Posthemorrhagic Anemia Research Articles

Final observation of an extremely severe case of Osler-Weber-Rendu disease in teaching at the pregraduate and postgraduate stages of education and the use of current English-language Internet applications for doctors and patients

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome, Osler-Weber-Rendu disease, etc) is diagnosed clinically according to the so called Curacao criteria, if at least three of four of them are present: recurrent spontaneous epistaxis, mucocutaneous telangiectasias on characteristic locations, visceral vascular lesions and same disease in close relative. The described clinical case with dramatic outcome demonstrates an extremely severe course of Osler-Weber-Rendu disease complicated with recurrent massive epistaxis, long severe posthemorrhagic anemia requiring systemic red blood cell transfusions all of which became unfavorable background for the development of a fatal coronavirus disease. Demonstrations to students and interns of a rare clinical case of hereditary hemorrhagic telangiectasia with the use of actual English-language Internet sites help to improve the process of teaching general practice — family medicine at the pregraduate and postgraduate levels.

State of Red Blood Indicators in Animals With Uranium Load

Research relevance: the study of uranium load on the state of red blood is relevant in connection with the effect on the bone marrow and changes in it. Research objectives: to study conditions of red blood indicators in animals with a uranium load. Research materials and methods: experiments were carried out on rabbits of the chinchilla breed, weighing 1.7-2 kg. The animals were divided into 4 groups depending on the altitude above sea level and on the receipt of uranium from food. To obtain posthemorrhagic anemia, a single bloodletting was performed in the amount of 3% of the animal’s weight. Research results: in animals that were in mid-mountain conditions, stimulation of the red and white sprouts of the bone marrow and a pronounced regenerative reaction to the preliminary administration of uranium radionuclide and blood loss were observed. Conclusions: in animals kept in mid-mountain conditions near the uranium tailing dump, the regenerative potential of red and white bone marrow sprouts was reduced, which was confirmed by the absence of regenerative, regenerative processes after blood loss.

Delayed surgery is associated with adverse outcomes in patients with hip fracture undergoing hip arthroplasty

BackgroundHip arthroplasty (HA) is one of the most effective procedures for patients with hip fractures. The timing of surgery played a significant role in the short-term outcome for these patients, but conflicting evidence has been found.MethodsThe Nationwide Inpatient Sample database was investigated from 2002 to 2014 and identified 247,377 patients with hip fractures undergoing HA. The sample was stratified into ultra-early (0 day), early (1–2 days) and delayed (3–14 days) groups based on time to surgery. Yearly trends, postoperative surgical and medical complications, postoperative length of hospital stay (POS) and total costs were compared after propensity scores were matched between groups by demographics and comorbidity.ResultsFrom 2002 to 2014, the percentage of hip fracture patients who underwent HA increased from 30.61 to 31.98%. Early surgery groups showed fewer medical complications but higher surgical complications. However, specific complication evaluation showed both ultra-early and early groups decreased most of the surgery and medical complications with increasing post hemorrhagic anemia and fever. Medical complications were also reduced in the ultra-early group, but surgical complications increased. Early surgery groups reduced the POS by 0.90 to 1.05 days and total hospital charges by 32.6 to 44.9 percent than delayed surgery groups. Ultra-early surgery showed no benefit from POS than early group, but reduced total hospital charges by 12.2 percent.ConclusionHA surgery performed within 2 days showed more beneficial effects on adverse events than delayed surgery. But surgeons should be cognizant of the potential increased risks of mechanical complications and post-hemorrhagic anemia.

