Procedure Codes Research Articles

A Unified Review of Deep Learning for Automated Medical Coding

A Unified Review of Deep Learning for Automated Medical Coding

Sociodemographic Disparities and Postoperative Outcomes Following Cranial Vault Remodeling for Craniosynostosis: Analysis of the 2012 to 2021 NSQIP-Pediatric Database.

The objective of this study was to assess whether race and ethnicity are independent predictors of inferior postoperative clinical outcomes, including increased complication rates, extended length of stay (LOS), and unplanned 30-day readmission following cranial vault repair for craniosynostosis. A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database. Pediatric patients under 2 years of age undergoing cranial vault repair for craniosynostosis between 2012 and 2021 were identified using the International Classification of Diseases-9/10 and Current Procedural Terminology codes. Patients were dichotomized into 4 cohorts: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, and other. Only patients with available race and ethnicity data were included in this study. Patient demographics, comorbidities, surgical variables, postoperative adverse events, and hospital resource utilization were assessed. Multivariate logistic regression analysis was used to assess the impact of race on complications, extended LOS, and unplanned readmissions. In our cohort of 7764 patients, 72.80% were NHW, 8.44% were NHB, 15.10% were Hispanic, and 3.67% were categorized as "other." Age was significantly different between the 4 cohorts (P<0.001); NHB patients were the oldest, with an average age of 327.69±174.57 days old. Non-Hispanic White experienced the least adverse events while NHB experienced the most (P=0.01). Total operative time and hospital LOS were shorter for NHW patients (P<0.001 and P<0.001, respectively). Rates of unplanned 30-day readmission, unplanned reoperation, and 30-day mortality did not differ significantly between the 4 cohorts. On multivariate analysis, race was found to be an independent predictor of extended LOS [NHB: adjusted odds ratio: 1.30 (1.04-1.62), P=0.021; other: 2.28 (1.69-3.04), P=0.005], but not of complications or readmission. Our study demonstrates that racial and ethnic disparities exist among patients undergoing cranial vault reconstruction for craniosynostosis. These disparities, in part, may be due to delayed age of presentation among non-Hispanic, non-White patients. Further investigations to elucidate the underlying causes of these disparities are necessary to address gaps in access to care and provide equitable health care to at-risk populations.

Legal Basis for the Application of the Principles of Legality and Justice in the System of Administrative Proceedings of the Republic of Kazakhstan

Abstract The purpose of the work is to study the principles of legality and justice in the practice of administrative proceedings of the Republic of Kazakhstan. For this, methods such as system and comparative analysis, logical analysis, deduction, induction, and formal-legal methods were used. During the implementation of the study, the significance, and role of legal principles in administrative justice in the Republic of Kazakhstan were investigated. After analysing the model of the transition of the countries of the former USSR to the system of administrative justice and the specifics of its implementation in Kazakhstan, it was concluded that the principles of legality and justice are legally fixed in the Administrative Procedure Code of the Republic of Kazakhstan. This article analyses the studies of both Kazakhstani and foreign scientists concerning the application of laws and principles in administrative proceedings. In addition, some aspects of improving the system of administrative justice in the context of legislative regulation of the application of legal principles are considered. The practical value of the results obtained is to provide recommendations that will have an impact on the activities of the administrative justice system of Kazakhstan and will allow it to be implemented more efficiently.

Towards a semi-automatic classifier of malware through tweets for early warning threat detection

This paper presents a method for developing a malware ontology structure by detecting malware instances on Twitter. The ontology represents a semi-automatic classifier fed by the data extracted from tweets. In particular, the automatic part of the presented methodology relies on a pattern-based approach to detect trigger expressions leading to new information about malware, whilst the manual one covers the evaluation of the results by domain-experts, who also validate the reliability of the semantic relationships within the ontology framework. We present preliminary results on the application of our methodology to tweets extracted from MalwareBazaar database showing how the documents’ collection analysis, through Natural Language Processing (NLP) tasks, can support the knowledge retrieval and documents’ classification procedures for building early warning system of detected malware. Results obtained from this research paper within the time framework of 2023 are referred to the previous version of the current social network X.

