Principal Procedure Research Articles

The relationship of paternalistic leadership and organizational commitment

Paternalistic leadership is reported to have a favourable correlation with employee organisational commitment. This commitment is provided in exchange for the paternalistic leaders' care, attention, and protection of employees in both professional and personal contexts. Nonetheless, numerous further research have identified a negative tendency in this association. This research employed a Systematic Literature Review (SLR) utilising PRISMA as the principal procedure, identifying 16 articles published from 2014 to July 2024 that investigate the correlation between paternalistic leadership and organisational commitment. This relationship is delineated through two frameworks: firstly, paternalistic leadership induces varying degrees of employee organisational commitment; secondly, organisational commitment serves as a mediator between paternalistic leadership and other variables. From these two schemes, it is evident that (i) a positive correlation exists between benevolence and moral leadership and organisational commitment, albeit with variations in the types of commitment elicited by these leadership dimensions; (ii) authoritarian leadership elicits a negative reaction towards two forms of organisational commitment (affective and normative) among employees, while inducing a marginally positive response towards continuance commitment; and (iii) organisational commitment as a mediator exhibits a "inconclusive" effect.

Incremental Societal Costs of Perioperative Complications Following Adult Elective Inpatient Major Therapeutic Surgery in the State of Florida: A Seven-Year Retrospective Epidemiological Analysis.

Introduction There is an expanding role for anesthesiologists in the preoperative optimization and postoperative management of patients, often in the context of a so-called perioperative surgical home. Such efforts typically include enhanced recovery after surgery (ERAS) protocols and often an anesthesiologist-led team for perioperative management. Studies of the cost-effectiveness of such approaches have generally been conducted at single institutions, with most patients cared for by small numbers of surgeons. This limitation creates generalizability issues as to whether improvement was related mostly to organizational culture or the studied surgeons' practices (non-generalizable) versusthe procedures (generalizable). We studied whether other organizations can rely on achieving similar benefits following the adoption of a studied process improvement strategy at a single institution. Methods All patients undergoing elective major therapeutic inpatient surgery discharged between October 2015 and June 2022 at non-federal hospitals in the state of Florida were included. For each discharge, the United States Medicare Severity Diagnosis-Related Group (MS-DRG) weighting factor (i.e., the multiplier for the hospital's base rate for admissions that determines reimbursement) and the Clinical Classification Software Refined (CCSR) code for the principal procedure were determined at admission and discharge from the state's inpatient healthcare database based on the diagnoses present at those time points. An increase in the weighting factor from admission to discharge represents societal costs from perioperative complications. Statewide, by hospital, and by surgeon, we calculated the total increase for each CCSR's weighting factor. Our primary hypothesis was that surgeon variability would be statistically greater than CCSR variability but that the incremental effect would be <5%. If CCSR and surgeon variability were comparable, this would be supportive of generalizability. In contrast, if there were a predominant effectrelated to the surgeon, results from one institution might not be applicable to others. Results Among the 1,482,344 discharges studied, the pooled (N=7 years) contributions to MS-DRG weighting factor increases from the upper 20% of surgeons were 2.8% more than from the upper 20% of CCSRs (95% CI 1.9%-3.9%, p=0.0006). Those CCSRs accounted for 85.5% (95% CI 79.4%-91.7%, p<0.0001) of the total increase in the MS-DRG weighting factor. The average contribution of the top two surgeons at each hospital to that hospital's increase in the weighting factor ranged among CCSRs from 68% to 97%.The median and 75th percentile of surgeons performing at least 10% of the total number of cases at each hospital was similar to those values for the contributions to the increases in the MS-DRG weighting factor, median 2.0 to 3.0, and 75th percentile 1.75 to 4.0. Conclusions Because variability among surgeons in their contributions to increases in the MS-DRG weighting factor only slightly exceeded the variability among CCSR surgical categories, perioperative surgical home and ERAS study research results involving single institutions and a small number of surgeons would likely be generalizable to other hospitals and healthcare systems. Funding agencies should not be hesitant to fund single-center perioperative surgical home studiesand ERAS interventions based on concerns related to lack of generalizability.

