National Database Study Research Articles

Predictors of 30-day readmissions for adrenal insufficiency: A retrospective national database study.

The aim of this study was to describe rates and characteristics of non-elective 30-day readmission among patients hospitalized for adrenal insufficiency and to assess predictors of readmission. We analysed the 2018 National Readmission Database. Adrenal insufficiency hospitalizations were identified using the International Classification of Diseases, Tenth Revisions, Clinical Modification diagnosis codes for principal diagnostic codes of primary adrenal insufficiency, Addisonian crisis, drug-induced adrenocortical insufficiency, and other and unspecified adrenocortical insufficiency. During the study period, 7738 index hospitalizations were identified as patients with AI who met the inclusion criteria. Of these, 7691 were discharged alive. We utilized chi-squared tests to compare baseline characteristics between readmissions and index hospitalizations. Multivariate Cox regression was used to identify independent predictors of readmission. The 30-day all-cause readmission rate for AI was 17.3%. About 1 in 5 readmissions was for AI. Other reasons for readmission included sepsis (10.8%), unspecified pneumonia (3.1%) and acute renal failure unspecified (1.6%). Readmission was associated with significantly higher odds of inpatient mortality. Independent predictors of 30-day all-cause readmissions included index hospitalizations with the Charlson Comorbidity Index (CCI) ≥3 (adjusted hazards ratio (aHR): 2.53, 95% CI: 1.85-3.46, p<.001), protein-energy malnutrition (aHR: 1.28, 95% CI: 1.02-1.60, p=.035) and obesity (aHR: 1.26, 95% CI: 1.02-1.56, p=.035). The 30-day all-cause readmission rate was 17.3%. AI was the most common reason for readmission among other causes. Readmissions were associated with increased mortality. CCIs of 3 or more, protein-energy malnutrition and obesity were significant predictors of readmission.

Hypercalcemia as a predictor of adverse treatment outcomes in DLBCL during chemotherapy: A national inpatient database study.

e19571 Background: Hypercalcemia occurs in up to 7% of NHL and up to 18% in diffuse large B-cell lymphoma (DLBCL) representing about 60% of cases. Thus far, there are only a few studies that have established the poor prognosis between hypercalcemia and outcomes in DLBCL. We sought to outline specific acute complications that can during admission for chemotherapy in patients with hypercalcemia. Methods: This is a retrospective analysis of hospital admission using the National Inpatient Sample database (2018), including 15,636 adult patients with DLBCL admitted for chemotherapy. We obtained descriptive data, conducted chi-square test, and stratified logistic regression to look for possible chemotherapy related acute medical complications &amp; predictors of mortality in DLBCL with &amp; without hypercalcemia. Study limitations included lack of long term follow up, variations in chemotherapy and possible under-reporting of test subjects. Results: The mean age among DLBCL patients with &amp; without hypercalcemia were 65.41 and 58.52 years respectively and the mean length of stay were 6.56 and 4.98 days respectively. Patient’s race, type of insurance and Charlson’s comorbidity index were found to be significant predictors of mortality in patients with DLBCL admitted for chemotherapy. Among race, Hispanics &amp; Asian or Pacific islanders were found to be at higher risk for mortality, while patients who had private insurance were found to be associated with higher mortality risk (p&lt;0.01). Similarly, Native Americans (aOR 8.72, 1.93-39.34, p&lt;0.01) and patients with Charlson comorbidity index of 4 or more were at higher risk of mortality (aOR 4.34, 2.30-8.18, p&lt;0.01). In regard to acute medical complications, DLBCL patients with hypercalcemia were at higher risk for tumor lysis syndrome (TLS) (aOR 3.86, p&lt;0.01), acute kidney injury (AKI) (aOR 4.28, p&lt;0.01) and hyperuricemia (aOR 9.74, p&lt;0.01). There was no significant association of hypercalcemia in DLBCL with hyperkalemia, fluid overload, ICU admission, mortality, total cost, or length of stay. Conclusions: Hypercalcemia is associated with higher adverse outcomes during chemotherapy treatment in patients with DLBCL including TLS, hyperuricemia, and AKI during chemotherapy admission. This confirms to the overall accession of poor outcomes as published by other studies.[Table: see text]

The effect of prescribing antibiotics with opioids on the development of opioid use disorder: a national database study

