Retrospective Analysis Of National Database Research Articles

Temporal trends, in-hospital outcomes, and risk factors of acute myocardial infarction among patients with epilepsy in the United States: a retrospective national database analysis from 2008 to 2017.

The relationship between epilepsy and risk of acute myocardial infarction (AMI) is not fully understood. Evidence from the Stockholm Heart Study indicates that the risk of AMI is increased in people with epilepsy. This study aims to analyze the temporal trends in prevalence, adverse clinical outcomes, and risk factors of AMI in patients with epilepsy (PWE). Patients aged 18 years or older, diagnosed with epilepsy with or without AMI and hospitalized from January 1, 2008, to December 31, 2017, were identified from the National Inpatient Sample (NIS) database. The Cochran-Armitage trend test and logistic regressions were conducted using SAS 9.4. Odds ratios (ORs) were generated for multiple variables. A total of 8,456,098 inpatients were eligible for our analysis, including 181,826 comorbid with AMI (2.15%). The prevalence of AMI diagnosis in PWE significantly increased from 1,911.7 per 100,000 hospitalizations in 2008 to 2,529.5 per 100,000 hospitalizations in 2017 (Ptrend < 0.001). Inpatient mortality was significantly higher in epilepsy patients with AMI compared to those without AMI (OR = 4.61, 95% CI: 4.54 to 4.69). Factors significantly associated with AMI in PWE included age (≥75 years old vs. 18 ~ 44 years old, OR = 3.54, 95% CI: 3.45 to 3.62), atherosclerosis (OR = 4.44, 95% CI: 4.40 to 4.49), conduction disorders (OR = 2.21, 95% CI: 2.17 to 2.26), cardiomyopathy (OR = 2.11, 95% CI: 2.08 to 2.15), coagulopathy (OR = 1.52, 95% CI: 1.49 to 1.54), dyslipidemia (OR = 1.26, 95% CI: 1.24 to 1.27), peptic ulcer disease (OR = 1.23, 95% CI: 1.13 to 1.33), chronic kidney disease (OR = 1.23, 95% CI: 1.22 to 1.25), smoking (OR = 1.20, 95% CI: 1.18 to 1.21), and weight loss (OR = 1.20, 95% CI: 1.18 to 1.22). The prevalence of AMI in PWE increased during the decade. Mortality rates were high among this population, highlighting the need for comprehensive attention to prophylaxis for risk factors and early diagnosis of AMI in PWE by physicians.

Sex differences in early-onset atrial fibrillation in Norwegian primary care: a retrospective national database analysis

BackgroundIndividual variation in the need for healthcare constitutes knowledge gaps for young atrial fibrillation (AF) patients. We aimed to estimate the prevalence and primary care burden of early-onset AF in...

Prevalence and trends in polypharmacy and excessive polypharmacy: a retrospective national database analysis (2012-2021).

Polypharmacy is a growing concern, impacting patient safety and healthcare costs. Monitoring its prevalence and temporal trends is essential for effective healthcare management. This study aimed to determine prevalence and trends of polypharmacy and excessive polypharmacy in Belgium. Utilizing a federal claims database, medication data were analyzed from 2012 to 2021. Polypharmacy (≥ 5 medications) and excessive polypharmacy (≥ 10 medications) were evaluated, with prevalence calculated per 1000 inhabitants, and reported per year, age group and region. Linear regression estimated the impact of age and year on polypharmacy prevalence. In 2021, polypharmacy and excessive polypharmacy were reported in 135/1000 and 31/1000 Belgians respectively. Prevalence of both increased steadily from 2012 to 2021, with excessive polypharmacy rising more prominently. Among adults aged ≥ 65years, prevalence rates were higher, with polypharmacy at 434/1000 and excessive polypharmacy at 106/1000. Regional variations were observed, with prevalence highest in the Walloons region. Patient age and year (2012-2021) were associated with both polypharmacy and excessive polypharmacy (p < 0.001). We observed increases in polypharmacy and excessive polypharmacy over a decade in Belgium, particularly among older adults. Efforts to monitor, manage, and optimize medication use are imperative to ensure safe and effective healthcare delivery.

