National Inpatient Sample Dataset Research Articles

Trend Analysis of Substance Use Disorder During Pregnancy.

Objectives: This study aims to analyze the trends in substance use among pregnant women in the United States.Methodology: In this retrospective study, we utilized the National Inpatient Sample (NIS) dataset sponsored by the Agency for Healthcare Research and Quality (AHRQ) under the Healthcare Cost and Utilization Project (HCUP). Major Diagnostic Category (MDC) 14 (Pregnancy, Childbirth, and the Puerperium) and International Classification of Disease (ICD 10) codes were used to identify pregnancy-related diagnoses and presentations with any of the substance use disorder (SUD) indicators that met the inclusion criteria among the birthing population in the NIS dataset (2016-2018). We analyzed the demographic and regional characteristics between 2015 and 2018.Results: Among the population, a total of 23,475 (2.7%) had a primary or secondary diagnosis of SUD, and 851,428 (97.3%) did not. In the study group of 332,275 (2.8%) that met the inclusion criteria, 12,750 (0.1%) use alcohol, 108,960 (0.9%) had opioid use disorder (OUD), 171,490 (1.4%) use cannabis, 6,375 (0.1%) use sedatives, 28,075 (0.2%) use cocaine, 48,765 (0.4%) use other stimulants, 1,155 (0%) use hallucinogens, 115 (0%) use inhalants, and 23,950 (0.2%) had other psychoactive diagnosis. Further analysis comparing the risk of severity and mortality at presentation, procedure type, delivery method, and cost of care shows statistically significant differences (p < 0.005) between the study and control groups.Conclusion: The current trends necessitate a further assessment and implementation of comprehensive community-based treatment programs tailored to the most frequent regional SUD presentations, which could aid in mitigating drug use during pregnancy.

Utilization of machine learning methods for predicting surgical outcomes after total knee arthroplasty.

BackgroundPredictive models could help clinicians identify risk factors that cause adverse events after total knee arthroplasty (TKA), allowing for appropriate preoperative preventive interventions and allocation of resources.MethodsThe National Inpatient Sample datasets from 2010–2014 were used to build Logistic Regression (LR), Gradient Boosting Method (GBM), Random Forest (RF), and Artificial Neural Network (ANN) predictive models for three clinically relevant outcomes after TKA—disposition at discharge, any post-surgical complications, and blood transfusion. Model performance was evaluated using the Brier scores as calibration measures, and area under the ROC curve (AUC) and F1 scores as discrimination measures.ResultsGBM-based predictive models were observed to have better calibration and discrimination than the other models; thus, indicating comparatively better overall performance. The Brier scores for GBM models predicting the outcomes under investigation ranged from 0.09–0.14, AUCs ranged from 79–87%, and F1-scores ranged from 41–73%. Variable importance analysis for GBM models revealed that admission month, patient location, and patient’s income level were significant predictors for all the outcomes. Additionally, any post-surgical complications and blood transfusions were significantly predicted by deficiency anemias, and discharge disposition by length of stay and age groups. Notably, any post-surgical complications were also significantly predicted by the patient undergoing blood transfusion.ConclusionsThe predictive abilities of the ML models were successfully demonstrated using data from the National Inpatient Sample (NIS), indicating a wide range of clinical applications for obtaining accurate prognoses of complications following orthopedic surgical procedures.

Nationwide Trends in Hospitalizations and Outcomes of Pulmonary Circulation Disorders Among Patients With Cannabis Use Disorder in the United States.

