National Database Study Research Articles

Intensive end-of-life care in acute leukemia from a French national hospital database study (2017\u20132018)

BackgroundA better understanding of how the care of acute leukemia patients is managed in the last days of life would help clinicians and health policy makers improve the quality of end-of-life care. This study aimed: (i) to describe the intensity of end-of-life care among patients with acute leukemia who died in the hospital (2017–2018) and (ii) to identify the factors associated with the intensity of end-of-life care.MethodsThis was a retrospective cohort study of decedents based on data from the French national hospital database. The population included patients with acute leukemia who died during a hospital stay between 2017 and 2018, in a palliative care situation (code palliative care Z515 and-or being in a inpatient palliative care support bed during the 3 months preceding death). Intensity end-of-life care was assessed using two endpoints: High intensive end-of-life (HI-EOL: intensive care unit admission, emergency department admission, acute care hospitalization, intravenous chemotherapy) care and most invasive end-of-life (MI-EOL: orotracheal intubation, mechanical ventilation, artificial feeding, cardiopulmonary resuscitation, gastrostomy, or hemodialysis) care. ResultsA total of 3658 patients were included. In the last 30 days of life, 63 and 13% of the patients received HI-EOL care and MI-EOL care, respectively. Being younger, having comorbidities, being care managed in a specialized hospital, and a lower time in a palliative care structure were the main factors associated with HI-EOL.ConclusionsA large majority of French young adults and adults with acute leukemia who died at the hospital experienced high intensity end-of-life care. Identification of factors associated with high-intensity end-of-life care, such as the access to palliative care and specialized cancer center care management, may help to improve end-of-life care quality.

Maternal Outcomes After Trauma in Pregnancy: A National Database Study.

Trauma is an important non-obstetric cause of mortality in pregnant females. The National Trauma Databank (NTDB) was queried between 2017 and 2018. Pregnant women >20weeks gestation, who underwent trauma, were included. They were categorized into different age groups from 12-18, 18-35, and 36-50years of age. The primary outcome measure was 30-day mortality. 1,058 pregnant trauma patients were included. Mean age was 26.7 ± 6years. Of those 94.5% had blunt and 3.8% had penetrating injuries. Median GCS and ISS were 15 (15, 15) and 2 (1, 5), respectively. Penetrating trauma patients required more operative intervention (57.5%) than blunt trauma patients (24.6%). Univariate analysis comparing age groups 12-18, 19-35, and >36years revealed differences. (P < .05) in ED systolic blood pressure (110.9 ± 19.7 vs 117.3 ± 20.3 vs 129.1 ± 29.3 mmHg, P = .01) and diabetes mellitus (.0 vs 2.7% vs 6.6% P = .03). There was no difference in HLOS (P = .72), complications (P = .279), and mortality (P = .32). Multivariate logistic regression analysis revealed that compared to patients 12-18 years old, patients 19 to 35 (P = .27) or those >36 (P = 1.0) did not show a significant difference in mortality. Patients with high ISS had higher complication rates (OR 1.09; 95% CI 1.04-1.15) and prolonged HLOS (OR 1.00; 95% CI 1.07-1.15). On average pregnant women (>20weeks gestation) who presented to trauma centers had minor injuries and maternal age or mechanism of injury did not affect mortality. Despite a low ISS, a significant number of these patients required operative procedures.

Emergency medicine resident clinical experience vs. in-training examination content: A national database study.

Emergency medicine (EM) residents take the In-Training Examination (ITE) annually to assess medical knowledge. Question content is derived from the Model of Clinical Practice of Emergency Medicine (EM Model), but it is unknown how well clinical encounters reflect the EM Model. The objective of this study was to compare the content of resident patient encounters from 2016-2018 to the content of the EM Model represented by the ITE Blueprint. This was a retrospective cross-sectional study utilizing the National Hospital Ambulatory Medical Care Survey (NHAMCS). Reason for visit (RFV) codes were matched to the 20 categories of the American Board of Emergency Medicine (ABEM) ITE Blueprint. All analyses were done with weighted methodology. The proportion of visits in each of the 20 content categories and 5 acuity levels were compared to the proportion in the ITE Blueprint using 95% confidence intervals (CIs). Both resident and nonresident patient visits demonstrated content differences from the ITE Blueprint. The most common EM Model category were visits with only RFV codes related to signs, symptoms, and presentations regardless of resident involvement. Musculoskeletal disorders (nontraumatic), psychobehavioral disorders, and traumatic disorders categories were overrepresented in resident encounters. Cardiovascular disorders and systemic infectious diseases were underrepresented. When residents were involved with patient care, visits had a higher proportion of RFV codes in the emergent and urgent acuity categories compared to those without a resident. Resident physicians see higher acuity patients with varied patient presentations, but the distribution of encounters differ in content category than those represented by the ITE Blueprint.

