PMSI Database Research Articles

Hospitalisations pour neutropénie fébrile chimio-induite en France en 2010–2011 : impact clinique et caractéristiques des patients à partir des données de la base PMSI

Febrile neutropenia (FN) is a severe complication of chemotherapy in terms of morbidity and mortality. Using data from the PMSI database, the objective of this work was to estimate the clinical burden caused by hospitalization for FN in France, assessed by number of patients, number of stays and hospital mortality. Using the PMSI database (which includes all hospitalizations occurring annually in France), an algorithm was used to select newly-diagnosed patients treated by chemotherapy in 2010/2011 who were hospitalized for FN within the 30 days following each administration of chemotherapy during their first year of treatment. The number, characteristics and comorbidities of patients were described, as well as the number and length of stay and mortality in hospitalized patients. In 2010-11, 10,229 patients were hospitalized for FN, representing a hospitalization rate of 7.4% in newly-diagnosed patients receiving chemotherapy. A total of 13,559 stays were identified, with an average duration of 6.3±8.7 days (median=4 days). A total of 720 deaths occurred during the hospital stays, corresponding to a mortality rate of 7%. Among patients hospitalized for FN, there were 14% of patients with diabetes, 8% with heart failure, 34% with hypertension and 41% with at least one of these three comorbidities. With 10,299 hospitalized patients and 13,559 stays in 2010-11, the clinical burden induced by febrile neutropenia in cancer patients treated with chemotherapy is considerable.

Management of venous thromboembolism in cancer patients: the economic burden of hospitalizations.

Venous thromboembolism (VTE) is one of the most frequent events associated with cancer, requiring hospitalization and generating additional healthcare costs. To date, no studies analyzing the additional costs resulting from VTE associated with cancer in France have been published. The objective of this study was to provide an estimation of the additional cost induced by VTE with cancer by analyzing hospital stays reported in the 2013 PMSI French Hospital Database ("Programme de Médicalisation des Systèmes d'Information", a national hospital administrative database) for four cancer types (breast, lung, hepatocellular carcinoma, and colon). The analysis is divided into three parts: a descriptive evaluation of hospitalizations for VTE with cancer, an analysis by severity level of diagnosis-related groups (DRG), and an estimation of the hospital costs based on the National Reference Costs (ENC). The French public ATIH ("Agence Technique de l'Information sur l'Hospitalisation", a national Agency for Data on Hospital Care) database was used. The critical approach of this study is based on analysis of the distribution of stays according to levels of severity of DRG. A total of 14,251 hospitalizations were analyzed combining VTE and cancer. Hospitalizations of the two highest levels of severity (levels 3 and 4) for VTE with cancer represented 81.7% of all hospitalizations in this population. Increased costs were seen for all four cancer types evaluated, with cost coefficients ranging from 1.34 to 2.01. For example, the average cost of lung cancer in cancer patients with VTE in the PMSI database was 7296 € versus 4647 € in the ATIH database. Cost coefficients were calculated, ranging from 1.34 in colon cancer, 1.50 for breast cancer, 1.57 in lung cancer, and 2.01 for hepatocellular carcinoma. As discussed in the article, the current costs are high. Better physician adherence to clinical practice guidelines could potentially reduce these costs by lowering the number of recurrent VTE in patients with cancer.

“Dual disorder with drugs”: Comparison of two French databases

ContextDual diagnosis (substance used disorders (SUD) and mental illness) represents 3% of general population. Among United States population, 42.3% of SUD patients have psychiatric troubles (without tobacco). Moreover, SUD can concern all psychoactive substances (PAS) or illicit PAS only named “dual disorder with drugs” (DDD).MethodsA quantitative analysis of DDD data from January 2013 to July 2014 of two epidemiological tools has been performed: PMSI database (Programme Médicalisé des Systeme d’Information) hospital discharge data is made up of data providing medical information for all patients discharged in Paris public hospital system (AP–HP) and NOT'S is a vigilance database of spontaneous NOTifications of drug abuse and dependence. We propose a descriptive analysis of DDD in Paris metropolitan area.ResultsWith PMSI, 9.2% of SUD inpatients (n = 617) have DDD, with mean age of 46 years (62% of men). In comparison, NOT'S reports 36% of SUD with DDD (n = 302) with mean age of 39.5 years (68% of men). Suicide attempt is also listed and reach 23% of cases.ConclusionThese two databases (Fig. 1) show the difficulty of DDD diagnosis with the discordance in results. DDD miss in PMSI database since addictovigilance database shows a first prevalence of DDD. Despite the high rates of DDD, the problem is often under diagnosed by clinicians practising. It is also important to promote the collaboration among health care workers (addictologist and psychiatrist) because these patients require intensive mental and substance abuse care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