Background and objectiveThe use of cannabis through smoking and vaping has increased significantly over the past decade. However, the prevalence of pulmonary circulation disorder (PCD)-related hospitalizations among cannabis users and their outcomes remain poorly understood. In this study, we used a nationally representative sample to assess the prevalence and trends of hospitalization among cannabis users with PCD.MethodsThe National Inpatient Sample (NIS) datasets (2007-2014) were used to analyze hospitalizations of patients with cannabis user disorder with PCD (C-PCD arm) versus those without PCD (C-non-PCD arm) to ascertain demographics, comorbidities, and in-hospital outcomes including all-cause mortality and healthcare resource utilization.ResultsA total of 3,307,310 hospitalizations involving cannabis users were reported, of which 20,328 (0.61%) were related to PCD. We noted a 200% relative increase in hospitalizations in the C-PCD arm (linearly increasing from 0.3% to 0.9% from 2007 to 2014, ptrend<0.001). When compared to the C-non-PCD arm, patients in the C-PCD arm tended to be older (mean age: 47 vs. 34 years), predominantly males (65.6% vs. 62.9%), with significantly higher rates of congestive heart failure (CHF, 28.8%), hypertension (HTN, 22%), chronic obstructive pulmonary disease (COPD, 21.5%), deficiency anemia (19.4%), and valvular heart disease (17.7%). The C-PCD arm had a statistically higher proportion of tobacco and amphetamine abusers (p<0.01) while the C-non-PCD arm had more cocaine and alcohol abusers (p<0.01). Urban teaching hospital admissions were more commonly associated with the PCD arm than the non-PCD arm (65.4% vs. 56.9%). In terms of hospital resource utilization, patients in the C-PCD arm had higher median hospital stay (six vs. three days) and more frequent discharges to a skilled nursing facility or home healthcare than the C-non-PCD group. All-cause mortality during hospitalization was found to be much higher in the C-PCD arm than the C-non-PCD arm (4.1% vs. 0.5%, p<0.001). Multivariable analysis revealed a two-fold higher risk for all-cause mortality with an adjusted odds ratio (OR) of 2.17 (95% CI: 1.99-2.36, p<0.001) with PCD.ConclusionThe findings of this nationwide study revealed significantly increased rates of hospitalizations among cannabis users with PCD with two times higher odds of all-cause in-hospital mortality. Further prospective studies are warranted in this subgroup of patients to confirm these findings and facilitate the management of these patients.

Abstract EP12: Uric Acid Predicts Recovery Of Left Ventricular Function And Adverse Events In Heart Failure With Reduced Ejection Fraction: Potential Mechanistic Insight From Network Analyses

Background and Aims: Heart failure with reduced ejection fraction (HFrEF) still carries a high risk for a sustained decrease in left ventricular ejection fraction (LVEF) even with the optimal medical therapy. Currently, there is no effective tool to stratify these patients according to their recovery potential. We tested the hypothesis that uric acid (UA) could predict recovery of LVEF and prognosis of HFrEF patients and attempted to explore mechanistic relationship between hyperuricemia and HFrEF. Methods: HFrEF patients with hyperuricemia were selected from the National Inpatient Sample (NIS) 2016-2018 database and our Xianyang prospective cohort study. Demographics, cardiac risk factors, and cardiovascular events were identified. Network-based analysis was utilized to examine the relationship between recovery of LVEF and hyperuricemia, and we further elucidated the underlying mechanisms for the impact of hyperuricemia on HFrEF. Results: After adjusting confounding factors by propensity score matching, hyperuricemia was a determinant of HFrEF [OR 1.247 (1.172-1.328); P &lt;0.001] of NIS dataset. In Xianyang prospective cohort study, hyperuricemia is a significant and independent risk factor for all-cause death (adjusted HR 2.387, 95% CI 1.141-4.993; P =0.021), heart failure readmission (adjusted HR 1.848, 95% CI 1.048-3.259; P =0.034), and composite events (adjusted HR 1.706, 95% CI 1.001-2.906; P =0.049) in HFrEF patients. UA value at baseline was negatively correlated to LVEF of follow-ups (r=-0.19; P =0.046). Cutoff UA value of 312.5 μmmol/L at baseline can work as a predictor of LVEF recovery during follow-up, with the sensitivity of 66.7%, the specificity of 35.1%, and the accuracy of 0.668 (95% CI, 0.561-0.775; P =0.006). Moreover, gene overlap analysis and network proximity analysis demonstrated a strong correlation between HFrEF and Hyperuricemia. Conclusion: Lower baseline UA value predicted the LVEF recovery and less long-term adverse events in HFrEF patients. Our results provide new insights into underlying mechanistic relationship between hyperuricemia and HFrEF.

