International Classification Of Disease Clinical Modification Research Articles

Respiratory-related workers’ compensation claims from private employers — Ohio, 2001–2018

Background: Diseases and conditions related to the respiratory system contribute to work-related morbidity, mortality, and disability. Details on the causes and nature of work-related respiratory disease and the specific industries in which they occur are limited. This study identifies respiratory-related claims in the Ohio Bureau of Workers’ Compensation (OHBWC) system and describes claim and worker characteristics to inform public health surveillance. Methods: We developed a list of respiratory-related International Classification of Diseases Clinical Modification (ICD-CM) diagnosis codes and searched over 2 million claims filed between 2001 and 2018 in the OHBWC system for at least one of these codes. The claim characteristics, rates of claims by employer industry classification, and causes of claims from narrative text were determined for these respiratory-related claims. Results: Among the 23,015 respiratory-related claims (5.8 per 10,000 full-time equivalents [FTE]), 54.6% had at least one ICD-CM code for Allergic Reactions and 30.6% had at least one code for Toxic Effects of Substances Chiefly Non-medicinal as to Source. Claim causes from narrative text included Chemical Exposure (30.3%), Activity Suggesting Exposure (24.4%), and Vapors, Gases, Dusts, or Fumes (VGDF) Exposure (19.3%). The highest overall rates of respiratory-related claims among private employers were for the agriculture, forestry & fishing (11.4 per 10,000), public safety (ambulance services) (11.3), and manufacturing (10.7) industry sectors. Conclusions: Respiratory-related claims in the OHBWC system were often acute in nature and included allergic reactions. Narratives from these claims provide insight into the work-related exposures and events causing claims or the disease and symptom factors surrounding claims.

(239) Postoperative Outcomes and Risk Factors in Patients Receiving Partial vs Total Penectomy for Penile Malignancy

Abstract Introduction Partial penectomies (PP) and total penectomies (TP) are both performed for penile cancer in the United States. Compared to TP, PP is performed more frequently to preserve functional urinary outcomes. To date TP and PP outcomes have not been compared, in this study we compared clinical characteristics and post-operative outcomes between TP and PP conducted between 2006–2016. Objective We conducted a retrospective review of penile cancer patients from National Surgical Quality Improvement Program (NSQIP) database for the years 2010–2016 using international classification of diseases clinical modification (ICD-CM) ninth revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. Methods We conducted a retrospective review of penile cancer patients from National Surgical Quality Improvement Program (NSQIP) database for the years 2010–2016 using international classification of diseases clinical modification (ICD-CM) ninth revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. Results Partial penectomy patients were less likely to be transferred patients (7.3% vs 20.9%, p=0.002), less likely to be suffering from diabetes (25.9% vs 40.3%, p=0.026), and were more likely to have preoperative laboratory values within normal limits. TP was associated with increased preoperative white blood cell count x109, preoperative white blood cell count > 7.5x109 (p<0.001), preoperative hematocrit (p<0.001). PP patients were, in contrast, shown to have higher pre-operative creatinine levels (p=.037) and lower platelet levels than TP patients (p=.045). PP patients had shorter operation times (78.8 vs 145.5 min, p<0.001). PP patients also had decreased levels of inpatient stay length (1.67 vs 4.31, p<0.001), any 30-day post-surgery complication (7% vs 31%, p<0.001), deep incisional surgical site infection (0.5% vs 6% p=0.017), wound disruption (0.5% vs 6.0%p=0.017), intraoperative or postoperative transfusion (1.6% vs 7.5%, p=0.029), and sepsis (0.5% vs 7.5%, p=0.005), when compared to patients who underwent TP. TP patients displayed a significantly greater number of concurrent surgical procedures (p<0.001), when compared to PP patients. There was no information on urinary, sexual, and erectile outcomes in the database. Conclusions PP is associated with fewer post-operative complications, shorter surgeries, shorter hospital stays, and fewer concurrent surgical procedures. Total penectomy is associated with a greater proportion of patients suffering from comorbid conditions, suggesting that TP patients are at higher risk for post-surgical complications and longer hospital stays. There is a gap in reported data pertaining to post-operative sexual function and erectile outcomes for PP at a national level. Disclosure No.

