Retrospective Database Analysis Research Articles

Epidemiological Characteristics of 101,471 Patients Hospitalized with Chronic Obstructive Pulmonary Disease (COPD) in Poland in 2019: Multimorbidity, Duration of Hospitalization, In-Hospital Mortality.

Chronic obstructive pulmonary disease (COPD) is a common lung disease. There is a limited amount of nationwide data on COPD patients in Poland. This study aimed to characterize patients hospitalized with COPD in Poland in 2019 as well as to identify factors associated with the risk of in-hospital death and prolonged hospitalization among patients with COPD. This study is a retrospective database analysis. Data on patients hospitalized with COPD in Poland were obtained from the Nationwide General Hospital Morbidity Dataset. Data on all adults aged ≥40 years with a diagnosis of COPD from a physician (J44 code) were included in the analysis. Data were analyzed separately for patients hospitalized due to COPD (primary diagnosis) and patients with COPD as a comorbidity (secondary diagnosis). Completed medical records were available for 101,471 patients hospitalized with COPD (36.9% were females). Of those, 32% were hospitalized due to COPD. The mean age was 71.4 ± 9.7 years. The mean duration of hospitalization was 9.4 ± 11.4 days (median 7 days). Most of the COPD patients (89.3%) had at least one comorbidity. The in-hospital mortality rate was 6.8%. Older age, presence of cardiovascular diseases, and diseases of the genitourinary system (p < 0.05) were the most important factors associated with the risk of in-hospital death among patients hospitalized due to COPD.

Intracorporeal Vessel Ligation in Laparoscopic Right Colectomy for Cancer is Associated with Increased Lymph Node Yield.

This study aimed to compare intra- and extracorporeal division of the vascular pedicle in laparoscopic right colectomy regarding pathological outcomes, short-term morbidity, and local recurrence and distant metastases. Retrospective analysis of an IRB-approved database of all patients who underwent laparoscopic right colectomy for cancer between 01/2011 and 08/2021. Main outcome measures were number of harvested lymph nodes, length of resected colon, R1 rate, positive lymph node ratio, short-term post-operative morbidity, local recurrence, and distant metastases. Two-hundred seventy-one consecutive patients (136 males) patients underwent laparoscopic right hemicolectomy for cancer during the study period. Vessel ligation was intracorporeal in 171 (63%) and extracorporeal in 100 patients (37%); groups had similar baseline characteristics except for extent of resection as extended right hemicolectomy was significantly more often performed in the intracorporeal group. When the two groups were matched for theextent of resection (standard versus extended right hemicolectomy),the mean number of harvested lymph nodes (28.61 ± 12.04 versus25.37 ± 10.06, p = 0.04) and median length of theresected colon [26.00 (IQR:21.00, 32.00) versus 23.00 (IQR:19.00, 27.00)cm, p = 0.003] were significantly higher in the intracorporeal than in the extracorporeal group. The intracorporeal group required a significantly longer operative time than didthe extracorporeal group (168.94±57.9 vs. 139.7±41.3mins, p=0.001). No significant differences were noted between the groups in terms of ileus, hemorrhage, surgical site infection, re-operation rates, recurrence, or distant metastases. Intracorporeal vessel ligation in laparoscopic right hemicolectomy was associated with increased lymph node yield and longer specimens, although requiring longer operative times. Postoperative clinical outcomes were similar to outcomes in the extracorporeal ligation group.

Economic Burden among Patients with Vitiligo in the United States: A Retrospective Database Claims Study

Patients with vitiligo incur direct and indirect costs associated with their condition; however, data regarding the economic burden of vitiligo are scarce and outdated. In this retrospective cohort analysis of the Merative MarketScan Commercial Database, healthcare costs and healthcare resource utilization (HCRU) were evaluated among US patients with vitiligo. Vitiligo patients were matched (1:2) with individuals without vitiligo (controls) between January 2007 and December 2021. Outcomes included all-cause and vitiligo-related costs (2021 dollars) and all-cause HCRU, including mental health-related HCRU, during a 1-year post-index period. Subgroup analyses were completed for patients with vitiligo treatments with systemic effects (such as phototherapy and oral steroids) or a new mental health diagnosis. The analysis was focused solely on direct costs. Baseline demographics were well balanced between matched vitiligo (49,512) and control (99,024) cohorts. Patients with vitiligo incurred significantly higher all-cause ($15,551 vs $7,735) and vitiligo-related ($3490 vs $54) costs than controls (P<0.0001). All-cause and mental health-related HCRU were also significantly higher among patients with vitiligo (P<0.0001). Differences in all-cause and vitiligo-related healthcare costs remained significantly higher in patients with treatments with systemic effects/mental health diagnoses versus controls (P<0.0001). Taken together, healthcare costs and HCRU were significantly higher among patients with vitiligo than controls.

