National Hospital Discharge Survey Research Articles

Overview of Secondary Data Analysis With a Description of Heart Failure Hospitalizations From the National Hospital Discharge Survey

Overview of Secondary Data Analysis With a Description of Heart Failure Hospitalizations From the National Hospital Discharge Survey

Trends in Anterior Cruciate Ligament Reconstruction in the United States.

Background:The anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee for which surgery is performed. United States national estimates of ACL reconstruction vary widely.Purpose:This study sought to use the most recently available Centers for Disease Control and Prevention data to investigate changes in the utilization of inpatient and ambulatory surgery for ACL tears in the United States.Study Design:Descriptive epidemiology study.Methods:The National Survey of Ambulatory Surgery, conducted in 1994, 1995, 1996, and 2006 (data from 1994, 1996, and 2006 were used in the study), and the National Hospital Discharge Survey, conducted between 1990 and 2007, were used to identify cases of ACL reconstruction. The data were analyzed for trends in demographics, treatment, and utilization.Results:Between 1994 and 2006, the population-adjusted estimate of the rate of ACL reconstructions increased by 37% (33.0/100,000 capita or 86,837 total procedures to 45.1/100,000 capita or 134,421 total procedures). There was an increase in the proportion of females undergoing reconstruction in both the ambulatory (30% to 40%) and inpatient (29% to 47%) settings over the study period, with a 304% increase in the sex-adjusted estimate of the rate of female ambulatory procedures between 1994 and 2006. Age-adjusted estimates of the rates of ambulatory ACL reconstruction increased among all age groups, with a 924% increase in patients less than 15 years of age. Concurrent meniscectomy remained relatively constant in the ambulatory (37% to 40%) and inpatient (37% to 33%) settings between 1994 and 2007. Private insurance was the largest compensator, representing 77% of cases in 2006. Between 1994 and 2006, the use of peripheral nerve blocks during ambulatory surgery increased from 0.7% to 30.8%.Conclusion:The rate of ACL reconstruction increased dramatically between 1990 and 2007 based on the National Survey of Ambulatory Surgery and National Hospital Discharge Survey databases, which represents the most up-to-date publicly available data. Knowledge of this increase and national practice patterns may aid policy makers and surgeons in appropriately allocating health care resources to ensure quality patient care.

National trends and perioperative outcomes in primary and revision total shoulder arthroplasty: Trends in total shoulder arthroplasty.

Total shoulder arthroplasty (TSA) is a highly successful procedure for management of glenohumeral arthritis, fractures and rotator cuff tears. The purpose of this study was to evaluate patient demographics, perioperative outcomes and assess recent national trends in both primary and revision TSA. The National Hospital Discharge Survey database was searched for patients admitted to US hospitals for primary and revision TSA from 2001 to 2010. A total of 1,297 patients who underwent primary TSA and 184 patients who underwent revision TSA were identified. The rates of primary TSA (r = 0.88) and revision TSA (r = 0.85) both demonstrated a strong positive correlation with time. The mean patient age of the primary group was significantly higher than the revision group. Gender was not significantly different between the groups. There was no significant difference in the racial make-up between the revision and primary groups. African Americans accounted for 3.3% of primaries versus 4.3% of revisions (p = 0.615). Revision TSA patients had a significantly longer average LOS (3.06days vs 2.46days, p < 0.01), more medical comorbidities (6.0 vs 5.1 comorbidities, p < 0.01) and a higher rate of developing a myocardial infarction (2.2% versus 0%, p < 0.01) than the primary TSA group. This study demonstrates that the rate of TSA is rapidly increasing in the US, with over a four-fold increase in revisions and five-fold increase in primaries over the tenyears studied.

