National Database Study Research Articles

Outcomes and mortality in parturient and non-parturient patients with peripartum cardiomyopathy: A national readmission database study.

Peripartum cardiomyopathy (PPCM) affects young females and mortality occurs after the peripartum period. Hospital readmissions for patients discharged with PPCM are poorly understood. The aim of this study was to evaluate differences in readmission rates, risk factors, and mortality in women with PPCM. We conducted a retrospective cohort analysis using the Healthcare Cost and Utilization Project 2013 National Readmissions Database. From the database, we selected patients with PPCM to include patients discharged between January and November 2013. Readmission rate, mortality rate and risk factors were analyzed. In our cohort of 3800 patients, we found a readmission rate of 15.1% and a mortality rate of 1.6%. Comorbidities associated with readmission were pulmonary hypertension, obesity, renal failure, and drug abuse. Mortality on initial admission was associated with coagulation disorders and respiratory failure. Women who delivered on initial admission had a statistically lower rate of readmission than women who did not deliver on initial admission. In a large retrospective nationwide analysis of PPCM patients, we found associated conditions that may help predict which patients will have a higher risk for readmission and mortality.

Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate

Apical vaginal support is considered the keystone of pelvic organ support. Level I evidence supports reestablishment of apical support at time of hysterectomy, regardless of whether the hysterectomy is performed for prolapse. National rates of apical support procedure performance at time of inpatient hysterectomy have not been well described. We sought to estimate trends and factors associated with use of apical support procedures at time of inpatient hysterectomy for benign indications in a large national database. The National (Nationwide) Inpatient Sample was used to identify hysterectomies performed from 2004 through 2013 for benign indications. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to select both procedures and diagnoses. The primary outcome was performance of an apical support procedure at time of hysterectomy. Descriptive and multivariable analyses were performed. There were 3,509,230 inpatient hysterectomies performed for benign disease from 2004 through 2013. In both nonprolapse and prolapse groups, there was a significant decrease in total number of annual hysterectomies performed over the study period (P < .0001). There were 2,790,652 (79.5%) hysterectomies performed without a diagnosis of prolapse, and an apical support procedure was performed in only 85,879 (3.1%). There was a significant decrease in the proportion of hysterectomies with concurrent apical support procedure (high of 4.0% in 2004 to 2.5% in 2013, P < .0001). In the multivariable logistic regression model, increasing age, hospital type (urban teaching), hospital bed size (large and medium), and hysterectomy type (vaginal and laparoscopically assisted vaginal) were associated with performance of an apical support procedure. During the study period, 718,578 (20.5%) inpatient hysterectomies were performed for prolapse diagnoses and 266,743 (37.1%) included an apical support procedure. There was a significant increase in the proportion of hysterectomies with concurrent apical support procedure (low of 31.3% in 2005 to 49.3% in 2013, P < .0001). In the multivariable logistic regression model, increasing age, hospital type (urban teaching), hospital bed size (medium and large), and hysterectomy type (total laparoscopic and laparoscopic supracervical) were associated with performance of an apical support procedure. This national database study demonstrates that apical support procedures are not routinely performed at time of inpatient hysterectomy regardless of presence of prolapse diagnosis. Educational efforts are needed to increase awareness of the importance of reestablishing apical vaginal support at time of hysterectomy regardless of indication.

Increasing rates of surgical treatment for paediatric diaphyseal forearm fractures: a National Database Study from 2000 to 2012.