The Impact of Computer-Assisted Navigation on Charges and Readmission in Lumbar Spinal Fusion.

Retrospective National Database Study. The purpose of this study is to evaluate the cost and patient outcomes associated with the utilization of computer-assisted navigation (CAN) utilization on patients undergoing lumbar spinal fusion. CAN systems have demonstrated comparable outcomes with instrumentation and procedural speed when compared with traditional techniques. In recent years, CAN systems have seen increased adoption in spinal surgery as they allow for better contextualization of anatomical structures with the goal of improving surgical accuracy and reproducibility. The 2016 National Readmission Database was queried for patients with lumbar spinal fusion ICD-10 codes, with 2 subgroups created based on computer-aided navigation ICD-10 codes. Nonelective cases and patients below 18 years of age were excluded. Univariate analysis on demographics, surgical data, and total charges was performed. Postoperative complication rates were calculated based on diagnosis. Lastly, multivariate analysis was performed to assess navigation's impact on cost and postoperative outcomes. A total of 88,445 lumbar fusion surgery patients were identified. Of the total, 2478 (2.8%) patients underwent lumbar fusion with navigation utilization, while 85,967 (97.2%) patients underwent surgery without navigation. The average total charges were $150,947 ($150,058, $151,836) and $161,018 ($155,747, $166,289) for the non-CAN and CAN groups, respectively ( P <0.001). The 30-day readmission rates were 5.3% for the non-CAN cohort and 3.1% for the CAN cohort ( P <0.05). The 90-day readmission rates were 8.8% for the non-CAN cohort and 5.2% for the CAN cohort ( P <0.001). CAN use was found to be significantly associated with increased cost and decreased 30-day and 90-day readmissions. Although patients operated on with CAN had increased routine discharge and decreased readmission risk, future studies must continue to evaluate the cost-benefit of CAN. Limitations include ICD-10 codes for CAN utilization being specific to region of surgery, not to exact type. Level III.

Management and Prognosis of Snake Envenomation Among Pediatric Patients: A National Database Study.

Snakebites constitute a common medical emergency in tropical and subtropical regions. Pediatric snake envenomation is a special category that has not been well studied. This study investigated the management and prognostic factors of snake envenomation in children using a Taiwanese national database. This observational study used the National Health Insurance database of all pediatric snake envenomation patients treated from 2005 to 2009. Patients' demographic data, antivenom types and doses, medical and surgical interventions, and prognostic variables were collected. Comparisons were made according to the envenomation types, age groups, and whether the patients were hospitalized using univariate and multivariate methods. A total of 106 patients' data were collected. Of the patients, 73 (68.9%) were male, 62 (58.5%) were under the age of 12, 69 (65.1%) received intravenous (IV) antibiotic treatment, 38 (35.9%) were hospitalized, 5 (4.72%) required surgical intervention, and none died. Compared with non-hospitalized patients, the patients who required hospitalization were more likely to have suffered hemorrhagic envenomation ( p = 0.035), receive IV antibiotic treatment ( p = 0.0078), and require surgical intervention ( p = 0.005). In the multivariate analysis, hemorrhagic envenomation was an independent predictor for hospitalization (odds ratio: 3.47, 95% confidence interval: 1.18-10.21) after adjusting for other covariates. No significant differences were observed between age groups in total antivenom usage ( p = 0.2880), IV antibiotic usage ( p = 0.3190), hospitalization ( p = 0.3988), and surgical intervention ( p = 0.1874). In this Taiwanese population-based national database study, antivenom treatment of pediatric snakebite patients resulted in zero mortality and a low surgical intervention rate. Patients with hemorrhagic envenomation were associated with a higher probability of hospitalization.