Increase in Perioperative Complications Following Primary Total Hip and Knee Arthroplasty in Patients With Hepatitis C Without Cirrhosis

The effects of hepatitis C on primary total hip (THA) and knee (TKA) arthroplasties are poorly understood. The National Hospital Discharge Survey was used to identify patients who underwent THA or TKA between 1990 and 2007 without a diagnosis of cirrhosis, HIV, or hepatitis A, B, D or E virus infection. Patients were split into two groups: 1) hepatitis C (n=26,444) and 2) non-hepatitis C (n=8,336,882) and analyzed for differences in length of hospital stay, discharge status and perioperative complications. Those with hepatitis C had shorter hospital stays, higher rates of nonroutine discharge and higher odds of in-hospital complications (OR: 1.686, range: 1.645–1.727), surgery related complications (OR: 1.559, range: 1.516–1.603) and general medical complications (OR: 2.012, range: 1.961–2.064) (P<0.001).

United States National Trends in Ankle Arthroscopy: Analysis of the National Survey of Ambulatory Surgery and National Hospital Discharge Survey.

. Ankle arthroscopy is increasingly being utilized for disorders previously limited to management with open surgery. Despite uniformly good results and few complications, little is known regarding national trends in ankle arthroscopy. This study sought to investigate changes in the use of inpatient and ambulatory ankle arthroscopy in the United States. . The National Survey of Ambulatory Surgery and the National Hospital Discharge Survey were used to identify cases of ankle arthroscopy. The data were analyzed for trends in demographics, treatment, and use. Between 1994 and 2006, the population-adjusted rate of ankle arthroscopy increased by 65% (4.9/100 000 capita to 8.1/100 000 capita). The rate of ambulatory procedures increased by 80%, whereas the rate of inpatient procedures decreased by 95%. Sex-adjusted rates increased by 90% for males and 32% for females. The largest increases in age-adjusted rates were among patients 35 to 54 years of age. The proportion of procedures performed in freestanding ambulatory facilities increased from 15% to 49%. Use of peripheral nerve blocks during ambulatory procedures increased from 6% to 26%. Private insurance was the largest compensator at all times, and the proportion of workers' compensation payments increased from 8% to 22% during the study period. . Results from the most recently available Centers for Disease Control and Prevention data demonstrated that rates of ambulatory ankle arthroscopy increased, whereas rates of inpatient ankle arthroscopy decreased dramatically between 1994 and 2006. Understanding national practice patterns can aid policy makers and surgeons in allocating health care resources, so as to ensure quality patient care. N/A (descriptive epidemiology study).

Predicting In-Hospital Mortality in Elderly Patients with Cervical Spine Fractures: A Comparison of the Charlson and Elixhauser Comorbidity Measures

Study design Retrospective analysis of nationally representative data collected for the National Hospital Discharge Survey. Objective To compare the performance of the Charlson and Elixhauser comorbidity-based measures for predicting in-hospital mortality after cervical spine fractures. Summary of background data Mortality occurring as a consequence of cervical spine fractures is very high in the elderly. The Charlson comorbidity measure has been associated with an increased risk of mortality, but its predictive accuracy has yet to be compared with the more recent and increasingly used Elixhauser measure. Methods Using the National Hospital Discharge Survey for the years 1990 through 2007, we identified all patients aged 65 years or older hospitalized with a diagnosis of cervical spine fracture. The association of each Charlson and Elixhauser comorbidity with mortality was assessed in bivariate analysis using χ tests. Two main multivariable logistic regression models were constructed, with in-hospital mortality as the dependent variable and 1 of the 2 comorbidity-based measures (as well as age, sex, and year of admission) as independent variables. A base model that included only age, sex, and year of admission was also evaluated. The discriminative ability of the models was quantified using the area under the receiver operating characteristic curve (AUC). Results Among an estimated 111,564 patients admitted for cervical spine fractures, 7.6% died in the hospital. Elixhauser comorbidity adjustment provided better prediction of in-hospital case mortality (AUC = 0.852, 95% confidence interval: 0.848-0.856) than the Charlson model (AUC = 0.823, 95% confidence interval: 0.819-0.828) and the base model with no comorbidities (AUC = 0.785, 95% confidence interval: 0.781-0.790). In terms of relative improvement in predictive ability, the Elixhauser model performed 43% better than the Charlson model. Conclusion The Elixhauser comorbidity risk adjustment method performed numerically better than the widely used Charlson measure in predicting in-hospital mortality after cervical spine fractures. Level of evidence N/A.