Variations in cesarean deliveries associated with payer type

Objective: The rates of cesarean deliveries (CD) in the United States (U.S.) have been increasing since the 1990s making it the most common operating room procedure in U.S. hospitals. CD may be necessary due to a variety of medical indications; however, it is not clear whether socioeconomic factors affect CD rates. This study examines the association between type of insurance coverage pregnant women have and rates of CD in the U.S.Methods: This is a retrospective analysis of the discharge records of pregnant women admitted to U.S. hospitals between 2012 and 2014 extracted from the National Inpatient Sample dataset. The study population was divided into two groups according to insurance coverage (public vs private). Logistic regression analysis was used to examine the association between type of insurance and CD rates while controlling for an array of demographic, medical, social and behavioral confounding factors.Results: 12,450,349 subjects were included in the analysis, of those, 29.9% had a CD. 82.6% of women are between 18-34 years old and 49.5% are Caucasians. 48.9% of women have private insurance. Women with private insurance received a higher percentage of cesarean deliveries (31.8%) compared to women with public insurance (28.3%), adjusted odds ratio (aOR): 1.30 (CI: 1.29-1.30, p&amp;lt;0.001). This ratio was more significant in AMA women (aOR: 1.37) but not among teenagers. Although, higher in all race/ethnicity groups, African American, Hispanic and Native American women have more significant association to receive CD when covered by private insurance compared to Caucasian women. Giving birth at an urban-teaching hospital was associated with a higher CD rate (31.9% vs. 27.4%), aOR: 1.42. Delivery in the Northeast was associated with increased CD rates (32.8% vs. 27.5%) when covered with private insurance, aOR: 1.43, while in the West, private insurance was associated with less CD, aOR: 1.17.Conclusion: After controlling for demographic, clinical, behavioral, and system variables, private insurance was associated with a 30% increase in rate of CD compared to public insurance.

Disparities in tracheostomies and gastrostomy tubes in infants at the edge of viability.

To assess trends of clinical practice of tracheostomy and gastrostomy tube (G-tube) placement over a 25-year period and to assess the association of both procedures with outcomes in extremely low birth weight (ELBW) infants (<1000 g). We reviewed and analyzed data obtained from the National Inpatient Sample dataset from 1993 to 2018. ELBW infants who received a tracheostomy and or G-tubewere included. Regression analysis was performed to assess the association of tracheostomy and/or G-tube placement with mortality after controlling for confounding variables. A total of 620,061 ELBW infants were identified in the weighted sample. Of them, 221,339 were included. G-tube was placed on 4867 (2.2%) infants, tracheostomy was placed on 1788 (0.8%) infants, and both procedures were placed on 1026 (0.46%). Mortality was highest (26.9%) in infants who received tracheostomy only and lowest (5.5%) in those who had G-tube only and (17.8%) in those who had both procedures with adjusted odds ratios of 7.1 (6.3-7.9), 0.7 (0.6-0.8), and 3.7 (3.1-4.4), respectively. The length of stay (LOS) was highest with the combined procedure (219 ± 171), and lowest in the nonintervention group (88 ± 57). The trend of G-tube placement has increased over the years (p < 0.01) but tracheostomy placement has decreased over time. Tracheostomy is associated with increased mortality in ELBW infants and increased LOS in survivors whereas the placement of both tracheostomy and G-tube is independently associated with decreased mortality. Prospective studies are needed to assess the relationship between clinical presentation, the timing of the procedure, and outcomes.

Psychiatric Hospitalization Associated with Emergency Department Visits

Psychiatric boarding in an emergency department (ED) has personal and social consequences that can increase healthcare expenditure through a variety of inter-related mechanisms. This study aimed to compare health outcomes (e.g., length of stays, the severity of illness) between patients who stayed in an emergency department and those who did not visit an emergency department before the hospitalization. With the National Inpatient Sample dataset in the United States, we compared psychiatric inpatient service utilization outcomes between those who had stated in an emergency department and those who had not. Results: Among those with ED visits, the in-hospital mortality was 0.80 times lower (95% CI: 0.79-0.81). The length of hospital stays and the total charges were not significantly different from those without ED visits. The integration of primary care with psychiatric inpatient services can improve the management of psychiatric prevention and treatment, with the reduction of ED visits. This study provides an essential value in reducing emergency visits as the plan for psychiatric inpatient utilization to achieve more cost-effective and adequate healthcare outcomes.

Increased Suicidality and Worse Outcomes in MDD Patients With OSA: A Nationwide Inpatient Analysis of 11 Years From 2006 to 2017.

