Trends In In-hospital Mortality Research Articles

National Trends and Hospitalizations Related to Pancreatic Cancer in Acute Pancreatitis Patients: A Nationwide Inpatient Sample Study.

BackgroundPancreatic cancer (PC) is one of the common cancers in the United States (U.S.) and is associated with high mortality and morbidity. In spite of the modest improvement in survival, cancer care costs including PC continue to rise and inpatient costs contribute a significant chunk to cancer care, which is often ignored. Acute pancreatitis (AP) is a rare manifestation of PC. This study aims to determine the national trends and associated health care utilization of PC patients hospitalized with AP in the U.S.MethodsWe used National Inpatient Sample (NIS) to extract data for patients hospitalized with a primary diagnosis of PC in AP in 2016 using International Classification of Diseases, 10th revision, and Clinical Modification (ICD-10-CM) codes. The analysis included disease etiologies, age, race, sex, hospital region, hospital size, institution type, mortality, length of hospital stay (LOS), and commonly associated comorbidities were correlated.ResultsThere were 250 patients with a discharge diagnosis of PC in patients admitted with AP. Most of the patients were whites (76.6%) with the mean age of 39.42 ± 2.51 years, had Medicare (63.26%) as primary insurance, were from Southern region (46%) and had higher Charlson comorbidity index (CCI) (76.00% with CCI > = 3). The mean hospital charges were $48,462.13, and mean LOS was 5.24 days. The LOS was significantly impacted by race, hospital region, endoscopic retrograde cholangiopancreatography (ERCP), and comorbidities such as dementia, smoking, and seizure. Out of the 250 patients admitted with PC, 245 patients (98%) were discharged alive.ConclusionsOur study shows a downward trend in LOS, hospital charges, and in-hospital mortality as compared to other studies despite PC and AP presenting together versus PC with or without other etiologies.

The whole is more than the sum of the parts: establishing an enabling health system environment for reducing acute child malnutrition in a rural South African district.

There is a gap in understanding of how national commitments to child nutrition are translated into sub-national implementation. This article is a mixed methods case study of a rural South African health district which achieved accelerated declines in morbidity and mortality from severe acute malnutrition (SAM) in young children, following a district health system strengthening (HSS) initiative centred on real-time death reporting, analysis and response. Drawing on routine audit data, the declining trends in under-five admissions and in-hospital mortality for SAM over a 5-year period are presented, comparing the district with two others in the same province. Adapting Gillespie et al.’s typology of ‘enabling environments’ for Maternal and Child Nutrition, and based on 41 in-depth interviews and a follow-up workshop, the article then presents an analysis of how an enabling local health system environment for maternal-child health was established, creating the conditions for achievement of the SAM outcomes. Embedded in supportive policy and processes at national and provincial levels, the district HSS interventions and the manner in which they were implemented produced three kinds of system-level change: knowledge and use of evidence by providers and managers (‘ways of thinking’), leadership, participation and coordination (‘ways of governing’) and inputs and capacity (‘ways of resourcing’). These processes mainstreamed responsibility, deepened accountability and triggered new service delivery and organizational practices and mindsets. The article concludes that it is possible to foster enabling district environments for the prevention and management of acute malnutrition, emphasizing the multilevel and simultaneous nature of system actions, where action on system ‘software’ complements the ‘hardware’ of HSS interventions, and where the whole is more than the sum of the parts.

Trends in In-hospital Coronary Artery Bypass Surgery Mortality by Gender and Race/Ethnicity --1998-2015: Why Do the Differences Remain?

Background and aimsBetween 1998 and 2015, the national coronary artery bypass graft surgery (CABG) in-hospital mortality rate fell nearly 45% to just 2.2% of CABG in-patients. By almost any standards, this large decline in the nation's in-hospital mortality for CABG inpatients has been extraordinary. Yet, over this time period, no studies have detailed these notable trends in in-hospital CABG mortality with an emphasis on the differences by gender and racial/ethnicity. The in-hospital CABG treatment period is the approximately 9 day inpatient length-of-stay the patient is completely under the care of hospital and its staff. Our research seeks to fill this research gap with analyses of 18 years of national data of over 5 million CABG inpatient discharges distinguishing gender by six categories of race/ethnicity (Asian, black, Hispanic, white, other known races/ethnicities, and unknown race/ethnicities) to evaluate three broad questions related to in-hospital CABG mortality: 1) What have been the 18-year national trends in CABG surgeries, length-of-stay, mortality, and type of discharge by gender and race/ethnicity? 2) Over time, what have been the in-hospital mortality trends by gender and race-ethnicity? 3) Using multivariate techniques to control for patient characteristics, risk factors and socioeconomic characteristics of the hospital setting and environment, what is the extent of the variations in in-hospital mortality among the 12 groupings of gender and race-ethnicity? Data and methodsData are from the Nationwide Inpatient Sample (NIS) data from the Healthcare Utilization Project (HCUP–NIS) collected yearly. These data represent 858 hospitals, a 20% national sample representing 5,032,985 CABG patient discharges from hospitals over an 18-year period -- 1998 to 2015. Descriptive and logistic regression analyses are used to evaluate the outcomes. ResultsThe national decline in in-hospital CABG mortality trends over the 18-year period has been dramatic. These declines have substantially impacted all 12 racial/ethnic and gender groupings analyzed during this timeframe. However, over the 18-year period, both univariate and logistic regression results reveal the disadvantages females and black males have in in-hospital CABG mortality rates when compared to the comparison group, white male CABG inpatients. Female CABG inpatients consistently, regardless of their race/ethnicity, have significantly higher in-hospital mortality rates than their corresponding male counterparts even after controlling for patient characteristics and socio-economic status. For males, however, the likelihood of dying in the hospital from a CABG procedure showed wide variation across the four racial/ethnic categories. Compared with white male patients undergoing CABG surgery in the nation's hospitals, after controlling for confounding factors, Hispanic and Asian-American had significantly lower in-hospital CABG mortality rates −9.7% and −17.9% respectively. In contrast, black male CABG patients had a 35.1% higher in-hospital CABG mortality rate than white males. ConclusionsWhile considerable progress has been made reducing overall in-hospital CABG mortality over the past 18-years across all gender and racial/ethnic inpatients, significant gaps persist between black males and other racial/ethnic groups.