National trends in hospitalization and mortality rates for patients with HIV, HCV, or HIV/HCV coinfection from 1996-2010 in the United States: a cross-sectional study.

BackgroundThe comparative impact of chronic viral monoinfection versus coinfection on inpatient outcomes and health care utilization is relatively unknown. This study examined trends, inpatient utilization, and hospital outcomes for patients with HIV, HCV, or HIV/HCV coinfection.MethodsData were from the 1996–2010 National Hospital Discharge Surveys. Hospitalizations with primary ICD-9-CM codes for HIV or HCV were included for HIV and HCV monoinfection, respectfully. Coinfection included both HIV and HCV codes. Demographic characteristics, select comorbidities, procedural interventions, average hospital length of stay (LOS), and discharge status were compared by infection status (HIV, HCV, HIV/HCV). Annual disease estimates and survey weights were used to generate hospitalization rates.Results~6.6 million hospitalizations occurred in patients with HIV (39%), HCV (56%), or HIV/HCV (5%). The hospitalization rate (hospitalizations per 100 persons with infection) decreased in the HIV group (29.8 in 1996; 5.3 in 2010), decreased in the HIV/HCV group (2.0 in 1996; 1.5 in 2010), yet increased in the HCV group (0.2 in 1996; 0.9 in 2010). Median LOS from 1996 to 2010 (days, interquartile range) decreased in all groups: HIV, 6 (3–10) to 4 (3–8); HCV, 5 (3–9) to 4 (2–6); HIV/HCV, 6 (4–11) to 4 (2–7). Age-adjusted mortality rates decreased for all three groups. The rate of decline was least pronounced for those with HCV monoinfection.ConclusionHospitalizations have declined more rapidly for patients with HIV infection (including HIV/HCV coinfection) than for patients with HCV infection. This growing disparity between HIV and HCV underscores the need to allocate more resources to HCV care in hopes that similar large-scale improvements can also be accomplished for patients with HCV.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-536) contains supplementary material, which is available to authorized users.

Predictors of allogeneic blood transfusion in spinal fusion for pediatric patients with idiopathic scoliosis in the United States, 2004-2009.

Analysis of population-based National Hospital Discharge Survey data collected for the Nationwide Inpatient Sample. To examine the predictors of allogeneic blood transfusion (ALBT) in spinal fusion for pediatric patients with idiopathic scoliosis. Spinal fusion for pediatric patients with idiopathic scoliosis is associated with major blood loss and often necessitates ALBT. The Nationwide Inpatient Sample was used to identify pediatric patients with idiopathic scoliosis who underwent spinal fusion from 2004 to 2009, using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Then, patients who received ALBT were identified using the appropriate International Classification of Diseases, Ninth Revision, Clinical Modification code. Patient demographics, surgical variables, and hospital characteristics were retrieved. Multivariate logistic regression analysis was performed to identify the predictors of ALBT in spinal fusion for pediatric patients with idiopathic scoliosis. The odds ratio (OR) increased with increasing Elixhauser Comorbidity Score (score 1: OR, 1.55; 95% confidence interval [95% CI], 1.23-1.97; score 2: OR, 2.23; 95% CI, 1.69-2.93; score 3: OR, 2.73; 95% CI, 1.6-4.66; score≥4: OR, 4.18; 95% CI, 1.93-9.06). Patients who underwent posterior approach or anterior and posterior approach surgical procedures were more likely to receive ALBT compared with those who underwent anterior approach surgery (posterior: OR, 2.24; 95% CI, 1.22-4.08; anterior and posterior: OR, 3.35; 95% CI, 1.69-6.63). Patients with a spinal fusion of 9 or more levels were more likely to receive ALBT compared with those with a spinal fusion of 4 to 8 levels (OR, 1.39; 95% CI, 1.05-1.85). There was no difference between patients with or without autologous-related blood transfusion (OR, 0.92; 95% CI, 0.59-1.43). This study identified significant predictors of ALBT in spinal fusion for pediatric patients with idiopathic scoliosis. These factors need to be taken into consideration for patient blood management before surgery. In this study, autologous-related blood transfusion could not avoid ALBT.

