Similar In-hospital Mortality Rates Research Articles

Community-acquired pneumonia in people with Human Immunodeficiency Virus (HIV) during the current era of effective antiretroviral therapy: A multi-center retrospective cohort study.

It is unclear if Human Immunodeficiency Virus (HIV) infection affects the prognosis for community acquired pneumonia (CAP) in the current era of effective anti-retroviral therapy. In this multi-center retrospective cohort study of patients admitted for CAP, we compared the in-hospital mortality rate between people with HIV (PWH) and people without HIV. The study included consecutive patients admitted with a diagnosis of CAP across 31 hospitals in Ontario, Canada from 2015 to 2022. HIV infection was based on discharge diagnoses and anti-retroviral prescription. The primary outcome was in-hospital mortality. Competing risk models were used to describe time to death in hospital or discharge. Potential confounders were balanced using overlap weighting of propensity scores. Of 82,822 patients admitted with CAP, 1,518 (1.8%) patients had a diagnosis of HIV. PWH were more likely to be younger, be male and have less comorbidities. In hospital, 67 (4.4%) PWH and 6,873 (8.5%) people without HIV died. HIV status had an adjusted sub-distribution hazard ratio (sHR) of 1.02 (95% CI 0.80-1.31 P=0.8440) for dying in hospital. Of 1,518 PWH, 440 (29.0%) patients had a diagnosis of acquired immunodeficiency syndrome (AIDS). AIDS diagnosis had an adjusted sHR of 3.04 (95% CI 1.69-5.45 P=0.0002) for dying in hospital compared to HIV without AIDS. People with and without HIV admitted for CAP had a similar in-hospital mortality rate. For PWH, AIDS significantly increased the mortality risk. HIV infection by itself without AIDS should not be considered a poor prognostic factor for CAP.

Morbidity and In-Hospital Mortality in Diabetic Patients Undergoing Cardiac Surgery: A Retrospective Cohort Study

Objective: To evaluate the impact of diabetes mellitus (DM) in hospital mortality and morbidity after cardiac surgery. Materials and Methods: The authors performed a retrospective cohort study in a tertiary medical center. One thousand two hundred fifteen patients had cardiac surgery between June 2015 and July 2021, divided into two groups, 824 non-diabetic, and 391 diabetic patients. Results: In-hospital mortality rates were comparable in diabetic and non-diabetic patients at 7.2% versus 6.6% (p=0.786). However, chronic kidney disease, high American Society of Anesthesiologists physical status, preoperative arrhythmias, and non-valvular surgery were statistically significant predictors of in-hospital mortality. In-hospital morbidities were higher in diabetic patients compared with non-diabetic patients (p<0.001) with neurological complications at 11.3% versus 7% (p=0.018), pulmonary complications at 57.5% versus 37.9% (p<0.001), renal complications at 39.4% versus 17.2% (p<0.001), infectious complications at 15.9% versus 7.3% (p<0.001), and arrhythmias at 26.6% versus 17.6 (p<0.001). After risk adjustment, DM remained a risk factor for postoperative arrhythmias with an odds ratio of 1.63 (p=0.005), neurological complications with an odds ratio of 2.03 (p=0.007), pulmonary complications with an odds ratio of 1.96 (p<0.001), infectious complications with an odds ratio of 2.76 (p<0.001), and renal complications with an odds ratio of 2.78 (p<0.001). Conclusion: Diabetic and non-diabetic patients have similar in-hospital mortality rates. DM was an independent predictor for postoperative complications. Keywords: Diabetic mellitus; Cardiac surgery; Mortality; Postoperative complications

Hepatic and Renal Outcomes in Systemic Lupus Erythematosus Patients following Coronary Artery Bypass Grafting: A Study from the National Inpatient Sample

Background and Aim of the Study. While several studies have suggested a relationship between adverse postoperative outcomes and systemic lupus erythematosus (SLE) in major surgical settings, no study to date has explored postoperative outcomes of SLE patients undergoing coronary artery bypass grafting (CABG). This study aimed to compare the characteristics and outcomes of SLE patients compared to non-SLE patients undergoing CABG. Methods. We utilized the Nationwide Inpatient Sample (NIS) data from 2008–2018 for CABG patients ≥18 years old. Patients were divided into two groups based on SLE status (confirmed SLE diagnosis or no SLE present). Primary outcomes were in-hospital mortality, favorable discharge, and length of stay (LOS). Secondary outcomes included acute kidney injury (AKI), acute liver injury (ALI), hemodialysis, acute myocardial infarction (AMI), and cardiogenic shock. Patient characteristics including age, sex, race, and preexisting comorbidities were considered. Multivariable models, adjusting for confounding variables, were utilized. Results. Data from a total of 352,772 patients who underwent CABG were analyzed. 980 patients had a diagnosis code for SLE. SLE and non-SLE patients had similar rates of in-hospital mortality (OR = 0.92, [0.63–1.35]), nonhome discharge (OR = 1.09, [0.95–1.24]), and LOS (OR = 1.02, [0.99–1.06]). SLE patients developed AKI at a higher rate (OR = 1.50, [1.05–1.48]) and ALI at a lower rate (OR = 0.35, [0.16–0.74]). Both groups had similar rates of hemodialysis (OR = 1.19, [0.98–1.44]), AMI (OR = 0.93, [0.81–1.06]), and cardiogenic shock (OR = 0.8, [0.61–1.05]). Conclusion. These findings suggest that SLE patients undergoing CABG have similar mortality, discharge disposition, and LOS compared to non-SLE patients. However, SLE patients are at increased risk of AKI and decreased risk of ALI than non-SLE patients. These associations warrant further investigation to elucidate their physiologic basis.