(020) Comparing Postoperative Outcomes and Risk Factors for Patients Undergoing Partial vs Total Penectomy for Penile Carcinoma

Abstract Introduction The American Cancer Society estimates that 2,200 men develop penile cancer annually and 440 men will die from the disease. Partial penectomies (PP) and total penectomies (TP) are both performed for penile cancer in the United States. Compared to TP, PP is performed more frequently to preserve functional urinary outcomes. Objective To date TP and PP outcomes have not been compared, in this study we compared clinical characteristics and post-operative outcomes between TP and PP conducted between 2006-2016. Methods We conducted a retrospective review of penile cancer patients from National Surgical Quality Improvement Program (NSQIP) database for the years 2010-2016 using international classification of diseases clinical modification (ICD-CM) ninth revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. Results Partial penectomy patients were less likely to be transferred patients (7.3% vs 20.9%, p=0.002), less likely to be suffering from diabetes (25.9% vs 40.3%, p=0.026), and were more likely to have preoperative laboratory values within normal limits. TP was associated with increased preoperative white blood cell count x109, preoperative white blood cell count > 7.5x109 (p<0.001), preoperative hematocrit (p<0.001). PP patients were, in contrast, shown to have higher pre-operative creatinine levels (p=.037) and lower platelet levels than TP patients (p=.045). PP patients had shorter operation times (78.8 vs 145.5 min, p<0.001). PP patients also had decreased levels of inpatient stay length (1.67 vs 4.31, p<0.001), any 30-day post-surgery complication (7% vs 31%, p<0.001), deep incisional surgical site infection (0.5% vs 6% p=0.017), wound disruption (0.5% vs 6.0%p=0.017), intraoperative or postoperative transfusion (1.6% vs 7.5%, p=0.029), and sepsis (0.5% vs 7.5%, p=0.005), when compared to patients who underwent TP. TP patients displayed a significantly greater number of concurrent surgical procedures (p<0.001), when compared to PP patients. There was no information on urinary, sexual, and erectile outcomes in the database. Conclusions PP is associated with fewer post-operative complications, shorter surgeries, shorter hospital stays, and fewer concurrent surgical procedures. Total penectomy is associated with a greater proportion of patients suffering from comorbid conditions, suggesting that TP patients are at higher risk for post-surgical complications and longer hospital stays. There is a gap in reported data pertaining to post-operative sexual function and erectile outcomes for PP at a national level. Disclosure No.

Predicting seizure recurrence after an initial seizure-like episode from routine clinical notes using large language models: a retrospective cohort study.

The evaluation and management of first-time seizure-like events in children can be difficult because these episodes are not always directly observed and might be epileptic seizures or other conditions (seizure mimics). We aimed to evaluate whether machine learning models using real-world data could predict seizure recurrence after an initial seizure-like event. This retrospective cohort study compared models trained and evaluated on two separate datasets between Jan 1, 2010, and Jan 1, 2020: electronic medical records (EMRs) at Boston Children's Hospital and de-identified, patient-level, administrative claims data from the IBM MarketScan research database. The study population comprised patients with an initial diagnosis of either epilepsy or convulsions before the age of 21 years, based on International Classification of Diseases, Clinical Modification (ICD-CM) codes. We compared machine learning-based predictive modelling using structured data (logistic regression and XGBoost) with emerging techniques in natural language processing by use of large language models. The primary cohort comprised 14 021 patients at Boston Children's Hospital matching inclusion criteria with an initial seizure-like event and the comparison cohort comprised 15 062 patients within the IBM MarketScan research database. Seizure recurrence based on a composite expert-derived definition occurred in 57% of patients at Boston Children's Hospital and 63% of patients within IBM MarketScan. Large language models with additional domain-specific and location-specific pre-training on patients excluded from the study (F1-score 0·826 [95% CI 0·817-0·835], AUC 0·897 [95% CI 0·875-0·913]) performed best. All large language models, including the base model without additional pre-training (F1-score 0·739 [95% CI 0·738-0·741], AUROC 0·846 [95% CI 0·826-0·861]) outperformed models trained with structured data. With structured data only, XGBoost outperformed logistic regression and XGBoost models trained with the Boston Children's Hospital EMR (logistic regression: F1-score 0·650 [95% CI 0·643-0·657], AUC 0·694 [95% CI 0·685-0·705], XGBoost: F1-score 0·679 [0·676-0·683], AUC 0·725 [0·717-0·734]) performed similarly to models trained on the IBM MarketScan database (logistic regression: F1-score 0·596 [0·590-0·601], AUC 0·670 [0·664-0·675], XGBoost: F1-score 0·678 [0·668-0·687], AUC 0·710 [0·703-0·714]). Physician's clinical notes about an initial seizure-like event include substantial signals for prediction of seizure recurrence, and additional domain-specific and location-specific pre-training can significantly improve the performance of clinical large language models, even for specialised cohorts. UCB, National Institute of Neurological Disorders and Stroke (US National Institutes of Health).