PCN76 - An Assessment of Annual Costs of Patients Hospitalized for Spinal Tumors in France: Analysis Using the Pmsi Database

To assess hospitalization costs of patients with spinal tumors in France. All hospital stays with spinal tumors were extracted from the PMSI-MCO 2012 database (French Medical Information System Program- Medicine, Surgery, Obstetric): ICD-10 codes C41.2 or C41.4 or C41.8 as principal/related or significantly associated diagnosis for primary tumors; association of ICD-10 codes C79.5 and M49.5 as principal/related or significantly associated diagnosis or M49.5 alone as principal/related diagnosis for secondary tumors. Patients were followed during one year from their first stay (e.g. March 2012/March 2013). An algorithm and a medical review excluded non spinal tumor related stays. Associated costs during this period were added up: a total annual cost (“burden”) as well as a mean annual cost per patient were estimated. Valuation was performed considering French official tariffs for 2012 and 2013 expressed in 2014 Euro. 9,415 stays were extracted and considered as directly related to spinal tumors corresponding to 3,284 patients. Patients were 66±19 years old on average, 55% were female. 94% of stays occurred in public hospitals. 56% of stays were ambulatory (length of stay, LOS = 0 day) and mean LOS associated with full hospitalizations was 11±14 days. Spine fracture management, chemotherapy and radiotherapy accounted for 30%, 30% and 28% of stays, respectively. Overall, the economic annual burden of hospitalizations for spinal tumor reason was €26 million; expensive drugs and implants funded in addition to DRGs (diagnosis related groups) accounted for 6% of this burden. The mean annual cost was €7,817±8,858 per patient. Spinal tumors are mainly managed in public hospital. Hospital-related costs associated with spinal tumors are high. New spinal tumors treatment modalities could decrease these costs.

One year of anaesthesia in France: A comprehensive survey based on the national medical information (PMSI) database. Part 1: In-hospital patients

Anaesthesia has evolved in France since the last epidemiologic survey in 1996. The national database program for medical information systems (the PMSI) can be used to track specific knowledge concerning anaesthesia for a selected period of time. The goal of this study was to perform a contemporary epidemiological description of anaesthesia in France for the year 2010. MethodsThe data concerning private or public hospital stays were collected from the national PMSI database. All surgical/medical institutions performing anaesthesia in France and French Overseas Departments and Territories were queried concerning the number of anaesthesias, patient age, sex ratios, institution characteristics, hospitalization types, the duration of hospital stays, and the surgical procedures performed. ResultsIn 2010, the number of anaesthesia procedures performed was 11,323,630 during 8,568,630 hospital stays. We found that 9,544,326 (84.3%) anaesthetic procedures were performed in adults (> 18 years of age; excluding childbirth), 845,568 (7.5%) were related to childbirth and 933,736 (8.2%) were acts in children (up to 18 years of age). The mean duration of hospital stay was 5.7±8.2 days. 56.5% of adults and 39.5% of children were managed as inpatient hospital stays. The male/female sex ratio and mean age were 42/58 and 54±19 years, respectively. In adults, anaesthesia was predominantly performed for abdominal surgery (24.5%), orthopaedics (16.7%), gynaecology (10.3%), ophthalmology (9.7%) and vascular surgeries (7.1%). For paediatric populations, the main surgical activities were Ear-Nose-Throat surgery (43.1%), orthopaedic surgery (15.1%) and urological surgeries (12.8%). DiscussionThe number of anaesthesias performed in France has dramatically increased (42.7%) since the last major epidemiological survey. Anaesthesia in the 21th century has been adapted to associated demographic changes: an older population with more comorbidities and fewer in-hospital procedures.

