Total Number Of Hospitalizations Research Articles

The favourable alliance between CardioMEMS and levosimendan in patients with advanced heart failure.

We report the results of a real-world study based on heart failure (HF) patients' continuous remote monitoring strategy using the CardioMEMS system to assess the impact of this device on healthcare outcomes, costs, and patients' management and quality of life. We enrolled seven patients (69.00±4.88years; 71.43% men) with HF, implanted with CardioMEMS, and daily remote monitored to optimize both tailored adjustments of home therapy and/or hospital infusions of levosimendan. We recorded clinical, pharmacological, biochemical, and echocardiographic parameters and data on hospitalizations, emergency room access, visits, and costs. Following the implantation of CardioMEMS, we observed a 50% reduction in the total number of hospitalizations and a 68.7% reduction in the number of days in the hospital. Accordingly, improved patient quality of life was recorded with EQ-5D (pre 58.57±10.29 vs. 1year post 84.29±19.02, P=0.008). Echocardiographic data show a statistically significant improvement in both systolic pulmonary artery pressure (47.86±8.67 vs. 35.14±9.34, P=0.022) and E/e' (19.33±5.04 vs. 12.58±3.53, P=0.023). The Quantikine® HS High-Sensitivity Kit determined elevated interleukin-6 values at enrolment in all patients, with a statistically significant reduction after 6months (P=0.0211). From an economic point of view, the net savings, including the cost of CardioMEMS, were on average €1580 per patient during the entire period of observation, while the analysis performed 12months after the implant vs. 12months before showed a net saving of €860 per patient. The ad hoc analysis performed on the levosimendan infusions resulted in 315days of hospital avoidance and a saving of €205158 for the seven patients enrolled during the observation period. This innovative strategy prevents unplanned access to the hospital and contributes to the efficient use of healthcare facilities, human resources, and costs.

Examining the effects of voluntary avoidance behaviour and policy-mediated behaviour change on the dynamics of SARS-CoV-2: A mathematical model

BackgroundThroughout the SARS-CoV-2 pandemic, policymakers have had to navigate between recommending voluntary behaviour change and policy-driven behaviour change to mitigate the impact of the virus. While individuals will voluntarily engage in self-protective behaviour when there is an increasing infectious disease risk, the extent to which this occurs and its impact on an epidemic is not known. MethodsThis paper describes a deterministic disease transmission model exploring the impact of individual avoidance behaviour and policy-mediated avoidance behaviour on epidemic outcomes during the second wave of SARS-CoV-2 infections in Ontario, Canada (September 1, 2020 to February 28, 2021). The model incorporates an information feedback function based on empirically derived behaviour data describing the degree to which avoidance behaviour changed in response to the number of new daily cases COVID-19. ResultsVoluntary avoidance behaviour alone was estimated to reduce the final attack rate by 23.1%, the total number of hospitalizations by 26.2%, and cumulative deaths by 27.5% over 6 months compared to a counterfactual scenario in which there were no interventions or avoidance behaviour. A provincial shutdown order issued on December 26, 2020 was estimated to reduce the final attack rate by 66.7%, the total number of hospitalizations by 66.8%, and the total number of deaths by 67.2% compared to the counterfactual scenario. ConclusionGiven the dynamics of SARS-CoV-2 in a pre-vaccine era, individual avoidance behaviour in the absence of government action would have resulted in a moderate reduction in disease however, it would not have been sufficient to entirely mitigate transmission and the associated risk to the population in Ontario. Government action during the second wave of the COVID-19 pandemic in Ontario reduced infections, protected hospital capacity, and saved lives.

The Association of multiple sclerosis, traumatic brain injury, and spinal cord injury to acute and long COVID-19 outcomes.

