Nationwide Trends Research Articles

The Nationwide Trends and Preparation Requirements of Alternative Route Programs in Special Education

In the United States, there exists a chronic shortage of qualified special education teachers to provide instructional services to students with disabilities. One policy solution developed to increase the number of qualified teachers is alternative routes (ARs), which are broadly defined as nontraditional and accelerated preparation paths to obtain a teaching license. In this longitudinal descriptive study, we investigate (a) the national trends of special education teacher enrollment and completion in AR programs from 2012 to 2020 and (b) the special education teacher preparation requirements in state alternative pathways that are disaggregated by their affiliation with institutions of higher education. Findings reveal that AR programs preparing special education teachers are on the rise within the United States, but they vary significantly on their preparation requirements. Implications for future research and policy recommendations needed within the recruitment and preparation of special education teachers will be discussed.

Trends and characteristics of potentially preventable emergency department visits among patients with cancer in the US.

e13643 Background: An initial step to reducing emergency department (ED) visits among patients with cancer is to identify the characteristics of patients visiting the ED and examine which of those visits could be prevented. The objective of this study was to explore nationwide trends and characteristics of ED visits and examine factors associated with potentially preventable ED visits and unplanned hospitalizations among patients with cancer in the US. Methods: This cross-sectional study used data on ED visits from the National Hospital Ambulatory Medical Care Survey from January 1, 2012, to December 31, 2019; US Cancer Statistics reports were used to estimate new cancer cases each year. Frequencies and trends of ED visits by adult patients (aged ≥18 years) with cancer were calculated. The primary outcome was potentially preventable ED visits (using the Centers for Medicare & Medicaid Services definition), and secondary outcomes were hospitalizations and the immediacy of the ED visits. Multivariable logistic regression analyses were performed to examine the associations of patient, hospital, and temporal factors with potentially preventable ED use and ED use resulting in hospitalization. Results: Among 854911106 ED visits, 35510014 (4.2%) were made by patients with cancer (mean [SD] age, 66.2 [16.2] years); of those, 55.2% of visits were among women, 73.2% were among non-Hispanic White individuals, 89.8% were among patients living in a private residence, and 54.3% were among Medicare enrollees. A total of 18 316 373 ED visits (51.6%) were identified as potentially preventable, and 5 770 571 visits (21.3%) were classified as high acuity. From 2012 to 2019, potentially preventable ED visits increased from 1 851 692 to 3 214 276. Pain (36.9%) was the most common reason for potentially preventable ED visits. The number of patients who visited an ED because of pain increased from 1 192 197 in 2012 to 2 405 849 in 2019 (a 101.8% increase). Overall, 28.9% of ED visits resulted in unplanned hospitalizations, which did not change significantly over time (from 32.2% in 2012 to 26.6% in 2019; P = .78 for trend). Factors such as residence in a nursing home (odds ratio, 1.73; 95% CI, 1.25-2.41) were positively associated with having a potentially preventable ED visit, and factors such as the presence of more than 1 comorbidity (odds ratio, 1.82; 95% CI, 1.43-2.32) were positively associated with having an unplanned hospitalization. Conclusions: In this study, 51.6% of ED visits among patients with cancer were identified as potentially preventable, and the absolute number of potentially preventable ED visits increased substantially between 2012 and 2019. These findings highlight the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.

RWD114 Is Medicare's Hospital Readmissions Reduction Program (HRRP) Delivering on the Decade's Promise?: A Trend Analysis

To analyze nationwide trends in hospitalization for six targeted CMS health measures under HRRP and evaluate the program’s success with respect to reduction of preventable readmissions.

Ten-year trends in incidence and prevalence of atrial fibrillation and flutter in Denmark according to demographics, ethnicity, educational level, and area of residence (2009-2018).