875 The Role of Frailty in Geriatric Cranial Neurosurgery for Primary Central Nervous System Neoplasms

INTRODUCTION: Frailty is a clinical state of increased vulnerability due to age-associated decline and has been well established as a perioperative risk factor. Yet, literature describing the effects of frailty on short- and long-term complications in geriatric patients is limited. METHODS: The authors conducted a retrospective cohort study between 2010 and 2017 by using the Nationwide Readmission Database. Demographics and frailty were queried at primary admission, and readmissions were analyzed at 30-, 90-, and 180-day intervals. Nearest-neighbor propensity score matching for demographics was implemented to identify nonfrail control patients with similar diagnoses and procedures. The analysis used Welch two-sample t-tests for continuous variables and chi-square test with odds ratios. RESULTS: A total of 6713 frail patients and 6629 nonfrail patients were identified at primary admission. At primary admission, frail geriatric patients undergoing cranial neurosurgery had increased odds of developing acute posthemorrhagic anemia (OR 1.56, 95% CI 1.23-1.98; p = 0.00020); acute infection (OR 3.16, 95% CI 1.70-6.36; p = 0.00022); acute kidney injury (OR 1.32, 95% CI 1.07-1.62; p = 0.0088); urinary tract infection prior to discharge (OR 1.97, 95% CI 1.71-2.29; p < 0.0001); acute postoperative cerebral infarction (OR 1.57, 95% CI 1.17-2.11; p = 0.0026); and mortality (OR 1.64, 95% CI 1.22-2.24; p = 0.0012) compared to nonfrail geriatric patients receiving the same procedure. In addition, frail patients had a significantly increased inpatient length of stay (p < 0.0001) and all-payer hospital cost (p < 0.0001) compared to nonfrail patients at primary admission. CONCLUSIONS: Frailty may significantly increase the risks of short-term acute complications in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. Long-term analysis revealed no significant difference in complications between frail and nonfrail patients.

Translated article] Usefulness of ICD-10 diagnostic triggers to identify adverse drug events in emergency care

ObjectivesTo assess the usefulness of a tool based on ICD-10 diagnostic codes to identify patients who consult an emergency department for adverse drug events (ADE). MethodsProspective observational study, in which patients discharged from an emergency department during May to August 2022 with a diagnosis coded with one of the 27 ICD-10 diagnoses considered as triggers were included. ADE confirmation was carried out by analyzing drugs prescribed prior to admission, and through a discussion among experts and a phone interview with patients after hospital discharge. Results1143 patients with trigger diagnoses were evaluated, of which 310 (27.1%) corresponded to patients whose emergency visit was attributed to an ADE. A 58.4% of ADE consultations were found with three diagnostic codes: K59.0-Constipation (n = 87; 28.1%), I16.9-Hypertensive Crisis (n = 72; 23.2%) and I95.1-Orthostatic hypotension (n = 22; 7.1%). The diagnoses with the highest degree of association with consultations attributed to ADE were E16.2-Hypoglycemia, unspecified (73.7%) and E11.65-Type 2 diabetes mellitus with hyperglycemia (71.4%), while diagnoses D62-Acute posthemorrhagic anemia and I74.3-Embolism and thrombosis of arteries of the lower limbs were not attributed to any case of ADE. ConclusionsThe ICD-10 codes associated with trigger diagnoses are a useful tool to identify patients who consult the emergency services with ADE and could be used to apply secondary prevention programs to avoid new consultations to the health care system.

Association between frailty status and complications in patients undergoing surgical excision of malignant esophageal neoplasms.

Research within the last decade highlights the patients' frailty status as an important predictor of esophageal cancer outcomes, but the literature evaluating frailty's role in these patients remains limited. We evaluated the role of frailty in patients undergoing resection of malignant esophageal neoplasms. We used the Nationwide Readmissions Database from 2016 and 2017 to identify patients who underwent excision of a malignant esophageal neoplasm. Patient frailty was queried using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Propensity score matching identified 289 frail patients and 281 non-frail patients. Mann-Whitney U testing was performed and receiver operating characteristic (ROC) curves were created, following the creation of logistic regression models for predicting discharge disposition. The area under the curve (AUC) served as a proxy for model performance. Frail patients had significantly more nonroutine discharges, longer inpatient lengths of stay, higher costs, more acute infections, posthemorrhagic anemia and deep vein thrombosis, and greater mortality (P<0.05). No significant differences were found between the 2 cohorts with respect to readmission rates, pulmonary embolism or dysphagia. Predictive models for patient discharge disposition demonstrated that frailty status in combination with age resulted in better ROC curves (AUC: 0.652) compared to models using age alone (AUC: 0.601). Frailty was found to be significantly correlated with higher rates of inpatient medical complications following esophagectomy. The inclusion of patient frailty status in predictive models for discharge disposition resulted in a better predictive capacity compared to those using age alone.