The rise in Clostridium difficile infection incidence among hospitalized adults in the United States: 2001-2010

Clostridium difficile infection (CDI) incidence is a growing concern. This study provides national estimates of CDI over 10 years and identifies trends in mortality and hospital length of stay (LOS) among hospitalized adults with CDI. We conducted a retrospective analysis of the US National Hospital Discharge Surveys from 2001-2010. Eligible cases included adults aged ≥ 18 years discharged from a hospital with an ICD-9-CM diagnosis code for CDI (008.45). Data weights were used to derive national estimates. CDI incidence rates were depicted as CDI discharges per 1,000 total adult discharges. These data represent 2.2 million adult hospital discharges for CDI over the study period. CDI incidence increased from 4.5 CDI discharges per 1,000 total adult discharges in 2001 to 8.2 CDI discharges per 1,000 total adult discharges in 2010. The overall in-hospital mortality rate was 7.1% for the study period. Mortality increased slightly over the study period, from 6.6% in 2001 to 7.2% in 2010. Median hospital LOS was 8 days (interquartile range, 4-14 days), and remained stable over the study period. The incidence of CDI among hospitalized adults in the United States nearly doubled from 2001-2010. Furthermore, there is little evidence of improvement in patient mortality or hospital LOS.

The Influence of Psychiatric Comorbidity on Perioperative Outcomes Following Primary Total Hip and Knee Arthroplasty; A 17-year Analysis of the National Hospital Discharge Survey Database

Studies conflict regarding the impact of psychiatric illnesses including depression, anxiety, dementia and schizophrenia on perioperative outcomes following total hip (THA) and knee arthroplasty (TKA). Psychiatric comorbidity incidence, in-hospital adverse events, discharge disposition, and mortality were assessed for THA or TKA patients between 1990 and 2007 using the US National Hospital Discharge Survey. A cohort representative of 8,379,490 patients was identified and analyzed using multivariable regression analysis. Diagnoses of depression, dementia and schizophrenia were associated with increased odds of adverse events (P<0.001). Schizophrenia and depression were associated with higher odds of perioperative blood transfusion (P<0.001). All psychiatric comorbidities were associated with higher odds of non-routine discharge (P<0.001). Diagnosis of dementia was associated with higher in-hospital mortality (P<0.001).

Influence of Second- and Third-Degree Heart Block on 30-Day Outcome Following Acute Myocardial Infarction in the Drug-Eluting Stent Era

This study was conducted to investigate the prognostic value of heart block among patients with acute myocardial infarction (AMI) treated with drug-eluting stents. A total of 13,862 patients with AMI, registered in the nation-wide AMI database from January 2005 to June 2013, were analyzed. Second- (Mobitz type I or II) and third-degree atrioventricular block were considered as heart block in this study. Thirty-day major adverse cardiac events (MACE) including all causes of death, recurrent myocardial infarction, and revascularization were evaluated. Percutaneous coronary intervention with implantation of drug-eluting stent was performed in 89.8% of the patients. Heart block occurred in 378 patients (2.7%). Thirty-day MACE occurred in 1,144 patients (8.2%). Patients with heart block showed worse clinical parameters at initial admission, and the presence of heart block was associated with 30-day MACE in univariate analyses. However, the prognostic impact of heart block was not significant after adjustment of potential confounders (p = 0.489). Among patients with heart block, patients with a culprit in the left anterior descending (LAD) coronary artery had worse clinical outcomes than those of patients with a culprit in the left circumflex or right coronary artery. LAD culprit was a significant risk factor for 30-day MACE even after controlling for confounders (odds ratio 5.28, 95% confidence interval 1.22 to 22.81, p = 0.026). In conclusion, despite differences in clinical parameters at the initial admission, heart block was not an independent risk factor for 30-day MACE in adjusted analyses. However, a LAD culprit was an independent risk factor for 30-day MACE among patients with heart block.

