Plan Database Research Articles

Outcomes after Robotic Ventral Hernia Repair: A Study of 21,565 Patients in the State of New York

The purpose of our study is to assess outcomes following robotic ventral hernia (RVH) repair. The New York Statewide Planning and Research Cooperative System administrative database was used to identify all patients undergoing laparoscopic ventral hernia (LVH) and RVH between 2010 and 2013. Outcome measures including complications, hospital length of stay (HLOS), 30-day readmissions, and 30-day emergency department (ED) visits were compared. Propensity score (PS) analysis was used to estimate the adjusted marginal differences between patients who underwent robotic-assisted and laparoscopic procedures. There were 20,896 LVH and 679 (3.2%) RVH repairs. Initial univariate analysis demonstrated that patients undergoing RVH had worse outcomes in terms of complications (20.18% vs 10.56%, P < 0.0001), longer HLOS (4.32 vs 2.19 days, P = 0.0023), higher rates in 30-day readmissions (9.28% vs 5.06%, P < 0.0001), and 30-day ED visits (14.43% vs 10.46%, P < 0.0001). Following PS analysis, which accounts for all patient associated variables, there was no difference found in 30-day readmission or 30-day ED visits between RVH and LVH (P = 0.2760 and 0.2043, respectively). Patients undergoing RVH had a significantly shorter HLOS (P < 0.0001) and lower rate of complications (P = 0.0134). Following PS analysis, this study demonstrates that RVH may be associated with shorter HLOS and lower complication rate. Further studies are necessary to compare laparoscopic and robotic approaches for ventral hernia.

Adverse effect of long work hours on incident diabetes in 7065 Ontario workers followed for 12 years

ObjectiveAccording to the International Diabetes Federation, the most important challenge for prevention is now to identify social and environmental modifiable risk factors of diabetes. In this regard, long work hours...

A Decade of Thoracic Endovascular Aortic Aneurysm Repair in New York State: Volumes, Outcomes, and Implications for the Dissemination of Endovascular Technology

The purpose of this study was to characterize utilization and outcomes of thoracic endovascular aortic aneurysm repair (TEVAR) in New York State during the first decade of commercial availability, with respect to evolving indications, results, and costs. Of specific interest was evaluation of the volume-outcome relationship for this relatively uncommon procedure. The New York Statewide Planning and Research Cooperative System database was queried to identify patients undergoing TEVAR from 2005 to 2014 for aortic dissection (AD), non-ruptured aneurysm (NRA), and ruptured aneurysm (RA). Outcomes assessed included in-hospital mortality, complications, and costs. Linkage to the National Provider Identifier and New York Office of Professions databases facilitated comparisons by surgeon and facility volume. One thousand eight hundred thirty-eight patients were identified: 334 AD, 226 RA, and 1,278 NRA. Since introduction, TEVAR implantation increased significantly over the 10-year period in all groups (P<0.01), with recent increase in utilization for AD. Increased in-hospital mortality correlated with RA (OR 5.52 [3.02-10.08], P<0.01), coagulopathy (3.38 [2.02-5.66], P<0.01), cerebrovascular disease (2.47 [1.17-5.22], P=0.02), and nonwhite/nonblack race (1.74 [1.08-2.82], P=0.02). Early in the experience (2005-2007), patients were more likely to be treated at high-volume facilities (>17 per year) and by high-volume surgeons (>5 per year), (P<0.01). Since 2011, however, most patients (53%) have undergone TEVAR by low-volume surgeons (<3 per year). Neither surgeon nor hospital volume was associated with clinical outcomes. Since the introduction of TEVAR, comparable results have been obtained across hospital and surgeon volume strata. Favorable outcomes, even in low-volume settings, underscore the complexity of volume-outcome relationships in high-acuity procedures. These findings have implications for credentialing, regionalization, and future dissemination of advanced endovascular technology.

Long-term etanercept retention patterns and factors associated with treatment discontinuation: a retrospective cohort study using Canadian claims-level data.

