Lower Charlson Comorbidity Index Scores Research Articles

Initial non-adherence to lipid-lowering medication: a systematic literature review

BackgroundThe impact on cardiovascular health is lost when a patient does not obtain a newly prescribed lipid-lowering medication, a situation termed “initial medication nonadherence” (IMN). This research summarizes the published evidence on the prevalence, associated factors, consequences, and solutions for IMN to prescribed lipid-lowering medication in the United States.MethodsA systematic literature search using PubMed and Google Scholar, along with screening citations of systematic reviews, identified articles published from 2010 to 2021. Studies reporting results of IMN to lipid-lowering medications were included. Studies that evaluated non-adult or non-US populations, used weaker study designs (e.g., case series), or were not written in English were excluded.ResultsThere were 19 articles/18 studies that met inclusion and exclusion criteria. Estimates of the prevalence of IMN to newly prescribed lipid-lowering medications ranged from 10 to 18.2% of patients and 1.4–43.8% of prescriptions (n = 9 studies). Three studies reported prescriber and patient characteristics associated with IMN. Hispanic ethnicity, Black race, lower Charlson Comorbidity Index score and no ED visits or hospitalization were associated with IMN. Lipid lowering prescriptions from primary care providers were also associated with IMN. Four studies described patient-reported reasons for IMN, including preference for lifestyle modifications, lack of perceived need, and side effect concerns. Four intervention studies reported mixed results with automated calls, live calls, or letters. One study reported worse clinical outcomes in patients with IMN: higher levels of low-density lipoprotein and greater risk of emergency department visits.ConclusionsUp to one-fifth of patients fail to obtain a newly prescribed lipid-lowering medication but there is limited information about the clinical consequences. Future research should assess outcomes and determine cost-effective approaches to address IMN to lipid-lowering therapy.

Impact of Smoking Cessation and Charlson Comorbidity Index on Influenza Vaccination Efficacy in COPD Patients.

Chronic obstructive pulmonary disease (COPD) patients are particularly susceptible to respiratory infections like influenza, which exacerbate symptoms and increase healthcare utilization. While smoking cessation and influenza vaccination are recommended preventive measures, their combined impact on healthcare resource utilization is underexplored. The Charlson Comorbidity Index (CCI) assesses comorbidity burden in COPD patients and may influence healthcare outcomes. We conducted a retrospective analysis of 357 COPD patients, evaluating smoking cessation success over one year and influenza vaccination receipt, stratifying patients by CCI scores. Healthcare utilization outcomes included emergency room visits, hospitalizations, and medical expenses. Results showed that 51.82% of patients quit smoking and 59.66% received influenza vaccination, with higher comorbidity prevalence in advanced COPD stages (p = 0.002). Both smoking cessation and influenza vaccination independently correlated with decreased emergency room visits, hospital admissions, days, and costs. Patients who both quit smoking and received influenza vaccination exhibited the lowest healthcare utilization rates. In conclusion, smoking cessation and influenza vaccination significantly reduce healthcare resource utilization in COPD patients, with the combination yielding synergistic benefits, particularly in those with lower CCI scores. Integrating these interventions and comorbidity management in COPD strategies is essential for optimizing patient outcomes and healthcare efficiency.

Comorbidities, acute kidney injury and long-term mortality in elderly patients hospitalized because of hip fracture: a moderation analysis

IntroductionFemoral fractures in elderly individuals present significant health challenges, often leading to increased morbidity and mortality. Acute kidney injury (AKI) during hospitalization further complicates outcomes, yet the interaction between AKI severity and comorbidities, as quantified by the Charlson Comorbidity Index (CCI), remains poorly understood in this population. This study aimed to assess the associations between AKI severity and the CCI and between AKI severity and one-year mortality postfemoral fracture in elderly patients.MethodologyThis study utilized data from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-IV) database and focused on elderly patients (> 65 years) admitted with hip fractures. Patients were categorized based on AKI stage according to the KDIGO criteria and CCI scores. The primary outcome assessed was all-cause mortality one year after hospital discharge. The statistical analyses included logistic regression, Cox proportional hazards regression and moderation analysis with the Johnson–Neyman technique to evaluate associations between AKI and long-term mortality and between the CCI and long-term mortality.ResultsThe analysis included 1,955 patients and revealed that severe AKI (stages 2 and 3) was independently associated with increased one-year mortality. Notably, the CCI moderated these associations significantly. A lower CCI score was significantly correlated with greater mortality in patients with severe AKI. The impact of severe AKI was greater for those with a CCI as low as 3, more than doubling the observed one-year mortality rate. In contrast, higher CCI scores (≥8) did not significantly impact mortality. Sensitivity analyses supported these findings, underscoring the robustness of the observed associations.ConclusionThis study elucidates the complex interplay between AKI severity and comorbidities and long-term mortality in elderly hip fracture patients. These findings underscore the importance of considering both AKI severity and comorbidity burden in prognostic assessments and intervention strategies for this vulnerable population. Targeted interventions tailored to individual risk profiles may help mitigate the impact of AKI on mortality outcomes, ultimately improving patient care and outcomes. Further research is warranted to explore the underlying mechanisms involved and refine risk stratification approaches in this population.