106. Usage trends and safety profile of recombinant human bone morphogenetic protein-2 for spinal column tumor surgery: a national matched analysis

<h3>BACKGROUND CONTEXT</h3> Achieving arthrodesis after spinal tumor surgery remains a significant challenge. Patients in this vulnerable cohort commonly experience poor bone quality, malnutrition and concurrent use of chemotherapy or radiotherapy—all of which interfere with proper bone formation and healing. To augment fusion efforts, recombinant human bone morphogenetic protein-2 (rhBMP-2) emerged as a powerful osteogenic factor after its FDA approval in 2002 but its use has remained a persistent concern. Although most recent evidence does not seem to suggest significantly increased rates of complications or carcinogenicity due to rhBMP-2 use, these findings remain poorly defined in the spinal oncology subcohort. <h3>PURPOSE</h3> To investigate national rates of rhBMP-2 utilization in spinal tumor surgery and examine its association with postoperative complications, revisions, and carcinogenicity. <h3>STUDY DESIGN/SETTING</h3> Retrospective national database analysis. <h3>PATIENT SAMPLE</h3> All patients diagnosed with primary or metastatic spinal tumors who underwent subsequent surgical intervention involving a spinal fusion recorded in Medicare, Medicaid, and commercial administrate claims databases in PearlDiver from 2005-2020. <h3>OUTCOME MEASURES</h3> Utilization rates; postoperative rates of complications, revisions, and failures; survivorship. <h3>METHODS</h3> Patients were organized into two cohorts according to rhBMP-2 usage and 1:1 matched based on age, gender, and Charlson Comorbidity Index. rhBMP-2 utilization trends were compared via a Pearson correlation across calendar years. Postoperative complications and revisions were examined at 1 month, 3 months, 6 months, and 1 year after spinal fusion. New cancer incidence following spinal tumor surgery was assessed until 5 years postoperatively. Post hoc comparisons were characterized using chi-squared analysis, and threshold for significance was established at P < 0.05. <h3>RESULTS</h3> A total of 11,198 patients underwent fusion surgery after resection of spinal tumors between 2005 and 2020, with 909 cases reporting the use of rhBMP-2 (8.1%). An annualized analysis revealed that the proportion of spine tumor fusion procedures utilizing rhBMP-2 has been significantly decreasing (R2 = 0.859, P < 0.001), with the most recent annual utilization rate at 1.1%. The final matched cohorts each comprised 894 patients. At least 6 months after surgery, significantly increased incidences of surgical site (7.3% vs 1.6%, P = 0.05) and systemic infections (13.8% vs 4.1%, P = 0.01) were observed in patients who underwent fusion with rhBMP-2. Across all time points, no significant differences were observed between the groups in survival, implant removal, or revision rates. In addition, incidence of new cancer diagnoses after fusion surgery was comparable between the two groups. <h3>CONCLUSIONS</h3> rhBMP-2 has been widely used off-label to promote arthrodesis; however. its role in spinal fusion procedures involving spinal tumors remains controversial. This analysis demonstrated significantly declining national utilization rates, and while rhBMP-2 usage was not associated with new cancer incidence postoperatively, its impact on local and metastatic progression remains unknown and requires further investigation. Compared with nonusers, spinal tumor cases utilizing rhBMP-2 sustained greater rates of surgical site and systemic infections. Furthermore, rhBMP-2 usage did not significantly reduce the risk of mortality, implant failure, or reoperation–suggesting it may not be essential to fulfilling the needs of this specific patient population. <h3>FDA DEVICE/DRUG STATUS</h3> BMP-2: not approved for this indication.

P147. Total hip arthroplasty in patients with prior lumbar spine fusion: does time between surgeries affect outcomes?

