Significant Difference In Odds Research Articles

Intrauterine Insemination After Human Chorionic Gonadotropin Trigger or Luteinizing Hormone Surge: A Meta-analysis.

To assess the odds of pregnancy after intrauterine insemination (IUI) timed by ultrasound monitoring and human chorionic gonadotropin (hCG) administration compared with monitoring luteinizing hormone (LH) levels. We searched PubMed (MEDLINE), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate Analytics), ClinicalTrials.gov (National Institutes of Health), and the Cochrane Library (Wiley) from the inception until October 1, 2022. No language limitations were applied. After deduplication, 3,607 unique citations were subjected to blinded independent review by three investigators. Thirteen studies (five retrospective cohort, four cross-sectional, two randomized controlled trials, and two randomized crossover studies) that enrolled women undergoing natural cycle, oral medication (clomid or letrozole), or both for IUI were included in the final random-effects model meta-analysis. Methodologic quality of included studies was assessed with the Downs and Black checklist. Data extraction was compiled by two authors, including publication information, hCG and LH monitoring guidelines, and pregnancy outcomes. No significant difference in odds of pregnancy between hCG administration and endogenous LH monitoring was observed (odds ratio [OR] 0.92, 95% CI 0.69-1.22, P=.53). Subgroup analysis of the five studies that included natural cycle IUI outcomes also showed no significant difference in odds of pregnancy between the two methods (OR 0.88, 95% CI 0.46-1.69, P=.61). Finally, a subgroup analysis of 10 studies that included women who underwent ovarian stimulation with oral medications (clomid or letrozole) did not demonstrate a difference in odds of pregnancy between ultrasonography with hCG trigger and LH-timed IUI (OR 0.88, 95% CI 0.66-1.16, P=.32). Statistically significant heterogeneity was noted between studies. This meta-analysis showed no difference between pregnancy outcomes between at-home LH monitoring and timed IUI. PROSPERO, CRD42021230520.

Early Complications after Prepectoral Tissue Expander Placement in Breast Reconstruction with and without Acellular Dermal Matrix.

Prepectoral breast reconstruction has become popularized with the concurrent use of acellular dermal matrix (ADM). The authors sought to compare 3-month postoperative complication rates and explantation rates for first-stage, tissue-expander-based, prepectoral breast reconstruction with and without the use of ADM. A single-institution retrospective chart review was performed to identify consecutive patients undergoing prepectoral tissue-expander-based breast reconstruction from August of 2020 to January of 2022. Chi-square tests were used to compare demographic categorical variables, and multiple variable regression models were used to identify variables associated with 3-month postoperative outcomes. The authors enrolled 124 consecutive patients. Fifty-five patients (98 breasts) were included in the no-ADM cohort and 69 patients (98 breasts) were included in the ADM cohort. There were no statistically significant differences between the ADM and no-ADM cohorts with regard to 90-day postoperative outcomes. On multivariable analysis, there were no independent associations between seroma, hematoma, wound dehiscence, mastectomy skin flap necrosis, infection, unplanned return to the operating room, or explantation in the ADM and no-ADM groups after controlling for age, body mass index, history of diabetes, tobacco use, neoadjuvant chemotherapy, and postoperative radiotherapy. The authors' results reveal no significant differences in odds of postoperative complications, unplanned return to the operating room, or explantation between the ADM and no-ADM cohorts. More studies are needed to evaluate the safety of prepectoral, tissue expander placement without ADM. Therapeutic, III.

Sex‐specific association of physical frailty and cognitive function in a population‐based cross‐sectional study of American older adults

AbstractBackgroundWe hypothesized that the association between physical frailty and cognition would be modified by participant sex in a nationally representative sample of elderly adults in the United States.MethodsCross‐sectional data from the National Health and Nutrition Examination Survey (NHANES 2011‐2014) were obtained for participants age ≥60 years. Physical frailty was defined by four measures developed by Fried et al.: exhaustion, weakness, low body mass, and low physical activity, and then categorized into robust (None), pre‐frail (1‐2 measures), or frail (3‐4 measures). Cognitive test scores were converted to z‐scores based on the study sample means and standard deviations. To estimate global cognition, a composite z‐score was calculated by averaging the individual z‐scores. Linear regression models were fit to evaluate the association between frailty and cognition. In addition to the cognitive tests, we evaluated frailty as a risk factor for self‐reported memory complaint (SMC) using logistic regression. We used sampling weights to account for the NHANES design.ResultsA total of 2863 participants aged 60 years or older were included. According to the 4‐items frailty measures, 50.5% of participants were robust, 44.7% were pre‐frail, and 4.8% were frail. The majority of the participants were > 70 (58.9%), women (54.4%), and White (79.4%). After adjustment for age, sex, race/ethnicity, education, alcohol use, income, marital status, diabetes, hypertension, and history of stroke, compared to robust, being frail (β = ‐0.69, 95%CI: ‐0.90, ‐0.48) and pre‐frail (β = ‐0.11, 95%CI: ‐0.19, ‐0.02) was associated with lower global cognitive z‐scores. Compared to men, pre‐frail women had mean adjusted global cognitive z‐scores that were ‐0.33 standard deviations lower (95% confidence interval (CI): ‐0.23, ‐0.42; P<0.001). Similarly, compared to frail men, frail women had mean adjusted global z‐scores that were lower but the difference was not significant. There were no significant differences in odds of SMC by sex with regard to frailty.ConclusionsIn this population‐based cohort, our findings suggest frailty was associated with lower cognitive performance in older adults and modified by sex. Participants who did not meet criteria for 3‐4 measures of frailty but had 1‐2 measures showed similar lower cognitive performance.