ForearmPurpose fractures are one of the most commonly sustained injuries in children and are often treated non-operatively. The purpose of this study was to estimate the rate of inpatient surgical treatment of paediatric forearm fractures over time using a large, publicly available, national database.MethodsThe Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) was evaluated between 2000 and 2012. Forearm fractures and surgeries were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis and procedure codes. Univariable and multivariable logistic regression were used to determine variables associated with greater proportion of surgical treatment. All statistical analyses were performed using SAS statistical software v.9.4 (SAS Institute Inc., Cary, NC, USA). Statistical significance was set at p < 0.05.ResultsThe database identified 30 936 forearm fracture admissions. Overall, 19 837 of these patients were treated surgically (64.12%). The percentage of patients treated with surgery increased from 59.3% in 2000 to 70.0% in 2012 (p < 0.001). Multivariable regression analysis found increased age (p < 0.001), more recent year (p < 0.001), male gender (p = 0.003) and admission to a children’s hospital (p < 0.001) were associated with an increased proportion of patients receiving surgical treatment. Medicaid payer status was associated with a lower proportion of surgical treatment (p < 0.001).ConclusionsThe rate of operative treatment for paediatric forearm fractures admitted to the hospital increased over time. Increased surgical rates were associated with older age, male gender, treatment at a children’s hospital and non-Medicaid insurance status.

Current status of superficial pharyngeal squamous cell carcinoma in Japan.

To investigate the status and treatment of superficial pharyngeal squamous cell carcinoma in Japan. We analyzed all cases diagnosed between 2011 and 2013, as recorded in the national database of hospital-based cancer registries. We extracted data on patient sex, age, tumor locations, histology, presentation routes, initial treatments, and TNM stages. Additionally, we compared the characteristics of pharyngeal carcinoma to those of esophageal cancer. A total of 16,521 oropharyngeal and hypopharyngeal cancers from 409 institutions were included. Diagnosis of Tis tumors was infrequent, and both cancers were likely to be diagnosed at an advanced stage (n=866, 5.3%). Tis diseases were the most commonly detected during follow-up examinations for other diseases (n=608, 70%). While more oropharyngeal Tis patients were men compared to T1-4 patients (88 vs 82%, respectively), hypopharyngeal cancer patients comprised an equally high proportion of men (94 vs 92%, respectively). The most common location of oropharyngeal Tis tumors was the posterior wall (32%), whereas T1-4 tumors were most commonly found on the lateral wall (36%). In hypopharyngeal cancer, both Tis and T1-4 were most commonly located in the pyriform sinus (62%). The proportion of Tis tumors diagnosed at individual institutions showed a positive correlation with the number of endoscopic treatments (r=0.32, P<0.001) and the number of esophageal cancer cases (r=0.37, P<0.001). Our national database study elucidated the current characteristics of superficial pharyngeal squamous cell carcinoma patients in Japan. Further improvements in early diagnosis and standardized treatments are warranted.

Outcomes after early and delayed rehabilitation for exacerbation of chronic obstructive pulmonary disease: a nationwide retrospective cohort study in Japan

BackgroundThe effectiveness of early pulmonary rehabilitation (PR) for exacerbation of chronic obstructive pulmonary disease (COPD) remains controversial. The present study aimed to compare the outcomes between early and delayed PR for exacerbation of COPD, using a national inpatient database.MethodsUsing the Japanese Diagnosis Procedure Combination database, we examined patients who were transported to hospital for exacerbation of COPD, received PR during hospitalisation, and were discharged to their home. The patients were divided into those who received early PR (defined as PR starting within 48 h of admission) and those who received delayed PR. The outcomes included 90-day readmission, length of stay (LOS), and activities of daily living (Barthel index ≥15) at discharge. Multiple imputation was used for missing data. To assess the associations between early PR and the outcomes, we used risk-adjusted treatment effects and instrumental variable methods.ResultsWe identified 12,572 eligible patients, including 8459 patients with delayed PR and 4113 with early PR. In the risk-adjusted treatment effect models, the early PR group had lower proportion of 90-day readmission (risk difference, −3.4%; 95% CI, −5.7% to −1.5%) and shorter LOS (−9.8 days; 95% CI, −10.8 days to −8.7 days) than the delayed PR group. There was no significant difference in activities of daily living at discharge between the two groups. The instrumental variable analyses showed similar results.ConclusionsIn this national database study, early PR was associated with reduced 90-day readmission and shortened LOS in patients with exacerbation of COPD.