Association between serum sodium levels within 24 h of admission and all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage: a retrospective analysis of the MIMIC-IV database.

The study aimed to evaluate the relationship between serum sodium and mortality in critically ill patients with non-traumatic subarachnoid hemorrhage. This is a retrospective investigation of critically ill non-traumatic patients with subarachnoid hemorrhage (SAH) utilizing the MIMIC-IV database. We collected the serum sodium levels at admission and determined the all-cause death rates for the ICU and hospital. We employed a multivariate Cox proportional hazard regression model and Kaplan-Meier survival curve analysis to ascertain the relationship between serum sodium and all-cause mortality. In order to evaluate the consistency of correlations, interaction and subgroup analyses were also conducted. A total of 864 patients with non-traumatic SAH were included in this study. All-cause mortality in the ICU and hospital was 32.6% (282/864) and 19.2% (166/864), respectively. Sodium levels at ICU admission showed a statistically significant J-shaped non-linear relationship with ICU and hospital mortality (non-linear P-value < 0.05, total P-value < 0.001) with an inflection point of ~141 mmol/L, suggesting that mortality was higher than normal serum sodium levels in hypernatremic patients. Multivariate analysis after adjusting for potential confounders showed that high serum sodium levels (≥145 mmol/L) were associated with an increased risk of all-cause mortality in the ICU and hospital compared with normal serum sodium levels (135-145 mmol/L), [hazard ratio (HR) = 1.47, 95% CI: 1.07-2.01, P = 0.017] and (HR = 2.26, 95% CI:1.54-3.32, P < 0.001). Similarly, Kaplan-Meier (K-M) survival curves showed lower survival in patients with high serum sodium levels. Stratified analysis further showed that the association between higher serum sodium levels and hospital all-cause mortality was stronger in patients aged < 60 years with a hospital stay of <7 days. High serum sodium levels upon ICU admission are related to higher ICU and hospital all-cause mortality in patients with non-traumatic SAH. A new reference is offered for control strategies to correct serum sodium levels.

Mean arterial pressure and mortality in patients with heart failure: a retrospective analysis of Zigong heart failure database.

It is commonly observed that a higher target of mean arterial pressure (MAP) is in previous studies. This study assessed the association of MAP with short-term mortality in heart failure (HF) patients. A retrospective cohort study was conducted by using data from Hospitalized patients with heart failure: integrating electronic healthcare records and external outcome database (v1.2 ). The characteristic of patients was described by 3 groups of MAP: below 80 mmHg, 80-100 mmHg, and above 100 mmHg. Univariate and multivariate logistic regression analyses were used to assess the relevance between MAP and all-cause mortality within 28 days and 6 months. For assessing the effect of multiple variables on patient survival time, 28-day and 6-month, Kaplan-Meier survival analysis and Forest plot were performed. The overall cohort comprised 2008 patients divided by MAP into 3 groups, each group had 344 (17.1%), 938 (46.7%), and 726 (36.2%) patients. Patients in MAP < 80 mmHg group had higher mortality than MAP 80-100 mmHg and MAP ≥ 100 mmHg in 28 days(3.8% versus 1.6% versus 1.2%) and in 6 months (4.9% versus 2.5% versus 2.3%). Univariate analysis showed that MAP as a continuous variate was associated with 28-day (OR was 0.98, 95% CIs: 0.96-0.99, P = 0.011) and 6-month mortality (OR was 0.98, 95% CIs: 0.97-1, P = 0.021) in HF patients. Model 4 put into multivariate logistic regression analyses showed MAP 80-100 mmHg (OR was 0.13, 95% CIs: 0.02-0.8, P = 0.027) stably associated with 28-day and 6-month mortality after adjusted covariable. Kaplan-Meier survival curves revealed a higher survival rate in the MAP ≥ 80 mmHg group than in the MAP < 80 mmHg group. The forest plot showed the stable effect of MAP ≥ 80 mmHg compared with MAP < 80 mmHg, the interaction analysis had no statistical significance effect between the two groups of MAP and multi-variable. It is indicated that MAP was independently associated with 28-day, 6-month all-cause mortality of HF patients, and compared with MAP < 80 mmHg, MAP ≥ 80 mmHg had a lower risk of 28-day, 6-month all-cause mortality of patients with HF.

