Nationwide Inpatient Sample Database Research Articles

Incidence and related risk factors for postoperative delirium following revision total knee arthroplasty: a retrospective nationwide inpatient sample database study.

Postoperative delirium (POD) is a common surgical complication. However, the incidence and risk factors associated with postoperative delirium after revision total knee arthroplasty (rTKA) have not been comprehensively explored through extensive national databases. Utilizing the National Inpatient Sample (NIS), the largest comprehensive U.S. hospital healthcare database, we undertook a retrospective investigation involving 127,400 patients who underwent rTKA between 2010 and 2019. We assessed various aspects, including patient demographics, hospital characteristics, pre-existing medical conditions, and perioperative complications. The overall incidence of postoperative delirium (POD) in patients undergoing rTKA between 2010 and 2019 was 0.97%. The highest incidence rate of 1.31% was recorded in 2013. Notably, this patient cohort demonstrated advanced age, increased burden of co-morbidities, prolonged hospital stays, increased hospitalization costs, and elevated in-hospital mortality rates (P < 0.001). Moreover, non-elective admissions, non-private insurance payments, and a preference for teaching hospitals were commonly observed among these patients. During their hospitalization, individuals who developed delirium subsequent to rTKA were more prone to experiencing certain perioperative complications. These complications encompassed medical issues like acute myocardial infarction, continuous invasive mechanical ventilation, postoperative shock, sepsis, stroke and other medical problems. Additionally, surgical complications including hemorrhage / seroma / hematoma, irrigation and debridement, prosthetic joint infection, periprosthetic fracture, and wound dehiscence / nonunion were noted. Several risk factors were found to be linked with the development of POD. These included advanced age (≥ 75years), alcohol abuse, coagulation disorders, congestive heart failure, depression, fluid and electrolyte imbalances, and more. Conversely, female sex, having private insurance, and undergoing elective hospitalization emerged as protective factors against POD. Our findings suggest that the general prevalence of POD in rTKA is relatively low according to NIS. There was a significant connection between the POD of rTKA and advanced age, prolonged length of stay (LOS), more in-patients' costs, higher in-hospital mortality rate, increased comorbidities, postoperative medical complications and postoperative surgical complications. This study helps to understand the risk factors associated with POD to improve poor outcomes.

Comparison of in-hospital outcomes of ST-elevation myocardial infarction patients with cardiogenic shock receiving left ventricular mechanical circulatory support devices based on transfer status.

We aimed to compare outcomes in patients who receive on-site left ventricular mechanical support versus those transferred to other facilities for mechanical support in ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock. This retrospective study analyzed data from the 2016 to 2020 Nationwide Inpatient Sample (NIS) database. We identified patients with STEMIand cardiogenic shock who received Impella and LVAD placement during their hospital stay. They were divided into two groups: those with in-house (direct) placement and those transferred to higher-level medical centers. The primary goal was to compare mortality rates between these groups. During the study, 15,934 (75.2%) received in-house left ventricular support, while 5255 (24.8%) were transferred. Mean age (63 vs. 64 years) and female percentage (25 vs. 26%) were similar. The average time from admission to receiving LV support was 0.8 days for direct group versus 2.8 days for transfer group (p < 0.001). Transferred patients had a higher rate of prior heart failure (68 vs. 79%, p < 0.001) and peripheral vascular disease (10 vs. 14%, p < 0.001) but a lower rate of hypertension (23 vs. 17%, p = 0.003). There were no significant differences in other comorbidities. Primary outcome mortality did not significantly differ (44.9 vs. 44.2, p = 0.66). After multivariate analysis, transferred patients had higher rates of ECMO usage, acute kidney injury, renal replacement therapy, major bleeding, and ischemic stroke. Length of stay (8 vs. 15 days, p < 0.001) and total charges ($391,472 vs. $581,183, p < 0.001) were significantly higher in the transferred group. Among STEMI patients with cardiogenic shock, our study found no significant difference in mortality between patients transferred for and those with on-site LV support. Those transferred patients experienced more complications, longer length of stay, and increased hospital costs.