The goal of this study was to examine the impact of inpatient- or emergency department- prescribed antibiotic treatment in combination with opioids on the risk of developing opioid use disorder 12 months following discharge from the hospital. The authors conducted a propensity score-matched cohort study with data from the TriNetX Research Network database to identify adult subjects (18–65 years old) with no previous history of an opioid use disorder. Three cohorts were defined for the analyses: subjects who were prescribed an opioid, opioid in combination with an antibiotic, or an antibiotic while in the emergency department or inpatient unit, from the years 2012 to 2018. The diagnosis of an Opioid Related Disorder (F11.10–F11.20) 12 months following discharge from the emergency department or inpatient unit was then observed within the cohorts following the index event as identified by the ICD-10 procedural coding system. Primary analysis (propensity-score matched on age and sex) showed that opioids prescribed in combination with antibiotics had a protective effect against the development of opioid use disorder. This effect was consistent throughout all of the years included in this study with the smallest protective effect observed in 2018 (2012 risk ratio = 1.27 (95% CI: 1.23, 1.32); 2018 risk ratio: 1.03 (95% CI: 1.01, 1.05). These findings suggest that opioids prescribed in combination with antibiotics in the hospital setting are protective against the development of OUD at later time points following hospital discharge.

Short-Term Complications and Readmission Following Total Shoulder Arthroplasty: A National Database Study.

The incidence of total shoulder arthroplasty (anatomic and reverse) is increasing as indications expand. The purpose of this study is to identify predictors of short-term complications and readmission following total shoulder arthroplasty for patients with glenohumeral osteoarthritis. The American College of Surgeons National Surgical Quality Improvement Program was used to identify 12,982 patients who underwent total shoulder arthroplasty (anatomic or reverse) from 2011-2016. Demographic data, postoperative complications, and readmission within 30 days were analyzed. Multivariable logistic regression was used to determine independent risk factors for complications and for readmission occurring within 30 days of surgery. The mean age of the cohort was 69.1 years, 56.1% were female. Mean American Society of Anesthesiologists (ASA) classification score was 2.6. The postoperative complication rate was 5.6% and the readmission rate was 2.8% within 30 days of surgery. Independent predictors for any complication included preoperative dependent functional status (OR 1.8, P<0.001), ASA class 3 (OR 3.6, P=0.021) and 4 (OR 8.5, P<0.001), age 70-79 (OR 1.4, P=0.019) age ≥ 80 years (OR 2.3, P<0.001, and female gender (OR 1.6, P=0.001). Independent predictors for readmission included congestive heart failure (OR 3.4, P=0.002) and ASA class 4 (OR 14, P = 0.013). Independent functional status was associated with decreased odds of readmission (OR 0.4, P<0.001). Patients with age greater than 70 years, congestive heart failure, and ASA class 3 and 4 are at increased risk for postoperative complications and readmission. Preoperative risk stratification and medical optimization are important in these patients.

Trends in operative duration of total shoulder arthroplasty from 2008 to 2018: a national database study.

As total shoulder arthroplasty has emerged as the fastest growing joint replacement performed, optimizing surgical efficiency and patient outcomes is essential. The goals of the current study were to identify trends and factors affecting the operative time of total shoulder arthroplasty over a 10-year period. The National Surgical Quality Improvement Program database was analyzed to determine the operative time and 30-day complications of total shoulder arthroplasty from 2008 to 2018. Factors affecting total shoulder arthroplasty operative time were also assessed. Multivariable linear regression was used to analyze operative time over years studied while controlling for patient demographics and comorbidities. A total of 20,587 total shoulder arthroplasty cases from 2008 to 2018 were included. Mean operative time in 2008 was 139.0 min, while in 2018, mean operative time decreased to 105.6 min (P < .001). Male sex, outpatient surgery, increased body mass index, and low preoperative hematocrit were associated with longer operative times, while elevated international normalized ratio, resident involvement, and elective surgeries were associated with decreased operative duration. Operative time for total shoulder arthroplasty has decreased from 2008 to 2018. Patient factors and comorbidities are associated with operative time, and such factors are important to consider in operative planning to ensure appropriate patient and surgeon expectations.