Although persons with disabilities are a high-risk group, little is known about the association between specific disabling conditions and acute or long COVID outcomes. To examine the severity of acute SARS-CoV-2 infection and post-COVID outcomes among people with a preexisting diagnosis of multiple sclerosis (MS), spinal cord injury (SCI), or traumatic brain injury (TBI). This was a retrospective cohort study using the TrinetX Research Database, a large representative database of medical records. COVID-19-positive persons with MS, SCI, or TBI (cases) were matched 1:1 on age, gender, race, ethnicity, and comorbidities to COVID-19-positive persons without these diagnoses (controls). The main outcomes assessed were hospitalization for acute COVID-19, length of stay (LOS), the total number of hospitalizations, mortality, and incidence of six prevalent post-COVID sequelae within 6 months following a COVID-19 diagnosis. There were 388,297 laboratory-confirmed COVID-19 cases identified. Of these cases, 2204 individuals had one of the following preexisting diagnoses: 51.3% TBI, 31.4% MS, and 17.3% SCI. People with TBI, MS, and SCI were significantly more likely to be hospitalized for COVID-19 (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.03-1.46) than matched controls. There was no difference in LOS, total hospitalizations, or mortality during the 6 months following the initial COVID diagnosis. Multivariable analyses reveal that persons with TBI, MS, and SCI were more likely to experience new weakness (OR = 1.54, 95% CI = 1.19-2.00), mobility difficulties (OR = 1.66, 95% CI = 1.17-2.35), and cognitive dysfunction (OR = 1.79, 95% CI = 1.38-2.33) than controls, even after controlling for the presence of these symptoms prior to their COVID infection and other risk factors. There were no differences in fatigue, pain, or dyspnea. Having a history of MS, SCI or TBI was not associated with higher mortality risk from COVID-19. However, associations between these diagnoses and postacute COVID-19 symptoms raise concern about widening health outcome disparities for individuals with such potentially disabling conditions following COVID-19 infection.

The Burden of Frequency of Hospitalization and Length of Hospital Stay by Children with Major Congenital Abnormalities That Require Surgical Treatment during the First Year of Life – a Case-control Study

Objective − To determine how much children with “major” congenital abnormalities during the first year of life, compared to those without them, burden the health care system more in terms of length of stay and number of admissions and discharges.Methods − The electronic records of 57 patients with major congenital abnormalities (study group) and 57 patients who were surgically treated for another condition in the first year of life (control group) were reviewed retrospectively.Results − Children with congenital abnormalities were first hospitalized at the age of 1 (IQR=5) day, compared to 121 (IQR=278) days in children without congenital abnormalities (P<0.001). The total number of hospitalizations in the study group was 2.39±1.57, while in the control group, it was 1.14±0.35 (P<0.001). The length of stay in the hospital in children with congenital abnormalities was 48 (IQR=74) days, compared to the control group, which was 3 (IQR=15) days (P<0.001). The average length of stay in children with congenital abnormalities was 22.5 (IQR=29) days, while in the control group, it was 3 (IQR=11) days (P<0.001). The average share of the length of stay in the intensive care unit in relation to the total length of stay in the hospital for the group with congenital abnormalities was 46.6%, while for the control group, it was 23.3% (P<0.001). Conclusion − Children with congenital abnormalities had a 4.9× overall longer length of hospital stay and a 3.1× longer length of stay in the intensive care unit.

Institution of an interdisciplinary IBD centre is associated with improved healthcare utilisation.

Despite the institution of an interdisciplinary Inflammatory Bowel Disease (IBD) centre is encouraged, how it may improve patient care is still unknown. In a 5-year period following organisation of an IBD centre, hospitalisations per patient/year decreased (0.41-0.17) and patients on biologics increased (7.7%-26.7%). Total number of hospitalisations (-18.4%) and length of hospitalisation (-29.4%) improved compared with a preceding 5-year period. These findings suggest that institution of an interdisciplinary IBD centre is associated with improved healthcare utilisation.

Trends in Hemophagocytic Lymphohistiocytosis Incidence and Outcomes: A Nationwide Hospital-Based Analysis of 939 Hospitalizations

