National Hospital Discharge Survey Research Articles

Malnutrition, Dysphagia, Sarcopenia and Weakness in the Older Population: A Retrospective Review to Enlighten Future Directions for Health System Best Practices.

The older population is growing exponentially causing greater demands on healthcare. Malnutrition, dysphagia, sarcopenia and weakness are highly prevalent diseases in the older population. Previous research (Byun et al. in BMC Geriatr 19(356):1-7, 2019; Fujishima et al. in Geriatr Gerontol Int 19:91-97, 2019; Hernandez et al. in Nutr Hosp 32(4):1830-1836, 2015; Nagano et al. in J Nutr Health Aging 23(3):256-265.5, 2019; Nishioka et al. in Clin Nutr 36(4):1089-1096, 2017; Robinson et al. in Clin Nutr 37(4):1121-1132, 2018, https://doi.org/10.1016/j.clnu.2017.08.016 ) has shown that these disorders are frequently associated, in many cases, preventable using screenings and intervention. This study utilized the National Hospital Discharge Survey of 2008 from the National Center of Health Statistics as secondary data to examine the associations amongst these four variables as well as possible correlations with age, days of care in the acute care hospital setting and frequency of rehabilitative and nutritional interventions received by these patients. Out of 165,630 cases, a sample size of 59,029 cases ages 65 and above were filtered by the researchers for desired diagnoses and procedure codes. After this, all neurological diagnoses were filtered and excluded by the researchers, resulting in 2458 cases. Using the Chi square test of independence, findings revealed significant associations between the variables of malnutrition and dysphagia (χ2 (1) = 1882.618, p = 0.001), dysphagia and weakness (χ2 (1) = 21.069, p = 0.001) and malnutrition weakness (χ2 (1) = 88.434, p = 0.001). The point biserial correlation coefficient was calculated to examine possible associations between these four conditions and age as well as days of care. A significant negative correlation was found between malnutrition and age (rpb (2456) = - 0.043, p = 0.05). In addition, days of care were significantly correlated with malnutrition (r(2456) = 0.138, p = 0.001) and inversely significantly correlated with dysphagia (r(2456) = - 110, p = 0.001), weakness (r(2456) = - 0.060, p = 0.001) and sarcopenia (r(2456) = - 0.041, p = 0.05). Lastly, the study found a large disparity between cases that received rehabilitative and nutritional intervention and those that didn't.

Live birth prevalence of hemolytic disease of the fetus and newborn in the United States from 1996 to 2010

Hemolytic disease of the fetus and newborn (HDFN) is mediated by maternal alloantibodies, a consequence of immune sensitization during pregnancy with maternal-fetal incompatibility with ABO, Rhesus factor (Rh), and/or other red blood cell antigens. RhD, Kell, and other non-ABO alloantibodies are the primary cause of moderate to severe HDFN, whereas ABO HDFN is typically mild. HDFN live birth prevalence owing to Rh alloimmunization among newborns in the United States was last estimated to be 106 per 100,000 births in 1986. HDFN live birth prevalence owing to all alloantibodies was estimated to be 817 to 840 per 100,000 in Europe. There is a need for updated prevalence estimates in the United States and a better understanding of disease demographics, severity, and treatments. This study aimed to estimate the live birth prevalence of HDFN and the proportion of severe cases of HDFN in the United States, to describe the associated risk factors, and to compare the clinical outcomes and treatments among healthy newborns, newborns with HDFN, and newborns who are sick without HDFN using a nationally representative hospital discharge database. In this retrospective, observational cohort study, we used data from the 1996 to 2010 National Hospital Discharge Survey to identify live births, defined by inpatient visits with the newborn flag, with and without a diagnosis of HDFN across 200 to 500 sampled hospitals (≥6 beds) per year. Patient and hospital characteristics, alloimmunization status, disease severity, treatment, and clinical outcomes were evaluated. Frequencies and weighted percentages were calculated for all variables. Logistic regression was used to compare the characteristics between newborns with HDFN and other newborns using odds ratios. Of 480,245 live births identified, 9810 HDFN cases were recorded. When weighted to the United States population, this corresponded to a live birth prevalence of 1695 per 100,000 live births. Compared with other newborns, newborns with HDFN were more likely to be female, Black, living in the South (vs the Midwest or West), and treated at larger (>100 beds) and government-owned hospitals. ABO and Rh alloimmunization accounted for 78.1% and 4.3% of newborns with HDFN, respectively, whereas HDFN caused by other antigens, such as Kell and Duffy, accounted for 17.6% of the cases. Among newborns with HDFN, 22% received phototherapy, 1% received simple transfusions, and 0.5% received exchange transfusions or intravenous immunoglobulin. Newborns affected by HDFN caused by Rh alloimmunization were more likely to require medical interventions, including simple or exchange transfusions, and more likely to be delivered by cesarean delivery. Overall, HDFN was associated with a longer hospital length of stay in the neonatal intensive care unit when compared with healthy and other sick newborns, a higher rate of cesarean delivery, and a higher rate of nonroutine discharge than healthy newborns. Overall, the live birth prevalence of HDFN was higher than those previously reported, whereas Rh-induced HDFN live birth prevalence was similar to those previously reported. HDFN live birth prevalence owing to Rh alloimmunization decreased over time, likely because of continued Rh immune globulin prophylaxis. Treatment patterns for newborns with HDFN and the comparative clinical outcomes when compared with healthy newborns confirm the continued clinical needs of this population.