Surgical disparities among patients with primary hyperparathyroidism: a national inpatient sample database study

Socioeconomic and racial disparities in access to medical care have been shown to impact the morbidity and mortality of patients with surgically managed conditions. Primary Hyperparathyroidism (PHPT) is cured only by parathyroidectomy. Limited data exists examining the role of racial and socioeconomic disparity on surgical referral. Patients carrying a diagnosis of PHPT between the years of 2000–2017 were identified through the National Inpatient Sample (NIS) database. A Chi Square analysis was used to compare categorical variables and a logistic regression model with odds ratios was used to identify social predictors of surgical management. Only patients with APR-DRG Severity of Illness classifications of mild/moderate were included in the analysis, excluding patients with severe comorbidities precluding surgery. 78,520 patients were included. 75% were female. 14% were Black and 6% were Hispanic. 77% underwent parathyroidectomy. In this analysis, no statistically significant difference in odds of surgery was observed in White vs. Black patients. Hispanic patients were more likely to undergo operation than White patients (OR 1.22 [1.02–1.47] p < 0.05). Income quartile did not affect odds of surgery. Patients with private insurance were significantly more likely to be surgically managed when compared to Medicaid patients (1.40 [1.15–1.72] p < 0.001). A subgroup analysis of patients <50 years old, all of whom met National Institute of Health criteria for parathyroidectomy, was performed. Of these patients, privately insured patients were significantly more likely to undergo surgery than Medicaid patients (1.50 [1.10–2.04] p < 0.05). No statistically significant difference in odds of operation was observed between racial categories in this subgroup analysis. Patients in the highest income quartile had an increased odds of surgery when compared to patients in the lowest income quartile (OR 1.47 [1.10–1.97] p < 0.001). In patients diagnosed with PHPT, being privately insured with income in the highest quartile were factors predictive of undergoing operation for PHPT. Therefore, it is expected that patients who are on Medicaid and in the lowest income quartile would be more likely to develop the morbidities associated with advanced primary hyperparathyroidism.

Scleroderma hypertensive renal crisis among systemic sclerosis patients: A national emergency department database study.

Literature regarding trends for incidence and mortality of scleroderma renal crisis (SRC) in systemic sclerosis (SSc) within the United States (US) emergency departments (EDs) is limited. To study the mortality of SRC among SSc patient encounters within the US EDs. Data from the National Emergency Department Sample (NEDS) constitutes 20% sample of hospital-owned EDs and inpatient sample in the US were analyzed for SSc with and without SRC using ICD-9 codes. A linear p-trend was used to assess the trends. Of the total 180,435 encounters with the diagnosis of SSc in NEDS for the years 2009 2014, 771 or 4.27/1000 patients (mean age 59.6 ± 15.5 years, 75.4% females) were recorded with SRC. The numerical differences in mortality among SRC (32 or 4.1%) and non-SRC subgroups (5487 or 3.1%) did not reach statistical significance (p = 0.3). Major complications among SRC in comparison to non-SRC subgroup include ischemic stroke (5.6% vs 0.98%, p = 0.001), new-onset AF (8% vs 6.9%, p = 0.001), new-onset congestive heart failure (24.1% vs 8.8%, p = 0.001), pulmonary arterial hypertension (15.8% vs 10.9%, p = 0.001), respiratory failure (27.5% vs 10.5%, p = 0.001), and deep vein thrombosis (4.7% vs 4.6%, p = 0.001). Congestive heart failure (CHF) was strongly associated with SRC among SSc (OR 4.3 95%CI 2.7-6.7; p < 0.001). The absolute yearly rate of SRC had increased over the study years from 2.11/1000 to 5.79/1000 (linear p-trend 0.002) while the mortality trend remained steady. SRC is a relatively rare medical emergency. Although there has been a significant rise in the rate of SRC among SSc patients over the study years, mortality rates had remained steady. SSc patients with CHF should be considered to have low threshold for admission to inpatient services from EDs.

Acute Operative Management of Osteoporotic Vertebral Compression Fractures Is Associated with Decreased Morbidity.

Retrospective national database study design. This study was designed to determine whether acute percutaneous vertebral augmentation (PVA) alters morbidity compared with nonoperative management. Osteoporotic vertebral compression fractures (OCFs) are common and represent a large economic and patient burden. Several recent studies have focused on whether PVA offers benefits compared with nonoperative treatment. A retrospective cohort analysis was conducted using the Nationwide Inpatient Sample from 2015 to 2018. Patients with nonelective admissions for OCFs were identified using International Classification of Diseases (10th edition) codes. The exclusion criteria included age of less than 50 years, fusion and decompression procedures, and the presence of neoplasms and infections. Propensity score matching was implemented to construct 2:1 matched cohorts with similar comorbidities at admission. The patients were divided into the operative and nonoperative treatment groups. Univariate and multivariate regression analyses were performed to compare differences in in-hospital complication rates between the groups. All p-values of less than 0.05 were considered significant. We identified 14,850 patients in the operative group and 29,700 patients in the nonoperative group. In the multivariate analysis, operative treatment was associated with significantly lower rates of pneumonia (odds ratio [OR], 0.75; p<0.001), acute respiratory failure (OR, 0.84; p=0.009), myocardial infarction (OR, 0.20; p<0.001), acute heart failure (OR, 0.80; p=0.001), cardiogenic shock (OR, 0.23; p=0.001), sepsis (OR, 0.39; p<0.001), septic shock (OR 0.50; p<0.001), and pressure ulcerations (OR, 0.71; p<0.001). However, operative treatment was associated with a significantly greater risk of acute renal failure (OR, 1.19; p<0.001) than nonoperative treatment. Patients who undergo acute PVA for OCFs have lower rates of respiratory complications, cardiac complications, sepsis, and pressure ulcerations while having a higher risk of acute renal failure.