Pneumoconiosis incidence and prevalence among US Medicare beneficiaries, 1999-2019.

Pneumoconiosis is a group of occupational lung diseases caused by dust and fiber exposure. This study analyzes Medicare claims to estimate the burden of pneumoconiosis among fee-for-service (FFS; Medicare Parts A and B) Medicare beneficiaries during 1999-2019 in the United States. Claim and enrollment information from 81 million continuously enrolled FFS Medicare beneficiaries were analyzed. Beneficiaries with any pneumoconiosis and cause-specific pneumoconiosis (e.g., asbestosis, silicosis) were identified using three case definitions (broad, intermediate, and narrow) with varying diagnostic criteria based on claim International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis codes and Healthcare Common Procedure Coding System codes. Results are presented as ranges of values for the three case definitions. The 21-year prevalence range for any pneumoconiosis was 345,383-677,361 (412-833 per 100,000 beneficiaries) using the three case definitions. The highest prevalence was among those ≥75 years of age, males, Whites, and North American Natives. Most claims (70.0%-72.5%) included an ICD-CM diagnosis code for asbestosis. The broad pneumoconiosis prevalence rate increased significantly (p < 0.001) during 2002-2009 by 3%-10% annually and declined significantly by 3%-5% annually starting in 2009. The average annual broad incidence rate declined significantly by 7% annually during 2009-2019. Despite the decline in rate for any pneumoconiosis among Medicare beneficiaries, which is primarily attributed to a decline in asbestosis, pneumoconiosis is prevalent among FFS Medicare beneficiaries.

Burden of Crohn’s Disease in the United States Medicaid Population, 2010–2019

Twenty-five percent of the United States population is enrolled in Medicaid. Rates of Crohn's disease (CD) have not been estimated in the Medicaid population since the Affordable Care Act expansion in 2014. We aimed to estimate the incidence and prevalence of CD by age, sex, and race. We identified all 2010-2019 Medicaid CD encounters using codes from the International Classification of Diseases, Clinical Modification versions 9 and 10. Individuals with ≥2 CD encounters were included. Sensitivity analyses were performed on other definitions (eg, ≥1 CD encounter). Incidence required ≥1 year of Medicaid eligibility prior to first CD encounter date (2013-2019). We calculated CD prevalence and incidence using the entire Medicaid population as the denominator. Rates were stratified by calendar year, age, sex, and race. Poisson regression models examined CD-associated demographic characteristics. We compared demographics and treatments of the entire Medicaid population with the multiple CD case definitions using percent and median. A total of 197,553 beneficiaries had ≥2 CD encounters. The CD point prevalence per 100,000 persons rose from 56 (2010) to 88 (2011) to 165 (2019). CD incidence per 100,000 person-years was 18 (2013) and 13 (2019). Higher incidence and prevalence rates correlated with female, white, or multiracial beneficiaries. Prevalence rates rose in later years. Incidence decreased over time. From 2010 to 2019, Medicaid population CD prevalence increased while incidence decreased from 2013 to 2019. Overall Medicaid CD incidence and prevalence ranges align with prior large administrative database studies.