Benign prostatic obstruction (BPO) as a possible risk factor for Peyronie's disease (PD). The influence of BPO and PD on mental health.

Not available.

Calcification in Peyronie's disease: Its role and clinical influence on the various symptoms and signs of the disease, including psychological impact. Our study of 551 patients.

The aim of study was to evaluate the impact of plaque calcification on symptoms of patients with Peyronie's disease (PD) and to evaluate mental health in PD patients with or without calcification. We performed a retrospective analysis of the clinical database of a single andrology clinic. We extracted 551 PD patients, and we sorted them into two groups: the first group included 201 PD patients with plaque calcification; the second group included 350 PD patients without plaque calcification. The inclusion criteria for both groups were as follows: aged between 21 and 81 years; thorough and available data on clinical history; baseline levels of blood glucose, glycosylated hemoglobin, cholesterol, and triglycerides; photographic documentation of the penile curvature; dynamic penile eco-color Doppler ultrasound with plaque measurements and volume calculation; and completion of the generalized anxiety disorder-7 questionnaire, patient health questionnaire-9 (for depression), visual analog scale for penile pain measurements, and the International Index of Erectile Function (IIEF) questionnaire. Plaque calcification was present in 36.4% of cases. The presence of calcification affects the presence and severity of penile curvature. Calcification is associated with the presence of hypertension. In PD patients, the prevalence of significant anxiety and significant depression was 89.1% and 57.3%, respectively. Calcification is associated with the presence of anxiety and depression but does not lead to an increase in their prevalence. In PD patients, the calcification was present in more than one third of cases. The size of the plaque calcification was < 15 mm in most cases. Calcification influences the presence of the curve and influences its severity. There was a prominent prevalence of anxiety and depression in PD patients.

Incident Comorbidity, Resource Use, and All-Cause Mortality Associated with Prurigo Nodularis: A United Kingdom Retrospective Database Analysis

We described comorbidity, resource utilization, and mortality for patients with prurigo nodularis (PN) using data from the Clinical Practice Research Datalink. Patients with incident PN (2008-2018) were selected and matched to controls. Of 2,416 patients with PN, 2,409 (99.7%) were matched to controls. Prevalence of atopic dermatitis (relative risk [RR]= 2.571; 95% confidence interval [CI]= 2.356-2.806), depression (RR= 1.705; 95% CI= 1.566-1.856), anxiety (RR= 1.540; 95% CI= 1.407-1.686), coronary heart disease (RR= 1.575; 95% CI= 1.388-1.787), chronic kidney disease (RR= 1.529; 95% CI= 1.329-1.759), and type 2 diabetes mellitus (RR= 1.836; 95% CI= 1.597-2.111) was significantly higher for patients with PN. Subsequent risk of atopic dermatitis (hazard ratio= 6.58; 95% CI= 5.17- 8.37), depression (hazard ratio= 1.61; 95% CI= 1.30-1.99), and coronary heart disease (hazard ratio= 1.37; 95% CI= 1.09-1.74) were significantly increased. Resource utilization was increased in all settings: incidence rate ratio= 1.48 (95% CI= 1.47-1.49) for primary care, incident rate ratio= 1.80 (95% CI= 1.75-1.85) for inpatients, incident rate ratio= 2.15 (95% CI= 2.13-2.18) for outpatients, and incidence rate ratio= 1.32 (95% CI= 1.27-1.36) for accident and emergency. Respective cost ratios were 1.78 (95% CI= 1.67-1.90), 1.52 (95% CI= 1.20-1.94), 2.34 (95% CI= 2.13-2.58), and 1.55 (95% CI= 1.33-1.80). Total primary and secondary healthcare costs were £2,531 versus £1,333, a cost ratio of 1.62 (95% CI= 1.36-1.94). The adjusted hazard ratio for mortality was 1.37 (95% CI= 1.14-1.66). Patients with PN had significantly increased rates of comorbidity, healthcare resources utilization, and mortality compared with matched controls.