375 Cervical Arthroplasty in the Treatment of Myelopathy: Clinical Predictors, Utilization, and Outcomes in a Large Administrative Database

INTRODUCTION: Cervical arthroplasty is a treatment for cervical radiculopathy; however, it may also be safe and effective in patients with mild myelopathy. METHODS: Retrospective data spanning 2016-2020 from the PearlDiver Patient Claims Database was used to select patients. Age, gender, osteoporosis, obesity, smoking, diabetes, Charlson Comorbidity Index (CCI), and 1- or 2-level surgery, re-operation rates, 90-day readmission, medical complications, and morphine milligram equivalents (MME) before/after surgery were collected. Univariate & multivariate analyses were performed to identify differences. Reoperation rates were compared using propensity-matched analysis. RESULTS: We identified n = 2,391 (4.5%) CDA and n = 50,845 ACDF procedures for cervical myelopathy. Predictors favoring CDA included female sex, younger age, lower CCI score, lower incidence of obesity, osteoporosis, diabetes, or smoking (p ≤ 0.001); remaining significant after multivariate analysis except sex (p = 0.06). Single-level surgery was more predictive for undergoing CDA. CDA patients had lower 90-day readmissions, complications, and lower opioid utilization. The overall reoperation rate was 5%. Predictors of reoperation included: male sex, younger age, greater CCI, obesity, osteoporosis, diabetes, smoking, and 2-level surgery, remaining significant after multivariable logistic regression except for diabetes (p = 0.23) and CCI (p = 0.05). The robustness of these factors were evaluated by matching patients (n = 2,391) with no difference in re-operation rates identified (p = 0.47). CONCLUSIONS: CDA patients are generally healthier (lower incidence of obesity, smoking, diabetes, CCI) and represents 4.5% of procedures for 1- or 2-level cervical myelopathy. Readmission rates, medical complications, and opiate use was lower with patients undergoing CDA, despite an overall similar reoperation rate. This study is limited by its retrospective nature and the lack of granular outcomes measurements. However, the data suggests that CDA is a viable option for cervical myelopathy.

Iron Management and Anemia in Patients on the Active Kidney Transplant List

IntroductionIron metabolism disorders and anemia are one of the main complications of end-stage renal disease that may affect the evaluation process for kidney transplantation. The study aimed to assess the iron metabolism in hemodialysis patients in relation to waiting list status. Study MethodThe study included 5068 hemodialysis patients, including those on the active waiting list (N = 449) and those who were not eligible for the waitlist (N = 4619). Demographic and biochemical data, Charlson's comorbidity index, duration of hemodialysis therapy and, respectively, hemoglobin, ferritin, and transferrin saturation levels were compared in both groups of patients. ResultsPatients on the active waiting list were significantly younger −53.2 vs 67.2 years (P < .001), with a lower Charlson comorbidity index score: 3.33 vs 4.42 (P < .001). The duration of hemodialysis therapy was similar: 66.0 vs 63.2 months (P = .416), the incidence of anemia according to World Health Organization (90.6%, vs 91.2%) and KDIGO (72.4% vs 70.4%). The degree of anemia correction in terms of hemoglobin concentration and transferrin saturation was comparable in both groups and amounted to an average of 10.9 g/dL (P = .349) for hemoglobin concentration and 32.7% vs 33.4% (P = .513) for transferrin saturation. However, there was a statistically significant difference in ferritin concentration: 554 ug/L vs 733 ug/L (P = .001). ConclusionsPatients on the active list have significantly lower ferritin levels despite similar duration of hemodialysis treatment and comparable hemoglobin values. This may be due to lower inflammation, and less frequent blood transfusions, and lead to a lower risk of immunization and an increased chance of potential kidney transplantation.