OUTCOMES OF IN-HOSPITAL CARDIAC ARREST IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS: A NATIONWIDE ANALYSIS OF 800,000 PATIENTS

OUTCOMES OF IN-HOSPITAL CARDIAC ARREST IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS: A NATIONWIDE ANALYSIS OF 800,000 PATIENTS

Trends in Cannabis-Related and Opioid-Related Hospitalization Rates in Maine, 2010-2020

Introduction: Medical marijuana use became legal in the state of Maine in 1999, and recreational adult-use marijuana became legal in 2016. However, the rates of hospitalization related to marijuana (also known as cannabis) use have not been studied. We estimated trends in cannabis-related hospitalization rates in Maine based on rurality and descriptively compared these trends to opioid-related hospitalization rates during the past decade. Methods: We obtained de-identified data of inpatient encounters for Maine residents between 2010 and 2020 from MaineHealth Data Organization. We then calculated age-standardized rates of cannabis-related and opioid-related hospitalizations overall and by rural-urban residence using International Classification of Diseases clinical modification (ICD-CM) diagnosis codes. We used Poisson regression models to assess linear trends over time, stratified by ICD-9-CM versus ICD-10-CM timeframes. Results: Cannabis-related inpatient encounters accounted for 2.3% of all inpatient encounters among Maine residents between 2010 and 2020 and increased 0.3% per quarter between 2016 and 2020. Rates for urban residents were higher than rates for rural residents. Opioid-related inpatient encounters among Maine residents accounted for 3.4% of all inpatient encounters, and rates increased 0.6% per quarter between 2016 and 2020. Rates were higher among urban versus rural residents. Discussion: We found increasing rates of cannabis-related and opioid-related inpatient encounters in Maine spanning a period that included when recreational adult-use marijuana was legalized, but largely preceded its retail sales in Maine (October 2020). Conclusions: These trends and other public health impacts of increased access to marijuana use in Maine should continue to be monitored, especially after recreational adult-use marijuana is fully implemented.

Changes in the accuracy of administrative data for the detection of surgical site infections

We performed a retrospective analysis of the changes in accuracy of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis codes for colectomy and hysterectomy surgical site infection surveillance. After the transition from ICD-CM ninth edition to tenth edition codes, there was no significant change in the accuracy of these codes for SSI surveillance.

Increased periprosthetic hip and knee infection projected from 2014 to 2035 in Taiwan

BackgroundPeriprosthetic joint infection (PJI) is a disastrous complication associated with hip and knee arthroplasty. The literature suggests that the economic consequences associated with treating PJI are substantial. Our study aimed to investigate the past trends of PJI rates, and to estimate the projected number of PJI cases, consequent bed-day requirements, and medical expenses in Taiwan up to year 2035. MethodsA nationwide epidemiological study was conducted using the inpatient database of the Bureau of National Health Insurance from 2004 through 2013. Patients with the International Classification of Disease-Clinical Modification, ninth revision (ICD9-CM) code 99,666 (PJI) who had received surgical treatment including debridement, removal of hip or knee prosthesis, or revision of total hip/knee arthroplasty (THA/TKA) were identified. Projections were performed with Poisson regression on historical incidence rates in combination with projections of arthroplasty numbers from 2014 to 2035. ResultsA total of 4935 hip (1871) and knee (3064) PJIs were identified between 2004 and 2013. The rates of PJI were 2.46% for hip arthroplasty and 1.63% for knee arthroplasty. The number of PJIs was expected to increase markedly with time from 728 in 2013 to 3542 in 2035 (a 4.87-fold increase). The bed-day requirements for treating PJI was 17,205 in 2013 and is expected to be 82,509 bed-days in 2035 (a 4.79-fold increase). The total hospitalization cost will increase 4.86-fold by 2035. ConclusionsThe number of PJI cases is increasing rapidly due to the increasing numbers of arthroplasty surgery and the cumulative number of latent infection. This may place a large economic burden on the health care system.

Potential Selection Bias in Observational Studies Comparing Cervical Disc Arthroplasty to Anterior Cervical Discectomy and Fusion.