Area-Level Socioeconomic Inequalities in Intracranial Injury-Related Hospitalization in Korea: A Retrospective Analysis of Data From Korea National Hospital Discharge Survey 2008-2015.

Although inequality in traumatic brain injury (TBI) by individual socioeconomic status (SES) exists, interventions to modify individual SES are difficult. However, as interventions for area-based SES can affect the individual SES, monitoring or public health intervention can be planned. We analyzed the effect of area-based SES on hospitalization for TBI and revealed yearly inequality trends to provide a basis for health intervention. We included patients who were hospitalized due to intracranial injuries (ICIs) between 2008 and 2015 as a measure of severe TBI with data provided by the Korea National Hospital Discharge Survey. Area-based SES was synthesized using the 2010 census data. We assessed inequalities in ICI-related hospitalization rates using the relative index of inequality and the slope index of inequality for the periods 2008-2009, 2010-2011, 2012-2013, and 2014-2015. We analyzed the trends of these indices for the observation period by age and sex. The overall relative indices of inequality for each 2-year period were 1.82 (95% confidence interval, 1.5-2.3), 1.97 (1.6-2.5), 2.01 (1.6-2.5), and 2.01 (1.6-2.5), respectively. The overall slope indices of inequality in each period were 38.74 (23.5-54.0), 36.75 (21.7-51.8), 35.65 (20.7-50.6), and 43.11 (27.6-58.6), respectively. The relative indices of inequality showed a linear trend for men (P = 0.006), which was most evident in the ≥ 65-year age group. Inequality in hospitalization for ICIs by area-based SES tended to increase during the observation period. Practical preventive interventions and input in healthcare resources for populations with low area-based SES are likely needed.

SPIKED THROUGH THE HEART: A RARE COMPLICATION OF INFERIOR VENA CAVA (IVC) FILTER PLACEMENT

SPIKED THROUGH THE HEART: A RARE COMPLICATION OF INFERIOR VENA CAVA (IVC) FILTER PLACEMENT

The Association between Comorbidities and Comorbid Injuries on Treatment Outcome in Pediatric and Elderly Patients with Injuries in Korea: An Observational Study.

We aimed to compare the characteristics and types of injuries affecting pediatric and elderly patients and to identify factors associated with treatment outcomes. We used data from the 2006–2017 Korea National Hospital Discharge Survey. The patients were divided into two groups, children (0–12 years) and elderly (≥65 years), based on their age at discharge. In total, 47,528 (11,842 children and 35,686 older adults) patients with injuries were identified. The number of deaths and the LOS were 36 (0.3%) and 7.6 days (±10.1), respectively, in the children group, and 861 (2.4%) and 18.5 days (±27.3), respectively, in the elderly group (p < 0.001). In the children group, there were increased odds for surgery among boys, Medicaid and health insurance subscribers, patients with multiple injuries, patients without a subdiagnosis, and an increasing number of hospital beds. In the elderly group, there were increased odds for surgery among women, Medicaid and health insurance subscribers, patients who died, patients with a single injury, patients with a subdiagnosis, and increasing numbers of hospital beds. Treatment outcomes could be improved by providing early diagnosis and prompt treatment in pediatric patients and by taking multilateral approaches for multiple injuries and comorbidities in elderly patients.

Decreasing rate of inpatient pediatric bipolar disorder diagnosis in the US between 2004 and 2010.

Diagnosis of bipolar disorder (BD) increased substantially among youth between the mid-1990s and mid-2000s in the United States. This dramatic increase in diagnosis resulted in concern regarding the potential for misdiagnosis of BD among youth. However, the rate of BD diagnosis in the United States had not been evaluated nationally since the mid-2000s. It was unclear whether changes in diagnostic rates continued to occur. Therefore, the present study aimed to assess the pattern of longitudinal trends in the rate of national inpatient BD diagnosis subsequent to 2004. Data included a nationally representative dataset of inpatient hospitalizations between 1996 and 2010. De-identified data were obtained from the National Hospital Discharge Survey (NHDS) conducted annually by the National Center for Health Statistics. The proportion of BD diagnoses relative to all psychiatric diagnoses increased between 1996 and 2004 among children and adolescents. The proportion of BD diagnoses then decreased between 2004 and 2010 among children but continued to increase for adolescents. However, population-adjusted rates of BD diagnosis per 10,000 individuals in the general population initially increased until the mid-2000s and then decreased until 2010 for both children and adolescents. Rates of BD diagnosis substantially decreased for youth between the mid-2000s and 2010. This decline coincided with recommendations for more conservative diagnostic practices due to concerns about overdiagnosis and increasing awareness of the side effects of front-line medications used to treat BD in youth. Findings provide insight into changing trends in inpatient service utilization for BD in the United States.