Incidence and risk factors of postoperative delirium following hepatic resection: a retrospective national inpatient sample database study

BackgroundPostoperative delirium (POD) is a common complication after major surgery and can cause a variety of adverse effects. However, no large-scale national database was used to assess the occurrence and factors associated with postoperative delirium (POD) following hepatic resection.MethodsPatients who underwent hepatic resection from 2015 to 2019 were screened using the International Classification of Diseases (ICD) 10th edition clinical modification code from the National Inpatient Sample (NIS) Database. Peri-operative factors associated with delirium were screened and underwent statistical analysis to identify independent predictors for delirium following hepatic resection.ResultsA total of 80,070 patients underwent hepatic resection over a five-year period from 2015 to 2019. The overall occurrence of POD after hepatic resection was 1.46% (1039 cases), with a slight upward trend every year. The incidence of elective admission was 6.66% lower (88.60% vs. 81.94%) than that of patients without POD after hepatic resection and 2.34% (45.53% vs. 43.19%) higher than that of patients without POD in teaching hospitals (P < 0.001). In addition, POD patients were 6 years older (67 vs. 61 years) and comprised 9.27% (56.69% vs. 47.42%) more male patients (P < 0.001) compared to the unaffected population. In addition, the occurrence of POD was associated with longer hospitalization duration (13 vs. 5 days; P < 0.001), higher total cost ($1,481,89 vs. $683,90; P < 0.001), and higher in-hospital mortality (12.61% vs. 4.11%; P < 0.001). Multivariate logistic regression identified hepatic resection-independent risk factors for POD, including non-elective hospital admission, teaching hospital, older age, male sex, depression, fluid and electrolyte disorders, coagulopathy, other neurological disorders, psychoses, and weight loss. In addition, the POD after hepatic resection has been associated with sepsis, dementia, urinary retention, gastrointestinal complications, acute renal failure, pneumonia, continuous invasive mechanical ventilation, blood transfusion, respiratory failure, and wound dehiscence / non-healing.ConclusionAlthough the occurrence of POD after hepatic resection is relatively low, it is beneficial to investigate factors predisposing to POD to allow optimal care management and improve the outcomes of this patient population.

The Importance of Analysis of Judicial Circumstances in the Sentence Dosimetry Process

The Constitution plays an important role as a point of reference for the critical analysis of the criminal system, not only because it derives from the legal assets susceptible to punitive protection, but also and among other reasons, because the principles enshrined as a government norm in the Penal Code governing The imposition of sanctions is a clear development of the constitutional text and doctrine that the Constitutional Court has been building with its pronouncements, in the form that criminal law must acquire. The dosimetry of punishment in Brazil takes a three-step approach, pushing the system of fixed sanctions implemented by the legislature or the full discretion of the judge, promoting, on the other hand, a distribution of functions between the two, as he chooses the minimum and maximum sentence levels and dosage parameters, and this determines the sanction in the specific case from the legal criteria. In this sense, the present research aims to analyze the importance of analyzing judicial circumstances in the process of penalty dosimetry. The specific objectives are: to present a brief history of criminal legislation in Brazil, to review the most recent literature on the application of the penalty and its principles, to analyze the relationship between the dosimetry of the penalty and judicial circumstances and to point out cases in the jurisprudence that materialize the revised theory. Thus, given the relevance of the theme in the current legal scenario, the research is justified by discussing a contemporary theme. Through research on the principles of exceptionality, state of innocence, motivation of decisions and proportionality and the dosimetry of the penalty, possible judgments of the judge that relate the dosimetry of the penalty with the principles of human rights will be discussed. The judge should take charge of the evidence produced in relation to the facts that, in his opinion, influence the minor or major measure of the exact penalty to be imposed. The lack of motivation currently constitutes a violation of the constitutional guarantee of due process and absolute grounds for invalidity under the Criminal Procedure Code.