Background Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening disorder characterized by excessive activation and proliferation of histiocytes and lymphocytes in various organs resulting in excessive release of cytokines leading to dysfunction of natural killer and cytotoxic T-cell cells. Both infection and on occasion malignancies have been identified as a trigger in both sporadic HLH and genetically predisposed HLH. While more commonly reported in the pediatric population, HLH can also occur in adults. Consequently, the outcome data on adult HLH (aHLH) remains limited, highlighting a gap in understanding and presenting an opportunity for further research. Methods: We performed a retrospective analysis of the National Inpatient Sample (HCUP-NIS) 2011- 2018 Databases. We included hospitalizations with a principal diagnosis of HLH and an age greater than 18 years. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 288.4 was used to identify aHLH hospitalizations in the 2011 - 2014 database. ICD-10-CM diagnosis code D76.1 identified aHLH hospitalizations in the 2015 database. The primary outcome was in-hospital mortality. Secondary outcomes were total number of hospitalizations, mean hospitalization charges, percentage of HLH hospitalizations with associated diagnosis of Epstein-Barr Virus (EBV) or Lymphoma. The adjusted rates were estimated by identifying potential confounders using multivariate analysis (adjusted models). Statistical significance was set at p-value < 0.01. Statistical tests were performed using STATA IC software. All analyses applied the HCUP-NIS weights. Results: Over an 8-year period from 2011 to 2018, we identified a total of 939 aHLH hospitalizations. The mean age was 28 years, with the most represented age group being 18-30 years (61.3%), followed by age 51-60 years (10.15%). The age group of 41-50 years accounted for the fewest hospitalizations, comprising 5.9% of the total. Males represented a larger proportion of the hospitalizations at 52.8 % compared to females at 47.12 %. The majority of patients are White (48.8%), followed by Hispanic (19.3%), Black (16.5%), Asian or Pacific Islander (8.5%), and Native American (1.16%). Other races accounted for 5.8% of the total. 59.6% were routine discharges but 7% were transferred to another acute care hospital. Our analysis revealed a steady increase in the number of aHLH hospitalizations over the span of 8 years (96 to 150). The mean length of stay was 19.4 days (17.6 - 21.09), with an significant downward trend in the length of stay from 2011 to 2018, with a parameter estimate of -0.08 (95% CI -0.09 to -0.07; p-value <0.01). The mean hospitalization charges amounted to $ 275108, and we observed a statistically significant upward trend in these charges, marked by a coefficient of 1207 (95% CI 932 - 1483, p-value <0.01). The mortality rate was 16%, we noted a downward trend in this rate, with an odds ratio (OR) of 0.93 (95% CI 0.92 to 0.93, p-value <0.01). (See table). Additionally, 5.92% of aHLH hospitalizations were associated with the diagnosis of EBV, and 1.16% of aHLH hospitalizations were associated with lymphoma. Discussion: Our study, utilizing the NIS discharge dataset, uncovered a rising trend in the incidence of aHLH hospitalizations over an 8-year period. Concurrently, we observed a significant increase in the total hospital charges associated with aHLH hospitalizations. Intriguingly, despite these increases, we identified a downward trend in both the length of hospital stay and the mortality rate among aHLH cases during the study period. These findings may indicate that aHLH is being diagnosed earlier and managed more effectively, reflecting potential improvements in care and treatment strategies.

A spatiotemporal analysis using expert-weighted indicators for assessing social resilience to natural hazards

Measuring social resilience to natural hazards is crucial for disaster risk reduction and sustainable development. In this study, we weighted 31 quantitative and qualitative resilience indicators using an expert-based procedure. The indicators were organized into five dimensions: social resilience, economic resilience, institutional resilience, and housing/infrastructural resilience, for measuring social resilience to natural hazards, with a specific focus on landslide vulnerability. We first modeled and mapped spatially explicit landslide vulnerability at the county level over a 20-year period in a mountainous region in western Iran using a random forest method. We next computed a county-level total resilience index (TRI) using the expert-weighted indicators in response to landslide vulnerability (i.e., physical resilience). Experts deemed total population density, proportion of employed economically active population, and total number of hospitals and health centers as the most important variables for imparting social resilience to landslide vulnerability. We found that increased unemployment rate, decreased bank deposits, and reduction of activities or closure of factories and workshops were the main causes of decreasing the resilience of the study counties over the past two decades. We suggest that enhancing the social resilience requires more efficient economic planning, development of investment, establishment of a disaster prevention system, and improved international relations.

Abstract 17709: ICD-10 Codes Have Low Sensitivity and Suboptimal Positive Predictive Value for Identifying Cases of Pulmonary Embolism With Cor Pulmonale in Electronic Healthcare Records