In-patient outcomes of patients with diabetic ketoacidosis and concurrent protein energy malnutrition: A national database study from 2016 to 2017

ABSTRACT Introduction: Patients often present to the hospital with a well-known complication of diabetes mellitus, namely diabetic ketoacidosis (DKA). In this study, we assess the clinical outcomes of DKA hospitalizations with and without protein-energy malnutrition (PEM). Methods: This was a population-based, retrospective observational study using data gathered from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. Hospitalizations of adults >/ = 18 years old with a principal diagnosis of DKA were obtained using ICD-10 codes and divided into groups based on a secondary diagnosis of PEM. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), total hospital charges (THC), and system-based complications. Results: Patients with PEM had a statistically significant difference in the adjusted odds for in-hospital mortality compared to patients without PEM (aOR 1.73, 95% CI: 1.20–2.49, p = 0.004). Patients with DKA and PEM had an increased risk of developing sepsis (aOR 2.99, 95% CI: 2.49–3.58, p < 0.001), septic shock (aOR 3.37, 95% CI: 2.31–4.91, p < 0.001), acute kidney failure (aOR 1.27, 95% CI: 1.17–1.37, p < 0.001), acute respiratory failure (aOR 2.23, 95% CI: 1.83–2.73, p < 0.001), deep vein thrombosis (aOR 1.91, 95% CI: 1.43–2.54, p < 0.001), and pulmonary embolism (aOR 2.36, 95% CI: 1.42–3.94, p = 0.001). Patients with DKA and PEM also had an increased mean THC (aOR 19,200, 95% CI 16,000–22,400, p < 0.001) in US dollars and increased LOS (aOR 2.26, 95% CI 1.96–2.57, p < 0.001) in days when compared to patients without PEM. Conclusion: Patients hospitalized for DKA with a secondary diagnosis of PEM within the same admission had a statistically significantly higher in-hospital mortality.

118 The Clinical and Demographic Predictors Associated with Physical Function in Pediatric Burn Survivors: A Burn Model System National Database Study

Abstract Introduction Burns are a common pediatric injury, and severe burns can interfere with a child’s physical function. Rehabilitation for these patients continues to evolve; however, little is known about how clinical and demographic factors affect long-term physical function outcomes. This study will evaluate the association between Patient Reported Outcome Measurement Information System-29 (PROMIS) physical function-mobility subscale scores (PF) and various clinical and demographic factors among pediatric burn survivors. Methods Data were collected from the Burn Model System National Database (1994–2020) and was compiled from five ABA verified burn centers. The data requested included pediatric self-report PROMIS PF scores assessed at 6 months post-burn. A linear regression model was performed with PF total score at 6 months as the dependent variable and total body surface area (TBSA) burned, age, sex, etiology of the burn, length hospital of stay (LOS), and race/ethnicity as independent variables. Results A total of 82 patients between the ages of 8–17 were included in the regression analysis. The mean physical function scores for the participants was 46.2 (SD=11.9), 20.0–57.1 with 50 (SD=10) being the average for the general population. The mean % TBSA burned was 37 (SD=19), 2–90. The regression model revealed an association (n=82; F=7.85; p&amp;lt; 0.001; R2=0.2648) of PF to the predictors LOS (p &amp;lt; 0.001; regression coefficient= -0.18) and White ethnicity compared to Hispanic (p&amp;lt; 0.001; regression coefficient=8.89). Conclusions In this study, pediatric burn patients’ self-reported physical function was associated with ethnicity and hospital stay, with longer hospital stay and Hispanic ethnicity resulting in lower PF.

Laparoscopic Sleeve Gastrectomy Following Failed Laparoscopic Adjustable Gastric Banding-a Comparison Between One- and two-Stage Procedures, an Israeli National Database Study.

The optimal revisional bariatric surgery procedure following a previous failed gastric band surgery is yet to be determined. The aim of our study was to compare single- and two-stage laparoscopic sleeve gastrectomy (LSG) following laparoscopic adjustable gastric banding (LAGB) in terms of short- and mid-term outcomes. Patients who underwent LSG after a failed LAGB in Israel during 2014-2017 were included. Data were obtained from the Israeli National Bariatric Surgery Registry. Data analyzed included comorbidities, postoperative complications, and anthropometric outcomes. Of 595 patients included in the data analysis, 381 (64%) underwent one-stage and 214 (36%) had two-stage LSG. No differences were observed between the groups in complication rates (5.0 vs. 5.1%, p=0.93). Percent of total weight loss was lower following one-stage than two-stage procedure at both 6 months (19.3±9.3 vs. 21.5±8.1%; p=0.02) and 1 year postoperative (24.9±10.4 vs. 27.8±9.9%; p=0.02). No difference was observed in the percent excess weight loss (51 vs. 56%; p=0.34 and 66 vs. 72%; p=0.38, at 6 months and 12 months postoperative, respectively). In a regression analysis, percent excess weight loss was greater in the two-stage procedure (p=0.02), with no difference in the complication rates (p=0.98). Single-step LSG had a similar safety profile as two-stage LSG following a failed LAGB. Better weight loss was seen following two-stage LSG. Further prospective studies should investigate long-term follow-up after one- and two-stage procedure.