Abstract 11955: Hospital Readmission Outcomes After Myocardial Infarction Among Patients With Myeloproliferative Neoplasms

Introduction: Myeloproliferative neoplasms (MPNs) are chronic leukemias associated with increased risk of arterial and venous thrombotic events. Prior studies suggest patients admitted for acute myocardial infarction (AMI) with MPN have similar in-hospital outcomes but lower rates of invasive management compared with patients without MPN. However, post-hospital outcomes in this patient population have not been well characterized. Methods: Adult MPN patients with a primary admission of AMI from January 2017 to December 2018 were identified using the National Readmission Database. Propensity score matching (PSM) was performed to match 1 MPN for 10 non-MPN controls. Primary outcomes were 30-day all-cause, arterial thrombosis (AT)-related, cardiovascular (CV)-related, and bleeding-related readmissions. Results: After PSM, patient characteristics were well-balanced between groups (Table 1). MPN patients had similar rates of in-hospital mortality but higher rates of bleeding during index hospitalization. MPN patients had increased risk of 30-day all-cause, CV, and AT readmissions but not bleeding (Figure). Conclusions: Among patients hospitalized with AMI, those with MPN are associated with increased risk of CV and AT but not bleeding-related readmissions despite higher rates of index hospitalization bleeding. Further investigation is needed in order to improve post-AMI outcomes in patients with MPN.

Abstract 12891: Outcomes After Heart Failure Hospitalization Among Patients With Myeloproliferative Neoplasms

Introduction: Myeloproliferative neoplasms (MPNs) are chronic leukemias associated with increased risk of cardiovascular (CV) events. MPNs most commonly harbor mutations in the JAK2 gene, which has been associated with adverse cardiac remodeling in mouse models of cardiomyopathy and heart failure (HF). Prior studies suggest patients with MPN are at increased risk of HF. However, in-hospital and readmission outcomes of patients with MPN admitted for HF have not been well characterized. Methods: Adult patients admitted with HF from January 2017 to December 2018 MPN were identified using the National Readmission Database. Propensity score matching (PSM) was performed to match 1 MPN for 10 non-MPN controls. Primary outcomes were in-hospital death and 90-day CV-related, HF-related and all-cause readmissions Results: Patient characteristics after PSM are described in Table 1. Patient characteristics were well-balanced between MPN and non-MPN groups after PSM. MPN patients had similar rates of in-hospital mortality but higher rates of bleeding during index hospitalization. MPN patients had increased risk of in-hospital death (OR 1.17, 95% CI 1.00 - 1.35) and 90-day CV-related (HR 1.10, 95% CI 1.02 - 1.18) and all-cause readmissions (HR 1.24, 95% CI 1.17 - 1.31) but not HF-related (HR 1.05, 95% CI 0.97 - 1.14). Conclusions: Among patients hospitalized for HF, MPN was associated with increased risk of in-hospital death, and 90-day CV-related readmissions. Further investigation is needed in order to improve outcomes in patients with MPN and HF.

Abstract 17180: Association of Arterial Return Cannula Size With Survival in Adults Undergoing Venoarterial Extracorporeal Membrane Oxygenation: An ELSO Registry Analysis