Compliance with pregnancy prevention plan recommendations in 8672 French women of childbearing potential exposed to acitretin.

Acitretin is an oral synthetic aromatic analogue of retinoic acid available in most European countries since 1988. It is mainly used to treat severe psoriasis. Like all systemic retinoids, acitretin is teratogenic. Strict pregnancy prevention is required in women of childbearing potential who use acitretin. This study assessed compliance with Pregnancy Prevention Plan (PPP) recommendations, specifically looking at compliance with pregnancy testing (PT) and pregnancy occurrence. A cohort of 8672 women aged 15-49 years initiating acitretin treatment from 1 January 2007 through 31 December 2013 was identified using French SNIIRAM (administrative claims data) and PMSI (hospitalisations data) databases. Pregnancy tests (PTs) were identified from reimbursed serum βHCG and urine laboratory PTs. To satisfy PT criteria, patients who started treatment had to undergo a PT within 3 days before acitretin was dispensed. Pregnancies were identified by a pregnancy-related hospital stay or an outpatient medical abortion. A PT was performed in only 12% of women starting treatment and was rarely performed during treatment or during the 24 months following discontinuation of treatment. Compliance with PPP recommendations although poor appeared to be better among private dermatologists, as a PT was performed for 16% of treatment initiations (vs. 4% for general practitioners, p < 0.001). Moreover, 470 pregnancies were reported corresponding to 27 pregnancies per 1000 person-years at risk of teratogenicity. This study highlights poor compliance with acitretin PPP recommendations in France. Physicians and pharmacists must more rigorously apply the acitretin PPP recommendations, and patients must be better informed about acitretin's risk of teratogenicity.

Tuberculose cutanée et érythème induré de Bazin : étude rétrospective de 13 cas

Tuberculosis is the most common mycobacterial disease in the world. The cutaneous form is rare in low endemic countries. The occurrence of several cutaneous tuberculosis cases in our dermatology department during 2011-2012 led us to investigate whether there was a resurgence of cutaneous tuberculosis in France. The aim was to analyse changes in cutaneous tuberculosis and the related clinical, microbiological and therapeutic data. We conducted a retrospective study in our hospital between 2005 and 2012 by querying the PMSI database (code: A 18.4). Epidemiological, clinical, paraclinical and therapeutic data were collected. Erythema induratum was regarded as a variety of cutaneous tuberculosis. Thirteen patients presented cutaneous tuberculosis between 2005 and 2012. The most frequent clinical forms were erythema induratum of Bazin (n=6) and scrofuloderma (n=3). Microbiological evidence was provided in only 4 cases. Diagnosis is difficult due to the varied clinical forms and to the relatively high frequency of paucibacillary forms. Further, the set of additional examinations is non-specific. In some cases, it is only therapeutic tests that allow diagnosis to be made. The place of new diagnostic tools must be clarified and a universally acceptable definition of erythema induratum devised.

0261: How to identify a risk for subsequent atrial fibrillation and higher risk of stroke in patients with hospitalization related to a cardiac cause?

A substantial part of ischemic strokes (IS) occurs in patients with atrial fibrillation (AF) and 20% of all strokes are attributed to AF. We aimed to identify patients with a cardiac condition without diagnosed AF at higher risk of having a subsequent diagnosis of AF. In a French longitudinal cohort study based on the PMSI database covering hospital care for the entire population, we analyzed incidence rates of new onset AF. Of 1,081,969 patients with hospitalization due to a cardiac condition in 2009, 826,416 patients did not have AF in their history but had hypertension (51%), heart failure (24%), coronary artery disease (40%), rhythm or conduction disturbances with no AF (23%), and/or valve disease (9%). A total of 61,062 (7.4%) of these patients were diagnosed as having AF during a follow-up of 17±15 months (yearly AF incidence rate 5.19%). CHA2DS2-VASc score was higher in these patients (4.63±1.66 vs 2.83±1.98 in those with no AF during FU, p<0.0001). Among these 61,062 patients, 3,623 (5.9%) also suffered stroke during follow-up and CHA2DS2-VASc score was even higher in these patients (5.29±1.60 vs 4.59±1.65 in those with AF and no stroke during FU, p<0.0001). Among them, 967/3,623 (27%) had a stroke before AF was diagnosed. A cardiac condition was associated with a substantial risk of AF (and stroke) during FU when CHA2DS2VASc score was higher.