Meta-analysis of Randomized Clinical Trials on Long-term Outcomes of Surgical Treatment of Perforated Diverticulitis.

To assess long-term outcomes of patients with perforated diverticulitis treated with resection or laparoscopic lavage (LL). Surgical treatment of perforated diverticulitis has changed in the last few decades. LL and increasing evidence that primary anastomosis (PRA) is feasible in certain patients have broadened surgical options. However, debate about the optimal surgical strategy lingers. PubMed, Scopus, and Web of Science were searched for randomized clinical trials (RCT) on surgical treatment of perforated diverticulitis from inception to October 2022. Long-term reports of RCT comparing surgical interventions for the treatment of perforated diverticulitis were selected. The main outcome measures were long-term ostomy, long-term complications, recurrence, and reintervention rates. After screening 2431 studies, 5 long-term follow-up studies of RCT comprising 499 patients were included. Three studies, excluding patients with fecal peritonitis, compared LL and colonic resection, and 2 compared PRA and Hartmann procedures. LL had lower odds of long-term ostomy [odds ratio (OR) = 0.133, 95% CI: 0.278-0.579; P < 0.001] and reoperation (OR = 0.585, 95% CI: 0.365-0.937; P = 0.02) compared with colonic resection but higher odds of diverticular disease recurrence (OR = 5.8, 95% CI: 2.33-14.42; P < 0.001). Colonic resection with PRA had lower odds of long-term ostomy (OR = 0.02, 95% CI: 0.003-0.195; P < 0.001), long-term complications (OR = 0.195, 95% CI: 0.113-0.335; P < 0.001), reoperation (OR = 0.2, 95% CI: 0.108-0.384; P < 0.001), and incisional hernia (OR = 0.184, 95% CI: 0.102-0.333; P < 0.001). There was no significant difference in odds of mortality among the procedures. Long-term follow-up of patients who underwent emergency surgery for perforated diverticulitis showed that LL had lower odds of long-term ostomy and reoperation, but more risk for disease recurrence when compared with resection in purulent peritonitis. Colonic resection with PRA had better long-term outcomes than the Hartmann procedure for fecal peritonitis.

E-25 | Comparing Same-Day Discharge Rates Following Elective PCI Before versus After Covid-19 and its Impact on 30-Day Complications: A Single-Center Analysis

Percutaneous coronary interventions (PCI) have historically required an overnight stay, especially in those with high-risk features. After the onset of Coronavirus disease 2019 (COVID), a shift towards primarily same-day discharge (SDD) for elective procedures occurred in our center. We compared differences in SDD rates and its impact on 30-day complications in patients who received elective PCI before versus after the onset of COVID. We collected retrospective data from 559 patients who underwent elective PCI in April-December of 2018-21. The pre-COVID (2018-19) and COVID (2020-21) study groups consisted of 271 and 288 patients, respectively. SDD rates and complications within 30-days after the index-procedure were compared (Table 1). Chi-squared tests were used to assess bivariate relationships and multivariate logistic regression models were used to adjust for control variables. The proportion of SDD was significantly higher in the COVID (n=231; 80.2%) versus the pre-COVID (n=149; 55%) group. The proportion of patients with complications was not significantly different for the pre-COVID (n=44; 16.2%) and COVID (n=41; 14.2%) groups. Multivariate logistic regression models showed no significant differences in odds of experiencing a complication (OR: 0.80; 95% CI: 0.49-1.33; p=0.392), controlling for age, frailty, SDD and multivessel procedure. This study showed that an increase in SDD rates following elective PCI led to no significant difference in the rate of 30-day complications. This suggests the change towards primarily SDD following an elective PCI is a safe alternative to traditional care.