<h3>BACKGROUND CONTEXT</h3> Concurrent disease of the hip and spine is becoming increasingly common. Existing evidence suggests that prior lumbar spine fusion (LSF) predisposes patients undergoing total hip arthroplasty (THA) to increased rates of instability and revision. However, consequences from the temporal relationship between the two procedures remain largely unknown and may have implications for surgical planning. <h3>PURPOSE</h3> To evaluate the impact of timing between LSF and subsequent THA on postoperative outcomes. <h3>STUDY DESIGN/SETTING</h3> Retrospective national database analysis. <h3>PATIENT SAMPLE</h3> Patients with a prior lumbar spinal fusion undergoing total hip arthroplasty recorded in Medicare, Medicaid and commercial administrative claims databases in PearlDiver from 2007-2020. <h3>OUTCOME MEASURES</h3> Postoperative complications and revisions. <h3>METHODS</h3> Five cohorts were identified and matched by age, gender, obesity, and Charlson Comorbidity Index, according to interval time between the two procedures: LSF with subsequent THA in 2 years, as well as a control group comprising THA without previous LSF. Postoperative complications and revisions were assessed at 90 days and 2 years after primary THA. Post hoc comparisons were characterized using five-way chi-squared analysis, and threshold for significance was P < 0.05. <h3>RESULTS</h3> A total of 3,260 patients were included for analysis. At 90 days, there was a significantly increased incidence of prosthetic instability in patients undergoing THA within 6 months of a prior LSF (0.77%, P = 0.015) compared to other groups. However, this difference did not persist at long-term followup. At 2 years, the incidences of postoperative infections (4.91%, P < 0.001), cellulitis (4.75%, P = 0.003), and wound complications (1.99%, P = 0.001) were significantly greater in patients whose surgeries were separated by less than a year. Additionally, patients who underwent THA within 2 years of a prior LSF demonstrated significantly increased rates of mechanical failure (2.45%, P = 0.002). <h3>CONCLUSIONS</h3> Lumbar fusion is known to alter dynamic pelvic motion and may impair hip implant accommodation. This analysis specifically found an increased risk of early postoperative instability in patients who underwent THA within 6 months of LSF. Furthermore, patients with both surgeries in 2-year proximity sustained greater rates of long-term wound, infectious and implant complications. To mitigate these risks, surgeons should consider delaying elective THA until biologic fusion matures. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Efficacy, Tolerability, and Acceptance of Long-Lasting Antipsychotics in Children and Adolescents: A Systematic Review.

Objectives: While long-lasting antipsychotics (LLA) were specifically developed to address the problem of adherence in patients with chronic psychiatric disorders, their role in pediatric populations is not clear. Methods: To document the efficacy, tolerance, and acceptance of LLAs in children and adolescents, a literature search was conducted using several databases for published studies (PubMed, PsycINFO) from January 1965 to December 2020. Twenty-two studies were identified (16 case reports/series, 3 open label studies, 2 controlled studies, and 1 retrospective analysis of national database). Results: Demographic features were widely heterogeneous across studies (total N = 480, 58% male, mean age = 15.0 ± 1.8). Case reports/series presented positive therapeutic outcomes in noncompliant youths with severe mental illness. Three open-label one-arm studies supported the clinical efficacy of risperidone long-acting injection in patients previously stabilized with oral risperidone. One study showed lower clinical symptoms and higher functioning at 12 months in youths treated for an acute psychotic episode with paliperidone palmitate compared to oral risperidone. The types and rates of side effects of LLA were comparable to those observed for oral antipsychotics. Two studies suggested better metabolic and neurological tolerance of LLA compared to an oral form. Preliminary evidence supported a satisfactory level of treatment satisfaction in patients treated with LLA and their families, while concerns were raised regarding practical administration in outpatient services. However, the average quality of the evidence based on the RoB2 tool was low. Conclusions: The level of evidence was low for the efficacy of LLA in pediatric populations and very low for the tolerance and acceptance. It concerned mostly the effect of risperidone long-acting injection in adolescents with psychotic disorders. Randomized maintenance clinical trials using noninferiority analysis would be more appropriate for further research.