Retrospective study using a national administrative database. To define the cohort differences in patient characteristics between patients undergoing cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) in a large national sample, and to describe the impact of those baseline patient characteristics on analyses of costs and complications. CDA was initially studied in high quality, randomized trials with strict inclusion criteria. Recently a number of non-randomized, observational studies have been published an attempt to expand CDA indications. These trials are predisposed to falsely attributing differences in outcomes to an intervention due to selection bias. Adults undergoing ACDF or CDA between 2004 and 2014 were identified using International Classification of Diseases, 9, Clinical Modification (ICD-9-CM) diagnosis and procedure codes. Perioperative demographics, comorbidities, complications, and costs were queried. Patient characteristics were compared via chi-square and t tests. Cost, mortality, and complications were compared between ACDF and CDA cohorts using models that adjusted for demographics and comorbidities, as well as "naïve" models that did not. A total of 290,419 procedures, 98.2% ACDF and 1.8% CDA, were included in the sample. Compared with ACDF patients, CDA patients were younger, healthier as evidenced by number of comorbidities, and had an improved socioeconomic status as measured by income and insurance. The naïve logistic regression model showed that hospital costs for CDA were $549 lower than ACDF. In the fully specified model, CDA was $574 more expensive. The naïve model for medical complications suggests a protective advantage for CDA over ACDF, odds ratio of 0.627, P < 0.01. No statistically significant difference was found in the fully specified model in terms of complications. Patients undergoing CDA were younger and healthier with higher socioeconomic statuses compared with ACDF patients. Accounting for these baseline differences significantly attenuated the apparent benefit for CDR on costs and medical complications. 3.

Effect on Mortality With Inferior Vena Cava Filters in Patients Undergoing Pulmonary Embolectomy

In the absence of a randomized controlled trial, it is important to obtain as much evidence as possible by other methods on whether inferior vena cava (IVC) filters reduce mortality in patients who undergo pulmonary embolectomy. Therefore, this retrospective cohort study based data from the National Inpatient Sample 2009 to 2014 was undertaken. We assessed in-hospital all-cause mortality in stable and unstable (in shock or on ventilator support) patients with acute pulmonary embolism who underwent pulmonary embolectomy. International Classification of Diseases-9-Clinical Modification (ICD-9-CM) codes were used to identify patients. Co-morbidities were assessed by the updated Charlson co-morbidity index. A time-dependent analysis was performed to control for immortal time bias. In stable patients who underwent pulmonary embolectomy, mortality with an IVC filter was 50 of 1,212 (4.1%) compared with 202 of 755 (27%) with no IVC filter (p <0.0001). In unstable patients, mortality with an IVC filter was 108 of 598 (18%) compared with 179 of 358 (50%) with no IVC filter (p <0.0001). Mortality was reduced with IVC filters only if the filters were inserted in the first 4 or 5 days. Co-morbid conditions and immortal time bias could not explain these results. We conclude that both stable and unstable patients who underwent pulmonary embolectomy had a lower mortality with IVC filters if inserted in the first 4 or 5 days.

Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study

ObjectiveTo assess the appropriateness of outpatient antibiotic prescribing for privately insured children and non-elderly adults in the US using a comprehensive classification scheme of diagnosis codes in ICD-10-CM (international classification...

Decreased trend in hospital mortality from pancreatic cancer despite increase in number of hospital admissions.