To examine 12-month retention rates over 6years of etanercept patients in Canada, and to identify factors associated with treatment discontinuation. A retrospective cohort study was conducted using longitudinal prescription drug claims data from IQVIA Private Drug Plan database (PDP), Ontario Public Drug Plan database (OPDP), and Régie de l'assurance maladie du Québec database (RAMQ). Between 07/2008 and 06/2010, bio-naïve patients who initiated etanercept were identified and followed for 72months. Twelve-month retention rates were estimated in one-year increments and factors associated with time to discontinuation over the 72-month period were identified using a Cox proportional hazards regression model. The study identified 4528 etanercept patients (61% female, 85% rheumatic diseases, and 15% psoriasis). Twelve-month etanercept retention rates increased significantly for patients following their first year on therapy (p < 0.0001), with 66% of patients retained at year 1 vs. 79, 82, 84, 83, and 79% at years 2, 3, 4, 5, and 6, respectively. 17.1% (n = 771) of patients were retained for the entire 72-month study. Patients with psoriasis were at increased risk (HR 1.199; p < 0.0001); while public drug coverage plan patients (OPDP HR 0.721; p < 0.0001 and RAMQ HR 0.537; p < 0.0001) were at decreased risk of treatment discontinuation. Twelve-month etanercept retention rates increased significantly for patients following their first year on therapy. Indication and drug coverage plan were associated with patients' time to etanercept discontinuation. With a better understanding of factors associated with retention, programs can be designed to address the specific needs of at-risk groups while supporting patients stable on therapy.

Trends and Disparities in Cervical Spine Fusion Procedures Utilization in the New York State.

A retrospective review of the Statewide Planning and Research Cooperative System database of the New York State. This study examined the rate of increase of cervical spine fusion procedures at low-, medium-, and high-volume hospitals, and analyzed racial and socioeconomic characteristics of the patient population treated at these three volume categories. There has been a steady increase in spinal fusion procedures performed each year in the United States, especially cervical and lumbar fusion. Our study aims to analyze the rate of increase at low-, medium-, and high-volume hospitals, and socioeconomic characteristics of the patient populations at these three volume categories. The New York State, Statewide Planning and Research Cooperative System (SPARCS) database was searched from 2005 to 2014 for the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Procedure Codes 81.01 (Fusion, atlas-axis), 81.02 (Fusion, anterior column, other cervical, anterior technique), and 81.03 (Fusion, posterior column, other cervical, posterior technique). Patients' primary diagnosis (ICD-9-CM), age, race/ethnicity, primary payment method, severity of illness, length of stay, hospital of operation were included. All 122 hospitals were categorized into high-, medium-, and low-volume. Trends in annual number of cervical spine fusion surgeries in each of the three hospital volume groups were reported using descriptive statistics. Low-volumes centers were more likely to be rural and non-teaching hospitals. African American patients comprised a greater portion of patients at low-volume hospitals, 15.1% versus 11.6% compared with high-volume hospitals. Medicaid and self-pay patients were also overrepresented at low-volume centers, 6.7% and 3.9% versus 2.6% and 1.7%, respectively. Compared with Caucasian patients, African American patients had higher rates of postoperative infection (P = 0.0020) and postoperative bleeding (P = 0.0044). Compared with privately insured patients, Medicaid patients had a higher rate of postoperative bleeding (P = 0.0266) and in-hospital mortality (P = 0.0031). Our results showed significant differences in hospital characteristics, racial distribution, and primary payments methods between the low- and high-volume categories. African American and Medicaid patients had higher rates of postoperative bleeding, despite similar rates between the three volume categories. This suggests racial and socioeconomic disparities remains problematic for disadvantaged populations, some of which may be attributed to accessibility to care at high-volume centers. 3.

Surgical outcomes for patients diagnosed with dementia: A coarsened exact matching study

BackgroundAn increasing number of elderly patients with dementia are undergoing surgical operations. Little is known about the differential impact of dementia on surgical outcomes. We investigated whether demented patients undergoing surgical operations have worse outcomes than their non-demented counterparts. MethodsWe performed a cohort study of all patients undergoing a series of surgical operations who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2009 to 2013. We examined the association of dementia with inpatient case-fatality, discharge to a facility, and length of stay (LOS). Coarsened exact matching was used to balance comorbidities among the comparison groups, and mixed effect methods were used to control for clustering at the hospital level. ResultsDuring the study period, 342,075 patients underwent surgical operations that met the inclusion criteria. Multivariable logistic regression models, after coarsened exact matching, demonstrated that demented patients were not associated with higher case-fatality (OR, 0.43; 95% CI, 0.13–1.36), but were associated with higher rates of discharge to a facility (OR, 1.71; 95% CI, 1.26–2.31) and longer LOS (Adjusted difference, 31%; 95% CI, 26%–36%). These persisted in pre-specified subgroups stratified on particular operations. ConclusionsUsing a comprehensive all-payer cohort of surgical patients in New York State we identified an association of dementia with increased rate of discharge to rehabilitation and longer LOS. No difference was identified in the case fatality of the two groups. Policy makers, payers, and physicians should take these findings into account when designing new policies, and when counseling patients.