Short-term outcomes after peroral endoscopic myotomy, Heller myotomy, and pneumatic dilation in patients with achalasia: a nationwide analysis.

Peroral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LHM), and pneumatic dilation (PD) are the most common modalities for management of achalasia. Our study aimed to directly compare their short-term outcomes and safety profile in a hospitalized cohort in the United States. The National Readmission Database (2016-2019) was queried using International Classification of Diseases, Tenth Revision, Clinical Modification codes to identify a cohort of inpatient admissions who underwent POEM, LHM, or PD. Baseline demographic variables, resource utilization, periprocedural outcomes, and 30-day readmissions were analyzed. A univariate and multivariate logistic regression model was used to compare odds of readmission with POEM as a reference. LHM was the most performed procedure (n= 9710) as compared with PD (n= 2453) and POEM (n= 1911). Patients undergoing PD were older with a higher Charlson Comorbidity Index. The 30-day readmission rate was 4.3%, 3.9%, and 12.6% for POEM, LHM, and PD, respectively. Compared with POEM, the adjusted odds of readmission for PD was 2.42 (95% confidence interval, 1.56-3.75). There was no statistically significant difference in odds of readmission for LHM (.91; 95% confidence interval, .62-1.33) compared with POEM. Within the 30-day readmitted population, 13.1% of PD and 3.4% of LHM patients required achalasia-related procedural intervention. The rate of bleeding (4.3%), blood transfusion (2.3%), and mortality were higher (1.1%) in PD as compared with POEM and LHM. In the United States, the risk of readmission and resource utilization are higher in patients with achalasia undergoing PD. The outcomes are comparable between POEM and LHM, but there is a significant difference between the utilization of these myotomy procedures.

33. Obesity as a Risk Factor in Cosmetic Abdominoplasty: A Systematic Review and Meta-Analysis

PURPOSE: The incidence of obesity is on the rise around the globe. Outside the massive weight loss patient population, knowledge of risk factors associated with abdominoplasty is limited. This systematic review and meta-analysis assesses the impact obesity has on cosmetic abdominoplasty outcomes. METHODS: A systematic review was conducted in accordance with PRISMA. PubMed, MEDLINE, Embase, Scopus, and COCHRANE databases were reviewed using syntax “obesity”, “abdominoplasty”, “panniculectomy”, and “body contouring” for articles. Cosmetic was defined as abdominoplasty or panniculectomy outside the context of massive weight loss. Obesity was defined as BMI ≥ 30 kg/m2. Studies reporting postoperative outcomes with less than 50% of their population involving massive weight loss patients were included. Postoperative outcomes were assessed by pooled analysis and meta-analysis. RESULTS: Of 3,088 initial studies, 16 met inclusion criteria. Of which, 9 studies included patient-reported outcomes that were used for pooled and meta-analysis. Six studies utilized national databases and were excluded from our data analysis. Meta-analysis demonstrated obesity was associated with more seromas (OR 1.45, 1.06-1.98, p=0.02), hematomas (OR 2.21, 1.07-4.57, p=0.03), and total surgical site occurrences (OR 1.99, 1.30-3.04, p=0.0016). There was no significant difference in odds of any other complications. Analysis by obesity class revealed no significant increase in odds in seromas or wound dehiscence. CONCLUSION: This review demonstrates obesity increased the odds of postoperative complications following cosmetic abdominoplasty. However, risk of complications does not continue to increase with higher obesity class. Additional research in cosmetic abdominoplasty is encouraged to further assess the impact of obesity on complications.

Household Composition and Inequalities in COVID-19 Vaccination in Wales, UK.

The uptake of COVID-19 vaccination in Wales is high at a population level but many inequalities exist. Household composition may be an important factor in COVID-19 vaccination uptake due to the practical, social, and psychological implications associated with different living arrangements. In this study, the role of household composition in the uptake of COVID-19 vaccination in Wales was examined with the aim of identifying areas for intervention to address inequalities. Records within the Wales Immunisation System (WIS) COVID-19 vaccination register were linked to the Welsh Demographic Service Dataset (WDSD; a population register for Wales) held within the Secure Anonymised Information Linkage (SAIL) databank. Eight household types were defined based on household size, the presence or absence of children, and the presence of single or multiple generations. Uptake of the second dose of any COVID-19 vaccine was analysed using logistic regression. Gender, age group, health board, rural/urban residential classification, ethnic group, and deprivation quintile were included as covariates for multivariable regression. Compared to two-adult households, all other household types were associated with lower uptake. The most significantly reduced uptake was observed for large, multigenerational, adult group households (aOR 0.45, 95%CI 0.43-0.46). Comparing multivariable regression with and without incorporation of household composition as a variable produced significant differences in odds of vaccination for health board, age group, and ethnic group categories. These results indicate that household composition is an important factor for the uptake of COVID-19 vaccination and consideration of differences in household composition is necessary to mitigate vaccination inequalities.