Utilidad de los diagnósticos alertantes CIE-10 para identificar acontecimientos adversos por los medicamentos en los servicios de urgencias

ObjectivesTo assess the usefulness of a tool based on ICD-10 diagnostic codes to identify patients who consult an emergency department for adverse drug events (ADE). MethodsProspective observational study, in which patients discharged from an emergency department during May to August 2022 with a diagnosis coded with one of the 27 ICD-10 diagnoses considered as triggers were included. ADE confirmation was carried out by analyzing drugs prescribed prior to admission, and through a discussion among experts and a phone interview with patients after hospital discharge. Results1,143 patients with trigger diagnoses were evaluated, of which 310 (27.1%) corresponded to patients whose emergency visit was attributed to an ADE. A 58.4% of ADE consultations were found with three diagnostic codes: K59.0-Constipation (n = 87; 28.1%), I16.9-Hypertensive Crisis (n = 72; 23.2%) and I95.1-Orthostatic hypotension (n = 22; 7.1%). The diagnoses with the highest degree of association with consultations attributed to ADE were E16.2-Hypoglycemia, unspecified (73.7%) and E11.65-Type 2 diabetes mellitus with hyperglycemia (71.4%), while diagnoses D62-Acute posthemorrhagic anemia and I74.3-Embolism and thrombosis of arteries of the lower limbs were not attributed to any case of ADE. ConclusionsThe ICD-10 codes associated with trigger diagnoses are a useful tool to identify patients who consult the emergency services with ADE and could be used to apply secondary prevention programs to avoid new consultations to the health care system.

Assessment of the effect of iron-rich humic substances on hematological parameters in the model of acute posthemorrhagic and iron deficiency anemia

Aim. To assess the effect of iron-rich humic substances on hematological parameters in acute post-hemorrhagic and iron deficiency anemia.Materials and methods. Materials for the study were samples of iron-rich active pharmaceutical ingredients based on humic substances (Fe(III) hydroxide complexes with humic substances and polymaltose): HA-Fe3+, HA-PMFe3+, FA-Fe3+, and FA-PM-Fe3+. The anti-anemic activity of the substances was studied on 53 female Wistar rats of the conventional rat line in the model of acute posthemorrhagic and iron deficiency anemia. Anti-anemic activity was assessed by the hemoglobin level, erythrocyte count, hematocrit, and serum iron level.Results. The studied substances HA-Fe3+ and FA-Fe3+ are the most effective in correcting the consequences of both experimental acute posthemorrhagic anemia and iron deficiency anemia. Their effect is comparable to that of the positive control drug Ferrum Lek.Conclusion. Fe(III) hydroxide complexes stabilized by humic and fulvic acids exhibit anti-anemic activity.