Atrial fibrillation is the most common cardiac arrhythmia and a major global health burden. Updated trends in the epidemiology of atrial fibrillation or flutter (AF) are needed. Using the Danish Heart Statistics, we investigated nationwide trends 2009-2018 in incidence rate and prevalence of AF according to age as well as age-standardized incidence rate (ASIR) and prevalence (ASP) of AF according to sex, ethnicity, educational level, and area of residence. Comparing year 2018 to 2009, we calculated stratum-specific ASIR ratios (ASIRR) and changes in ASP. During 2009-2015 the ASIR for AF increased for both men and women, followed by a decline from 2015-2018. Overall, this resulted in a 9% increase among men (ASIRR: 1.09, 95% CI: 1.06-1.12), but no change among women (ASIRR: 1.00, 95% CI: 0.97-1.04). The ASP increased by 29% among men and 26% among women. An increase in ASIR was observed in all ethnic groups except men of Far Eastern ethnicity. Lower educational level was associated with greater increases in both ASIR and ASP. ASIR and ASP differed slightly between the Danish regions but increased in all of them. During 2009-2018 the incidence and prevalence of AF in Denmark increased although the increase in incidence was transient among women. Factors associated with higher incidence were male sex, higher age, Danish and Western ethnicity as well as Middle Eastern/North African ethnicity among women, and lower educational level. Within Denmark, we observed only minor regional differences in AF incidence and prevalence.

Nationwide trends in the prevalence and incidence of depressive disorders and their correlates among adults with disabilities in Korea from 2006 to 2017.

Evidence suggests that people with disabilities are more likely to suffer from depression. Previous studies have focused on depressive disorders in specific disability types or age groups using small-scale cross-sectional samples. We investigated longitudinal trends in the prevalence and incidence of depressive disorders according to disability types and severity levels in the entire Korean adult population. The age-standardised prevalence and incidence of depressive disorders were investigated using National Health Insurance claims data from 2006 to 2017. The odds of depressive disorders by type and severity were examined using logistic regression after adjusting for sociodemographic characteristics and comorbidities based on merged 2006 to 2017 data. Both the incidence and prevalence of depressive disorders were higher among the disabled than the non-disabled, with the prevalence gap being larger than the incidence gap. In regression analyses, adjusting for sociodemographic characteristics and comorbidities considerably reduced the odds ratios, particularly for incidence. The severity of disabilities was inversely associated with the incidence of depressive disorders. Brain injury and disabilities in major internal organs were associated with lower odds of developing depressive disorders than in non-disabled individuals. A significant proportion of depressive disorders in disabled individuals are caused by financial hardships or comorbidities rather than disabilities themselves. We must pay special attention to those who cannot access healthcare services due to severe disabilities and those whose depressive disorders are misdiagnosed as intellectual disabilities. More research is required to elucidate the causal mechanisms underlying depressive disorders in people with various types and severities of disabilities.

Trends in adoption of extravascular devices compared to conventional devices: real-world data from the Netherlands Heart Registration

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Extravascular devices (EVD), such as the subcutaneous ICD (S-ICD) and leadless pacemaker (LP), have been developed to circumvent pocket- and lead-related device complications. Knowledge on trends in adoption of these devices among patient categories and hospital types is mainly derived from industry-initiated studies or selected populations. Purpose To assess the real-world nationwide trends in adoption of EVDs in the Netherlands. Methods Using real-world data registered at the Netherlands Heart Registration from 72 Dutch device-implanting hospitals, all consecutive patients were included with an EVD implantation (de novo or replacement) from 2012-2020. To describe the relative adoption of EVDs, all consecutive patients with a single-chamber conventional ICD or pacemaker were also included (pacemakers from 2014, the first LP registration). Trends in EVD adoption are described for different patient (age, gender, and BMI) and hospital (tertiles of device-implanting volume and implanting center [general , intervention, or thorax]) characteristics. Differences in adoption were tested using Chi-square and Fisher’s exact tests. Results From 2012-2020, 2862 S-ICDs and 15806 single-chamber conventional ICDs were implanted, while from 2014-2020, 785 LPs and 16530 single-chamber conventional pacemakers were implanted. S-ICD use among single-chamber ICD recipients increased from 7% to 22% and LP use among single-chamber pacemaker recipients increased from 1% to 8%, although utilization has levelled off in recent years (Fig. 1). The relative use of S-ICDs was largest in patients aged 10-30 years and declined with higher age (p<0.001); LP use ranged between 0 and 6% among age groups, with no specific preference at older age (p=0.002)(Fig. 2A). S-ICDs were used more in female than male ICD recipients (p=0.005); LPs more in male than female pacemaker recipients (p=0.002)(Fig. 2B). EVD utilization was largest in patients with a BMI <25 kg/m2 (S-ICDs p<0.001; LPs p=0.02)(Fig. 2C). EVDs were mostly implanted in high-volume centers (S-ICDs p=0.03; LPs p<0.001). S-ICDs were implanted mostly in thorax centers (p<0.001); LPs in thorax centers only. Conclusions Although EVDs have been adopted early in the Netherlands, their utilization has levelled off in recent years, possibly driven by higher cost, battery issues, or the COVID-19 pandemic. Utilization of S-ICDs is highest among younger patients while utilization of LPs was not specifically high in certain age groups. The effects of gender and BMI were smaller. EVDs were mainly implanted in high-volume thorax centers.