A Decreasing National Trend in Lumbar Disc Arthroplasty.

Retrospective National Database Study. The aim of this study was to investigate the national trend of lumbar disc arthroplasty (LDA) utilization from 2005 to 2017. Patients undergoing primary LDA between 2005 and 2017 were identified in the National Inpatient Sample (NIS) database. Year of the procedure, demographic, socioeconomic, hospital, and cost parameters were analyzed. The data was weighted using provided weights from the NIS database to generate national estimates of LDA procedure incidence. Lastly, we assessed the incidence of cervical disc arthroplasty (CDA) between 2005 and 2017 to serve as a historical comparison. An estimated 20460 patients underwent primary LDA in the United States between 2005 and 2017. There was an initial decrease in LDA procedures between 2005 and 2006 and then a plateau between 2006 and 2009. From 2010 to 2013, there was a significant year-over-year decrease in annual LDA procedures performed, followed by a second plateau from 2014 to 2017. Overall, LDA procedures decreased 82% from 2005 to 2017. Over the same time, the annual incidence of CDA utilization increased 795% from approximately 474 procedures in 2005 to 4245 procedures in 2017 (P < .01). Lumbar disc arthroplasty utilization decreased 82% from 2005 to 2017, with a significant decrease in the rate of utilization noted after 2010. The utilization of LDA to treat selected degenerative lumbar conditions has not paralleled the increasing popularity of CDA, and, in fact, has demonstrated a nearly opposite utilization trend.

Using machine learning methods to predict prolonged operative time in elective total shoulder arthroplasty

BackgroundMachine learning (ML) is a form of artificial intelligence in which computer algorithms improve automatically with experience. Recently, ML has been utilized to predict operative characteristics and patient outcomes for orthopedic procedures, thereby allowing for better patient selection and preoperative planning. This study sought to develop ML models to aid in predicting operative time and 30-day postoperative complications for elective total shoulder arthroplasty and to compare them to regression models. MethodsThis cross-sectional national database study identified patients who underwent elective total shoulder arthroplasty from 2012 to 2018 in the American College of Surgeons National Surgical Quality Improvement Program registry. Boosted decision tree and artificial neural network (ANN) ML models were developed to predict prolonged operative time and 30-day postoperative complication rates. Model performance was measured using the area under the receiver operating characteristic curve and overall accuracy. Multivariate binary logistic regression analyses were also used to identify variables that predicted prolonged operative time and 30-day postoperative complication rates. ML model performance was then compared to the regression models in predicting outcomes. ResultsIn total, 21,544 elective total shoulder arthroplasty procedures met inclusion criteria. Variables associated with greater odds of prolonged operative time included male sex (odds ratio [OR] = 0.66; 95% confidence interval [CI] = 0.61-0.71; P < .001), obesity (OR = 1.19; 95% CI = 1.09-1.29; P < .001), age under 70 years (OR = 0.77; 95% CI = 0.71-0.85; P < .001), smoking history (OR = 1.16; 95% CI = 1.03-1.32; P = .022), and history of cancer (OR = 2.91; 95% CI = 1.52-5.54; P = .001). The boosted decision tree model yielded an area under the curve (AUC) of 0.642, with an overall accuracy of 85.6% for predicting prolonged operative time. The ANN model had an AUC of 0.906 and overall accuracy of 84.7%, while the regression model had an AUC of 0.590 with overall accuracy of 85.6%. Thirty-day complication rate (7.7% vs. 3.9%, respectively; P < .001) and reoperation rate (1.8% vs. 1.2%, respectively; P = .006) also differed significantly between the prolonged operative duration and normal operative duration cohorts. ConclusionThis is the first study to successfully develop ML models for predicting operative time in total shoulder arthroplasty and compare them to existing methods of data analysis. The ANN model was superior to the other models in predicting prolonged operative time. With regard to 30-day postoperative complications, both ML models displayed fair predictive capacity, compared to the regression model, which had poor predictive performance. Level of evidenceLevel III; Database Retrospective Comparative Cohort Study