Use of induction therapy in pediatric heart transplant recipients in Switzerland – Analysis of the Swiss national database

BackgroundData on individualized immunosuppressive protocols for the pediatric heart recipients are missing in Europe. To contribute to this very small but specialized field, we describe the use of induction therapy (IT) in pediatric heart transplant patients in Switzerland and the retrospective outcomes. MethodThis is a retrospective national database analysis of children <19 years of age at time of heart transplantation (HT) from 05/2008–01/2018. Use of IT or no IT, use of steroids, calculated panel reactive antibodies (cPRA) and outcomes (Mortality, post-transplant lymphoproliferative disease (PTLD), rejection rates) were studied within a mean follow-up period of 2.9 years (0.2–8.1 years). ResultsAll 32 patients (12♂, 20♀), median age at HT of 6.4 years (24 days - 18 years) received IT using either polyclonal antibodies (ATG; 72%) or interleukin-2 receptor antagonist (anti-IL-2R mAb; 28%). Length of treatment was median of 4 (1–63) days. At time of HT all patients received steroids, while at discharge 32% and one year after HT 19%. Kaplan-Meier analysis of survival revealed a one-year survival of 86%. Three out of 7 patients with elevated cPRA (43%) died. Median time to first treated rejection was 19.4 months (±60.5 SD) without significant difference if treated with anti-IL-2R mAb or ATG (p:0.5). No development of PTLD, chronic renal failure needing ongoing renal replacement therapy or diabetes mellitus were recorded. DiscussionThis is the first report of the national practice use of IT within Switzerland. It reveals a high use of IT, no development of PTLD and a low use of steroids at one-year post HT.

Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the United States from 2006 to 2013

Background ContextThe typically accepted surgical procedure for cervical disc pathology has been the anterior cervical discectomy and fusion (ACDF), although recent trials have demonstrated equivalent or improved outcomes with cervical disc arthroplasty (CDA). Trends for these two procedures regarding utilization, revision procedures, and other demographic information have not been sufficiently explored. PurposeThe present study aims to provide data regarding ACDF and CDA from 2006 to 2013 in the United States. DesignThe present study is a retrospective national database analysis. Patient SampleThe present study included 20% sample of discharges from US hospitals, which is weighted to provide national estimates. Outcome MeasuresFunctional measures such as national incidence, hospital costs, length of stay (LOS), routine discharge, revision burden, and patient characteristics were used in the present study. MethodsPatients from the National Inpatient Sample (NIS) database who underwent primary ACDF, revision ACDF, primary CDA, and revision CDA from 2006 to 2013 were included. Demographic and economic data for the procedures' respective International Classification of Diseases, Ninth Revision, Clinical Modification codes were collected. ResultsA total of 1,059,403 ACDF and 13,099 CDA surgeries were performed in the United States from 2006 to 2013. The annual number of ACDF increased by 5.7% nonlinearly from 120,617 in 2006 to 127,500 in 2013 (mean per year 132,425; range 120,617–147,966); CDA increased by 190% nonlinearly from 540 in 2006 to 1,565 in 2013 (mean per year 1,637; range 540–2,381). Cervical disc arthroplasty patients were younger and had more private or “other” insurance, including worker's compensation (p<.0001). Mean LOS was longer for ACDF (ACDF 2.3 days vs. CDA 1.5; p<.0001). Routine discharge was higher in the CDA group (CDA 96% vs. ACDF 89%; p-value<.0001). The mean hospital-related cost was more expensive for ACDF (ACDF $16,178 vs. CDA $13,197; p-value=.0007). Cervical disc arthroplasty mean revision burden, defined as the ratio of revision procedures to the sum of primary and revision procedures, was greater (CDA 5.9% vs. ACDF 2.3%, p-value=.01). ConclusionsNationally approximately 132,000 ACDFs are done each year compared with only 1,600 CDAs. The number of ACDF surgeries performed far outpaces CDA by a ratio of 81:1 in the United States without a clear direction in the trend for utilization given recent fluctuations. Cervical disc arthroplasty revision burden was more than double compared with the ACDF revision burden (5.9% vs. 2.3%), which was not accounted for by patient baseline demographics. The etiologies of these findings are likely multifactorial and require further research.