Social Anxiety Across Sexual and Gender Identity Subpopulations

Recent research indicates that gay/lesbian identified sexual minority individuals report lower social anxiety than their counterparts who identify as bisexual or indicate an emerging identity label (e.g., queer, pansexual, or asexual). The current study advances the knowledge base by comparing levels of social anxiety across both sexualandgender identity subpopulations in a sexual minority sample residing in the Republic of Ireland. Six hundred two sexual minority adults participated in an online survey in which they completed measures of sociodemographic variables (including sexual and gender identity) and social anxiety. Across gender identity subpopulations, transgender/non-binary individuals were more likely to report elevated social anxiety symptoms than both cisgender men and cisgender women; further, cisgender women were more likely to report elevated social anxiety symptoms than cisgender men. Within each of these gender identity groups, there was no significant difference in odds of elevated social anxiety symptoms across sexual identity subgroups (gay/lesbian, bisexual, and emerging identity) when adjusted for sociodemographic variables. Results highlight the necessity to represent the mental health experiences of diverse sexual minority subpopulations, especially in population-based studies of sexual minority mental health. Additionally, future studies should aim to explore the potentially distinctive and complex social stressors encountered by the diverse groups within the sexual and gender minority population.

Physician self-identified race and opioid prescription practices in upper extremity injuries in the pediatric emergency department

BackgroundMinority children have been shown to receive fewer opioid analgesics for acute pain. ObjectiveAssess if both White and non-White physicians prescribe fewer opioids to non-White children presenting to the pediatric emergency department (PED) with upper extremity (UE) fractures. MethodsPatients with acute UE fractures were evaluated. Attending physicians provided their self-identified race and consented to analysis of their opioid prescribing practices. Primary outcome was receipt of an opioid prescription at discharge. Bivariate analyses measured the association between patient race and receipt of an opioid prescription; further analysis evaluated the effect of physician race on prescription practices. Generalized linear models measured these associations while controlling for confounders. ResultsThirty-four percent of eligible patients (2754/8155) were discharged with an opioid prescription. There was no statistically significant difference in odds of being discharged with an opioid prescription for non-Hispanic Black (NHB) compared to non-Hispanic White (NHW) patients. There was no statistically significant difference in odds of prescribing opioids by both White physicians and non-White physicians. In patients with the most severe fractures, requiring sedation for reduction, NHB patients had lower odds of receiving an opioid prescription (OR 0.80; 95% CI: 0.65–0.98). ConclusionWithin our institution, NHB patients received fewer opioid prescriptions at discharge for UE fractures. There is no statistically significant association between NHB race and odds of receiving an opioid prescription. In patients sedated for fracture reductions, NHB patients had lower odds of receiving an opioid prescription and non-White physicians had lower odds of prescribing opioids to NHB patients compared to NHW patients.

Patient Satisfaction with Care Providers During the COVID-19 Pandemic: An Analysis of Consumer Assessment of Healthcare Providers and Systems Survey Scores for In-Person and Telehealth Encounters at an Academic Medical Center.

Background: Previous research has demonstrated high patient satisfaction with telehealth encounters. The objective of this study was to compare patient satisfaction scores regarding their physician using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys between in-person and telehealth outpatient encounters during the pandemic at a large academic health center. Methods: We analyzed CAHPS patient satisfaction survey data within the UC Davis Health system between August 2020 and February 2022. The questions analyzed pertained to patients' satisfaction with their care provider; whether they felt included in discussions, would recommend their physician, received clear explanations, and that their concerns were heard. Using logistic regression models adjusting for confounders, we compared CAHPS care provider top box scores-a score of 4 or 5 on the 5-point scale-for 5 survey items. Results: Survey results from 76,687 (84.2%) in-person encounters and 14,404 (15.8%) telehealth encounters were evaluated. The odds of a telehealth patient giving a top box score for whether they would recommend their care provider to others were 0.97 those of an in-person patient (95% confidence interval [0.87-1.06]; p = 0.494). Similarly, there was no significant difference in odds of giving a top box score between telehealth and in-person patients for the other four questions analyzed. Discussion: Our findings indicate that patient experience and care provider rankings for in-person care and telehealth care are comparable across a variety of specialties and conditions at a large academic health center. Future studies should investigate patient satisfaction with in-person and telehealth encounters by diagnosis and specialty.