Sex-based disparities in patients with lung cancer undergoing lobectomy via robotic-assisted thoracoscopic surgery.

e20005 Background: The 2023 report from the World Health Organization(WHO) ranked lung cancer (LC) as the top cause of cancer-related fatalities worldwide. Recently, minimally invasive procedures such as robotic-assisted thoracoscopic surgery (RATS) have been introduced as part of the treatment of some LC cases. Our study aims to bridge the understanding of potential sex-based disparities among LC patients undergoing lobectomy via RATS. Methods: We analyzed the 2016-2020 National Inpatient Sample (NIS) for adult lung cancer(malignant or carcinoma in situ) patients with a principal procedure code of lobectomy with RATS. Cases with underlying mycoses, mycobacterial infection, and pulmonary abscesses were excluded based on recommendations from prior studies. Multivariate regression models helped evaluate sex-based differences in several complications. Results: An estimated 26385 lung cancer patients underwent lobectomy via RATS, consisting of 56.68% females (14955 cases) and 43.32% males (11430 cases). Age differences were noted as females were younger (mean age 67.80 years vs. 69.14 years, p &lt; 0.01). We also found that females were less likely to report several complications, such as acute kidney injury (AKI) (3% vs. 6.6%, aOR 0.538, p &lt; 0.001), pneumonia (2.8% vs. 4.3%, aOR 0.725, p &lt; 0.001), post-procedural air leak (9.2% vs. 11.2%, aOR 0.797, p &lt; 0.001), post-procedural cardiac arrest (0.6 % vs. 1.6%, aOR 0.349, p &lt; 0.001), pulmonary embolism (0.2% vs. 0.5%, aOR 0.345, p &lt; 0.001), deep vein thrombosis (DVT)(1.5% vs. 2.2%, aOR 0.742, p: 0.003), atrial fibrillation (AF)(13% vs 21.7%, aOR 0.564, p &lt; 0.001), acute myocardial infarction (AMI) (0.2% vs. 0.5%, aOR 0.58, p:0.027), and death (0.3% vs. 0.9%, aOR 0.505, p &lt; 0.001). Notably, females were more likely to have an open procedure conversion (0.2% vs 0.1%, aOR 2.235, p:0.017). However, there is no significant difference between the two sexes regarding post-procedural pneumothorax and respiratory failure, atelectasis, supraventricular tachycardia, and events of acute ischemic stroke. Conclusions: Our most recent analysis confirms that among LC patients undergoing lobectomy via RATS, males were more prone to several complications than females. However, we also found that females were more likely to necessitate an open procedure conversion. We, therefore, advocate for further research to enhance our understanding of such disparities and strategies to address them effectively.

Fast Fractional Fourier Transform-Aided Novel Graphical Approach for EEG Alcoholism Detection.

Given its detrimental effect on the brain, alcoholism is a severe disorder that can produce a variety of cognitive, emotional, and behavioral issues. Alcoholism is typically diagnosed using the CAGE assessment approach, which has drawbacks such as being lengthy, prone to mistakes, and biased. To overcome these issues, this paper introduces a novel paradigm for identifying alcoholism by employing electroencephalogram (EEG) signals. The proposed framework is divided into various steps. To begin, interference and artifacts in the EEG data are removed using a multiscale principal component analysis procedure. This cleaning procedure contributes to information quality improvement. Second, an innovative graphical technique based on fast fractional Fourier transform coefficients is devised to visualize the chaotic character and complexities of the EEG signals. This elucidates the properties of regular and alcoholic EEG signals. Third, thirty-four graphical features are extracted to interpret the EEG signals' haphazard behavior and differentiate between regular and alcoholic trends. Fourth, we propose an ensembled feature selection method for obtaining an effective and reliable feature group. Following that, we study many neural network classifiers to choose the optimal classifier for building an efficient framework. The experimental findings show that the suggested method obtains the best classification performance by employing a recurrent neural network (RNN), with 97.5% accuracy, 96.7% sensitivity, and 98.3% specificity for the sixteen selected features. The proposed framework can aid physicians, businesses, and product designers to develop a real-time system.

Institutional framework, macroeconomic instability and financial markets: perspective from emerging economies

Purpose The study evaluates the role of institutional framework and macroeconomic instability on financial market development among emerging economies.Design/methodology/approach The study uses panel data compiled from 32 countries from the sub-region of Sub-Sahara Africa (SSA), covering the period starting from 1996 to 2019. Empirical analyses were carried out using the two-step system generalized method of moments (TS-GMM) statistical framework.Findings Reviewed results suggest that institutional quality, effective governance and corruption control have a significant positive impact on financial market development among economies in the sub-region. Further empirical estimates show that macroeconomic risk and macroeconomic uncertainty have significant adverse effects on financial market development. Additionally, reported empirical estimates suggest that an improved institutional framework has the potential to lessen the adverse effect of macroeconomic instability on financial market development among economies in the sub-region.Originality/value The uniqueness of this empirical inquiry compared to related studies in the present literature stems from the fact that studies employing similar empirical approaches on the subject matter for economies in the sub-region are rare. Additionally, the analysis pursued in this study employs critical variables whose impact on financial market performance in the sub-region has not been examined per our review. These variables include indexes such as macroeconomic risk and institutional quality, which are unique to this study based on their construction; these indexes are generated using a principal component analysis procedure with different underlying variables compared to what may be found in the literature.

