Annual Number Of Cases Research Articles

Reliability of hospital-level mortality in abdominal aortic aneurysm repair

ObjectiveThe relationship between volume and surgical outcomes has been shown for a variety of surgical procedures. The effects in abdominal aortic aneurysm repair have continued to be debated. Reliability adjustment has been used as a method to remove statistical noise from hospital-level outcomes. However, its impact on aortic aneurysm repair is not well understood. MethodsWe used prospectively collected data from the Vascular Quality Initiative to identify all patients who had undergone abdominal aortic aneurysm repair from 2003 to 2019. We first calculated the hospital-level risk-adjusted 30-day mortality rates. We subsequently used hierarchical logistic regression modeling to adjust for measurement reliability using empirical Bayes techniques. The effect of volume on risk- and reliability-adjusted mortality rates was then assessed using linear regression. ResultsBetween 2003 and 2019, 67,073 abdominal aortic aneurysms were repaired, of which 11,601 (17.3%) were repaired with an open approach. The median annual volume was 7.4 (interquartile range, 3.0-13.3) for open repairs and 35.4 (interquartile range, 18.8-59.8) for endovascular repairs. Of the 223 hospitals that had performed open repairs during the study period, only 11 (4.9%) had performed ≥15 open repairs annually, and the risk-adjusted mortality rates varied from 0% to 75% across all centers. After reliability adjustment, the variability of the risk-adjusted mortality rates had decreased significantly to 1.3% to 8.2%. The endovascular repair risk-adjusted mortality rate variability had decreased from 0% to 14.3% to 0.3% to 2.8% after reliability adjustment. A decreasing trend in mortality was found with increasing an annual case volume for open repair with each additional annual case associated with a 0.012% decrease in mortality (P = .05); however, the relationship was not significant for endovascular repair (P = .793). ConclusionsWe found that most hospitals do not perform a sufficient number of annual cases to generate a reliable center-specific mortality rate for open aneurysm repair. Center-specific mortality rates for low-volume centers should be viewed with caution, because a substantial proportion of the variation for these outcomes will be statistical noise rather than true center-level differences in the quality of care.

Trends in uro-oncological surgery in Germany-comparative analyses from population-based data

Obwohl urologische maligne Erkrankungen mit etwa 100.000 Neuerkrankungen pro Jahr eine relevante gesundheitsökonomische Aufgabe darstellen, existieren kaum Erkenntnisse über die Struktur und Entwicklung der entsprechenden tumorchirurgischen Eingriffe an den mehr als 400 urologisch-chirurgisch tätigen Kliniken in Deutschland. Somit erfassten wir mittels Datenbankabfrage der DRG-Datenbank („diagnosis related groups“) des statistischen Bundesamtes sämtliche Fälle von 5 großen tumorchirurgischen Eingriffen in Deutschland (Prostatektomie, Zystektomie, Nierentumoroperation, retroperitoneale Lymphadenektomie, penischirurgische Eingriffe) von 2006 bis 2013 (bzw. 2016) und untersuchten die Einflüsse von technischen Neuerungen sowie Leitlinienänderungen auf die Entwicklungen der Fallzahlen. Zudem analysierten wir die Zusammenhänge zwischen jährlicher Fallzahl und perioperativem Ergebnis. Die Ergebnisse zeigten eine deutliche Korrelation zwischen Fallzahlvolumen (und damit Expertise) einer Klinik und einem verbesserten perioperativen Ergebnis. Dennoch existiert kaum Tendenz zur Zentralisierung bei diesen uroonkologischen Eingriffen. Die Fallzahlentwicklungen scheinen vielmehr vom Werbeeffekt durch technische Innovationen oder auch vom regionalen Bezug der Patienten zu einer bestimmten Klinik abhängig zu sein. Zentral gesteuerte Versuche mittels Einführung von Mindestfallzahlen oder der freiwilligen Zertifizierung von Zentren hatten in der Vergangenheit nur geringen Einfluss auf die Fallzahlverteilungen.

Impact of COVID-19 social distancing measures on future incidence of invasive pneumococcal disease in England and Wales: a mathematical modelling study

ObjectivesIn January 2020, the UK moved to a 1+1 schedule for the 13-valent pneumococcal conjugate vaccine (PCV13) with a single priming dose at 3-month and a 12-month booster. We modelled...