Use of administrative hospital database to identify adverse drug reactions in a Pediatric University Hospital

The aim of the study was to detect adverse drug reactions (ADRs) in pediatric inpatients using the medical administrative database "Programme de Médicalisation des Systèmes d'Information" (PMSI) and to compare these cases ADRs with those spontaneously reported to a regional PharmacoVigilance (PV) Centre. The study was conducted from January 2008 to December 2011 in the Children University Hospital of Toulouse (Midi-Pyrénées, South-west France). From PMSI database, all discharge summaries including selected ICD-10 codes (10th International Classification of Diseases) were analyzed. All ADRs spontaneously reported by the Children Hospital of Toulouse and registered in the French PV Database (FPVDB) were included. The capture-recapture method was applied to estimate the incidence of ADRs. During the study period, we identified 60 reports from the PMSI database and 200 from the FPVDB. The rate of "serious" ADRs was higher in PMSI reports (74.6% vs 38.9%, p < 0.0001). The most frequent ADRs reported were musculoskeletal (12.4%) and central (11.3%) ADRs in PMSI database versus cutaneous (22.4%) and general (17.5%) ADRs in FPVDB. The most frequently suspected drugs were antineoplastic drugs (31.1%) in PMSI database versus anti-infectives (38.2%) in FPVDB. The estimated number of ADRs was 717 [95% confidence interval (CI) 513, 921], and the incidence of ADRs among admissions was 0.6% (95% CI 0.4, 0.8). Use of PMSI database improves from around 30% detection of ADRs in children. In comparison with classical pharmacovigilance database, it also allows to detect different ADRs and drugs, thus enhancing safe medicine use for pediatric patients.

Évaluation du PMSI comme moyen d'identification des cas incidents de cancer colorectal

Cancer registries are a reliable source of data to estimate national cancer incidence rates, but they are not always available in all regions. This study assessed the value of medical information systems (PMSI) to identify incident cases of colorectal cancer Two algorithms were elaborated to identify these incident cases in the PMSI database. The first algorithm was based on diagnosis and medical procedure codes and the second algorithm was based exclusively on diagnoses and the absence of diagnoses over the last five years. The results obtained for two departments were compared with those derived from two cancer registries, constituting the reference data. We then elaborated two multivariate logistic regression models to correct the national number of incident cases estimated by the algorithm adopted after evaluation of the results. The first algorithm provided results that were very close to those derived from the regional registries (646 vs 645 cases) with a good sensitivity and positive predictive value of 75%. The second algorithm overestimated the incidence by about 50% with a positive predictive value of 60% and was therefore not adopted for the national estimation. By applying the first algorithm to the national PMSI MCO database (medicine, surgery, obstetrics), and after modelling, the estimated incidence differed by only 2.34% compared to that observed by all 14 registries. The national estimation of cancer incidence was 39,122 [37,020; 41,224] cases for 2005, which is consistent with the figure published by the Francim national registry network (37,413). This study demonstrates the value of PMSI data for estimation of national incidence rates for certain cancers in the absence of cancer registries. However, raw data must be corrected and can be achieved by the method proposed here.