Impact of pneumothorax on mortality, morbidity, and hospital resource utilization in COVID-19 patients: a propensity matched analysis of nationwide inpatient sample database

BackgroundSpontaneous pneumothorax (PTX) is more prevalent among COVID-19 patients than other critically ill patients, but studies on this are limited. This study compared clinical characteristics and in-hospital outcomes among COVID-19 patients with concomitant PTX to provide insight into how PTX affects health care utilization and complications, which informs clinical decisions and healthcare resource allocation.MethodsThe 2020 Nationwide Inpatient Sample was used analyze patient demographics and outcomes, including age, race, sex, insurance status, median income, length of hospital stay, mortality rate, hospitalization costs, comorbidities, mechanical ventilation, and vasopressor support. Propensity score matching was employed for additional analysis.ResultsAmong 1,572,815 COVID-19 patients, 1.41% had PTX. These patients incurred significantly higher hospitalization costs ($435,508 vs. $96,668, p < 0.001) and longer stays (23.6 days vs. 8.6 days, p < 0.001). In-hospital mortality was substantially elevated for PTX patients (65.8% vs. 14.4%, p < 0.001), with an adjusted odds ratio of 14.3 (95% CI 12.7–16.2). Additionally, these patients were more likely to require vasopressors (16.6% vs. 3.3%), mechanical circulatory support (3.5% vs. 0.3%), hemodialysis (16.6% vs. 5.6%), invasive mechanical ventilation (76.9% vs. 15.1%), non-invasive mechanical ventilation (19.1% vs. 5.8%), tracheostomy (13.3% vs. 1.1%), and chest tube placement (59.8% vs. 0.8%).ConclusionsOur findings highlight the severe impact of PTX on COVID-19 patients, characterized by higher mortality, more complications, and increased resource utilization. Also, being Hispanic, male, or obese increased the risk of developing concomitant PTX with COVID-19.

Inpatient prevalence and factors associated with Merkel Cell Carcinoma inpatient hospitalization in the United States.

Merkel Cell Carcinoma is a rare and aggressive cutaneous carcinoma with a propensity for metastasis and death. Our study describes the prevalence, sociodemographics and inpatient mortality of Merkel Cell Carcinoma related hospitalizations in the United States from 2011 to 2020. We conducted an observational study using the Nationwide Inpatient Sample database, which captures a 20% sample of all hospitalizations in the United States. We utilized the International Classification of Disease Clinical Modification codes from the ninth and tenth revision to identify Merkel Cell Carcinoma and demographic factors. There was a total of 28,809 cases of Merkel Cell Carcinoma in the United States from 2011 to 2020. Merkel Cell Carcinoma was associated with white race (11.4 per 100,000) and disposition of death (26.8 per 100,000). It was most prevalent in the highest quartile income (12.5 per 100,000) and Medicare as primary payer (13.0 per 100,000). Hospitalization was lowest in nonwhite races, particularly NH-Blacks and NH-Others. Inpatient mortality was significantly associated with NH-Others(odds ratio 2.18, 95% confidence interval = 1.38-3.45) and self-pay patients (odds ratio = 2.93, 95% confidence interval 1.84-4.67).This study contributes to reported socio-demographic factors related to Merkel Cell Carcinomas and brings awareness to factors associated with increased hospitalization and inpatient mortality.

Prior Bariatric Surgery Predicts Lower Life-Threatening Morbidity in Patients Admitted for Acute Allergic Reaction and Anaphylaxis: a Propensity Score-Matched Analysis of the U.S. Nationwide Inpatient Sample, 2005–2018

PurposeAcute allergic reactions may occur in susceptible individuals following exposure to various allergens. Obesity is linked to allergic reactions, and weight loss from bariatric surgery may attenuate the severity of certain conditions such as airway hyperresponsiveness in asthma. This retrospective observational study investigates associations between prior bariatric surgery and lower risk for life-threatening conditions in patients hospitalized with acute allergic reactions and anaphylaxis.Materials and MethodsAdults ≥ 18 years old diagnosed with morbid obesity and admitted to US hospitals with acute allergic reactions/anaphylaxis were included. All data were extracted from the US Nationwide Inpatient Sample (NIS) database 2005–2018. Patients without information on in-hospital mortality, discharge destination, hospital costs, and length of stay (LOS) were excluded. Patients were divided into two groups based on prior bariatric surgery or not. All diagnoses were verified through ICD-9 and ICD-10 codes. Between-group differences and associations between variables were evaluated using logistic regression analysis.ResultsAfter matching, patients with prior bariatric surgery had significantly lower proportions of any life-threatening morbidity (37.2% vs. 47.4%), respiratory distress or failure (11.2% vs. 17.0%), pneumonia or severe infection (7.4% vs. 10.2%), sepsis/septic shock (15.2% vs. 20.9%), intubation and mechanical ventilation (11.2% vs. 14.6%), prolonged LOS (10.3% vs. 20.6%) and unfavorable discharge (6.9% vs. 12.5%) than those without prior bariatric surgery.ConclusionPrior bariatric surgery predicts a lower risk of life-threatening morbidity and prolonged LOS among adults hospitalized for acute allergic reaction and anaphylaxis. Future prospective studies are warranted to confirm the present findings and reveal underlying mechanisms.Graphical