Risk Factors for Readmission with Cerebrospinal Fluid Leakage Within 30 Days of Vestibular Schwannoma Surgery.

Cerebrospinal fluid (CSF) leak is a well-recognized complication after surgical resection of vestibular schwannomas and is associated with a number of secondary complications, including readmission and meningitis. To identify risk factors for and timing of 30-d readmission with CSF leak. Patients who had undergone surgical resection of a vestibular schwannoma from 1995 to 2010 were identified in the California Office of Statewide Health Planning and Development database. The most common admission diagnoses were identified by International Classification of Disease, ninth Revision, diagnosis codes, and predictors of readmission with CSF leak were determined using logistic regression. A total of 6820 patients were identified. CSF leak, though a relatively uncommon cause of admission after discharge (3.52% of all patients), was implicated in nearly half of 490 readmissions (48.98%). Significant independent predictors of readmission with CSF leak were male sex (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.32-2.25), first admission at a teaching hospital (OR 3.32, 95% CI 1.06-10.39), CSF leak during first admission (OR 1.84, 95% CI 1.33-2.55), obesity during first admission (OR 2.10, 95% CI 1.20-3.66), and case volume of first admission hospital (OR of log case volume 0.82, 95% CI 0.70-0.95). Median time to readmission was 6 d from hospital discharge. This study has quantified CSF leak as an important contributor to nearly half of all readmissions following vestibular schwannoma surgery. We propose that surgeons should focus on technical factors that may reduce CSF leakage and take advantage of potential screening strategies for the detection of CSF leakage prior to first admission discharge.

Trends and Risk Factors for 1-Year Revision of the Latarjet Procedure: The New York State Experience During the Past Decade.

Little research has been conducted evaluating surgical trends during the past 10 years and subsequent procedure risk factors for patients undergoing bone-blocking procedures for the treatment of anterior shoulder instability. The Statewide Planning and Research Cooperative System database was queried between 2003 and 2014 to identify patients undergoing soft tissue or bone-blocking procedures for anterior shoulder instability in New York. Patient demographics and 1-year subsequent procedures were analyzed. Multivariate logistic regression analyses were conducted to identify 1-year subsequent procedure risk factors. From 2003 through 2014, a total of 540 patients had Latarjet procedures performed. During this period, the volume of Latarjet procedures increased by 950%, from 12 procedures in 2003 to 126 procedures in 2014. The volume of open Bankart repairs declined by 77%; arthroscopic Bankart repairs fluctuated, being up (328%) between 2003 and 2012 and then down (6%) between 2012 and 2014. Of the 540 patients, 2.4% (13 of 540) required intervention for recurrent shoulder instability events. Age older than 20 years and workers' compensation were identified as independent risk factors for reoperation. The number of bone-blocking procedures, such as the Latarjet, has increased by nearly 1000% during the past decade in New York. Only 2.4% (13 of 540) of the patients had subsequent shoulder instability interventions. [Orthopedics. 2018; 41(3):e389-e394.].

Racial Disparity in Utilization of High-Volume Hospitals for Surgical Treatment of Esophageal Cancer

Utilization of high-volume hospitals (HVH) for esophagectomy has been associated with improved perioperative outcomes and reduced mortality. We aimed to test the hypothesis that black-white racial disparities exist in HVH utilization and identify predictors of in-hospital surgical outcomes of esophageal cancer while adjusting for HVH utilization patterns. We queried the New York Statewide Planning and Research Cooperative System database (1995 to 2012) for esophageal cancer patients who underwent surgical resection exclusively. Only records for patients with self-reported white or black race and a valid New York State ZIP code were included (n= 2,895). Analysis was performed to identify factors associated with HVH hospital (≥20 esophagectomies/year) utilization and determine predictors of complications and in-hospital mortality. Black patients (361 [12.5%]) were significantly different (p < 0.001) than their white counterparts in the proportion of women, Medicaid, income distribution, and privately insured individuals. Although 55% patients overall utilized an HVH, blacks were significantly less likely to utilize an HVH than whites (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.14 to 0.24), even though 74.5% resided within 8.9 miles of one. Operations performed at HVHs were associated with lower in-hospital mortality (OR, 0.48; 95% CI, 0.35 to 0.65); however, mortality remained higher for blacks (OR, 2.04; 95% CI, 1.65 to 3.30; propensity matched OR, 2.45; 95% CI, 1.5 to 4.03). Black patients were less likely to undergo esophagectomy at an HVH and experienced higher mortality. Efforts should be made to understand factors influencing patients' decision process and improve referral practices to ensure optimal care is provided across all segments of the population, irrespective of race, insurance, or income status.