Major depressive disorder (MDD) is the most common psychiatric disorder characterized by changes in mood, cognition, and physical symptoms. MDD has an approximate 18% prevalence of comorbid OSA. Several studies have looked into plausible mechanisms that have shown a strong relationship between OSA and MDD. The primary objective of this study was to compare suicidal ideation/attempt among MDD patients with and without a comorbid diagnosis of OSA. The secondary objective was to compare the length of stay, total hospital charge, recurrent or severity of depression, and clinical comorbidities. Data were obtained from the National (Nationwide) Inpatient Sample dataset from 2006 to 2017. For data collection, we queried for all adult patients (age≥18 y), with MDD as a primary indication of admission. Further, we categorized MDD patients with and without a secondary diagnosis of OSA. To reduce the imbalance in baseline characteristics between the groups, we performed one to one age-gender matching between MDD patients with and without OSA. In the matched cohort, 79,308 patients were included in MDD with OSA and 78,792 patients in the MDD without OSA group. MDD patients with OSA were more likely to be racially white (80% vs 75%, P < 0.001), and to have more clinical comorbidities (hypertension, heart failure, obesity, and chronic lung disease). Prevalence of recurrent type of depression (77% vs 69%, P < 0.001) and moderate to severe depression (72% vs 68%, P<0.001) was more likely in the MDD with OSA group. Further, suicidality (composite of suicidal ideation/attempt) was more in MDD with OSA (49.5%) compared to MDD without OSA (41.8%) (P<0.001). In the multivariate analysis, MDD with OSA was associated with higher odds of suicidal ideation/act compared to MDD without OSA (adjusted odds ratio: 1.27, P<0.001). The total length of stay was longer in the MDD with OSA group (7.4 vs 6.9 d, P<0.001). In our study, poorer outcomes were observed in patients with MDD and OSA. Hence, clinicians should be vigilant for symptoms of OSA in patients with recurrent MDD or treatment-resistant MDD. We recommend that a thorough suicide risk assessment should be conducted in MDD patients with OSA, and validated questionnaires should be a part of the evaluation.

Abstract 10416: Rising Trends in the Burden of Cardiovascular Comorbidities and Major Adverse Cardiovascular Events in Young Female Smokers Across Two Nationwide Cohorts Studied a Decade Apart (2017 vs. 2007)

Background: Ample evidence has suggested that female smokers are at a higher risk of smoking-related health problems compared to men. With the increasing number of young smokers in the US, there is limited data on the impact of smoking in young female smokers in the last decade. Methods: The National Inpatient Sample datasets (2007 and 2017) were utilized to identify hospitalizations among young (18-44 years) female tobacco smokers. We compared differences in frequency of admissions, comorbidity burden, and in-hospital outcomes (all-cause mortality and MACE) and resource utilization across two young cohorts 10-years apart. Results: A total of 1,224,479 (median age 32) admissions among young female smokers were identified in 2017 vs. 665,901 (median age 35) in 2007. Both cohorts showed the majority of admissions among white female smokers, followed by African Americans (Table 1) . Compared to the 2007 cohort, the rate of alcohol abuse, hyperlipidemia, uncomplicated diabetes and chronic pulmonary disease decreased inn 2017, whereas a rising trend was observed for deficiency and chronic blood loss anemias, diabetes with complications, drug abuse, hypertension, congestive heart failure, depression, liver disease, and obesity (p&lt;0.001). On adjusted multivariable analysis, the 2017 cohort showed significantly higher odds of all-cause mortality [aOR 1.25 (95%CI: 1.16-1.35)] with a higher risk of MACE [aOR 1.17 (95%CI:1.14-1.20)] (p&lt;0.001). There were fewer routine discharges and higher requirements of home health care in the 2017 cohort vs. 2007. Conclusion: The study reveals escalating trends in the burden of comorbidities, MACE and healthcare resource utilization in admissions (irrespective of primary cause) among young female smokers in this decade apart analysis. It is essential to raise awareness among young female smokers about the adverse impact of tobacco and associated polysubstance abuse on cardiovascular outcomes.

Abstract 11616: Seizures in Infants with Congenital Heart Disease

Background: Infants with congenital heart disease (CHD) may have an increased risk to develop seizures during hospitalization. Objectives: to examine the association of CHD with non-epileptic, non-traumatic seizures in hospitalized infants up to one year of age. Methods: We conducted a retrospective analysis of the U.S. National Inpatient Sample dataset (2015-2018). We used the international classification of disease-10 th version to identify infants with different types of CHD. We included infants up to one year of age. We excluded infants &lt;35 week gestational age, infants with central nervous system or with major congenital anomalies, common trisomy or genetic disorders. We used chi square testing to examine the association of subtypes of CHD with seizures excluding post traumatic and epileptic seizures. We calculated mortality in infants with CHD who developed seizures versus those who did not have seizures. Results: There was 12,023,781 infants in the weighted sample who met our inclusion criteria. Of them, 48.7% were females, 46.7% were Caucasians, 195,685 (1.63%) were identified with a CHD and 20,565 (0.17%) suffered at least one episode of seizure during hospitalization. Seizures occurred in 4225 (2.2%) of infants with any type of CHD compared to 16,340 (0.14%) in infants with no CHD, odds ratios for seizures is 15.6 (CI: 15.2-16.5, p &lt;0.001). The association of seizures with subtypes of CHD is shown in table-1. Among infants with CHD, 2205 infants expired during hospitalization. Mortality was higher in infants with CHD who suffered seizures (8.5%) vs. those who did not have seizures (1.0%), OR 9.6 (8.5-10.8, p &lt;0.001). Conclusion: Infants with CHD have a higher chance to experience seizure episodes during their hospitalization and those who have seizures have higher chances of mortality during hospitalization. Further analysis is required to understand the pathological correlation between seizures and CHD and its impact on long term developmental outcomes.