Rates of preeclampsia in subsequent pregnancies by race/ethnicity

To assess whether race/ethnicity impacts rates of preeclampsia amongst pregnant persons with a history of preeclampsia in the previous pregnancy. A retrospective cohort study of two consecutive births in California between 2000-2012 among pregnant persons who had a history of preeclampsia in the index pregnancy. We included singleton, non-anomalous index pregnancies from gestational ages 23-42 weeks. We assessed rates of preeclampsia in the second pregnancy by race/ethnicity, age, BMI, educational attainment and insurance type in chi-squared analysis. We conducted a multivariable logistic regression for repeat cases of preeclampsia by race/ethnicity adjusting for pre-pregnancy BMI, age, education, and insurance type as potential confounders. Race/Ethnicity was stratified into patients who identified as Non-Hispanic White, Non-Hispanic Black, Non-Hispanic Asian, Hispanic, American Indian/American Native (Non-Hispanic), and Other. There were 22,096 births that met our inclusion criteria. Of those, 3,908 had preeclampsia in the subsequent pregnancy. Of those with preeclampsia in the second pregnancy, the majority (47%) identified as Hispanic, as did the majority of those without preeclampsia in the second pregnancy (49%). The rest of the populations racial/ethnic makeup were comparable. In our multivariable regression, compared to patients who identified as Non-Hispanic White, there were no significant difference in odds of having preeclampsia again in a subsequent pregnancy by race/ethnicity. Among patients who have had preeclampsia in a prior pregnancy, there were no significant differences in odds of having preeclampsia in the subsequent pregnancy by race/ethnicity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Sociodemographic Differences in Patient-Reported Pain and Pain Management of Patients With Head and Neck Cancer in a Community Oncology Setting.

While pain is prevalent among survivors of head and neck cancer (HNC), there is a lack of data on pain management in the community oncology setting. We described sociodemographic correlates and disparities associated with patient-reported pain among patients with HNC. We used the 2017-2021 nationwide community oncology data set from Navigating Cancer, which included electronic patient-reported outcomes. We identified a retrospective cohort of patients diagnosed with HNC (N = 25,572), with ≥ 1 patient-reported pain event. We adjusted for demographic (sex, age, smoking history, marital status) and clinical (cancer site) factors associated with pain reporting and pain resolution by new pain prescription on the basis of race (White v non-White patients), using multivariate logistic regression models. Our analytic cohort included 2,331 patients, 90.58% White, 58.62% married, with an average age of 66.47 years. Of these, 857 patients (36.76%) reported ≥ 1 pain event during study period. Mean resolution time (in minutes) for pain incidents was significantly longer for White patients than non-White patients (99.6 ± 3.2 v 74.9 ± 7.2, P < .05). After adjusting for covariates, smoking was associated with a 25% increased odds of reporting pain incidents (adjusted odds ratio [aOR], 1.25; 95% CI, 1.03 to 1.52). There was no statistically significant difference in odds of pain reporting between White versus non-White patients (aOR, 0.97; 95% CI, 0.73 to 1.30). However, White patients were significantly more likely to receive new prescription for pain than non-White patients (aOR, 2.52; 95% CI, 1.09 to 5.86). We found racial differences in patient-reported pain management, with White patients significantly more likely to receive new pain prescriptions. As pain management is a mainstay in cancer care, equity in pain management is critical to optimize quality of life for patients with HNC.

Outcomes Following Endoscopic versus Open Carpal Tunnel Release—A Matched Study

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the world. Surgical treatment can be performed in an open or endoscopic fashion. To date, similar rates of complications for both approaches have been described. We sought to compare the results of endoscopic carpal tunnel release (ECTR) with open carpal tunnel release (OCTR) in patients with CTS. Patients with a diagnosis of CTS undergoing open or endoscopic surgical management were identified between January 2010 and October 2020. The primary outcome of the study was nerve injury within 30 days of the procedure. Secondary outcomes included readmission, wound-related complications, hematoma, seroma formation, and cost. A total of 735,631 patients were identified as undergoing CTR. Following a 1:1 match procedure, 292,626 patient records were analyzed. Patients undergoing OCTR versus ECTR had an increased odds of readmission at 30 days (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.73-2.06), developing an infection (OR 1.59, 95% CI 1.41-1.80), and experiencing wound complications (OR 1.97, 95% CI 1.74-2.23). No significant difference in odds of developing a seroma (OR 1.17, 95% CI 0.83-1.65), hematoma (OR 1.15, 95% CI 0.95-1.39), or nerve injury (OR 1.18, 95% CI 0.98-1.43) was noted. The reimbursement cost of ECTR was significantly greater than OCTR ($310.60 ± $1639.57 vs. $237.69 ± $1488.93, P < 0.001). In the largest study to date on the surgical management of CTR, OCTR was seen to be associated with an increased odds of readmission, infection, and wound complications, but reduced costs for the procedure alone.