Association of select preventative services and hospitalization in people with diabetes.

The purpose of this study was to assess the utilization rates and trends of preventative outpatient visits to providers in a population of people with diabetes, and evaluate which preventative services may offer protection against poor outcomes (i.e. all-cause hospitalization). The National Health and Nutrition Examination Survey (NHANES) was used to examine the relationship between select outpatient services and risk of all-cause hospitalization in people with diabetes. NHANES data from 2011 to 2016 were included. We assessed five outpatient services commonly recommended to prevent future complications in patients with diabetes: (1) routine examination from a physician (2) assessment of hemoglobin A1C (3) eye exam with pupil dilation (4) foot exam and (5) assessment from a diabetes specialist. Logistic regression models were performed to assess the independent association of outpatient services used in the past 1 year, and hospitalization within that same year. The prevalence of diabetes within the NHANES population was 10.5% (n = 3054). Hospitalization was significantly more common among diabetics who were older, had lower income levels (i.e. under $20,000) and those who considered themselves in 'fair' or 'poor health'. After adjustment for important covariates, patients who received a preventative foot exam within the last year (i.e. 1-4 times per year) were 33% less likely to be hospitalized within that year (OR 0.67, 95%CI 0.46, 0.96). Those visiting a diabetes specialist were 44% less likely to be hospitalized that year (OR 0.56, 95%CI 0.39, 0.82) if the visit was preventative in nature (i.e. occurred more than one year before the hospitalized event). No other outpatient services displayed an independent association with hospitalization. Outpatient Services were consistently being used annually by the diabetic population. Receiving a preventative foot exam and visiting a diabetes specialist were associated with protection against hospitalization, resulting in a 33% and 44% decreased risk, respectively. Evidence before this study: Current guidelines focus on preventative care measures to avert diabetes complications. In a 2018 national database study of approximately one-third of the Italian population, guidelines for prevention were not consistently being met among the diabetes population, however, patients who regularly received all the recommended preventative measures experienced a 20% risk reduction in hospitalization. The study's preventative measures included periodic lab monitoring including glycated hemoglobin and lipid profiles and dilated eye exams. Added value of this study: In our study, we used a national database representing the United States' non-institutionalized population to identify the prevalence of prevention measures being utilized in adults with diabetes and further examine their relationship with all-cause hospitalization. Logistic regression analysis identified two preventative measures with inconsistent utilization, however, when these measures were used according to guidelines, they contributed to a risk reduction in all-cause hospitalization. Implications of all the available evidence: Current preventative guidelines can contribute to a risk reduction in hospitalization among adults with diabetes. National guidelines and quality improvement initiatives should be aimed at improving the utilization of foot exams as a preventative measure and referral to a diabetes specialist before complications incur.

National database study of trends in bacteraemia aetiology among children and adults in Japan: a longitudinal observational study

ObjectivesDomestic epidemiological studies are needed to ascertain the disease burden of bacteraemia in individual countries. This study aimed to evaluate the domestic trends in paediatric and adult bacteraemia in Japan.SettingLaboratory-based...

Urinary incontinence before and after pelvic organ prolapse surgery-A national database study.