Introduction: Peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to support critically ill adults with cardiogenic shock (CS), but the impact of arterial cannula size on survival remains poorly understood. Hypothesis: A smaller arterial return cannula will be associated with similar survival. Methods: We queried the ELSO registry for adults undergoing VA-ECMO from 2017-2022 and stratified them into small (<16 Fr) versus large (≥16Fr) arterial cannula size. We restricted the cohort to patients with body surface area (BSA) 1.8-2.2 m 2 and excluded patients with a concomitant left ventricular venting device, central cannulation, and multiple ECMO runs. The primary outcome was 30-day in-hospital mortality and secondary outcomes included 24-hour lactate clearance and rates of on-support acute renal and liver injury. Results: Among 2963 adults receiving peripheral VA-ECMO without a concomitant left ventricular venting device, 491 (16.6%) patients had a small arterial cannula and 2,472 (83.4%) had a larger cannula. Patients with a larger cannula were more often male, had marginally higher BSA, a higher incidence of pre-ECMO organ failures, and more often had a distal perfusion cannula (Figure, panel A). There was no difference in 30-day mortality between patients with small (40.3%) versus large (42.9%) arterial cannula, p= 0.295 (Figure, panel B), which persisted after multivariable modeling: adjusted hazard ratio 0.97 (95% CI: 0.79-1.19, p= 0.78). Lactate clearance at 24 hours of ECMO support (Figure, panel C) and the rates of acute renal injury (37% vs 41%, p = 0.024) and hyperbilirubinemia (4.3% vs 4.3%, p = 0.96) were similar between the two arterial cannula size cohorts. Conclusion: For adult patients undergoing peripheral VA-ECMO support, the use of a smaller (<16F) versus larger (≥16F) arterial return cannula was associated with similar rates of in-hospital mortality and metrics of end-organ perfusion.

Emergence of novel ST1299 vanA lineages as possible cause for the striking rise of vancomycin resistance among invasive strains of Enterococcus faecium at a German university hospital.

Since 2019, we have observed a remarkable rise of vancomycin resistance among invasive strains of Enterococcus (E.) faecium at the University Hospital Erlangen (UKER), a tertiary-care hospital in Germany. Here, we analyzed the genetic diversity of E. faecium isolated from blood cultures of in-patients by core genome multilocus sequence typing to see whether the occurrence of vancomycin resistance was associated with the spread of new clonal lineages. Between January and December 2022, 37 consecutive non-duplicate isolates were included in this study. Resistance to vancomycin was detected in 15 isolates (40.5%). The affected patients had a median age of 65 years, and 26 of them (70.3%) were males. Patients with bloodstream infection caused by vancomycin-resistant E. faecium (VREfm) or vancomycin-susceptible E. faecium (VSEfm) showed a similar in-hospital mortality rate (33.3% vs 27.3%, P = 0.692), indicating that VREfm were not more virulent than VSEfm. In contrast, the genetic diversity was higher in VSEfm (15 clonal lineages) than in VREfm isolates (seven clonal lineages). The majority of VREfm isolates (73.2%) belonged to only three clonal lineages: ST117/CT71 vanB (n = 4), which is the most commonly detected vancomycin-resistant lineage in Germany, and two novel ST1299 vanA lineages classified as CT3109 (n = 4) and CT1903 (n = 3). We conclude that the high rate of vancomycin resistance among invasive E. faecium isolates at UKER could be associated with the emergence of novel ST1299 vanA lineages, which is likely to be relevant also for other hospitals and countries. Future studies will focus on the prevalence of ST1299 vanA in the general population. IMPORTANCE The proportion of VREfm among all Enterococcus faecium isolated from blood cultures in German hospitals has increased in the period 2015-2020 from 11.9% to 22.3% with a country-wide spread of the clonal lineage ST117/CT71 vanB. In this study, we provided useful information about the genetic diversity of invasive strains of E. faecium. Moreover, our findings confirm the nosocomial spread of novel ST1299 vanA lineages, which recently had a rapid expansion in Austria and the south-eastern part of Germany.

Percutaneous cannulation is associated with lower rate of severe neurological complication in femoro-femoral ECPR: results from the Extracorporeal Life Support Organization Registry

BackgroundPercutaneous cannulation is now accepted as the first-line strategy for extracorporeal cardiopulmonary resuscitation (ECPR) in adults. However, previous studies comparing percutaneous cannulation to surgical cannulation have been limited by small sample size and single-center settings. This study aimed to compare in-hospital outcomes in cardiac arrest (CA) patients who received femoro-femoral ECPR with percutaneous vs surgical cannulation.MethodsAdults with refractory CA treated with percutaneous (percutaneous group) or surgical (surgical group) femoro-femoral ECPR between January 2008 and December 2019 were extracted from the international Extracorporeal Life Support Organization registry. The primary outcome was severe neurological complication. Multivariable logistic regression analyses were performed to assess the association between percutaneous cannulation and in-hospital outcomes.ResultsAmong 3575 patients meeting study inclusion, 2749 (77%) underwent percutaneous cannulation. The proportion of patients undergoing percutaneous cannulation increased from 18% to 89% over the study period (p < 0.001 for trend). Severe neurological complication (13% vs 19%; p < 0.001) occurred less frequently in the percutaneous group compared to the surgical group. In adjusted analyses, percutaneous cannulation was independently associated with lower rate of severe neurological complication (odds ratio [OR] 0.62; 95% CI 0.46–0.83; p = 0.002), similar rates of in-hospital mortality (OR 0.93; 95% CI 0.73–1.17; p = 0.522), limb ischemia (OR 0.84; 95% CI 0.58–1.20; p = 0.341) and cannulation site bleeding (OR 0.90; 95% CI 0.66–1.22; p = 0.471). The comparison of outcomes provided similar results across different levels of center percutaneous experience or center ECPR volume.ConclusionsAmong adults receiving ECPR, percutaneous cannulation was associated with probable lower rate of severe neurological complication, and similar rates of in-hospital mortality, limb ischemia and cannulation site bleeding.