МИОМА МАТКИ БОЛЬШИХ РАЗМЕРОВ ПОСЛЕ ОСЛОЖНЕННОГО КЕСАРЕВА СЕЧЕНИЯ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Uterine fibroids is a benign, encapsulated tumor of the female genital area, often found in reproductive age. The pathogenetic mechanism and causes of the development of uterine fibroids are unknown, hence there are questions and disputes on identifying causation. A predisposition of fibroids can serve as chronic inflammatory diseases of the female genital organs, methods of surgical treatment (artificial abortions, cesarean section, biopsy of lining of uterus), dysfunctions of the hypothalamus-pituitary gland-adrenal glands-ovaries, heredity, occupational hazards, extragenital diseases. One of the current issues of modern obstetric and gynecological care is the increasing frequency of cesarean section. Caesarean section is one of the most important risk factors for infection, which causes adverse long-term complications for a woman’s health. Research purpose : to highlight with an example of clinical case how a complicated caesarean section provoked the occurrence of complicated large uterine fibroids in a woman of the reproductive period. The presented material describes a clinical case of a patient who underwent surgical treatment in the gynecological department with a diagnosis of “Multiple uterine fibroids. Tumor growth. Hypermenstrual syndrome. Posthemorrhagic anemia”. The presented clinical case emphasizes the need for a qualified approach to operative delivery, the technique of performing a caesarean section and postoperative management. Conclusion . Treatment of patients with uterine fibroids should be carried out in full, including observation and monitoring for early detection of this pathology, as well as timely preoperative preparation with surgical treatment such as myomectomy and metroplasty. In the early and late postoperative period, measures after caesarean section should be comprehensive and include timely detection of infectious complications, rational antibiotic therapy.

The influence of frailty on perioperative outcomes in patients undergoing surgical resection of liver metastases: a nationwide readmissions database study.

Liver metastases arise frequently from primary colorectal, pancreatic, and breast cancers. Research has highlighted the patient's frailty status as an important predictor of outcomes, but the literature evaluating the role of frailty in patients with secondary metastatic disease of the liver remains limited. Using predictive analytics, we evaluated the role of frailty in patients who underwent hepatectomy for liver metastases. We used the Nationwide Readmissions Database from 2016-2017 to identify patients who underwent resection of a secondary malignant neoplasm of the liver. Patient frailty was evaluated using the Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining diagnosis indicator. Propensity score matching was performed and Mann-Whitney U testing was used to analyze complication rates. Receiver operating characteristic (ROC) curves were created following creation of logistic regression models for predicting discharge disposition. Frail patients reported significantly higher rates of nonroutine discharges, longer inpatient stays, greater costs, higher rates of acute infection, posthemorrhagic anemia, urinary tract infection (UTI), deep vein thrombosis (DVT), wound dehiscence and readmission, and greater mortality (P<0.05). Predictive models for patient discharge disposition, DVT and UTI demonstrated that the use of frailty status and age improved the area under the ROC curves significantly compared to models using age alone. Frailty was found to be significantly correlated with higher rates of medical complications during inpatient stay following hepatectomy in patients with liver metastasis. The inclusion of patient frailty status in predictive models improved their predictive capacity compared to those using age alone.

Varicose veins of the esophagus as a manifestation of left-sided portal hypertension

An autopsy of pancreatic cancer in a woman who died from acute posthemorrhagic anemia due to repeated bleeding from esophageal varices is presented. The mechanism of development of esophageal varices associated with the so-called left-sided portal hypertension, caused by compression of the splenic vein by the tumor and the opening of porto-caval anastomoses, is considered. A brief review discusses other possible causes of left-sided portal hypertension syndrome and its consequences.