In-Hospital Outcomes and Complications of Coronary Artery Bypass Grafting in the United States Between 2008 and 2012

To investigate the frequency and predictors of in-hospital complications among patients undergoing coronary artery bypass grafting (CABG) in the United States. Retrospective national database analysis SETTINGS: United States hospitals. A weighted sample of 1,910,236 patients undergoing CABG surgery identified from the National (Nationwide) Inpatient Sample from 2008 to 2012. CABG surgery MEASUREMENTS AND MAIN RESULTS: The number of CABG surgeries decreased from 436,275 in 2008 to 339,749 in 2012. The Deyo comorbidity index showed a steady increase from 2008 to 2012. The rate of in-hospital mortality decreased from 2.7% in 2008 to 2.2% in 2012 (p<0.001). The most common in-hospital complication was postoperative hemorrhage (30.4%), followed by cardiac (11.34%) and respiratory complications (2.3%). During the 5-year period, the rates of in-hospital cardiac, respiratory and infectious complications decreased (p<0.001), while the rate of postoperative hemorrhage showed a 35.8% relative increase in 2012 compared to 2008. The annual number of CABG surgeries is declining in the United States. While the burden of comorbidities is increasing, the rates of mortality and most in-hospital complications are improving. The increasing rate of postoperative bleeding necessitates the need to develop strategies to improve the risk of bleeding in this patient population.

Weekend versus weekday transplant surgery and outcomes after kidney transplantation in the USA: a retrospective national database analysis

ObjectiveTo determine whether kidney transplants performed during a weekend had worse outcomes than those performed during weekdays.DesignRetrospective national database study.SettingUnited Network for Organ Sharing database of the USA.Participants136 715 adult...

In-hospital mortality and morbidity after robotic coronary artery surgery.

The objective of this study was to assess the impact of robotic approaches on outcomes of coronary bypass surgery. Retrospective national database analysis. United States hospitals. A weighted sample of 484,128 patients undergoing isolated coronary artery surgery identified from the Nationwide Inpatient Sample from 2008 through 2010. Robotically assisted coronary artery bypass surgery versus conventional bypass surgery. Robotic approaches were used in 2,582 patients (0.4%). Patients undergoing robotic surgery were less likely to be female (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.57-0.87), present with acute myocardial infarction (OR 0.53, 95% CI 0.38-0.73), or have cerebrovascular disease (OR 0.41, 95% CI 0.23-0.71) compared to patients undergoing conventional surgery. In 59% of robotic cases, a single bypass was performed, and 2 bypasses were performed in 25% of cases. After adjusting for comorbidity, reduced postoperative stroke (0.0% v 1.5%, p = 0.045) and transfusion (13.5% v 24.4%, p = 0.001) rates were observed in patients who underwent robotic single-bypass surgery compared to conventional surgery. In patients undergoing multiple bypass grafts, higher mortality (1.1% v 0.5%), and cardiovascular complications (12.2% v 10.6%) were observed when robotic assistance was used, but the differences were not statistically significant (p = 0.5). The mean number of robotic cases carried out annually at institutions sampled was 6. Robotic assistance is associated with lower rates of postoperative complications in highly selected patients undergoing single coronary artery bypass surgery, but the benefits of this approach are reduced in patients who require multiple coronary artery bypass grafts.

Incidence and Outcomes of Heparin-Induced Thrombocytopenia in Patients Undergoing Cardiac Surgery in North America: An Analysis of the Nationwide Inpatient Sample

The objective of this study was to quantify the impact of heparin-induced thrombocytopenia (HIT) on outcomes after cardiac surgery. Retrospective analysis of national database. United States hospitals. Patients identified from 186,771 discharge records undergoing cardiac surgery from the Nationwide Inpatient Sample between 2009 and 2010. None. Heparin-induced thrombocytopenia was diagnosed in 506 (0.3%), and secondary thrombocytopenia was diagnosed in 16,809 (8.7%). Operative mortality was 11.1% in patients with HIT compared to 4.5% for patients without thrombocytopenia (p<0.001) and 4.0% for patients with a diagnosis of secondary thrombocytopenia (p<0.001). After adjusting for baseline patient comorbidity, the strongest independent predictors of HIT in patients undergoing cardiac surgery were female gender (OR 1.4, 95% confidence interval [CI] 1.28-1.48), congestive heart failure (OR 1.8, 95% CI 1.71-1.98), cardiac insufficiency (OR 2.2, 95% CI 1.97-2.39), atrial fibrillation (OR 1.4, 95% CI 1.30-1.51), liver disease (OR 2.2, 95% CI 1.96-2.50), and chronic renal failure (OR 1.4, 95% CI 1.30-1.51). HIT was associated with significantly increased risk of major adverse postoperative outcomes including death (OR 1.5, 95% CI 1.3-1.7), stroke (OR 2.4, 95% CI 1.9-3.1), amputation (OR 7.46, 95% CI 4.0-14.0), and acute renal failure (OR 2.3, 95% CI 2.1-2.5), respiratory failure (OR 1.9, 95% CI 1.8-2.1), and need for tracheostomy (OR 2.7, 95% CI 2.3-3.1). Heparin-induced thrombocytopenia is associated with a 50% increase in early mortality, and most patients with this diagnosis experience major postoperative morbidity or functional deficits.