Sex differences in clinical characteristics and outcomes associated with alcoholic hepatitis.

Alcohol-associated liver disease is increasing among females with an earlier onset and more severe disease at lower levels of exposure. However, there is paucity of literature regarding sex differences related to alcoholic hepatitis. Hospitalized patients with alcoholic hepatitis were selected from the US Nationwide readmissions database 2019. In this cohort, we evaluated sex differences in baseline comorbidities, alcoholic hepatitis related complications and mortality. A subset of patients with alcoholic hepatitis who were hospitalized between January and June 2019 were identified to study sex differences in 6 month readmission rate, mortality during readmission, and composite of mortality during index hospitalization or readmission. Among 112 790 patients with alcoholic hepatitis, 33.3% were female. Female patients were younger [48 (38-57) vs. 49 (39-58) years; both P < 0.001] but had higher rates of important medical and mental-health related comorbidities. Compared with males, females had higher rates of hepatic encephalopathy (11.5% vs. 10.1; P < 0.001), ascites (27.9% vs. 22.5%; P < 0.001), portal hypertension (18.5% vs. 16.4%; P < 0.001), cirrhosis (37.3% vs. 31.9%; P < 0.001), weight loss (19.0% vs. 14.5%; P < 0.001), hepatorenal syndrome (4.4% vs. 3.8%; P < 0.001), spontaneous bacterial peritonitis (1.9% vs. 1.7%; P = 0.026), sepsis (11.1% vs. 9.5%; P < 0.001), and blood transfusion (12.9% vs. 8.7%; P < 0.001). Females had a similar in-hospital mortality rate (4.3%) compared to males (4.1%; P = 0.202; adjusted odds ratio (OR) 1.02, 95% CI (cardiac index) 0.89-1.15; P = 0.994). In the subset of patients ( N = 58 688), females had a higher 6-month readmission rate (48.9% vs. 44.9%; adjusted OR 1.12 (1.06-1.18); P < 0.001), mortality during readmission (4.4% vs. 3.2%; OR 1.23 (1.08-1.40); P < 0.01), and composite of mortality during index hospitalization or readmission (8.7% vs. 7.2%; OR 1.15 (1.04-1.27); P < 0.01). Compared to their male counterparts, females with alcoholic hepatitis were generally younger but had higher rates of comorbidities, alcoholic hepatitis related complications, rehospitalizations and associated mortality. The greater risks of alcohol-associated liver dysfunction in females indicate the need for more aggressive management.

Diabetes mellitus impact on left ventricular assist deviceoutcomes in heart failure patients: National Inpatient Sample study.

Aim: Diabetes mellitus (DM) is a recognized risk factor for heart failure (HF), increasing the likelihood of requiring left ventricular assist device (LVAD) therapy. Objective: This retrospective cohort study aims to assess the impact of DM on LVAD patients, focusing on in-hospital mortality as the primary outcome. Methods: Utilizing the National Inpatient Sample administrative database, data from 11,506 adult HF patients who underwent LVAD implantation were analyzed. Results: Of the patients, 44.28% had diabetes. Adjusting for various factors, diabetic patients exhibited shorter hospital stays, lower admission costs and similar in-hospital mortality rates compared with non-diabetic patients. Conclusion: These findings enhance our understanding of the risks and benefits of LVAD therapy in patients with refractory HF and DM.

Association of race and in-hospital outcomes following acute pulmonary embolism: A retrospective cohort study.

Racial disparities in health care are well established, with Black patients frequently experiencing the most significant consequences of this inequality. Acute pulmonary embolism (PE) is increasing in incidence and an important cause of morbidity and mortality in the United States, but little is known about racial disparities in the inpatient setting. Black and White patients admitted with acute PE will have different in-hospital outcomes. All PE patients from January 1, 2016 to June 30, 2017 were retrospectively identified using ICD-10 codes. Data were abstracted by manual chart review for all image-confirmed PEs. A total of 782 patients with acute PE were identified, of which 319 (40.8%) were Black and 463 (59.2%) were White. Black patients had higher BMI (median [Q1-Q3]: 30.3 [25.4-36.6] vs. 29.3 [24.5-33.8] kg/m2 , p = .017), were younger (61 [48-74] vs. 67 [54-75] years, p = .001), and were more likely to have a history of heart failure (16.0 vs. 7.1%, p < .001), while White patients had higher rates of malignancy (46.9 vs. 34.5%, p = .001) and recent surgery (29.6 vs. 18.2%, p < .001). Black patients were more likely to receive systemic thrombolysis (3.1% vs. 1.1%, p = .040), while White patients had numerically higher rates of surgical embolectomy (0.3% vs. 1.1%, p = .41). No difference in inpatient mortality was observed; however, Black patients had longer hospital length of stay (5.0 [3-9] vs. 4.0 [2-9] days, p = .007) and were more likely to receive warfarin (23.5 vs. 12.1%, p < .001). Similar in-hospital mortality rates were observed in Black and White patients following acute PE. However, Black patients had longer hospital stays, higher warfarin prescription, and fewer traditional PE-related risk factors.