Procedure Valuation: How a Code Becomes an RVU and a Review of the Current Literature

Abstract Purpose of Review The goal of this review is to describe the complex process by which a procedure code is assigned value using relative value units (RVUs) and discuss current research that assesses the objectivity and equity of the process. Recent Findings While research on this topic is somewhat limited, the authors of a majority of studies call for revaluation of common codes within their surgical specialty due to misvaluation when comparing current RVU scales with national procedure time data. In addition, several studies report that the current system does not adequately reflect patient-based factors that influence physician workload during a case. Finally, certain small subspecialties and pediatric subspecialties in surgical fields are particularly vulnerable to misvaluation. Summary Procedure valuation is critically important for surgeons to understand to ensure advocacy for their field and their patients. Continued research using large, national datasets will provide evidence for needed improvements in objectivity in this process and increased surgeon participation in this committee-based decision is imperative for equitable change.

Long-Term Results After Laparoscopic Lavage for Perforated Diverticulitis Purulent Peritonitis in Sweden: A Population-Based Observational Study

Objective: To compare long-term outcomes after laparoscopic lavage with resection surgery for perforated diverticulitis, Hinchey grade III as practiced in Sweden for 3 years. Background: Laparoscopic lavage has been studied in 3 randomized controlled trials. Long-term results indicate that additional surgery and a remaining stoma are less common after lavage compared with resection, but data from routine care and larger cohorts are needed to get a more complete picture. Methods: LapLav is a national cohort study with nearly complete coverage of all patients operated in Sweden between 2016 and 2018. The cohort was retrieved from the national patient register by a definition based on the Classification of Diseases and Related Health Problems-10 code plus the surgical procedural code. All medical records have been reviewed and data retrieved in addition to registry data. Propensity score with inverse probability weighting was used to balance the 2 groups, that is, laparoscopic lavage vs resection surgery. Results: Before the propensity score was applied, the cohort consisted of 499 patients. Additional surgery was more common in the resection group [odds ratio, 0.714; 95% confidence interval (CI) = 0.529–0.962; P = 0.0271]. Mortality did not differ between the groups (hazard ratio, 1.20; 95% CI = 0.69–2.07; P = 0.516). In the lavage group, 27% of patients went on to have resection surgery. Conclusions: In Swedish routine care, laparoscopic lavage was feasible and safe for the surgical treatment of perforated diverticulitis, Hinchey grade III. Our results indicate that laparoscopic lavage can be used as a first-choice treatment.

Problems of closing criminal proceedings due to the expiration of pre-trial investigation deadlines

The article is dedicated to addressing the current issues in the theory and practice of closing criminal proceedings during the pre-trial investigation stage, particularly focusing on the basis of closing due to the expiration of pre-trial investigation deadlines. The problem of closing criminal proceedings by the investigating judge based on paragraph 10 of Part 1 of Article 284 of the Criminal Procedure Code of Ukraine is currently the subject of active discussions among legal professionals. This basis is directly related to the pre-trial investigation stage and, according to the current established practice of the Supreme Court, is classified as exclusive competence of the prosecutor, limiting the Investigating Judge's ability to exercise effective judicial control during the pre-trial investigation stage. It is noted that the absence of these powers in the Investigating Judge entails the risk of violating the reasonable time requirements for pre-trial investigation, as the pre-trial investigation deadline is not just a formality. Enshrining in procedural law the prosecutor's obligation to apply to the court with an accusatory document or close the criminal proceedings as soon as possible but not later than the procedural deadline after notifying the suspect of the accusation is a guarantee of the fundamental right of individuals to have their cases heard within a reasonable time frame. Unfortunately, in practical terms, this guarantee is not always implemented, and the lack of effective judicial control only contributes to the spread of prosecutorial inactivity. The article suggests that the most optimal solution to this problem is the alternative competence of both the prosecutor and the Investigating Judge regarding the authority to close criminal proceedings during the pre-trial investigation stage. This would help achieve a balance of interests between the parties involved in criminal proceedings and prevent abuses of power. To improve the mechanism for ensuring compliance with reasonable deadlines, the author proposes expanding and specifying the powers of the Investigating Judge when closing criminal proceedings. Specifically, it is suggested to add Part 2-1 to Article 284 of the Criminal Procedure Code of Ukraine: «Criminal proceedings at the pre-trial investigation stage are closed by the Investigating Judge based on the grounds provided for in paragraph 10 of this article if the suspect does not object to the closure on these grounds.»