Utilizing the National Early Warning Score 2 (NEWS2) to confirm the impact of emergency department management in sepsis patients: a cohort study from taiwan 1998–2020

BackgroundMost sepsis patients could potentially experience advantageous outcomes from targeted medical intervention, such as fluid resuscitation, antibiotic administration, respiratory support, and nursing care, promptly upon arrival at the emergency department (ED). Several scoring systems have been devised to predict hospital outcomes in sepsis patients, including the Sequential Organ Failure Assessment (SOFA) score. In contrast to prior research, our study introduces the novel approach of utilizing the National Early Warning Score 2 (NEWS2) as a means of assessing treatment efficacy and disease progression during an ED stay for sepsis.ObjectivesTo evaluate the sepsis prognosis and effectiveness of treatment administered during ED admission in reducing overall hospital mortality rates resulting from sepsis, as measured by the NEWS2.MethodsThe present investigation was conducted at a medical center from 1997 to 2020. The NEWS2 was calculated for patients with sepsis who were admitted to the ED in a consecutive manner. The computation was based on the initial and final parameters that were obtained during their stay in the ED. The alteration in the NEWS2 from the initial to the final measurements was utilized to evaluate the benefit of ED management to the hospital outcome of sepsis. Univariate and multivariate Cox regression analyses were performed, encompassing all clinically significant variables, to evaluate the adjusted hazard ratio (HR) for total hospital mortality in sepsis patients with reduced severity, measured by NEWS2 score difference, with a 95% confidence interval (adjusted HR with 95% CI). The study employed Kaplan-Meier analysis with a Log-rank test to assess variations in overall hospital mortality rates between two groups: the “improvement (reduced NEWS2)” and “non-improvement (no change or increased NEWS2)” groups.ResultsThe present investigation recruited a cohort of 11,011 individuals who experienced the first occurrence of sepsis as the primary diagnosis while hospitalized. The mean age of the improvement and non-improvement groups were 69.57 (± 16.19) and 68.82 (± 16.63) years, respectively. The mean SOFA score of the improvement and non-improvement groups were of no remarkable difference, 9.7 (± 3.39) and 9.8 (± 3.38) years, respectively. The total hospital mortality for sepsis was 42.92% (4,727/11,011). Following treatment by the prevailing guidelines at that time, a total of 5,598 out of 11,011 patients (50.88%) demonstrated improvement in the NEWS2, while the remaining 5,403 patients (49.12%) did not. The improvement group had a total hospital mortality rate of 38.51%, while the non-improvement group had a higher rate of 47.58%. The non-improvement group exhibited a lower prevalence of comorbidities such as congestive heart failure, cerebral vascular disease, and renal disease. The non-improvement group exhibited a lower Charlson comorbidity index score [4.73 (± 3.34)] compared to the improvement group [4.82 (± 3.38)] The group that underwent improvement exhibited a comparatively lower incidence of septic shock development in contrast to the non-improvement group (51.13% versus 54.34%, P < 0.001). The improvement group saw a total of 2,150 patients, which represents 38.41% of the overall sample size of 5,598, transition from the higher-risk to the medium-risk category. A total of 2,741 individuals, representing 48.96% of the sample size of 5,598 patients, exhibited a reduction in severity score only without risk category alteration. Out of the 5,403 patients (the non-improvement group) included in the study, 78.57% (4,245) demonstrated no alteration in the NEWS2. Conversely, 21.43% (1,158) of patients exhibited an escalation in severity score. The Cox regression analysis demonstrated that the implementation of interventions aimed at reducing the NEWS2 during a patient’s stay in the ED had a significant positive impact on the outcome, as evidenced by the adjusted HRs of 0.889 (95% CI = 0.808, 0.978) and 0.891 (95% CI = 0.810, 0.981), respectively. The results obtained from the Kaplan-Meier analysis indicated that the survival rate of the improvement group was significantly higher than that of the non-improvement group (P < 0.001) in the hospitalization period.ConclusionThe present study demonstrated that 50.88% of sepsis patients obtained improvement in ED, ascertained by means of the NEWS2 scoring system. The practical dynamics of NEWS2 could be utilized to depict such intricacies clearly. The findings also literally supported the importance of ED management in the comprehensive course of sepsis treatment in reducing the total hospital mortality rate.

The prognosis of clinical stage IIIa non-small cell lung cancer in Taiwan.

Lung cancer is the leading cause of cancer death. The treatment of stage IIIa remained the most controversial of all stages of non-small cell lung cancer (NSCLC). We reported on the heterogenicity and current treatment strategies of stage IIIa NSCLC in Taiwan. This study is a retrospective analysis using data from the Taiwan Society of Cancer Registry between January 2010 and December 2018. 4232 patients with stage IIIa NSCLC were included. Based on cell type, the best 5-year OS (40.40%) occurred among adenocarcinoma victims. The heterogenicity of T1N2 had the best 5-year OS (47.62%), followed by T4N0 (39.82%), and the others. Patients who underwent operations had better 5-year OS (over 50%) than those who did not (less than 30%). Segmentectomy (75.28%) and lobectomy (54.06%) showed better 5-year OS than other surgical methods (less than 50%). In multivariable analysis, young age, female, lower Charlson Comorbidity Index score, adenocarcinoma cell type, well differentiated, T1N2/T4N0 heterogenicity, treatment with operation, and segmentectomy/lobectomy/bilobectomy were significant factors. In conclusions, the heterogenicity of T1N2 had the best outcomes followed by T4N0. Patients received surgical treatment revealed much better outcomes than those did not. As always, multimodal therapies with individualized treatment tend to provide better survival outcomes.