A review on application and innovation of wind-solar power generation technologies based on dual carbon targets

With the increasing depletion of traditional energy sources, the greenhouse effect is becoming increasingly serious, mankind is in urgent need of clean and renewable new energy demand is increasing, in order to support the carbon peak&amp;carbon neutral goal, in the future a longer period of time, the improvement of wind power age innovation is the principal procedure for the advancement of numerous nations today, many countries and international organizations to vigorously promote the development of wind power and photovoltaic power generation system will also continue to accelerate the development of new energy generation systems in China. Chinas renewable power age framework, which is basically founded on wind power and will keep on progressing, is being fiercely promoted by many nations and international organizations. This thesis mainly exemplifies the many applications of wind power generation technology in China based on the dual-carbon target through the approaches of literature reviews, and incorporates the inventive innovation model of wind power age innovation and different methodologies. Combined with domestic and international cases, this review summarizes how to solve the dilemmas faced by renewable energy technologies and how to optimize the operation and improve the efficiency of power generation by using innovative technologies, which can provide technical support for the realization of the dual-carbon goal.

Scoring system related to retrograde percutaneous coronary intervention for coronary chronic total occlusion

AbstractThe retrograde approach is a principal procedure used in coronary chronic total occlusion percutaneous coronary intervention. However, the retrograde approach presents more challenges compared with the antegrade approach, as it is associated with a lower rate of success and a higher risk of complications. An accurate pre‐procedural evaluation of the complexity of a lesion could aid in the planning of the procedure, in estimating the procedure's duration, or in determining whether the patient should be referred to another center specializing in CTO‐PCI, as well as in a more precise evaluation of the risk‐benefit ratio. In recent years, multiple scoring systems have been created to forecast the success and efficiency of the retrograde procedure. However, each scoring system was developed independently, and comparative studies were lacking. This article provides a review of these scoring systems, offers an overview of the current state of the retrograde approach, and aims to stimulate further discussion on this topic.

Diagnostic implication of thyroid spherules for cytological diagnosis of thyroid nodules.

Thyroid fine-needle aspiration (FNA) is a principal diagnostic procedure for thyroid nodules. A specific cytomorphological structure, known as the thyroid spherule, is often seen in FNA specimens. The clinical significance of these spherules in terms of diagnosis and prevalence remains largely unexplored. We performed a retrospective study on 310 thyroid FNA specimens and categorized them according to the Bethesda System for Reporting Thyroid Cytopathology. The presence, size and number of thyroid spherules in each specimen were examined and these data were subsequently correlated with the clinicopathological features. Thyroid spherules were almost exclusively detected in benign cases, comprising 7.6% of all benign diagnoses. The average diameter of spherules in benign cases was 84.9 μm. Benign cases and cases with atypia of undetermined significance cases primarily exhibited low cellularity, while follicular neoplasms and malignant cases typically showed moderate to high cellularity. In the subgroup of FNA cases with moderate to high cellularity, spherules were identified in 12 (20%) of 59 benign FNA cases. Within this group, the sensitivity and specificity of thyroid spherules for detecting benign FNA cases were 20% and 100%, respectively. Our results suggest that the presence of thyroid spherules in FNA specimens can serve as a highly specific marker for benign thyroid conditions. The prevalence of spherule detection is strongly influenced by the cellularity. In cases with moderate to high cellularity, the identification of spherules can assist the cytopathologists in diagnosing thyroid FNA cases as benign.

Dynamic prediction of survival using multivariate functional principal component analysis: A strict landmarking approach.

Dynamically predicting patient survival probabilities using longitudinal measurements has become of great importance with routine data collection becoming more common. Many existing models utilize a multi-step landmarking approach for this problem, mostly due to its ease of use and versatility but unfortunately most fail to do so appropriately. In this article we make use of multivariate functional principal component analysis to summarize the available longitudinal information, and employ a Cox proportional hazards model for prediction. Additionally, we consider a centred functional principal component analysis procedure in an attempt to remove the natural variation incurred by the difference in age of the considered subjects. We formalize the difference between a 'relaxed' landmarking approach where only validation data is landmarked and a 'strict' landmarking approach where both the training and validation data are landmarked. We show that a relaxed landmarking approach fails to effectively use the information contained in the longitudinal outcomes, thereby producing substantially worse prediction accuracy than a strict landmarking approach.