Multivessel vs. culprit vessel-only percutaneous coronary intervention in ST-segment elevation myocardial infarction with and without cardiogenic shock.

Early revascularization of the culprit vessel is the most effective treatment for reducing the risk of mortality from acute STEMI with and without cardiogenic shock. However, the most recent trends and impact of multivessel percutaneous coronary intervention (PCI) during the index hospitalization on in-hospital outcomes are unknown. The National Inpatient Sample was queried from October 2015 to 2019 for hospitalizations with STEMI. The impact of multivessel PCI on in-hospital outcomes of patients with and without cardiogenic shock was evaluated. Of 624,605 STEMI hospitalizations treated with PCI, 12.5% were complicated by cardiogenic shock. Among hospitalizations without cardiogenic shock, 15.7% were treated by multivessel PCI, which declined from 20.8% in 2015 to 13.9% in 2019 (P trend < 0.001). Multivessel and culprit-only PCI had similar rates of In-hospital mortality (2.4 vs. 2.3%, p = 0.027) and major adverse cardiac and cerebrovascular events (MACCE; 7.4 vs. 7.2%, p = 0.072). Among hospitalizations with cardiogenic shock, 22.1% were treated by multivessel PCI, which declined from 29.2% in 2015 to 19.4% in 2019 (P trend < 0.001). Multivessel PCI was associated with higher rates of in-hospital mortality (30.9 vs. 28.4%, p < 0.001) and MACCE (39.9 vs. 36.5%, p < 0.001) than culprit-only PCI. The frequency of multivessel PCI for STEMI with and without cardiogenic shock is declining. Multivessel PCI is associated with worse in-hospital outcomes for STEMI with cardiogenic shock but not for STEMI without cardiogenic shock.

Abstract 14448: On-Table Extubation Associated With Lower Resource Utilization and Non-Inferior Outcomes After Coronary Bypass

Introduction: Minimizing the duration of postoperative ventilation facilitates early discharge from the intensive care unit (ICU) thus promoting enhanced recovery after cardiac surgery (ERAS). Hence, we sought to investigate the impact of on-table extubation on outcomes and resource utilization after coronary artery bypass graft (CABG) surgery. Methods: We performed a retrospective review of a prospectively collected local database, including all patients undergoing CABG surgery at a large academic center from January 2020 to December 2021. Patients were stratified into two groups, on-table (before leaving the operating room) extubation versus early (&lt; 6 hours after procedure) extubation. In-hospital mortality and postoperative complications were compared using univariate analyses. Length of stay (LOS), 30-day readmission and high resource utilization (HRU), a binary outcome defined as direct procedure cost of the highest quartile, were investigated. Results: A total of 691 patients were included in our analysis, 267 (38.6%) of which were extubated on-table. The two groups had similar median age and preoperative ejection fractions. However, on-table extubation patients were more likely to be males (86.9% vs 76.6%, p&lt;0.001) with smaller BMIs (27.7% vs 28.5%, p=0.002), lower STS risk scores (0.75% vs 0.95%, p=0.022) and lower cerebrovascular disease prevalence (8.2% vs 14.2%, p=0.017). Compared to early extubation, on-table extubation patients had similar rates of in-hospital mortality (0 % vs 1.4 %, p=0.051), postoperative blood transfusion (7.5% vs 9.0%, p=0.494), reintubation (2.6% vs 3.5%, p=0.499) and pneumonia (1.9% vs 3.3%, p=0.263). As hypothesized, on-table extubation patients had shorter ICU LOS (32hrs vs 39hrs, p=0.02), shorter postoperative LOS (4.9 days vs 5.9 days, p=0.003), and lower incidence of high resource utilization (18.0% vs 29.5%, p&lt;0.001). ICU readmission (3.8% vs 3.5%, p=0.887) and 30-day readmission (5.2% vs 7.3%, p=0.277) were similar in the two groups. Conclusions: On-table extubation is a safe and effective ERAS practice, that is associated with lower ICU LOS, postoperative LOS, and resource utilization, without affecting rates of reintubation, ICU readmission, 30-day readmission or operative mortality.