Current issues of properties of evidence in criminal proceedings

The article, in accordance with the provisions of the Criminal Procedure Code of Ukraine, discloses the content of the propriety of evidence as a factor that must be taken into account during the evaluation of evidence in criminal proceedings. The relationship between the evidence's propriety and some legal categories of the institution of proof is indicated. Proposals have been put forward that can be useful during the improvement of the conceptual apparatus of the theory of evidence and the provisions of the current legislation. The relevance of the publication is due to the need to improve the process of proof during the pre-trial investigation and trial, to develop effective mechanisms for the successful performance of the tasks of criminal proceedings, which are defined in Art. 2 of the CCP of Ukraine. The purpose of preparing the article was to reveal the main issues of the legal nature of the ownership of evidence, in accordance with the definition given in Art. 85 of the CPC of Ukraine. The prerequisites for the formation of the specified goal were the modern problems that arise during the pre-trial investigation in criminal proceedings. During the preparation of the publication, general scientific and special methods of scientific knowledge were used. Thus, from the general scientific methods, in particular, the system- structural method, the method of functional analysis, from the special ones - formal-legal, logical-procedural methods, the method of comparative jurisprudence were used. The main legislative norms related to the topic of the publication have been analyzed. The publication proves that the improvement of the conceptual apparatus, the correct formulation of the legal features of evidence and the implementation of the norms of international conventions into domestic legislation will contribute to the perfection of the procedural law and provide a unified approach to the proper protection of the rights, freedoms and legitimate interests of the participants in criminal proceedings. At the same time, the authors took into account that the requirements for the propriety of the evidence have not acquired an imperative character in the legislation, and therefore they are decided individually by the investigator, the prosecutor and the court in each individual case. Knowing the circumstances to be proven in criminal proceedings is the purpose of proof, and propriety is a feature that not only characterizes the evidence, but also acts as a means of achieving the specified goal.

Circumstances to be established during investigation of the involvement of minors in the illegal production, manufacture, purchase, storage, transportation, shipment or sale of narcotics, psychotropic substances or their analogues

The scientific article discloses the circumstances to be established during the investigation of the involvement of minors in the illegal production, manufacture, acquisition, storage, transportation, forwarding or sale of narcotic drugs, psychotropic substances or their analogues. As a result of a detailed analysis of the scientific literature on criminology and the criminal process, it was established that at the current stage of development, this issue remains insufficiently researched. The positions of scientists regarding the importance of the circumstances to be established in certain methods of investigation of criminal offenses are considered. It is established that in criminal offenses committed by minors, in addition to the circumstances provided for in Art. 91 of the Criminal Procedure Code of Ukraine, it is also necessary to find out: 1) complete and comprehensive information about the person of the minor: his age (date, month, year of birth), state of health and level of development, other social and psychological features of the person, which must be taken into account when individualizing responsibility or selected educational events. If there is evidence of a minor's mental retardation not related to mental illness, it should also be determined whether he could fully understand the meaning of his actions and to what extent he could control them; 2) the minor's attitude towards the act committed by him; 3) living conditions and upbringing of a minor; 4) the presence of adult instigators and other accomplices of the criminal offense. In the course of the study, it was found that every circumstance that must be established at the beginning of the pre-trial investigation of this category of crimes in accordance with Art. 91 of the Criminal Procedure Code of Ukraine should be considered in relation to the circumstances provided for in Art. 485 of the Criminal Code of Ukraine (taking into account the age and socio-psychological characteristics of minors) in order to achieve the objectives of criminal proceedings, in particular when establishing: a) the circumstances of the fact (event) involving a minor in the illegal production, manufacture, acquisition, storage, transportation, forwarding or sale of narcotics means, psychotropic substances or their analogues; the circumstances of the minor's culpability (it is necessary to establish the exact age in order to be able to prosecute); b) circumstances characterizing the person of a minor (their living conditions, upbringing, state of health, level of development).