Clinical Manifestations and Risk Factors Associated with 14 Deaths following Swarm Wasp Stings in a Chinese Tertiary Grade A General Hospital: A Retrospective Database Analysis Study.

The objective was to evaluate the poisoning severity score (PSS) as an early prognostic predictor in patients with wasp stings and identify associated clinical characteristics and risk factors for mortality. A total of 363 patients with wasp stings at Suining Central Hospital between January 2016 and December 2018 were enrolled. Within the first 24 h of admission, the poisoning severity score (PSS) and the Chinese expert consensus on standardized diagnosis and treatment of wasp stings (CECC) were utilized for severity classification, and their correlation was examined. Patients were then divided into survival and death groups based on discharge status. Logistic regression analysis was employed to analyze factors influencing patients' outcomes. The mortality of wasp sting patients was 3.9%. The PSS and CECC were found to correlate for severity classification. Additionally, female gender, age, number of stings, and PSS were identified as independent risk factors for mortality in wasp sting patients. Combining these four factors yielded an AUC of 0.962 for predicting death. PSS aids in early severity classification of wasp stings. Female gender, age, number of stings, and PSS were independent mortality risk factors in these patients.

Omission of perioperative morphine reduces postoperative pain in proctological interventions: a single-center analysis

There is an increase in outpatient procedures and this trend will continue in the future. For hemorrhoidectomy, it is the standard of treatment in many health care systems. Perioperative management including adequate pain control is of paramount importance to ensure successful ambulatory surgery. This study investigates the role and effect of morphine compared to short-acting opiates applied before, during, or after proctological interventions and with focus on hemorrhoidectomy. A retrospective analysis of a prospective database was conducted comparing two populations. The control cohort received morphine (Yes-Mô) intra- and postoperatively, while the intervention group did not receive morphine (No-Mô) between January 2018 and January 2020. Both cohorts were balanced by propensity score matching. The outcomes were postoperative pain measured by numeric ratings scale (NRS) one hour postoperatively, pain 24 h postoperatively, success rate of outpatient management, and complication rate including postoperative nausea and vomiting as well as urinary retention. The intervention population comprised 54 patients and the control group contained 79 patients. One hour after surgery, patients in No-Mô reported lower NRS (1.44 ± 1.41) compared to Yes-Mô (2.48 ± 2.30) (p = 0.029). However, there was no difference in NRS 24 h postoperatively (No-Mô: 1.61 ± 1.41 vs Yes-Mô: 1.63 ± 1.72; p = 0.738). 100% of No-Mô was managed as outpatients while only 50% of Yes-Mô was dismissed on the day of the operation (p = < 0.001). There was no difference in postoperative complications (including postoperative nausea and vomiting (PONV) and urinary retention) between the two groups (PONV No-Mô 7.4% vs Yes-Mô 5.6%, p = 1.0 and urinary retention No-Mô 3.7% vs Yes-Mô 7.4%, p = 0.679). No-Mô received an oral morphine equivalent of 227.25 ± 140.35 mg intraoperatively and 11.02 ± 18.02 mg postoperatively. Yes-Mô received 263.17 ± 153.60 mg intraoperatively and 15.97 ± 14.17 mg postoperatively. The difference in received morphine equivalent between the groups was not significant after matching for the intraoperative (p = 0.212) and postoperative (p = 0.119) received equivalent. Omission of perioperative morphine is a viable but yet not understood method for reducing postoperative pain. Omission of morphine leads to a lower use of total morphine equivalent to attain satisfactory analgesia. The reduction of the overall opiate load and using opiates with a very short half-life potentially leads to a reduction of side effects like sedation. This in turn promotes discharge of the patient on the day of surgery. Omission of morphine is safe and does not increase postoperative complications.

Incidence and risk factors of in-hospital prosthesis-related complications following total shoulder arthroplasty.