Introduction: The International Classification of Diseases, 10 th revision (ICD-10) codes were updated in 2015 to include designation of pulmonary embolism (PE) with cor pulmonale . These codes can be advantageous to identify higher-risk patients with PE for research or quality improvement. However, the validity of these codes is unknown. Methods: We reviewed patient data from Mass General Brigham (MGB) health system (01/2016-12/2021). Patients were randomly selected from 3 groups: Patients with Principal discharge diagnosis codes for PE, patients with secondary discharge diagnosis of PE, and patients with no PE codes. Accuracy of codes for PE with cor pulmonale were assessed with reference to manual review by 2 independent physicians using pre-specified criteria. Weighted estimates were obtained by considering the total number of hospitalizations. Results: 1,712 patients were included (age: 60.6±17.8 years, 52.3% female). Chart review found 865 patients with PE, of whom 360 (41.6%) had PE with cor pulmonale according to predefined clinical criteria. Of these 360 PE patients, 358 (99.4%) had ICD-10 codes for PE. However, only in 36 (10.1%) cases, the specific cor pulmonale codes were used. There were 24 additional cases with ICD-10 codes for PE with cor pulmonale in whom the diagnosis was not confirmed per manual review. Sensitivity and specificity for PE with cor pulmonale codes in Principal-or-secondary position were 10.0% and 98.2% (Table, panel A). The positive predictive value (PPV) for PE with cor pulmonale in Principal-or-secondary discharge position was 63.2% in the weighted sample (Table, panel B). Conclusions: ICD-10 codes for identification of acute PE with cor pulmonale have excellent specificity, but very poor sensitivity and suboptimal PPV. These results are informative for investigators who may use such ICD-10 codes for research or quality improvement purposes.

Abstract 16342: Age- and Sex-Differences in Accuracy of ICD-10 Codes for Identifying Adults With Pulmonary Embolism: PE-EHR+ Study

Background Age and sex-differences exist in presentation of adults with pulmonary embolism (PE). However, it remains unclear if these differences influence the accuracy of International Classification of Diseases, Tenth Revision (ICD-10) codes used for identification of PE. Methods: Using multicenter data from Mass General-Brigham Health System (2016-2021), patients were randomly selected from 3 groups: 578 patients with Principal Discharge codes for PE, 578 with Secondary Discharge codes for PE, and 578 without codes for PE. The reference standard for identification of PE was manual chart review by 2 independent physicians. Sensitivity, specificity, and positive and negative predictive values were determined by age (<65 vs ≥65 years) and sex (female vs male). Weighted estimates were obtained by using the total number of hospitalizations. Results: Among 1712 patients included in final analyses, 896 (52.3%) were female and 775 (45.3%) were ≥65 years. Use of Principal-or-Secondary ICD-10 codes had a similar sensitivity by sex (99.5% vs 100% among females vs males) and age (99.8% among both groups) in the study sample. The weighted sensitivity among females was 72.8% (vs 100% for males) and 80.4% among patients ≥65 years (vs 85.2% for <65 years). In the weighted cohort, the positive predictive value was 78.2% among females (vs 80.3% for males) and 78.3% among those ≥65 years (vs 80.0% for <65 years) (Table). Age and sex-differences in the diagnostic accuracy were similarly observed in analyses restricted to Principal, or to Secondary codes. Conclusions: Principal-or-Secondary ICD-10 codes had lower sensitivity and positive predictive value among females and older adults, though the sex-differences in sensitivity may be influenced by limited number of false negatives in this study. Additionally, Secondary codes had higher false positives among older adults. These findings may have important implications for identification of patients with PE using ICD-10 codes.

Abstract 17700: Double Trouble With Identification of Isolated Sub-Segmental Pulmonary Embolism Using ICD-10 Discharge Diagnosis Codes: The PE-EHR+ Study

Introduction: International Classification of Diseases 10 th revision (ICD-10) discharge diagnosis codes are widely used for research studies that use electronic databases. The accuracy of the codes for identifying patients with isolated sub-segmental pulmonary embolism (issPE) is unknown. Methods: We used data from the Mass General Brigham (MGB) health system (01/2016-12/2021) and included 1,734 patients randomly selected from 3 groups: Patients with ICD-10 Principal Discharge Diagnosis codes for PE, patients with secondary Discharge Diagnosis codes for PE, and patients with no ICD-10 codes for PE. Weighted estimates were obtained by considering the total number of hospitalizations in each category at MGB hospitals. Accuracy of the codes was assessed by two independent physicians who reviewed discharge summaries, daily notes, and radiology reports. Results: Of 1,734 records reviewed, 1,712 were included (age: 60.6±17.8 years, 52.3% female). Manual chart review found 865 patients with acute PE, including 104 (12.0%) with issPE. Of these 104 patients, 103 (98.3%) had ICD-10 codes for PE. However, only in 15 (14.6%) cases, PE codes were specified as being limited to subsegmental vessels (issPE). In turn, in another 43 cases, Principal-or-secondary ICD-10 codes for issPE were listed but the patients did not have acute issPE during index hospitalization per review of records. The sensitivity and specificity for issPE codes in Principal or secondary discharge position were 14.4% and 97.3% (Table, panel A). Positive predictive value in the weighted sample was only 26.2% (Table, panel B). Conclusions: ICD-10 codes are insensitive and have a poor positive predictive value for detection of isolated subsegmental PE and should not be used for case identification for research purposes or quality improvement initiatives.