Further examination of the dual-factor model: characteristics of emerging adults with non-traditional mental health profiles

Traditionally, the mental health field has focused on psychological symptoms and distress, and health is considered the absence of illness. An alternative view suggests that optimal mental health must include the presence of positive characteristics in addition to the absence of illness. Accordingly, a dual-factor model of mental health includes measures of both psychopathology and positive subjective well-being to determine an individual’s mental health status. The current study investigated this dual-factor model by examining whether subjective well-being and psychopathology combine to produce distinct mental health profiles in emerging adults. A sample of 559 university students completed self-report surveys indicating their life satisfaction and internalizing and externalizing symptoms. Cluster analysis yielded four unique mental health groups. The well-adjusted cluster included individuals with high life satisfaction and low internalizing and externalizing symptoms. The dissatisfied cluster consisted of individuals with low externalizing, but also low life satisfaction and slightly above-average levels of internalizing. The externalizing cluster had high life satisfaction but also high externalizing psychopathology, and the troubled cluster exhibited low life satisfaction and high levels of both psychopathology symptoms. The clusters also differed in their personality traits, coping responses, and automatic thoughts, with the most favorable pattern across all three dimensions exhibited by the well-adjusted cluster. These findings highlight the importance of considering positive indicators of mental health in addition to measures of psychopathology and support the use of an empirical classification procedure in determining the mental health status of emerging adults.

A Data-Driven Approach to Defining Risk-Adjusted Coding Specificity Metrics for a Large U.S. Dementia Patient Cohort

Medical coding impacts patient care quality, payor reimbursement, and system reliability through the precision of patient information documentation. Inadequate coding specificity can have significant consequences at administrative and patient levels. Models to identify and/or enhance coding specificity practices are needed. Clinical records are not always available, complete, or homogeneous, and clinically driven metrics to assess medical practices are not logistically feasible at the population level, particularly in non-centralized healthcare delivery systems and/or for those who only have access to claims data. Data-driven approaches that incorporate all available information are needed to explore coding specificity practices. Using N = 487,775 hospitalization records of individuals diagnosed with dementia and discharged in 2022 from a large all-payor administrative claims dataset, we fitted logistic regression models using patient and facility characteristics to explain the coding specificity of principal and secondary diagnoses of dementia. A two-step approach was produced to allow for the flexible clustering of patient-level outcomes. Model outcomes were then used within a Poisson binomial model to identify facilities that over- or under-specify dementia diagnoses against healthcare industry standards across hospitalizations. The results indicate that multiple factors are significantly associated with dementia coding specificity, especially for principal diagnoses of dementia (AUC = 0.727). The practical use of this novel risk-adjusted metric is demonstrated for a sample of facilities and geospatially via a U.S. map. This study’s findings provide healthcare facilities with a benchmark for assessing coding specificity practices and developing quality enhancements to align with healthcare industry standards, ultimately contributing to better patient care and healthcare system reliability.

Epidemiology and Outcomes of Hospitalized Chimeric Antigen Receptor T-Cell (CAR-T) Therapy Patients Who Developed Acute Respiratory Failure.