The occurrence of prosthesis-related complications after total shoulder arthroplasty is devastating and costly. The purpose was to determine the incidence and risk of in-hospital prosthesis-related complications after total shoulder arthroplasty utilizing a large-scale sample database. A retrospective database analysis was performed based on Nationwide Inpatient Sample from 2010 to 2014. Patients who underwent total shoulder arthroplasty were included. Patient demographics, hospital characteristics, length of stay, economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated. A total of 34,198 cases were capture from the Nationwide Inpatient Sample database. There were 343 cases of in-hospital prosthesis-related complications after total shoulder arthroplasty and the overall incidence was 1%, with a more than 2.5-fold decrease from 2010 to 2014. Dislocation was the most common category among prosthesis-related complications (0.1%). The occurrence of in-hospital prosthesis-related complications was associated with significantly more total charges and slightly longer length of stay while less usage of Medicare. Risk factors of prosthesis-related complications were identified including younger age (<64years), female, the native American, hospital in the South, alcohol abuse, depression, uncomplicated diabetes, diabetes with chronic complications, fluid and electrolyte disorders, metastatic cancer, neurological disorders, and renal failure. Interestingly, advanced age (≥65years) and proprietary hospital were found as protective factors. Furthermore, prosthesis-related complications were associated with aseptic necrosis, rheumatoid arthritis, rotator cuff tear arthropathy, Parkinson's disease, prior shoulder arthroscopy, and blood transfusion. It is of benefit to study risk factors of prosthesis-related complications following total shoulder arthroplasty to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.

Development and validation of a prognostic nomogram for predicting cancer-specific survival in advanced endometrial carcinoma after surgery: a retrospective analysis of the SEER Database

ObjectiveWe aimed to construct and validate a prognostic nomogram to predict cancer-specific survival (CSS) after surgery in patients with advanced endometrial carcinoma (EC).DesignRetrospective cohort study.Setting and participantsThe Surveillance, Epidemiology, and...

Impact of Fatigue on Emergency Physicians' Decision-making for Computed Tomographic Scan Requests and Inpatient Referrals: An Observational Study from a Tertiary Care Medical Center of the Sultanate of Oman.

Multiple factors contribute to decision fatigue experienced by emergency physicians (EPs). This study examines the association between decision fatigue and the frequency of computed tomographic (CT) scan requests and inpatient referrals among EPs. This retrospective database analysis was done for 3 months. Scans and inpatient referral requests were coded and analyzed to assess the impact of physician fatigue on decision-making. Subsequently, the outcomes were evaluated. The majority of patients (n = 481; 51.1%) had a CT brain request. Among these requests, the morning shift (8:00 a.m.-3:00 p.m.) accounted for the highest number (n = 400; 42.5%), followed by the evening shift (3:00-11:00 p.m.) (n = 345; 36.7%). Approximately one-third of the patients (n = 301; 31.9%) had positive CT scan findings. Statistical analysis comparing the first and the second halves of each shift did not reveal significant variations in the percentage of negative CT results (p-value: 0.093). Inpatient referral was necessary for over half of the patients (n = 1,048; 52.7%), and the majority of these referrals (n = 778; 74.2%) were deemed necessary for treatment under various surgical or medical specialties. There was a statistically significant difference in the proportion of negative inpatient referrals between the first and the second halves of the afternoon shift (p-value < 0.001). Fatigue among EPs was observed, leading to more frequent consultations without inpatient admission during the latter half of the afternoon shift. However, the study found no significant impact of decision fatigue on CT scan decision-making. Al-Arimi AH, Hazra D, Al-Alawi AKA. Impact of Fatigue on Emergency Physicians' Decision-making for Computed Tomographic Scan Requests and Inpatient Referrals: An Observational Study from a Tertiary Care Medical Center of the Sultanate of Oman. Indian J Crit Care Med 2023;27(9):620-624.