Insurance status impacts survival of hepatocellular carcinoma patients after liver resection.

This study intends to examine the effect of public insurance status on survival outcomes of HCC patients after liver resection in China. We divided 2911 HCC patients after liver resection included in our study into the Urban Employed-based Medical Insurance group (UEBMI group, n = 1462) and the non-Urban Employed-based Medical Insurance group (non-UEBMI group, n = 1449). A propensity score matching (PSM) analysis was used to control confounding factors. Overall survival (OS) was estimated by Kaplan-Meier curves and Cox proportional hazard models based on variables screened by Lasso regression. Competing risk analysis was used to analyze cancer-specific survival (CSS). UEBMI group had more male patients (p = 0.031), patients in the UEBMI group were older (p < 0.001) and had lower Charlson Comorbidity Index scores (CCI score, p < 0.001). Meanwhile, patients in the UEBMI group had better liver function (albumin-bilirubin grade I [ALBI I], p < 0.001) and lower tumor burden (α-fetoprotein [AFP], p = 0.009; Barcelona Clinic Liver Cancer stage [BCLC], p = 0.026; Milan criteria, p < 0.001; tumor size, p < 0.001; microvascular invasion [MVI], p = 0.030; portal vein tumor thrombosis [PVTT], p = 0.002). More patients in the UEBMI group received laparoscopic surgery (p = 0.024) and adjuvant transarterial chemoembolization (TACE, p < 0.001). After PSM, patients in the two matched groups had similar characteristics. Patients with recurrent HCC in the UEBMI were more likely to receive curative therapy (p < 0.001) and less likely to receive supportive care (p < 0.001). HCC patients after liver resection in the non-UEBMI group had a worse OS before (p < 0.0001) and after PSM (p = 0.0031). In our Lasso-Cox risk regression model, public health insurance status was an independent factor linked with OS (non-UEBMI vs. UEBMI, hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 1.12-1.46; p < 0.001). In the competing risk analysis, patients in the UEBMI group had a lower cumulative incidence of CSS before (p < 0.001) and after PSM (p = 0.001), and public insurance status of HCC patients after liver resection remained independently associated with CSS (non-UEBMI vs. UEBMI; HR:1.36; 95% CI: 1.18-1.58; p < 0.001). Underinsured HCC patients after liver resection had worse survival outcomes. Less access to care for underinsured patients may explain the difference in survival, but the corresponding conclusions need to be further explored.

Comparison of patients with renal cell carcinoma in adjuvant therapy trials to a real-world population.

To compare characteristics and outcomes of patients included versus those not in adjuvant therapy trials post complete resection of renal cell carcinoma (RCC). Adult patients following complete resection for clear cell RCC between January 1, 2011, and March 31, 2021, were included. Patients had intermediate high, high risk nonmetastatic disease (modified UCLA Integrated Staging System) or fully resected metastatic (M1) disease as per the inclusion criteria of adjuvant studies. Demographic, clinical, and outcomes between trial and nontrial patients were compared. Of 1,459 eligible patients, 63 (4.3%) participated in an adjuvant trial. Disease characteristics were similar between groups. Trial patients were younger (mean age 58.1 vs. 63.6 years; P < 0.0001) and had lower Charlson Comorbidity Index scores (mean 4.2 vs. 4.9; P = 0.009). Unadjusted disease-free survival (DFS) at 5 years for trial patients was 48.6% and 39.2% for nontrial patients (HR 0.71, 0.48-1.05, P = 0.08). Median DFS was higher for trial patients in comparison to nontrial patients (4.4 years, IQR 1.7- not reached; vs. 3.0 years, IQR 0.8-8.6; P = 0.08). Cancer specific survival (CSS) at 5 years for trial patients was 85.2% in comparison to 78.6% for nontrial patients (HR 0.45, 0.22-0.92, P = 0.03). Unadjusted estimated overall survival (OS) at 5 years was 80.8% for trial patients and 74.8% (HR 0.42, 0.18-0.94; P = 0.04) for nontrial patients. Patients in adjuvant trials were younger and healthier with longer CSS and OS in comparison to those not included in adjuvant trials. These findings may have implications when we generalize trial results to real world patients.