Factors predicting the outcomes of elderly hospitalized myasthenia gravis patients: a national database study.

BackgroundMyasthenia gravis (MG) in elderly populations is increasing. This study aimed to evaluate predictors for treatment outcomes in elderly hospitalized MG patients using the national database.MethodsWe collected data of elderly hospitalized MG patients from the National Health Security Office from October 2009 to September 2010. Predictors for treatment outcomes were examined.ResultsDuring the study period, 1,948 identified MG patients were admitted to hospitals throughout Thailand. Of those, 441 patients (22.64%) were aged ≥ 60 years. There were 66 patients (14.97%) who had poor outcomes. There were only three significant factors in the final model. Presence of pneumonia, use of mechanical ventilators, and septicemia had adjusted odds ratios (95% confidence interval) of 2.83 (1.03, 7.75), 5.33 (2.24, 12.72), and 4.47 (1.86, 10.75), respectively.ConclusionPneumonia, being on a mechanical ventilator, and septicemia were independent factors associated with poor treatment outcomes in elderly hospitalized MG patients according to national data.

Safety of ERCP in patients with liver cirrhosis: a national database study.

Background and aims Given the limited data on the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with liver cirrhosis, we attempted to evaluate this question using a large national database. Methods We conducted a matched case – control study using the 2010 National Inpatient Sample database in which four non-cirrhotic controls were matched randomly for every cirrhotic patient from the same 10-year age group. We compared adverse events and safety of inpatient ERCP between patients with (n = 3228) and without liver cirrhosis (controls, n = 12 912). Results Of the 3228 cirrhotic patients, 2603 (80.6 %) had decompensated and 625 (19.4 %) had compensated disease. Post-procedure bleeding (2.1 % vs. 1.2 %, P < 0.01) was higher in patients compared to controls. On multivariable analysis, decompensated cirrhosis (adjusted odds ratio [aOR], 2.7; 95 % confidence interval [CI], 2.2 – 3.2), compensated cirrhosis (aOR 2.2; 95 %CI 1.2 – 3.9), therapeutic ERCPs (aOR 1.4; 95 % CI 1.2 – 2.1), and biliary sphincterotomy (aOR 1.6; 95 %CI 1.1 – 2.1) were independently associated with increased risk of post-procedure bleeding. Performing ERCPs in large (aOR 0.5; 95 %CI 0.4 – 0.6) and medium (aOR 0.7; 95 %CI 0.6 – 0.9) sized hospitals was associated with a decreased risk of post-procedure bleeding. Biliary sphincterotomy (aOR 1.7; 95 %CI 1.2 – 2.3) and therapeutic ERCPs (aOR 1.1; 95 %CI 1.1 – 1.3) increased the risk of post-ERCP pancreatitis, and pancreatic stent placement was associated with a decreased risk of post-ERCP pancreatitis (aOR 0.8; 95 %CI 0.7 – 0.9). Conclusions Cirrhosis (both compensated and decompensated), performing therapeutic ERCPs and biliary sphincterotomy increase the risk of post-procedure bleeding. Performing ERCPs in large and medium sized hospitals may improve outcomes.

Association Between Psychotropic and Cardiovascular Iatrogenic Alerts and Risk of Hospitalizations in Elderly People Treated for Dementia: A Self-Controlled Case Series Study Based on the Matching of 2 French Health Insurance Databases