280. FEASIBILITY OF ROBOTIC-ASSISTED SURGERY FOR BENIGN ESOPHAGEAL LESIONS: SINGLE-CENTER EXPERIENCE

Abstract Background Benign esophageal lesions are uncommon conditions compared to malignant cases. Thoracotomy is an extremely invasive procedure that can cause severe complications and delay recovery. Conventional VATS is limited in its approach to deep and narrow angles and difficult to manipulate due to abundance of vital structures that are always mobile in mediastinal area. Robotic-assisted surgery is a new challenge that aims to achieve minimally invasive procedures and improve postoperative outcomes for benign esophageal lesions. Methods We conducted a retrospective analysis of a single-center database from May 2012 to November 2022, including patients aged 20–75 years with diagnosed benign esophageal lesions such as esophageal leiomyoma and esophageal diverticulum who underwent robotic-assisted esophageal surgery using the Da Vinci Robotic surgery system. The operation was performed using either a transthoracic or transabdominal approach. Patient data, surgical procedures, interventions, and early outcomes (within 30 days post-operation) were collected and analyzed to assess postoperative variables. The study included 13 patients, and the primary outcome was the incidence of pulmonary complications during the hospital stay. Results The number of patients with each esophageal lesion was as follows: esophageal leiomyoma, 6 cases (46.1%); esophageal diverticulum, 3 cases (23.1%); and other benign lesions, 4 cases (30.8%). Robotics approaches were divided into 11 cases (84.6%) and 2 cases (15.4%) for transthoracic and transabdominal, respectively. The overall incidence of postoperative pulmonary complications was 5 cases (38.5%), with mild pulmonary infection occurred in 2 cases (15.4%). Other pulmonary complications occurred in the transthoracic approach due to patient characteristics related to underlying lung diseases, such as COPD and asthma. There was no evidence of 30 days mortality in our series. Conclusion Robotic-assisted surgery is feasible for benign esophageal surgery using both transthoracic and transabdominal approaches. Robotic devices can provide stabilization for both 3D camera views and instrument arms, particularly enhancing suturing ability. Robotic surgery is precise and maneuverable, with potential to perform intricate surgical procedures in tight angles and confined spaces such as the thoracic cavity and hiatal area. These factors can improve the overall operative outcome and enhance recovery due to minimally invasive access.

274. ROBOTIC-ASSISTED THORACOSCOPIC ESOPHAGECTOMY WITH MEDIASTINAL LYMPH NODE DISSECTION: DOES IT FEASIBLE FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA SURGERY?

Abstract Background Esophageal cancer is sixth leading cause of cancer-related mortality globally in 2020. Esophageal squamous cell carcinoma is one of most aggressive and need extensive operative treatment for radical and oncologic purpose. Conventional thoracotomy is highly invasive, conventional video-assisted is quite technical difficulty related with deep and narrow angle of exposure. Robotic-assisted procedure is new challenging to beat this limitation. This is descriptive report of initial robotic-assisted experiences regard to feasibility, safety and oncologic outcome. Methods We conducted a retrospective analysis of a single-center database from March 2012 to February 2023, including patients aged 45–85 years with resectable lesions of the esophageal squamous cell carcinoma who underwent robotic-assisted thoracoscopic esophagectomy using the Da Vinci Robotic surgery system. Patient data, surgical procedures, interventions, and early outcomes (within 30 days postoperation) were collected and analyzed to assess postoperative variables and adequacy of cancer clearance. The study included 12 patients, and the primary outcome was the incidence of pulmonary complications during the hospital stay. Results The overall incidence of postoperative pulmonary complications was 4cases (33.3%), with mild pulmonary infection occurring in 2cases (16.7%) without 30-day mortality in robotic-assisted thoracoscopic esophagectomy. The median admission period were 2 days and 15 days for ICU and hospital stay, respectively. The median time for the thoracic phase of operation was 210 minutes (150-445 minutes), and the median blood loss volume was 55 mL (20–300 mL). Pathological results showed that overall proximal and distal margins were uninvolved by tumor, and the median number of lymph nodes retrieval in the thoracic region was 22.5lymph nodes (14-73lymph nodes). 41.7% of patients were classified in pathological stage I. Conclusion Robotic-assisted thoracoscopic esophagectomy has shown promising early postoperative outcomes, low blood loss volume, short ICU and hospital stay, a low rate of pulmonary complications and including adequate lymph node retrieval and pathological results. These findings support the feasibility and safety of robotic-assisted thoracoscopic esophagectomy, which enhance postoperative recovery and improve surgical outcomes for the treatment of esophageal squamous cell carcinoma.