Objectives:The aim of the study was to examine the incidence, baseline characteristics, and outcomes of Chimeric Antigen Receptor T-cell (CAR-T) therapy admissions in individuals who developed acute respiratory failure (ARF). The study utilized the National Inpatient Sample (NIS) database for the years 2017 to 2020. Methods: The study identified CAR-T cell therapy hospitalizations through the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) codes. Patients with acute respiratory failure (ARF) were further classified using specific International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Descriptive statistics were performed to analyze baseline characteristics, comorbidities, complications, and outcomes. Results: Analysis of the NIS Database identified 5545 CAR-T therapy admissions between 2017 and 2020, revealing a rising trend over time. In our study, we found that hypertension (39%), dyslipidemia (21.7%), and venous thromboembolism (13%) were the most frequently observed comorbidities in CAR-T cell therapy admissions. Acute respiratory failure (ARF) was reported in 7.1% of admissions, and they had higher all-cause in-hospital mortality than CAR-T cell therapy admissions without ARF (32.9% vs 1.3%, P < 0.001). ARF admissions that required invasive mechanical ventilation (IMV) also had higher all-cause in-hospital mortality compared to admissions not requiring IMV (48.9% vs 11.8%, P = 0.001). There was no difference in the mortality rate among admissions with non-Hodgkin's Lymphoma, Multiple Myeloma, and Leukemia that utilized CAR-T therapy. Conclusions: In this largest study to date, we illuminate the incidence and outcomes of CAR-T cell therapy admissions with ARF. Higher mortality rates were observed in CAR-T cell therapy admissions with ARF. The study emphasizes the crucial role of interdisciplinary collaboration in CAR-T patient management and calls for additional research to clarify ARF's etiology and inform effective management strategies.

The judicial expertise - a mandatory part of legal investigations

Both the Civil Procedure Code and the Criminal Procedure Code as well as their application in criminal, civil, commercial and contraventional cases, state the use of scientific evidence in finding out the truth, consisting in the judicial expertise. Unless the law expressly provides for the obligation to carry out an expertise, and we consider here the forensic expertise - meant to establish the days of medical care provided, or the cause of death, or establishing the identity of a person based on the expertise of biological traces, in various other cases the procedural legislation does not oblige the court to administer scientific evidence, leaving the choice to its discretion or, where appropriate, to the criminal investigation body. However, even if there are no provisions that expressly oblige the use of judicial expertise, we consider that both the investigation and prosecution body, the policeman or the prosecutor, as well as the courts, are obliged to order the performance of a judicial expertise when the facts deduced through the investigation or judgment cannot be clarified otherwise than on scientific basis and using the knowledge of experts in the respective domain. Beyond the classical forensic expertise of writing, namely the graphoscopic expertise, of ballistic expertise and automotive technical expertise on the dynamics of the occurrence of driving accidents - our list is not exhaustive - which are commonly carried out in both civil files, but especially in criminal cases there are situations in which we believe that it is necessary to administer scientific evidence to find out the truth. No matter how well prepared the person who finds and investigates a contravention or a crime, is, or those who are called upon to rule on civil cases, they cannot rule on technical issues, the existence of chemicals or possibly prohibited substances, as well as the overcoming of accepted decibels or the existence of products that could be considered waste - and the list could continue with other examples. However, in practice the tendency of those called to perform the act of justice is increasingly observed, to be limited to the mere findings made “with their own senses” by agents, local police or national police workers, employees of the Environmental Guard. These so-called technical findings or observations do not have the value of judicial expertise and cannot supplement such evidence by scientific quality or by objectivity, as long as they are drawn up by individuals who do not have the necessary and recognised level of scientific training, and are part of the bodies who only observe and note the facts and sanction them or send them to competent bodies for resolution. Consistent with European jurisprudence, we believe that finding out the truth involves the use of independent and objective judicial experts, highly trained specialists, or recognized and independent laboratories of expertise.