Abstract 9578: Cholesterol Embolization Syndrome Among Patients With Acute Coronary Syndrome Post-Percutaneous Coronary Intervention: A National Inpatient Analysis

Introduction: Percutaneous coronary intervention (PCI) is associated with an increased risk of cholesterol embolization syndrome (CES), accounting for approximately 70% of iatrogenic cholesterol embolization. The clinical outcomes of patients with acute coronary syndrome (ACS), who develop CES post-PCI is yet to be explored on a national scale. Objectives: To evaluate the length of hospital stay (LOS), cost of hospitalization; proportion of patients with acute kidney injury (AKI), sepsis, cardiogenic shock and in-hospital mortality among those with ACS who develop CES post-PCI. Methods: Adults who had a diagnosis of ACS and PCI done who eventually had CES, were identified from the National In-Patient Sample (NIS) dataset between 2016-2018 using ICD10 codes. Weighted multivariable logistic and linear regression models were used as appropriate. Various sociodemographic, clinical and hospital level factors were adjusted for in the analysis. Results: Of the 365 patients who had ACS and developed CES post-PCI; 48% were women, 76.7% were non-Hispanic White and the average age was 69.5 years. The mean LOS was 8.2 days and the mean cost of hospitalization was $99,958.02. Overall, 32.9% of the patients developed AKI, 6.8% developed sepsis, 4.1% subsequently had cardiogenic shock and 11% had in-hospital mortality. Conclusions: Our study highlights important patient characteristics, resource utilization and clinical outcomes among patients with ACS who develop CES post-PCI, which provides relevant information needed to generate hypothesis linked to this disease condition.

28.12 Homicidal Ideation and Psychiatric Comorbidity in Inpatient Adolescents Aged 12 to 17 Years

Adolescents with homicidal tendencies are a serious growing concern in the United States. Research studies in the past have showcased the relationship between homicidal ideation (HI) and mental illnesses, but very limited information is available on the adolescent and inpatient population. We aim to evaluate the difference in the prevalence of demographic characteristics and mental health disorders in adolescents with and without HI. The adolescent population (ages 12-17 years) that admitted to the hospital with the diagnosis of HI was identified from the 2016 to 2018 National (Nationwide) Inpatient Sample dataset. Patients without HI were used as a control group. The prevalence of mental illness comorbidities between the group was compared using the Rao-Scott adjusted χ2 test. A total of 18,935 patients (mean age: 14.5 years) with HI diagnosis were identified in the study. The majority of the patients in the HI group were male compared to the control group (58.7% vs 41.2%; p < 0.001). Racially, it was more prevalent in the White race (56.0% vs 52.6%; p < 0.001) as well as the Black race (22.3% vs 17.8%; p < 0.001). It was less prevalent among the Hispanic race (14.9% vs 21.3%; p < 0.001). MDD prevalence was 48.2% in patients with HI and 22.3% in the control group. Bipolar disorders (17.7% vs 3.8%; p < 0.001), and anxiety disorders (49.5% vs 20.0%; p < 0.001) were highly prevalent among patients with HI. Suicidal ideation/attempt was prevalent in 66.9% of patients with HI. The study found a higher prevalence of mental illnesses such as depression, anxiety, and bipolar disorder in adolescents with HI. The White race was more prevalent in the homicidal group of the study. Further large-scale longitudinal research studies are warranted to establish the causal relationship between mental health disorders and HI among adolescents.

Disparities in Care Management During Terminal Hospitalization Among Adults With Metastatic Cancer From 2010 to 2017