488 Comparison of Efficacy Between Suture-Mediated and Plug-Based Vascular Closure Devices Following Endovascular Procedures via Large-Bore Femoral Punctures

Abstract Introduction Endovascular aneurysm repair is typically performed via large-bore percutaneous femoral access; with haemostasis achieved using vascular closure devices (VCDs). Such VCDs include suture-mediated closure devices like ProGlide or plug-based such as the MANTA. We compared the efficacy of two techniques, early and late complications related to the devices. Method We undertook a retrospective analysis of a prospective database of large-bore access procedures from 2017-2022, comparing two groups by VCD used, designated Group A (ProGlide) and Group B (Manta). We classified haemostasis as Grade 1 (haemostasis without adjuncts), Grade 2 (haemostasis with adjuncts such as pressure dressings) and Grade 3 (failed haemostasis needing rescue). Grades 1 &amp; 2 were considered successful haemostasis. We used Minitab 21 for statistical analysis. Results We assessed 207 endovascular procedures with 374 large-bore accesses (243 Group A and 131 Group B). The mean age was 74.9±8 (183 males), and the average BMI was 28±5.8. 191 had EVAR and 11 TEVAR. 5% had redo groins (11 Group A and 8 Group B, p = 0.47). The average sheath outer diameter was 16±2.5F. Successful haemostasis was achieved in 91.1% (222 in Group A and 119 in Group B). 8.8% needed a rescue operation (21 in Group A and 12 in Group B, p = 0.86). Pseudoaneurysms developed in 4.8% (n = 18) and were more frequent in Grade 2 haemostasis (11 Group A and 2 Group B, p = 0.058). Conclusions The overall success rate was comparable between the two groups. However, ProGlide deployments required more adjuncts to achieve haemostasis. Pseudoaneurysm formation was more frequent with adjuncts.

Greater cost without greater benefit: The need to refine transfer criteria for patients with severe acute pancreatitis

BackgroundAppropriate and timely care is essential in the management of severe acute pancreatitis (SAP). We hypothesized that transferred patients with SAP undergoing procedural intervention would have higher mortality compared to those managed directly at academic centers. MethodsThis was a retrospective analysis of Maryland's statewide claims database from 2009 to 2022 of adult patients admitted with a primary diagnosis of SAP (acute pancreatitis with organ failure). Patients were divided into three groups: those admitted directly from the emergency room to academic facilities (AD), non-academic facilities (NA), or transferred to academic facilities (TR). Procedural intervention included endoscopic, percutaneous image-guided, or surgical. The primary outcome was in-hospital mortality. Secondary outcomes were admission costs, length of stay (LOS), and intensive care unit (ICU) admission. ResultsThere were 7,648 (48.9%) in the NA group, 6,682 (42.7%) in the AD group and 1,316 (8.4%) in the TR group. On regression analysis, odds of death were 0.57x lower in the NA group and 0.67x lower in the AD group compared to transfers (<0.001). Procedural intervention was not associated with increased mortality. Transferred patients had longer median LOS (11 vs NA = 5, AD = 6, p < 0.001), increased median cost of admission ($41k vs NA = $12k, AD = $17k, p < 0.001) and greater ICU admission (45.6% vs NA = 20.6%, AD = 23.9%, p < 0.001). ConclusionTransferred patients have greater burden of illness and cost of care without evidence of improved outcomes in the management of SAP regardless of procedural intervention. Transfer criteria for patients with SAP must be further refined to reduce unnecessary transfers.

Antithrombin concentrates may benefit cardiopulmonary bypass patients with suspected heparin resistance: A retrospective analysis of real-world data