Perforations and haemorrhages after colonoscopy in 2010: A study based on comprehensive French health insurance data (SNIIRAM)

To estimate the perforation and haemorrhage rate after colonoscopy in the French population in 2010 and to identify risk factors for these complications. Study based on SNIIRAM and the PMSI databases. Patients treated for IBD or colorectal cancer were excluded. Two types of complications were investigated: perforation and haemorrhage. OR adjusted for patient (gender, age, chronic disease) and colonoscopy (polypectomy, emergency) characteristics were calculated by using a logistic regression model. The cohort was composed of 947,061 individuals. The estimated perforation rate was between 4.5 and 9.7 per 10,000 procedures and the estimated haemorrhage rate was between 9.9 and 11.0 per 10,000 procedures. The main risk factors associated with perforation and haemorrhage were the patient's age (over 80 years compared to under 40, OR=7.51 and 3.23), resection of polyps larger than 1 cm or more than 4 polyps (compared to no polypectomy, OR=2.72 and 5.12) and emergency colonoscopy (OR=4.63 and 5.99). Colonoscopy performed by a gastroenterologist performing less than 244 colonoscopies per year was associated with an increased risk of perforation (OR=2.29). Complication rates were higher in institutions performing less than 510 colonoscopies per year, but this was no longer the case after adjustment for emergency colonoscopies. This study, which includes nearly one million colonoscopies, suggests taking the gastroenterologist's number of colonoscopies into account to ensure optimal organization of the management of very elderly patients requiring colonoscopy.

État des lieux et évaluation de la surveillance des Staphylococcus aureus résistants à la méticilline (SARM) : PMSI versus surveillance Raisin

BackgroundThe surveillance of methicillin-resistant Staphylococcus aureus (MRSA) is a national priority. The rate of MRSA infections is one of six indicators tracked by the Department of Health. Since 2002, the French institute for public health surveillance (InVS) has monitored MRSA infections to estimate incidence density. Today, the use of the French administrative database (PMSI) could facilitate this surveillance. The aim of this study was to compare MRSA incidence density computed at a national level using PMSI databases with the results from the InVS taken as the reference. MethodsPMSI databases for the years 2006 to 2009 were used. The reference results were those published by the InVS from 2006 to 2009. MRSA density defined as the number of MRSA infections recorded per year over 1000 hospitals stays was computed. It was then compared with the MRSA incidence density measured by InVS. The time course of MRSA incidence in the PMSI records was modeled using a Poisson regression. ResultsThe incidence density measured by the InVS was higher than the MRSA density computed using the PMSI, but this difference appeared to decrease over time. The PMSI density/InVS MRSA incidence density ratio was 0.8% in 2006 and about 9.2% in 2009. We observed inverted trends with a growing trend in MRSA density identified by the PMSI. Furthermore, the year of study was significantly associated with incidence density (P=0.01). ConclusionUsing PMSI data as an additional source of information in the hospital MRSA surveillance process makes it possible to detect and analyze patient repeats at the regional and national levels with linkage facilities. Estimation of incidence density for hospitals not participating to this surveillance system will be the next step.

Parcours de soins des patients atteints de cancer bronchique traités chirurgicalement

The aim of the study is to describe the hospital management of patients undergoing pulmonary resection for lung cancer in France. Data from patients who underwent resection for "malignant neoplasm of bronchus and lung" in 2008 were analyzed from French PMSI database. Hospitalizations, chemotherapy and radiotherapy sessions were analyzed one year before and after the procedure. In 2008, 9161 patients were hospitalized for a resection of lung tumor. Sex ratio was 2.8 (n=6736 men) and average age was 62.8 years. During hospitalization for surgery, 3.5% of patients (n=323) died. In the year before the procedure, 10% of patients (n=961) received neoadjuvant chemotherapy (mean number: 5.2 sessions per patient). In the year after the procedure, 41% of patients (n=3796) received adjuvant chemotherapy (6.6 sessions per patient), 9% (n=812) received adjuvant radiotherapy (16.8 sessions per patient), 6% (n=562) were re-hospitalized for surgery for an additional procedure. In France, pulmonary resection for lung cancer was associated for about half of patients in a multimodal treatment with combination between chemotherapy and/or radiotherapy.