BackgroundElderly people are at risk of repeated hospitalizations, some of which may be drug related and preventable. In 2011, a group of French healthcare experts selected 5 iatrogenic alerts (IAs), based on criteria identified in a literature search and from their professional experience, to assess the appropriateness of medication in elderly patients. ObjectivesOur objective was to examine the association between hospitalizations and IAs in elderly patients treated for Alzheimer disease who are particularly sensitive to adverse drug events. DesignA 2-year (January 1, 2011, to December 31, 2012) longitudinal national database study, with a study design similar to self-controlled case series, was performed to analyze data on drug prescriptions and hospitalization. IAs were defined as (1) long half-life benzodiazepine; (2) antipsychotic drugs in patients with Alzheimer disease; (3) co-prescription of 3 or more psychotropic drugs; (4) co-prescription of 2 or more diuretics; and (5) co-prescription of 4 or more antihypertensive drugs. Data were obtained by matching of 2 French National Health Insurance Databases. SettingFrance. ParticipantsAll affiliates, aged ≥75 years, receiving treatment for Alzheimer disease, alive on January 1, 2011 were included. MeasurementsWe calculated the relative increase in the number of hospitalizations in patients with IAs. The analysis was performed over four 6-month periods. ResultsA total of 10,754 patients were included. During the periods with IAs, hospitalization rates increased by 0.36/year compared with 0.23/year in the periods without for the same patient, and the number of hospitalizations doubled [proportional fold change = 1.9, 95% confidence interval (1.8, 2.1)]. We estimated that 22% [95% confidence interval (20%, 23%)] of all hospitalizations were associated with IAs, 80% of which were due to psychotropic IAs. ConclusionsThe IAs could be used as a simple and clinically relevant tool by prescribing physicians to assess the appropriateness of the prescription in elderly patients treated for Alzheimer disease.

Impact of HIV on inpatient mortality and complications in stroke in Thailand: a National Database Study.

The co-existence of stroke and HIV has increased in recent years, but the impact of HIV on post-stroke outcomes is poorly understood. We examined the impact of HIV on inpatient mortality, length of acute hospital stay and complications (pneumonia, respiratory failure, sepsis and convulsions), in hospitalized strokes in Thailand. All hospitalized strokes between 1 October 2004 and 31 January 2013 were included. Data were obtained from a National Insurance Database. Characteristics and outcomes for non-HIV and HIV patients were compared and multivariate logistic and linear regression models were constructed to assess the above outcomes. Of 610 688 patients (mean age 63·4 years, 45·4% female), 0·14% (866) had HIV infection. HIV patients were younger, a higher proportion were male and had higher prevalence of anaemia (P < 0·001) compared to non-HIV patients. Traditional cardiovascular risk factors, hypertension and diabetes, were more common in the non-HIV group (P < 0·001). After adjusting for age, sex, stroke type and co-morbidities, HIV infection was significantly associated with higher odds of sepsis [odds ratio (OR) 1·75, 95% confidence interval (CI) 1·29-2·4], and inpatient mortality (OR 2·15, 95% CI 1·8-2·56) compared to patients without HIV infection. The latter did not attenuate after controlling for complications (OR 2·20, 95% CI 1·83-2·64). HIV infection is associated with increased odds of sepsis and inpatient mortality after acute stroke.

Satisfaction with life after burn: A Burn Model System National Database Study

ObjectivesWhile mortality rates after burn are low, physical and psychosocial impairments are common. Clinical research is focusing on reducing morbidity and optimizing quality of life. This study examines self-reported Satisfaction With Life Scale scores in a longitudinal, multicenter cohort of survivors of major burns. Risk factors associated with Satisfaction With Life Scale scores are identified. MethodsData from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Model System (BMS) database for burn survivors greater than 9 years of age, from 1994 to 2014, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures were the individual items and total Satisfaction With Life Scale (SWLS) scores at time of hospital discharge (pre-burn recall period) and 6, 12, and 24 months after burn. The SWLS is a validated 5-item instrument with items rated on a 1–7 Likert scale. The differences in scores over time were determined and scores for burn survivors were also compared to a non-burn, healthy population. Step-wise regression analysis was performed to determine predictors of SWLS scores at different time intervals. ResultsThe SWLS was completed at time of discharge (1129 patients), 6 months after burn (1231 patients), 12 months after burn (1123 patients), and 24 months after burn (959 patients). There were no statistically significant differences between these groups in terms of medical or injury demographics. The majority of the population was Caucasian (62.9%) and male (72.6%), with a mean TBSA burned of 22.3%. Mean total SWLS scores for burn survivors were unchanged and significantly below that of a non-burn population at all examined time points after burn. Although the mean SWLS score was unchanged over time, a large number of subjects demonstrated improvement or decrement of at least one SWLS category. Gender, TBSA burned, LOS, and school status were associated with SWLS scores at 6 months; scores at 12 months were associated with LOS, school status, and amputation; scores at 24 months were associated with LOS, school status, and drug abuse. ConclusionsIn this large, longitudinal, multicenter cohort of burn survivors, satisfaction with life after burn was consistently lower than that of non-burn norms. Furthermore mean SWLS scores did not improve over the two-year follow-up period. This study demonstrates the need for continued efforts to improve patient-centered long term satisfaction with life after burn.