(310) Nationwide Priapism Emergency Department Encounters in the United States

Abstract Introduction There is a lack of understanding of recent trends and costs in emergency department visits and inpatient admissions for priapism. In particular no studies have evaluated nationwide trends in priapism since the roll out of ICD-10CM coding in 2015. Objective To determine contemporary national estimates for emergency department visits and inpatient admissions for priapism in the United States from 2016-2019. Methods Emergency department (ED) encounters for priapism were analyzed using the Nationwide Emergency Department Sample (NEDS) from the Healthcare Cost and Utilization Project (HCUP). Patients presenting to the ED with a diagnosis of priapism were identified by ICD-10-CM codes. Patient demographics, hospital characteristics, patient disposition, and costs were evaluated for each visit. Statistical analysis was performed using established weighting provided by the HCUP to create national estimates. Comparisons of demographics were performed using t-tests and chi-square tests with a p-value for significance <0.05. Prolonged length of stay was defined as over two days. Results Between 2016-2019, there was a weighted total of 78,993 ED visits for priapism nationwide out of an estimated 576,544,259 ED encounters making up 0.014% (p<0.01) of all ED encounters. The average age of a patient diagnosed with priapism was 41 (SEM=0.102). Patients diagnosed with unspecified priapism made up 73.67% (58,197) of encounters, while those diagnosed with drug-induced priapism accounted for 14.34% (11,325) of encounters, and 7.26% (5,738) encounters of priapism were due to disease. The South region had the greatest number of priapism encounters each year accounting for 46.59% (36,800) of all ED visits mostly in metropolitan teaching hospitals hosted 70.53% (55,713). Inpatient admissions occurred in 16.07% (12,696) of ED visits for priapism. Of those admitted, 79.10% (10,043) had a prolonged length of stay with those staying only a day making up 16% (2,031). Inpatient admissions averaged a total charge of $72,668 compared with $3,763 (p<.0001) for patients not admitted. Of the expected primary payers, private insurance covered 32.14% (25,356) of ED visits for priapism with Medicaid covering 30.24% (23,857), Medicare covering 17.50% (13,805), and self-payers covering 14.77% (11,648). Conclusions ED visits for priapism remain a frequent and costly event in the United States Healthcare System. Patients requiring inpatient admission leads to a significantly increased cost for the overall encounter. Future studies should examine interventions that can decrease repeated ED visits and inpatient admission for priapism on a regional and national level. Disclosure No

(474) Trends and Costs of Ambulatory vs Inpatient Penile Prosthesis Placement

Abstract Introduction Current literature is limited in assessing nationwide trends of penile prosthesis (PP) placement in the United States largely due to a lack of data on outpatient PP placement. Particularly no nationwide comparison of ambulatory surgery center (ASC) versus inpatient hospital (IH) PP placement has been published. Objective Our objective is to determine the trends of PP placement in ASCs vs IHs utilizing representative nationwide data. Additionally, we examined patient demographics that are associated with the setting for PP placement. Methods Inpatient and outpatient encounters for PP placement between 2016 and 2019 were analyzed using data from the Nationwide Inpatient Sample (NIS) and the Nationwide Ambulatory Surgery Sample (NASS) from the Healthcare Cost and Utilization Project (HCUP). These are the largest publicly available inpatient and ambulatory surgery databases available in the United States. PP operations were identified by CPT and ICD-10-PCS codes. Subsequent analysis was performed using the established weighting provided by the HCUP, which utilizes stratified cluster sampling to create national estimates. Comparisons of demographics were performed using t-tests and chi-square tests with a p-value for significance <0.05. Results Over the study period, there were 67,722 PP placements in the United States. The percentage placed in ASCs was 93.1%. In 2016, 16,290 PP placements occurred, of which 92.3% were placed in ASCs. Comparatively in 2019, there was a 7.3% increase (17,473) in the number of PP placements, with 94.5% placed in ASCs (p<0.01). Over the study period, 33,008 PP placements were performed in the South (93.8% ASCs), 12,481 in the Midwest (94.6% ASCs), 12,192 in the Northeast (92.4% ASCs), and 10,040 in the West (90.1% ASCs, p<0.01). The average age of patients receiving a PP placement was 64.4 in ASCs compared with 62.5 in IHs (p<0.01). The average cost associated with PP placement in ASCs was $25,935, about half the cost of inpatient settings, which averaged $51,594 (p<0.01). Of all PP implants, the primary payer was medicare for 57.1% (38,660; 93.1% ASCs), medicaid for 4.4% (2980; 86.6% ASCs), private for 33.6% (22,778; 94.3% ASCs), and self-pay for 1.1% (768; 90.9% ASCs, p <0.01). Conclusions Our results suggest that the number of PP placements is consistently rising each year, with an increasing majority of PP placements performed in ASCs. The procedure costs roughly half on average when performed in ASCs compared to IHs. Further investigation is needed to compare complication rates and outcomes of PP placements in ASC versus IH. Disclosure No