Association of baseline frailty status and age with outcomes in patients undergoing intracranial meningioma surgery: Results of a nationwide analysis of 5818 patients from the National Surgical Quality Improvement Program (NSQIP) 2015–2019

PurposeThe objective of this study was to compare the effect of frailty, as measured by the 5-factor modified frailty index (mFI-5), with that of age on postoperative outcomes of patients undergoing surgery for intracranial meningiomas, using data from a large national registry. MethodsThe National Surgical Quality Improvement Program (NSQIP) database (2015–2019) was queried to analyze data from patients undergoing intracranial meningioma resection (N = 5,818). Univariate and multivariate analyses of age and mFI-5 score were performed for 30-day mortality, major complications, unplanned reoperation, unplanned readmission, extended hospital length of stay (eLOS), and discharge to a non-home destination. ResultsBoth univariate and multivariate analyses (adjusted for sex, body mass index, transfer status, smoking, and operative time) demonstrated that mFI-5 and age were significant predictors of adverse postoperative outcomes in patients with intracranial meningioma. However, based on odds ratios (OR) and effect sizes, increasing frailty tiers were better predictors than age of adverse outcomes. Severely frail patients showed highest effects sizes for all postoperative outcome variables [OR 11.17 (95% CI 3.45–36.19), p<0.001 for mortality; OR 4.15 (95% CI 2.46–6.99), p<0.001 for major complications; OR 4.37 (95% CI 2.68–7.12), p<0.001 for unplanned readmission; OR 2.31 (95% CI 1.17–4.55), p<0.001 for unplanned reoperation; OR 4.28 (95% CI 2.74–6.68), p<0.001 for eLOS; and OR 9.34 (95% CI 6.03–14.47, p<0.001) for discharge other than home. ConclusionIn this national database study, baseline frailty status was a better independent predictor for worse postoperative outcomes than age in patients with intracranial meningioma.

Acute myocardial infarction and acute heart failure among renal transplant recipients: a national readmissions database study.

The literature on the mortality and 30-day readmissions for acute heart failure and for acute myocardial infarction among renal-transplant recipients is limited. To study the in-hospital mortality, cardiovascular complications, and 30-day readmissions among renal transplant recipients (RTRs). Data from the national readmissions database sample, which constitutes 49.1% of all hospitals in the United States and represents more than 95% of the stratified national population, wasanalyzed for the years 2012-2018 using billing codes. A total of 588,668hospitalizations inrenal transplant recipients (mean age 57.7 ± 14.2years; 44.5% female) were recorded in the study years. A total of 15,788 (2.7%) patients had a diagnosis of acute heart failure; 11,320 (71.7%) had acute heart failure with preserved ejection fraction and 4468 (28.3%) had acute heart failure with reduced ejection fraction; 17,256 (3%) patients had myocardial infarction, 3496 (20%) had ST-Elevation myocardial infarction while 13,969 (80%) had non-ST-elevation myocardial infarction. Overall,11,675 (2%) renal-transplant patients died, of whom 757 (6.5%) had acute heart failure, 330 (2.8%) had acute reduced and 427 (3.7%) had acute preserved ejection fraction failure. Among 1652 (14.1%) patient deaths with myocardial infarction, 465 (4%) were ST-elevation- and 1187 (10.1%) were non-ST-Elevation-related. The absolute yearly mortalityrate due toacute heart failure increased over the years 2012-2018 (p-trend 0.0002, 0.001, 0.002, 0.05, respectively), while the mortality rate due to myocardial infarction withST-elevation decreased (p-trend 0.002). Cardiovascular complications are significantly associated with hospitalizations among RTRs. The absolute yearly mortality, and rate of heart failure (withreduced orpreserved ejection fraction) increasedover the study years, suggesting thatmore research is needed to improve the management ofthese patients.

Relicensing Practices of Taxi Drivers and Crane Operators Aged 70 Years and above in Singapore

Singapore is a rapidly ageing society, underpinned by national policies to promote successful and active ageing. Whilst older worker participation in the workforce is encouraged, policymakers are challenged to ensure that work competency is not compromised with any normal age- and/or health-related changes. This paper will briefly outline how policymakers responded to the needs of two subgroups of older workers aged 70 years and above (taxi drivers; crane operators) who desire to continue working in the last two decades. Whilst a mandatory retirement age policy exists for older taxi drivers in Singapore, there is none for older crane operators. Despite this, stricter relicensing protocols were introduced for both types of workers, with active collaboration involving additional occupational therapy services for functional work competency assessments to complement the routine medical fitness screening. Comparisons will be made of these two relicensing frameworks, including the mention of any relevant studies to align with the call of evidence-based practices. In mid-2020, the relicensing policy for older taxi drivers was revised based on findings of a retrospective national database study. Currently, a 4-year national database study on older crane operators aged 70 years and above is being undertaken with preliminary findings to be reported.