Direct Oral Anticoagulants: Overcoming the Challenges of Managing Venous Thromboembolism in Children

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism, is relatively common among adults, with estimated incidence rates ranging from approximately 10 to 1200 per 100 000 adults aged ≥30 years. 1 Raskob G.E. Angchaisuksiri P. Blanco A.N. Büller H. Gallus A. Hunt B.J. et al. Thrombosis: a major contributor to global disease burden. Semin Thromb Hemost. 2014; 40: 724-735 Crossref PubMed Scopus (73) Google Scholar VTE is less common in children than in adults, with estimated incidence rates ranging from 0.7 to 4.9 per 100 000 children. 2 Andrew M. David M. Adams M. Ali K. Anderson R. Barnard D. et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood. 1994; 83: 1251-1257 Crossref PubMed Google Scholar , 3 van Ommen C.H. Heijboer H. Büller H.R. Hirasing R.A. Heijmans H.S. Peters M. Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr. 2001; 139: 676-681 Abstract Full Text Full Text PDF PubMed Scopus (517) Google Scholar , 4 Stein P.D. Kayali F. Olson R.E. Incidence of venous thromboembolism in infants and children: data from the National Hospital Discharge Survey. J Pediatr. 2004; 145: 563-565 Abstract Full Text Full Text PDF PubMed Scopus (237) Google Scholar , 5 Tuckuviene R. Christensen A.L. Helgestad J. Johnsen S.P. Kristensen S.R. Pediatric venous and arterial noncerebral thromboembolism in Denmark: a nationwide population-based study. J Pediatr. 2011; 159: 663-669 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar However, it can have serious consequences, such as death, recurrence of thrombosis, loss of vessel patency required for future intravascular cannulation or organ transplantation, chronic pulmonary hypertension, or post-thrombotic syndrome. 2 Andrew M. David M. Adams M. Ali K. Anderson R. Barnard D. et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood. 1994; 83: 1251-1257 Crossref PubMed Google Scholar ,6 Goldenberg N.A. Donadini M.P. Kahn S.R. Crowther M. Kenet G. Nowak-Göttl U. et al. Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors. Haematologica. 2010; 95: 1952-1959 Crossref PubMed Scopus (137) Google Scholar , 7 Greene L.A. Goldenberg N.A. Deep vein thrombosis: thrombolysis in the pediatric population. Semin Intervent Radiol. 2012; 29: 36-43 Crossref PubMed Scopus (18) Google Scholar , 8 Pelland-Marcotte M.C. Tucker C. Klaassen A. Avila M.L. Amid A. Amiri N. et al. Outcomes and risk factors of massive and submassive pulmonary embolism in children: a retrospective cohort study. Lancet Haematol. 2019; 6: e144-e153 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Despite its relative rarity, the incidence of pediatric VTE has increased in recent years. 5 Tuckuviene R. Christensen A.L. Helgestad J. Johnsen S.P. Kristensen S.R. Pediatric venous and arterial noncerebral thromboembolism in Denmark: a nationwide population-based study. J Pediatr. 2011; 159: 663-669 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar ,9 Sandoval J.A. Sheehan M.P. Stonerock C.E. Shafique S. Rescorla F.J. Dalsing M.C. Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: an increasing population at risk. J Vasc Surg. 2008; 47: 837-843 Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar ,10 Carpenter S.L. Richardson T. Hall M. Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014. Blood Adv. 2018; 2: 1403-1408 Crossref PubMed Scopus (38) Google Scholar This increase is considered related to a number of factors, including the increased use of central venous catheters (CVCs), improved survival rates for children with chronic or critical conditions, and more frequent VTE diagnoses through improved pediatrician awareness and imaging techniques. 11 Raffini L. Huang Y.S. Witmer C. Feudtner C. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics. 2009; 124: 1001-1008 Crossref PubMed Scopus (569) Google Scholar ,12 Malec L. Young G. Treatment of venous thromboembolism in pediatric patients. Front Pediatr. 2017; 5: 26 Crossref PubMed Scopus (18) Google Scholar First to the public, next to youThe Journal of PediatricsVol. 240PreviewThanks to direct-to-consumer marketing, snappy jingles, familiar spokespeople, and ubiquitous slogans, you are probably familiar with some direct oral anticoagulants (as well as any number of other classes of medications), such as rivaroxaban (Xarelto) and apixaban (Eliquis). You might not have focused on their use, however, since they were initially developed for use in adults. This volume of The Journal includes a Medical Progress report on direct anticoagulants (DOACs) for use in children with venous thromboembolism, including data from the latest trials and projected approval by the US Food and Drug Administration. Full-Text PDF

Association of marital status with takotsubo syndrome (broken heart syndrome) among adults in the United States.