Comparison of clinical outcomes of VISIONAIRE patient-specific instrumentation with conventional instrumentation in total knee arthroplasty: a systematic literature review and meta-analysis

IntroductionMalalignment and resulting complications are major challenges in total knee arthroplasty (TKA) which patient-specific instrumentation (PSI) is proposed to alleviate. Previous PSI meta-analyses of TKA outcomes typically do not differentiate between PSI systems and assess relatively few outcomes, so the value of their findings is limited. VISIONAIRE™ cutting guides (Smith + Nephew Inc., Memphis, TN, USA) is a PSI system based on preoperative magnetic resonance and X-ray imaging. A systematic literature review (SLR) and meta-analysis, focussed specifically on VISIONAIRE, were conducted to assess TKA accuracy, intraoperative outcomes, and postoperative outcomes, compared with conventional instrumentation (CI).Materials and methodsThe SLR was performed using PubMed, Embase, and Google Scholar databases to identify relevant studies published until March 2022. Depending on statistical heterogeneity, meta-analyses were performed for outcome measures with fixed effect (I2 < 50%) or random-effects models (I2 ≥ 50%). Dichotomous outcomes were reported as odds ratios and continuous outcomes were reported as mean differences. Descriptive analyses were performed for outcomes not amenable to meta-analysis.ResultsOutcomes for VISIONAIRE versus CI were reported in 25 studies. Compared with CI, VISIONAIRE reduced odds of mechanical outliers by 40% (p < 0.0001), with no statistically significant differences in odds of overall coronal, sagittal, or rotational plane component outliers. VISIONAIRE improved surgical efficiency (operating room, turnover, and tourniquet times reduced by 7.3% (p = 0.02), 42% (p = 0.022), and 15.9% (p = 0.01), respectively), lowering the odds of blood transfusion by 53% (p = 0.01) and shortening patients’ hospital stays (11.1% reduction; p < 0.0001). There were no significant differences between groups in incidence of postoperative complications and (descriptively analyzed) return-to-function outcomes.ConclusionOptions for PSI in TKA differ substantially, and it is important to assess the outcomes of individual systems. The current findings suggest that VISIONAIRE guides can lead to improved alignment accuracy and surgical efficiency compared with CI, without compromising postoperative safety and return-to-function outcomes.

Mortality of COVID-19 in Patients with Hematological Malignancies Versus Solid Tumors: A Systematic Literature Review and Meta-Analysis

Background: As of May 2022, the COVID-19 pandemic has been the cause of 6.3 million deaths worldwide and over one million deaths in the United States. Cancer patients are more vulnerable to COVID-19 compared to the general population, but it remains unclear which types of cancer have the highest risk of COVID-19-related mortality. This study examines mortality rates for those with hematological malignancies (Hem) versus solid tumors (Tumor). Methods: PubMed and Embase were systematically searched for relevant articles using Nested Knowledge software (Nested Knowledge, St Paul, MN). Articles were eligible for inclusion if they reported mortality for Hem or Tumor patients with COVID-19. Articles were excluded if they were not published in English, non-clinical studies, had insufficient population/outcomes reporting, or were irrelevant. Baseline characteristics collected included age, sex, and comorbidities. Primary outcomes were all-cause and COVID-19-related in-hospital mortality. Secondary outcomes included rates of invasive mechanical ventilation (IMV) and intensive care unit (ICU) admission. Effect sizes from each study were computed as logarithmically transformed odds ratios (ORs) with random effects, and Mantel-Haenszel weighting. The between-study variance component of random-effects models was computed using restricted effects maximum likelihood estimation, and 95% confidence intervals (CIs) around pooled effect sizes were calculated using Hartung-Knapp adjustments. Results: 12,057 patients were included in the analysis, with 2,714 (22.5%) patients in the Hem group and 9,343 (77.5%) patients in the Tumor group. The overall unadjusted odds of all-cause mortality were 1.64 times higher in the Hem group compared to the Tumor group (95% CI: 1.30-2.09) [Fig. 1]. This finding was consistent with multivariable models presented in moderate- and high-quality cohort studies, suggestive of a causal effect of cancer type on in-hospital mortality. Additionally, the Hem group had increased odds of COVID-19-related mortality compared to the Tumor group (OR=1.86 [95% CI: 1.38-2.49]) [Fig.2]. There was no significant difference in odds of Invasive Mechanical Ventilation or ICU admission between cancer groups (OR=1.13 [95% CI: 0.64-2.00] and OR=1.59 [95% CI: 0.95-2.66], respectively). Discussion: The current study fills a gap in the literature by comparing mortality for patients with hematological versus solid cancers. While the mechanism of action is unclear, it is possible that the hematological manifestations of COVID-19 interact with the hematological cancer disease state to result in worse outcomes for these patients. COVID-19 is known to cause leukopenia, lymphopenia, and thrombocytopenia in those infected, which contribute to a prothrombotic state and can serve as predictors of patient outcome. D-dimer levels are also associated with thrombosis, and studies have shown that underlying cancer may elevate D-dimer levels for patients with COVID-19, increasing likelihood of severe illness or mortality. Furthermore, evidence shows that hematological cancer patients have a significantly lower seroconversion rate following COVID-19 vaccination compared to those with solid tumors, suggesting a weaker immune response upon infection with COVID-19. Conclusions: Cancer is a serious comorbidity associated with severe outcomes in COVID-19 patients, with especially alarming mortality rates in patients with hematological malignancies, which are typically higher compared to patients with solid tumors. A meta-analysis of individual patient data is needed to better assess the impact of specific cancer types on patient outcomes and to identify optimal treatment strategies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