Анемия при кровотечении у животных

Iron is essential to virtually all living organisms and is integral to multiple metabolic functions. The most important function is oxygen transport in hemoglobin. Iron deficiency anemia in dogs and cats is usually caused by chronic blood loss and can be discovered incidentally as animals may have adapted to the anemia. Severe iron deficiency is characterized by a microcytic, hypochromic, potentially severe anemia with a variable regenerative response. Iron metabolism and homeostasis will be reviewed, followed by a discussion of diagnostic testing and therapeutic recommendations for dogs and cats with iron deficiency anemia. Severe iron deficiency is characterized by microcytic, hypochromic, potentially severe anemia with variable regenerative response. Iron metabolism and homeostasis will be reviewed, followed by diagnostic testing and therapeutic recommendations for dogs and cats with iron deficiency anemia. In chronic cases, the characteristic symptoms develop slowly, gradually progressing. The course and outcome of posthemorrhagic anemia depend on the etiological factors that led to blood loss, and on the functional usefulness of the hematopoietic organs, as well as other body systems as a whole (age, pregnancy, fatness…). The diagnosis is based on the data of anamnesis, clinical examination of the animal, as well as on the basis of the results of a laboratory study of the composition of peripheral blood. Treatment. It is necessary to stop the bleeding and establish the causes that caused blood loss. With external injuries, this is achieved by tight tamponade of wounds, the application of a tourniquet, etc. With internal bleeding, drugs are used that increase blood clotting and cause contractions of small blood vessels. For these purposes, calcium chloride and calcium gluconate are injected intravenously at a 10% concentration of 10-20 ml. To stop internal bleeding, intravenous injections of 10% calcium chloride solution, 10% gelatin solution, 5% ascorbic acid solution are used. Use blood transfusion, the introduction of isotonic sodium chloride solution, Ringer-Lock solution. From stimulants: glycerophosphate, hemostimulator, preparations of cobalt, copper. In chronic cases, specific antianemic agents are used, including preparations of iron, copper, cobalt, vitamin B12, and folic acid. It is useful to feed raw liver to dogs.

Micotic aneurysm of the internal carotid artery in a patient with sarcoidosis as a cause of ischemic stroke and profuse epitaxis

The article describes the following case: a 63-year-old patient with sarcoidosis, who was on long-term therapy with metipred, developed profuse epistaxis, and upon admission to the hospital, clinical manifestation of stroke. Computer tomography (CT) of the brain at admission revealed destruction of the posterior wall of the sphenoid bone and an area of increased density in the projection of the left optic nerve regarded as a neoplasm of the sphenoid sinus or inflammatory changes. CT angiography revealed the occlusion of the left internal carotid artery (LICA) from the C1 segment throughout. At the time of thrombus extraction, the patient developed profuse bleeding from the nasal cavity. According to staged angiography, the antegrade blood flow through the LICA to the sphenoid segment was restored; against the background of profuse bleeding, the flow of contrast from the LICA into the sphenoid sinus and further into the nasopharynx is visualized; in the projection of the sphenoid sinus, a formation was revealed that required differentiation between a giant aneurysm, an arteriovenous fistula, and a neoplasm of the sphenoid sinus. Destructive embolization of the LICA at the level of the petrosal segment was performed for vital indications, the bleeding was stopped, but the patient died due to acute posthemorrhagic anemia. An autopsy revealed a mycotic aneurysm of the LICA, the rupture of the wall of which caused nasal bleeding, which was spontaneously stopped due to the formation of an extended thrombus, which, in turn, became the cause of stroke.

What Is the Safest Intersurgical Interval between Staged Bilateral Total Knee Arthroplasty? A Nationwide Analysis of 20,279 Patients.

In staged bilateral total knee arthroplasty (BTKA), the intersurgical time is yet to be determined. This study aimed to (1) test for differences in in-hospital metrics between the index and contralateral TKA and (2) determine the safest intersurgical time interval to minimize adverse outcomes after the contralateral surgery. The National Readmissions Database was queried for patients who received staged BTKA (2016-2017). A total of 20,279 patients were included. Demographics, comorbidities, baseline determinants, and intersurgical time between index and contralateral TKAs (≤ 3 month, 4-6 months, 7-9 months, and 10-12 months intervals) were captured. Outcomes included healthcare utilization (length of stay [LOS] and nonhome discharge), in-hospital costs, and in-hospital complications. Outcomes were compared between index versus contralateral surgeries and among contralateral surgeries of various intersurgical intervals. Contralateral surgeries had shorter LOS (2.2 ± 1.9 vs. 2.4 ± 2.0 days; p < 0.001), lower nonhome discharge (n = 2692[13.2%] vs. n = 2963[14.7%]; p = 0.001), and in-hospital costs ($16,476 ± $7,404 vs. 16,774 ± $9,621; p < 0.001), but similar rates of nonmechanical (p = 0.40) complications compared with index TKA. Multivariable regression demonstrated that intersurgical time was not associated with nonmechanical complications or transfusion, or 30-day readmission (p > 0.05, each). Compared with the less than or equal to 3-month interval, the 4 to 6-month interval exhibited highest odds ratio (OR) of any infection (OR: 1.81; 95% confidence interval [CI]: [1.13-2.88]; p = 0.013), urinary tract infection (OR:1.81, 95%CI: [1.13-2.90]; p = 0.014), and any-cardiac complications (OR:1.17; 95%CI: [1.01-1.35]; p = 0.037). Patients in the 10-12-month cohort had lowest odds of posthemorrhagic anemia (OR: 0.84; 95% CI: [0.72-0.98]; p = 0.03). Overall, the second surgery of a staged BTKA has lower healthcare utilization despite similar complication rates. While patients in the 10 to 12-month intersurgical interval had the most favorable overall safety profile, no single interval exhibited consistently lower complications for all measured outcomes. Special care pathways should be optimized to care for patients undergoing staged BTKA.