BACKGROUNDThe pathophysiology of takotsubo syndrome (TTS) is not well understood, however, it is often precipitated by psychological or physical stress. Marital status is related to emotional stress, but its associations with TTS are limited.AIMTo explored the potential association between marital status and TTS. METHODSWe conducted a case-control study using data on patients aged ≥ 40 years with marital status data in the National Hospital Discharge Survey (2006-2010). The International Classification of Diseases Ninth Revision codes were used to identify cases with TTS and other comorbid conditions. Each case was matched to 5 controls by age, sex, year of TTS diagnosis and bed size of hospital. Two sets of controls were selected: Acute myocardial infarction (AMI) controls and non-cardiovascular disease (CVD) controls. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association of marital status with TTS. RESULTSThe 59 patients with TTS who had information on marital status were matched to 295 controls with AMI and 295 non-CVD controls, resulting in a sample of 649 patients. The average age of cases was 69.7 ± 11 years with 90% being women and 88% reporting White race. In multivariable-adjusted models, compared to singles, patients who were married had lower odds of TTS (OR = 0.86, 95%CI: 0.79–0.93) while those who were widowed (OR = 1.14, 95%CI: 1.05–1.23) or divorced/separated (OR = 1.32, 95%CI: 1.21–1.45) had elevated odds for TTS when compared to non-CVD controls. Similar results were observed when cases were compared to controls with AMI. CONCLUSIONIn this study, being married was associated with lower odds for TTS while being divorced/separated or widowed was related to elevated odds for TTS. These novel findings that underscore the potential importance of social factors like marital status in the development of TTS need confirmation in larger studies.

968 Estimation of hemolytic disease of the newborn in the United States from 1996-2010

Hemolytic Disease of the Newborn (HDN) or Fetus and Newborn (HDFN) has not been assessed over years at the national level in the United States (US) since the 1980’s when the incidence of Rh HDN was estimated to be 106/100,000 births based on the CDC’s Birth Defects Monitoring Program. Current estimates of 3-80/100,000 for Rh HDFN and 30-700/100,000 for ABO HDFN are derived from indirect data sources. We utilized a nationally representative medical care survey, the National Hospital Discharge Survey to estimate the rate of HDN in neonates in the US from 1996 to 2010. Data were collected from neonates with ICD-9 codes 773.0-773.5, indicating HDN caused by Rh, ABO and other/unknown red cell antigens. Rates of neonatal HDN, demographics, and outcomes were analyzed over the 15-year timeframe and compared to those of non-HDN newborns. Severe HDN was defined as neonates requiring exchange transfusion or IVIg or suffering hydrops, late onset of anemia or death. Weighted frequencies and Chi Square analyses (SAS v9.4) were utilized. A total of 480,230 births were included in the analysis. The rate of all HDN remained stable at 1,700 cases/100,000 newborns whereas Rh HDN declined, on average, from 85 to 60 cases per 100,000 newborns. The majority of HDN was caused by ABO incompatibility or other/unknown antigens. While white newborns formed the majority of HDN cases, the rate of HDN was observed to be higher amongst black (2.3%) versus white (1.6%) neonates. Compared to healthy newborns, HDN newborns experienced longer hospital stays (3 days vs 2 days), were less likely to be routinely discharged (97.99% vs 99.72%) and had higher Caesarean section rates (30.6% vs 20.9%). Severe HDN occurred in 5.8-7.5/100,000 newborns. Using a nationally representative database, the estimated rate of HDN is consistent with those observed in previous studies. Despite RhIg prophylaxis, a low rate of Rh HDN persists as does severe disease and the need for increased neonatal care. Demographic and clinical disparities merit further investigation.

S0269 Changing Demographics in Colorectal Cancer: A Nationwide Study

INTRODUCTION: The incidence of colorectal cancer (CRC) in patients less than 50 years of age has increased in recent years. Previous research has led to creation of different screening guidelines for certain populations (e.g., lower age for African Americans [AA]). This study examines demographics for CRC patients over time periods in the United States. METHODS: The National Hospital Discharge Survey and the National Hospital/Ambulatory Medical Care Survey were queried from 2001 to 2015 to identify patients with an ICD-9 code for CRC. Five-year time periods were used to compare trends for age, sex, and region among CRC patients. Also, patients age 40–50 vs > 50 years old were compared on sex, race, and region. SPSS was used for chi-square analysis and the least significant difference post hoc test for one-way analysis of variance. Inferences were at the 0.05 level of significance. RESULTS: Among 19,214 CRC patients, 10,819 were diagnosed in the 2001–2005 period, 7,870 in the 2006–2010 period, and 525 in the 2011–2015 period. The 40–50 age group included 1,762 patients while the >50 age group included 16,968 patients. The mean age of CRC diagnosis decreased linearly from 2001–2005 (68.78 yrs.) to 2006–2010 (67.55 yrs.) and 2011–2015 (64.05 yrs.) (P < 0.001) (Figure 1). The proportion of patients in the 40–50 age group increased for the three time periods (8.7% vs 10.2% vs 11.9%) (P < 0.001) (Figure 2). When taking all cases into account, gender of CRC patients did not differ over the three time periods (50.6%, 50.0% and 53.5% female respectively). There was a decrease in the proportion of patients diagnosed in the Northeast over time (25.9% vs 22.7% vs 13.6%) while increases were observed in the South (33.5% vs 39% vs 40.2%) and the West (11.2% vs 9.8% vs 19.7%) (P < 0.001). The Midwest maintained similar rates (29.3% vs 28.5% vs 26.4%). Compared to >50 age group, the 40–50 age group had a higher proportion of males ( 52.5% Vs 49.2%, P = 0.004 ), higher proportion of AA (11.6% Vs 16.0%, P < 0.001)), lower proportion of Caucasians ( 52.5% Vs 57.3% P < 0.001) , more likely to be from the South ( 42.2% Vs 35.0% P < 0.001) and less likely to be from Midwest ( 23.6% Vs 29.7% P < 0.001).Figure 1.: Mean age of CRC diagnosis over time (P < 0.001).Figure 2.: Proportion of CRC patients age 40-50 over time (P < 0.001).CONCLUSION: Over time periods, the mean age of CRC patients has decreased. Concurrently, the proportion of patients diagnosed at age 50 or younger increased. Further, the 40–50 age group had a higher proportion of AAs and males. These trends lend further support for consideration of adjustments and individualization in screening guidelines.