Early operative management of complicated appendicitis is associated with improved surgical outcomes in adults

BackgroundThere is no consensus on the ideal management of complicated appendicitis. MethodsThe New York State Planning and Research Cooperative database was used to identify all patients admitted with complicated appendicitis and undergoing appendectomy within 1-year. Primary outcome was any complication. Secondary outcomes included length of stay (LOS), hospital charges, and laparoscopy use. Outcomes were compared in appendectomy before or after 48h from admission. Results31,167 patients ≥18yo were identified for analysis, 28,015(89.9%) underwent early appendectomy. Early appendectomy patients were more likely to be White (69.8% vs. 64.2% p < 0.01), and commercially insured (53.1% vs. 45.4%, p < 0.01). Of the 3152 undergoing delayed surgery, 1610(51.1%) had surgery later during the index admission, 715(22.7%) were readmitted urgently and underwent appendectomy, and 827(26.2%) had elective appendectomy. Patients undergoing delayed surgery had more complications (OR 1.34 95%CI 1.23–1.45), readmissions (OR 1.55 95%CI 1.42–1.70), high hospital charges (OR 4.79 95%CI 4.35–5.27), and prolonged LOS (OR 6.12 95%CI 5.61–6.68). ConclusionsIn this population-level study of complicated appendicitis we found more complications, longer LOS, and higher charges in patients undergoing delayed surgery.

Risk of Ischemic Stroke After Perioperative Atrial Fibrillation in Total Knee and Hip Arthroplasty Patients

BackgroundTo determine if new-onset perioperative atrial fibrillation during arthroplasty represents a benign response to intraoperative cardiac stress or is a risk factor for stroke, we evaluated the subsequent risk of ischemic stroke in patients with new-onset atrial fibrillation occurring during primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). MethodsDischarge data of all adult patients undergoing primary TKA or THA from 1997 to 2013 were queried via the New York Statewide Planning and Research Cooperative System database to find patients with new-onset perioperative atrial fibrillation. These patients were then followed up over time to determine their risk of ischemic stroke. ResultsOf the 312,636 TKA and 215,610 THA unique patient admissions, 3646 (0.7%) had a diagnosis of new-onset perioperative atrial fibrillation. The cohort of patients with this finding was 58.9% female with an average age of 73.6 years and higher prevalence of vascular risk factors. Adjusting for validated stroke risk factors, the risk of ischemic stroke within 1 year after THA or TKA in patients with new-onset atrial fibrillation was 2.7 times higher than in those without a history of atrial fibrillation (odds ratio: 2.7, 95% confidence interval: 1.5-4.8). Hospital length of stay and charges for patients with new-onset atrial fibrillation were also greater than patients with either a prior diagnosis or no diagnosis of atrial fibrillation. ConclusionNew-onset atrial fibrillation during TKA and THA may indicate risk of ischemic stroke following surgery that should warrant medical follow-up and may increase hospital length of stay and charges.

Association between Amyotrophic Lateral Sclerosis and Diabetes Mellitus Type I and II, a New York State Planning and Research Cooperation System Database Analysis (1998–2014) (P6.461)

Association between Amyotrophic Lateral Sclerosis and Diabetes Mellitus Type I and II, a New York State Planning and Research Cooperation System Database Analysis (1998–2014) (P6.461)

Disposition of Patients Diagnosed with Myasthenia Gravis Crisis, a New York State Planning and Research Cooperation System Database Analysis (1998–2014) (P6.447)

Disposition of Patients Diagnosed with Myasthenia Gravis Crisis, a New York State Planning and Research Cooperation System Database Analysis (1998–2014) (P6.447)