Nationwide Trends and the Influence of Age and Gender in the In-Patient Care of Patients with Hepatocellular Carcinoma in Germany between 2010 and 2020.

This study analyzes nationwide trends in HCC hospitalizations focusing on interventional liver-directed treatments and the influence of age and gender. Using data from the German Federal Statistical Office all hospitalizations for HCC between 2010 and 2020 were included. Uni- and multivariable logistic regression analyses were performed to identify variables independently associated with the use of liver-directed therapies. Due to the COVID-19 pandemic, data from 2020 were analyzed separately. A total of 134,713 hospitalizations (2010-2019) were included, increasing by 3.4% annually (12,707 to 13,143). The mean in-hospital stay (-15.0% [7.2 to 6.1 days]) and mortality (-23.2% [6.8 to 5.2%]) decreased while transarterial, surgical, and percutaneous ablative interventions increased by 38.6, 31.5, and 19.3%, respectively. In-hospital mortality was 7.7% in admissions with surgical treatment, while it was 0.6 and 0.5% for transarterial and percutaneous interventions. Mortality was higher in females (6.2 vs. 5.7%). Females (OR 0.89 [0.86,0.91], p < 0.001) and patients ≥80 years (OR 0.81 [0.79,0.84], p < 0.001) were less likely to receive liver-directed treatments. Liver-directed therapies were increasingly performed while in-hospital mortality and in-hospital stay decreased. Minimally invasive approaches showed lower mortality, shorter in-hospital stay, and lower costs compared to surgery. Proportionately, more women and older patients were hospitalized, receiving fewer liver-directed treatments while their mortality was higher.

Changing nationwide trends away from overtreatment among patients undergoing radical prostatectomy over the past 25 years

PurposeThe objective of the current study was to assess whether and how preoperative risk group distribution and pathological outcomes have changed in men treated with radical prostatectomy (RP) over the past 25 years.Methods11,071 patients from a large contemporary registry-based nationwide cohort with RP as primary treatment between 1995 and 2019 were included. Preoperative risk stratification, postoperative outcomes, and 10 years other-cause mortality (OCM) were analyzed.ResultsAfter 2005, the proportion of low-risk prostate cancer (PCa) decreased from 39.6% to 25.5% in 2010 and decreased further to 15.5% in 2015, and 9.4% in 2019 (p < 0.001). The proportion of high-risk cases increased from 13.1% in 2005 to 23.1% in 2010 and 36.7% in 2015, and 40.4% in 2019 (p < 0.001). After 2005, the proportion of cases with favorable localized PCa decreased from 37.3% to 24.9% in 2010 and decreased further to 13.9% in 2015, and 1.6% in 2019 (p < 0.001). The overall 10 years OCM was 7.7%.ConclusionThe current analysis documents a clear shift in utilization of RP toward higher-risk PCa in men with long life expectancy. Patients with low-risk PCa or favorable localized PCa are rarely operated. This suggests a shift in applying surgery only to patients who may really benefit from RP and the long-standing discussion of overtreatment might become outdated.

Age- and Population-Adjusted Trends in Inpatient Surgical Management of Vaginal Prolapse, Rectal Prolapse, and Concurrent Vaginal and Rectal Prolapse Surgery

ObjectiveTo report age- and population-adjusted trends in the prevalence of inpatient vaginal prolapse (VP), rectal prolapse (RP), and concurrent VP/RP surgical procedures in women in Washington State over a 12-year period.MethodsThe Comprehensive Hospital Abstract Reporting System, an inpatient claims database, was queried for female patients aged 20 years or older with a diagnosis of VP and/or RP and associated surgical procedures from 2008 to 2019. Rates for female patients were adjusted by age and population based on census results.ResultsBetween 2008 and 2019, inpatient admissions for concurrent VP/RP surgery remained stable, with adjusted rates ranging from 1.42 to 3.38 per 100 000, with a majority performed in patients &lt; 80 years old. The population-adjusted rate of inpatient RP repairs remained stable at 3.12 to 5.14 per 100 000. The population-adjusted rate of inpatient VP repairs decreased dramatically, from 81.79 to 6.96 per 100 000.ConclusionsThe rate of inpatient RP and combined RP/VP surgical procedures was low and remained stable, while inpatient VP surgical repairs decreased substantially. Since the dataset is limited to inpatient surgery, this trend may reflect a shift to outpatient settings for VP surgeries. Nationally in the United States, there has been a trend toward multidisciplinary surgical management of concurrent VP/RP. However, this same trend does not appear to be reflected in Washington State, suggesting that nationwide trends may not be reflective of trends within each state. Further study is needed to understand how and why local trends in the management concurrent VP/RP may differ from national trends, and potentially improve concurrent VP/RP management using multidisciplinary approaches.

Geographic Disparities in Case Fatality and Discharge Disposition Among Patients With Primary Intracerebral Hemorrhage

Background We evaluate nationwide trends and urban-rural disparities in case fatality (in-hospital mortality) and discharge dispositions among patients with primary intracerebral hemorrhage (ICH). Methods and Results In this repeated cross-sectional study, we identified adult patients (≥18 years of age) with primary ICH from the National Inpatient Sample (2004-2018). Using a series of survey design Poisson regression models, with hospital location-time interaction, we report the adjusted risk ratio (aRR), 95% CI, and average marginal effect (AME) for factors associated with ICH case fatality and discharge dispositions. We performed a stratified analysis of each model among patients with extreme loss of function and minor to major loss of function. We identified 908 557 primary ICH hospitalizations (overall mean age [SD], 69.0 [15.0] years; 445 301 [49.0%] women; 49 884 [5.5%] rural ICH hospitalizations). The crude ICH case fatality rate was 25.3% (urban hospitals: 24.9%, rural hospitals:32.5%). Urban (versus rural) hospital patients had a lower likelihood of ICH case fatality (aRR, 0.86 [95% CI, 0.83-0.89]). ICH case fatality is declining over time; however, it is declining faster in urban hospitals (AME, -0.049 [95% CI, -0.051 to -0.047]) compared with rural hospitals (AME, -0.034 [95% CI, -0.040 to -0.027]). Conversely, home discharge is increasing significantly among urban hospitals (AME, 0.011 [95% CI, 0.008-0.014]) but not significantly changing in rural hospitals (AME, -0.001 [95% CI, -0.010 to 0.007]). Among patients with extreme loss of function, hospital location was not significantly associated with ICH case fatality or home discharge. Conclusions Improving access to neurocritical care resources, particularly in resource-limited communities, may reduce the ICH outcomes disparity gap.

Trends in Resources for Neonatal Intensive Care at Delivery Hospitals for Infants Born Younger Than 30 Weeks’ Gestation, 2009-2020

In an ideal regionalized system, all infants born very preterm would be delivered at a large tertiary hospital capable of providing all necessary care. To examine whether the distribution of extremely preterm births changed between 2009 and 2020 based on neonatal intensive care resources at the delivery hospital. This retrospective cohort study was conducted at 822 Vermont Oxford Network (VON) centers in the US between 2009 and 2020. Participants included infants born at 22 to 29 weeks' gestation, delivered at or transferred to centers participating in the VON. Data were analyzed from February to December 2022. Hospital of birth at 22 to 29 weeks' gestation. Birthplace neonatal intensive care unit (NICU) level was classified as A, restriction on assisted ventilation or no surgery; B, major surgery; or C, cardiac surgery requiring bypass. Level B centers were further divided into low-volume (<50 inborn infants at 22 to 29 weeks' gestation per year) and high-volume (≥50 inborn infants at 22 to 29 weeks' gestation per year) centers. High-volume level B and level C centers were combined, resulting in 3 distinct NICU categories: level A, low-volume B, and high-volume B and C NICUs. The main outcome was the change in the percentage of births at hospitals with level A, low-volume B, and high-volume B or C NICUs overall and by US Census region. A total of 357 181 infants (mean [SD] gestational age, 26.4 [2.1] weeks; 188 761 [52.9%] male) were included in the analysis. Across regions, the Pacific (20 239 births [38.3%]) had the lowest while the South Atlantic (48 348 births [62.7%]) had the highest percentage of births at a hospital with a high-volume B- or C-level NICU. Births at hospitals with A-level NICUs increased by 5.6% (95% CI, 4.3% to 7.0%), and births at low-volume B-level NICUs increased by 3.6% (95% CI, 2.1% to 5.0%), while births at hospitals with high-volume B- or C-level NICUs decreased by 9.2% (95% CI, -10.3% to -8.1%). By 2020, less than half of the births for infants at 22 to 29 weeks' gestation occurred at hospitals with high-volume B- or C-level NICUs. Most US Census regions followed the nationwide trends; for example, births at hospitals with high-volume B- or C-level NICUs decreased by 10.9% [95% CI, -14.0% to -7.8%) in the East North Central region and by 21.1% (95% CI, -24.0% to -18.2%) in the West South Central region. This retrospective cohort study identified concerning deregionalization trends in birthplace hospital level of care for infants born at 22 to 29 weeks' gestation. These findings should serve to encourage policy makers to identify and enforce strategies to ensure that infants at the highest risk of adverse outcomes are born at the hospitals where they have the best chances to attain optimal outcomes.

Nationwide Trends in Osteoporosis in Koreans With Disabilities From 2008 to 2017.

This study examined the 10-year trends in the prevalence of osteoporosis according to disability grade and type compared with those without disabilities in South Korea. We linked national disability registration data with the National Health Insurance claims data. Age- and sex-standardized prevalence of osteoporosis were analyzed from 2008 to 2017 according to sex, disability type, and disability grade. Adjusted odds ratios for osteoporosis according to disability characteristics in the most recent years' data were also confirmed by multivariate analysis. Over the past decade, the prevalence of osteoporosis has increased in people with disabilities compared with people without disabilities, and the gap has gradually widened from 7% to 15%. By analysis of the most recent year data, both male and female individuals with disabilities had a higher risk of osteoporosis than those without disability (odds ratios [OR] 1.72, 95% confidence interval [CI] 1.70-1.73 in males; OR 1.28, 95% CI 1.27-1.28 in females); the multivariate-adjusted OR was especially prominent in disability related to respiratory disease (OR 2.07, 95% CI 1.93-2.21 in males; OR 1.74; 95% CI 1.60-1.90 in females), epilepsy (OR 2.16, 95% CI 1.78-2.61 in males; OR 1.71; 95% CI 1.53-1.91 in females), and physical disability types (OR 2.09, 95% CI 2.06-2.21 in males; OR 1.70; 95% CI 1.69-1.71 in females). In conclusion, the prevalence and risk of osteoporosis have increased in people with disabilities in Korea. In particular, the risk of osteoporosis increases significantly in people with respiratory diseases, epilepsy, and physical disability types. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

PO-02-048 U.S. TRENDS IN THE HIGH-VOLUME MEDICARE CARDIAC IMPLANTABLE ELECTRONIC DEVICE EXTRACTION WORKFORCE, 2013-2020

Extraction of cardiac implantable electronic devices (CIEDs) is a complex potentially life-saving procedure performed by a subset of specially trained cardiac electrophysiologists and surgeons. Approximately 60% of US CIED extraction procedures occur in Medicare beneficiaries. High volume CIED extractors (HVE) have superior outcomes and the Heart Rhythm Society recommends a minimum of 15 CIED extractions/extractor/year to maintain competence. To examine nationwide trends in the Medicare CIED HVE workforce and CIED extraction volume in the US. Using data from the Medicare Provider Utilization and Payment Database (MPUPD) we identified all extractors who used an individual transvenous CIED extraction procedure code (CPT 33234, 33235, 33244) >10 times in any year from 2013-2020. The number, demographics, and location of these HVEs were trended over the study period. There were an average of 1621 CIED extractions performed annually by 74 HVEs over the study period. Only 5% (n=3) of HVEs were women (Figure Panel A). During the 8-year period, the number of HVEs in the MPUPD as well as the total number of CIED extraction procedures performed by HVEs decreased by 60% (Figure Panel A, C). The proportion of women HVEs remained unchanged (Figure Panel A). In 2020, fewer than 50% of states had a HVE and only 2 states had a woman HVE (Figure Panel B). The median procedural volume between represented men and women HVEs was similar. A minority of cardiac electrophysiologists and surgeons perform a high volume of CIED extractions and the number of HVEs is declining, leading to a growing disparity of geographic availability. Future study is needed to determine whether fewer CIED extractions are being performed or a greater proportion of CIED extractions are being performed by lower volume extractors.

567 Mohs micrographic surgery vs. wide local excision for cutaneous sebaceous adenocarcinoma: An analysis of nationwide trends

567 Mohs micrographic surgery vs. wide local excision for cutaneous sebaceous adenocarcinoma: An analysis of nationwide trends

Nationwide trends of laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis in Germany: A slow path forward.

Since its introduction, laparoscopic pyloromyotomy (LP), has become increasingly popular in many countries. We have noticed an attenuated trend in Germany. The aim of this study was to analyse the distribution of open and LP in Germany. The national database of administrative claims data of the Institute for the Remuneration System in Hospitals (InEK) was analysed regarding numbers of patients with pyloromyotomy in the years 2019-2021. The German quality reports of the hospitals of 2019 and 2020 were analyzed regarding the number of procedures performed per hospital and pediatric surgical department. A total of 2050 patients underwent pyloromyotomy. The incidence of hypertrophic pylorus stenosis (HPS) was 699 and 657 patients in 2019 and 2021, respectively. Regarding age, 31.1% were admitted before 28 days of age. LP gradually increased from 216 patients (30.9%) in 2019 to 239 patients (36.4%) in 2021. Thirty-three laparoscopic operations (4.8%) were converted to an open approach. In 24 of all patients, there was an injury to the stomach, in 20 patients to the duodenum, needing repair with sutures. Analysis of the quality reports indicated that 44% of pediatric surgical departments performed LP. Although LP has became more prevalent in Germany recently, about two thirds of patients still undergo an open procedure.

Nationwide Trends and Determinants of Germline BRCA1/2 Testing in Patients With Breast and Ovarian Cancer.

Germline genetic testing (GT) for BRCA1/2 is instrumental in identifying patients with breast and ovarian cancers who are eligible for PARP inhibitors (PARPi). Little is known about recent trends and determinants of GT since PARPi were approved for these patients. We performed a retrospective cohort study of patients in a nationwide electronic health record (EHR)-derived oncology-specific database with the following GT eligibility criteria: breast cancer diagnosed at age ≤45 years, triple-negative breast cancer diagnosed at age ≤60 years, male breast cancer, or ovarian cancer. GT within 1 year of diagnosis was assessed and stratified by tumor type. Multivariable log-binomial regressions estimated adjusted relative risks (RRs) of GT by patient and tumor characteristics. Among 2,982 eligible patients with breast cancer, 56.4% underwent GT between January 2011 and March 2020, with a significant increase in GT over time (RR, 1.08; 95% CI, 1.05-1.11, for each year), independent of when PARPi were approved for BRCA1/2-mutated metastatic breast cancer in January 2018. In multivariable analyses, older age (RR, 0.93; 95% CI, 0.90-0.96, for every 5 years) and Medicare coverage (RR, 0.69; 95% CI, 0.49-0.96 vs commercial insurance) were associated with less GT. Among 5,563 eligible patients with ovarian cancer, 35.4% underwent GT between January 2011 and March 2020, with a significant increase in GT over time (RR, 1.11; 95% CI, 1.07-1.14, for each year) that accelerated after approval of PARPi for BRCA1/2-mutated, chemotherapy-refractory ovarian cancer in December 2014 (RR, 1.42; 95% CI, 1.19-1.70). Older age (RR, 0.95; 95% CI, 0.93-0.97, for every 5 years) and Black or African American race (RR, 0.80; 95% CI, 0.65-0.98 vs White race) were associated with less GT. GT remains underutilized nationwide among patients with breast and ovarian cancers. Although GT has increased over time, significant disparities by age, race, and insurance status persist. Additional work is needed to design, implement, and evaluate strategies to ensure that all eligible patients receive GT.

Nationwide Trends of Modern Endodontic Practices Related to Working Length, Instrumentation, Magnification, and Obturation: A Comparative Cross-Sectional Survey Comparing Endodontic and Non-Endodontic Specialties Practicing Root Canal Treatment in India.

The present study was designed to assess trends in contemporary endodontic practice regarding the techniques and materials used in endodontic therapy among dental practitioners from various regions of India. A cross-sectional questionnaire-based study was conducted amongst dentists who were pursuing postgraduates in endodontics (PG Endo) and other branches (PG-OB), specialists from other branches (MDS-OB) and specialists in endodontics (MDS-Endo) in various dental colleges representing East, West, North, South, and Central zones through an e-survey using Google forms. State-wise postgraduate dental college lists were obtained from the Dental Council of India (DCI) website. Using a multistage cluster random sampling method and considering the unanticipated response rate, emails were sent to 2100. A 29-item close-ended questionnaire, framed according to different aspects of endodontic treatment, was used to record the responses. When the distribution of the groups of dentists was compared, the central zone had the highest number of PG-OB (44.2%) and the lowest number of MDS-Endo (8.4%). The electronic apex locator (EAL) method of working length determination has been reported less among MDS-Endo than MDS-OB. The difference between the usage of various methods for working length determination was significant among the different groups in all the zones. (p < 0.0001) Most MDS-Endo preferred the rotary method of instrumentation over the combination method for different zones. The majority of dental practitioners preferred a combination method of instrumentation. Zone-wise comparisons among dentists showed the majority of general dental practitioners preferred the combination method (radiographs and electronic apex locator) for working length determination. Most MDS-Endo preferred the rotary method of instrumentation over the combination method for different zones. All dental practitioners did not so commonly use magnification in all the zones. The single cone technique was the most opted by dental practitioners of all the zones.

MP46-05 GENDER, RACIAL AND ETHNIC DIFFERENCES IN PATHOLOGIC RESPONSE FOLLOWING NEOADJUVANT CHEMOTHERAPY FOR BLADDER CANCER PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP46-05 GENDER, RACIAL AND ETHNIC DIFFERENCES IN PATHOLOGIC RESPONSE FOLLOWING NEOADJUVANT CHEMOTHERAPY FOR BLADDER CANCER PATIENTS Irasema Paster, Jiping Zeng, Alejandro Recio-Boiles, and Juan Chipollini Irasema PasterIrasema Paster More articles by this author , Jiping ZengJiping Zeng More articles by this author , Alejandro Recio-BoilesAlejandro Recio-Boiles More articles by this author , and Juan ChipolliniJuan Chipollini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The purpose of this study was to evaluate nationwide trends in pathologic complete response (CR) racial variations in patients with muscle-invasive bladder cancer (MIBC) undergoing cystectomy. METHODS: The National Cancer Database was queried for patients from 2004 to 2016 with non-metastatic MIBC who underwent neoadjuvant chemotherapy and definitive surgery. The primary endpoints, CR and mortality, were evaluated using Cochran-Armitage test, multivariable regression, and Kaplan-Meier analyses. RESULTS: The final analytic cohort was 9,955 patients. Non-Hispanic black (NHB) patients presented with younger age (p<0.001), higher comorbidity score (p=0.036), and higher clinical tumor (cT) stage (p<0.001). The overall CR rate was highest for non-Hispanic white (NHW) males (13.4%) while Hispanic white (HW) females and NHB males had lower CR rates (both, 9.1%). There was a significant increase in CR trends for NHW patients (p<0.001), and non-significant increases for NHB (p=0.311) and Hispanic patients (p=0.236). On multivariable analysis, NHW females had significantly lower odds of achieving CR (OR; 0.83, 95%CI 0.71-0.97); however, NHB males (HR: 1.21, 1.01-1.44) and NHB females (HR: 1.25, 1.03-1.53) had higher overall mortality on adjusted analysis. Overall survival differences were not seen in patients who achieved CR regardless of racial background; however, for those with residual disease, the 2-year survival probabilities were 60.7, 62.5, and 51.1% for NHW, HW, and NHB patients, respectively (log-rank p=0.010). CONCLUSIONS: Our findings showed differences in chemotherapy response based on gender and race/ethnicity. The trends in CR for all racial/ethnic groups appear to be increasing over time. However, even after guideline-directed care, black patients were found with worse survival particularly when residual disease is present. Clinical studies with more underrepresented minorities are needed to verify biological differences in response and help mitigate potential socioeconomic disparities in MIBC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e632 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Irasema Paster More articles by this author Jiping Zeng More articles by this author Alejandro Recio-Boiles More articles by this author Juan Chipollini More articles by this author Expand All Advertisement PDF downloadLoading ...