Annual dementia incidence and socioeconomic costs attributable to fine particulate matter (PM2.5) exposure in Sweden

BACKGROUND AND AIM: Alzheimer’s disease (AD) and other dementias currently represent the fifth most common cause of death in the world, according to the World Health Organization, with a projected future increase as the proportion of the elderly in the population is growing. Air pollution has emerged as a plausible risk factor for AD, but studies estimating dementia cases attributable to exposure to fine particulate matter (PM2.5) air pollution and resulting socioeconomic costs are lacking. METHODS: We used data on average population-weighted exposure to ambient PM2.5 for the entire population of Sweden above 30 years of age. To estimate the annual number of dementia cases in Sweden attributable to air pollution we used the latest concentration response functions (CRF) between PM2.5 exposure and dementia incidence, based on ten longitudinal cohort studies. To estimate the socioeconomic costs of dementia, we calculated average life-time costs related to dementia, including formal health care costs, informal care, indirect costs, and intangible costs by including quality-adjusted life years (QALYs) lost. Two applied monetary valuations of QALYs in Sweden decision-making process was used to estimate the monetary value of reduced quality-of-life. RESULTS:The annual number of dementia cases attributable to PM2.5 exposure was estimated to be 820, which represents 5% of the annual dementia cases in Sweden. Formal life-time average cost per incidence of dementia was calculated to correspond € 213,000. From a societal perspective, this corresponds to monetarized annual dementia burden of €215 per individual at risk. Reducing PM2.5 by 1 µg/m3 would correspond to 0.6% of Swedish GDP in opportunity costs due to reduced incident of dementia. CONCLUSIONS:This study estimated that 5% of annual dementia cases could be attributed to PM2.5 exposure, and that the resulting socioeconomic costs were substantial. These findings suggest the need to consider airborne toxic pollutants associated with dementia incidence in public health policy decisions. KEYWORDS: Air pollution, Policy, particulate matter,

CATastrophe: Response to the challenges of zoonotic sporotrichosis in southern Brazil.

In Brazil, zoonotic sporotrichosis became a national public health problem, with thousands of cases in the last decade in several regions of the country. In this context, health education activities are critical, especially in promoting early diagnosis and access to proper health care in sporotrichosis hyperendemic areas. Therefore, we report the implementation of a public specialised reference service (SRS) for diagnosis and treatment of sporotrichosis in southern Brazil. We evaluated the impact of the SRS on diagnostic confirmation and speed of diagnosis. The SRS was implemented in Rio Grande City. We implemented a public service to promote the correct diagnosis, treatment and follow-up of human sporotrichosis cases. To study the impact of implementing SRS, the annual number of cases and the period between the appearance of lesions until diagnosis were compared, using prior data and that post-implementation. The implementation of the SRS directly benefited almost 50 patients in only four years, with the collaboration of almost 50% of the local health groups, together with an increase of more than 200% in diagnosis confirmation and speed of diagnosis, showing the reach, impact and importance of the SRS. The impact on the individual and collective health of the local population highlights the value of this public health approach in facing the epidemiological threat of zoonotic sporotrichosis.

Can Radiation Therapy Quality Assurance Improve Nasopharyngeal Cancer Outcomes in Low- and Middle-Income Countries: Reporting the First Phase of a Prospective International Atomic Energy Agency Study