Abstract 14084: Safety and Outcomes of Percutaneous Coronary Intervention in Patients Presenting With Acute Coronary Syndrome With Prior Liver Transplantation

Background: There is a paucity of data about the outcomes of performing Percutaneous coronary intervention (PCI) for Liver transplant (LT) patients presenting with acute coronary syndrome (ACS). Methods: We queried the national readmission database for patients who underwent PCI hospitalized between 2016 and 2019, patient were classified into two groups based on prior LT status. International classification of disease codes (ICD-10) were used for diagnosis and procedures codes. Our outcomes were In-hospital mortality and 90-day readmission rate. A multivariate adjusted regression model was performed to risk adjust for predictors of 90-day readmission (all-cause). Results: A total of 1400,861 patients underwent PCI between the years 2016 and 2019 for ACS and underwent PCI. 1,532 patients had a history of LT (0.1%). Hospitalized patients with prior LT were of similar age (65.2 ±0.31 vs 65.3 ±0.04 years, p=0.9), and less likely to be women (20.8.6% vs. 32.5%, p&lt;0.01) compared with those without prior LT history. Hospitalized patients with prior LT had similar In-hospital mortality rate (3.9% vs 2.9%, p=0.3), shock (5.3% vs 4.5%, p=0.34), and Mechanical circulatory support utilization rate (4.9% vs 4.3%, p=0.452) but longer length of stay (5.8±0.3 vs 4.1±0.02, P&lt;0.001) compared to the cohort that had no prior LT. Patients with prior LT had a higher readmission rate within 90 days 29.6% vs 19.4%, p= 0.001), and were less likely to have repeat PCI in the readmission (7.9% vs 12.3%, p&lt;0.001), however more likely and acute kidney injury. Both cohorts had similar rates of acute heart failure exacerbation, bleeding complications, or in-hospital mortality in the readmission. Conclusion: There was no significant difference in mortality between both cohorts, however, readmission rate was higher in the LT cohort, Further studies exploring these differences may help to mitigate these readmissions.

Periprocedural outcomes of transcatheter aortic valve replacement (TAVR) in patients with and without cardiac amyloidosis-analysis from 2016–2019 national inpatient sample

Abstract Background Cardiac Amyloidosis is often misdiagnosed due to its non-specific presenting symptoms. There is a lack of evidence on the clinical outcomes in patients with cardiac amyloidosis undergoing transcatheter aortic valve replacement (TAVR). Purpose To study periprocedural outcomes in patients hospitalised primarily for TAVR with and without cardiac amyloidosis. Methods This is a retrospective observational study involving index hospitalizations for TAVR between January 1, 2016 to December 31, 2019 from the National Inpatient Sample (NIS), the largest all-payer public database of hospital care data in the United States. Our study sample included discharged adult patients (≥18 years) primarily hospitalised for TAVR using ICD-10 codes. Confounders were adjusted using multivariable regression analysis. Results During 2016–2019, there were 43270 principal hospitalizations (unweighted sample) identified for TAVR, among them 4999 patients had a history of cardiac amyloidosis. Mean age was 79.3±8.4 years. Among patients hospitalised for TAVR, 54.4% (n=23539) were males, 45.6% (n=19731) were females (p&amp;lt;0.001), 1.71% (n=740) developed cardiogenic shock, 1.53% (n=662) required mechanical ventilation with an in-hospital mortality of 1.3% (n=563). There were 87% Whites, 4.2% Blacks, 4.8% Hispanics, 1.3% Asians, and 2.7% were other races. A total of 23,819 (55.1%) hospitalizations had a Charlson Comorbidity Index (CCI) of three or higher. After undergoing TAVR, compared to the non-cardiac amyloidosis cohort, the cardiac amyloidosis cohort had less females (27.8% vs 45.6%, p=0.01), had similar age (mean age: 80.2 vs 79.3; p=0.665), higher incidence of congestive heart failure (CHF) (100% vs 74%, p=0.012), higher mechanical ventilation requirement (11.1% vs 1.5%, p=0.001)) but with a similar length of hospital stay (3.9% vs 3.9%, p=0.99). Multivariate regression analysis revealed that TAVR in cardiac amyloidosis cohort did not significantly increase the odds of in-hospital mortality than the non-cardiac amyloidosis cohort (aOR: 5.2; 95% CI: 0.7, 38.3; p=0.103). However, females had higher odds of mortality post-TAVR compared to males (aOR: 1.45; 95% CI: 1.22, 1.73; p&amp;lt;0.001) after controlling for age, sex, race, regional hospital location, hospital bed capacity, income, and CCI. There is an increasing trend of index TAVR hospitalizations with cardiac amyloidosis with 109.4 per 100,000 hospitalizations in 2016, 139.7 per 100,000 in 2017, 157.5 per 100,000 in 2018, 201.4 per 100,000 in 2019 (p trend&amp;lt;0.001). Conclusions After TAVR, cardiac amyloidosis is associated with higher incidence of CHF increased need for mechanical ventilation, similar in-hospital mortality rate in comparison to non-cardiac amyloidosis cohort. There was an increasing trend in the index hospitalizations for TAVR with cardiac amyloidosis from 2016–2019. Funding Acknowledgement Type of funding sources: None.