In-Hospital Outcomes after Hemiarthroplasty versus Total Hip Arthroplasty for Isolated Femoral Neck Fractures.

Previous studies suggest total hip arthroplasty may have some benefits compared to hemi-arthroplasty for displaced intracapsular femoral neck fractures in patients more than 60 years of age. The primary research question of our study was whether in-hospital adverse events, post-operative length of stay (LOS) and mortality in patients 60 year of age or older differed between total hip and hemi-arthroplasty for femoral neck fracture. We obtained data on 82951 patients more than 60 years of age with an isolated femoral neck fracture treated with either hemi-arthroplasty or total hip arthroplasty in 2009 or 2010 from the National Hospital Discharge Survey (NHDS) database. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9, CM) was used to code diagnoses, comorbidities, complications, and procedures. Controlling for demographics and comorbidities, patients treated with hemi-arthroplasty had a 40% (95% CI 1.4-1.5) higher risk of adverse events compared to patients treated with a total hip arthroplasty. Length of stay and in-hospital mortality did not differ between these groups. The observed advantage for total hip arthroplasty might reflect greater infirmity in hemi-arthroplasty patients that was not accounted for by ICD-9 codes alone.

Probabilistic change detection and visualization methods for the assessment of temporal stability in biomedical data quality

Knowledge discovery on biomedical data can be based on on-line, data-stream analyses, or using retrospective, timestamped, off-line datasets. In both cases, changes in the processes that generate data or in their quality features through time may hinder either the knowledge discovery process or the generalization of past knowledge. These problems can be seen as a lack of data temporal stability. This work establishes the temporal stability as a data quality dimension and proposes new methods for its assessment based on a probabilistic framework. Concretely, methods are proposed for (1) monitoring changes, and (2) characterizing changes, trends and detecting temporal subgroups. First, a probabilistic change detection algorithm is proposed based on the Statistical Process Control of the posterior Beta distribution of the Jensen---Shannon distance, with a memoryless forgetting mechanism. This algorithm (PDF-SPC) classifies the degree of current change in three states: In-Control, Warning, and Out-of-Control. Second, a novel method is proposed to visualize and characterize the temporal changes of data based on the projection of a non-parametric information-geometric statistical manifold of time windows. This projection facilitates the exploration of temporal trends using the proposed IGT-plot and, by means of unsupervised learning methods, discovering conceptually-related temporal subgroups. Methods are evaluated using real and simulated data based on the National Hospital Discharge Survey (NHDS) dataset.

Time Trends of US Hospitalization for Esophageal Disease

The occurrence of reflux disease seems to be rising in the United States. The aim of the present study was to follow the time trends of hospitalization for gastroesophageal reflux disease (GERD) and other esophageal disease during the past 4 decades. US hospital utilization data were available for individual years from 1970 to 2010 through the National Hospital Discharge Survey. Esophageal diagnoses were stratified by their ninth revision of the International Classification of Diseases codes. Annual hospitalizations were expressed as rates per 100,000 living US population. GERD was by far the most common esophageal disorder resulting in hospitalization. However, in only 5% of instances did GERD-related diagnoses constitute the primary cause of hospitalization. Between 1970 and 2010 the rates of GERD-related hospitalizations increased in an exponential manner almost 10-fold. This rise affected both sex and all age groups alike. A 3-fold rise was noted in hospitalizations for esophageal adenocarcinoma. Other esophageal diagnoses, such as achalasia, dyskinesia, or stricture were characterized by falling or stable trends. US hospitalization data show a continued exponential rise in the occurrence of GERD without any signs of leveling off. These trends are likely to represent ongoing changes in the underlying incidence and prevalence of the disease.