A national analysis on complications and readmissions for adult cerebral palsy patients undergoing primary spinal fusion surgery.

Retrospective National Database Study. Surgical intervention with spinal fusion is often indicated in cerebral palsy (CP) patients with progressive scoliosis. The purpose of this study was to utilize the National Readmission Database to determine the national estimates of complication rates, 90-day readmission rates, and costs associated with spinal fusion in adult patients with CP. The 2012-2015 NRD databases were queried for all adult (age ≥ 19years) patients diagnosed with CP (ICD-9: 333.71, 343.0-4, and 343.8-9) undergoing spinal fusion (ICD-9: 81.00-08). 1166 adult patients with CP (42.7% female) underwent spinal fusion surgery between 2012 and 2015. 153 (13.1%) were readmitted within 90days following the primary surgery, with a mean 33.8 ± 26.5days. Mean hospital charge of the primary admission was $141,416 ± $157,359 and $167,081 ± $145,416 for the non-readmitted and readmitted patients, respectively (p = 0.06). The mean 90-day readmission charge was $72,479 ± $104,100. Most common complications with the primary admission included UTIs (no readmission vs. readmission: 7.6% vs. 4.8%; p = 0.18), respiratory (6.9% vs. 5.6%; p = 0.62), implant (3.8% vs. 6.0%; p = 0.21), and paralytic ileus (3.6% vs. 3.2%; p = 0.858). Multivariate analyses demonstrated the following as independent predictors for 90-day readmission: comorbid anemia (OR: 2.8; 95% CI: 1.6-4.9; p < 0.001), coagulopathy (2.9, 1.1-8.0, 0.037), perioperative blood transfusion (2.0, 1.1-3.8, 0.026), wound complication (6.4, 1.3-31.6, 0.023), and transfer to short-term hospital versus routine disposition (4.9, 1.0-23.3, 0.045). Quality improvement efforts should be aimed at reducing rates of infection related complications as this was the most common reason for short-term complications and unplanned readmission following surgery.

RISK FACTORS FOR DEVELOPMENT OF PROSTATE CANCER IN PATIENT WITH INFLAMMATORY BOWEL DISEASE (IBD)

Abstract BACKGROUND Prostate cancer (PC) is a 2nd leading cause of cancer death in the USA among men. We aim to investigate incidence, characteristics, and risk factors for PC in patients diagnosed with Inflammatory bowel disease (IBD) using Cerner Health Facts, a national longitudinal database representing approximately 69 million patients. METHODS All male patients over 40 years of age with IBD were included in our analysis. Our primary endpoint was development of PC, specified by ICD coding. Patient characteristics were evaluated as potential risk factors for development of PC using multivariable regression built using all variables with p&amp;lt;0.1 on univariable analysis. RESULTS Overall, 2.23% patients with IBD developed prostate cancer (992/44,551). Mean age was 59.7±12.7 years and 9.65% (04,297/44,551) of patients were obese. In terms of race, 82.9% (36,929/44,551) were white and 7.8% (3,470/44,551) were African American. 94.9% (41829/44,551) received care at an acute care facility and 83.7% (37,266/44,551) received care at an urban facility. On multivariable regression, the risk factors associated with higher risk of prostate cancer include diabetes (odds ratio OR 1.20), obesity (OR 1.22), age (OR 1.07), family history of prostate cancer (OR 6.04), African American race (OR 2.00), and married status (OR 1.43). Factors that decreased risk of pancreatic cancer include other race (OR 0.70; 95% CI 0.53-0.92), and presentation at acute facility (OR 0.59; 95% CI 0.46-0.76). Factors not found to be associated with high risk of PC in our study includes sexually transmitted disease, alcohol use disorder, smoking, presentation at teaching facility, and facility size/type (Table 1). The most protective variable against PC was presentation at acute facility (OR 0.59), other-race (OR 0.70). Table 1 contains our univariable analysis and multivariable regression model with 95% confidence intervals; 6 variables were predictive for PC and 2 variables were protective against PC. CONCLUSION We describe risk factors for development of PC from IBD. In this longitudinal national database study of patient with diagnosed IBD – age, diabetes, obesity, married status, family history of prostate cancer, and African American race were noted to be associated with high risk of developing prostate cancer. Careful evaluation and follow up is advised for IBD patients.

