from December 27, 2020, until incident myocarditis or pericarditis, censoring, or study end (October 5, 2021). Data on SARS-CoV-2 vaccinations, hospital diagnoses of myocarditis or pericarditis, and covariates for the participants were obtained from linked nationwide health registers in Denmark, Finland, Norway, and Sweden. The 28-day risk periods after administration date of the first and second doses of a SARS-CoV-2 vaccine, including BNT162b2, mRNA-1273, and AZD1222 or combinations thereof. A homologous schedule was defined as receiving the same vaccine type for doses 1 and 2. Incident outcome events were defined as the date of first inpatient hospital admission based on primary or secondary discharge diagnosis for myocarditis or pericarditis from December 27, 2020, onward. Secondary outcome was myocarditis or pericarditis combined from either inpatient or outpatient hospital care. Poisson regression yielded adjusted incidence rate ratios (IRRs) and excess rates with 95% CIs, comparing rates of myocarditis or pericarditis in the 28-day period following vaccination with rates among unvaccinated individuals. Among 23 122 522 Nordic residents (81% vaccinated by study end; 50.2% female), 1077 incident myocarditis events and 1149 incident pericarditis events were identified. Within the 28-day period, for males and females 12 years or older combined who received a homologous schedule, the second dose was associated with higher risk of myocarditis, with adjusted IRRs of 1.75 (95% CI, 1.43-2.14) for BNT162b2 and 6.57 (95% CI, 4.64-9.28) for mRNA-1273. Among males 16 to 24 years of age, adjusted IRRs were 5.31 (95% CI, 3.68-7.68) for a second dose of BNT162b2 and 13.83 (95% CI, 8.08-23.68) for a second dose of mRNA-1273, and numbers of excess events were 5.55 (95% CI, 3.70-7.39) events per 100 000 vaccinees after the second dose of BNT162b2 and 18.39 (9.05-27.72) events per 100 000 vaccinees after the second dose of mRNA-1273. Estimates for pericarditis were similar. Results of this large cohort study indicated that both first and second doses of mRNA vaccines were associated with increased risk of myocarditis and pericarditis. For individuals receiving 2 doses of the same vaccine, risk of myocarditis was highest among young males (aged 16-24 years) after the second dose. These findings are compatible with between 4 and 7 excess events in 28 days per 100 000 vaccinees after BNT162b2, and between 9 and 28 excess events per 100 000 vaccinees after mRNA-1273. This risk should be balanced against the benefits of protecting against severe COVID-19 disease.