Assessment of Inpatient Mortality in the Peri-Transplant Period in Elderly Allogeneic Stem Cell Transplant Recipients with Co-Existing Mental Health Illnesses

Background Allogeneic hematopoietic stem cell transplant (alloHCT) is a potentially curative treatment for patients with hematological malignancies and nonmalignant conditions. AlloHCT involves invasive procedures, conditioning chemotherapy regimens, and prolonged isolation during hospitalization, which is physically and emotionally challenging. Transplant related mortality is higher in older individuals. Careful assessment of mortality risk before transplant is essential for optimal patient selection and informed decision-making, especially in elderly patients. Hematopoietic cell transplantation-specific comorbidity index (HCT-CI), an important prognostic scoring tool used in patients before alloHCT, includes psychiatric comorbidity as one of the scoring criteria. Patients with depression or anxiety disorders receive one point on the scoring scale, with the assumption that the two groups of patients are at an equivalent risk. However, there is literature showing decreased overall survival and worse inpatient outcomes in patients receiving alloHCT with co-morbid depression. Our primary objective was to evaluate the inpatient outcomes of elderly patients undergoing allogeneic stem cell transplant with a concurrent diagnosis of depression and patients with anxiety and adjustment disorders. Methods: Patients of ages ≥ 60 years, admitted with a principal procedure code of allogeneic stem cell transplant, were recruited from the 2016-2020 National Inpatient Sample. Three cohorts were created based on ICD-10 diagnostic codes for Depression and Anxiety and adjustment disorders: patients without depression and anxiety disorders, patients with depression only, and patients with anxiety and adjustment disorders only. Patients with diagnoses of other mental illnesses were excluded. The patient characteristics between the three cohorts were evaluated. Multiple Logistic Regression models were used to determine the impact of depression and anxiety disorders on inpatient mortality. Results: We evaluated 11655 hospital admissions with the primary procedure code for Allogeneic Stem Cell Transplant in patients aged 60 years and above. 8375 patients did not have any mental illness. 800 patients (9.5%) had a diagnosis of Depression, and 1640 patients (19.5%) had a diagnosis of Anxiety and adjustment disorders. Comparing the primary outcomes in patients with and without Depression, the length of stay was 31.3 days vs 28.2 days (p&amp;lt;0.01), the mean hospital charge was 558398.01 USD vs 498971.9 USD (p &amp;lt;0.01), and in-patient mortality was 8.1% vs 5.9% (aOR = 1.359, 95% CI 1.010-1.829, p=0.04). Utilization of mechanical ventilation was more prevalent in patients with depression (8.8 %vs 5.8 %, p &amp;lt;0.01). Out of different infectious complications, pneumonia was more common in patients with depression (14.4 % vs 9.8 %, p &amp;lt;0.01) (Table 1a). Baseline socio-demographic characteristics that were associated with having depression included: Female gender, White race, and Medicare insurance. Patients with depression had an increased prevalence of congestive heart failure, prior stroke, Obesity with BMI &amp;gt;= 35, chronic kidney disease, and COPD compared to patients without depression (p&amp;lt;0.01). For the primary outcomes in patients with and without anxiety and adjustment disorders, the length of stay was 29.15 days vs 28.2 days (p &amp;lt;0.01), the mean hospital charge was 474274.71 USD vs 498971.94 USD (p 0.612), and the in-patient mortality was 4% vs 5.9 % (aOR=0.61, 95% CI 0.45-0.83, p&amp;lt;0.01). Baseline socio-demographic characteristics that were prevalent in patients with anxiety and adjustment disorders were: female gender, white race, and Medicare as the most common insurance (P&amp;lt;0.01) (Table 1b). Conclusion We found that in elderly patients admitted for alloHCT, depression was independently associated with worse inpatient outcomes, while anxiety was not. Patients with depression were noted to have an increased incidence of infectious complications as compared to those without depression, possibly accounting for their increased mortality. Prognostic scoring systems like HCT-CI may need to be modified to assign more weight to depression as a psychiatric co-morbidity. Elderly transplant recipients with depressive disorders are a vulnerable group and multidisciplinary teams such as psychiatry and palliative care should be involved in their care.