Background and aimPancreatic cancer is one of the common cancers in US and is associated with high mortality and morbidity. The objectives of our study were to look at the recent trends in the number of hospitalizations with pancreatic cancer.MethodsWe identified patients with a discharge diagnosis of pancreatic cancer in the National Inpatient Sample from 2007 to 2011 using International Classification of Diseases—Clinical Modification, 9th revision (ICD-9-CM) codes. We looked at the yearly trend in the hospitalizations with pancreatic cancer and the outcomes which included length of stay (LOS), hospital charges and in-hospital mortality. We also performed multivariate analysis to look for the predictors of mortality.ResultsThere were 450, 414 patients with discharge diagnosis of pancreatic cancer. There was 18% increase in hospitalizations with pancreatic cancer in 2011 compared to 2007. Most of the patients were Caucasian (63%) with the mean age of 68 ± 0.14 years, had Medicare (57%) as primary insurance, were from Southern region (35%) and had higher Charlson Comorbidity Index (CCI) (87% with CCI > = 5). 6% underwent Whipple’s procedure in the index hospitalization. After the adjustment for inflation, the mean hospital charges increased from $ 47,331 in 20007 to $ 53, 854 in 2011 (p = 0.01). LOS decreased from 7.31 ± 0.11 days in 2007 to 6.70 ± 0.09 days in 2011 (<0.001). Despite the increase in the number of hospitalizations of patients with pancreatic cancer, mortality decreased from 9.8% in 2007 to 8.1% in 2011 (p<0.001). On multivariate analysis, the independent factors associated with higher mortality were older age, male sex African-American race, insurance status other than Medicare, higher CCI and enrollment in palliative care. There was regional variation in mortality. Whipple’s procedure conferred lower mortality.ConclusionsOur study showed downward trends in LOS and in-hospital mortality despite increasing hospitalizations with pancreatic cancer.

Severe sepsis and cardiac arrhythmias.

Although sepsis is a known risk factor for cardiac arrhythmias, data on incidence and outcomes of atrial and ventricular arrhythmias in severe sepsis is limited. The purpose of this study is to examine the association of severe sepsis with cardiac arrhythmias and their impact on outcome in this patient population. We used hospital discharge data from the Nationwide Inpatient Sample (NIS) during the year 2012. All patients 18 years or older were included in the study. The International Classification of Diseases-Clinical Modification, 9th revision (ICD-9-CM) code was used to identify patients with discharge diagnosis of severe sepsis, atrial fibrillation (A Fib), atrial flutter (AFL), ventricular fibrillation (VF) arrest and non-ventricular fibrillation (non-VF) arrest. In order to study the association of arrhythmias with severe sepsis, two groups were defined: group a-with severe sepsis was compared to group b-without severe sepsis. Univariate and multivariate logistic regression methods were used to adjust for potential confounding factors and variables associated with cardiac arrhythmias were determined. A total of 30,712,524 NIS hospital discharges (weighted for national estimate) were included in our study, of which 1,756,965 (5.7%) had severe sepsis. On multivariate analysis, after adjusting for potential confounders, severe sepsis was associated with higher risk of A Fib (OR, 1.23; 95% CI, 1.21-1.24), AFL (OR, 1.34; 95% CI, 1.30-1.40), VF arrest (OR, 2.58; 95% CI, 2.38-2.79) (OR, 3.31; 95% CI, 3.07-3.57) and non-VF arrest (OR, 4.91; 95% CI, 4.74-5.07). In the severe sepsis group, cardiac arrhythmia was associated with higher in-hospital mortality (OR, 1.41; 95% CI, 1.37-1.45), length of stay (LOS) >75% quartile (OR, 1.50; 95% CI, 1.46-1.53) and total hospital charges >75% quartile (OR, 1.37; 95% CI, 1.34-1.41). Advanced age, male sex, ischemic heart disease, diabetes mellitus (DM), congestive heart failure (CHF), valvular heart disease, respiratory failure, mechanical ventilation and use of vasopressors were independently associated with cardiac arrhythmias. Patients with severe sepsis are at high risk of atrial and life threatening ventricular arrhythmias. Despite adjustment for potential confounding factors, patients hospitalized with severe sepsis carry a significantly higher risk for cardiac arrest and increased mortality.

Prevalence of in-hospital nonsteroidal antiinflammatory drug exposure in patients with a primary diagnosis of heart failure.

To determine the prevalence of in-hospital nonsteroidal antiinflammatory drug (NSAID) exposure and associated outcomes in patients admitted with a primary diagnosis of heart failure. We performed a propensity-matched cohort analysis of patients admitted to Houston Methodist Hospital System with a primary diagnosis of heart failure according to the International Classification of Diseases-9-Clinical Modification (ICD-9-CM) from January 1, 2011 to December 31, 2014. Of the 9742 patients admitted with a primary diagnosis of heart failure, 384 patients (3.9%) were exposed to NSAID. After applying propensity scores we matched 305 NSAID exposed with 915 unexposed patients. Patients with in-hospital NSAID exposure had a longer length of stay (7.0±8.8days vs 6.1±8.5; P=.003) and increased prevalence of worsening renal function (34.4% vs 27.9%; P=.030). There were not statically significant differences in in-hospital mortality rate or 30-day all-cause readmission rate. Exposure to NSAID in patients admitted with a primary diagnosis of heart failure was low but was associated with adverse outcomes including longer length of stay and higher prevalence or worsening renal function.