The Evolution of Cystic Echinococcosis in Humans and Ruminants in Portugal-A One Health Approach.

Cystic echinococcosis, also known as hydatid disease, is a significant parasitic zoonosis with public health implications, albeit often neglected. In Portugal, data on this zoonosis are scarce despite being a mandatory notifiable disease in both humans and animals. To assess the impact of cystic echinococcosis on both livestock and humans, we compiled data from slaughterhouse records of ruminants, human hospitalizations, and confirmed cases of human echinococcosis. Overall, a total of 298 cases of cystic echinococcosis were identified in ruminants slaughtered from national farms for human consumption in Portugal between 2008 and 2022, comprising 192 cases in ovines, 95 in bovines, and 11 in caprines. Echinococcosis led to 582 hospitalizations in Portuguese public hospitals, with an average hospital stay of 11 days (±15.66), and resulted in 13 deaths (2.23%) from 2008 to 2018. Each infected animal was associated with a 7% increase in the incidence rate of human hospitalization (p = 0.002, IRR = 1.070, 95% CI: 1.025-1.117). Additionally, for every 100,000 person-years observed between 2008 and 2018, the total number of hospitalizations was 0.528. Residence in the Alentejo region was associated with a 5.3-fold increase in the incidence rate of human hospitalizations and an 8-fold higher risk of death from echinococcosis.

Pulmonary outcomes of congenital diaphragmatic hernia patients based on defect size (CDH Study Group Stage).

Congenital diaphragmatic hernia (CDH) is associated with significant pulmonary morbidity. Previous investigation has shown that postnatal inpatient morbidity is linked to diaphragmatic defect size. The objective of this study was to evaluate long-term pulmonary outcomes by CDH study group defect size. A retrospective analysis was conducted for CDH patients (n=133) managed in a neonatal intensive care unit (NICU) at a single children's hospital within an adult hospital system and subsequently followed up at a comprehensive multidisciplinary CDH clinic (n=102) from January 2012 to April 2022. CDH patients were stratified according to Congenital Diaphragmatic Hernia Study Group (CDHSG) Stage, and then categorized as low-risk (LR), defect size A and B, or high-risk (HR), defect size C and D. Inpatient data, including the presence of pulmonary hypertension, extracorporeal life support (ECLS) utilization, and mechanical ventilation days, were collected. Post-discharge data including the prevalence of asthma, pulmonary hypertension, emergency department visits, the total number of hospitalizations, and average rehospitalization days were collected. Frequentist analysis was used. The outcomes for 133 NICU patients were analyzed (HR: n=54, LR: n=79). During NICU stay, the prevalence of pulmonary hypertension [HR: 16/54 (30%) vs. LR: 9/79 (12%), P=0.009], ECLS utilization [HR: 19/54 (35%) vs. LR: 4/79 (5%), P<0.001], and the average number of mechanical ventilation days [HR: 17 days (IQR: 12-27) vs. LR: 5 days (IQR: 2-9), P<0.001] were significantly higher in the HR CDH group. Post NICU discharge, the prevalence of asthma [HR: 20/54 (37%), vs. LR: 17/79 (22%), P=0.050)] and the total days of rehospitalization [HR: 9 (IQR: 2-27) vs. LR: 4 (IQR: 1-8), P=0.035] were significantly higher in HR group. Of the patients seen in the comprehensive multidisciplinary CDH clinic, obstructive lung disease measured by impulse oscillometry was increased in the HR CDH population compared to the reference group [median R5Hz was 12.95 kPa/(L/s) in CDH vs. 9.8 kPa/(L/s) (P=0.010)]. HR CDHSG Stage is associated with worse inpatient and long-term pulmonary outcomes.