Regulatory policy uncertainty, banking industry innovations and financial development among emerging markets

PurposeThis study examines the extent to which regulatory policy uncertainty, macroeconomic risk, banking industry innovations, etc. influence variability in financial sector development among emerging economies in sub-Sahara Africa (SSA).Design/methodology/approachData for the empirical inquiry were compiled from a sample of 25 economies from the subregion from 2010 to 2020. Empirical estimates examining the relationships noted above were carried out using the two-step system generalized method of moments estimation technique.FindingsResults the empirical estimates suggest that regulatory policy uncertainty and macroeconomic risk adversely influence or constrain financial sector development among the economies examined in the study. Banking industry innovations on the other hand is found to positively influence the development of the financial sector in these economies. Furthermore, moderating empirical analysis suggests that effective governance positively moderates the relationship between banking industry innovations and financial development among economies in the subregion.Originality/valueThis study’s approach to the mechanics of financial development among economies in SSA is designed to offer different perspectives to those found in the existing literature on financial development in three fundamental ways. First, although the verification of the role of banking industry innovations in financial development may not be new, it is important to point out that the approach used in this study is based on an index for innovations with different constituents or principal components in its construction; making the variable significantly different from what has been examined in the literature. In addition, the review of regulatory policy uncertainty and macroeconomic risk (both variables are multifaceted constructs using the principal component analysis procedure) further brings into this study’s analysis, a different approach to examining conditions influencing variability in financial development among developing economies.

Mapping Abandoned Uranium Mine Features Using Worldview-3 Imagery in Portions of Karnes, Atascosa and Live Oak Counties, Texas

Worldview-3 (WV3) 16-band multispectral data were used to map exposed bedrock and mine waste piles associated with legacy open-pit mining of sandstone-hosted roll-front uranium deposits along the South Texas Coastal Plain. We used the “spectral hourglass” approach to extract spectral endmembers representative of these features from the image. This approach first requires calibrating the imagery to reflectance, then masking for vegetation, followed by spatial and spectral data reduction using a principal component analysis-based procedure that reduces noise and identifies homogeneous targets which are “pure” enough to be considered spectral endmembers. In this case, we used a single WV3 image which covered an ~11.5 km by ~19.5 km area of Karnes, Atascosa and Live Oak Counties, underlain by mined rocks from the Jackson Group and Catahoula Formation. Up to 58 spectral endmembers were identified using a further multi-dimensional class segregation method and were used as inputs for spectral angle mapper (SAM) classification. SAM classification resulted in the identification of at least 117 mine- and mine waste-related features, most of which were previously unknown. Class similarity was further evaluated, and the dominant minerals in each class were identified by comparison to spectral libraries and measured samples of actual Jackson Group uranium host rocks. Redundant classes were eliminated, and SAM was run a second time using a reduced set of 23 endmembers, which were found to map these same features as effectively as using the full 58 set of endmembers, but with significantly reduced noise and spectral outliers. Our classification results were validated by evaluating detailed scale mapping of three known mine sites (Esse-Spoonamore, Wright-McCrady and Garbysch-Thane) with published ground truth information about the vegetation cover, extent of erosion and exposure of waste pile materials and/or geologic information about host lithology and mineralization. Despite successful demonstration of the utility of WV3 data for inventorying mine features, additional landscape features such as bare agricultural fields and oil and gas drill pads were also identified. The elimination of such features will require combining the spectral classification maps presented in this study with high-quality topographic data. Also, the spectral endmembers identified during the course of this study could be useful for larger-scale mapping efforts using additional well-calibrated WV3 images beyond the coverage of our initial study area.

Patient Outcomes of Non-Operative Versus Operative Management of Humeral Shaft Fractures: A Randomized Controlled Trial

Objective: To determine the non-surgical versus surgical outcomes in individuals who suffered from humeral shaft fractures. Methods: A randomized controlled trial was undertaken at the Department of Orthopedics Bolan Medical College Hospital Quetta, Pakistan between 09-March-2019 to 08-October-2019. A total number of 248 patients who presented with humeral shaft fractures having age 20-60 years were included in this study. Eligible patients were randomly grouped into two equal sets. Group I: were allotted to patients in whom non-operative management of humeral shaft fractures was done. In group II patients: operative management was done. Surgical outcomes were noted in terms of delayed union and radial nerve palsy. Study outcomes were noted after 1 month of principal procedure. Results: The mean age of individuals included in this study was 45.46±9.64 years. Mean body mass index (BMI) of patients was 25.44±4.63 kg/m2. Mean duration of fracture to surgery was 8.80±8.07 days. There were 169 (68.15%) male patients and 79 (31.85%) female patients. Delayed union was found in 27 (21.80%) patients in non-operative groups versus 19 (15.30%) in patients who underwent operative management (p-value of 0.191). On comparison of frequency of radial nerve palsy between the groups, radial nerve palsy was found in 12 (9.70%) patients in non operative group versus 16 (12.90%) in patients in operative group (0.422). Conclusion: The study revealed that the non-surgical management of humeral shaft fractures gives outcomes that are comparable to operative management. We did not find any evidence of significant difference in the frequency of delayed union and radial nerve palsy between the groups. Keywords: humeral shaft fractures, operative management, non-operative management.