Trends in Legionnaires' Disease-Associated Hospitalizations, United States, 2006-2010.

Background Legionella pneumophila is a waterborne cause of both healthcare-associated and community-acquired pneumonia. Legionella pneumophila serogroup 1 is responsible for 80% of infections. There is currently limited published disease burden data on Legionnaires’ disease-associated hospitalization in the United States.MethodsIn this study, we estimated the annual incidence of Legionnaires’ disease-associated hospitalizations in United States and identified demographic, temporal, and regional characteristics of individuals hospitalized for Legionnaires’ disease. A retrospective study was conducted using the National Hospital Discharge Survey (NHDS) data from 2006 to 2010. The NHDS is a nationally representative US survey, which includes estimates of inpatient stays in short-stay hospitals in the United States, excluding federal, military, and Veterans Administration hospitals. All discharges assigned with the Legionnaires’ disease International Classification of Diseases 9th Clinical Modification discharge diagnostic code (482.84) were included in this study.ResultsWe observed the annual incidence and number of Legionnaires’ disease-associated hospitalizations (per 100 000 population) in the United States by year, age, sex, race, and region. Over a 5-year period, 14 574 individuals experienced Legionnaires’ disease-associated hospitalizations in the United States The annual population-adjusted incidence (per 100 000 population) of Legionnaires’ disease-associated hospitalizations was 5.37 (95% confidence interval [CI], 5.12–5.64) in 2006, 7.06 (95% CI, 6.80–7.40) in 2007, 8.77 (95% CI, 8.44–9.11) in 2008, 17.07 (95% CI, 16.62–17.54) in 2009, and 9.66 (95% CI, 9.32–10.01) in 2010. A summer peak of Legionnaires’ disease-associated hospitalizations occurred from June through September in 2006, 2007, 2008, and 2010.ConclusionsLegionnaires’ disease-associated hospitalizations significantly increased over the 5-year study period. The increasing disease burden of Legionnaires’ disease suggests that large segments of the US population are at risk for exposure to this waterborne pathogen.

Epidemiologic characteristics of hospitalised patients after suicidal acts from 2005 to 2016 in Korea: Analysis of the Korean National Hospital Discharge Survey

BackgroundSuicide is a major cause of death in many countries, and previous suicidal attempt is known to be the predictor of future suicide. Korea is considered one of the countries with the highest suicide rate among the Organisation for Economic Co-operation and Development (OECD) members for over a decade. We aimed to investigate the epidemiologic characteristics of hospitalised patients after suicidal acts in Korea. MethodsData from the Korean National Hospital Discharge In-depth Injury Survey were analysed, and patients older than 9 years admitted to nationwide hospitals after suicidal acts from 2005 to 2016 were included. Their epidemiologic characteristics were explored, and we divided them into groups according to suicidal means (injury vs. poisoning) and treatment outcome (good vs. poor). The association of each characteristic with injury as suicidal means and with poor treatment outcome were explored. ResultsThe sample included 7609 patients (corresponding to 227,571 in national population). More patients were female than male, and most were in their 40s in both sexes. Hospitalisation rate peaked in patients older than 80 years for both sexes. Male and young patients aged 10–19 years and capital residents showed relatively higher odds of choosing injury as suicidal means. Males and patients aged 40–64 and ≥65 years showed relatively higher odds of poor treatment outcome. LimitationsSome suicide attempters were excluded from the survey such as those who did not visit a hospital after the suicide attempt. ConclusionsThis epidemiologic feature of suicide attempters might serve as baseline data for preventive policies regarding suicide.

Incidence and risk factors for perioperative death after revision total hip arthroplasty: a 20-year analysis.