Predictive values of diagnostic codes for identifying serious hypocalcemia and dermatologic adverse events among women with postmenopausal osteoporosis in a commercial health plan database

BackgroundPost-marketing safety studies of medicines often rely on administrative claims databases to identify adverse outcomes following drug exposure. Valid ascertainment of outcomes is essential for accurate results. We aim to quantify the validity of diagnostic codes for serious hypocalcemia and dermatologic adverse events from insurance claims data among women with postmenopausal osteoporosis (PMO).MethodsWe identified potential cases of serious hypocalcemia and dermatologic events through ICD-9 diagnosis codes among women with PMO within claims from a large US healthcare insurer (June 2005-May 2010). A physician adjudicated potential hypocalcemic and dermatologic events identified from the primary position on emergency department (ED) or inpatient claims through medical record review. Positive predictive values (PPVs) and 95% confidence intervals (CIs) quantified the fraction of potential cases that were confirmed.ResultsAmong 165,729 patients with PMO, medical charts were obtained for 40 of 55 (73%) potential hypocalcemia cases; 16 were confirmed (PPV 40%, 95% CI 25–57%). The PPV was higher for ED than inpatient claims (82 vs. 24%). Among 265 potential dermatologic events (primarily urticaria or rash), we obtained 184 (69%) charts and confirmed 128 (PPV 70%, 95% CI 62–76%). The PPV was higher for ED than inpatient claims (77 vs. 39%).ConclusionDiagnostic codes for hypocalcemia and dermatologic events may be sufficient to identify events giving rise to emergency care, but are less accurate for identifying events within hospitalizations.

PD38-12 THE EFFECT OF HOSPITAL AND PROVIDER VOLUME ON READMISSIONS, MORTALITY AND LENGTH OF STAY FOR RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2018PD38-12 THE EFFECT OF HOSPITAL AND PROVIDER VOLUME ON READMISSIONS, MORTALITY AND LENGTH OF STAY FOR RADICAL PROSTATECTOMY Mark Finkelstein and Michael Palese Mark FinkelsteinMark Finkelstein More articles by this author and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1759AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES An emerging body of literature has established a relationship between case volume and outcomes after radical prostatectomy (RP). The purpose of this study was to expand on this body of knowledge by analyzing a larger breadth of outcomes while factoring hospital, provider, and patient-level variables. METHODS Patients who underwent RP between 2009 and 2014 were identified using ICD-9-CM codes from the Statewide Planning and Research Cooperative System database, a comprehensive all-payer reporting system that contains all hospital discharges in New York State. Data was supplemented with facility-level information from the American Hospital Association, provider-level information from the American Medical Association Masterfile, and additional information from US Census data. Multivariable regression was used to assess the effect of hospital and physician volume, while adjusting for patient and hospital characteristics. RESULTS 25,550 encounters involving RP were identified from 2009 to 2014 of which 25,425 could be matched to a urologist and were used during the course of this study. These encounters occurred at 122 different facilities under the supervision of 388 surgeons. Of the total considered, 1,329 (5.2%) were readmitted within 90 days, 107 (0.4%) died within a year, and the median total charge was $27,216 (IQR; $21,302:$35,333). Every two-fold increase in physician caseload was associated with a 5% decrease 90-day readmission (OR 0.95 [0.92, 0.98]), 20% decrease in prolonged stay (OR 0.80 [0.78, 0.82]), no significant change in 1-year mortality rate (OR 0.91 [0.81, 1.02]), and a 7% decline in total charge (OR -0.07 [-0.08,-0.06]). Every two-fold increase in facility caseload was associated with no significant change in 90-day readmission (OR 1.03 [0.99, 1.07]), 19% decrease in prolonged stay (OR 0.81 [0.79, 0.83]), no significant change in 1-year mortality rate (OR 0.98 [0.86, 1.11]), and a 6% increase in total charge (0.06 [0.05, 0.07]). CONCLUSIONS This study demonstrated that increasing physician caseload in RP is associated with benefits in decreasing rates of 90-day readmission and prolonged stay as well as lowering associated total charges. Increasing facility volume was associated with decreases in rates of prolonged stay, but increases in associated total charges. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e741 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mark Finkelstein More articles by this author Michael Palese More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Discharge Destination After Shoulder Arthroplasty: An Independent Risk Factor for Readmission and Complications.