Many patients with metastatic cancer receive high-cost, low-value care near the end of life. Identifying patients with a high likelihood of receiving low-value care is an important step to improve appropriate end-of-life care. To analyze patterns of care and interventions during terminal hospitalizations and examine whether care management is associated with sociodemographic status among adult patients with metastatic cancer at the end of life. This retrospective, population-based cross-sectional study used data from the Healthcare Cost and Utilization Project to analyze all-payer, encounter-level information from multiple inpatient centers in the US. All utilization and hospital charge records from national inpatient sample data sets between January 1, 2010, and December 31, 2017 (n = 58 761 097), were screened. The final cohort included 21 335 patients 18 years and older at inpatient admission who had a principal diagnosis of metastatic cancer and died during hospitalization. Data for the current study were analyzed from January 1, 2010, to December 31, 2017. Patient demographic characteristics, patient insurance status, hospital location, and hospital teaching status. Receipt of systemic therapy (including chemotherapy and immunotherapy), receipt of invasive mechanical ventilation, emergency department (ED) admission, time from hospital admission to death, and total charges during a terminal hospitalization. Among 21 335 patients with metastatic cancer who had terminal hospitalizations between 2010 and 2017, the median age was 65 years (interquartile range, 56-75 years); 54.0% of patients were female; 0.5% were American Indian, 3.3% were Asian or Pacific Islander, 14.1% were Black, 7.5% were Hispanic, 65.9% were White, and 3.1% were identified as other; 58.2% were insured by Medicare or Medicaid, and 33.2% were privately insured. Overall, 63.2% of patients were admitted from the ED, 4.6% received systemic therapy, and 19.2% received invasive mechanical ventilation during hospitalization. Racial and ethnic minority patients had a higher likelihood of being admitted from the ED (Asian or Pacific Islander patients: odds ratio [OR], 1.43 [95% CI, 1.20-1.72]; P < .001; Black patients: OR, 1.39 [95% CI, 1.27-1.52]; P < .001; and Hispanic patients: OR, 1.45 [95% CI, 1.28-1.64]; P < .001), receiving invasive mechanical ventilation (Black patients: OR, 1.59 [95% CI, 1.44-1.75]; P < .001), and incurring higher total charges (Asian or Pacific Islander patients: OR, 1.35 [95% CI, 1.13-1.60]; P = .001; Black patients: OR, 1.23 [95% CI, 1.13-1.34]; P < .001; and Hispanic patients: OR, 1.50 [95% CI, 1.34-1.69]; P < .001) compared with White patients. Privately insured patients had a lower likelihood of being admitted from the ED (OR, 0.47 [95% CI, 0.44-0.51]; P < .001), receiving invasive mechanical ventilation (OR, 0.75 [95% CI, 0.69-0.82]; P < .001), and incurring higher total charges (OR, 0.64 [95% CI, 0.59-0.68]; P < .001) compared with Medicare and Medicaid beneficiaries. In this study, patients with metastatic cancer from racial and ethnic minority groups and those with Medicare or Medicaid coverage were more likely to receive low-value, aggressive interventions at the end of life. Further studies are needed to evaluate the underlying factors associated with disparities at the end of life to implement prospective interventions.

The incidence of pericardial effusion requiring intervention in infants with a history of umbilical catheter placement: the US national database.

To assess the association of umbilical catheters (UC) placement with pericardial effusion (PCE) in newborn infants. We analyzed the National Inpatient Sample dataset. We compared prevalence of PCE in infants with UC versus those without in three subpopulations: infants with birth weight (BW) > 2500 g or GA > 34 weeks, preterm infants with BW < 1500 g, and term infants with congenital heart disease (CHD) using regression analysis methods while controlling for clinical and demographic variables. First analysis included a weighted sample of 22,751,313 infants with no hydrops fetalis. Of them, 1869 neonates (0.01%) had PCE. Pericardial effusion was found in 0.17% of infants with only UAC, 0.21% of infants with only UVC and 0.29% of infants with both catheters with an adjusted odds ratios (aOR) (1.5, CI:1.2-1.9), (2.3, CI:1.7-2.9), and (2.9, CI:2.4-3.6), p < 0.001, respectively. Similar findings were found in infants <1500 g and in those with CHD. Umbilical Catheter placement is associated with increased risk for pericardial effusion.

Surgical resection for patients with pulmonary aspergillosis in the national inpatient sample.