Mortality and prognostic factors in hospitalized COVID-19 patients with cancer: an analysis from a large healthcare system in the United States.

To evaluate clinical outcomes in patients with malignancy who are SARS-CoV-2 (COVID-19) positive and investigate if factors such as age, gender, and race contribute to COVID-19 mortality in patients with malignancy. Retrospective data was gathered from Memorial Healthcare System of COVID-19 patients hospitalized from March 1, 2020 to January 18, 2021. Active malignancy was defined as either receiving antineoplastic therapy or being under surveillance. The primary endpoint was in-hospital mortality. Descriptive statistics were used to summarize the characteristics and outcomes. Univariate and multivariate logistic analysis were performed to define baseline clinical characteristics potentially associated with mortality in cancer patients with COVID-19. A total of 4,870 COVID-19 patients were enrolled in the study, and 265 of those patients had a diagnosis of active malignancy. The study population was diverse which included non-Hispanic whites (NHW) 816 (16.8%), Hispanics 2,271 (46.6%) and Blacks 1,534 (31.5%). Of the cancer patients, 24.1% were NHW, 43% were Hispanic and 28.7% were Black. Amongst the races, 37.5% of in-hospital mortalities were NHW, while 18.4% were Hispanics and 19.7% were Black. The in-hospital mortalities amongst the two malignancy types, solid and hematological, accounted for 24.6% and 23.5% of deaths and they were not found to be statistically significant (P=0.845). After adjustments for age, gender and race were made, cancer was independently associated with an increased in-hospital mortality, with an adjusted odds ratio of 1.48 [95% confidence interval (CI): 1.08-2.01]. Increased age and elevated serum levels of creatinine and C-reactive protein (CRP) were associated with an increased risk of death in cancer patients with COVID-19. COVID-19 in patients with cancer had poorer outcomes in comparison to those who were cancer-free. Both hematological and solid malignancies had similar in-hospital mortality rates. The highest in-hospital mortalities of cancer patients with COVID-19 were non-Hispanic whites in-comparison to Hispanics with the least. Age, elevated levels of creatinine and CRP were independently associated with increased risk of death in cancer patients hospitalized with COVID-19. The findings indicate the need for close surveillance and monitoring of these patients as they are more likely to have higher risk of death from COVID-19.

Increased Travel Time to the Tertiary Centre Is Associated With Decreased Long-term Survival Following Ascending Aortic Operations.

The association between travel time from tertiary care centre and outcomes after ascending thoracic aortic surgery is unknown. We determined the effect of travel time from the tertiary care centre on outcomes in ascending aortic repair in Nova Scotia. A retrospective analysis of patients undergoing elective and emergent ascending thoracic aortic operations from 2005 to 2015 was carried out. Patient's residential geographic coordinates were used to calculate travel time to the tertiary care centre, and patients who resided < 1 hour vs ≥ 1 hour were compared. Multivariable logistic regression was performed to determine the effect of travel time on in-hospital outcomes. Cox-proportional hazard modelling and Kaplan-Meier survival estimates were created to determine the effect on long-term survival. A total of 476 patients underwent ascending thoracic aortic surgery from 2005 to 2015. Patients who resided < 1 hour from the tertiary care centre vs patients who resided ≥ 1 hour had similar rates of in-hospital mortality (4.4% vs 6.1%, P= 0.42), in-hospital composite complications (66.7% vs 67.7%, P= 0.80), hospital length of stay (median 9 days; interquartile range [7-16] vs 10 [7-17], P= 0.41), and discharge disposition other than home (9.7% vs 11.7%, P= 0.55). Compared with patients who resided < 1 hour from the tertiary centre, patients who resided ≥ 1 hour were at higher risk for long-term mortality (hazard ratio, 2.19; 95% confidence interval, 1.13-4.28; P= 0.02). Patients who reside remotely from the tertiary centre experience equivalent in-hospital outcomes but decreased long-term survival following ascending aortic operations. These findings may guide resource expansion for postoperative follow-up.