Methodology for the evaluation of vascular surgery manpower in France

The French population is growing and ageing. It is expected to increase by 2.7% by 2020, and the number of individuals over 65 years of age is expected to increase by 3.3 million, a 33% increase, between 2005 and 2020. As the number of vascular surgery procedures is closely associated with the age of a population, it is anticipated that there will be a significant increase in the workload of vascular surgeons. A model is presented to predict changes in vascular surgery activity according to population ageing, including other parameters that could affect workload evolution. Three types of arterial procedures were studied: infrarenal abdominal aortic aneurysm (AAA) surgery, peripheral arterial occlusive disease (PAOD) procedures and carotid artery (CEA) procedures. Data were selected and extracted from the national PMSI (Medical Information System Program) database. Data obtained from 2000 were used to predict data based on an ageing population for 2008. From this model, a weighted index was defined for each group by comparing expected and observed workloads. According to the model, over this 8-year period, there was an overall increase in vascular procedures of 52.2%, with an increase of 89% in PAOD procedures. Between 2000 and 2009, the total increase was 58.0%, with 3.9% for AAA procedures, 101.7% for PAOD procedures and 13.2% for CEA procedures. The weighted model based on an ageing population and corrected by a weighted factor predicted this increase. This weighted model is able to predict the workload of vascular surgeons over the coming years. An ageing population and other factors could result in a significant increase in demand for vascular surgical services.

Utilisation des données du programme de médicalisation des systèmes d’information (PMSI) dans les études épidémiologiques : application à la Cohorte Enfant Scanner

BackgroundThe “Cohorte Enfant Scanner”, a study designed to investigate the risk of radiation-induced cancer after childhood exposure to CT (computed tomography) examinations, used clinical information contained in the “programme de médicalisation des systèmes d’information” (PMSI) database, the French hospital activities national program based upon diagnosis related groups (DRG). However, the quality and adequacy of the data for the specific needs of the study should be verified. The aim of our work was to estimate the percentage of the cohort's children identified in the PMSI database and to develop an algorithm to individualize the children with a cancer or a disease at risk of cancer from medical diagnoses provided by the DRGs database. MethodsOf the 1519 children from the “Cohorte Enfant Scanner”, who had had a CT scan in the radiology department of a university hospital in 2002, a cross linkage was performed with the DRGs database. All hospitalizations over the period 2002–2009 were taken into account. An algorithm was constructed for the items “cancer” and “disease at risk for cancer” on a sample of 150 children. The algorithm was then tested on the entire population. ResultsOverall, 74% of our population was identified in the DRGs database. The algorithm individualized cancer diagnoses with 91% sensitivity (95% confidence interval [95%CI]: 86%; 97%) and 98% specificity (95%CI: 97%; 99%) and 86% positive predictive value (95%CI: 80%; 93%). For the diagnosis of disease at risk for cancer, the sensitivity, specificity and positive predictive value were respectively 91% (95%CI: 84%; 98%), 94% (95%CI: 92%; 95%) and 52% (95%CI: 43%; 61%). ConclusionThe DRG database identified with excellent sensitivity and specificity children with diagnoses of cancer or disease at risk for cancer. Hence, potential confounding factors related to the disease of the child can be taken into account for analyses performed with the cohort.

Évaluation des performances du PMSI pour l’identification des tumeurs incidentes du système nerveux central par rapport à un registre spécialisé en Gironde, France, en 2004

BackgroundCancer registries cover 18% of the French population. A national surveillance might be warranted for some potentially environment-related cancers such as tumors of the central nervous system (CNS) to detect abnormal incidence variations. The PMSI database provides an interesting source of comprehensive, standardized and mandatory data collected from all health facilities. The aim of this work was to develop methods to identify incident CNS tumors using the PMSI database. MethodsA selection of patients living in Gironde was made in the 2004 PMSI database of the hospital of Bordeaux, using the CNS tumors codification. Cases were validated via the CNS primary tumor registry of Gironde taken as the reference, or medical records. Various combinations of criteria were defined and tested. ResultsThe first selection based on diagnoses identified patients with a sensitivity of 84% and a positive predictive value (PPV) of 34%. Patients wrongly identified by the PMSI were non-incident cases (49%) or patients without a CNS tumor (45%). Patients with a tumor not identified by the PMSI had been hospitalized in 2005 (44%) or had no code for CNS tumor (42%). According to the algorithms, the sensitivity ranged from 64% to 84%, and the PPV from 34% to 69%. The best combination had a sensitivity of 67% and a PPV of 69% and was obtained with codes for CNS tumor in 2004 associated with a diagnostic or therapeutic code for persons under 70 years without code for CNS tumor in previous years or code for metastasis in 2004. ConclusionAccording to these results, the PMSI database cannot be used alone to calculate the incidence of these complex tumors. However the PMSI database plays an important role in cancer surveillance, in combination with other information sources and the expertise of cancer registries. This role could increase with further reflection and improvement of data quality.