BackgroundThe role of lung resection in patients with pulmonary aspergillosis is generally reserved for those with localized disease who fail medical management. We used a national database to investigate the influence of preoperative patient comorbidities on inpatient mortality and need for surgery.MethodsPatients admitted with pulmonary aspergillosis between 2007 to 2015 were identified in the National Inpatient Sample dataset. Inpatient mortality rates were compared between patients treated medically and surgically. Predictors of mortality, surgical intervention, and non-elective admission were evaluated using multivariable logistic regression.ResultsAmong a population estimate of 112,998 patients with pulmonary aspergillosis, 107,606 (95.2%) underwent medical management alone and 5,392 (4.8%) underwent surgical resection. Positive predictors for surgery included hemoptysis, and history of lung cancer or chronic pulmonary diseases. Surgically treated patients had a lower inpatient mortality when compared to those treated medically (11.5% vs. 15.1%, P<0.001) in univariate analysis, but this finding did not persist in multivariable analysis (AOR 0.97, P=0.509). The odds of mortality were lower in patients undergoing video assisted thoracoscopic surgery compared to an open approach (AOR 0.77, P=0.001). Among patients treated surgically, mortality was higher in those with a history of lung cancer, solid organ transplantation, liver disease, human immunodeficiency virus infection, hematologic diseases, chronic pulmonary diseases, and those admitted non-electively requiring surgery.ConclusionsIn this generalizable study, medical and surgical management of pulmonary aspergillosis were comparable in terms of inpatient mortality. However, non-elective admission and patients with select comorbidities have significantly worse outcomes after surgical intervention.

760 Does Obstructive Sleep Apnea Increase Suicidality in Patients with Bipolar Disorder?

Abstract Introduction Bipolar disorder (BPD) is associated with suicidality in adult population. There are several risk factors for suicide, however the relationship between Obstructive Sleep Apnea (OSA) and suicidality in patients with BPD has not been explored. Hence, we decided to perform this study with primary objective of comparison of suicidality by OSA diagnosis in patients with BPD. Methods We used inpatient hospitalization data from National Inpatient sample dataset year 2016–2018. Our primary population (BPD + OSA) was composed of adult patients admitted to the hospital with the primary diagnosis of Bipolar Disorder and secondary diagnosis of Obstructive sleep apnea. Age-gender matched (1:4 matching) control population was selected with primary diagnosis of BPD having no OSA (BPD-OSA). Data on suicidality (suicidal ideation/attempt) were collected and compared between the groups using logistic regression analysis methods by including OSA, age, gender, race, substance use disorder and personality disorder as predictors. Results From the dataset, 17895 patients were obtained for the BPD + OSA group (average age: 50.5 years, male 45.5%). After 1:4 age-gender matching, 71575 patients were included in the BPD-OSA group. In the unadjusted analysis, suicidal ideation was significantly high BPD+OSA group compared the BPD-OSA group (38.4% vs. 31.9%, p &amp;lt; 0.001). Rate of suicide attempt and self-inflicted injuries were similar in two groups (3.5% vs. 3.3%, p: 0.27). In the adjusted logistic regression analysis odds of suicidality were 36% more in BPD+OSA group compared to BPD-OSA (Odds Ratio: 1.36, 95% Confidence interval: 1.25–1.48, p &amp;lt; 0.001). Conclusion In adult patients with BPD, diagnosis of OSA significantly increases the odds of suicidality. Addressing OSA in patients with BPD, can improve management, and potentially reduce the incidence of suicide. We believe our study will be helpful in guiding future research and development on this issue. Support (if any) None

Survival outcomes of in-hospital cardiac arrest in pediatric patients in the USA.

We report on in-hospital cardiac arrest outcomes in the USA. The data were obtained from the National (Nationwide) Inpatient Sample datasets for the years 2000-2017, which includes data from participating hospitals in 47 US states and the District of Columbia. We included pediatric patients (< 18 years of age) with cardiac arrest, and we excluded patients with no cardiopulmonary resuscitation during the hospitalization. Primary outcome of the study was in-hospital mortality after cardiac arrest. A multivariable logistic regression was performed to identify factors associated with survival. A total of 20,654 patients were identified, and 8226 (39.82%) patients survived to discharge. The median length of stay and cost of hospitalization were significantly higher in the survivors vs. non-survivors (LOS 18 days vs. 1 day, and cost $187,434 vs. $45,811, respectively, p < 0.001). In a multivariable model, patients admitted to teaching hospitals, elective admissions, and those admitted on weekdays had higher survival (aOR=1.19, CI: 1.06-1.33; aOR=2.65, CI: 2.37-2.97; and aOR=1.17, CI: 1.07-1.27, respectively). There was no difference in mortality between patients with extracorporeal cardiopulmonary resuscitation (E-CPR) and those with conventional cardiopulmonary resuscitation. E-CPR patients were likely to have congenital heart surgery (51.0% vs. 20.8%).Conclusion: We highlighted the survival predictors in these events, which can guide future studies aimed at improving outcomes in pediatric cardiac arrest. What is Known: • In-hospital cardiac arrest occurs in 2-6% of pediatric intensive care admissions. • Cardiac arrests had a significant impact on hospital resources and a significantly high mortality rate. What is New: • Factors associated with higher survival rates in patients with cardiac arrest: admission to teaching hospitals, elective admissions, and week-day admissions. • The use of rescue extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest has increased by threefold over the last two decades.