PurposeMost new nasopharyngeal cancer cases occur in low-income and middle-income countries, and these patients experience poorer overall survival than that of new nasopharyngeal cancer cases in high-income countries. The goal of this research project is to determine whether the introduction of a radiation therapy quality assurance program can ultimately improve outcomes for nasopharyngeal cancer patients in lower-income and middle-income countries. This study reports the results of the first phase of the International Atomic Energy Agency Coordinated Research Project (325-E3-TM-47712). Methods and MaterialsThis prospective study has 2 phases. Phase 1 is a survey of radiation therapy resources, patient characteristics and treatment, and results of radiation therapy quality assurance performed by the expert panel. An educational workshop reviewing phase 1 results for each center was completed before accrual of patients for phase 2. The ultimate aim of the study is to compare the first and second cohort of patients to see if quality assurance can result in fewer major protocol deviations and a 15% improvement in patients’ 3-year progression-free survival. ResultsOf 14 participating centers, 13 (93%) had computed tomography simulators and linear accelerators (LINAC) with intensity modulated radiation therapy (IMRT) capacity, median 3 LINAC (range, 1-13), and median 10 radiation oncologists (range, 5-51). The annual number of nasopharyngeal cancer cases irradiated was median 54 (range, 10-627). Five of 14 centers (36%) had no local radiation therapy quality assurance. For the current phase 1 study, 134 patients were evaluated, 82.1% had MRI staging, 99.3% had metastatic workup, 65.6% undifferentiated histology, 51% stage 3 and 49% stage 4. Radiation therapy quality assurance revealed 81 (60.4%) of 134 patients had major protocol violations in gross tumor volume and high dose planning target volume contours and/or dosimetry, 28.4% patients had borderline plans, 15 (11.2%) acceptable, and only 6 (4.2%) had inevitable compromise due to tumor extent. ConclusionsThis is the first International Atomic Energy Agency study to address the fundamental issue of treatment quality rather than altered treatment regimens. The high rate of unacceptable radiation therapy plans is a major concern, and we hope phase 2 will show a significant reduction and improved patient outcomes.

Effects of minimum unit pricing for alcohol in South Africa across different drinker groups and wealth quintiles: a modelling study

ObjectivesTo quantify the potential impact of minimum unit pricing (MUP) for alcohol on alcohol consumption, spending and health in South Africa. We provide these estimates disaggregated by different drinker groups...

Annual cost of wasted indocyanine green during sentinel lymph node mapping for patients with endometrial cancer

<h3>Objectives:</h3> To estimate the annual cost of wasted indocyanine green (ICG) used for sentinel lymph node (SLN) mapping in patients with localized endometrial cancer. <h3>Methods:</h3> We used the Surveillance, Epidemiology, and End Results (SEER) program database to estimate the number of annual cases of localized uterine cancer. We queried the Premier database (www.premierinc.com; Premier, Inc; Charlotte, NC) to determine the median cost to institutions and charge to patients associated with ICG. We searched Premier for all patients who underwent surgery for endometrial hyperplasia or uterine cancer from January 2006 to June 2018. Among 142,629 patients, there were 12,543,758 billing records. The median charge and median variable cost associated with ICG were estimated from 7,826 records that identified ICG use in the hospital charge description. To further validate these estimates, we conducted a separate search for lymph node sampling and radiopharmaceutical mapping to confirm these billings were separate from ICG billings. To perform the drug waste analysis, we assumed that gynecologic oncologists use 2-4 mL of the only currently available ICG vial kit (25 mg per 10 mL) per SLN case, resulting in presumptive waste of 60-80% of the total vial. Estimated waste was then calculated using the variable cost as a measure of institutional waste and charge as excess cost transferred to patients or payers. <h3>Results:</h3> In SEER 2020, there were 65,520 estimated cases of uterine cancer. Seventy percent of these cases (45,934) were localized and thus eligible for SLN mapping. The median cost associated with ICG was $56.70 (25%ile: $22.32; 75%ile: $71.00), and the charge was $419.34 (25%ile: $219.79; 75%ile: $527.47). The estimated annual waste associated with current ICG packaging was $1,562,674 - $2,083,566 to hospitals. The estimated annual excess charge imposed on patients or payers was $11,557,178 - $15,409,570. <h3>Conclusions:</h3> The annual cost of wasted ICG due to its current manufactured vial size is $1.5-$2.1 million for hospitals and $11.5-$15.4 million for patients. This is a gross underestimate, as it does not include cases of atypical hyperplasia or vulvar cancer, which would also be eligible for SLN biopsy. We suggest ICG vials should be packaged and sold in a 10-mg vial size to avoid drug waste and excess costs to institutions and patients.