To investigate how pelvic organ prolapse (POP) surgery affects symptoms of urinary incontinence (UI) in women with POP and concomitant UI. Data from the Danish Urogynaecological Database were collected from 2013 to 2016. Inclusion criteria were urinary incontinent women who underwent POP surgery alone. Based on the preoperative results of the International Consultation on Incontinence Questionnaire-Urinary Incontinence-short form (ICIQ-UI-sf), women were categorized with stress urinary incontinence (SUI), urgency urinary incontinence (UUI) or mixed urinary incontinence (MUI). Postoperatively, the women were categorized based on the postoperative ICIQ-UI-sf, except here, undefined urinary incontinence and urinary continence were added to the categories. Statistical analyses included multivariate logistic regression analyses, examining the odds of urinary continence in each category. The included parameters were preoperative POP stage (POP-Q), compartment, BMI, age and preoperative ICIQ-UI-sf total score. P-values < 0.05 were considered statistically significant. A total of 1657 women were included. Significantly more women with preoperative UUI achieved urinary continence (60%) compared to women with preoperative SUI (52%) and MUI (38%). More than 70% of all women achieved either urinary continence or an improvement in UI, regardless of subtype. For women with UUI, the likelihood of achieving urinary continence was higher if the anterior compartment was involved. Women with MUI were more likely to achieve urinary continence if they had POP-Q stage 3-4. Most women with symptomatic POP and concomitant UI find that their UI is either cured or improved after POP surgery alone.

Incidence, predisposing conditions and outcomes of cutaneous mucormycosis: A national database study.

The body of evidence on cutaneous mucormycosis is largely derived from case reports or single-centre databases. Our study aimed to describe incidence, predisposing factors and inpatient outcomes of cutaneous mucormycosis in the United States. We conducted a population-based retrospective study using the National Inpatient Sample 2016-17 data. Fifty-six discharges had a diagnosis of cutaneous mucormycosis on the International Classification of Diseases, tenth revision. Descriptive analysis was performed for the demographics, predisposing factors, length of stay (LOS), cost and inpatient mortality. The NIS represents 20% of all discharges in the United States, which allowed us to estimate the national incidence of cutaneous mucormycosis. An estimated total of 280 admissions occurred between 2016 and 2017, indicating 3.9 cases per million admissions across the United States. The estimated incidence rate was 0.43 cases per million people per year. Median agewas 49.5 (19-59) years, 44.6% were female, and 54.9% were Caucasian. We identified haematologic malignancies (48.2%) and solid organ transplantations (10.7%), often accompanied by skin/soft tissue or post-procedural infections, were the most common predisposing conditions. Median LOS was 15 (6-31) days, median total charges were 187,030 (65,962-446,265) USD, and in-hospital mortality ratewas 16.1%. In current clinical practice, physicians may encounter cutaneous mucormycosis most commonly in severely immunocompromised hosts with haematologic malignancies or transplantations, accompanied by skin/soft tissue or post-procedural infections. A high index of suspicion and prompt tissue sampling in at-risk groups is important to improve the outcomes.

Postoperative Mortality in Patients With Cirrhosis: Reconsidering Expectations.

A diagnosis of cirrhosis increases a patient's risk of postoperative mortality. Surgeons are reticent to operate when cirrhosis is known unless no option is available. This study aimed to identify the modern perioperative risk in cirrhotic patients undergoing intervention under general anesthesia for non-transplant operations. A retrospective chart review was conducted utilizing the Rush Medical Center electronic medical record. All patients over 18 years of age with a diagnosis of cirrhosis undergoing intervention between 2009 and 2019 were reviewed. 90-day mortality rates in patients grouped by Child's score, Model for End-Stage Liver Disease (MELD), and Model for End-Stage Liver Disease with sodium incorporated (MELDNa) were compared to previously accepted rates. 93 patients (46% women) aged 22-72years of all Child-Turcot-Pugh (CTP) (40% A, 36% B, and 25% C) classifications and MELD/MELDNa ranging 6-40 were analyzed. 90-day mortality of the entire population was 16%, significantly lower than expected based on CTP score (16% vs. 32%; P = .0005), MELD (16% vs. 41%; P < .0001), and MELDNa (16% vs. 46.8%; P < .0001). This was also true for CTP-B patients (12% vs. 30%; P = .025), CTP-C patients (35% vs. 70%; P = .0002), patients with MELD >14 (27% vs. 70%; P < .001), and patients with MELDNa >14 (23% vs. 70%; P < .0001). Data indicate that perioperative mortality is lower than widely accepted. This suggests the need for a national database study using a representative population to determine the risk of mortality for patients with cirrhosis having surgery in recent times. Accurate estimation of this risk allows for meaningful discussion between physicians and patients when deciding to proceed with elective, necessary operations.