Identifying prevalence and inpatient outcomes of anemia and hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a multifactorial inflammatory disorder. Previous studies have ascertained an association between anemia and HS; however, they were limited by low sample size and lack of demographic information. The objective of this study is to address the concerns of prior research and identify specific subgroups and subtypes of anemia present in HS patients and evaluate how these subgroups impact hospital outcomes. We analyzed HS hospitalizations using the National Inpatient Sample from the years 2016 to 2019. HS was associated with the nutritional anemia, aplastic anemia, and acute posthemorrhagic anemia subgroups. Within these subgroups, HS was specifically associated with iron deficiency anemia, anemia of chronic disease, and other anemia subtypes. HS patients also displayed a lower risk of having aplastic anemia, also described as anemia from bone marrow failure. Our findings build upon previous studies evaluating HS and anemia and provide a clearer understanding of the association as well as how it impacts inpatient outcomes.

Heart Failure is Associated with Early Medical and Surgery-Related Complications Following Total Hip Arthroplasty: A Propensity-Scored Analysis

IntroductionThere is a paucity of literature that examines how heart failure (HF) impacts surgery-related complications following total hip arthroplasty (THA). We hypothesized that patients who had HF will be at increased risk of early medical- and surgery-related complications following THA. MethodsPatients who had HF and underwent primary THA between 2010 and 2019 were identified using a large national insurance database. Ninety-day incidence of various medical complications, surgery-related complications, and hospital utilizations were evaluated for patients who did and did not have HF, as well as subgroup analyses were performed on patients who were prescribed mortality-benefitting medications for HF 1 year prior to THA. Propensity score matching resulted in 34,000 HF patients who underwent primary THA and 340,000 matching patients. ResultsThe HF cohort was associated with a higher 90-day incidence of pulmonary embolism (PE), deep vein thrombosis (DVT), transfusion, pneumonia, cerebrovascular accident (CVA), myocardial infarction (MI), sepsis, acute post hemorrhagic anemia, acute renal failure (ARF), and urinary tract infection (UTI), as well as 1-year risk of revision THA, periprosthetic joint infection (PJI), aseptic loosening, and dislocation compared to controls. The HF cohort was associated with a higher 90-day incidence of emergency department visits, readmissions, lengths of stay (LOS), and 1-year costs of care. The medication cohort was at decreased risk of PE, DVT, CVA, return to ED, readmission and MI within 90 days of surgery, and 1-year risk of revision THA and aseptic loosening. DiscussionThese findings may help to better risk-stratify patients who have HF and are scheduled to undergo THA, as well as call for additional surveillance of these patients in the immediate and early postoperative period. This study also helps surgeons and internists understand how chronic medications used to treat HF can impact medical- and surgery-related outcomes following THA.