Impact of Atrial Fibrillation Case Volume in the Emergency Department on Early and Late Outcomes of Patients With New Atrial Fibrillation

To define the association between atrial fibrillation case volume in the emergency department and death or all-cause hospitalization at 30 days and 1 year in patients with new atrial fibrillation. Secondary objectives examined repeat ED visits and the management of atrial fibrillation within 90 days. We identified all adults presenting to an ED in Alberta, Canada, with a new primary diagnosis of atrial fibrillation/flutter between 2009 and 2015 using International Classification of Diseases, 10th Revision code I48. Volume was classified in tertiles weighted by annual ED number of atrial fibrillation cases. The association between volume and outcomes was evaluated using generalized linear mixed models, adjusting for prognostically important covariates as fixed effects and ED as a random effect to account for potential clustering within EDs. The tertiles consisted of 4 high, 9 medium, and 68 low atrial fibrillation volume EDs, with 4,217, 4,193, and 4,112 patients, respectively. Volume was not independently associated with the primary outcome or individual components. However, medium- and high-volume EDs had fewer repeat ED visits at 30 days (respective adjusted odds ratio [aOR] 0.75 [95% confidence interval {CI} 0.66 to 0.87] and 0.64 [0.52 to 0.79]) and 1 year (respective aOR 0.77 [95% CI 0.67 to 0.90] and 0.71 [0.56 to 0.90]). Fewer patients were admitted from medium- (37.1%) and high- (32.0%) compared with low-volume (39.5%) EDs. Patients attending medium- and high-volume EDs were more likely to be cardioverted (aOR 3.28 [95% CI 1.94 to 5.53] and 3.81 [1.39 to 10.48] for medium- and high-volume EDs, respectively). Treatment in higher volume EDs was associated with significantly lower admission rates and repeat ED visits but no difference in survival.

Safety and acute efficacy of cryoballoon ablation for atrial fibrillation at community hospitals.

Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) is an established procedure for treating symptomatic paroxysmal and persistent atrial fibrillation (AF). The safety and efficacy of PVI performed at community hospitals are unknown. We aimed to determine the safety and acute efficacy of PVI using CBA performed at community hospitals with limited annual case numbers. This registry study included 1004 consecutive patients who had PVI performed for symptomatic paroxysmal (n = 563) or persistent AF (n = 441) from January 2019 to September 2020 at 20 hospitals. Each hospital performed fewer than 100 CBA-PVI procedures/year according to local standards. Procedural data, efficacy, and complication rates were determined. The mean number of CBA procedures performed/year at each centre was 59 ± 25. The average procedure time was 90.1 ± 31.6 min and the average fluoroscopy time was 19.2 ± 11.4 min. Isolation of all pulmonary veins was documented in 97.9% of patients. The most frequent reason for not achieving complete isolation was development of phrenic nerve palsy. No hospital deaths were observed. Two patients (0.2%) suffered a clinical stroke. Pericardial effusion occurred in six patients (0.6%), two of whom (0.2%) required pericardial drainage. Vascular complications occurred in 24 patients (2.4%), two of whom (0.2%) required vascular surgery. Phrenic nerve palsy occurred in 48 patients (4.8%) and persisted up to hospital discharge in six patients (0.6%). Pulmonary vein isolation procedures for paroxysmal or persistent AF using CBA can be performed at community hospitals with high acute efficacy and low complication rates.

Neglected tropical zoonotic diseases in Tigray region, northern Ethiopia: Spatial distribution and trend analysis of rabies, tuberculosis, schistosomiasis, and visceral leishmaniasis in humans.