The number of revision total hip arthroplasty (THA) procedures is increasing in the US. Revision THA is associated with higher complication rates compared with primary THA. We describe patterns in incidence and risk factors for perioperative death after revision THA. Using the National Hospital Discharge Survey, we identified nearly 700,000 cases of revision THA from 1990 through 2010. Procedure incidence, perioperative mortality rates, comorbidities, discharge disposition, and duration of hospital stay were analysed. Multivariable logistic regression was used to identify independent risk factors for perioperative death. Alpha = 0.01. Population-adjusted incidence of revision THA per 100,000 people increased from 9.2 cases in 1990 to 15 cases in 2010 (p < 0.001). The rate of perioperative death was 0.9% during the study period and decreased from 1.5% during the "first" period (1990-1999) to 0.5% during the "second" period (2000-2010) (p < 0.001), despite an increase in comorbidity burden over time. Factors associated with the greatest odds of perioperative death were acute myocardial infarction (odds ratio [OR], 37; 95% confidence interval [CI], 33-40; p < 0.001), pneumonia (OR, 16; 95% CI, 15-18; p < 0.001), and pulmonary embolism (OR, 13; 95% CI, 11-15; p < 0.001). The rate of perioperative death in patients undergoing revision THA in the US decreased from 1990 to 2010 despite an increase in comorbidities. Acute myocardial infarction, pneumonia, and pulmonary embolism were associated with the highest odds of perioperative death after revision THA.

Increased reporting but decreased mortality associated with adverse events in patients undergoing lung cancer surgery: Competing forces in an era of heightened focus on care quality?

IntroductionAdvances in surgical techniques have improved clinical outcomes and decreased complications. At the same time, heightened attention to care quality has resulted in increased identification of hospital-acquired adverse events. We evaluated these divergent effects on the reported safety of lung cancer resection.Methods and materialsWe analyzed hospital-acquired adverse events in patients undergoing lung cancer resection using the National Hospital Discharge Survey (NHDS) database from 2001–2010. Demographics, diagnoses, and procedures data were abstracted using ICD-9 codes. We used the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSI) to identify hospital-acquired adverse events. Weighted analyses were performed using t-tests and chi-square.ResultsA total of 302,444 hospitalizations for lung cancer resection and were included in the analysis. Incidence of PSI increased over time (28% in 2001–2002 vs 34% in 2009–2010; P<0.001). Those with one or more PSI had increased in-hospital mortality (aOR = 11.1; 95% CI, 4.7–26.1; P<0.001) and prolonged hospitalization (12.5 vs 7.8 days; P<0.001). However, among those with PSI, in-hospital mortality decreased over time, from 17% in 2001–2002 to 2% in 2009–2010.ConclusionsIn a recent ten-year period, documented rates of adverse events associated with lung cancer resection increased. Despite this increase in safety events, we observed that mortality decreased. Because such metrics may be incorporated into hospital rankings and reimbursement considerations, adverse event coding consistency and content merit further evaluation.

Temporal Pattern of CABG and PCI after Non-ST Elevation Myocardial Infarction Among Elderly Patients from NHDS.

BackgroundManagement of elderly patients with Non-ST Elevation Myocardial Infarction (NSTEMI) continues to be a source of controversy due to underrepresentation in large-scale clinical trials and the increased risk of adverse outcomes after both invasive (Percutaneous coronary intervention and Coronary artery bypass grafting) and non-invasive therapies. Recent randomized clinical trials have shown improved short term and intermediate term outcomes among high risk NSTEMI patients receiving early invasive management versus conservative medical management. However, how this is reflected in U.S. clinical practice for elderly patients has not been reported.ObjectiveTo identify the trend of invasive management in patients with NSTEMI, particularly among elderly population.MethodsWe used data from National Hospital Discharge Survey to identify all adult patients with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for NSTEMI from the years 2005 to 2009. The goal was to investigate the trends in time of invasive therapy for patients diagnosed with NSTEMI. We then stratified the patients according to age >65 and ≤65, and compared the temporal trends between two age groups.ResultsAmong 21,306 patients diagnosed with NSTEMI between 2005 and 2009, the median age was 73 years (IQR: 61-82 years), 54% were males and 57% were White. The proportions of patients age>65 years receiving invasive management (21%, N=13978) was significantly lower than those age≤65 (41%, N=7328) (p<0.001). Moreover, in both age groups, the proportion of patients receiving early invasive management decreased substantially over time (p<0.001).ConclusionDespite numerous studies promoting the use of early invasive management for NSTEMI patients, the proportion of patients receiving invasive intervention gradually decreased from 2005-2009, more so in elderly population. The decrease seen in overall proportion of patients receiving invasive therapy could be associated with older median age of NSTEMI patients; 73 years (IQR: 61-82). Our future analyses will investigate if this trend maintains after adjusting for other factors (sex, co-morbid conditions, insurance status, year of procedure, hospital region, and hospital bed-size) thought to be associated with the management of NSTEMI in elderly patients.

Cost Containment of Total Knee Arthroplasty in the US: DEA Analysis on Regional Cost and Clinical Comparison between 2010 and 2013

The purpose of this research is to evaluate clinical and cost effectiveness of total knee replacement surgery (TKA) for adults hospitalized in the United States between 2010 and 2013. We tried to answer the question that whether lower length of stay and higher utilization of post-op facilities would be helpful to control the overall costs. Using the National Hospital Discharge Survey (NHDS) database and cost data from Blue Cross Blue shield, this study seeks to identify which U.S. region renders the highest quality patient care during a three-year span of 2008-2010. Using length of stay and discharge disposition (2010) as input factors, and regional TKA costs (2013) as output factors, Data Envelopment Analysis (DEA), a non-parametric method, illustrated the efficiency ranking of four regions in the US on TKA expenditures. The result shows the West is the most efficient region on controlling the overall cost by shrinking the length of stay and increasing the utilization of short-term/long-term care facilities.