A Geometric Classification of Jaw Deformities

In the United States, the most widely used classification system for jaw deformities is the one provided by the Center for Medicare and Medicaid Services and the National Center for Health Statistics. This classification is part of the International Classification of Diseases, Clinical Modification (ICD-CM), a taxonomy scheme that is based on the World Health Organization’s ICD, the world’s standard diagnostic tool for epidemiology, health management, and clinical care. 1 The most recent iteration of ICD-CM, the Tenth Revision (ICD-10-CM), sorts jaw deformities according to geometry into 3 groups: anomalies of jaw size, anomalies of the relation between the jaw and the cranial base, and unspecified (Table 1). 2 However, these deformities can affect 6 different geometric attributes: size, position, orientation, shape, symmetry, and completeness. In clinical practice and in teaching, the authors have found the ICD-CM classification to be incomplete and disjointed. With this in mind, the authors have developed a better classification system. The purpose of this report is to present it.

Severe Sepsis and Cardiac Arrhythmias

SESSION TITLE: Advances in Cardiac Disease SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 26, 2015 at 04:30 PM - 05:30 PM PURPOSE: Although sepsis is a known risk factor for cardiac arrhythmias, data on incidence and outcomes of atrial and ventricular arrhythmias in severe sepsis are limited. We examine the association of severe sepsis with cardiac arrhythmias and their impact on outcome in this patient population. METHODS: We used hospital discharge data from the Nationwide Inpatient Sample (NIS) from 2012. All patients 18 and older were included in the study. The International Classification of Diseases-Clinical Modification, 9th revision (ICD-9-CM) code was used to identify patients with discharge diagnosis of severe sepsis, atrial fibrillation, atrial flutter, ventricular fibrillation (VF) arrest and non-ventricular fibrillation (non-VF) arrest. To study the association of arrhythmias with severe sepsis, we defined two groups; a group with severe sepsis was compared to a group without severe sepsis. We used univariate and multivariate logistic regression methods to adjust for potential confounding factors and determined variables associated with cardiac arrhythmias. RESULTS: A total of 30,712,524 NIS hospital discharges (weighted for national estimate) were included in our study, of which 1,756,965 (5.7%) had severe sepsis. On multivariate analysis, after adjusting for potential confounders, severe sepsis was associated with higher prevalence of atrial fibrillation (OR 1.23; 95% CI 1.21-1.24), atrial flutter (OR 1.34; CI 1.30-1.40), VF arrest (OR 2.58; CI 2.38-2.79) (OR 3.31; CI 3.07-3.57) and non-VF arrest (OR 4.91; 4.74-5.07). In the severe sepsis group cardiac arrhythmia was associated with higher in-hospital mortality (OR 1.41; 95% CI 1.37-1.45), length of stay >75% quartile (OR 1.50; CI 1.46-1.53) and total hospital charges >75% quartile (OR 1.37; CI 1.34-1.41). Advanced age, male sex, ischemic heart disease, diabetes mellitus, congestive heart failure, valvular heart disease, respiratory failure, mechanical ventilation and use of vasopressors were independently associated with cardiac arrhythmias. CONCLUSIONS: Patients with severe sepsis are at high risk of atrial and life-threatening ventricular arrhythmias. Despite adjustment for potential confounding factors, patients hospitalized with severe sepsis carry significantly higher risk for cardiac arrest and increased mortality. CLINICAL IMPLICATIONS: Increased risk of life-threatening ventricular arrhythmias associated with severe sepsis warrants closer monitoring and highlights a need for developing preventive strategies, which could lead to better outcomes in this population. DISCLOSURE: The following authors have nothing to disclose: Krishna Thandra, Jawad Hussain, Muhammad Shahreyar, Sanjay Bhandari, Atul Thakur, Geetanjali Dang, Arshad Jahangir No Product/Research Disclosure Information