Bronchiolite aiguë du nourrisson en France : bilan des cas hospitalisés en 2009 et facteurs de létalité

Little information is available on the characteristics of infants hospitalized for acute bronchiolitis in France. An analysis of hospital records (PMSI) was conducted at the national level to describe the cases of bronchiolitis that require hospitalization among infants under 1 year of age and the factors associated with death. The analysis of all admissions that occurred during 2009, for which the diagnosis of acute bronchiolitis was recorded in the PMSI database for infants aged less than 1 year, was performed. Cases were described according to age, sex, underlying conditions (including bronchopulmonary dysplasia, cystic fibrosis, and congenital heart disease), length of hospital stay, recurrent admissions, admission to an intensive care unit (ICU), and use of assisted ventilation. Factors associated with death during hospitalization were studied by logistic regression. The hospitalization rate was 35.8 per 1000 infants under 1 year in 2009 in France. Approximately 10% of hospitalized infants required ICU admission. Twenty-two infants died. The estimated case-fatality rate was 0.08% among hospitalized infants and 0.56% for those hospitalized in the ICU. Mortality among all infants under 1 year was 2.6/10(5) in France. Factors associated with death were bronchopulmonary dysplasia (OR=6.7, 95% CI [1.5-29.8]), hospitalization in an ICU (OR=6.46, 95% CI [2.4-17.4]), and the use of assisted ventilation (OR=6.2, 95% CI [2.2-17.1]). This study has enabled the quantification of the rate of hospitalization and mortality, and a better description of infants who need hospitalization. The results are consistent with international literature, but further prospective analysis will be needed to better describe the cases at higher risk, aiming to improve their management.

FRAX® probabilities and risk of major osteoporotic fracture in France

The incidence of hip fracture, death and the estimated incidence of major osteoporotic fracture in France were used to determine the lifetime and 10-year probability of fracture and incorporated into a probability model (FRAX®) calibrated to the French population. Fracture probabilities in the French population have not been determined. Our aim was to determine the incidence of hip fracture in France and the estimated 10-year probabilities of hip and major osteoporotic fractures. The study population included adults over 50years living in France in 2004. Incident hip fracture cases were identified from the French PMSI database. Incidence of the other major osteoporotic fractures was imputed from the relationship between hip fracture incidence and other major fracture in Sweden. These data were used to calculate population-based fracture probabilities according to age and BMD using cutoff values for femoral neck T-scores from the NHANES III data in Caucasian women. The probability model (FRAX®) calibrated to the French population was used to compute individual fracture probabilities according to specific clinical risk factors. We identified 15,434 men and 51,469 women with an incident hip fracture. The remaining lifetime probability of hip fracture at 50years was approximately 10 and 30% respectively. With a femoral neck T-score of -2 SD, one in two women and one in five men would sustain a major osteoporotic fracture in their lifetime. The 10-year probability of other major osteoporotic fractures increased with declining T-score and increasing age. Low body mass index and other clinical risk factors had an independent effect on fracture probability whether or not BMD was included in the FRAX® model. This analysis provides detailed estimation on the risk of fracture in the French population and may help to define therapeutic guidelines.