Navigating Professional Registration and Development Pathways: Perspectives of Healthcare Practitioners

The Saudi Commission for Health Specialties (SCFHS) has undertaken a comprehensive evaluation of its registration and classification services to pinpoint areas for optimization. Recognizing healthcare professionals as essential stakeholders, SCFHS actively solicited their perspectives to better understand their needs and to collect actionable suggestions for service enhancement. Employing a multifaceted research approach, this study utilized focus groups, a large-scale survey involving over 700,000 healthcare practitioners, and comparative benchmarking against selected G-20 nations. The findings indicate a strong desire among practitioners for a reorganisation of the current registration and classification procedures. Notably, there was a consensus for extending the registration period, with a predominant preference for a five-year duration. Participants also advocated for various improvements, such as an increase in Continuing Medical Education (CME) hours, financial cost reductions, and streamlining of registration processes. While benchmarking revealed that SCFHS's existing registration durations are generally on par with other G-20 countries, it also highlighted potential opportunities for diversifying registration types to better meet the needs of healthcare professionals.

The National Cancer Database Conforms to the Standardized Framework for Registry and Data Quality.

Standardization of procedures for data abstraction by cancer registries is fundamental for cancer surveillance, clinical and policy decision-making, hospital benchmarking, and research efforts. The objective of the current study was to evaluate adherence to the four components (completeness, comparability, timeliness, and validity) defined by Bray and Parkin that determine registries' ability to carry out these activities to the hospital-based National Cancer Database (NCDB). Tbis study used data from U.S. Cancer Statistics, the official federal cancer statistics and joint effort between the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), which includes data from National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) to evaluate NCDB completeness between 2016 and 2020. The study evaluated comparability of case identification and coding procedures. It used Commission on Cancer (CoC) standards from 2022 to assess timeliness and validity. Completeness was demonstrated with a total of 6,828,507 cases identified within the NCDB, representing 73.7% of all cancer cases nationwide. Comparability was followed using standardized and international guidelines on coding and classification procedures. For timeliness, hospital compliance with timely data submission was 92.7%. Validity criteria for re-abstracting, recording, and reliability procedures across hospitals demonstrated 94.2% compliance. Additionally, data validity was shown by a 99.1% compliance with histologic verification standards, a 93.6% assessment of pathologic synoptic reporting, and a 99.1% internal consistency of staff credentials. The NCDB is characterized by a high level of case completeness and comparability with uniform standards for data collection, and by hospitals with high compliance, timely data submission, and high rates of compliance with validity standards for registry and data quality evaluation.

Foster Care and Health in Medicaid-Enrolled Children Experiencing Parental Opioid Use Disorder

The burden of the US opioid crisis has fallen heavily on children, a vulnerable population increasingly exposed to parental opioid use disorder (POUD) in utero or during childhood. A paucity of studies have investigated foster care involvement among those experiencing parental opioid use during childhood and the associated health and health care outcomes. To examine the health and health care outcomes of children experiencing POUD with and without foster care involvement. This population-based cohort study used nationwide Medicaid claims data from January 1, 2014, to December 31, 2020. Participants included Medicaid-enrolled children experiencing parental opioid use-related disorder during ages 4 to 18 years. Data were analyzed between January 2023 and February 2024. Person-years with (exposed) and without (nonexposed) foster care involvement, identified using Medicaid eligibility, procedure, and diagnostic codes. The main outcomes included physical and mental health conditions, developmental disorders, substance use, and health care utilization. The Pearson χ2 test, the t test, and linear regression were used to compare outcomes in person-years with (exposed) and without (nonexposed) foster care involvement. An event study design was used to examine health care utilization patterns before and after foster care involvement. In a longitudinal sample of 8 939 666 person-years from 1 985 180 Medicaid-enrolled children, 49% of children were females and 51% were males. Their mean (SD) age was 10 (4.2) years. The prevalence of foster care involvement was 3% (276 456 person-years), increasing from 1.5% in 2014 to 4.7% in 2020. Compared with those without foster care involvement (8 663 210 person-years), foster care involvement was associated with a higher prevalence of developmental delays (12% vs 7%), depression (10% vs 4%), trauma and stress (35% vs 7%), and substance use-related disorders (4% vs 1%; P < .001 for all). Foster children had higher rates of health care utilization across a wide array of preventive services, including well-child visits (64% vs 44%) and immunizations (41% vs 31%; P < .001 for all). Health care utilization increased sharply in the first year entering foster care but decreased as children exited care. In this cohort study of Medicaid-enrolled children experiencing parental opioid use-related disorder, foster care involvement increased significantly between 2014 and 2020. Involvement was associated with increased rates of adverse health outcomes and health care utilization. These findings underscore the importance of policies that support children and families affected by opioid use disorder, as well as the systems that serve them.