Impact of Imatinib on reducing the painful crisis in patients with sickle cell disease

Sickle cell disease (SCD) is a common hemoglobinopathy worldwide that causes painful crises and hospitalization of patients. These attacks decrease survival and cause chronic end-organ damage in these patients. For this reason, finding new treatment approaches could be helpful. In this study, Imatinib was applied as a mast cell inhibitor to reduce pain crises in these patients. Seven patients resistant to hydroxyurea and folic acid treatment and who had at least four painful crises per year with hospitalization were enrolled in this study with treatment with Imatinib (100mg, twice daily). Subsequently, the number and duration of hospitalizations, analgesic requirement, the severity of chronic pain, and changes in the hematological parameters of these patients were evaluated before and after the treatment. The data showed that the total number of hospitalizations and the entire duration of hospitalizations were reduced 16 times after treatment with Imatinib, without apparent changes in hematological parameters. Also, the demand for pethidine, tramadol, and nonsteroidal anti-inflammatory drugs (NSAIDs) was reduced in all patients. The average reduction in chronic pain was over 70%. This study demonstrates that treatment with Imatinib in patients with SCD or sickle cell anemia (SCA) may be a suitable therapeutic option for reducing painful crises.

One year of SARS-CoV-2 circulation in the Nouvelle-Aquitaine region, February 2021-2022, France.

Since 2021, 3 variants of concern (VOC) have spread to France, causing successive epidemic waves. To describe the features of Alpha, Delta and Omicron VOC circulation in the Nouvelle-Aquitaine region, France, between February 2021 and February 2022. Data from the three university hospitals (UH) of Nouvelle-Aquitaine were used to describe regional SARS-CoV-2 circulation (RT-PCR positive rates and identified VOC) as well as its consequences (total number of hospitalizations and admissions in intensive care unit). They were analyzed according to the predominant variant and compared with national data. A total of 611,106 SARS-CoV-2 RT-PCR tests were performed in the 3 Nouvelle-Aquitaine UH during the study period. The 37,750 positive samples were analyzed by variant-specific RT-PCR or whole-genome sequencing. In 2021, Alpha VOC was detected from week 5 until week 35. Delta became the most prevalent variant (77.3%) in week 26, reaching 100% in week 35. It was replaced by Omicron, which was initially detected week 48, represented 77% of positive samples in week 52 and was still predominant in February 2022. The RT-PCR positive rates were 4.3, 4.2, and 21.9% during the Alpha, Delta and Omicron waves, respectively. The ratio between intensive care unit admissions and total hospitalizations was lower during the Omicron wave than during the two previous waves due to the Alpha and Delta variants. This study highlighted the need for strong regional cooperation to achieve effective SARS-CoV-2 epidemiological surveillance, in close association with the public health authorities.

Hospitalizations of children and adolescents with complex chronic conditions in Brazil: a temporal analysis from 2009 to 2020.

Access to advanced and sophisticated health technologies made it possible to increase the survival of children with complex chronic conditions. Thus, the profile of pediatric patients admitted to hospitals has changed in recent decades. In Brazil, there are few epidemiological studies on this subject. This study aims to evaluate the main characteristics and temporal trend of hospital admissions of children and adolescents with complex chronic conditions in Brazil, 2009-2020. This is a cross-sectional study with data on hospitalizations of children and adolescents with complex chronic conditions, extracted from the Hospital Information System of the Unified Health System, 2009-2020, in the 26 Brazilian states and the Federal District. The analysis included descriptive statistics and a generalized linear model. From 2009 to 2020, there were 1,337,120 hospitalizations of children and adolescents with complex chronic conditions, and of these, 735,820 (55.0%) were male. The percentage of hospital deaths during the analyzed period was 4.0%. The most recurrent diagnostic category was malignancy (41.0%), with an annual incidence increase of 2.61 (95% CI: 1.16-4.05). Between 2009 and 2019, the increase in hospitalizations for complex chronic conditions was 27.4% for boys and 25.2% for girls, and the reductions in the number of hospitalizations for other causes were 15.4% and 11.9% for boys and girls, respectively. Conclusions: Hospitalizations for complex chronic conditions in pediatrics are increasing in Brazil. This increase is a new challenge for the Brazilian public health system. What is Known: •The profile of pediatric patients admitted to hospitals has changed in recent decades, with a reduction in the total number of hospitalizations, but with an increase in the complexity and costs of these hospitalizations. •The world's scientific production on CCC is concentrated in the United States health care system. Epidemiological studies on the topic in universal health care systems are scarce. What is New: •This is the first study that evaluated the temporal trend of hospitalizations of children and adolescents with CCC in Brazil. •Hospitalizations for CCC in pediatrics are increasing in Brazil, with emphasis on the condition of malignancy, higher incidence in males and in children under one year of age. Furthermore, our study found a decrease in hospitalizations for other pediatric causes.

Environmental factors in autoimmune bullous diseases with a focus on seasonality: new insights.