Disease course in patients admitted to Bærum Hospital with the Delta and Omicron variants of the SARS-CoV-2 virus

Waves of infection have formed the pattern of the COVID-19 pandemic. A wave dominated by the delta variant of the SARS-CoV-2 virus in autumn 2021 was superseded by the omicron variant over the course of a few weeks around Christmas. We describe how this transition affected the population of patients admitted to a Norwegian local hospital with COVID-19. All patients admitted to Bærum Hospital with confirmed SARS-CoV-2 virus were included in a quality study which aimed to describe patient characteristics and clinical course. We present patients admitted in the periods 28June 2021-31December 2021 and 1January 2022-12June 2022, described here as the delta wave and the omicron wave. The SARS-CoV-2-virus was confirmed in a total of 144 patients who were admitted during the delta wave, and in 261 patients during the omicron wave, where 14/144 (10%) and 89/261 (34%) were admitted for reasons other than COVID-19. Patients with COVID-19 during the delta wave were younger on average (59 vs. 69 years) and had a lower Charlson comorbidity index score (2.6 vs. 4.9) and a lower Clinical Frailty Scale score (2.8 vs. 3.7) than patients in the omicron wave. Among 302/405 patients admitted with COVID-19 as the principal diagnosis, 88/130 (68%) patients had respiratory failure during the delta wave and 59/172 (34%) during the omicron wave, with a median number of 8 bed days (interquartile range 5-15) and 5 (interquartile range 3-8). The transition from the wave of infection that was dominated by the delta variant of the SARS-CoV-2 virus to the wave dominated by the omicron variant had a considerable effect on the characteristics and clinical course of patients admitted to hospital with SARS-CoV-2 infection.

Impact of comorbidity burden on immune-related adverse events and survival among older adults with cancer on immunotherapy.

12061 Background: Comorbidities are more prevalent among older adults and predict worse outcomes for cytotoxic chemotherapy. Immunotherapies are increasingly used to treat various cancers and have a milder but less predictable toxicity profile. This study aimed to evaluate the association of comorbidity burden with immune-related adverse events (irAEs) and survival among older adults treated with these immunotherapies for any cancer type. Methods: We created a retrospective registry of consecutive patients ≥ 70 years old treated with one or more doses of an immune checkpoint inhibitor for any cancer indication between 2/1/2011- 4/7/2022 at our comprehensive cancer center. Treatment outcomes, including treatment-emergent adverse events, were captured via chart review. The comorbidity burden at the time of immunotherapy initiation was captured by chart abstraction and classified using the Charlson Comorbidity Index (CCI). We compared patients with high CCI scores (≥ 4) to patients with low CCI scores (CCI &lt;4) on the outcome of any irAE yes/no, using chi-square tests. We used the Kaplan-Meier method to compare progression-free survival (PFS) and overall survival (OS) between the two CCI groups. Survival analyses were calculated from the first dose of immunotherapy to death, last follow-up, or disease progression. A two-sided alpha of 0.05 was used for analyses. The study had institutional IRB approval. Results: Our cohort consisted of 1,216 patients (median age 76 years [interquartile range 73 to 80]), of which 217 (18%) had a high CCI score. The most common comorbidities were chronic obstructive lung disease (45%), coronary artery disease (29%), and diabetes (29%). The most common cancer type was lung cancer (46%), followed by melanoma (15%). Patients with a high CCI score had a shorter median overall survival than patients with a low CCI (11.2 vs. 13.8 months, respectively, p = 0.049). However, there was no significant difference in PFS between the high and low CCI groups (median PFS 27.1 vs. 25.0 months, p=0.32). There was no association between the CCI group and the incidence of any-grade irAEs (39% vs. 40%, p = 0.82). There was also no association between CCI group and high-grade (grade ≥3) irAEs (17% vs. 15%, p = 0.35). We did not find any associations between any individual CCI comorbid condition and risk of irAE.1 Conclusions: A high comorbidity burden, as measured by the CCI, was not associated with increased immunotherapy toxicity or shorter PFS among older adults. The presence of comorbidities was associated with shorter OS. These data can support informed decision-making for older adults with comorbidity considering immunotherapy. Reference: 1. Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. Psychother Psychosom. 2022;91(1):8-35. doi: 10.1159/000521288. Epub 2022 Jan 6. PMID: 34991091.