Robotic Versus Navigation Assisted Posterior Lumbar Fusion: A National Database Study.

Retrospective cohort study. Compare perioperative adverse events and reoperations between navigation-assisted and robotic-assisted posterior lumbar fusion. Navigation has become increasingly utilized for posterior lumbar fusion (PLF). More recently, robotic assistance systems have been gaining traction. However, the incremental advantage of these systems has been unclear in the literature. Patients undergoing one to three level PLF (with or without anterior or posterior interbody fusion) were identified from the 2015-2022 M161Ortho PearlDiver Database using CPT codes. Navigation assistance was identified based on CPT coding and robotic assistance was based on ICD-10 procedural coding. Navigation-assisted cases were matched 4:1 to robotic assisted patients based on age, sex, Elixhauser Comorbidity Index, number of levels fuse, and concomitant anterior fusion. Incidence of 90-day adverse outcomes were assessed and compared with multivariable logistical regression. Bonferroni correction was applied for multiple testing. Rate of reoperation was assessed using a Kaplan-Meier survival analysis. From 2015 to 2022, there has been a significant increase in both navigation and robotic assisted lumbar fusions, with navigation-assisted surgery being significantly more common. After matching, there were 2,401 navigation-assisted cases and 651 robotic-assisted cases. On multivariate analysis, there no significant differences in 90-day any, severe, or minor adverse events. There was a significant increase odd of readmissions in the robotic cohort (OR: 1.77, P<0.001). There were no differences in three-year reoperation rates between the navigation-assisted and robotic-assisted cohorts (95.8% versus 94.0%, P=0.30). As spinal navigation has been gaining popularity and robotic assistance is starting to be further utilized, the incremental advantage of different techniques may be questioned. While further study and technique evolution are ongoing, the current study was not able to demonstrate 90-day or 3-year incremental advantages for robotics relative to navigation based on the metrics evaluated.

Comparison of Work Relative Value Units Assigned to Urological and Gynecological Surgical Procedures.

We sought to determine if work relative value unit differences exist between analogous, sex-specific procedures. Representatives from the AUA and the American College of Obstetricians and Gynecologists independently reviewed the entire procedural code set and identified sex-specific procedures that had an analogous procedure in the opposite sex. These pairs were then evaluated and compared using current American Medical Association Relative Value Scale Update Committee methodology. Comparable code pair values were then examined to determine any systemic bias in the work relative value units assigned between the procedures. Mean differences and 95% confidence intervals were used to determine any differences in procedure or physician time values. The methodology used considered global period, intraservice time, total time, hospital days, postoperative office visits, and the date of the committee review. Of the 10 directly analogous code pairs reviewed, 7 of the female procedures had higher work relative value unit differences (range 0.29-6.47), and 3 of the male procedures had higher work relative value unit differences (range 1.23-2.34). There was no statistical difference between the code pair work relative value units. The work relative value unit per minute of intraservice time and total time were not statistically different. In this study, we compared operative procedures performed in women with clinically comparable operative procedures performed in men that had similar surgical approaches, global periods, and valuation methodologies. Overall, no statistical differences in work relative value units were demonstrated.