Postdischarge disposition after shoulder replacement lacks uniform guidelines. The goal of this study was to identify complication and readmission rates by discharge disposition and determine whether disposition was an independent risk factor for adverse events, using a statewide database. Data from the California Office of Statewide Health Planning and Development discharge database were used. Patient information was assessed, and 30- and 90-day complication rates were identified. Univariate and multivariate analyses were used to determine the complication risk. From 2011 to 2013, 10,660 procedures were identified, with 7,709 patients discharged home, 1,858 discharged home with home health support, and 1,093 discharged to postacute care (PAC) facilities. Patients discharged to PAC facilities or to home with health support tended to be older, female, and using Medicare. After controlling for confounders, at 30 and 90 days, patients discharged to PAC facilities were found to be more likely to experience a complication. Discharge to a PAC facility was an independent risk factor for complications and readmission. Level III, retrospective cohort design, observational study.

MP36-18 PREDICTORS OF READMISSIONS WITHIN 90 DAYS FOLLOWING RADICAL NEPHRECTOMY: A POPULATION-BASED ANALYSIS FROM 1995 TO 2015

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging II1 Apr 2018MP36-18 PREDICTORS OF READMISSIONS WITHIN 90 DAYS FOLLOWING RADICAL NEPHRECTOMY: A POPULATION-BASED ANALYSIS FROM 1995 TO 2015 Anthony Yang, Mark Finkelstein, Khawaja Bilal, Natan Davoudzadeh, and Michael Palese Anthony YangAnthony Yang More articles by this author , Mark FinkelsteinMark Finkelstein More articles by this author , Khawaja BilalKhawaja Bilal More articles by this author , Natan DavoudzadehNatan Davoudzadeh More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1152AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We examined the trends and risk factors for all-cause unplanned readmissions following radical nephrectomy (RN) up to 90 days. METHODS Patients who underwent RN between 1995 and 2015 were identified from the Statewide Planning and Research Cooperative System (SPARCS) database, a comprehensive all-payer reporting system containing patient level data on all hospital discharges in New York State. Donor nephrectomy patients were excluded. The chi-square test was used to compare variables. Multivariable logistic regression was used to determine independent predictors of readmission at 90 days. RESULTS 47,153 patients underwent RN in 1995-2015. The readmission rate at 90 days was 14.9%. The top diagnoses associated with readmissions at 90 days were postoperative infection (4.6%), and acute kidney failure (3.2%). Multivariable analysis demonstrated that risk factors for 90 day readmission included sex (OR female vs. male: 1.09, [1.03,1.16], p=0.002), ethnicity (OR Hispanic vs. non-Hispanic: 1.2, [1.09,1.39], p=0.001), race (OR black vs. white: 1.28, [1.17,1.4], p<0.001), income (OR bottom quartile vs. top quartile: 1.14, [1.05,1.24], p=0.003), having more comorbidities (p<0.001), insurance (OR Medicaid vs. private insurance: 1.25, [1.12,1.39], p<0.001) and large hospital bed size (OR beds greater than 600 vs. less than 200: 1.19, [1.05,1.35], p=0.006). Protective factors against 90 day readmission were age (OR 45-65 year old vs. less than 45 years old: 0.8, [0.73,0.87], p<0.001), surgeon volume (OR top quartile vs. bottom quartile: 0.73, [0.67,0.81], p<0.001) and procedure type (OR laparoscopic vs. open: 0.88, [0.8,0.96], p=0.006) (OR robotic vs. open: 0.79, [0.69,0.91], p=0.001). CONCLUSIONS Readmission at 90 days following RN is significant. Multiple patient and provider characteristics, including demographics, volume and procedure type, can predict readmission up to 90 days. This data can be used to identify patients at high risk of readmissions as well as aid in quality improvement efforts. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e465-e466 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Anthony Yang More articles by this author Mark Finkelstein More articles by this author Khawaja Bilal More articles by this author Natan Davoudzadeh More articles by this author Michael Palese More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Reoperation and complications after anterior cervical discectomy and fusion and cervical disc arthroplasty: a study of 52,395 cases.