PSUN296 Impact of Diabetes Mellitus on Outcomes of Hospitalizations for SIADH

Abstract Introduction Diabetes mellitus (DM) is known to cause hyponatremia via multiple mechanisms and is often a confounder in the diagnosis of the syndrome of inappropriate anti-diuretic hormone secretion (SIADH). However, not much is known about the prevalence of DM in patients with SIADH or the effect it has on outcomes of hospitalizations for SIADH. Method: Data was extracted from the US Nationwide Inpatient Sample (NIS) for 2019. The NIS contains hospital discharge information estimating yearly US hospitalizations. We included hospitalizations with a principal discharge diagnostic code for SIADH using the ICD-10-CM code (E22.2). We excluded hospitalizations of patients less than 18 years. This cohort was divided based on the secondary diagnosis of diabetes mellitus (DM). We compared inpatient mortality rates, mean length of hospital stay (LOS), mean hospitalization cost (THC), and rates of septic shock, acute myocardial infarction (AMI), acute respiratory failure (ARF), acute renal failure (AKI), and acute pulmonary edema (PE) between the subgroups. Adjustments were made for age, sex, race, primary payer, median household income by zip code, Charlson Comorbidity Index (CCI), hospital location, bed-size, and teaching status using multivariate regression analysis. Statistical significance was set at a p-value &amp;lt; 0.05. Results In 2019, there were 39,110 hospitalizations with SIADH as the reason for the admission. Comorbid DM was prevalent in 25.4% of these admissions. A higher proportion of hospitalizations involved females, with no significant difference between both cohorts (62.3 vs 60.1%, p=0.084). Patients with DM had a higher mean age (73.3±12 vs 72.4±13.8 years, p=0.005), a higher proportion of CCI &amp;gt;2, and a higher proportion of ethnic minorities. In patients with SIADH, DM was associated with no mortality difference (1.2% vs 0.9%, p=0.317) and no difference in LOS (4.9 vs 5.1 days, p=0.328) despite increased THC (10,873 vs 10,641 US$, p =0.03). Comorbid DM was associated with lower odds of AMI (0.4 vs 0.8%, aOR: 0.315, p=0.002), PE (0.15 vs 0.4%, aOR: 0.22, p=0.012) and ARF (6.8% vs 7.5%, aOR: 0.77, p=0.016), higher odds of AKI (15.9 vs 10.7, aOR: 1.23, p=0.008), with no significant difference in odds of septic shock or CVA. Conclusions Comorbid DM was associated with no difference in mortality or LOS despite an association with increased THC and AKI in hospitalizations of patients with SIADH. Notably, DM also appeared to lower the odds of AMI, PE, and ARF in this cohort of patients. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Age-specific trends in intravenous thrombolysis and mechanical thrombectomy utilization in acute ischemic stroke in children under age 18.