Autoimmune bullous diseases are a heterogeneous group of rare conditions clinically characterized by the presence of blisters and/or erosions on the skin and the mucous membranes. Practically, they can be divided into two large groups: the pemphigoid group and the pemphigus group, depending on the depth of the autoimmune process on the skin. A family history of autoimmune diseases can often be found, demonstrating that genetic predisposition is crucial for their development. Moreover, numerous environmental risk factors, such as solar radiation, drugs, and infections, are known. This study aimed to evaluate how seasonality can affect the trend of bullous pemphigoid and pemphigus vulgaris, especially considering the number of hospitalizations recorded over the course of individual months. The total number of hospitalizations in the twelve months of the year was evaluated. Moreover, blood chemistry assay and, for some patients, enzyme-linked immunosorbent assay were executed to evaluate antibodies. Regarding the severity of the disease, the bullous pemphigoid area index and the pemphigus disease area index score systems were used. Results showed a complex interplay between environmental factors such as seasons and autoimmune conditions.

Clinical Outcomes and Complications for Achalasia Patients Admitted After Per-Oral Endoscopic Myotomy.

Per-oral endoscopic myotomy (POEM) is a rapidly emerging minimally invasive procedure for management of achalasia. Same-day discharge after POEM is safe and feasible; however, some patients may need hospitalization. We aimed to identify characteristics and outcomes for achalasia patients requiring hospitalizations after POEM in the United States (US). The US National Inpatient Sample was utilized to identify all adult achalasia patients who were admitted after POEM from 2016 to 2019. Hospitalization characteristics and clinical outcomes were highlighted. From 2016 to 2019, we found that 1,885 achalasia patients were admitted after POEM. There was an increase in the total number of hospitalizations after POEM from 380 in 2016 to 490 in 2019. The mean age increased from 54.2 years in 2016 to 59.3 years in 2019. Most POEM-related hospitalizations were for the 65 - 79 age group (31.8%), females (50.4%), and Whites (68.4%). A majority (56.2%) of the study population had a Charlson Comorbidity Index of 0. The Northeast hospital region had the highest number of POEM-related hospitalizations. Most of these patients (88.3%) were eventually discharged home. There was no inpatient mortality. The mean length of stay decreased from 4 days in 2016 to 3.2 days in 2019, while the mean total healthcare charge increased from $52,057 in 2016 to $65,109 in 2019. Esophageal perforation was the most common complication seen in 1.3% of patients. The number of achalasia patients needing hospitalization after POEM increased. There was no inpatient mortality conferring an excellent safety profile of this procedure.

The impact of general and central obesity for all-cause hospitalization among Iranian adults: a 20 year follow-up-results from the TLGS cohort

BackgroundFew studies have examined the effect of obesity indices on total number of hospitalizations. We examined the associations between body mass index (BMI) and waist circumference (WC) and rate of all-cause hospitalizations among Iranian adult participated in the Tehran Lipid and Glucose Study cohort.MethodsThis study included 8202 individuals (3727 men) aged ≥ 30 years, who were followed for a median of 18 years. Participants were categorized into three groups according to their baseline BMI: normal weight, overweight and obese. In addition, they were classified according to WC in two categories: normal WC and high WC. Negative Binomial regression model was used to estimate the incidence rate ratios (IRRs) and 95% confidence interval (95% CI) of all-cause hospitalizations in relation to obesity indices.ResultsThe overall crude rate of all-cause hospitalizations were 77.6 (95% CI, 73.9–81.2) and 76.9 (73.4–80.3) per 1000 person-year in men and women, respectively. The covariate adjusted rate of all-cause hospitalizations was 27% higher in obese men than normal weight men (IRR (95% CI): 1.27 (1.11–1.42)). Among women, overweight and obese individuals had 17% (1.17 (1.03–1.31)) and 40% (1.40 (1.23–1.56)) higher rate of hospitalization compared to normal weight women. Having high WC was associated with 18% (1.18 (1.08–1.29)) and 30% (1.30 (1.18–1.41)) higher rate of all-cause hospitalization in men and women, respectively.ConclusionsObesity and high WC were associated with increased hospitalization rates during long-term follow-up. Our findings suggests that successful obesity prevention programs may decrease the number of hospitalizations, particularly, in women.