UK Neovascular Age-Related Macular Degeneration Database. Report 6: time to retreatment after a pause in therapy. Outcomes from 92 976 intravitreal ranibizumab injections

Background/aimsTo study the time to retreatment in eyes with neovascular age-related macular degeneration (nAMD) that had been treatment-free for intervals of 3 months, 6 months, 9 months and 12 months...

Abstract P6-19-02: Clinicopathologic features and radiation therapy utilization in patients with male breast cancer: A national cancer database (NCDB) study

Abstract Introduction: Male breast cancer (MBC) is an uncommon malignancy, accounting for approximately 1% of all breast cancers (BC). The purpose of this study was to compare the clinicopathologic features of and radiation therapy (RT) utilization by patient age in patients with non-metastatic MBC and female breast cancer (FBC) using a large national database. Methods: The NCDB is a comprehensive national database that captures approximately 70% of newly diagnosed cancer patients in the US. Data for patients meeting study criteria were extracted including patient demographics, tumor characteristics, treatment modalities used, and overall survival (OS). Comparison of clinicopathologic factors between MBC and FBC were made using the Chi-Square test. Overall survival curves were estimated using Kaplan-Meier method. All results are presented as MBC vs FBC patients. Results: A total of 23,305 MBC patients and 2,678,061 FBC patients with non-metastatic breast cancer were identified in the NCDB database. The median patient age was 65 vs 60 yrs (MBC vs FBC, p &amp;lt; 0.001). Median tumor size was 19mm vs 15 mm (p &amp;lt; 0.001). In patients who had a LN evaluation, the median number of LN examined was 4 vs 3 and the median number of positive LN's were 1 vs 0. Percentage of patients undergoing breast conserving surgery was 25.6% vs 54.8%. Central tumor location was most common in MBC (30.3% vs 6.3%) and UOQ location was most common in FBC (17.2% VS 33.6%). The pathologic tumor characteristics for patients with MBC and FBC is shown in Table 1. Invasive lobular histology was less common in MBC patients (3.1% vs 7.5%). Higher percentage of female patients had non-invasive and Grade I cancers. MBC patients were more likely to have ER or PR positive tumors and less likely to have triple negative tumors. Lymph vascular invasion (LVI) was more likely to be present in MBC patients. There was a tendency towards earlier stage tumors in female patients. Regardless of gender, postoperative RT use was lower in patients 70 years or older compared to younger patients. Doing a stage-by-stage comparison, median survival was lower for patients with MBC compared to FBC. Conclusion: MBC is an uncommon malignancy accounting for approximately 1% of all breast cancers. Compared to FBC, patients with MBC presented with more advanced stage BC, and were more likely to have LVI. Median survival rates were lower for patients with MBC compared to FBC. MBCFBCp-valueBehaviorInvasive86.5%80.3%&amp;lt; 0.001GradeII13.7%18.1%&amp;lt; 0.001 II41.535.5 III/undif30/0.9%29.6/1.3% ER or PR positive 92.2%81.6%&amp;lt; 0.001Her2/neu positive 11.6%14.6%&amp;lt; 0.001Triple Negative 5.3%12.9%&amp;lt; 0.001LVIPresent27.7%16.6%&amp;lt;0.001Tumor StageTis11.1%16.4%&amp;lt; 0.001 T141.547.3 T228.119.7 Nodal StageNx17.0%18.1%&amp;lt; 0.001 N053.861.0 N121.115.8 N25.73.5 Stage Grouping010.5%16.9%&amp;lt; 0.001 I35.848.7 II39.426.6 III14.37.8 RT after BCSAll patients60.4%73.5%&amp;lt; 0.001RT after MastectomyT34 N12344.9%45.6% Older RT after BCSAll patients51.6%63.1%&amp;lt; 0.001Older RT after MastectomyT34 N12340.1%31.9%&amp;lt; 0.001Median OS (Mo)Stage 0 / I180 / 168NR / 189&amp;lt; 0.001 Stage II / III120 / 78180 / 98&amp;lt; 0.001Older - 70 years or greater; NR - Not reached Citation Format: Algan O, Herman T. Clinicopathologic features and radiation therapy utilization in patients with male breast cancer: A national cancer database (NCDB) study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-19-02.