Risk Factors for Unexpected Hospital Admission Following Achilles Tendon Repair: A National Database Study

INTRODUCTION Achilles tendon rupture (ATR) repair is one of the most common orthopaedic surgeries performed in the United States, however there is a paucity of literature on predisposing risk factors for hospital readmissions. The purpose of this study is to identify risk factors for 30-day readmission in patients undergoing ATR repair with emphasis on procedures performed in the outpatient setting. Specifically, we examine: 1) 30-day post-operative hospital readmission rates; 2) the medical comorbidities and patient characteristics that predisposed this cohort to post-operative complications; and 3) the complications leading to readmission. METHODS The ACS-NSQIP was queried for patients who underwent ATR from 2015 to 2019 using CPT code 27650 in all fields yielding a sample size of 3,887 cases. The following demographic, lifestyle, and comorbidity variables were recorded: age, sex, race, BMI, morbid obesity (BMI ≥ 40.00 kg/m2), bleeding disorders, chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension, tobacco use, and chronic steroid use. The primary outcome of 30-day readmission was defined as unplanned hospital readmission likely related to the principal procedure. Independent samples Student’s t-tests, chi-squared, and, where appropriate, Fisher’s exact tests were used in univariate analyses to identify demographic, lifestyle, and peri-operative variables related to 30-day readmission following ATR. Multivariate logistic regression modeling was subsequently performed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and reported. RESULTS Of the 3,887 patients included in our sample, 28 were readmitted within the 30-day post-operative period, corresponding to a readmission rate of 0.73%. Significant relationships with univariate analyses between readmission status and the following patient variables included: mean patient age (p = 0.02); hypertension (p &lt; 0.001); BMI (p = 0.01); morbid obesity (p = 0.002); ASA Classification (p = 0.006); and bleeding disorders (p = 0.03). Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission: age, p = 0.02), OR = 1.03, 95% CI [1.01, 1.06]; hypertension, p &lt; 0.001, OR = 3.82, 95% CI [1.81, 8.06]; BMI, p = 0.01, OR = 1.06, 95% CI [1.01, 1.11]; morbid obesity, p = 0.004, OR = 3.53, 95% CI [1.49, 8.36]. CONCLUSION Our study indicated that only 0.73% of patients were readmitted after their outpatient procedure. Patients who: 1) have BMIs greater than 40; 2) are older in age 3) have hypertension; and 4) a higher ASA Classification were at increased risk for readmission.

Explaining racial disparities in surgical survival: a tapered match analysis of patient and hospital factors

ObjectivesEvaluate whether hospital factors, including nurse resources, explain racial differences in Medicare black and white patient surgical outcomes and whether disparities changed over time.DesignRetrospective tapered-match.Setting571 hospitals at two time points...

TO DRAW OR NOT TO DRAW: UNDERSTANDING THE TEMPORAL ORGANIZATION OF DRAWING BEHAVIOR USING FRACTAL ANALYSES

Studies on drawing often focused on spatial aspects of the finished products. Here, the drawing behavior was studied by analyzing its intermittent process, between drawing (i.e. marking a surface) and interruption (i.e. a pause in the marking gesture). To assess how this intermittence develops with age, we collected finger-drawings on a touchscreen by 185 individuals (children and adults). We measured the temporal structure of each drawing sequence to determine its complexity. To do this, we applied temporal fractal estimators to each drawing time series before combining them in a Principal Component Analysis procedure. The youngest children (3-year-old) drew in a more stereotypical way with long-range dependence detected in their alternations between states. Among older children and adults, the complexity of drawing sequences increased showing a less predictable behavior as their drawings become more detailed and figurative. This study improves our understanding of the temporal aspects of drawing behavior, and contributes to an objective understanding of its ontogeny.