Neglected tropical zoonotic diseases (NTZDs) continue to affect the health and livelihoods of humans particularly the poor and marginalized populations in developing countries. Mapping the distribution and burden of these diseases will support making an informed decision. A retrospective study was conducted to map the spatial distribution and analyse trend of NTZDs in Tigray region, Northern Ethiopia. A health management information system (HMIS) data between 2012/13 and 2016/17 was obtained from Tigray National Regional State Health Bureau. The Quantum-GIS software was used to map the spatial distribution and burden of selected NTZDs at zonal level. Only four of the NTZDs namely rabies, tuberculosis (TB), schistosomiasis and visceral leishmaniasis (VL) from the records of HMIS data were considered. A high incidence rate (IR) at least for one of the NTZDs was reported in males above 15years old. In the 5-year period, of the 60,099 reported NTZD cases, 30.3% (18,220), 26.6% (16,005), 23.3% (14,001), 14.4% (8,661), and 5.3% (3,212) were, respectively, schistosomiasis, extra-pulmonary TB, rabies, pulmonary TB, and visceral leishmaniasis. The year-wise analysis showed an irregular trend for the NTZDs where both the decreasing and increasing trends didn't show statistically significant variation. However, the overall regional number of TB cases showed a decreasing trend, where the decrease for extra-pulmonary TB (1.8 cases per 100,000 population) was higher than pulmonary TB (0.5 cases per 100,000 population). Similarly, the annual number of rabies and VL cases showed a decreasing trend. On the other hand, the number of schistosomiasis cases showed an increasing trend (8.2 cases per 100,000 population). The annual average number of TB (171 cases per 100,000 population), schistosomiasis (354 cases per 100,000 population), and VL (63 cases per 100,000 population) cases were much higher in Western zone compared to the rest of the zones. The incidence rate of rabies was higher in Mekelle and Southeastern (100 cases per 100,000 population) and Northwestern (97 cases per 100,000 population) zones. Intervention strategies applied in the region should take into account the zonal distribution and burden of NTZDs.

Residual malaria in Jazan region, southwestern Saudi Arabia: the situation, challenges and climatic drivers of autochthonous malaria

BackgroundSaudi Arabia and Yemen are the only two countries in the Arabian Peninsula that are yet to achieve malaria elimination. Over the past two decades, the malaria control programme in Saudi Arabia has successfully reduced the annual number of malaria cases, with the lowest incidence rate across the country reported in 2014. This study aims to investigate the distribution of residual malaria in Jazan region and to identify potential climatic drivers of autochthonous malaria cases in the region.MethodsA cross-sectional study was carried out from 1 April 2018 to 31 January 2019 in Jazan region, southwestern Saudi Arabia, which targeted febrile individuals attending hospitals and primary healthcare centres. Participants’ demographic data were collected, including age, gender, nationality, and residence. Moreover, association of climatic variables with the monthly autochthonous malaria cases reported during the period of 2010–2017 was retrospectively analysed.ResultsA total of 1124 febrile subjects were found to be positive for malaria during the study period. Among them, 94.3 and 5.7% were infected with Plasmodium falciparum and Plasmodium vivax, respectively. In general, subjects aged 18–30 years and those aged over 50 years had the highest (42.7%) and lowest (5.9%) percentages of malaria cases. Similarly, the percentage of malaria-positive cases was higher among males than females (86.2 vs 13.8%), among non-Saudi compared to Saudi subjects (70.6 vs 29.4%), and among patients residing in rural rather than in urban areas (89.8 vs 10.2%). A total of 407 autochthonous malaria cases were reported in Jazan region between 2010 and 2017. Results of zero-inflated negative binomial regression analysis showed that monthly average temperature and relative humidity were the significant climatic determinants of autochthonous malaria in the region.ConclusionMalaria remains a public health problem in most governorates of Jazan region. The identification and monitoring of malaria transmission hotspots and predictors would enable control efforts to be intensified and focused on specific areas and therefore expedite the elimination of residual malaria from the whole region.

Anesthesia services in Taiwan: A nationwide population-based study.

This study was conducted to provide an overview of anesthesia services in Taiwan from 2001 to 2010. A retrospective population-based analysis was performed using data from Taiwan's National Health Insurance Research Database for the period 2001 to 2010. The results were stratified by patient sex, patient age, anesthesia type, and hospital setting. Categorical data are presented as totals and percentages. Linear regression was performed to analyze the anesthesia trends. The annual use of anesthesia increased continually from 964,440 instances in 2001 to 1,073,160 in 2010, totaling 10,076,600 cases with a total cost of 25.4 billion USD. The overwhelming majority (83.9%) of anesthesia cases was for anesthesia in an inpatient setting; general anesthesia accounted for 73.8% of anesthesia cases, and female patients outnumbered male patients (52.4% vs 47.6%). The average number of anesthesia cases was 44.2 per thousand of the population annually, but this percentage was much higher in elderly people (100.9 cases per thousand people annually). The annual number of anesthesia cases per thousand of the population increased from 104.4 in 2001 to 113.0 in 2010 in the oldest group (>80 years). By contrast, a considerable decline in use of anesthesia was discovered over the study period among those aged younger than 18 years. The use of anesthesia services in Taiwan has increased over the years. The relationships of age with anesthesia volume and cost were found to follow an inverse U-shaped pattern. Elderly people used anesthesia services more frequently. The planning of geriatric anesthesia services deserves attention, especially in continually aging societies such as Taiwan.