ST-elevation myocardial infarction among cardiac amyloidosis patients; a national readmission database study.

Literature regarding recent trends, mortality outcomes of ST-elevation myocardial infarction (STEMI) in cardiac amyloidosis (CA) patients is limited.To study coronary interventions, and trends in prevalence and mortality outcomes among CA patients with STEMI.Data from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the USA, representing more than 95% of the national population, were analyzed for hospitalizations associated with CA with STEMI. A linear p-trend was used to assess the trends.Out of the total 4252 adult patients (mean age 73.3 ± 11.7years, 40.2% females) with diagnosis of CA, 439 (10.3%) had STEMI while 3813 (89.7%) had no STEMI. STEMI-CA patients had higher rates of multi-organ manifestations including VT/VF (12% vs 8.5%; p-value < 0.001), cardiogenic shock (12.7% vs 7.3%; p < 0.001), AKI requiring dialysis (5.3% vs 4%; p < 0.001), and ICU admissions (25.2% vs 15.3%; p < 0.001) compared to CA without STEMI. CA-STEMI had increased mortality rates (23.7% vs 16.1%, p < 0.001) compared to CA without STEMI. On multivariate logistic regression analysis, coronary interventions includingPCI (OR 0.6, CI 0.4-1.1; p = 0.3) and CABG (OR 0.7, CI 0.3-1.8; p = 0.2) had no association with mortality among CA patients.The absolute yearly trends for prevalence and mortality associated with STEMI in CA patients remained steady over the study years (linear p-trends 0.2 and 0.6, respectively).CA-STEMI is associated with significant complications and mortality. Coronary interventions may not have significant mortality benefits. Thus, more research will be needed to improve mortality rates among these patients.

Patient Characteristics, Length of Stay, Cost of Care, and Complications in Super-Obese Patients Undergoing Total Hip Arthroplasty: A National Database Study.

The purpose of this study was to compare postoperative complication rates in super-obese (SO) patients with a body mass index (BMI) ≥ 50 kg/m2 undergoing total hip arthroplasty (THA) versus non-super-obese (NSO) patients undergoing THA. In this retrospective study using the National Inpatient Sample (NIS) database, 1,646 cases of THA in SO (BMI ≥ 50 kg/m2) patients were reviewed. We used International Classification of Diseases (ICD)-10 codes to assess postoperative variables including length of stay, cost of care (cost of inpatient hospitalization), and medical and surgical complications among SO patients undergoing THA compared to NSO patients before being discharged. A comparison of demographic variables showed there were more women in both groups and nearly 17.2% of SO patients were diabetic patients, 11.1% of SO patients were tobacco users, and 74.8% of the SO patients were whites (African American, 15.1%; Hispanic, 2.9%). The mean length of stay was 3.43 days in the SO group and 2.32 days in the NSO group, and this difference was statistically significant. The cost of care was $79,784.64 for the SO group, which was significantly higher than $66,821.75 for the NSO group. The SO group also showed higher odds of developing medical complications such as anemia (odds ratio [OR], 1.555; 95% confidence interval [CI], 1.395-1.734; p < 0.001), acute renal failure (OR, 3.375; 95% CI, 2.816-4.045; p < 0.001), pneumonia (OR, 2.319; 95% CI, 1.241-4.331; p = 0.014), and need for blood transfusion (OR, 1.596; 95% CI, 1.289-1.975; p < 0.001). The SO patients also showed a higher risk of several postoperative surgical complications such as periprosthetic fractures, infection, and wound dehiscence. Postoperative complication rates in SO patients were higher than those in the NSO group. Length of stay and cost of care were higher, whereas the mean age was lower for the SO group. Therefore, THA in SO patients should be undertaken only after careful consideration and preferably in a tertiary facility capable of handling all medical and surgical in-hospital complications.

Predictive Factors of Outcome in Cases of Out-of-hospital Cardiac Arrest Due to Traffic Accident Injuries in Thailand; a National Database Study.