A287 HOME PARENTERAL NUTRITION FOR INDIVIDUALS WITH SHORT BOWEL SYNDROME SECONDARY TO CROHN’S DISEASE VERSUS OTHER ETIOLOGIES: A PROSPECTIVE COHORT STUDY

Abstract Background Individuals with short bowel syndrome (SBS) have reduced intestinal absorptive capacity and many require home parenteral nutrition (PN) support. One of the common causes of SBS is secondary to intestinal resections in the management of Crohn’s disease (CD). Complication rates and survival in SBS secondary to CD on PN versus other etiologies remains unknown. Purpose To determine whether patients with SBS secondary to CD versus SBS secondary to other etiologies on home PN, have increased risk of hospitalizations and complications including central line associated bloodstream infection (CLABSI) and venous thromboembolism and whether there is a difference in overall survival between groups. Method This is a multicentre prospective cohort study using the Canadian Home Parenteral Nutrition (HPN) Registry on individuals with defined SBS separated into two cohorts: 1) Patients with SBS secondary to Crohn’s disease vs. 2) Patients with SBS secondary to other aetiologies (trauma, surgical complication, vascular event, volvulus, malignancy). Patient characteristics and clinical factors are presented as mean (standard deviation) for continuous variables and as frequency (percentage) for categorical variables. Comparison between groups (SBS CD vs SBS other) were performed using 2-sample t-test for continuous variables and Chi-square or Fisher exact tests when appropriate for categorical variable. Survival probabilities will be estimated using the Kaplan-Meier method. Result(s) The study included a total of 379 patients with short bowel syndrome on home PN. There are 170 (45%) patients with SBS secondary to CD and 209 (55%) patients with SBS from other secondary causes. The average age of those with CD is 52 and 65% female patients. The average age of those with other causes of SBS is 56 with similar percentage of female patients (65%). There were significant differences in baseline medications with higher use of immunosuppressant therapy (39% vs. 7%, p&amp;lt;0.001) in those with CD. There was no significant difference in total number of hospitalizations, hospitalizations related to PN and CLABSI. Image Conclusion(s) Individuals with SBS secondary to CD do not appear to be at increased risk of central line infections or hospitalizations compared those with SBS from other causes. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

A99 EFFICACY OF THE IN-HOSPITAL OBSERVATORY PERIOD FOR IBD PATIENTS WITH FLARE TREATED WITH ORAL CORTICOSTEROIDS

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic, debilitating collection of diseases with significant impairment to patient quality of life and hospital burden. Patients with acute flare of their disease are managed with IV corticosteroids and ultimately transitioned to an oral equivalent. Despite no formal guideline recommendation, some patients remain in hospital on oral corticosteroids, primarily for observation. Given that each day spent in hospital carries significant costs, examining this observatory period is warranted. The utility of the observatory period for patients recently switched to oral corticosteroids has not yet been studied and may be unnecessarily increasing hospital stays and costs to the Canadian medical system. Purpose - Analyse the efficacy of the in-hospital period for patients on oral corticosteroids after an acute IBD flare in preventing recurrence in the 14 and 28 days post discharge. - Assess the relationship between length of the in-hospital “observatory” period with future hospital burden. Method - This retrospective cohort study identified patients with known IBD who were admitted to Royal Columbian Hospital under the Gastroenterology service primarily for acute flare of their disease from June 1, 2020 to June 30th, 2022. Patients were identified through the clinic EMR (Plexia) and hospital information was accessed via the Fraser Health Health Records Department. This study acheived ethics approval by the Fraser Health Research Ethics Board (Event: 2022376). - Inclusion criteria are as follows: - Age &amp;gt; 18 years old - Prior diagnosis of IBD as per CAG guidelines - Acute IBD flare is primary reason for hospitalization - Hospital management includes IV corticosteroids and discharge medications include a tapering course of oral corticosteroid. - Exclusion criteria are as follows: - Patients found to be non-compliant on outpatient medication regimen (i.e tapering dose of PO prednisone). - Patients with a complicated course in management (concurrent illness that impacted hospital stay). Result(s) -20 patients were identified, with 60 total hospital admissions. -35 visits included an observatory period, with 6 less than 24hr (1 hospital re-presentation), and 29 greater than 24hr (3 hospital re-presentations). -25 visits did not have an observatory period. -The relative risk of patients without an observatory period returning to hospital within 14 and 28 days compared to those with an observatory period was 4.2 and 1.75, respectively. Conclusion(s) These preliminary results suggest an increased relative risk for those without an in-hospital observatory period for short term re-hospitalization. However, we hypothesize this will significantly change once we have broadened our date range and increased our total number of hospitalizations, which is planned prior to the poster presentation date. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared