Nonteaching Hospitals Research Articles

Abstract #1407267: In-hospital Outcomes of Myxedema Coma in Teaching Vs Non-teaching Hospitals

Many studies have analyzed current data on outcomes at teaching vs non-teaching hospitals, and the results have been found to be dissimilar in certain hospitalizations in the United States. this study set out to examine the differences in healthcare outcomes between teaching and non-teaching hospitals in patients who were admitted for myxedema coma using a nationally representative sample. We reviewed data from the National Inpatient Sample (NIS) of patients between 2016-2019. Using ICD-10 diagnosis codes, we identified patients who were admitted due to myxedema coma within the study period. We further categorized our study population into 2 groups based on teaching vs non-teaching status. Multivariate analysis was done to investigate the in-hospital outcomes between both groups and adjust for confounders. During the study period, 3,839 myxedema coma admissions were identified. Teaching hospitals received 70.7% (2,715) of these admissions, while non-teaching hospitals received 29.3% (1,124). The mean age of the cohort was 66 years, 70% were females and 69% were white. The mean length of stay (LOS) was 9.4 days and the average total hospital charge was 89,068 $. There was no significant difference in in-hospital mortality in both groups (OR 1.23, 95% CI 0.66 -2.27, p=0.507). The teaching hospital group had increased odds of acute respiratory failure (OR 1.6, 95% CI 1.07 – 2.4, p = 0.021), acute kidney injury (OR 1.48, 95% CI 1.04 – 2.1, p = 0.028), and bradycardia (OR 1.67, 95% CI 1.06 – 2.6, p = 0.025). No significant risk difference between the two groups in terms of hyponatremia (OR 0.91, 95% CI 0.6 – 1.36, p= 0.66), pericardial effusion (OR 0.87, 95% CI 0.41 – 1.8, p= 0.719) or sepsis (OR 1.38, 95% CI 0.69 – 2.7, p= 0.353). Hospital teaching status was associated with an increased mean LOS (10 vs 7.9 days, p=0.002) and mean total hospital charges (93,122 vs 79,336 $, p=0.035). The study clearly showed that patients admitted with myxedema coma in teaching hospitals have an increased risk of in-hospital outcomes including acute respiratory failure, acute kidney injury, and bradycardia compared to non-teaching hospitals. Teaching hospital status was not associated with increased in-hospital mortality in myxedema coma admissions.

Abstract #1407342: The Impact of Hospital Teaching Status on Patients Admitted for Total Thyroidectomy: Insight from National Inpatient Sample

Total thyroidectomy is a common procedure performed by skilled physicians or physicians-in-training under direct supervision. The goal of this study is to ascertain if any difference exists in in-hospital mortality and other outcomes with regard to total thyroidectomy performed at teaching versus non-teaching hospitals. Patients undergoing total thyroidectomy were identified using ICD-10 procedural codes from the National Inpatient Sample (NIS) Database 2020. The data were divided based on the hospital's teaching status. The researchers used univariate and multivariate logistic regression analyses to adjust for major confounders. During this period of time, the NIS database reported 7,139 total thyroidectomy procedures. Teaching hospitals performed 88% of all procedures, while non-teaching facilities performed the remaining 12%. The mean age of all patients was 53 years, 67.5% were females and 61% were white. The mean length of stay (LOS) was 3.9 days and the average total hospital charges were 94,337 $. The total number of patients who died was 20 (all in the teaching group). There was no statistical difference between the two groups in risk of developing post-procedural hypoparathyroidism (OR 0.91, 95% CI 0.25 – 3.27, p=0.887), requirement for post-op transfusion (OR 0.55, 95% CI 0.06 – 4.6, p=0.588), sepsis (OR 0.84, 95% CI 0.08 – 8.3, p=0.882) or septic shock (OR 0.2, 95% CI 0.01 – 2.3, p=0.204). Hospital teaching status was associated with increased mean total hospital charges (97,318 vs 72,668 $, p=0.003) but not the mean LOS (4 vs 2.8 days, p=0.88). No post-procedural hematoma, seroma, or vocal cord dysfunction complications were identified in the study cohort. The study showed no statistical difference between teaching and non-teaching hospitals in patients who underwent total thyroidectomy in terms of in-hospital mortality or post-procedural complications.

PO-03-184 ASSESSMENT OF PRICE VARIATION IN PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE DEVICE PROCEDURES AT US HOSPITALS

Since their approval in the US in 2015, left atrial appendage closure (LAAC) devices have served as an alternative to oral anticoagulation in atrial fibrillation (AF) patients at increased risk of bleeding. However, few studies have explored the commercial cost footprint of LAAC procedures, despite the 2021 Hospital Price Transparency Final Rule mandating US hospitals publish their insurer-negotiated prices. This study sought to characterize and identify factors contributing to variation in LAAC procedure prices across the US. We queried a commercial database containing hospital-disclosed prices to characterize variation in LAAC procedure prices within and across US hospitals. We then linked this price data to hospital characteristics using Medicare Facility IDs. Univariate analysis was conducted to compare commercial prices across multiple factors. In total, 683 hospitals reported commercial prices for LAAC procedures. Among reporting hospitals, median prices were greater at major investor-owned vs. non-major investor-owned facilities ($10,991 vs. $7,227, p<0.01) and for-profit centers vs. not-for-profit and government centers ($10,991 vs. $7,417 vs. $5,051, p<0.01). Prices were also greater at non-teaching hospitals compared to minor and major teaching hospitals (p<0.01). The Pacific region exhibited the highest median price ($18,652), while the Middle Atlantic exhibited the lowest median price ($5191). There was no association between price and CMS hospital-wide mortality (p=0.21) or all-cause readmissions (p=0.29). Patient hospital ratings were correlated with price (p<0.01) but not CMS overall hospital ratings (p=0.62). Commercial and self-pay prices were 2.30- and 2.61-times higher than the Medicare price. Within hospitals, the 90th percentile payer-negotiated rate was 2.0 (IQR 1.00-4.06) times the 10th percentile rate (within-center ratio). Across hospitals within the same hospital referral region (HRR), the median price at the 90th percentile hospital was 1.54 (IQR 1.00-2.63) times that at the 10th percentile hospital (between-center ratio). Prices for LAAC procedures varied widely, with commercial and self-pay rates over double the Medicare price. Within-center variation in price was higher than between-center variation. Non-teaching, investor-owned, and for-profit hospitals had higher prices; however, there was no association between prices and hospital-wide mortality or readmission rates.Tabled 1Univariate Analysis of Factors Associated with Left Atrial Appendage Closure Device Procedures Commercial PriceCategorical Values (% Reporting)# ofHospitals (%)Median Price ($)Interquartile Range ($)P-ValueRegion (93.6)<0.01 New England (CT, MA, ME, NH, RI, VT)Middle Atlantic (NJ, NY, PA)South Atlantic (DC, DE, MD, VA, WV, C, SC, GA, FL))East North Central (OH, IN, IL, MI, WI)East South Central (KY, TN, AL, MS)West North Central (MN, IA, MO, ND, SD, NE, KS)West South Central (AR, LA, OK, TX)Mountain (MT, ID, WY, CO, NM, AZ, UT, NV)Pacific (WA, OR, CA, AK, HI)26 (4.1)59 (9.2)157 (24.6)119 (18.6)57 (8.9)78 (12.2)107 (16.7)26 (4.1)10 (1.6)90915191104657682113425900719911150186524865-125783839-94483652-145313562-113323005-152592780-124784030-114763094-122562891-26874Hospital Type (87.8)<0.01 For-ProfitNot-For-ProfitGovernment154 (25.7)407 (67.8)39 (6.5)10991741750516853-152603077-124772731-14581Major Investor Owned (96.8)<0.01 Major Investor OwnedNot Major Investor Owned173 (26.2)488 (73.8)1099172276997-152603050-12344Teaching Status (93.6)<0.01 Major TeachingMinor TeachingNon-Teaching84 (13.1)332 (52.0)223 (34.9)56488012106162475-91313340-123443840-15260Urban/Rural (100)0.06 UrbanRural620 (90.8)63 (9.2)823488373428-129183634-13784Disproportionate Share Hospital (82.3)0.63 Disproportionate Share Hospital (DSH)Sole Community Hospital (not DSH-eligible)Not DSH474 (84.3)14 (2.5)74 (13.2)81681073987693510-129885052-128633241-14189CMS Hospital-Wide Readmission Rate (82.6)0.26 Above National AverageSame as National AverageBelow National Average227 (40.2)80 (14.2)257 (45.6)8633863286493340-133264079-142673840-12579CMS Hospital-Wide Mortality (80.7)0.25 Above National AverageSame as National AverageBelow National Average99 (18.0)375 (68.1)77 (14.0)8819823789043486-119703544-132163473-15159HCAHPS Patient Overall Hospital Rating (81.1)<0.01 1234517 (3.1)96 (17.3)211 (38.1)209 (37.7)21 (3.8)10991875869649044136316295-205573635-128202856-112883844-146829078-18372CMS Overall Hospital Rating (83.1)0.62 1234526 (4.6)92 (16.2)160 (28.2)186 (32.7)104 (18.3)922490048620761886934492-120864918-126313632-130232864-132513803-13693Comparisons were done via the Kruskal-Wallis test. Open table in a new tab

Data in brief: Factors associated with in-patient admission among stroke patients (P1-5.024)

<h3>Objective:</h3> To estimate the probability of admission among patients with stroke evaluated in the emergency department. <h3>Background:</h3> Misuse of inpatient resources is a central problem to the healthcare system. Elucidating certain trends behind inpatient admission in patients with a cerebral infarction may reveal opportunities to improve safe and effective stroke triage and throughput. <h3>Design/Methods:</h3> We retrospectively queried the 2019 National Emergency Department Sample Database for patients who had a cerebral infarction. Disposition from the emergency department was classified into one of several categories: routine discharge, discharge against medical advice, transfer to short term hospital, home care, death, and admission to the inpatient setting. The primary endpoint was inpatient admission versus all other dispositions and was assessed using multivariable logistic regression after adjustment for key patient characteristics, hospital teaching and trauma status, geographic regions, insurance status. <h3>Results:</h3> Of the 598,818 patients diagnosed with acute cerebral infarction, 471,464 (78.7%) were admitted to an inpatient acute care facility. Patients with private insurance (OR 0.85, 95%CI 0.78–0.93) or self-pay (OR 0.80, 95%CI 0.70–0.91) had lower odds of being admitted, compared to Medicare patients. Compared to Metropolitan Non-Teaching hospitals, Metropolitan teaching hospitals (OR 1.59, 95%CI 1.27–1.97) had a higher odds of admission, whereas non-metropolitan hospitals (OR 0.35, 95%CI 0.27–0.44) had a lower odds of admission. Additionally, compared to non-trauma hospitals, patients evaluated at level 1 trauma centers (OR 3.17, 95%CI 2.48–4.05) had higher odds of admission. In addition, hyperlipidemia (OR 2.25, 95%CI 2.09–2.42), overweight (OR 2.15, 95%CI 1.90–2.42), and hypertension (OR 1.55, 95%CI 1.47–1.63) were independently associated with a higher odds of admission. <h3>Conclusions:</h3> Optimization of certain high-risk comorbidities may not only reduce stroke incidence, but they may reduce inpatient utilization. Further, differences in admission based on patient-level socioeconomic factors warrant greater exploration to minimize disparities in access to acute care. <b>Disclosure:</b> Mr. Wolfe has nothing to disclose. Karan Patel has nothing to disclose. Mr. Taneja has nothing to disclose. Mr. Oak has nothing to disclose. The institution of Dr. Favilla has received research support from National Institutes of Health. The institution of Dr. Favilla has received research support from American Heart Association. The institution of Dr. Favilla has received research support from OpenWater, Inc.. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Focus group participant with Alexion. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AstraZeneca.

Predictors of Delayed Diagnosis of Pediatric CNS Tumors in the Emergency Department.

Central nervous system (CNS) tumor diagnoses are frequently delayed in children, which may lead to adverse outcomes and undue burdens on families. Examination of factors associated with delayed emergency department (ED) diagnosis could identify approaches to reduce delays. We performed a case-control study using data from 2014 to 2017 for 6 states. We included children aged 6 months to 17 years with a first diagnosis of CNS tumor in the ED. Cases had a delayed diagnosis, defined as 1 or more ED visits in the 140 days preceding tumor diagnosis (the mean prediagnostic symptomatic interval for pediatric CNS tumors in the United States). Controls had no such preceding visit. We included 2828 children (2139 controls, 76%; 689 cases, 24%). Among cases, 68% had 1 preceding ED visit, 21% had 2, and 11% had 3 or more. Significant predictors of delayed diagnosis included presence of a complex chronic condition (adjusted odds ratio [aOR], 9.73; 95% confidence interval [CI], 6.67-14.20), rural hospital location (aOR, 6.37; 95% CI, 1.80-22.54), nonteaching hospital status (aOR, 3.05, compared with teaching hospitals; 95% CI, 1.94-4.80), age younger than 5 years (aOR, 1.57; 95% CI, 1.16-2.12), public insurance (aOR, 1.49, compared with private; 95% CI, 1.16-1.92), and Black race (aOR, 1.42, compared with White; 95% CI, 1.01-1.98). Delayed ED diagnosis of pediatric CNS tumors is common and frequently requires multiple ED encounters. Prevention of delays should focus on careful evaluation of young or chronically ill children, mitigating disparities for Black and publicly insured children, and improving pediatric readiness in rural and nonteaching EDs.

Hospital Teaching Status and Patient-Reported Outcomes Following Primary Total Hip Arthroplasty: An American Joint Replacement Registry Study

IntroductionPrevious studies have shown lower morbidity and mortality rates after total hip arthroplasty (THA) at academic teaching hospitals. This study sought to determine the relationship between hospital teaching status and patient-reported outcome measures following primary THA. MethodsUsing American Joint Replacement Registry data from 2012 to 2020, 4,447 primary, elective THAs with both preoperative and one year postoperative Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) scores were analyzed. The main exposure variable was hospital teaching status, with three cohorts, as follows: major teaching hospitals, minor teaching hospitals, and non-teaching hospitals. Mean preoperative and one year postoperative HOOS, JR scores were compared. ResultsPreoperative HOOS, JR scores (nonteaching: 49.69 ± 14.42 versus major teaching: 47.68 ± 15.10 versus minor teaching: 42.46 ± 19.19, P < .001) were significantly higher at non-teaching hospitals than major and minor teaching hospitals, and these differences persisted at one year postoperatively (87.40 ± 15.14 versus 83.87 ± 16.68 versus 80.37 ± 19.27, P < .001). Both preoperative and postoperative differences in HOOS, JR scores were less than the minimum clinically important difference (MCID) at both time points. In multivariate regressions, non-teaching and minor teaching hospitals had similar odds of MCID achievement in HOOS, JR scores compared to major teaching hospitals. ConclusionUsing the HOOS, JR score as a validated outcome measure, undergoing primary THA at an academic teaching hospital did not correlate with higher postoperative HOOS, JR scores or greater chances of MCID achievement in HOOS, JR scores compared to non-teaching hospitals. Further work is required to determine the most important factors that may lead to improvement in patient-reported outcomes following THA.

Abstract 4378: Risk factors for death in the emergency department for melanoma patients

Abstract Introduction: Many cancer deaths are related to melanoma. While there have been many studies that have identified risk factors for death in these patients, very few of them have analyzed the risk factors for death in melanoma patients in the emergency department (ED). Methods: We utilized the 2006-2012 Nationwide Emergency Department Sample to characterize melanoma patients who die in the ED. Multivariate logistic regression was used to identify patient and hospital characteristics that were significantly associated with a higher chance of death. A p-value ≤0.05 was considered significant. Results: From 2006 to 2012, 239,956 melanoma patients presented to the ED, and 2.1% of these melanoma patients died. Most melanoma patients who died in the ED were over the age of 70 years (60.0%), male (63.8%), Medicare beneficiaries (65.6%), of the highest income quartile (31.0%), presenting to a hospital in the South (35.3%), presenting to non-trauma hospitals (48.3%), and presenting to metropolitan non-teaching hospitals (43.4%). The most common reasons for patients who died upon presentation to the ED were a secondary malignancy (20.7%), septicemia (10.8%), acute cerebrovascular disease (7.5%), pneumonia (5.2%), and congestive heart failure (2.6%). The top 3 factors associated with high risk of death were septicemia (odds ratio (OR)=7.39, 95% confidence interval (CI)=5.79-9.43; p&amp;lt;0.001), acute cerebrovascular disease (OR=3.44, 95%CI=2.62-4.51; p&amp;lt;0.001), and age &amp;gt;70 years (OR=2.50, 95%CI=1.24-5.03; p=0.010). Table 1 lists all risk factors associated with a higher risk of death. Conclusion: Melanoma patients over the age of 70, with septicemia, acute cerebrovascular disease, or pneumonia, and of male sex are at higher risk for death in the ED. Clinicians should be aware of these risk factors when melanoma patients present to the ED. Risk Factors Associated with Death for Melanoma Patients in the Emergency Department Risk Factor Odds Ratio (95% Confidence Interval) p-value Septicemia 7.39 (5.79-9.43) &amp;lt;0.001 Acute Cerebrovascular Disease 3.44 (2.62-4.51) &amp;lt;0.001 Age &amp;gt;70 2.50 (1.24-5.03) 0.010 Charlson Comorbidity Index of 3 or More 2.32 (1.89-2.84) &amp;lt;0.001 Pneumonia 1.76 (1.27-2.45) 0.001 Charlson Comorbidity Index of 1 1.64 (1.40-1.93) &amp;lt;0.001 Charlson Comorbidity Index of 2 1.63 (1.31-2.03) &amp;lt;0.001 Medicaid 1.63 (1.19-2.23) 0.002 Metropolitan Teaching Hospital 1.33 (1.05-1.68) 0.017 Citation Format: Jayla Hsiung, Kamil Taneja, Karan Patel, Michael Diaz, Jared Wolfe, Eric M. Toloza. Risk factors for death in the emergency department for melanoma patients. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4378.

HF02-08 PAUL ROSENSTEIN 1875-1964, A JEWISH UROLOGIST IN TROUBLED TIMES

You have accessJournal of UrologyCME1 Apr 2023HF02-08 PAUL ROSENSTEIN 1875-1964, A JEWISH UROLOGIST IN TROUBLED TIMES Daniel Taussky, Jonathan Taussky, and Daniel Liberman Daniel TausskyDaniel Taussky More articles by this author , Jonathan TausskyJonathan Taussky More articles by this author , and Daniel LibermanDaniel Liberman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003242.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The biography of the German urologist Dr. Paul Rosenstein is unique as he documented and recorded the history of eminent urologists like James Israel and describes his own career in German urology following Israel. The life of Paul Rosenstein reflected the tumultuous times for European Jewish physicians, struggling to maintain a successful academic practice in the emerging sub-specialty of urology and the rise of Nazi Regime. METHODS: James Israel was his predecessor at the Jewish Hospital in Berlin. Israel was Chief of Urology a position that Dr Rosenstein later held. Israel was considered one of the founders of European Urology. Rosenstein referred to Israel as a genius in the clinical palpation of the kidney. Rosenstein described Israel’s ability to train and mentor 5 professors of surgery. This was especially significant since the hospital was a non-teaching hospital. While most articles about Israel are full of admiration, Rosenstein describes a very reserved aristocratic man, who had difficulties accepting new techniques such as ureteroscopy into his practice. RESULTS: Rosenstein’s description of his own the education is quite telling. He first trained as a general surgeon, under the supervision of the eminent Anton Freiherr von Eiselsberg who later became head of surgery in Vienna. Rosenberg describes how after the First World War he and Dr Lichtenstein invented Pneumoradiography whereby the contours of the kidneys were imaged by injecting oxygen around them. Moreover, Rosenstein later pioneered with others the injection of iodine for the imaging of the renal position, form and excretion. Paul Rosenstein often reported antisemitic events in a straight forward, unemotional tone attempting to remain objective. One of the most interesting portraits he paints is his description of his time during the Frist World War where he served as a general surgeon and received the first and second Federal Cross of Merit (Bundesverdienstkreuz). While many Jewish physicians of his time had to convert to be named professor by the government, he obtained this title in 1919, without needing to convert. Astonishingly, in his description of his military service and the difficult visceral, neurosurgical, and facial operations that he performed. In 1933, with the coming to power of the Nazi-Party and the immediate discrimination against Jewish doctors, he immediately relinquished his position as head of the Urological Society of Berlin. CONCLUSIONS: In 1938 he was able to emigrate to Brazil but was unable to practice. In 1953 he received an honorary membership from the German Urological Society. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e252 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Taussky More articles by this author Jonathan Taussky More articles by this author Daniel Liberman More articles by this author Expand All Advertisement PDF downloadLoading ...

Defining the Price Tag of Complications Following Pancreatic Surgery: A US National Perspective

IntroductionPancreatic surgery tends to have a high rate of postoperative complications due to its complex nature, significantly increasing hospital costs. Our aim was to describe the true association between complications and hospital costs in a national cohort of US patients. MethodsThe National Inpatient Sample was used to conduct a retrospective analysis of elective pancreatic resections performed between 2004 and 2017, categorizing them based on whether patients experienced major complications (MaC), minor complications (MiC), or no complications (NC). Multivariable quantile regression was used to analyze how costs varied at different percentiles of the cost curve. ResultsOf 37,893 patients, 45.3%, 28.6%, and 26.1% experienced NC, MiC, and MaC, respectively. Factors associated with MaC were a Charlson Comorbidity Index of ≥4, prolonged length of stay, proximal pancreatectomy, older age, male sex, and surgery performed at hospitals with a small number of beds or at urban nonteaching hospitals (all P < 0.01). Multivariable quantile regression revealed significant variation in MiC and MaC across the cost curve. At the 50th percentile, MiC increased the cost by $3352 compared to NC while MaC almost doubled the cost of the surgery, increasing it by $20,215 (both P < 0.01). The association between complications and cost was even greater at the 95th percentile, increasing the cost by $10,162 and $108,793 for MiC and MaC, respectively (P < 0.01). ConclusionsMiC and MaC were significantly associated with increased hospital costs. Furthermore, the relationship between MaC and costs was especially apparent at higher percentiles of the cost curve.

Epidemiology and early mortality patterns of acute promyelocytic leukemia in the United States.

There is a lack of contemporary population-based data on the epidemiology of acute promyelocytic leukemia (APL) in the United States. In this study, we aim to elucidate the demographics and early mortality patterns of APL hospitalizations utilizing the National Inpatient Sample database from 2016-2019. APL's annual age-adjusted incidence rate was 0.28/100,000, and the incidence increased with age, with the peak incidence in the 75-79 age group at 0.62/100,000. Whites constituted the majority of admissions at 67.7%, followed by Hispanics at 15.3%, the youngest racial group with a median age of 40years. The median length of stay was 31days for patients age < 60years and 25days for age ≥ 60years (p < 0.001). After adjusting for confounders, the mean length of stay was 7days higher in teaching hospitals compared to non-teaching hospitals (p 0.001). Overall mortality was 12.1% (22.2% for age ≥ 60 and 6.4% for < 60years {p < 0.001}), and 56.5% of deaths happened before 7days, with the median time to death being 6days. The proportion of early deaths (< 7days) in non-teaching hospitals was higher than late deaths (≥ 7days) (19.2% vs. 5%; p 0.03), and admission to a teaching hospital was associated with lower mortality (adjusted odds ratio 0.27; p 0.01). Therefore, optimal treatment strategies need to be explored to mitigate this significant early mortality, especially in non-teaching hospitals.

Updated Trends in Inferior Vena Cava Filter Use by Indication in the United States After Food and Drug Administration Safety Warnings: A Decade Analysis From 2010 to 2019

Background: Overall inferior vena cava filter (IVCF) utilization has decreased in the United States since the 2010 US Food and Drug Administration (FDA) safety communication. The FDA renewed this safety warning in 2014 with additional mandates on reporting IVCF-related adverse events. We evaluated the impact of the FDA recommendations on IVCF placements for different indications from 2010 to 2019 and further assessed utilization trends by region and hospital teaching status. Methods: Inferior vena cava filter placements between 2010 and 2019 were identified in the Nationwide Inpatient Sample database using the associated International Classification of Diseases, Ninth Revision, Clinical Modification, and Tenth Revision codes. Inferior vena cava filter placements were categorized by indication for venous thromboembolism (VTE) “treatment” in patients with VTE diagnosis and contraindication to anticoagulation and “prophylaxis” in patients without VTE. Generalized linear regression was used to analyze utilization trends. Results: A total of 823 717 IVCFs were placed over the study period, of which 644 663 (78.3%) were for VTE treatment and 179 054 (21.7%) were for prophylaxis indications. The median age for both categories of patients was 68 years. The total number of IVCFs placed for all indications decreased from 129 616 in 2010 to 58 465 in 2019, with an aggregate decline rate of −8.4%. The decline rate was higher between 2014 and 2019 than between 2010 and 2014 (−11.6% vs −7.2%). From 2010 to 2019, IVCF placement for VTE treatment and prophylaxis trended downward at rates of −7.9% and −10.2%, respectively. Urban nonteaching hospitals saw the highest decline for both VTE treatment (−17.2%) and prophylactic indications (−18.0%). Hospitals located in the Northeast region had the highest decline rates for VTE treatment (−10.3%) and prophylactic indications (−12.5%). Conclusion: The higher decline rate in IVCF placements between 2014 and 2019 compared with 2010 and 2014 suggests an additional impact of the renewed 2014 FDA safety indications on national IVCF utilization. Variations in IVCF use for VTE treatment and prophylactic indications existed across hospital teaching types, locations, and regions. Clinical Impact Inferior vena cava filters (IVCF) are associated with medical complications. The 2010 and 2014 FDA safety warnings appeared to have synergistically contributed to a significant decline in IVCF utilization rates from 2010 – 2019 in the US. IVC filter placements in patients without venous thromboembolism (VTE) declined at a higher rate than VTE. However, IVCF utilization varied across hospitals and geographical locations, likely due to the absence of universally accepted clinical guidelines on IVCF indications and use. Harmonization of IVCF placement guidelines is needed to standardize clinical practice, thereby reducing the observed regional and hospital variations and potential IVC filter overutilization.

Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States

Lung lobectomy is the standard of care for early-stage lung cancer. Studies have suggested improved outcomes associated with lobectomy performed by specialized thoracic surgery providers. We hypothesized that disparities would exist regarding access to thoracic surgeons among patients receiving lung lobectomy for cancer. The Premier Hospital Database was used to identify adult inpatients receiving lung lobectomy from 2009 to 2019. Patients were categorized as receiving their lobectomy from a thoracic surgeon, cardiovascular surgeon, or general surgeon. Sample-weighted multivariable analysis was performed to identify factors associated with provider type. When adjusted for sampling, 121,711 patients were analyzed, including 71,709 (58.9%) who received lobectomy by a thoracic surgeon, 36,630 (30.1%) by a cardiovascular surgeon, and 13,373 (11.0%) by a general surgeon. Multivariable analysis showed that thoracic surgeon provider type was less likely with Black patients, Medicaid insurance, smaller hospital size, in the western region, and in rural areas. In addition, non-thoracic surgery specialty was less likely to perform minimally-invasive (MIS) lobectomy (cardiovascular OR 0.80, p < 0.001, general surgery OR 0.85, p = 0.003). In this nationally representative analysis, smaller, rural, non-teaching hospitals, and certain regions of the United States are less likely to receive lobectomy from a thoracic surgeon. Thoracic surgeon specialization is also independently associated with utilization of minimally invasive lobectomy. Combined, there are significant disparities in access to guideline-directed surgical care of patients receiving lung lobectomy.

25, 50 and 75 years ago.

25, 50 and 75 years ago.

Financial vulnerability of trauma centers: A national analysis.

Trauma centers function as an essential safeguard in the United States health care system. However, there has been minimal study of their financial health or vulnerability. We sought to perform a nationwide analysis of trauma centers using detailed financial data and a recently developed Financial Vulnerability Score (FVS) metric. The RAND Hospital Financial Database was used to evaluate all American College of Surgeons-verified trauma centers nationwide. The composite FVS was calculated for each center using six metrics. Financial Vulnerability Score tertiles were used to classify centers as high, medium, or low vulnerability, and hospital characteristics were analyzed and compared. Hospitals were also compared by US Census region and teaching versus nonteaching hospitals. A total of 311 American College of Surgeons-verified trauma centers were included in the analysis, with 100 (32%) Level I, 140 (45%) Level II, and 71 (23%) Level III. The largest share of the high FVS tier was consisted of Level III centers (62%), with the majority of Level I (40%) and Level II (42%) in the middle and low FVS tier, respectively. The most vulnerable centers had fewer beds, negative operating margins, and significantly less cash on hand. Lower FVS centers had greater asset/liability ratios, lower outpatient shares, and three times less uncompensated care. Nonteaching centers were statistically significantly more likely to have high vulnerability compared with teaching centers (46% vs. 29%). Statewide analysis showed high discrepancy among individual states. With approximately 25% of Levels I and II trauma centers at high risk for financial vulnerability, disparities in characteristics, including payer mix and outpatient status, should be targeted to reduce vulnerabilities and bolster the health care safety net. Prognostic and Epidemiological; Level IV.

Pediatric Surgery from the Roads Less Traveled: Challenges, Communication, and Collaboration from a Community Nonteaching Hospital

Unique challenges face pediatric surgeons at community-based nonteaching hospitals. Communication and collaboration among and between healthcare providers, hospital administrators, and quaternary referral programs is crucial for the success of these smaller hospitals as they care for children.

Improved survival for severely injured patients receiving massive transfusion at US teaching hospitals: A nationwide analysis.

Previous studies have shown improved survival for patients treated at American College of Surgeons (ACS)-verified level I trauma centers compared with level II, level III, and undesignated centers. This mortality difference is more pronounced in severely injured patients. However, a survival benefit for severely injured trauma patients has not been established at teaching institutions compared with nonteaching centers. Because massive transfusion (MT) is associated with high mortality, we hypothesize that patients receiving MT have lower mortality at teaching hospitals than at nonteaching hospitals. All adult ACS Trauma Quality Improvement Program-eligible patients who underwent MT, defined as >10 U of packed red blood cells in the first 4 hours after arrival, in the 2019 ACS Trauma Quality Programs participant use file were eligible. Patients with severe head injury (head Abbreviated Injury Scale score, ≥3), prehospital cardiac arrest, and interhospital transfers were excluded. Logistic regression models were used to assess the effects of trauma center hospital teaching status on the adjusted odds of 3-hour, 6-hour, and 24-hour mortality. A total of 1,849 patients received MT (81% male; median Injury Severity Score, 26 [18-35]), 72% were admitted to level I trauma centers, and 28% were admitted to level II centers. Overall hospital mortality was 41%; 17% of patients died in 3 hours, 25% in 6 hours, and 33% in 24 hours. Teaching hospitals were associated with decreased 3-hour (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.27-0.75), 6-hour (OR, 0.37; 95% CI, 0.24-0.56), 24-hour (OR, 0.50; 95% CI, 0.34-0.75), and overall mortality (OR, 0.66; 95% CI, 0.44-0.98), compared with nonteaching hospitals, controlling for sex, age, heart rate, injury severity, injury mechanism, and trauma center verification level. Severely injured patients requiring MT experience significantly lower mortality at teaching hospitals compared with nonteaching hospitals, independently of trauma center verification level. Therapeutic/Care Management; Level III.

Association of Academic Medical Center Presence With Clinical Outcomes at Neighboring Community Hospitals Among Medicare Beneficiaries

Studies suggest that academic medical centers (AMCs) have better outcomes than nonteaching hospitals. However, whether AMCs have spillover benefits for patients treated at neighboring community hospitals is unknown. To examine whether market-level AMC presence is associated with outcomes for patients treated at nonteaching hospitals within the same markets. This retrospective, population-based cohort study assessed traditional Medicare beneficiaries aged 65 years and older discharged from US acute care hospitals between 2015 and 2017 (100% sample). Data were analyzed from August 2021 to December 2022. The primary exposure was market-level AMC presence. Health care markets (ie, hospital referral regions) were categorized by AMC presence (percentage of hospitalizations at AMCs) as follows: no presence (0%), low presence (>0% to 20%), moderate presence (>20% to 35%), and high presence (>35%). The primary outcomes were 30-day and 90-day mortality and healthy days at home (HDAH), a composite outcome reflecting mortality and time spent in facility-based health care settings. There were 22 509 824 total hospitalizations, with 18 865 229 (83.8%) at non-AMCs. The median (IQR) age of patients was 78 (71-85) years, and 12 568 230 hospitalizations (55.8%) were among women. Of 306 hospital referral regions, 191 (62.4%) had no AMCs, 61 (19.9%) had 1 AMC, and 55 (17.6%) had 2 or more AMCs. Markets characteristics differed significantly by category of AMC presence, including mean population, median income, proportion of White residents, and physicians per population. Compared with markets with no AMC presence, receiving care at a non-AMC in a market with greater AMC presence was associated with lower 30-day mortality (9.5% vs 10.1%; absolute difference, -0.7%; 95% CI, -1.0% to -0.4%; P < .001) and 90-day mortality (16.1% vs 16.9%; absolute difference, -0.8%; 95% CI, -1.2% to -0.4%; P < .001) and more HDAH at 30 days (16.49 vs 16.12 HDAH; absolute difference, 0.38 HDAH; 95% CI, 0.11 to 0.64 HDAH; P = .005) and 90 days (61.08 vs 59.83 HDAH; absolute difference, 1.25 HDAH; 95% CI, 0.58 to 1.92 HDAH; P < .001), after adjustment. There was no association between market-level AMC presence and mortality for patients treated at AMCs themselves. AMCs may have spillover effects on outcomes for patients treated at non-AMCs, suggesting that they have a broader impact than is traditionally recognized. These associations are greatest in markets with the highest AMC presence and persist to 90 days.

Abstract WP120: Factors And Outcomes Associated With Early And Delayed Gastrostomy In Intracerebral Hemorrhage Patients In The United States

Background: The appropriate timing of gastrostomy in patients with intracerebral hemorrhage who have dysphagia remains unclear. Objective: To identify factors and outcomes associated with timing of gastrostomy in patients with after hospitalization in the United States. Methods: We analyzed the data from the Nationwide Inpatient Sample (2016-2019), the largest all payer nationally representative dataset. We identified all patients presenting with primary diagnosis of intracerebral hemorrhage who underwent gastrostomy. Early gastrostomy was identified if gastrostomy was performed within 7 days of admission. We performed logistic regression analysis to identify the effect of timing of gastrostomy (early versus late) on none to minimal disability, length of stay, and hospitalization cost after adjusting for variables that were significantly different in univariate analysis. Results: Of 22,530 patients with intracerebral hemorrhage who underwent gastrostomy during hospitalization, 5765 (25.6%) underwent early gastrostomy. Patients who underwent early gastrostomy were more likely to be older (P &lt;0.001), women (p=0.02), white patients (p&lt;0.001), and admitted to non-teaching hospitals (P = 01). Among intracerebral hemorrhage patients who survived, patients who underwent early gastrostomy were more likely discharged with none to minimal disability odds ratio [OR] 1.51, 95% confidence interval [CI] 1.16-1.97) compared with those in the delayed gastrostomy group after adjusting for potential confounders. Early gastrostomy was associated with both lower length of stay (P &lt;0.001) and hospitalization cost (P &lt;0.001) in the multivariate analyses. Conclusion: Patients with intracerebral hemorrhage who undergo early gastrostomy are more likely to be discharged with none to minimal disability. Furthermore, early gastrostomy is associated with both reduction in hospital cost and length of stay.

Abstract 47: Outcomes In Acute Ischemic Stroke Patients Treated With Endovascular Thrombectomy Before And After 2015: An Analysis Of The National Inpatient Sample

Background: Endovascular thrombectomy (EVT) demonstrated superiority to medical management in the 2015 trials. We sought to compare outcomes in acute ischemic stroke (AIS) treated with EVT before and after 2015. Methods: A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences &gt;0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for EVT on outcomes. Significance set at an alpha level of &lt;0.001. All analysis performed in R version 4.1.3. Results: A total of 10,415,286 patients with AIS were identified; 149,367 (1.4%) underwent EVT. Among the EVT cohort, 35,562 patients were treated before 2015 (23.8%) vs. 113,805 (76.2%) after. EVT patients after 2015 were more likely to be younger, on private insurance, treated at large urban nonteaching hospitals, had lower Elixhauser Comorbidity Scores (14.71 ± 9.15 vs. 16.21 ± 9.17; p&lt;0.001) but increased markers of stroke severity such as higher rates of ventilator use, paresis, seizures, craniotomy and tracheostomy placement (all p&lt;0.001). After propensity matching, EVT patients after 2015 were more likely to be discharged home (AOR 1.35, 95%CI:1.24-1.47), have increased hospital charges ($40828.79; 95%CI: $36391.76-45265.81), had shorter hospital stay (-0.74 days, 95%CI: -0.99 - -0.48)(all p&lt;0.001), with no difference in In-hospital mortality. Conclusions: This 20-year nationally representative propensity matched analysis of AIS patients shows that outcomes after EVT continue to improve following the landmark 2015 publications, with a higher chance of favorable outcome, lower hospital charge and shorter hospital stay compared to before 2015.

Low Levels of RSV Testing Among Adults Hospitalized for Lower Respiratory Tract Infection in the United States.

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI)-related hospitalizations in older adults. Without RSV-specific treatment for adults, testing is uncommon, leading to potential underestimation of RSV incidence in real-world data studies. This study aimed to quantify the frequency of RSV testing during LRTI-related hospitalizations of older adults to inform interpretation of incidence estimates. Administrative and billing data for hospitalizations of adults aged≥65years with a primary or secondary diagnosis of LRTI during the 2016-2019 RSV seasons (October-April) were extracted from the US all-payer Premier Healthcare Database (PHD). Billing codes identified RSV tests administered during eligible hospitalizations. The proportion of LRTI-related hospitalizations with a billed RSV test was calculated for each hospital in PHD, and summarized descriptively by hospital bed size, teaching status, and population served. Most of the 937 study hospitals performed RSV testing infrequently during LRTI hospitalization; median percentage of LRTI hospitalizations with RSV testing was 4.3%, and 78.4% of hospitals performed RSV testing in less than 25% of LRTI-related hospitalizations. RSV testing varied extensively by hospital type. Median percentage tested was significantly higher for hospitals with≥200 beds (9.1%) versus<200 beds (1.6%), for teaching (11.0%) versus non-teaching (2.5%) hospitals, and in urban (7.4%) versus rural (0.7%) settings. The median percentage of RSV testing increased over time, from 0.8% to 6.3% between the 2016/17 and 2018/19 seasons. A small proportion of older adults hospitalized with LRTI are tested for RSV in US hospitals. Large variability occurs across hospital types. Consequently, retrospective database analyses likely result in a substantial underestimation of the true RSV-related hospitalization incidence. RSV incidence studies using real-world data need to assess for RSV testing frequency and adjust their results for under ascertainment associated with limited testing.