Obesity-associated outcomes after ACL reconstruction: a propensity-score-matched analysis of the US Nationwide Inpatient Sample 2005–2018

BackgroundAnterior cruciate ligament (ACL) injuries are common among physically active individuals, and obesity may increase the risk of such injuries due to factors like biomechanical stress on the knee. We aimed to determine if obesity affects postoperative outcomes after ACL reconstruction.MethodsData from adults aged 20 years and older with ACL injuries who underwent inpatient reconstruction from 2005 to 2018 were extracted from the United States (US) Nationwide Inpatient Sample (NIS) database. Patients were divided into two groups based on the presence of co-existing obesity, defined as a body mass index (BMI) ≥ 30 kg/m2. Propensity-score matching (PSM) was employed to balance between-group differences. Associations between obesity and concomitant meniscus injury, length of stay (LOS), post-procedural complications, and non-routine discharge were examined using univariate and multivariable logistic and linear regressions.ResultsAfter PSM, data from 1323 patients (representing 6396 individuals in the US) were analyzed. Of these, 441 (33%) were classified as obese, while 882 (67%) were not obese. After adjustment, obesity was significantly associated with a longer LOS (adjusted beta (aBeta) = 0.32, 95% confidence interval (CI) 0.31–0.321) and an increased likelihood of non-routine discharge (adjusted OR (aOR) = 2.18, 95% CI 1.47–3.22). There were no significant associations between obesity and concomitant meniscus injury (aOR = 1.04, 95% CI 0.81–1.32) or post-procedural complications (aOR = 0.97, 95% CI 0.74–1.27).ConclusionsIn patients undergoing ACL reconstruction in the US, obesity is independently associated with a longer LOS and a higher risk of non-routine discharge. Nevertheless, obesity does not appear to be associated with concomitant meniscus injury or post-procedural complications.

Outcomes of radiofrequency ablation for liver tumors in patients on hemodialysis: Results from the US Nationwide Inpatient Sample 2005–2020

ObjectiveFew studies have examined the outcomes of radiofrequency ablation (RFA) for liver tumors in patients on hemodialysis. This study aimed to investigate short-term outcomes following RFA for liver tumors in patients on hemodialysis. MethodsData of patients ≥ 20 years old diagnosed with liver tumors who underwent RFA were extracted from the Nationwide Inpatient Sample (NIS) database 2005–2020. The study population was divided into two groups: patients on hemodialysis and those not on hemodialysis. Propensity score matching (PSM) was employed to address baseline differences. Associations between hemodialysis and in-hospital outcomes, including prolonged length of stay (LOS), in-hospital mortality, unfavorable discharge, and complications were determined using logistic regression analyses. ResultsAfter applying the inclusion and exclusion criteria, a total of 12,749 patients constituted the study population, with 550 remaining after 1:4 PSM (110 on hemodialysis and 440 without hemodialysis). After adjustment in the multivariable analyses, patients on maintenance hemodialysis showed significantly higher risks of prolonged LOS (adjusted odds ratio [aOR] = 2.88, 95 % confidence interval [CI]: 1.78–4.65), in-hospital mortality (aOR=31.90, 95 % CI: 17.68–57.58), unfavorable discharge (aOR=3.79, 95 % CI: 2.05–7.01), at least one complications (aOR=3.68, 95 % CI: 2.49–5.44), and greater total hospital costs (adjusted Beta [aBeta] = 126.75, 95 % CI: 113.68–139.82). ConclusionsPatients on hemodialysis undergoing RFA for liver tumors have greater risks of adverse short-term outcomes including in-hospital mortality, prolonged LOS, complications, and unfavorable discharge. Careful consideration and close monitoring are warranted for patients on hemodialysis when planning for RFA.3

Trends and epidemiology in robotic-assisted total knee arthroplasty: Reduced complications and shorter hospital stays.