Congenital FVIII/IX or VWF Deficiency Does Confer a Lower Rate of Myocardial Infarction-Related Mortality Despite Decreased Cardiovascular Interventions

Introduction: Patients with common inherited bleeding disorders (IBDs) including hemophilia and von Willebrand disease (VWD) are at risk of coronary artery disease (CAD) as they age, albeit lower than the general population. Intuitively, these patients would appear to have a higher mortality rate given an increased risk of hemorrhagic complications and/or possibly cardiovascular complications from undertreatment with antithrombotic agents and/or procedures. Methods: Data from National Hospital Discharge Survey (NHDS) from 2001-2010 were analyzed using diagnosis codes (ICD 9) to identify patients with hemophilia, VWD and myocardial infarction (MI). Demographics and discharge information were compared amongst patients who had an MI with and without these coagulopathies, using chi-squared tests, Fisher's exact tests, and linear regressions. All tests were adjusted for survey design with sampling weights. Yearly rates of MI were compared between patients with and without these coagulopathies. All analyses were performed in STATA 12.0. Results: During the years 2001-2010, about 0.2 million patients (weighted data) were discharged with IBD i.e. hemophilia and VWD. Among them, the incidence of MI was 0.26% in hemophilia and 1.61% in VWD patients. Hemophilia patients were more likely to be men (76.9% vs 56.2%) and Caucasians (66% vs 65%) while VWD patients were more likely to be younger (67 vs 69 years), women (52% vs 44%) and Caucasians (66% vs 65%) compared to the normal population (all p-values &lt;0.001). Compared to non-bleeding disorder patients, the patients with VWD and hemophilia had shorter duration of hospital stay and lower in-hospital mortality compared to normal population. Furthermore, VWD patients were less likely to undergo coronary artery bypass graft (CABG) (2.0% vs 30.4%), coronary angiogram (14.5% vs 29.5%) and systemic thrombolysis (0.0% vs 1.1%) for the treatment of MI whereas patients with hemophilia are less likely to undergo CABG (11.1% vs 30.4%) but more likely to undergo coronary angiogram (41.2% vs 29.5%) (all p-values &lt;0.001). They are also less likely to undergo systemic thrombolysis (0.0% vs 1.1%) but the difference was not statistically significant (p-value 0.121). On the other hand, hemophilia patients with MI had a higher prevalence of the following complications: cardiogenic shock (26% vs 2.3%), pneumonia (32.9% vs 8.2%), respiratory failure (25.9% vs 9%) and intubation (25.9% vs 7%) compared to MI patients without hemophilia (all p-values &lt;0.001). While VWD patients with MI had comparatively better outcomes in terms of lower risk of cardiogenic shock (0.0% vs 2.3%), pneumonia (0.8% vs 8.2%), respiratory failure (0.0% vs 9%), and GI bleeding (0.0 vs 1.6%) compared to MI patients without VWD (all p-values &lt;0.001), they did have increased prevalence of acute kidney injury (50.1% vs 9.0%, p-value &lt;0.001). Conclusion: Although patients with coagulopathic disorders are historically thought to have a lower risk of MI, they can be at an increased risk of complications. But, nonetheless, they have a lower risk of in-hospital mortality which may be due to the putative protective effect of lower levels of FVIII/IX or VWF. These patients, in general, are less likely to receive therapeutic interventions. Further prospective study is needed in order to confirm and better understand the discordance of a lower in-patient mortality in inherited bleeding disorder patients despite a decrease in some cardiac interventions and an increase in some non-cardiac complications Disclosures No relevant conflicts of interest to declare.

LENGTH OF HOSPITAL STAY AND DISCHARGE OUTCOMES AMONG PATIENTS WITH HIV-ASSOCIATED PULMONARY ARTERIAL HYPERTENSION (HIV-PAH) IN THE UNITED STATES