Report on Steroid- Responsive Encephalopathy in a Case of Hashimoto’s Thyroiditis

Introduction: Thyroiditis caused by Hashimoto's common, Thyroid gland enlargement that is painless and diffuse that affects mostly women in their forties and fifties. While most patients are euthyroid, hypothyroidism may grow. In addition, several patients have thyroid antigen-specific cell-mediated immunity, which can be demonstrated using a variety of strategies. The annual number of cases per 10,000 people prevalence of at least 2% among women. Thyroiditis causes the thyroid gland to become extinct capacity to keep iodine in a safe place, generate together with secrete circulating iodoproteins in the blood, and produce inefficient hormone. As a result, the thyroid gland is overstimulated, and the patient has a high rate of Iodine in the thyroid turnover.&#x0D; Clinical Finding: enlargement of thyroid gland. Difficulty in swallowingand breathing, unexplained weight gain,constipation, slow heart beat, fatigue, swelling in extremities, dryness.&#x0D; Medical History: In 2010 she was suffering from same problems. Hashimoto thyroiditis cured for medical intervention in Nagpur medical college, after that treatment of Hashimoto thyroiditis she took the treatment in A.V.B. R. Hospitalfor management of Hashimoto thyroiditis. Now she is admitted in peadiatrics ward for further management of Hashimoto thyroiditis.&#x0D; The Diagnosis and Therapeutic Intervention: After physical examination and investigation, this case was diagnosed as Hashimoto thyroiditis. Thyroid hormone replacement therapy was used to treat the condition. This normally entails taking levothyroxine.&#x0D; Leoxyl Check: After six to eight weeks of treatment, the TSH level should be normal with dose 12.5-25 mcg. Absorption of levothyroxin may be affected by some drugs, supplements, and diets taken 4 hours. Triiodothyronine 5 to 10 mcg received in twice in day.&#x0D; Nursing Perspectives: Assessement of anterior or posterior location of the thyroid IV Fluid was provided. Check blood pressure and vital signs per hourly. Monitor the Pulse oximetry, ABG, and respiratory rate, and pattern are all factors to consider.&#x0D; Conclusion: Comprehensive systemic review of autoimmune disease, our best estimate of incidence rates for hypothyroidism in female and male treatment and management improves the outcomes of Hashimoto thyroiditis.

Association of hospital procedural volume with incidence and outcomes of surgical bailout in patients undergoing transcatheter aortic valve replacement.

This study sought to examine the association of hospital procedural volume with the incidence and outcomes of surgical bailout (SB) in patients who undergo transcatheter aortic valve replacement (TAVR). SB is required for serious complications during or after TAVR. It remains unclear whether hospital experiences affect the incidence and outcomes of SB. We retrospectively identified patients who underwent endovascular TAVR using the Nationwide Readmissions Database 2012-2017. We examined the association of annual hospital procedural volume (annual number of endovascular TAVR cases in each hospital in each year) with the incidence and in-hospital mortality of SB using multivariable logistic regressions and restricted cubic splines. Among 82,764 eligible patients, the incidence of SB was 0.95% (n=789) and decreased from 2012 to 2017 (from 2.66% to 0.49%; Ptrend < 0.001), while in-hospital mortality of SB remained high over years (from 26.0% to 23.5%; Ptrend =0.773). Very-high-volume hospitals (≥200 cases/year), as compared with low-volume hospitals (≤49 cases/year), showed significantly a lower incidence of SB (0.49% vs. 1.81%; adjusted OR=0.28, 95% CI=0.21-0.38), but similar in-hospital mortality of SB (26.2% vs. 25.6%; adjusted OR=0.88, 95% CI=0.47-1.66). There was a significant nonlinear, inverse association of hospital volume with the incidence of SB, but not with the in-hospital mortality of SB. Hospitals with higher TAVR volumes have a lower risk of SB, but the in-hospital mortality after SB does not change with hospital TAVR volume. Our findings highlight the importance that physicians should always be aware of the high mortality risk of SB following TAVR regardless of hospital procedural experiences.