CORR Insights®: the National Hospital Discharge Survey and the Nationwide Inpatient Sample: the databases used affect results in THA research.

CORR Insights®: the National Hospital Discharge Survey and the Nationwide Inpatient Sample: the databases used affect results in THA research.

Pulmonary Hypertension Surveillance: United States, 2001 to 2010

Pulmonary hypertension (PH) is an uncommon but progressive condition, and much of what we know about it comes from specialized disease registries. With expanding research into the diagnosis and treatment of PH, it is important to provide updated surveillance on the impact of this disease on hospitalizations and mortality. This study, which builds on previous PH surveillance of mortality and hospitalization, analyzed mortality data from the National Vital Statistics System and data from the National Hospital Discharge Survey between 2001 and 2010. PH deaths were identified using International Classification of Diseases, Tenth Revision codes I27.0, I27.2, I27.8, or I27.9 as any contributing cause of death on the death certificate. Hospital discharges associated with PH were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes 416.0, 416.8, or 416.9 as one of up to seven listed medical diagnoses. The decline in death rates associated with PH among men from 1980 to 2005 has reversed and now shows a significant increasing trend. Similarly, the death rates for women with PH have continued to increase significantly during the past decade. PH-associated mortality rates for those aged 85 years and older have accelerated compared with rates for younger age groups. There have been significant declines in PH-associated mortality rates for those with pulmonary embolism and emphysema. Rates of hospitalization for PH have increased significantly for both men and women during the past decade; for those aged 85 years and older, hospitalization rates have nearly doubled. Continued surveillance helps us understand and address the evolving trends in hospitalization and mortality associated with PH and PH-associated conditions, especially regarding sex, age, and race/ethnicity disparities.

Trends in bone graft use in the United States.

Bone graft and bone graft substitutes are used to provide structural support and enhance bone healing. Autogenous, allogeneic, and artificial bone grafts each have advantages and drawbacks. The development of allografts, synthetic bone grafts, and new operative techniques may have influenced the use of bone grafts in recent years. The goal of this study was to analyze the use of bone grafts and bone graft substitutes in the United States during a 16-year period. Using data from the National Hospital Discharge Survey, the authors analyzed the use of autogenous and artificial bone grafts in almost 2 million patients in the United States between 1992 and 2007 using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes in 4 periods (1992-1995, 1996-1999, 2000-2003, and 2004-2007). Among an estimated almost 2 million bone graft procedures (83% autogenous, 17% artificial), the use of both types of grafts decreased. The main diagnoses for which bone grafts were used did not change; however, cervical spine diseases and lower-limb fractures decreased more remarkably. Although sex (52% male in the early 1990s to 47% in 2000-2003) and discharge status (more discharges to a short-term or long-term-care facility) significantly changed, age increased from 47 to 53 years and inpatient days decreased significantly from 6 to 5 days during the study period. The use of bone grafts and bone graft substitutes is decreasing in the United States, with a slight shift from autogenous to substitute grafts.

Trends in the incidence and treatment of necrotizing soft tissue infections: an analysis of the National Hospital Discharge Survey.

Necrotizing soft tissue infections are a rare but potentially fatal condition of the soft tissues caused by virulent, toxin-producing bacteria. In the United States, there is an estimated annual incidence of 0.04 cases per 1000 annually, but previous estimates of the Centers for Disease Control and Prevention had the incidence at 500 to 1500 cases yearly. Early reports of mortality were variable with rates ranging from 46 to 76% but outcomes have been improving over time. The National Hospital Discharge Survey was analyzed to study current trends in the demographics, incidence, use, and mortality of patients diagnosed with necrotizing soft tissue infections. The authors analyzed the 1999, 2002, and 2007 National Hospital Discharge Survey by using a sampling weighting method. A total of 13,648 cases of necrotizing soft tissue infections were identified in 2007. This represents an increase from 12,153 cases in 2002 and 6612 cases in 1999. In the 9 years from 1999 to 2007 the gross incidence of necrotizing soft tissue infections more than doubled. Hospital stay was essentially unchanged within study years, at 16 days. Mean age increased from approximately 50 years in 1999 to 54 years in 2007. Further, mortality went from 10.45% in 1999 to 9.75% in the 2007 survey. The population-adjusted incidence rate increased 91% in the studied years. Rising use of immunosupression, exponential growth in the incidence of obesity, and type 2 diabetes could be a major contributing factor. The mortality rate is far below the rate in reports published from as early as 20 years ago, and at 9.75% compares with modern case series, but is a more accurate measure of mortality in this condition.