Population-based cohort study of the management and survival of patients with early-stage oesophageal adenocarcinoma in England.

Until recently, oesophagectomy was the treatment of choice for early oesophageal cancer. Endoscopic treatment has been introduced relatively recently. This observational national database study aimed to describe how endoscopic therapy has been introduced in England and to examine the safety of this approach. A population-based cohort study was undertaken of patients diagnosed with oesophageal adenocarcinoma between October 2007 and June 2009 using three linked national databases. Patients with early-stage disease (T1 tumours with no evidence of spread) were identified, along with the primary treatment modality where treatment intent was curative. Short-term outcomes after treatment and 5-year survival were evaluated. Of 5192 patients diagnosed with oesophageal adenocarcinoma, 306 (5·9 per cent) were considered to have early-stage disease before any treatment, of whom 239 (79·9 per cent of 299 patients with data on treatment intent) were managed with curative intent. Of 175 patients who had an oesophagectomy, 114 (65·1 (95 per cent c.i. 57·6 to 72·7) per cent) survived for 5 years. Among these, 47 (30·3 per cent of 155 patients with tissue results available) had their disease upstaged after pathological staging; this occurred more often in patients who did not have staging endoscopic ultrasonography before surgery. Of 41 patients who had an endoscopic resection, 27 (66 (95 per cent c.i. 49 to 80) per cent) survived for 5 years. Repeat endoscopic therapy was required by 23 (56 per cent) of these 41 patients. Between 2007 and 2009, oesophagectomy remained the initial treatment of choice (73·2 per cent) among patients with early-stage oesophageal cancer treated with curative intent; one in five patients were managed endoscopically, and this treatment was more common in elderly patients. Although the groups had different patient characteristics, 5-year survival rates were similar.

Risk Factors for Free Flap Failure in 2,846 Patients With Head and Neck Cancer: A National Database Study in Japan

The risk factors for an unfavorable outcome after microvascular free flap reconstruction in head and neck cancer are not fully understood. We sought to identify factors affecting the occurrence of free flap failure. This was a retrospective cohort study using data from the national inpatient database in Japan between 2010 and 2012. We identified patients diagnosed with head and neck cancer who underwent tumor resection and consecutive free flap reconstruction. Cox proportional hazards regression was used to assess risk factors for free flap failure. The threshold for significance was P<.05. Missing data were imputed by using multiple imputation. We identified 2,846 eligible patients. The overall proportion of free flap failure was 3.3%. Free flap failure was associated with diabetes mellitus (hazard ratio [HR], 1.80; 95% confidence interval [95%CI], 1.18 to 2.76; P= .007), peripheral vascular disease (HR, 4.49; 95% CI, 1.61 to 12.52; P=.004), renal failure (HR, 3.67; 95% CI, 1.45 to 9.33; P= .006), preoperative radiotherapy (HR, 2.14; 95% CI, 1.11 to 4.13; P= .022), and duration of anesthesia greater than 18hours (compared with <12hours; HR, 2.72; 95% CI, 1.19 to 6.22; P= .018). Diabetes mellitus, peripheral vascular disease, renal failure, preoperative radiotherapy, and a longer duration of anesthesia were significant predictors of the occurrence of free flap failure.