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Studies have shown that PAH is the leading cause of hospitalization and death in patients with HIV associated PAH (HIV-PAH). However, not much is known about the length of hospital stay (LOS), an indicator of healthcare resource utilization and the different discharge outcomes in hospitalized patients with HIV-PAH compared to patients with HIV without PAH (HIV non-PAH) METHODS: We conducted a retrospective analysis of the National Hospital Discharge Survey data for the time period 2001–2010. Cases of HIV infection or AIDS were identified using ICD-9 codes 042, 043, 044, 079.53, and V08 in any of the discharge diagnoses. PAH was identified using ICD-9 code 416.0. We determined the prevalence of HIV-PAH in the cohort stratified by age, sex, and race. LOS in patients with HIV-PAH was compared with patients that are HIV non-PAH. We also evaluated and compared the discharge status between the two groups. In-hospital mortality in both groups was calculated based on patients whose discharge status was listed as death and logistic regression was used to determine the odds of mortality. Data analysis was conducted using STATA 13 for MAC RESULTS: Seven hundred ninety-seven of 1,944,388 discharged patients with HIV infection were identified as having HIV-PAH (prevalence of 0.04%). The mean age (±SD) of the cohort was 44 years (±7.5) and African Americans (AA) had a higher prevalence of HIV-PAH than whites (0.05% vs. 0.009%). HIV-PAH prevalence was also higher in females than males (0.061% vs. 0.037%). LOS was longer in patients with HIV-PAH than HIV non-PAH (9.8 days vs. 5.3 days, P < 0.05). The most common discharge status for patients with HIV-PAH was discharge to home (81.7%) followed by leaving against medical advice (LAMA) (8.1%), death (8%), and long-term acute facilities (LTAC) (1.8%). While in patients with HIV non-PAH, 74% were discharged home, 2% left against medical advice (LAMA), 4.2% were listed as dead, and 7.7% transferred to LTAC. The differences between the percentage of patients in both groups were statistically significant for all categories of discharge status reviewed (P < 0.05). Patients with HIV-PAH were more likely to have a mortality outcome at discharge compared to HIV non-PAH patients independent of race or sex (OR 2.98. 95% CI: 1.67 – 3.2). CONCLUSIONS: Our study shows a significantly higher LOS and increased risk of mortality in patients with HIV-PAH compared to HIV non-PAH. Though the HIV-PAH group had a higher percentage of patients discharged home, the significantly higher proportion of patients LAMA compared to the HIV non-PAH group may lead to poorer outcomes overall. CLINICAL IMPLICATIONS: PAH is associated with increased healthcare resource utilization and poorer clinical outcomes in patients with HIV compared to HIV patients without PAH. Future studies should evaluate the predictors of in-patient mortality and different discharge outcomes in patients with HIV-PAH. DISCLOSURES: No relevant relationships by Abimbola Chris-Olaiya, source=Web Response No relevant relationships by Valery Effoe, source=Web Response No relevant relationships by Mesfin Fransua, source=Web Response No relevant relationships by Titilope Olanipekun, source=Web Response No relevant relationships by Gloria Westney, source=Web Response

Continuing Use of Inferior Vena Cava Filters Despite Data and Recommendations Against Their Use in Patients With Deep Venous Thrombosis

The purpose of the present investigation is to determine the response to the evidence and recommendations against the use of inferior vena cava (IVC) filters in patients with deep venous thrombosis (DVT). This was a retrospective cohort study based on administrative data from the National Hospital Discharge Survey 1979 to 2006 and from the National (Nationwide) Inpatient Sample 2007 to 2014. The number of IVC filters inserted in patients with lone DVT peaked in 2009 and then decreased from 2009 to 2014. The proportion of patients with lone DVT who received an IVC filter peaked in 2010 and then decreased from 2010 to 2014. Both the number of IVC filters inserted yearly and the proportion of patients who received an IVC filter remained higher than in 1998 when a randomized controlled trial showed no reduced mortality with permanent IVC filters in patients with DVT. In conclusion, large numbers of patients with lone DVT continue to receive IVC filters despite a randomized controlled trial that showed no reduced mortality with IVC filters in patients with DVT and despite clinical guideline recommendations against the use of IVC filters in such patients.

Increasing Numbers and Reported Adverse Events in Patients with Lung Cancer Undergoing Inpatient Lung Biopsies: A Population-Based Analysis.

The use of molecular biomarkers to guide lung cancer management has led to increasing frequency and amounts of tissue required for repeat lung biopsies. While patient safety and reporting of adverse events has been increasingly emphasized in recent decades, the safety of lung biopsies in patients with lung cancer has only been studied in small cohorts. We therefore analyzed adverse events in patients with lung cancer undergoing lung biopsies in the National Hospital Discharge Survey (NHDS) database. Data were abstracted using ICD-9 lung cancer diagnosis (162.X) and lung biopsy procedure codes (33.20, 33.24, 33.25, 33.26, 33.27, 33.28) from 2001 to 2010. Agency for Healthcare Research and Quality (AHRQ) Patient-Safety Indicators (PSI) were used to identify hospital-acquired adverse events. Weighted analyses were performed using SAS version 9.4. A total of 540,747 patients were included for analysis. The number of biopsies increased over time, from 51,221 in 2001, to 63,239 in 2010 (P < 0.001). Overall, 159,683 (30%) patients suffered ≥ 1-PSI event during their hospitalization. Incidence of PSI varied by biopsy type: bronchoscopic (26%), percutaneous (34%), surgical (39%). The proportion of patients with ≥ 1 PSI event increased from 24% in 2001 to 38% in 2010 (P < 0.001). Patients with ≥ 1 PSI had longer length of stay (mean, 11.6 vs 8.1days; P < 0.001) and higher in-hospital mortality (adjusted odds ratio, 5.9, 95% CI 3.9-8.9; P < 0.001). The frequency of lung biopsies performed and rate of documented adverse events in hospitalized lung cancer patients have increased. These findings have policy, funding, research, and practice implications.