SURG-38. ASSESSING THE ROLE OF FRAILTY IN CRANIAL NEUROSURGERY FOR PRIMARY CNS NEOPLASMS IN THE GERIATRIC POPULATION: SEVEN YEAR RETROSPECTIVE ANALYSIS USING THE NATIONWIDE READMISSION DATABASE

Abstract Frailty is a clinical state of increased vulnerability due to age-associated decline and has been well established as a perioperative risk factor. Yet, literature describing the effects of frailty on short- and long-term complications in geriatric patients is limited. In this study, the authors evaluate the effects of frailty in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. For this purpose, we conducted a retrospective cohort study between 2010 and 2017 by using the Nationwide Readmission Database. Demographics and frailty were queried at primary admission, and readmissions were analyzed at 30-, 90-, and 180-day intervals. Nearest-neighbor propensity score matching for demographics was implemented to identify nonfrail control patients with similar diagnoses and procedures. The analysis used Welch two-sample t-tests for continuous variables and chi-square test with odds ratios. A total of 6713 frail patients and 6629 nonfrail patients were identified at primary admission. At primary admission, frail geriatric patients undergoing cranial neurosurgery had increased odds of developing acute posthemorrhagic anemia (OR 1.56, 95% CI 1.23-1.98; p = 0.00020); acute infection (OR 3.16, 95% CI 1.70-6.36; p = 0.00022); acute kidney injury (OR 1.32, 95% CI 1.07-1.62; p = 0.0088); urinary tract infection prior to discharge (OR 1.97, 95% CI 1.71-2.29; p &amp;lt; 0.0001); acute postoperative cerebral infarction (OR 1.57, 95% CI 1.17-2.11; p = 0.0026); and mortality (OR 1.64, 95% CI 1.22-2.24; p = 0.0012) compared to nonfrail geriatric patients receiving the same procedure. In addition, frail patients had a significantly increased inpatient length of stay (p &amp;lt; 0.0001) and all-payer hospital cost (p &amp;lt; 0.0001) compared to nonfrail patients at primary admission. Frailty may significantly increase the risks of short-term acute complications in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. Long-term analysis revealed no significant difference in complications between frail and nonfrail patients.

Surgical Complication Risk Factor Identification Using High-Dimensional Hospital Data: An Illustrative Example in Hemostasis-Related Complications.

To describe an approach wherein high-dimensional hospital data can be used to identify generalizable risk factors for surgical complications for which there may be limited prior knowledge, as illustrated in the context of hemostasis-related complications (HRC). This was a retrospective study of the Premier Healthcare Database. Patients included for the study underwent video-assisted thoracoscopic lobectomy (VATL), laparoscopic right colectomy (LRC), or laparoscopic sleeve gastrectomy (LSG) on an inpatient setting between Oct-2015 and Feb-2020 (first = index). The outcome, HRC, comprised hemorrhage, control of bleeding, and acute posthemorrhagic anemia. For each cohort, a high-dimensional dataset (ie, comprising 1000s of candidate risk factors) was constructed using taxonomies from the Clinical Classification Software Refined (CCSR). Candidate risk factors were fed into logistic regression models with a 70%/30% train/test split for each cohort; clinically plausible risk factors that were consistently significant predictors of HRC across the 3 training models were then used in a final parsimonious model including sex, age, race, and payor; finally, the parsimonious model was applied to the test data to compare predicted risk with observed incidence of HRSC. The study included 11,141 VATL, 20,156 LRC, and 121,547 LSG patients, in whom 7.5%, 7.8%, and 1.2% experienced HRSC, respectively. Ultimately, 6 clinically plausible CCSR categories were identified as being statistically significant predictors across all 3 cohorts (eg, coagulation and hemorrhagic disorders, malnutrition, alcohol-related disorders, among others). In the parsimonious model applied to the test data, the observed incidence of HRSC was substantially higher in the top quintile vs bottom quintile of predicted risk: LSG 2.05% vs 0.53%, LRC 13.30% vs 4.11%, VATS 12.49% vs 5.04%. High-dimensional real-world data can be useful to identify risk factors for outcomes that generalize across multiple cohorts. The risk factors identified herein should be considered for inclusion in future studies of hemostasis-related complications.