1631 EVOLUTION OF RADICAL PROSTATECTOMY PRACTICE IN FRANCE OVER A 10-YR PERIOD

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111631 EVOLUTION OF RADICAL PROSTATECTOMY PRACTICE IN FRANCE OVER A 10-YR PERIOD Jean-nicolas Cornu, Jean-Baptiste Terrasa, Philippe Sèbe, François Haab, Olivier Cussenot, and Bertrand Lukacs Jean-nicolas CornuJean-nicolas Cornu Paris, France More articles by this author , Jean-Baptiste TerrasaJean-Baptiste Terrasa Paris, France More articles by this author , Philippe SèbePhilippe Sèbe Paris, France More articles by this author , François HaabFrançois Haab Paris, France More articles by this author , Olivier CussenotOlivier Cussenot Paris, France More articles by this author , and Bertrand LukacsBertrand Lukacs Paris, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1740AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer incidence is growing in developed countries and several new therapeutic options emerged in the last 10 years for localized disease management. Our objective was to describe the evolution of the number of radical prostatectomies (RP) in France at a whole population level since 1998. METHODS Data concerning RP were extracted yearly from the national PMSI database held by the French national health insurance program. Registration of every surgical act conducted in any healthcare center is mandatory for all surgeons, so that the PMSI database is comprehensive. Data are anonymised and submitted to regular national control. We obtained the yearly number of RPs done in each French region from 1998 to 2009, divided in three surgical approaches: open, laparoscopic/robotic, and perineal. RESULTS The total number of prostatectomies grew up regularly until 2007, and started to fall down in 2008 (figure 1). The number of RPs done by laparoscopic/robotic approach was still growing, probably sustained by the recent expand of robotic surgery in the last two years. The analysis by regions, focused on year 2006 (figure 2) showed that adjusted to the number of men over 50, the rate of RP was highly variable according to the geographic area. CONCLUSIONS Despite a growing incidence of prostate cancer, the number of RPs per year severely decreased after 2007. Without any obvious reason, clinical practices are highly variable among French regions. These data should encourage practitioners from other countries to publish their results to appreciate the evolution and disparities of surgical indications at the European level. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e654 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jean-nicolas Cornu Paris, France More articles by this author Jean-Baptiste Terrasa Paris, France More articles by this author Philippe Sèbe Paris, France More articles by this author François Haab Paris, France More articles by this author Olivier Cussenot Paris, France More articles by this author Bertrand Lukacs Paris, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Benfluorex and valvular heart disease: a cohort study of a million people with diabetes mellitus

To evaluate and quantify in diabetic patients treated with benfluorex in France, a fenfluramine-derivated product, a possible increase in risk of valvular heart disease, previously suggested by several published case reports. This was a French comparative cohort study using data from two large national linked databases, health insurance system (SNIIRAM) and hospitalization (PMSI). Patients aged 40-69 years with reimbursement for oral antidiabetic and/or insulin in 2006 were eligible. Exposed patients were defined as patients with at least one benfluorex reimbursement in 2006. Selected admission diagnoses of interest in 2007 and 2008 PMSI databases were valvular insufficiency for any cause, mitral insufficiency, aortic insufficiency, and valvular replacement surgery with cardiopulmonary bypass. Relative risks (RR) were adjusted on gender, age, and history of chronic cardiovascular disease. A total of 1,048173 diabetic patients were included, with 43,044 (4.1%) exposed to benfluorex. The risk of hospitalization in 2007 and 2008 for any cardiac valvular insufficiency was higher in the benfluorex group: crude RR=2.9 [95% confidence interval 2.2-3.7] and adjusted RR=3.1 [2.4-4.0], with a lower risk for patients with lower cumulative dose of benfluorex. Adjusted RR for mitral insufficiency and aortic insufficiency admissions were 2.5 [1.9-3.7] and 4.4 [3.0-6.6], respectively. Adjusted RR for valvular replacement surgery was 3.9 [2.6-6.1]. Benfluorex in diabetic patients was significantly associated with hospitalization for valvular heart disease in the 2 years following benfluorex exposure. Linkage between SNIIRAM and PMSI databases is in France a valuable tool to quantify the risk of serious adverse drug reactions.