Effect of neoadjuvant chemotherapy on overall survival in stage II and stage III colon cancer: A propensity-score matched analysis of the National Cancer Database.

e15632 Background: Neoadjuvant chemotherapy (NAC) is currently indicated for patients with advanced colon cancer. However, there are little data regarding the impact of NAC on short-term outcomes and overall survival (OS). This study aimed to determine the role of NAC in patients with advanced colon cancer. Methods: A retrospective analysis of all patients with stage II-III colonic adenocarcinoma in the US National Cancer Database (NCDB) between 2006 and 2019. Propensity score matching was used to adjust for possible confounders. The cohort was divided into two equally matched groups: patients who received NAC and controls. The primary outcome was 5-year OS. Results: 902 (1.6% of the original cohort) patients with clinical stage II-III colonic adenocarcinoma were treated with NAC. Before matching, patients treated with NAC were significantly younger (61 vs 76 years; p &lt; 0.001) and more often male (54.5% vs. 46.5%; p &lt; 0.001) and had more private insurance (46.9% vs 22.6%; p &lt; 0.001) and a lower Charlson comorbidity index score (p &lt; 0.001). In addition, patients treated with NAC had more left-sided tumors (41.7% vs 30.1%; p &lt; 0.001) and underwent more resections of a contiguous organ with colonic resection (27.1% vs 7.6%; p &lt; 0.001). After matching, 620 patients were included in each group. The mean OS of patients in the NAC group was comparable to the control group (105.2 months, 95%CI: 98.1-112.2 vs 105 months, 95%CI: 98.2-111.7; p = 0.627). Stratifying OS based on clinical stage demonstrated that mean OS was significantly longer in patients with stage III (100.8 months, 95%CI 92.6-109.1 vs 88.4 months, 95%CI 79.7-97.1; p = 0.01), while the opposite effect was noted in stage II patients (106.1 months, 95%CI 96-116.3 vs 119.8 months, 95%CI 110.5-129.2; p = 0.04). Cox regression survival analysis showed that NAC was significantly associated with a lower risk of mortality (HR 0.72, 95%CI 0.64-0.8; p &lt; 0.001). Conclusions: Preoperative neoadjuvant chemotherapy is associated with improved OS in patients with Stage III colon cancer, but not in patients with stage II disease.

Hip Resurfacing is Associated with Significantly Shorter Length of Stay and Increased Postoperative Mobilization than Total Hip Arthroplasty

AbstractMetal-on-metal hip resurfacing (HRA) is performed as an alternative for total hip arthroplasty (THA) for symptomatic hip osteoarthritis in young, active male patients. This article seeks to determine if there is a difference in postoperative pain, mobilization, and opioid consumption between HRA and THA. A single-institution total joint arthroplasty database was utilized to identify adult patients who underwent elective HRA or THA between 2016 and 2019. Baseline demographic data along with operative time and Charlson Comorbidity Index (CCI) were collected. Patients were matched by age, sex, race, smoking status, body mass index (BMI), and CCI. Morphine milligram equivalents (MME) and visual analog scale scores were collected. Activity Measure for Post-Acute Care (AM-PAC) was used to determine physical therapy progress. A total of 7,387 cases were identified: 96.59% THA (7,135) and 3.41% HRA (252). HRA patients were significantly younger (52.52 vs. 64.04 years; p &lt; 0.001), had higher BMI (30.03 vs. 29.40; p = 0.029), and were almost exclusively male as compared with the THA cohort (98.8% vs. 42.2%; p &lt; 0.001). HRA patients had lower CCI scores (0.36 vs. 1.14; p &lt; 0.001). Surgical time was greater for HRA (124.81 vs. 103.82 minutes; p &lt; 0.001). HRA patients had significantly shorter length of stay (LOS) than THA patients (1.17 vs. 1.48 days; p &lt; 0.001) and had significantly better AM-PAC scores (21.52 vs. 20.65; p = 0.032). HRA patients exhibited a trend toward home discharge (0.4% vs. 2.4%; p = 0.057). Aggregate opioid consumption (23.63 vs. 27.89 MME; p = 0.321) and pain scores (3.47 vs. 3.28; p = 0.438) were not different between matched cohorts. HRA patients are younger, almost exclusively male, and have lower CCI scores at time of surgery. HRA is associated with significantly shorter LOS and greater mobilization measures. They tended to have a higher rate of home discharge. Both groups had similar pain scores and opioid consumption. Level III Retrospective Cohort Study.

Trends and Predictors of Short Length of Stay Following Transcatheter Aortic Valve Replacement

BackgroundMinimalist approaches to Transcatheter aortic valve replacement (TAVR) have allowed for improved efficiency in care of patients. We hypothesized that improved efficiencies in care process may have led to increased adoption of a one night length of stay (LOS) in this patient group. ObjectivesThe authors aimed to study temporal trends in short length of stay following TAVR. MethodsThis is a nationwide temporal trends study using the 2016–2019 National In Patient Sample (NIS) registry. Short stay was defined as LOS of one night or less. Trends in proportion of patients with short stay were obtained. A multivariate model to identify predictors of short stay was built after adjusting for confounders. Secondary analysis of temporal trends was stratified by presence or absence of major complications (major bleeding requiring transfusion or pacemaker implantation [PPMI]). ResultsA total of 217,110 patients were included in the weighted sample. The proportion of patients with short stay significantly increased for those with and without complications (Ptrend < 0.001). The morbidity burden, as defined by the proportion of patients with a Charlson comorbidity index (CCI) score of ≥2 and rate of major complications decreased significantly. On multivariate analysis short stay was predicted by male sex, white ethnicity, Southern/Western regions and lower CCI score. Patients with major bleeding requiring transfusion or PPMI were less likely to have short stay (aOR 0.23 and aOR 0.12, p < 0.001 respectively). ConclusionThere is a national trend towards shorter LOS following TAVR. There is a decrease in major post procedural complication rates from 2016 to 2019.