Demographic and clinical characteristics of prevention-eligible patients with migraine in the US: a linked national survey and administrative claims database study

Objective To characterize burden of migraine in prevention-eligible patients compared with prevention non-eligible patients in the United States (US). Receipt of preventive therapy was also examined among prevention-eligible patients. Methods This retrospective study utilized data from the 2017 US National Health and Wellness Survey linked with medical and pharmacy claims. Patients aged ≥18 years who self-reported experiencing migraine and had confirmed evidence of migraine (≥1 medical or pharmacy claim) were included. Prevention eligibility was based on number of headache days in the past 30 days (prevention-eligible: ≥4 and prevention non-eligible: <4). Descriptive statistics summarized study variables; bivariate and multivariable analyses were conducted to examine the association of prevention-eligibility status with outcomes. Results Analyses included 450 patients, 291 (65%) prevention-eligible, and of these 56 (19%) received preventive therapy. Overall, patients were 42.98 ± 14.51 years old; 84% were female. Prevention-eligible patients reported significantly more migraine headache days in the past 6 months (29.27 ± 37.96 vs. 8.61 ± 7.88), had lower mental component summary scores (35.80 ± 2.73 vs. 37.90 ± 2.96), and more presenteeism (47.30 ± 2.98% vs. 37.90 ± 2.60%), overall work impairment (46.30 ± 2.87% vs. 37.90 ± 2.55%) and activity days missed due to migraine (8.16 ± 3.05 vs. 3.82 ± 1.58) than prevention non-eligible patients (all p<.001). Prevention-eligible patients receiving preventive therapy reported more migraine headache days during the past month (9.21 ± 7.99 vs. 6.06 ± 7.10; p=.002) and activity days lost due to migraine (18.39 ± 28.08 vs. 10.69 ± 21.43, p=.015) than those not receiving preventive therapy. Conclusions Prevention-eligible patients experience greater burden due to migraine, including more headache days, worse health-related quality-of-life, and greater work and activity impairment than prevention non-eligible patients.

Mid-term outcomes of anterior cruciate ligament reconstruction across age groups: A national database study

BackgroundThe purpose of this study was to examine the impact of age on complication risk after anterior cruciate ligament reconstruction. MethodsThe TriNetX research database was retrospectively queried for patients undergoing primary arthroscopic ACL reconstruction. Univariate logistic regression was performed to evaluate the risk of complication by age group. ResultsA total of 21,449 patients were included in the study. Patients ≥61 years old demonstrated significantly higher rates of repeat reconstruction. Rates of postoperative opioid related disorders and surgical site infection varied by age. ConclusionFor patients undergoing ACL reconstruction, increasing age is associated with increased risk of developing opioid related disorders, and repeat reconstruction.

Bariatric Surgery Before Elective Anterior Cervical Discectomy and Fusion (ACDF) in Obese Patients Is Associated With Reduced Risk of 90-Day Postoperative Complications and Readmissions.

This was a national database study. The objective of this study was to assess the impact of prior bariatric surgery (BS) on altering 90-day postoperative outcomes following elective anterior cervical discectomy and fusions (ACDFs). Though obesity has previously been shown to be linked with adverse outcomes following elective spine surgical procedures, the effectiveness of weight-loss strategies such as BS has not been explored. The PearlDiver program was used to query the 2007-2013 100% Medicare Standard Analytical Files (SAF100) for patients undergoing an elective ACDF. The study cohort was divided into 2 groups-(1) obese ACDF patients (body mass index ≥35 kg/m 2 ) receiving a BS procedure within 2 years before an ACDF and (2) obese ACDF patients (body mass index ≥35 kg/m 2 ) without a known history of a BS procedure within the last 2 years. Multivariate regression analyses were used to assess the impact of a BS procedure on postoperative outcomes following ACDF while adjusting for age, sex, region, and Elixhauser Comorbidity Index. A total of 411 ACDF patients underwent BS within the 2 years before an ACDF. Multivariate analysis showed that undergoing BS before an elective ACDF was associated with a significantly reduced risk of pulmonary complications [odds ratio (OR)=0.53; P =0.002], cardiac complications (OR=0.69; P =0.012), sepsis (OR=0.69; P =0.035), renal complications (OR=0.54; P =0.044), and 90-day readmissions (OR=0.53; P =0.015). Surgery-induced weight loss before an ACDF in obese patients is associated with reduced 90-day complication and readmission rates. Orthopaedic and bariatric surgeons should counsel obese patients on the benefits of BS following ACDFs.

Early Mortality and Overall Survival in Acute Promyelocytic Leukemia: Do Real-World Data Match Results of the Clinical Trials?