Isomerism is not Associated with Thrombocytosis or Thromboembolic Events in Adulthood: Results from a National Database Study

Background: So-called heterotaxy, better called bodily isomerism, is associated with increased frequency of thrombocytosis and thromboembolic events in childhood. This is likely mediated by splenic dysfunction present with isomerism. Data for adults with isomerism is lacking with a paucity of data regarding thrombosis and isomerism. This study aimed to determine the risk of thrombocytosis and thromboembolic events in adults with isomerism. Methods: The 2012 iteration of the Nationwide Inpatient Sample was used. International classification of disease codes were used to identify admissions associated with isomerism, thrombocytosis, and thromboembolic events. Chi-square analysis was conducted to determine factors associated with thrombocytosis and various thromboembolic events. Logistic regression was used to estimate the adjusted odds ratio of isomerism. Results: A total of 6,907,109 admissions were included, 861 of which had isomerism. Thrombocytosis was equally prevalent in those with and without isomerism with a frequency of 0.1%. Acute thromboembolic events were equally prevalent in both groups as well, with lower extremity thromboembolic events being most prevalent in both. Older age and male gender were both independent risk factors for thromboembolic events but not isomerism. Conclusion: Thrombocytosis and acute thromboembolic events are not more common in those with isomerism. They do, however, occur at a younger in those with isomerism and are associated with increased length and cost of hospitalization.

Hepatorenal syndrome in hospitalized patients with chronic liver disease: results from the Nationwide Inpatient Sample 2002–2012

Hepatorenal syndrome (HRS) is one of the leading causes of hospitalizations in patients with chronic liver disease (CLD). We conducted a retrospective national database study to determine the epidemiology of...

Establishing standard hospital performance measures for cervical spinal trauma: a Nationwide In-patient Sample study.

A retrospective national administrative database study. Patient safety indicators (PSIs) and hospital-acquired conditions (HACs) are metrics for quality of health care and are linked to reimbursement. The prevalence of PSIs/HACs may impact access to health care for certain conditions. We estimated the national occurrence rates of PSIs/HACs among cervical trauma patients and identified patient factors that correlate with their occurrence. United States of America. We queried Nationwide In-patient Sample database (NIS) hospitalizations (2002-2010) for diagnoses of cervical fracture with and without spinal cord injury (SCI). The incidence of each PSI/HAC was determined by ICD-9 (International Classification of Disease, 9th Revision) codes. Multivariate analysis was used to identify the correlation between specific variables and the probability of each indicator. There were 52,377 hospitalizations for cervical fracture in the NIS (without SCI, n = 41,708; with SCI, n = 10,669). Among those without SCI, there were 5374 (12.9%) reported PSIs and 117 (0.3%) HACs. Leading adverse events were postoperative respiratory failure (8.45%), pulmonary embolism (1.70%) and pressure ulcer (1.12%). Among those with SCI, there were 6600 (61.9%) PSIs and 143 (1.3%) HACs. Leading adverse events were postoperative respiratory failure (39.2%), pressure ulcer (7.78%), sepsis (5.71%), deep venous thrombosis (3.81%) and PE (1.70%). Adverse events were associated with several factors, including age, gender, Comorbidity Score and Injury Severity Score. Those with ⩾ 1 PSI/HAC had significantly longer lengths of stay (P < 0.0001) and higher hospital costs (P < 0.0001) and mortality (P < 0.0001) compared with patients without events. These results estimate baseline national rates of PSIs/HACs in patients with cervical spine trauma. These data may be used to gauge individual institutional quality of care in comparison with national data.