Synchronous Head and Neck Cancer and Superficial Esophageal Squamous Cell Neoplasm: Endoscopic Treatment or No Treatment for the Superficial Esophageal Neoplasm

There are no studies on treating synchronous head and neck cancer (HNC) and superficial esophageal squamous cell neoplasm (SESCN). We aimed to report the outcomes of endoscopic resection (ER) and no treatment (NT) of SESCN in patients with synchronous HNC and SESCN (SHNSESCN). This retrospective study included 47 patients with SHNSESCN. Treatment for SESCN was ER (n = 30) or NT (n = 17). The ER group had significantly lower Charlson comorbidity index scores and a higher proportion of Eastern Cooperative Oncology Group performance status (ECOG PS) scores ≤1. The location and stage of the two tumors did not differ significantly between the groups. The 1-year, 3-year, and 5-year OS rates of the ER group were significantly better than those in the NT group. Treatment-related morbidity and mortality were not significantly different between the two groups. In the subgroup analysis of synchronous advanced HNC and SESCN, ER for SESCN also had a higher OS rate. Multivariate analysis showed that ECOG PS score and HNC disease progression were the two independent indicators of OS. In conclusion, treatment of SESCN with ER is the recommended approach for patients with SHNSESCN, but further randomized controlled trials are needed to confirm this.

High-flow cannula for frail patients with SARS-CoV-2 infection non-eligible for intensive care unit management

ObjectivesHigh-flow nasal cannula (HFNC) was widely used during the COVID-19 pandemic in intensive care units (ICU), but there is no recommendation for elderly patients non-eligible for ICU management. We aimed to describe the outcomes of HFNC treatment in patients with COVID-19 who are not eligible for ICU management. MethodsRetrospective bicentric cohort study performed between September 1, 2020 and June 30, 2021 in two infectious diseases departments of Colmar Hospital and Antoine Beclere University Hospital, France. ResultsSixty-four patients were treated with HFNC: 33 in Colmar and 31 in Beclere hospital (median age: 85 years; IQ, 82–92). Of these, 16 patients survived (25%). Surviving patients had a lower Charlson comorbidity index score than deceased patients (five vs six; p = 0.02). ConclusionsDespite a high death rate, with survivors being younger and having fewer comorbidities, HFNC is an easy tool to implement in non-ICU wards for the frailest patients.

Malnutrition and Poor Physical Function Are Associated With Higher Comorbidity Index in Hospitalized Older Adults.

BackgroundThe Charlson Comorbidity Index (CCI) is the most widely used method to measure comorbidity and predict mortality. There is no evidence whether malnutrition and/or poor physical function are associated with higher CCI in hospitalized patients. Therefore, this study aimed to (i) analyze the association between the CCI with nutritional status and with physical function of hospitalized older adults and (ii) examine the individual and combined associations of nutritional status and physical function of older inpatients with comorbidity risk.MethodsA total of 597 hospitalized older adults (84.3 ± 6.8 years, 50.3% women) were assessed for CCI, nutritional status (the Mini Nutritional Assessment-Short Form [MNA-SF]), and physical function (handgrip strength and the Short Physical Performance Battery [SPPB]).ResultsBetter nutritional status (p < 0.05) and performance with handgrip strength and the SPPB were significantly associated with lower CCI scores among both men (p < 0.005) and women (p < 0.001). Patients with malnutrition or risk of malnutrition (OR: 2.165, 95% CI: 1.408–3.331, p < 0.001) as well as frailty (OR: 3.918, 95% CI: 2.326–6.600, p < 0.001) had significantly increased the risk for being at severe risk of comorbidity. Patients at risk of malnutrition or that are malnourished had higher CCI scores regardless of being fit or unfit according to handgrip strength (p for trend < 0.05), and patients classified as frail had higher CCI despite their nutritional status (p for trend < 0.001).ConclusionsThe current study reinforces the use of the MNA-SF and the SPPB in geriatric hospital patients as they might help to predict poor clinical outcomes and thus indirectly predict post-discharge mortality risk.