Heparin-Induced Thrombocytopenia Is Associated with Higher in-Hospital Mortality after Left Ventricular Assist Device Placement: A Retrospective Cohort Study from National Inpatient sample2016-2019

Background: Heparin is widely used to implant and maintain left ventricular assist devices (LVAD). Heparin-induced thrombocytopenia (HIT) is a severe complication that can hamper successful LVAD implantation or maintenance. The incidence and outcomes of HIT among hospitalized patients undergoing principal LVAD procedures are not well studied. Purpose: We hypothesized that HIT is not associated with increased or decreased odds of in-hospital mortality in LVAD. Methods: This is a retrospective cohort study from principal LVAD hospitalizations between January 1, 2016, and December 31, 2019, using the 2016-2019 National Inpatient Sample (NIS), the largest all-payer public database of hospital care data in the United States. Our study sample included any hospitalizations with LVAD, as a principal procedure, aged 18 years or older, using the ICD 10 procedural codes validated in previous studies. Results: From 2016 to 2019, a total of 2924 (weighted N =13,205) hospitalizations with the principal procedure as LVAD were identified. Among them, 21.96% (n= 642) were females, and 78.04% (n = 2281) were males (p &lt; 0.001), and 1.47 % (n=43) developed HIT. MeanThe mean age was 56.8 ± 13.3 years. Moreover, 60.7% of total LVAD were performed in Whites, 26.6% in Blacks, 7% in Hispanics, and 2% in Asians. 2111 (72.2%) hospitalizations had a Charlson comorbidity index (CCI) of three or higher. Compared to non-HIT, those who had HIT, were similar in age (mean age: 55.6 vs. 56.8; p=0.542), had lower CCI of three or higher (53.5% vs. 72.5%, p=0.015), but higher in-hospital mortality (23.3% vs 9.4%, p=0.006). Multivariate regression analysis showed that, compared with non-HIT, HIT had a significantly increased odds of in-hospital mortality (aOR: 3.37; 95% CI: 1.61, 7.01; p=0.001) after controlling for age, race, regional location of the hospital, hospital bed capacity, income, insurance provider, and Charlson comorbidity index. From 2016 to 2019, the annual incidence of principal LVAD per 100,000 hospitalizations have been stable at 10.1 in 2016, 10.8 in 2017, 10.2 in 2018 and 10.0 in 2019 (p-trend=0.475). Conclusion: The incidence of HIT in patients undergoing LVAD is low. However, HIT carries significantly higher in-hospital mortality in patients getting LVAD. The incidence of LVAD procedures has been stable over recent years.

Influence of Malnutrition on the Outcomes of Autologous Hematopoietic Stem Cell Transplant in Multiple Myeloma Patients

Background: Patients with malignancy are more prone to be malnourished due to a combination of factors including the disease process itself, chemotherapy and the associated catabolism. Studies have shown that Protein Energy Malnutrition (PEM) can adversely affect outcomes in hospitalized patients. We aim to study the impact of PEM in Multiple Myeloma patients undergoing Hematopoietic stem cell transplant (HSCT). Methods: A retrospective cohort study was designed using data obtained from the 2017 to 2019 combined National Inpatient Sample (NIS) database. Adult patients (age >18) admitted with a principal diagnosis of Multiple Myeloma and a principal procedure of autologous HSCT were identified using the International Diseases Classification code, tenth revision (ICD-10). They were further stratified based on the presence of Protein Energy Malnutrition (PEM). Primary outcomes assessed were, mortality, length of stay (LOS), and Total Hospitalization Charges (THC). Secondary outcomes included a diagnosis of Acute Kidney Injury (AKI), Acute Respiratory Failure (ARF), sepsis, neutropenia, blood transfusion. Multivariate linear and logistic regressions were used to adjust for confounders. Results: There was a total of 21,965 adult hospitalizations of MM patients undergoing HSCT and among them 2,955 (0.13%) had a secondary diagnosis of PEM. Those with PEM were older (62 vs 61 p=0.005). The overall mortality was less at 0.007% (N=150) and after adjusting for confounders PEM was associated with an increased odds of mortality, 0.019 vs 0.005% (AOR :3.20, p=0.008, 95% CI: 1.35 - 7.57). There was also an increased LOS in patients with PEM, 19 days vs 16.1 days (adjusted difference of 2.17 days, p=0.000, 95% CI: 1.35 - 2.99), as well as an increase in THC, 221,624 USD vs 195,635 USD (adjusted difference of 17,435 USD, p=0.036, 95% CI: 1173.60 - 33696.16). Similarly, the presence of PEM was associated with an increased odds of several secondary outcomes measured, including anemia (AOR : 1.67, p=0.002, 95% CI: 1.20 - 2.32), intubation (AOR : 4.40, p< 0.001, 95% CI: 2.29 - 8.48) and mechanical ventilation (AOR : 5.10, p< 0.001, 95%CI: 2.63 - 9.90), AKI (AOR : 1.49, p=0.004, 95% CI: 1.14 - 1.95), sepsis (AOR : 2.16, p< 0.001, 95% CI: 1.53 - 3.05), ARF (AOR : 3.39, p< 0.001, 95% CI: 1.99 - 5.75) and pneumonia (AOR : 1.73, p=0.005, 95% CI: 1.18 - 2.53) compared to the other cohort. However, there was no difference in the odds of pressor requirement, neutropenia and UTI between the two groups. Conclusion: Presence of PEM leads to poor clinical outcomes. This highlights the importance of addressing nutritional status as an independent prognostic factor. Appetite stimulants, as well as attention to underlying nausea, vomiting, mucositis can improve oral intake and appetite. A multidisciplinary approach with nutritionists, the nursing team, and social work can identify at-risk patients and help improve outcomes.