Understanding rates, risk factors, and complications associated with manipulation under anesthesia after total knee arthroplasty (TKA): An analysis of 100,613 TKAs

BackgroundConsidering the growing adoption of technology-assisted total knee arthroplasties (TKA), previous database studies evaluating post-operative stiffness may be outdated. The present study aimed to: (1) evaluate the incidence of manipulation under anesthesia (MUA) after primary TKA; (2) determine independent risk factors for MUA; and (3) assess complications after MUA. MethodsPrimary TKAs, with at least 6-month follow-up, were identified from the Florida State Inpatient Database (January 2016–June 2018) and linked to outpatient records from the Florida State Ambulatory Surgery and Services Database. Multivariable regression analyses were performed to compare patient factors and complications (e.g., mechanical, non-mechanical, infectious) associated with MUA, while adjusting for baseline demographics, comorbidities, use of robotic- and computer-technologies, time to MUA (0–3, 3–12, or >12 months), and need for repeat MUA (one-time vs >1). ResultsThe MUA rate was 2.8% (2821 of 100,613). Being younger, a woman, Black or Hispanic; having private or self-pay insurance; and conventional TKA were associated with significantly higher odds of undergoing MUA. Higher rates of mechanical complications and acute posthemorrhagic anemia were observed in the MUA cohort. Time to MUA, repeat MUA, and baseline demographics were not associated with complication rates among the MUA cohort. ConclusionOverall, 1 in 36 patients underwent MUA after primary TKA. Several non-modifiable patient characteristics, such as Black or Hispanic race, female sex, and younger age were associated with an increased risk of MUA. However, technology-assisted TKA might help to decrease the risk of MUA.

Retrospective Comparison of Clinical and Economic Outcomes of Non-Donor Patients Undergoing Radical Nephrectomy Using One of Two Different Linear Stapler Technologies for Transection of the Renal Vessels: Fixed-Height Gripping Surface Reloads vs Variable-Height Reloads.

PurposeTo compare outcomes of non-donor patients undergoing radical nephrectomy using fixed-height gripping surface (FHGS) vs variable-height Tri-Staple™ (VHTS) reloads for transection of the renal vessels.Patients and MethodsUsing the Premier Healthcare Database of US hospital discharge records, we selected non-donor patients undergoing inpatient radical nephrectomy with dates of admission between 1 October 2015, and 31 December 2020 (first=index admission). The primary outcome was in-hospital hemostasis-related complications (hemorrhage, acute posthemorrhagic anemia, and/or procedure to control bleeding) during the index admission. Secondary outcomes included index admission intraoperative injury, blood transfusion, conversion from minimally invasive to open surgery, total hospital costs, length of stay (LOS), discharge status, and mortality as well as 30-day all-cause inpatient readmission. We used stable balancing weights to balance the FHGS and VHTS groups on numerous patient, procedure, and hospital/provider characteristics, allowing a maximum post-weighting standardized mean difference ≤0.01 for all covariates; we also exactly matched the groups on laterality (right vs left kidney) and intended surgical approach (open, laparoscopic, robotic). We used bivariate multilevel mixed-effects generalized linear models accounting for hospital-level clustering to compare the study outcomes between the FHGS and VHTS groups.ResultsAfter weighting, the FHGS and VHTS groups comprised 2952 and 795 patients, respectively. The observed incidence proportion of the primary outcome of hemostasis-related complications during the index admission was similar between the groups (8.6% for FHGS vs 9.0% for VHTS, difference 0.4% [95% CI −3.2% to 2.5%], P=0.808). Differences between the FHGS and VHTS groups were not statistically significant for any of the secondary outcomes.ConclusionEndoscopic surgical staplers have become common for transection of the renal vessels during radical nephrectomy, with FHGS and VHTS being the predominant reload types. In this retrospective study of 3747 non-donor patients undergoing radical nephrectomy, use of FHGS vs VHTS reloads was associated with similar clinical and economic outcomes.