Equal receipt of specialized palliative care in breast and prostate cancer: a register study

PurposeThere are inequalities in cancer treatment. This study aimed to investigate whether receipt of specialized palliative care (SPC) is affected by typical female and male diagnoses (breast and prostate cancer), age, socioeconomic status (SES), comorbidities as measured by the Charlson Comorbidity Index (CCI), or living arrangements (home vs nursing home residence). Furthermore, we wanted to investigate if receipt of SPC affects the place of death, or correlated with emergency department visits, or hospital admissions.MethodsAll breast and prostate cancer patients who died with verified distant metastases during 2015–2019 in the Stockholm Region were included (n = 2516). We used univariable and stepwise (forward) logistic multiple regression models.ResultsLower age, lower CCI score, and higher SES significantly predicted receipt of palliative care 3 months before death (p = .007–p < .0001). Patients with prostate cancer, a lower CCI score, receiving palliative care services, or living in a nursing home were admitted to a hospital or visited an emergency room less often during their last month of life (p = .01 to < .0001). Patients receiving palliative care services had a low likelihood of dying in an acute care hospital (p < .001). Those who died in a hospital were younger, had a lower CCI score, and had received less palliative care or nursing home services (p = .02– < .0001).ConclusionAge, comorbidities, and nursing home residence affected the likelihood of receiving SPC. However, the diagnosis of breast versus prostate cancer did not. Emergency room visits, hospital admissions, and hospital deaths are registered less often for patients with SPC.

Charlson comorbidity index predicts the 10-year survivorship of the operatively treated hip fracture patients

PurposeThe aim of this study was to determine how Charlson comorbidity index (CCI) predicts the 10-year survival of operatively treated hip fracture patients aged ≥ 65 years.MethodsThis retrospective cohort study included all consecutive patients who had a hip fracture and were operatively treated upon in the study period from 01 January 2007 to 31 December 2007 at the university hospital. The clinical patient data were obtained from the medical records, and CCI score was calculated. The CCI predicts the 10-year mortality for a patient who may have a range of 22 comorbid conditions. Cumulative survival and complications were evaluated in terms of gender.ResultsA total of 241 hip fractures were studied; of these, 183/241 (76%) were females. A total of 32/241 (15%) complications were found, of which 26/241 (11%) were considered major. Overall, 213/241 (88%) patients died during the 10 years of follow-up. Cumulative survival estimates for females were 13% at 10 years (SE = 0.3, 95% CI 3.8–4.8), and for males, it was 12% at 10 years (SE = 0.5, 95% CI 2.8–4.6) (p = 0.33). CCI was significantly associated with mortality after the hip fracture as patients with CCI scores ≥ 4 were at a 3.1–8.5 times higher risk of death compared to patients with low CCI scores of 2–3 (p < 0.001).ConclusionComplications are common after operatively treated hip fracture. Advanced age, living in a care facility, ASA class 4 and high CCI score ≥ 4 were risk factors of mortality after the operatively treated hip fracture.

Minimally invasive, benign foregut surgery is not associated with long-term, persistent opioid use postoperatively: an analysis of the IBM® MarketScan® database.

It is unknown if opioid naïve patients who undergo minimally invasive, benign foregut operations are at risk for progressing to persistent postoperative opioid use. The purpose of our study was to determine if opioid naïve patients who undergo minimally invasive, benign foregut operations progress to persistent postoperative opioid use and to identify any patient- and surgery-specific factors associated with persistent postoperative opioid use. Opioid-naïve, adult patients who underwent laparoscopic fundoplication, hiatal hernia repair, or Heller myotomy from 2010 to 2018 were identified within the IBM® MarketScan® Commercial Claims and Encounters Database. Daily drug logs of the preoperative and postoperative period were evaluated to assess for changes in drug use patters. The primary outcome of interest was persistent postoperative opioid use, defined as at least 33% of the proportion of days covered by opioid prescriptions at 365-day follow-up. Patient demographic information and clinical risk factors for persistent postoperative opioid use at 365days postoperatively were estimated using log-binomial regression. A total of 17,530 patients met inclusion criteria; 6895 underwent fundoplication, 9235 underwent hiatal hernia repair, and 1400 underwent Heller myotomy. 9652 patients had at least one opioid prescription filled in the perioperative period. Sixty-five patients (0.4%) were found to have persistent postoperative opioid use at 365days postoperatively. Lower Charlson comorbidity index scores and a history of mental illness or substance use disorder had a statistically but not clinically significant protective effect on the risk of persistent postoperative opioid use at 365days postoperatively. Only half of opioid naïve patients undergoing minimally invasive, benign foregut operations filled an opioid prescription postoperatively. The risk of progression to persistent postoperative opioid use was less than 1%. These findings support the current guidelines that limit the number of opioid pills prescribed following general surgery operations.