Spontaneous intestinal perforation in premature infants: a national study

To assess the prevalence and outcomes of spontaneous intestinal perforation (SIP) in very low birth weight infants. This cross-sectional study utilized the National Inpatient Sample dataset for the years 2002-2017. All premature infants with birth weight (BW) <1500 g and with gestational age (GA) ≤32 weeks were included. Analyses were repeated after stratifying the population into two BW sub-categories <1000 g and 1000-1499 g. Trend analysis was done using Cochran-Armitage test. Regression analysis was conducted to control for gestational age, race, and sex. A total of 658,001 infants were included. SIP (n = 10,443, 1.6%) was mostly (81.9%) in the category <1000 g with 89.9% ≤28 weeks of gestation. There was a significant trend for increased SIP over the years (p < 0.001). SIP was associated with increased mortality (aOR = 2.24, CI: 2.04-2.46, p < 0.001). After controlling for gestational age and other confounders, SIP is associated with increased mortality in premature infants.

Sex differences in health resource utilization, costs and mortality during hospitalization for infective endocarditis in the United States

BackgroundFew studies have assessed the association between sex and outcomes among patients with infective endocarditis. The aim of the study was to better understand the association between biologic sex, clinical outcomes and surgical treatment patterns among a contemporary cohort of patients admitted to hospital with infective endocarditis. MethodsWe used the National Inpatient Sample dataset from the Health Care Utilization Project to identify adult patients admitted for infective endocarditis between January and December 2016. We compared outcomes between men and women including inpatient hospital mortality, direct hospital costs, length of stay, and inpatient surgical treatment patterns. Multivariable analyses were performed with adjustment for age, socioeconomic status, and comorbidity burden. ResultsAmong 18,702 patients with infective endocarditis, there were 8730 (46.7%) women and 1753 (8.4%) in-hospital deaths. In multivariable analysis, female sex was associated with a trend toward lower in-hospital mortality (adjusted odds ratio (OR) 0.90; 95% confidence interval (CI) 0.80 to 1.01, p = 0.06). Additionally, female sex was associated with significantly shorter hospital length of stay (−0.5 days; 95% CI −0.88 to −0.12, p = 0.009) and lower hospital costs (−$3035; 95% CI −$4277 to −$1792; p < 0.001). Notably, women were less likely to undergo surgical intervention (adjusted OR 0.59; 95% CI 0.52 to 0.67, p < 0.001). ConclusionsIn a contemporary, nationally representative cohort of patients admitted for IE in the United States, there were sex-specific differences in management and in-hospital outcomes. Possible sex-based bias in treatment patterns and access to inpatient surgical intervention for infective endocarditis warrants further study.

Trends and racial disparities for acute kidney injury in premature infants: the US national database.

To assess prevalence and outcomes of acute kidney injury (AKI) in very-low-birth-weight infants. This cross-sectional study utilized the National Inpatient Sample (NIS) dataset for years 2000-2017. All premature infants with birth weight (BW) <1500g and/or gestational age (GA) ≤32 weeks were included. Analyses were conducted for overall population and two BW categories: <1000g and 1000-1499g. Adjusted odds ratios were calculated after controlling for confounding variables in logistic regression analysis. Cochrane-Armitage test was used to assess for statistically significant trends in AKI frequency over the years. In total, 1,311,681 hospitalized premature infants were included; 19,603 (1.5%) were diagnosed with AKI. The majority (74.3%) were BW <1000g and 63.9% ≤28 weeks gestation. Prevalence of AKI differed by ethnicity; White had significantly less AKI than Black (OR=0.79, p<0.001) and Hispanic (OR=0.83, p<0.001). AKI was significantly associated with higher mortality compared to controls (35.1 vs. 3.0%, p<0.001). AKI was associated with comorbidities such as necrotizing enterocolitis, patent ductus arteriosus, bronchopulmonary dysplasia, intraventricular hemorrhage, and septicemia. In a regression model, AKI was associated with higher mortality after controlling confounding factors (aOR=7.79, p<0.001). AKI was associated with significant increase in length of stay (p<0.001) and cost of hospitalization in survivors (p<0.001). There is a significant trend for increased AKI frequency over the years (Z score=4.33, p<0.001). AKI is associated with increased mortality and comorbidities in preterm infants, especially in infants with BW <1000g. Further studies are needed to understand precipitating factors and assess preventative measures for this serious complication.