BackgroundHeparin resistance is a common complication of surgical patients requiring anticoagulation, such as those undergoing cardiopulmonary bypass (CPB). Treatments to address heparin resistance include supplementation of antithrombin (AT) or fresh frozen plasma (FFP). This retrospective database analysis compared key outcomes in suspected heparin-resistant patients undergoing CPB treated with AT or FFP. MethodsDe-identified United States electronic health records (Cerner Health Facts®) were queried. International Classification of Diseases (ICD-9/10) codes were used to determine CPB procedures and FFP administration. AT administration was identified using medication data, while a combination of lab and medication data examining activated clotting times detected heparin resistance in FFP patients. Adult inpatients (≥18 years old) seen between 2001 and 2018 were included. Differences in mortality, intensive care unit (ICU) length of stay (LOS), and hospital-free days (using a 30-day post-discharge period) were assessed with univariate models as well as adjusted logistic regression models controlling for patient characteristics and Charlson Comorbidity Index (CCI) scores. ResultsOf the 502 patients identified, 247 received AT and 255 received FFP. The FFP cohort was associated with a higher CCI compared to the AT cohort (3.3 ± 2.4 vs. 2.3 ± 2.0, P < .001). The AT cohort was associated with a 71% (Odds Ratio [OR]: 0.29, 95% Confidence Interval [CI]: P = .003) and 66% (OR: 0.34, 95% CI: P = .01) reduction in mortality when compared to FFP using univariate and adjusted logistic regression models, respectively. Similarly, use of AT also showed a 22% shorter ICU LOS (P = .02) and 10% more hospital-free days in the 30 days following discharge (P = .004) according to the univariate models, though statistical significance was absent within adjusted models in both ICU LOS (P = .08) and hospital-free days (P = .53). ConclusionsCompared to FFP, AT use suggests a reduction in the odds of mortality in suspected heparin-resistant patients undergoing CPB, though larger prospective studies are necessary to elucidate potential differences in hospital-free days or ICU LOS across treatment modalities.

Epidemiology of progressive multifocal leukoencephalopathy in Japan and effectiveness of mefloquine: A retrospective analysis of a nationwide inpatient database

IntroductionProgressive multifocal leukoencephalopathy (PML) is an infrequent yet devastating neurological infection that arises in immunocompromised patients. The epidemiological features of PML in Japan and its evolution in recent years remain unclear. There are no established treatments that directly target PML. Although mefloquine has shown in vitro activity against JC virus, its clinical effectiveness has not been confirmed in population-level studies. MethodsWe retrospectively analyzed the admission data of patients with PML recorded in the Diagnosis Procedure Combination (DPC) database from fiscal year 2010 to 2020 (11 years). Descriptive statistics were used to illustrate the epidemiological features. Changes in the frequency of PML admission, underlying diseases, and in-hospital mortality over time were also examined. Furthermore, we evaluated the effectiveness of mefloquine in improving activities of daily living at discharge using propensity score matching. ResultsWe identified 610 PML cases diagnosed by the treating physicians, which may include possible PML. Among them, 419 were first-time admissions. The median age at admission was 62.0 years, and 62.8% were men. HIV was the most common underlying condition, accounting for 22.9% of cases, followed by hematologic malignancies (18.4%), and autoimmune diseases (17.9%). Over the study period, the frequency of PML admissions showed an increasing trend, whereas the in-hospital mortality rate showed a decreasing trend. The effectiveness of mefloquine was not confirmed. ConclusionsThe results of this study will help clarify and update the clinical picture of PML in Japan. The DPC database was shown to be useful tool for epidemiological research on rare infectious disease such as PML.

Admission NLPR predicts long-term mortality in patients with acute ischemic stroke: A retrospective analysis of the MIMIC-III database.

The neutrophil to lymphocyte*platelet ratio (NLPR) is a new index based on platelets, neutrophils, and lymphocytes associated with the prognosis of patients with infectious diseases and cancer. However, its use in acute ischemic stroke has rarely been reported. This study examined the relationship between levels of systemic immunoinflammatory indices at admission and patient outcomes at different times after onset to assess stroke prognosis by NLPR. This was a retrospective cohort study. The data from 1222 stroke patients were obtained from multi-parameter intelligent monitoring in the Intensive Care III database(MIMIC- III). Cox proportional risk model was conducted to evaluate the relation between NLPR, all-cause mortality, and ischemic. The results were further verified via a subgroup analysis. After adjusting for multiple covariates, it was found that NLPR was related with all-cause mortality in stroke patients. High NLPR was accompanied by an increase in mortality with longer follow-up (30 days: HR = 1.52, 95% CI = 1.14-2.02,90 days: HR = 1.67, 95% CI = 1.29-2.16, 365 days: HR = 1.56, 95% CI = 1.24-1.96 and 2 years: HR = 1.52, 95% CI = 1.22-1.89). The neutrophil to lymphocyte*platelet ratio (NLPR) are related to long-term adverse outcomes in patients with acute ischemic stroke. Therefore, NLPR is a promising inflammatory index for predicting the long-term prognosis of stroke.