This study provides an in-depth analysis of the immediate postoperative outcomes and implications or robotic-assisted total knee arthroplasty (RA-TKA) compared with conventional TKA (C-TKA), particularly with regard to mortality, complications, hospital stay and costs, drawing from a comprehensive nationwide data set. The Nationwide Inpatient Sample (NIS) database, the largest all-payer inpatient healthcare database in the United States, was used to identify all patients who underwent RA-TKA or C-TKA from 2016 to 2019. A total of 527,376 cases, representing 2,638,679 patients who underwent elective TKA were identified, of which 88,415 had RA-TKA. To mitigate potential variations and selection bias in baseline characteristics between the two groups, a propensity score-matched analysis was employed to further balance and refine our data set, resulting in 176,830 patients evenly distributed between the groups. Analysis was performed according to demographics, immediate post-operative complications, and economic data, including payor class, length of stay and total charges. There was a marked shift towards RA-TKA, from an initial 0.70% in 2016 to a notable 7.30% by 2019. Patients who underwent RA-TKA were slightly younger (66.2 ± SD years), compared to the C-TKA group (66.7 ± SD years). Hospital stay was 1.89 days and 2.29 days for RA-TKA and C-TKA, respectively. Charges metrics revealed slightly higher charges for RA-TKA. Less postoperative complications were found in the RA-TKA group, such as blood loss, anaemia, acute kidney injury, venous thromboembolism, pulmonary embolism, pneumonia and surgical wound complication. Even following the propensity score matching, these findings remained consistent and statistically significant. RA-TKA use in the United States has grown substantially in the last few years and has been associated with significantly reduced immediate post-operative complications and length of hospital stay compared to C-TKA, offering safer surgical management for TKA patients. Further studies on the short- and long-term outcomes of RA-TKA would improve the understanding of the full potential of this technology. Level III.

Impact of Hypoglycemia on Hospitalized Patients With Hepatocellular Carcinoma.

Aims Hepatocellular carcinoma (HCC) is one of the common liver malignancies that presents a challenge to global healthcare. The impact and outcomes of hypoglycemia in HCC have not been studied in detail before. This study aimed to investigate the outcomes and prognosis associated with hypoglycemia in patients diagnosed with HCC, utilizing a large-scale database approach. Methods Using the Nationwide Inpatient Sample (NIS) database from 2017 to 2020, we conducted a comprehensive retrospective analysis to examine the incidence, risk factors, and clinical implications of hypoglycemia on HCC patients. The patients were divided into two groups: those with hypoglycemia and those without hypoglycemia. Univariate and multivariate logistic regression were used to conduct the analysis. STATA® version 17.0 software(StataCorp LLC, College Station, TX) was used for this purpose. Results Out of a total of 343,895 patients with HCC, the prevalence of hypoglycemia was present in 1.5% of this patient population. We found that hypoglycemia was common in the male population (68%). Compared with patients without hypoglycemia, patients who had hypoglycemia with HCC had higher mortality (42%, p-value < 0.05) and higher risks of secondary outcomes such as hepatic failure, spontaneous bacterial peritonitis (SBP), ascites, and portal vein thrombosis compared to patients who did not have hypoglycemia. The multivariate-adjusted odds ratio for hepatic failure was 2.7 (2.3-3.1), for SBPwas 2.9 (1.8-3.0), for ascites was 1.6 (1.4-1.9), and for portal vein thrombosis was 1.2 (0.9-1.4). Conclusion In conclusion, hypoglycemia in HCC is associated with increased mortality and worse outcomes.

Changes in adverse obstetrical and neonatal outcomes over time in American women with polycystic ovary syndrome: an 11-year study of a population database.

To determine whether the prevalence in American demographic and resultant adverse obstetric outcomes changed in women with polycystic ovary syndrome between the years of 2004-2014 inclusively, based on data derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database. This is a retrospective population-based study using data derived from the HCUP-NIS database from the years of 2004-2014, inclusively. Within this group, all pregnancies to women with PCOS were identified and separated by year, creating 11 groups. Risk factors including non-Caucasian race, lower socioeconomic status, andrates of obesity and thyroid disease increased over time.The rates of gestational diabetes mellitus demonstrated a slight decrease, (21.3% in 2004 to 18.0% in 2014, P = 0.01). The number of women with preterm premature rupture of membranes decreased from 3.0% in 2004 to 2.0% in 2014 (P = 0.04). Rates of preterm delivery decreased from 14.8% in 2004 to 9.8% in 2014 (P < 0.001). Rates of cesarean section decreased from 57.3% in 2004 to 45.7% in 2014 (P < 0.001), while rates of spontaneous vaginal delivery increased from 37.4% in 2004 to 50.1% in 2014 (P < 0.001). The rate of wound complications decreased from 2.1% in 2004 to 0.4% in 2014 (P < 0.001). However, the rate of congenital anomalies increased from 0.5% in 2004 to 1.2% in 2014 (P = 0.001). In spite of increases in demographic risk factors associated with increased pregnancy complications, we hypothesize that the interventions made to minimize the risks of cesarean section and manage metabolic complications in women with PCOS during the period of study have resulted in improved pregnancy outcomes during the period of study.