Staged versus concomitant transcatheter aortic valve replacement and percutaneous coronary intervention: A national analysis

ObjectiveAlthough patients with significant coronary artery disease and aortic stenosis have traditionally undergone open valve replacement and bypass grafting, percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) are increasingly considered. Because of the lack of data regarding timing of PCI/TAVR, in the present study we evaluated associations of staged and concomitant PCI/TAVR on outcomes in a nationally representative cohort. MethodsAdults who underwent TAVR and PCI were identified using the 2016 to 2018 Nationwide Readmissions Database. If PCI/TAVR occurred on the same day, patients were considered Concomitant and otherwise considered Staged. Staged were further classified as Early-Staged if both occurred in the same hospitalization or Late-Staged if TAVR ensued PCI in a subsequent hospitalization. Multivariable regression models were developed to evaluate the association of TAVR timing on outcomes. The primary end point was in-hospital mortality whereas perioperative complications including acute kidney injury and hospitalization costs were secondarily considered. ResultsOf an estimated 5843 patients, 843 (14.4%) were Concomitant and 745 (12.7%) and 4255 (72.8%) were Early-Staged and Late-Staged, respectively. Although age and TAVR access were similar, Concomitant had a lower proportion of chronic kidney disease and more commonly underwent single-vessel PCI. Staged showed similar risk-adjusted mortality but greater odds of acute kidney injury (Early-Staged adjusted odds ratio: 2.68; 95% CI, 1.57-4.55 and Late-Staged: 1.97; 95% CI, 1.29-2.99) compared with Concomitant. Although post-TAVR hospitalization duration was similar, total length of stay and costs were increased in Staged. ConclusionsConcomitant PCI/TAVR was associated with similar rates of in-hospital mortality but reduced rates of acute kidney injury and lower resource utilization. While evaluating patient-specific factors, concomitant PCI/TAVR might be reasonable in select individuals.

Impact of Chronic Lymphocytic Leukemia on Outcomes and Readmissions After Cardiac Operations

BackgroundOutcomes of cardiac operations in patients with chronic lymphocytic leukemia (CLL) have been examined in limited series. The present study aimed to assess the impact of CLL on clinical outcomes and resource utilization after cardiac operations in a nationally representative cohort. MethodsAll adult patients undergoing elective coronary artery bypass grafting, valve repair, or valve replacement were identified utilizing the 2010 to 2017 Nationwide Readmissions Database. Patients were stratified by history of CLL. Incidence of in-hospital mortality, perioperative complications, blood transfusions, and readmission within 90 days were examined. We subsequently performed 3:1 nearest neighbor matching between CLL and non-CLL patients for all primary and secondary outcomes of interest. ResultsOf an estimated 1,250,882 patients undergoing cardiac operations, 0.23% had a diagnosis of CLL. Among 11,237 propensity matched patients, those with CLL had similar rates of in-hospital mortality (3.8% vs 2.6%; P = .08) and perioperative complications (33.4% vs 33.6%; P = .92) compared with their non-CLL counterparts. Although the incidence of infection was comparable (8.5% vs 9.4%; P = .38), CLL patients did require blood transfusions more frequently (33.7% vs 28.4%; P = .003) than others. Furthermore, CLL patients were more likely to be readmitted with respiratory etiologies contributing significantly to rehospitalization. ConclusionsPatients with CLL generally have similar outcomes after cardiac operations but may more commonly require blood transfusion. Blood-conserving interventions may be considered in this at-risk population to improve outcomes. Furthermore, interventions to mitigate readmission deserve further exploration.

Opioid dependence and treatment outcomes among patients with burn injury

BackgroundPatients with burn injuries cause significant healthcare economic burden, often utilising extra-hospital resources, caregiving, and specialized care. MethodsWe present a retrospective cohort analysis of the hospitalized patients in the USA with a primary diagnosis of burn injury. Opioid dependence was identified using ICD-10 CM codes. The 30-day all-cause readmission rate was the main outcome while secondary outcomes were inhospital mortality rate, resource utilization which included hospital length of stay, total hospitalization costs and charges and surgical procedures for burn injury treatment as well as the most important five principal diagnoses for admission and readmission. ResultsOut of 22,348 patients included in the study, 597 had opioid dependence. Older patients (43 years, range: 38.6–47.2 years) as well as males (70.8%) were more likely to be opioid dependent. Opioid dependence was associated with higher 30-day readmission rates (aOR: 1.83, 95% confidence interval (CI): 1.30–2.57, p-value: <0.01), higher total hospitalization costs (aMD: $14,981, CI: $3820–$26,142, p-value: 0.01), total hospitalization charges (aMD: $47,078, CI: −$5093 to $89,063, p-value: 0.03), and a shorter mean length of stay (aMD: 5.13 days, CI: 2.60–7.66, p-value: <0.01). However, patients with and without opioid dependence had similar in-hospital mortality rates (aOR: 0.27, CI: 0.06–1.28, p-value: 0.10). ConclusionWe are the first to our knowledge to report the association of treatment outcomes and opioid dependence in patients hospitalized at the national level with a burn injury. We show that there were higher 30-day all-cause readmission rates and in-hospital resource utilization among patients with opioid-dependence.