The Effect of Local Intraoperative Steroid Administration on the Rate of Postoperative Dysphagia following ACDF: A National Database Study of 245,754 Patients

The Effect of Local Intraoperative Steroid Administration on the Rate of Postoperative Dysphagia following ACDF: A National Database Study of 245,754 Patients

Voice disorders in the elderly: A national database study.

To determine the type, frequency, and factors associated with voice disorders in the elderly. Retrospective analysis of data from a large national administrative US claims database. Elderly outpatients (>65 years old) with a laryngeal/voice disorder (LVD) diagnosis based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist or primary care physician (PCP) were included. Data regarding age, gender, comorbid conditions, geographic location, employment history, and type of physician providing the diagnosis were collected, and multiple logistic regression was used to determine the influence of these factors in otolaryngologist-determined LVD diagnoses. Of the almost 55 million individuals in the database, 60,773 unique patients (mean age = 74.9 years, standard deviation = 6.6 years, range = 65-105 years) had an encounter with a PCP or otolaryngologist and received an LVD diagnosis. The most frequent diagnoses overall were acute and chronic laryngitis, nonspecific dysphonia, and benign vocal fold lesions. PCPs more commonly diagnosed acute laryngitis, whereas otolaryngologists more commonly diagnosed nonspecific dysphonia and laryngeal changes/lesions. In the otolaryngology group, odds of nonspecific dysphonia and vocal fold paralysis/paresis diagnoses increased with advancing age, whereas benign laryngeal pathology, and acute and chronic laryngitis decreased. As compared to men, women had lower odds of paralysis/paresis and laryngeal cancer but higher odds of acute laryngitis and nonspecific dysphonia. Odds of specific LVDs also varied depending upon comorbid conditions and geographic location. Age, gender, comorbid conditions, geographic location, and physician type were significantly associated with specific LVD diagnoses within the elderly. 4.

Risk of Systemic Hypertension and Cerebrovascular Accident in Patients With Aortic Coarctation Aged

Patients with coarctation of the aorta (CoA) may develop hypertension and cerebrovascular accident (CVA) late after intervention, but the risk is still unclear. Therefore, we studied the epidemiologic profile from a general population aged <60years to assess the relative risk. Our study population consisted of 126,943 patients with congenital heart disease (CHD) derived from Taiwan's National Health Insurance database from 2000 to 2010 (population 22,765,535). There were 2,295 patients with CoA (50.3% men) (prevalence: 0.116/1000). Associated cardiac lesions in 44% of the patients with CoA included ventricular septal defect (VSD; 23.3%), patent ductus arteriosus (7.5%), atrial septal defect (9.0%), and so forth. Hypertension occurred in 190 patients (8.3%) and was related to age, without associated VSD (odds ratio [OR] 5.90, 95% confidence interval [CI] 2.12 to 16.39, p= 0.001) and male gender (OR 1.59, 95% CI 1.09 to 2.30, p= 0.015). The incidence of hypertension increased rapidly in the young adulthood and was 1.36% in pediatric age group and 28.9% and 45.7% in age group 20 to 29 and 30 to 39, respectively. CVA occurred in 29 patients (1.67%), and the coexisting hypertension was the single predictor (OR 3.19, 95% CI 1.13 to 9.00, p= 0.029). Furthermore, in all patients with CHD, CoA was an independent risk factor for hypertension (OR 15.65, 95% CI 12.44 to 19.68, p <0.001) and CVA (OR 6.55, 95% CI 4.41 to 9.74, p <0.001). Comparing with non-CoA CHD patients, patients with CoA, particularly men, adult, and patients without VSD, have high risk of hypertension, which would further increase the risk of CVA. Early recognition and timely intervention forthe hypertension in patients with CoA is mandatory.