To evaluate current trends in the utilization of intravenous thrombolysis (IV-tPA) and mechanical thrombectomy (MT) in acute ischemic stroke (AIS) in various age groups of children in the United States. We conducted a serial cross-sectional study using primary AIS admissions in children ⩽ 17 years (weighted n = 2807) contained in the 2009-2019 KIDS Inpatient Database. Age-specific utilization frequency of IV-tPA and MT were calculated. Multivariable-adjusted models were used to evaluate demographic predictors of treatment. From 2009 to 2019, there were 2807 AIS admissions in children in the KID of which 55.9% were in boys and 29.9% were 15-17 years old.128 (4.6%) received IV-tPA. IV-tPA utilization differed by age (5-9 years: 3.1%, 15-17 years 8.1% p value < 0.001). Overall MT usage was 2.3% and this also varied by age (1-4 years: 0.9% and 15-17years 4.0%, p value = 0.006). IV-tPA utilization almost tripled across the study period (2.5% 2009 to 6.5% in 2019, p value = 0.001) while MT use more than doubled over time (1.2% in 2009 and 3.0% in 2019, p value = 0.048). Increased IV-tPA utilization was seen primarily in children 10-14 years (0.8% in 2009 to 7.2% 2019, p value = 0.005) and 15-17 years (5.4% in 2009 to 10.4% in 2019, p value = 0.045). Utilization in younger age groups remained unchanged over time. MT usage was very variable across various age groups over time. IV-tPA and MT utilization increased over time in nonchildren's hospitals (both p values < 0.05) but usage in designated children's hospitals did not change significantly over time. In multivariable models, there was no significant difference in odds of IV-tPA and MT use by sex, race or insurance status. IV-tPA and MT utilization in pediatric AIS increased in the United States over the past decade mainly in older children 10-17 years. Utilization increased mainly in patients hospitalized in nonchildren's hospitals. Usage in children's hospitals did not change significantly over time.

Primary Cervical Disc Arthroplasty Among Medicare Beneficiaries Versus Alternative Payers: Is It Time to Consider Nationwide Coverage?

Retrospective cohort study. As of 2022, the Centers for Medicare and Medicaid Services does not provide nationwide coverage for cervical disc arthroplasty (CDA). The aim was to determine whether Medicare beneficiaries have differences in: (1) lengths of stay (LOS); (2) complications; (3) readmissions; and (4) costs of care. Using the 2010 to 2020 PearlDiver database, we queried patients undergoing primary CDA for degenerative disc pathology. Study groups patients were those undergoing CDA with Medicare coverage (n = 1467); patients without Medicare coverage were the comparison cohort (n = 15,389). Endpoints were to compare demographics and comorbidities within the Elixhauser comorbidity index (ECI), LOS, 90-day complications, 90-day readmissions, and 90-day reimbursements. A multivariate logistic regression was used to calculate odds (OR) of medical complications and readmissions within 90-days. A P-value less than .003 was significant. Patients with Medicare coverage undergoing CDA had higher mean ECI compared to alternative payers (5.24 vs 3.26; P < .0001). Mean LOS was significantly higher for Medicare beneficiaries (2.20 vs 1.76 days; P < .010). There was no significant differences in odds of all medical complications (OR: 1.19, 95% CI: .98-1.44; P = .069) or readmission rates (1.77% vs 1.33%, OR:0.82, 95% CI: .50-1.29; P = .417) within 90-days following the index procedure among Medicare beneficiaries vs alternative payers. Non-Medicare beneficiaries had higher 90-day reimbursements compared to Medicare beneficiaries ($6,700 vs $7,086,P < .001). Medicare beneficiaries despite having slightly longer lengths of stay did not have higher rates of medical complications or readmissions. Surgeons and policy makers may use this data to consider alternative treatments in Medicare patients.

Smoking Cessation May Reduce Risk of Visual Field Progression in Heavy Smokers.

The earlier a person quits smoking the more likely is the optic nerve be spared from damage. To investigate the effect of smoking cessation on visual field (VF) progression in glaucoma. Primary open angle glaucoma patients with a minimum of 3 years follow-up and 5 VFs were included. Linear mixed models were used to investigate the effects of smoking on the rates of 24-2 VF mean deviation loss after adjusting for confounding factors. Cox proportional hazard regression was used to identify whether different levels of smoking intensity were associated with VF progression with respect to different duration of quitting. Five hundred eleven eyes of 354 patients were included over the mean follow-up of 12.4 years. Mean baseline age (95% confidence interval) was 62.3 (61.2, 63.4) years. One hundred forty nine (42.1%) patients were smokers. In a multivariable model, smoking intensity was associated with faster VF loss (-0.06, 95% confidence interval (-0.10, -0.01) dB/year per 10 pack-years, P =0.01) among smokers. Heavy smokers (≥20 pack-years) who had quit ˂25 years prior had significantly greater odds of VF progression compared with never smokers (odds ratio=2.49 (1.01, 6.08); P =0.046). There was no significant difference in odds of VF progression in heavy smokers who had quit smoking more than 25 years compared with never smokers ( P =0.43). A significantly higher proportion of VF progression was found in heavy smokers who quit < 25 years compared with heavy smokers who quit ≥25 years by Kaplan-Meier analysis ( P =<0.001). After ≥25 years of smoking cessation, the risk of VF progression in former heavy smokers becomes similar to never smokers. Long-term smoking cessation may be associated with lower VF progression in glaucoma patients.