Introduction Acute promyelocytic leukemia (APL), considered a medical emergency, requires prompt treatment at the first suspicion of the diagnosis. Treatment is initiated even before cytogenetic or molecular confirmation of diagnosis because of high early mortality with APL, mostly due to hemorrhage and disseminated intravascular coagulation. Once a cancer with dismal prognosis, APL is now considered a highly curable cancer with the introduction of all-trans retinoic acid and arsenic trioxide. In fact, recent clinical trials in APL report excellent outcomes with &amp;gt;90% OS at 3-years with &amp;lt;5% mortality in the first 4-6 weeks. Here we analyze a large National Cancer Database (NCDB) to determine one-month mortality and overall survival (OS) of patients with APL treated in real-world practices. Methods We utilized the NCDB Participant User File to identify patients of all age groups who were diagnosed between 2004 and 2015. A Chi-square test was used to determine association of different covariates with one-month mortality. Multiple logistic regression analysis was used to evaluate the effect of covariates on the probability of one-month mortality. A full model was run that included all covariates; the subsequent reduced model included covariates significant at the p&amp;lt;0.1. OS was analyzed with Kaplan Meier methods. Results Our study included a total of 7190 patients- median age was 50 years, 50% were female, 82% were white, 53% had private insurance, 82% had Charlson comorbidity index (CCI) of 0 or 1, and 57% were treated at academic centers. Ninety-seven percent of patients were treated with either multiagent (67%) or single-agent chemotherapy (30%). Patients diagnosed in 2004-2009 comprised 49% of total cohort, the remaining 51% were diagnosed in 2010-2015. One-month mortality for the entire cohort was 12%. One-month mortality varied significantly for different age groups: 6% for &amp;lt;35, 8% for 35-54, and 18% for ≥55 years. One-month mortality was not significantly different based on the year of diagnosis or CCI. In a multivariate analysis, patients &amp;lt;55 years of age (p&amp;lt;0.0001), and those with private insurance (p&amp;lt;0.0001) had lower one-month mortality (Table 1). Patients treated at comprehensive cancer centers, as compared to academic centers, had worse one-month mortality (p=0.005). Median OS at 1-, 3-, and 5-year were 81%, 75%, and 71% respectively. OS differed significantly based on age. Median OS was not reached for patients &amp;lt;55 years, compared to 6.5 years for patients ≥55 years (Figure 1). Detailed analysis will be presented. Conclusion Our large national database study demonstrates that early mortality is still high in real-world practices. OS at 1 year (81%) is worse than reported OS of &amp;gt;90% in clinical trials. Surprisingly, only 1/3rd of patients received single agent chemotherapy, which is not the standard of care. The use of suboptimal chemotherapy may not explain high early mortality rate but may explain worse OS. We also identified age as a significant predictor of outcomes with older adults ≥55 years almost at a two-fold higher risk of early and late mortality. Lower rate of enrollment of older adults may yet be another reason for higher OS seen in clinical trials. Our findings highlight the challenges associated with translating trial findings to clinical practices and provide rationale to support studies aimed at improving outcomes of APL in the real world. Disclosures Gundabolu: BioMarin: Consultancy; Bristol Myers Squibb pharmaceuticals: Consultancy. Chaulagain:Sanofi Genzyme: Honoraria. Bhatt:Tolero: Research Funding; Pfizer: Research Funding; Abbvie: Consultancy, Research Funding; Incyte: Consultancy, Research Funding; Jazz: Research Funding; Rigel: Consultancy; Oncoceutics: Other; National Marrow Donor Program: Research Funding; Partnership for health analytic research: Consultancy; Takeda: Consultancy; Omeros: Consultancy; Agios: Consultancy.

Factors associated with bronchiectasis in Korea: a national database study.