International Classification of Disease Clinical Modification 9 Modeling of a Patient Comorbidity Score Predicts Incidence of Perioperative Complications in a Nationwide Inpatient Sample Assessment of Complications in Spine Surgery

A patient comorbidity score (RCS) was developed from a prospective study of complications occurring in spine surgery patients. To validate the RCS, we present an International Classification of Disease Clinical Modification (ICD-CM)-9 model of the score and correlate the score with complication incidence in a group of patients from the Nationwide Inpatient Sample database. We compare the predictive value of the score with the Charlson index. We conducted a retrospective assessment of Nationwide Inpatient Sample patients undergoing cervical or thoracolumbar spine surgery for degenerative pathology from 2002 to 2009. We generated an ICD-9-CM coding-based model of our prospectively derived RCS, categorizing diagnostic codes to represent relevant comorbidities. Multivariate models were constructed to eliminate the least significant variables. ICD-9-CM coding was also used to calculate a Charlson comorbidity score for each patient. The accuracy of the RCS was compared with the Charlson index through the use of a receiver-operating curve. A total of 352,535 patients undergoing 369,454 spine procedures for degenerative disease were gathered. Hypertension and hyperlipidemia were the most common comorbidities. Cervical procedures resulted in 8286 complications (4.50%), whereas thoracolumbar procedures produced 25,118 complications (13.55%). Increasing RCS correlated linearly with increasing complication incidence (odds ratio [OR] 1.11; 95% confidence interval [CI], 1.10-1.13; P<0.0001). Logistic regression revealed that neurological deficit, cardiac conditions, and drug or alcohol use had greatest association with complication occurrence. The Charlson index also correlated with complication occurrence in both cervical (OR 1.25; 95% CI, 1.23-1.27) and thoracolumbar (OR 1.11; 95% CI, 1.10-1.12) patient groups. Receiver-operating curve analysis allowed a comparison of accuracy of the indices by comparing predictive values. The RCS performed as well as the Charlson index in predicting complication occurrence in both cervical and thoracic spine patients. ICD-9-based modeling validated that RCS correlates with complication occurrence. The RCS performed as well as the Charlson index in predicting risk of complication in spine patients.

Depression in Taiwanese patients with Alzheimer's disease determined by the National Institutes of Mental Health Provisional Criteria

Depression is a common behavioral and psychological symptom of Alzheimer's disease (AD). The aims of the present study were to determine the rate of depression in Taiwanese patients with AD using the National Institutes of Mental Health Provisional Criteria for Depression in AD (NIMH-dAD criteria) and to investigate the association of depression with other behavioral and psychological symptoms. A consecutive series of 302 AD patients registered in a dementia clinic were investigated in this study. All patients met the criteria of the National Institute of Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association for probable AD. The rates of depression were determined according to the criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders for major depression (DSM-IV), the International Classification of Diseases-9-Clinical Modification (ICD-9-CM) for neurotic depression, the depression subscale of the Neuropsychiatric Inventory (NPI), and the NIMH-dAD criteria. Depression severity was assessed using the 17-item Hamilton Depression Rating Scale. The rates of depression determined by the NIMH-dAD criteria were compared with the rates derived from each of the other instruments. Other behavioral and psychological symptoms were assessed using NPI. A behavioral neurologist or a geriatric psychiatrist interviewed all the patients. Using the NIMH-dAD criteria, it was found that 90 (29.8%) of the AD patients had depression, and all depressive symptoms in NIMH-dAD were significantly higher among depressed patients. Among other depression instruments, the frequency of depression was lowest using the DSM-IV major depression criteria (9.3%) and highest with the NPI depression subscale (54%). Behavioral and psychological symptoms determined with NPI were significantly higher among depressed patients in all domains except euphoria. This is the first study of depression in Taiwanese patients with AD using the NIMH-dAD criteria. Our findings suggest that comorbid depression is high in Taiwanese patients with AD. It is clinically important to note the high frequency of most behavioral and psychological symptoms among depressed AD patients.