Incidence and Trends of Anterior Cruciate Ligament Reconstruction in the United States

Background: Anterior cruciate ligament (ACL) injury is among the most commonly studied injuries in orthopaedics. The previously reported incidence of ACL injury in the United States has varied considerably and is often based on expert opinion or single insurance databases. Purpose: To determine the incidence of ACL reconstruction (ACLR) in the United States; to identify changes in this incidence between 1994 and 2006; to identify changes in the demographics of ACLR over the same time period with respect to location (inpatient vs outpatient), sex, and age; and to determine the most frequent concomitant procedures performed at the time of ACLR. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes 844.2 and 717.83 were used to search the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS) for the diagnosis of ACL tear, and the procedure code 81.45 was used to search for ACLR. The incidence of ACLR in 1994 and 2006 was determined by use of US Census Data, and the results were then stratified based on patient age, sex, facility, concomitant diagnoses, and concomitant procedures. Results: The incidence of ACLR in the United States rose from 86,687 (95% CI, 51,844-121,530; 32.9 per 100,000 person-years) in 1994 to 129,836 (95% CI, 94,993-164,679; 43.5 per 100,000 person-years) in 2006 (P = .015). The number of ACLRs increased in patients younger than 20 years and those who were 40 years or older over this 12-year period. The incidence of ACLR in females significantly increased from 10.36 to 18.06 per 100,000 person-years between 1994 and 2006 (P = .0003), while that in males rose at a slower rate, with an incidence of 22.58 per 100,000 person-years in 1994 and 25.42 per 100,000 person-years in 2006. In 2006, 95% of ACLRs were performed in an outpatient setting, while in 1994 only 43% of ACLRs were performed in an outpatient setting. The most common concomitant procedures were partial meniscectomy and chondroplasty. Conclusion: The incidence of ACLR increased between 1994 and 2006, particularly in females as well as those younger than 20 years and those 40 years or older. Research efforts as well as cost-saving measures may be best served by targeting prevention and outcomes measures in these groups. Surgeons should be aware that concomitant injury is common.

Why U.S. epilepsy hospital stays rose in 2006.

We observed a substantial increase in age-adjusted hospitalization rates in the United States National Hospital Discharge Survey data from 1996 to 2010. We aimed to assess reasons for this increase. The National Hospital Discharge Survey collected data on a national sample of short-term hospital stays in nonfederal hospitals. We determined epilepsy-related discharge diagnoses by age, gender, and region using weighted analysis, and estimated age-adjusted rates and annual percent changes using regression analysis. We also looked at epilepsy as the principal discharge diagnosis in the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. In the United States, on average, nearly 110,000 more admissions were reported each year with epilepsy as the principal discharge diagnosis in 2006-2010 than in 1996-2005, a 2.7-fold increase in hospitalization rates from epilepsy. During this period, there were more hospitalizations with principal discharge diagnosis of epilepsy not otherwise specified, and among older patients. The number of discharges with seizure not otherwise specified dropped dramatically after 2006, and was more evident among pediatric patients. The age-adjusted rates of hospital stays combining discharges with any mention of epilepsy (345.XX) or seizures unspecified (780.39) in seven discharge diagnoses, were similar in 1996-2005 and 2006-2010. We postulate that the excess in hospitalizations with epilepsy as first discharge diagnosis in 2006-2010 in the United States was related to the changes in coding in 2006. Any use of U.S. hospital discharge data with epilepsy-related diagnosis after that date will require further validation. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.