BackgroundMany important clinical features of bronchiectasis have been reported. However, the factors were evaluated using a specific disease cohort. Thus, clinical factors associated with bronchiectasis have not been well assessed in comparison to the general population. The aim of this study was to evaluate the factors associated with bronchiectasis using a national representative database.MethodsWe conducted a cross-sectional study using data from the Korean National Health and Nutrition Examination Survey 2007–2009. To evaluate factors associated with bronchiectasis, a multivariable logistic analysis was used with adjustment for demographic and socioeconomic factors.ResultsIn the present study, the prevalence of bronchiectasis was 0.4%. Compared with subjects without bronchiectasis, subjects with bronchiectasis were older (55.1 vs. 44.4 years, P<0.001) and had lower body mass index (BMI) (23.2 vs. 24.2 kg/m2, P<0.001). The proportions of low family income (70.5% vs. 40.2%, P<0.001) and low educational level (less than high school) (85.3% vs. 70.6%, P=0.041) were higher in subjects with bronchiectasis than in subjects without bronchiectasis. Regarding comorbidities, subjects with bronchiectasis were more likely to have asthma (17.8% vs. 2.9%, P<0.001), previous history of pulmonary tuberculosis (TB) (43.5% vs. 5.0%, P<0.001), osteoporosis (19.1% vs. 7.8%, P=0.002), and depression (9.3% vs. 3.0%, P=0.015) compared with subjects without bronchiectasis. In addition, subjects with bronchiectasis had more respiratory symptoms and poorer quality of life measured using the EuroQoL five dimensions questionnaire (EQ-5D) index (0.87 vs. 0.93, P<0.001) than subjects without bronchiectasis. In multivariable logistic regression analysis, low family income (adjusted odds ratio, OR =3.83, 95% confidence interval, CI: 1.46–10.03), asthma (adjusted OR =3.73, 95% CI: 1.29–10.79), pulmonary TB (adjusted OR =7.88, 95% CI: 2.65–23.39), and the presence of airflow limitation (adjusted OR =2.98, 95% CI: 1.01–8.98) were independently associated with bronchiectasis.ConclusionsSubjects with bronchiectasis suffered from more respiratory symptoms with limited physical activity and poorer quality of life than the general population. Factors independently associated with bronchiectasis were lower family income and comorbid pulmonary conditions, such as previous pulmonary TB, asthma, and airflow limitation.

Mortality rate associated with carbon monoxide poisoning in Turkey: A national database study.

To investigate non-fire and unintentional deaths caused by carbon monoxide poisoning in the light of official national data, and to calculate the national mortality rate associated with carbon monoxide poisoning in Turkey. The retrospective cross-sectional study was conducted in Ankara, Turkey, from January to March 2019, and comprised data of deaths registered with the Turkish Statistical Institute between January 1, 2013, and December 31, 2017. Data was analysed using SPSS 21and Microsoft Excel. Of the 1896 deaths, 1310(69.1%) were males, and the highest number of deaths 622(33%) was recorded in 2014. Deaths were most common in the 18-64 years age group 1071(56.6%). Overall, there were 1841(97.1%) Turkish citizens and 55(92.9%) foreign nationals. Manisa had the highest number of deaths 266(14%) at a mortality rate of 3.84 per 100,000 population. The factual situation of death associated with carbon monoxide in Turkey will lead to steps to reduce the risk.

National pharmacological treatment trends for ankylosing spondylitis in South Korea: A national health insurance database study.

No studies of the current status of treatment options are available for ankylosing spondylitis (AS) patients in South Korea. This study assesses the current status of AS treatment trends using a nationwide database. This study was conducted using a Korean National Health Insurance System (KNHIS) dataset from 2006 to 2016. We randomly extracted 50% of the total number of patients registered as As patients in the KNHIS. The distribution of the number of patients according to age and gender was analyzed each year. The types and combination methods of drugs used during the study period were estimated yearly. Between 2006 and 2016, the number of AS patients increased linearly by an average of 9% annually, 6372 in 2006 to 15188 in 2016. The study found that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) was the most commonly prescribed pharmacological treatment option, followed by disease-modifying anti-rheumatic drugs (DMARDs) and then biologics. Biologics such as tumor necrosis factor alpha (TNF-α) inhibitors increased from 10% to 35% consistently for 10 years. In terms of combination therapy, DMARDs + NSAIDs accounted for almost 90% of treatments in 2006, but decreased by 65% in 2016. The use of biologics and NSAIDs increased from 3% to 28%. Prescriptions for dual therapies and mono therapies largely dominated prescription habits, accounted for up to approximately 80% of treatments. Among 10- to 14-year-old patients, there was no triple therapy, dual and triple therapies decreased gradually for those 60 and older, and the ratio of conservative treatments has increased. This study shows how South Korea reflects changes in AS treatment trends, along with the emergence of TNF-α inhibitors that are effective in treating AS. Research on clinical outcomes for AS treatments will be needed on following these drug changes.