Sequencing of Renal Mass Biopsy and Ablation: Results from the National Cancer Database.

We assessed current utilization and sequencing of renal mass biopsy (RMB) and thermal ablation for renal cell carcinoma (RCC) patients in the United States. The 2004-2014 National Cancer Database was queried for adult patients with histopathologically diagnosed American Joint Committee on Cancer stage I RCC ≤5 cm undergoing RMB and thermal ablation. RMB sequencing was stratified into "staged RMB" (separate sessions for RMB/ablation) or "concomitant RMB" (same date RMB/ablation). Demographics, cancer variables and time trends were compared. Univariate and multivariable logistic regression identified predictors of concomitant RMB, and evaluated their impact on inpatient hospital stay and 30-day unplanned readmissions. A total of 6,323 patients were included, of whom 2,913 (46.1%) underwent staged RMB and 3,410 (53.9%) underwent concomitant RMB. Concomitant RMB was more frequently performed until 2012, and staged RMB thereafter (trend p <0.001). In multivariable logistic regression models, private insurance, clear cell RCC, right-sided disease and smaller tumor diameter demonstrated higher probability of concomitant RMB. Furthermore, geographical differences across the United States were evident (concomitant RMB West/South Central region 64.6% versus New England 29.3%, multivariable p <0.05). Concomitant RMB was associated with greater odds of inpatient hospital stay (multivariable OR=1.42, 95% CI=1. 27-1. 60; p <0.001) and 30-day unplanned hospital readmissions (OR=1.55, 95% CI=1.07-2.27; p=0.022). Staged RMB is more frequently performed in more recent years and is associated with lower odds of inpatient hospital stay and unplanned readmissions within 30 days. These potential benefits, combined with the potential to limit ablation of benign tumors, need to be weighed against additional health care costs and inconvenience associated with 2 interventions.

The Improvement of Gynecological Gasless Laparoscopic Surgery Using a Subcutaneous Abdominal Wall Lifting Method

Background: To evaluate the usefulness of gasless laparoscopic surgery using a Subcutaneous Abdominal Wall Lifting method (SAWL) for gynecological tumors. Methods: 5309 patients underwent gasless surgery with SAWL in our hospital between April 1993 and December 2015. Patient background as well as the number of annual cases, operation time, estimated blood loss, number of ports, blood transfusion, and shift to laparotomy were examined. With regards to Laparoscopic Cystectomy (LC), Laparoscopic Myomectomy (LM) and Laparoscopic Tubectomy (LT), we divided their cases into two stages-the first stage (FS) that we performed surgery with double-operated ports (1993-2005), and the second stage (SS) after a single-operated port surgery introduction (2008-2015) for comparison. Results: LC was the most frequently performed (2068 patients), followed by LM (1738 patients) and LT (510 patients). A single-operated port laparoscopic surgery, which we called a Gasless Reduced Port Surgery (GRPS), was introduced in 2005, and by 2008 it had accounted for almost 90% of gasless laparoscopic surgeries overall except for total laparoscopic hysterectomy. The mean operation time was significantly shorter in SS than FS for LC and LT, and it was no significant difference between two stages for LM. The estimated blood loss significantly decreased in SS compared to FS for LM and LT, and no significant difference for LC. The conversion rate in SS was 0.07%. Conclusion: GRPS is an operative procedure that is superior to the rate of conversion to laparotomy and is aesthetically superior in addition to having advantages of the conventional gasless method.

Kaposi Sarcoma Incidence, Burden, and Prevalence in United States People with HIV, 2000-2015.