Traffic accident injury is one of the global leading causes of death and an important public health problem. This study aimed to evaluate the predictive factors of return of spontaneous circulation (ROSC) at the scene in out-of-hospital cardiac arrest (OHCA) due to traffic accidents. This retrospective cross-sectional study was conducted on cases of OHCA due to traffic accident, who were resuscitated at the scene by emergency medical services (EMS) in Bankok, Thiland, from January 1, 2020, to December 31, 2020 (1 year). Patients were divided into two groups of with and without ROSC and independent predictive factors of outcome were evaluated. 2400 OHCA cases met the inclusion criteria, among them, 1728 (72.0%) achieved ROSC at the scene. Facial injury (adjusted OR = 2.17, 95%CI: 1.37-3.44, p = 0.001); prehospital airway management using bag valve mask (adjusted OR = 1.69, 95%CI: 1.21-2.34, p = 0.002), and endotracheal tube (adjusted OR = 3.88, 95%CI: 1.84-8.18, p <0.001); and prehospital fluid therapy using normal saline (adjusted OR = 4.24, 95%CI: 3.12-5.77, p <0.001), ringer lactate (adjusted OR = 5.13, 95%CI: 3.47-7.61, p <0.001), and other solutions (adjusted OR = 5.25, 95%CI: 2.16-12.8, p <0.001) were independent predictive factors of ROSC at the scene in OHCA due to traffic accidents. Based on the findings, the rate of ROSC at the scene for cases with OHCA due to traffic accidents, serviced by EMS was high, i.e., 72%, and three independent predictive factors of ROSC at the scene were facial injury, prehospital airway management, and prehospital fluid management.

Potential beneficial effects of bariatric surgery on the prevalence of kidney cancer: a national database study.

The incidence of obesity has been steadily increasing, especially in developed countries. Also, obesity is considered one of the modifiable risk factors of kidney cancer. This study aims to determine the impact of bariatric surgery-induced weight loss on the prevention of kidney cancer. Academic Hospital, United States. The National (Nationwide) Inpatient Sample (NIS) was queried for the period 2010 to 2015 for first-time kidney cancer-related hospitalization, used as a proxy for cancer incidence, in patients with a history of bariatric surgery (cases) and patients with obesity but no history of bariatric surgery (controls). Patients with a previous diagnosis of cancer were excluded from the analysis. In order to identify comparable patients, all controls had to have a body mass index ≥35 kg/m2, as per the existing qualification criteria for bariatric surgery. The International Classification of Diseases-9 codes (ICD-9) was used to identify admissions for kidney cancer. A univariate analysis was conducted to compare demographics and co-morbidities between groups. A multivariate logistic regression model was performed to assess differences between surgical and control groups and adjust for independent variables such as smoking history and family history of malignancy. All percentages and means (with confidence intervals [CIs]) were weighted. A total of 2,300,845 were included in the analysis, of which 2,004,804 controls-subjects, with a mean age of 54.4 ± .05 years, and 296,041 treatment-subjects, with a mean age of 51.9 ± .05 years. Demographics and co-morbidities, such as tobacco use, diabetes, and hypertension, were also measured. Patients with a history of bariatric surgery were significantly less likely to experience renal cancer than patients without a history of bariatric surgery, with 5935 cases in the control group and 684 in the case group (P < .0001). After a multivariate logistic regression was performed, the OR was 1.10 (95% CI: 1.02-1.22, P < .0224). Our finding suggests that bariatric surgery-induced weight loss could significantly prevent first-time kidney cancer-related hospitalizations in patients with obesity. Prospective studies are needed to confirm our findings.

Comparable Esophagectomy Outcomes by Surgeon Specialty: A NSQIP Analysis.

A few observational studies have found that outcomes after esophagectomies by thoracic surgeons are better than those by general surgeons. Non-emergent esophagectomy cases were identified in the 2016-2017 American College of Surgeons NSQIP database. Associations between patient characteristics and outcomes by thoracic versus general surgeons were evaluated with univariate and multivariate logistic regression. Of 1,606 cases, 886 (55.2%) were performed by thoracic surgeons. Those patients differed from patients treated by general surgeons in race (other/unknown 19.3% vs 7.8%; P<.001) but not in other baseline characteristics (age, sex, BMI, and comorbidities). Thoracic surgeons performed an open approach more frequently (48.9% vs 30.8%, P<.001) and had operative times that were 30minutes shorter (P<.001). General surgeons had lower rates of reoperation (11.8% vs 17.2%; P=.003) and were more likely to treat postoperative leak with interventional means (6.3% vs 3.4%, P=.01). Thoracic surgeons were more likely to treat postoperative leak with reoperation (5.9% vs 3.6%, P=.01). There were no other differences in univariate comparison of outcomes between the two groups, including leak, readmission, and death. General surgery specialty was associated with lower risk of reoperation. Our multivariable model also found no relationship between general surgeon and risk of any complication (odds ratio 1.10; 95% CI .86 to 1.42). In our large, national database study, we found that outcomes of esophagectomies by general surgeons were comparable with those by thoracic surgeons. General surgeons managed postoperative leaks differently than thoracic surgeons.