The aim of this study was to analyze rates of perioperative complications and subsequent cervical surgeries in patients treated for cervical degenerative disc disease with anterior cervical discectomy and fusion (ACDF) and those treated with artificial cervical disc arthroplasty (ACDA) for up to 5-year follow-up. California's Office of Statewide Health Planning and Development discharge database was analyzed for patients aged 18-65years undergoing single-level ACDF or ACDA between 2003 and 2010. Medical comorbidities were identified with CMS-Condition Categories. Readmissions for short-term complications of the procedure were identified and rates of subsequent cervical surgeries were calculated at 90-day and 1-, 3-, and 5-year follow-up. Multivariate regression modeling was used to identify associations with complications and subsequent cervical surgeries correcting for patient and provider characteristics. A total of 52,395 eligible cases were identified: 50,926 ACDF and 1469 ACDA. Readmission was less common in the ACDA group (OR: 0.69, 95% CI: 0.48-1.0, p = 0.048). Subsequent cervical spine surgery was more common in the ACDF group in the immediate perioperative period (within 90days of surgery) (ACDF 3.35% vs. ACDA 2.04%, OR: 0.63, 95% CI: 0.44-0.92, p = 0.015). At 1-, 3-, and 5-year postoperatively, rates of subsequent cervical surgeries were similar between the two cohorts. We found no protective benefit for ACDA versus ACDF for single-level disease at up to 5-year follow-up in the largest cohort of patients examined to date. Early complications were rare in both cohorts stressing the value of large cohort studies to study risk factors for rare events. These slides can be retrieved under Electronic Supplementary Material.

Incidence of cholecystectomy after bariatric surgery

BackgroundBariatric surgery predisposes patients to development of cholelithiasis, and therefore the need of a subsequent cholecystectomy; however, the incidence of cholecystectomy after bariatric surgery is debated. ObjectiveThe purpose of our study is to assess the incidence of cholecystectomy after 3 of the most common bariatric procedures. SettingUniversity Hospital, involving a large database in New York State. MethodsThe Statewide Planning and Research Cooperative System administrative longitudinal database was used to identify all patients undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) between 2004 and 2010. Through the use of a unique identifier patients were followed to evaluate for the need of a subsequent cholecystectomy over at least 5 years. Cox proportional hazard regression analysis was used to identify risk factors for subsequent cholecystectomy. ResultsDuring this time period, there were 15,301 LAGB procedures, 19,996 RYGB, and 1650 SG. There were 989 (6.5%) patients who underwent cholecystectomy after LAGB, 1931 (9.7%) patients after RYGB, and 167 (10.1%) after SG. Approximately one quarter of follow-up cholecystectomies were performed at the same institutions. LAGB and RYGB were less likely to have a subsequent cholecystectomy compared with SG (hazard ratio .5, 95% confidence interval .4–.6 for LAGB; and hazard ratio .7, 95% confidence interval .6–.9 for RYGB). Risk factors for a subsequent cholecystectomy included age, sex, race, and some co-morbidities and complications (P<.05) based on a multivariable Cox proportional hazard model. ConclusionThe rate of cholecystectomy after LAGB, RYGB, and SG was 6.5%, 9.7% and 10.1%, respectively. Patients should be counseled preoperatively about this risk and biliary prophylaxis should be contemplated.

Unplanned Emergency Department Visits and Hospital Admissions Following Ureteroscopy: Do Ureteral Stents Make a Difference?

To evaluate unplanned medical visits within the early postoperative period after ureteroscopy in patients with and without ureteral stent placement. We identified all ureteroscopic procedures for urinary stone disease in the California Office of Statewide Health Planning and Development database from 2010 to 2012. The primary outcome was any emergency department visit or inpatient hospital admission in the first 7 days following ureteroscopy. Patients were subcategorized by type of ureteroscopy (ie, laser lithotripsy vs basket retrieval) and were analyzed for significant differences between stented and unstented patients. Multivariable logistic regression was performed to determine if ureteral stent placement was independently associated with unplanned visits. Our analytic cohort included 16,060 patients undergoing 17,716 ureteroscopy procedures. A ureteral stent was placed in 86.2% of patients undergoing laser lithotripsy and in 70.5% of patients receiving basket retrieval. In the 7 days following ureteroscopy, 6.6% of patients were seen in the emergency department and 2.2% of patients were admitted to a hospital. In a fully adjusted model, the utilization of a ureteral stent was not associated with emergency department visits or inpatient admissions. Ureteral stent placement during ureteroscopy is not associated with an increased odds of emergency department visits and inpatient admissions in the early postoperative period.