Outcomes of Cervical Spine Surgery in Teaching and Non-Teaching Hospitals

Retrospective national database analysis. A national population-based database was analyzed to characterize cervical spine procedures performed at teaching and nonteaching hospitals with regards to patient demographics, clinical outcomes/complications, resource use, and costs. There are mixed reports in the literature regarding the quality and costs of health care provided by teaching hospitals in the United States. However, outcomes of cervical spine surgery based upon teaching status remains largely unknown. METHODS.: Data from the Nationwide Inpatient Sample were obtained from 2002-2009. Patients undergoing elective anterior or posterior cervical fusion, or posterior cervical decompression (i.e., laminoforaminotomy, laminectomy, laminoplasty) for a diagnosis of cervical myelopathy and/or radiculopathy were identified and separated into 2 cohorts (teaching and nonteaching hospitals). Patient demographics, comorbidities, complications, length of hospitalization, costs, and mortality were compared for both groups. Regression analysis was performed to assess independent predictors of mortality. A total of 212,385 cervical procedures were identified from 2002-2009 in the United States, with 54.6% performed at teaching hospitals. More multilevel fusions and posterior approaches were performed in teaching hospitals (P < 0.0005). Patients treated in teaching hospitals trended toward male sex, increased costs, and hospitalizations. Overall, procedure-related complications and inhospital mortality were increased in teaching hospitals. Regression analysis revealed that significant predictors of mortality were age 65 years or more (odds ratio = 3.0) and multiple comorbidities. Teaching status was not a significant predictor of mortality (P = 0.07). Patients treated in teaching hospitals for cervical spine surgery demonstrated longer hospitalizations, increased costs, and mortality compared with patients treated in nonteaching hospitals. Incidences of postoperative complications were identified to be higher in teaching hospitals. Possible explanations for these findings are an increased complexity of procedures performed at teaching hospitals. Older age and presence of comorbidities were more significant predictors of inhospital mortality than teaching status. Future studies should identify long-term complications and costs beyond an inpatient setting to assess if differences extend beyond the perioperative period. 4.

Improving the Perioperative Value of Care for Vulnerable Kidney Transplant Recipients

The increased use of marginal donors, an aging recipient population, and Diagnosis-Related Group (DRG) cost restraints place significant pressures on kidney transplant centers to maintain financial viability while sustaining high quality outcomes. We engaged in a quality initiative in delayed graft function (DGF) kidney transplant recipients aimed at improving safe and efficient discharge. This was a retrospective analysis of national databases comparing the perioperative outcomes and costs for our transplant center and national benchmark values for kidney recipients undergoing transplantation between October 2008 and March 2012. During this time, we developed and implemented quality initiatives aimed at improving health care value for kidney transplant recipients, and focused efforts particularly in patients who developed DGF. Pediatric patients and multiorgan transplant recipients were excluded. There were 583 kidney transplants performed at our institution; these were compared with 37,712 transplants available from national data. Rates of DGF increased at our institution from 6% to 25% but were steady at 27% nationally. The quality initiatives improved hospital length of stay (LOS) in DGF patients from an average of 8 days initially to 4 days at study end, which reduced overall LOS from 3.6 ± 1.5 days to 3.3 ± 0.8 days (p = 0.021); national LOS was consistent at a mean of 10 days; hospital costs decreased by 42% at our institution, while national rates rose by 12%. Our institutional 30-day readmission rates in all patients and those with DGF were significantly lower than national rates across the entire study period (9% vs 15% and 12% vs 18%, respectively). These results demonstrate that health care value can be significantly improved in kidney transplant recipients, particularly in DGF patients, by implementing a multidisciplinary initiative aimed at safely and efficiently discharging patients.