The introduction of combination antiretroviral therapy (cART) has led to a significant reduction in Kaposi sarcoma (KS) incidence among people with HIV (PWH). However, it is unclear if incidence has declined similarly across key demographic and HIV transmission groups and the annual number of incident and prevalent KS cases remains unquantified. Using population-based registry linkage data, we evaluated temporal trends in KS incidence using adjusted Poisson regression. Incidence and prevalence estimates were applied to CDC HIV surveillance data, to obtain the number of incident (2008-2015) and prevalent (2015) cases in the United States. Among PWH, KS rates were elevated 521-fold [95% confidence intervals (CI), 498-536] compared with the general population and declined from 109 per 100,000 person-years in 2000 to 47 per 100,000 person-years in 2015, at an annual percentage change of -6%. Rates declined substantially (P trend < 0.005) across all demographic and HIV transmission groups. Of the 5,306 new cases estimated between 2008 and 2015, 89% occurred among men who have sex with men. At the end of 2015, 1,904 PWH (0.20%) had been diagnosed with KS in the previous 5 years. A consistent gradual decline in KS incidence has occurred among PWH in the United States during the current cART era. This decrease is uniform across key demographic and HIV transmission groups, though rates remain elevated relative to the general population. Continued efforts to control HIV through early cART initiation and retention in care need to be maintained and possibly expanded to sustain declines.

Reduction of central line-associated bloodstream infections in a large acute care hospital in Midwest United States following implementation of a comprehensive central line insertion and maintenance bundle.

Central line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality. We describe the impact of various quality improvement interventions on the incidence of CLABSI in an 848-bed community teaching hospital from 1 January 2013 to 31 December 2017. To reduce CLABSI rates after implementation of a comprehensive central line insertion and maintenance bundle. A comprehensive bundle of interventions was implemented incorporating the standard US Centers for Disease Control and Prevention bundle with additional measures such as root-cause analysis of all CLABSI cases, use of passive disinfection caps on vascular access ports, standardisation of weekly central venous catheter (CVC) site dressing changes, and use of antithrombotic and antimicrobial-coated CVCs with fewer lumens. A retrospective study evaluated CLABSI rates and time of CLABSI onset after CVC placement in both intensive care unit (ICU) and non-ICU settings. The annual number of CLABSI cases declined 68% (34 to 11 patients) from 2013 to 2017. There was a 30% decline in CVC days from years 2014 to 2017. Over the same period, CLABSI cases per 1000 CVC days decreased from 0.624 to 0.362: a 42% decline. Following the implementation of a comprehensive bundle of interventions for CVC insertion and maintenance, we found a reduction in rates of CLABSI.

Impact of Hospital volume on postoperative outcomes after radical prostatectomy: A 5-Year nationwide database analysis

BackgroundHospital volume is considered to be a quality measure for outcomes after major oncological surgery. However, countrywide data are lacking for radical prostatectomy (RP). ObjectiveTo assess the impact of hospital volume on postoperative outcomes after RP performed using an open (ORP) versus a minimally invasive surgery (MIS, including pure and robot-assisted RP) approach. Design, setting, and participantsData for patients undergoing RP in France from 2014 to 2019 were extracted from the central database of the national health care system. Outcome measurements and statistical analysisPrimary endpoints were length of hospital stay (LOS), complications (measured as severity index [SI] scores), and hospital readmission rates at 30 and 90 d. Results and limitationsThe median annual hospital volume was 19 RPs (interquartile range 1–40) in the overall cohort. MIS was associated with better outcomes than ORP. Greater hospital volume was correlated with shorter LOS (p < 0.001), high SI scores (SI3: p < 0.001; SI4: p < 0.001), and 30-d (p < 0.001) and 90-d readmission rates (p < 0.001). Incidence rates for SI3 and SI4 scores, and 30-d and 90-d readmission were 12.8 %, 5.8 %, 29.8 %, and 35.4 % in very low-volume centres (<10 annual cases) compared with 8.1 %, 1.9 %, 18.1 %, and 23.9 %, respectively, in other centres (all p < 0.001). Hospital volume was an independent risk factor for all outcomes after taking into account age, lymph node dissection, year of surgery, and surgical approach (ORP vs MIS). The main limitation is the lack of post-RP oncological and functional data. ConclusionsThis nationwide analysis of RP procedures shows a significant correlation between hospital volume and postoperative outcomes irrespective of the surgical approach. Very low case volume (<10 annual procedures per centre) is associated with the highest risk of complications, readmission, and prolonged LOS. Greater hospital volume is directly correlated with shorter LOS even beyond this threshold. Patient summaryIn this study we analysed the French nationwide database for removal of the prostate for prostate cancer. We found that the number of these cases that a hospital carries out per year was associated with outcomes after surgery, with better outcomes for higher annual case numbers.