A National Database Study on Racial Disparities in Route of Hysterectomy With a Surrogate Control for Uterine Size: A Proposed Quality Metric for Benign Indications

Study ObjectiveTo investigate the association between race and route of hysterectomy among patients undergoing hysterectomy for abnormal uterine bleeding in the absence of uterine fibroid disease and excluding malignancy. DesignA cross-sectional cohort study utilizing the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and National Ambulatory Surgical databases to compare abdominal to minimally invasive route of hysterectomy. SettingHospitals and hospital-affiliated ambulatory surgical centers participating in the Healthcare Cost and Utilization Project in 2019 Patients75,838 patients who had undergone hysterectomy for abnormal uterine bleeding excluding uterine fibroids and malignancy. Interventionsn/a Measurements and Main ResultsOf the 75,838 hysterectomies performed for abnormal uterine bleeding in the absence of uterine fibroids and malignancy, 10.1% were performed abdominally and 89.9% minimally invasively. After adjusting for confounders, Black patients were 38% more likely to undergo abdominal hysterectomy compared to White patients (OR 1.38, CI 1.12-1.70 p=0.002). Black race thus is independently associated with open surgery. ConclusionDespite excluding uterine fibroids as a risk factor for an abdominal route of hysterectomy, Black race remained an independent predictor for abdominal versus minimally invasive hysterectomy and Black patients were found to undergo a disproportionately higher rate of abdominal hysterectomy compared to White patients.

Association between Insurance Status and Outcomes of Hospitalizations for Necrotizing Soft Tissue Infections.

Background: Lack of insurance is associated with poorer outcomes in hospitalized patients. However, few studies have explored this association in hospitalizations for necrotizing soft tissue infections (NSTIs). This study examined the impact of insurance status on the outcome of NSTI admissions. Methods: All adult hospitalizations for necrotizing fasciitis, gas gangrene, and Fournier gangrene between 2016 and 2018 were examined using the Nationwide Inpatient Sample database. Insurance status was categorized as insured (including Medicare, Medicaid, and Private, including Health maintenance organization (HMO) or uninsured (Self-pay). Outcome measures included mortality rates, limb loss, length of hospital stay, prolonged hospital stay, and critical care admissions. Statistical analysis included weighted sample analysis, chi-square tests, multivariate regression analysis, and negative binomial regression modeling. Results: Approximately 29,705 adult hospitalizations for NSTIs were analyzed. Of these, 57.4% (17,065) were due to necrotizing fasciitis, 22% (6,545) to gas gangrene, and 20.5% (6,095) to Fournier gangrene. Approximately 9.7% (2,875) were uninsured, whereas 70% (26,780) had insurance coverage. Among the insured, Medicare covered 39.6% (10,605), Medicaid 29% (7,775), and private insurance 31.4% (8,400). After adjustments, Medicare insurance was associated with greater odds of mortality (adjusted odds ratio [aOR]: 1.81; 95% confidence interval [CI]: 1.33-2.47; p = 0.001). Medicaid insurance was associated with increased odds of amputation (aOR: 1.81; 95% CI: 1.33-2.47; p < 0.001), whereas private insurance was associated with lower odds of amputation (aOR: 0.70; 95% CI: 0.51-0.97; p = 0.030). Medicaid insurance was associated with greater odds of prolonged hospital stay (aOR: 1.34; 95% CI: 1.09-1.64; p < 0.001). No significant association was observed between the lack of insurance or self-pay and the odds of primary or secondary outcomes. Conclusion: Medicare insurance was correlated with greater odds of mortality, whereas Medicaid insurance was associated with increased odds of amputation and longer hospital stay. Uninsured status was not associated with significant differences in NSTI outcomes.

P-625 Association between advanced maternal age in women with polycystic ovary syndrome and adverse obstetric outcomes

Abstract Study question What is the effect of advanced maternal on the likelihood of experiencing adverse pregnancy, delivery, and neonatal outcomes in pregnant women with PCOS? Summary answer Advanced maternal age in women with polycystic ovary syndrome confers an additional risk of pregnancy induced hypertension, preeclampsia, preterm delivery, c-section, and placenta previa. What is known already Women with PCOS have an increased risk of obstetric complications, including preterm delivery, PROM, hypertensive disorders, gestational diabetes, cesarean section, and placental abruption. Similarly, the impact of advanced maternal age on pregnancy outcomes has been widely studied. Studies have highlighted the association between advanced maternal age and increased risks of preeclampsia, gestational diabetes mellitus, preterm labor, cesarean section, stillbirth, and fetal growth restriction. The role of advanced maternal age on pregnancy complications in PCOS in a population database has not been thoroughly evaluated. Study design, size, duration A retrospective population-based study using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database was performed. All deliveries between 2004 to 2014, inclusively, were studied using ICD-9 codes. Within the study period, 14,846 women had a diagnosis of PCOS, of which 943 (6.35%) were of significant advanced maternal age (38-43 years/old). The study could not be extended since in 2015 ICD-10 codes were used which are not compatible with ICD-9 codes. Participants/materials, setting, methods Chi-squared tests were used for comparison of demographics. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI), controlling for confounding effects. According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available Main results and the role of chance Women with PCOS and advanced maternal age were more likely to develop pregnancy complications, including pregnancy induced hypertension (aOR 1.32; 95% CI: 1.09-1.59; p = 0.004), preeclampsia (aOR 1.51; 95% CI: 1.16-1.98; p = 0.003), and gestational diabetes mellitus (aOR 1.66; 95% CI: 1.40-1.97; p &amp;lt; 0.001), after controlling for confounding demographics. Women with PCOS of advanced maternal age were also at increased risk of delivery by cesarean section (aOR 1.20 95% CI: 1.10-1.43; p &amp;lt; 0.001). Women with PCOS and advanced maternal age were not at an increased risk of preterm delivery, PPROM, placental abruption, chorioamnionitis, operative vaginal delivery, post-partum hemorrhage, wound complications, transfusion, maternal infection, deep vein thrombosis, pulmonary embolism, venous thromboembolism, disseminated intravascular coagulation and eclampsia (p &amp;gt; 0.05 in all cases). Results demonstrated no difference in the rate of women who gave birth to SGA infants, the rate of IUFDs, and the rate of infants with congenital anomalies between the two groups. Limitations, reasons for caution The limitations of our study are its retrospective nature and use of an administrative database which relies on the accuracy and consistency of the individuals coding the data. There are known limitations in how accurately hospital coding is able to capture perinatal conditions and complications. Wider implications of the findings The impact of advanced maternal age on the relationship between PCOS and pregnancy outcomes should be considered when counseling and planning care for pregnant women affected by these conditions. This emphasizes the importance of optimal perinatal care in older women with PCOS as they have higher risks of obstetric complications. Trial registration number NA

Incidence and risk factors of blood transfusion after total knee arthroplasty: A retrospective nationwide inpatient sample database study

IntroductionCommon postoperative complications of total knee arthroplasty (TKA) include blood transfusion. Although risk factors and incidence of blood transfusion have been studied through national databases, the relative impact of each risk factor needs to be synthesized over a longer time period into a new model need to be revised. Material and methodsPatient data were extracted from the National Inpatient Sample (NIS), which is the largest hospital care database in the US, and analyse patient data retrospectively from 2010 through 2019. The final data included the patients undergoing TKA. The final analysis assessed the demographics of patients, type of insurance, type of hospital, length of stay (LOS), preoperative comorbidities, total charge, inpatient mortality, medical-surgical postoperative complications. ResultsAfter extracting data from the NIS database, a total of 1,250,533 patients with TKA were included in the analysis, and the rate of transfusion was 6.60 %. TKA patients who receive blood transfusion had longer LOS (from 2-3 days to 3–4 days), more preoperative comorbidities, higher inpatient mortality rate, and increased total charge (P < 0.001). Moreover, postoperative complications associated with inpatients included sepsis, acute myocardial infarction and shock. Elective admission and private insurance were also regarded as protective factors. ConclusionBlood transfusion could bring postoperative complications to patients, which were also linked to health costs and risks. It was also a common preoperative comorbidities for older patients who underwent TKA. Through better blood management strategies, we could reduce patient transfusion rates and improve clinical outcomes.Level of Evidence: Diagnostic Level Ⅲ.

In Patients with Cardiogenic Shock, Extracorporeal Membrane Oxygenation Is Associated with Very High All-Cause Inpatient Mortality Rate.

Background: The goal of this study was to evaluate the effect of extracorporeal membrane oxygenation (ECMO) on mortality in patients with cardiogenic shock excluding Impella and IABP use. Method: The large Nationwide Inpatient Sample (NIS) database was utilized to study any association between the use of ECMO in adults over the age of 18 and mortality and complications with a diagnosis of cardiogenic shocks. Results: ICD-10 codes for ECMO and cardiogenic shock for the available years 2016-2020 were utilized. A total of 796,585 (age 66.5 ± 14.4) patients had a diagnosis of cardiogenic shock excluding Impella. Of these patients, 13,160 (age 53.7 ± 15.4) were treated with ECMO without IABP use. Total inpatient mortality without any device was 32.7%. It was 47.9% with ECMO. In a multivariate analysis adjusting for 47 variables such as age, gender, race, lactic acidosis, three-vessel intervention, left main myocardial infarction, cardiomyopathy, systolic heart failure, acute ST-elevation myocardial infarction, peripheral vascular disease, chronic renal disease, etc., ECMO utilization remained highly associated with mortality (OR: 1.78, CI: 1.6-1.9, p < 0.001). Evaluating teaching hospitals only revealed similar findings. Major complications were also high in the ECMO cohort. Conclusions: In patients with cardiogenic shock, the use of ECMO was associated with the high in-hospital mortality regardless of comorbid condition, high-risk futures, or type of hospital.

Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes: A retrospective cohort study.

The impact of type 2 diabetes mellitus (T2DM) on acute respiratory distress syndrome (ARDS) is debatable. T2DM was suspected to reduce the risk and complications of ARDS. However, during coronavirus disease 2019 (COVID-19), T2DM predisposed patients to ARDS, especially those who were on insulin at home. To evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes. We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database. Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus (DM) (IDDM) and non-insulin-dependent DM (NIDDM) groups. After applying exclusion criteria and matching over 20 variables, we compared cohorts for mortality, duration of mechanical ventilation, incidence of acute kidney injury (AKI), length of stay (LOS), hospitalization costs, and other clinical outcomes. Following 1:1 propensity score matching, the analysis included 274 patients in each group. Notably, no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates (32.8% vs 31.0%, P = 0.520), median hospital LOS (10 d, P = 0.537), requirement for mechanical ventilation, incidence rates of sepsis, pneumonia or AKI, median total hospitalization costs, or patient disposition upon discharge. Compared to alternative anti-diabetic medications, outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

Incidence and risk factors of postoperative pulmonary complications following total hip arthroplasty revision: a retrospective Nationwide Inpatient Sample database study

BackgroundPostoperative pulmonary complications (PPCs) are among the most severe complications following total hip arthroplasty revision (THAR), imposing significant burdens on individuals and society. This study examined the prevalence and risk factors of PPCs following THAR using the NIS database, identifying specific pulmonary complications (SPCs) and their associated risks, including pneumonia, acute respiratory failure (ARF), and pulmonary embolism (PE).MethodsThe National Inpatient Sample (NIS) database was used for this cross-sectional study. The analysis included patients undergoing THAR based on NIS from 2010 to 2019. Available data include demographic data, diagnostic and procedure codes, total charges, length of stay (LOS), hospital information, insurance information, and discharges.ResultsFrom the NIS database, a total of 112,735 THAR patients in total were extracted. After THAR surgery, there was a 2.62% overall incidence of PPCs. Patients with PPCs after THAR demonstrated increased LOS, total charges, usage of Medicare, and in-hospital mortality. The following variables have been determined as potential risk factors for PPCs: advanced age, pulmonary circulation disorders, fluid and electrolyte disorders, weight loss, congestive heart failure, metastatic cancer, other neurological disorders (encephalopathy, cerebral edema, multiple sclerosis etc.), coagulopathy, paralysis, chronic pulmonary disease, renal failure, acute heart failure, deep vein thrombosis, acute myocardial infarction, peripheral vascular disease, stroke, continuous trauma ventilation, cardiac arrest, blood transfusion, dislocation of joint, and hemorrhage.ConclusionsOur study revealed a 2.62% incidence of PPCs, with pneumonia, ARF, and PE accounting for 1.24%, 1.31%, and 0.41%, respectively. A multitude of risk factors for PPCs were identified, underscoring the importance of preoperative optimization to mitigate PPCs and enhance postoperative outcomes.

Multivariate Analysis of Risk Factors for In-Hospital Dislocation Following Primary Total Hip Arthroplasty.

Background: Early dislocation following primary total hip arthroplasty (THA) is a rare but devastating complication and represents a source of patient morbidity and financial burden to the healthcare system. The objective of this study was to identify patient characteristics and comorbidities that are associated with increased early in-hospital dislocation rates following primary THA. Methods: A retrospective cohort study was conducted using patient data from the Nationwide Inpatient Sample (NIS) database; we identified patients who had undergone THA from 2016 to 2019 and compared those with an early periprosthetic dislocation prior to discharge to those without. The patient characteristics and comorbidities were compared using univariate analysis with a subsequent investigation of statistically significant variables using multivariate analysis. The variables were compared using chi square, Fisher's exact test, and independent sample t-tests with data assessed using odds ratio with 95% confidence intervals. Results: A total of 5151 patients sustained an early dislocation compared to 362,743 who did not. Those who sustained an in-hospital dislocation were more likely to share the following characteristics: female sex (OR 1.21, p < 0.01), age > 70 (OR 1.45, p < 0.01), Caucasian ethnicity (OR 1.22, p < 0.01), SLE (OR 1.87, p < 0.01), and Parkinson's disease (OR 1.93, p < 0.01). Certain characteristics were also associated with decreased odds of having an in-hospital dislocation including elective surgery (OR 0.14, p < 0.01), tobacco use (OR 0.8, p < 0.01), diabetes without complications (OR 0.87, p < 0.01), and a history of heart valve replacement (OR 0.81, p < 0.01). The length of stay was significantly longer (4.7 days vs. 2.3 days) as was the total hospital charges (USD $101,517 vs. USD $66,388) for the early in-hospital dislocation group. Conclusions: Several patient characteristics and comorbidities are associated with early in-hospital dislocation episodes following total hip arthroplasty including female sex, age > 70, non-elective surgery, SLE, and Parkinson's. This information may be useful to help guide intraoperative implant selection and/or postoperative protocol in select patient populations to limit early instability as well as decrease the financial burden associated with this postoperative complication.

The Incidence and Outcomes of Venous Thromboembolisms in Patients Admitted with Different Gastrointestinal Malignancies

Introduction: Venous thromboembolism (VTE) is associated with significant morbidity and mortality in cancer patients. Our study compares the mortality in hospitalized VTE patients among the four most common gastrointestinal (GI) malignancies which include esophageal, gastric, pancreatic, and colorectal cancer. Methods: A retrospective study was conducted utilizing the Nationwide Inpatient Sample database (NIS) from 2016 to 2019. Patients with VTE were identified using ICD-10 codes from all primary discharge diagnoses. Only deep venous thrombosis (DVT) and pulmonary embolism (PE) were considered. Patients with VTE were further divided into groups: esophageal cancer, gastric cancer, pancreatic cancer, and colorectal cancer, and compared with patients who did not have these malignancies. The adjusted odds ratio (aOR) was calculated using multivariate regression analysis. Results: Among 999,559 patients discharged with a VTE diagnosis, 25,775 (2.6%) had one of the four GI malignancies. Among patients with one of the four included GI malignancy diagnosis, 18,816 (73%) patients had PE and 6,959 (27%) patients had DVT. The study shows that adults admitted to the hospitals for VTE have higher mortality when compared to patients who did not have GI malignancies, with esophageal cancer having the highest inpatient mortality with an aOR of 2.701; 95% confidence interval (CI) 1.989–3.669, p value <0.000. For the remaining GI cancers, gastric cancer had an aOR 1.576; CI: 1.094–2.269, p value 0.015, and pancreatic cancer had an aOR of 1.736; 95% CI: 1.445–2.085, p value <0.000. Patients with colorectal cancer had no significant increase in the odds of mortality with aOR of 1.213; 95% CI: 0.988–1.489, p value 0.066. Conclusions: This study demonstrates that VTE in hospitalized patients with esophageal cancer is associated with greater mortality compared to other GI malignancies.

Racial Differences in Non-variceal Upper Gastrointestinal (GI) Bleeding: A Nationwide Study.

Background and aims Knowledge about the impact of race on non-variceal upper GI bleeding (NVUGIB) is limited. This study explored the racial differences in the etiology and outcome of NVUGIB. Methods We conducted a study from 2009 to 2014 using the Nationwide Inpatient Sample (NIS) database. NIS is the largest publicly available all-payer inpatient database in the USA with more than seven million hospital stays each year. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for NVUGIB, esophagogastroduodenoscopy (EGD) and demographics were obtained. The outcomes of interest were in-hospital mortality, hospital length of stay (HLOS), total hospital charges, admission to the intensive care unit (ICU), and patient disposition. Analysis was conducted using Chi-square tests and Tukey multiple comparisons between groups. Results Among 1,082,516 patients with NVUGIB, African American and Native Americans had the highest proportions of hemorrhagic gastritis/duodenitis (8.2% and 4.2%, respectively) and Mallory-Weiss bleeding (10.4% and 5.4%, respectively; p<0.01). African Americans were less likely to get an EGD done within 24 hours of admission compared to Whites and Latinxs (45.9% vs 50.1% and 50.4%, respectively; p<0.001). In-hospital mortality was similar among African Americans, Latinxs, and Whites (5.8% vs 5.6% vs 5.9%, respectively; p=0.175). Asian/Pacific Islanders and African Americans were more likely to be admitted to the ICU (9.6% and 9.0%, respectively; p<0.001). Moreover, African Americans had a longer HLOS compared to Latinxs and Whites (7.5 vs 6.5 and 6.4 days, respectively; p<0.001). Conversely, Asian/Pacific Islanders and Latinx incurred the highest hospital total charges compared to African Americans and Whites ($81,821 and $69,267 vs $61,484 and $53,767, respectively; p<0.001). Conclusion African Americans are less likely to receive EGD within 24 hours of admission and are more likely to be admitted to the ICU with prolonged hospital lengths of stay. Latinxs are more likely to be uninsured and incur the highest hospital costs.