Abstract 12062: Additional Burden of Esophageal and Gastric Varices on Hospitalized Patients With Moderate or Severe Congenital Heart Disease

Introduction: Elevated central venous pressure (CVP) occurs in many forms of congenital heart disease (CHD) which may result in esophageal or gastric varices. We sought to describe the incidence of varices and acute outcomes for hospital admissions with moderate or severe CHD compared to those without CHD. Methods: Vizient Clinical Database was queried from 10/2018-12/2021 for admissions aged 1-89 years with ICD-10 codes for moderate or severe CHD with and without ICD-10 codes for esophageal (I85-I85.11) or gastric (I86.4) varices. For comparison (NO-CHD), admissions with no CHD codes with and without varices were queried. Data included demographics, hospital outcomes, principal procedure and costs. Results: There were 54,979 CHD admissions, 489 (0.9%) with varices and 28,282,750 NO-CHD admissions, 231,633 (0.8%) with varices ( p = 0.069); summary in Table 1. Compared to the NO-CHD population, admission with CHD and varices were younger, had longer lengths of stay, higher complication rates and hospital costs with no difference in in-hospital mortality. Table 2 shows the top 5 principal procedures for each group. Conclusions: Hospitalized patients with moderate or severe CHD and varices have worse acute hospital outcomes and higher costs compared to those without CHD. These findings suggest a potential additional disease burden in this already fragile population. Future work to identify and potentially treat modifiable factors could improve care for these patients.

Transcatheter aortic valve replacement in patients with a concomitant aortic aneurysm

Abstract Background Although there is extensive literature present on transcatheter aortic valve replacement (TAVR), there is limited data on TAVR patients with a concomitant aortic aneurysm. Purpose In this study, we investigate the short-term, in-hospital outcomes of patients undergoing TAVR with and without an aortic aneurysm. Methods This was a retrospective cohort study comparing adult patients undergoing TAVR with and without an aortic aneurysm from 2016 to 2018. We queried the National Inpatient Sample database to identify patients admitted for a principal procedure of TAVR, principal diagnosis of aortic stenosis and secondary diagnosis of aortic aneurysm. We analyzed the categorical and continuous variables by Pearson's chi-squared and Student t-test respectively. Multivariable logistic regression, adjusted for age, gender and comorbidities, was used to compare mortality. The comorbidities adjusted for included coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, hypertension, obesity and type 2 diabetes mellitus. Results 109,170 patients met our inclusion criteria. Patients undergoing TAVR with an aortic aneurysm had 1.97 times higher odds of suffering in-hospital mortality compared to TAVR patients without an aortic aneurysm (aOR 1.97, 95% CI: 1.05–3.73; p=0.036). When separated by race, patients with an aortic aneurysm had higher mortality rates amongst White (3.4% vs 1.7%, p&amp;lt;0.001) and Hispanic (5.2% vs 2.6%, p=0.11, Figure 1) patients. TAVR patients with an aortic aneurysm were predominantly male and had higher average Charlson Comorbidity Index scores (Table 1). Furthermore, these patients also had higher rates of comorbidities such as coronary artery disease, chronic obstructive pulmonary disease and prior myocardial infarction, but decreased rates of chronic kidney disease, hypertension, obesity and type 2 diabetes mellitus (Table 1). In terms of operative complications, TAVR patients with an aortic aneurysm were more likely to have intraoperative cardiac arrest (1.1% vs 0.4%, p&amp;lt;0.001, Table 1). There was no significant difference between our two cohorts in postoperative cardiac arrest and postoperative cerebral infarction. Conclusion Patients undergoing TAVR with an aortic aneurysm had higher odds of suffering in-hospital mortality compared to patients undergoing TAVR without an aortic aneurysm. These patients are also at an increased risk of intraoperative cardiac arrest. Surgical intervention with a concomitant aortic aneurysm poses its own unique set of clinical challenges. Our findings emphasize the importance of risk-benefit analysis and collaborative discussion amongst the medical team prior to choosing the appropriate treatment modality. Additional studies should explore if certain races are at increased risk of operative complications and mortality. Funding Acknowledgement Type of funding sources: None.