Trends in hospitalizations for chronic liver disease-related liver failure in the United States, 2005-2014.

Current estimates of the population-based disease burden of liver failure or end-stage liver disease (ESLD) are lacking. We investigated recent trends in hospitalizations and in-hospital mortality among patients with ESLD in the United States (US). A retrospective analysis was performed utilizing the National Inpatient Sample from 2005 to 2014. We defined ESLD as either decompensated cirrhosis or hepatocellular carcinoma (HCC), criteria obtained from the International Classification of Diseases, Ninth Revision. Nationwide rates of hospitalization and in-hospital mortality were analysed from 2005 to 2014. Hospitalization rates for decompensated cirrhosis during this period increased from 105.3/100000 persons to 159.9/100000 persons. In terms of HCC, hospitalization rates increased from 13.6/100000 to 22.1/100000. In patients with non-alcoholic fatty liver disease (NAFLD)-related decompensated cirrhosis, the hospitalization rate increased from 13.4/100000 to 32.1/100000 with an annual incremental increase of 10.6%, a magnitude twofold higher than other aetiologies. The proportion of NAFLD among hospitalizations with ESLD steadily increased from 12.7% to 20.1% for decompensated cirrhosis while the proportion of chronic hepatitis C (HCV) and alcoholic liver disease (ALD) declined (from 29.3% to 27.6% for HCV; from 39.0% to 37.4% for ALD). Although the overall in-hospital mortality rates for ESLD declined during the study, mortality rates for NAFLD-related decompensated cirrhosis showed no significant change. Among aetiologies of chronic liver disease, NAFLD demonstrated the fastest growing rate of hospitalizations in non-HCC patients with ESLD in the US. Our study highlights the need for a focus on NAFLD-related hospitalizations and its impact on resource utilization.

Trends of in-hospital mortality and constituent ratio of patients with acute myocardial infarction

Objective: To analyze the trends on constituent ratio of non-ST-segment-elevation (NSTEMI) and ST-segment-elevation myocardial infarction (STEMI) and related in-hospital mortality in acute myocardial infarction (AMI) patients hospitalized in Beijing Anzhen Hospital from 2004 to 2014. Methods: This is a single-center, retrospective study. We reviewed all patients hospitalized for AMI in Beijing Anzhen Hospital from January 1 2004 to December 31 2014, and collected all related information including hospitalization stay, the type of AMI, revascularization and in-hospital mortality. We analyzed the trends of constituent ratio of NSTEMI and STEMI, and their in-hospital mortalities during the 11 years. Results: Data from a total of 23 864 patients with AMI, including 5 539 STEMI and 18 325 NSTEMI, were analyzed. Compared with STEMI patients, NSTEMI patients were older, less likely to be male (P<0.001), had higher prevalence of hypertension, hyperlipidemia, diabetes (P<0.001), and lower prevalence of smoking (P<0.001). Additionally, patients with NSTEMI were more likely to have prior history of MI (12.6% (695/5 539) vs. 7.4% (1 354/18 325), P<0.001) and coronary artery bypass graft surgery (2.7% (152/5 539) vs. 0.7% (124/18 325), P<0.001). The constituent ratio of NSTEMI was significantly increased during the observation period, rising from 15.8% (107/802) in 2004 to 35.7% (1 273/3 583) in 2014 (P value for trend <0.001). The in-hospital mortality of NSTEMI patients was significantly lower compared with those with STEMI (1.84% (102 cases) vs. 2.74% (502 cases), P<0.001). The mortality of both STEMI and NSTEMI were significantly decreased during the 11 years (both P value for χ(2) trend test <0.001). After adjusting for other risk factors, NSTEMI was independently associated with lower in-hospital mortality (OR=0.50, 95%CI 0.40-0.63, P<0.001). Conclusions: In patients with AMI, the constituent ratio of NSTEMI versus STEMI is increased during the 11 years. The in-hospital mortality is decreased for both STEMI and NSTEMI patients in the past 11 years, and the in-hospital mortality rate of NSTEMI patients is lower than STEMI patients in this patient cohort during the observation period.

Trends in Post-Heart Transplant Biopsies for Graft Rejection versus Non-Rejection

Purpose With alternatives to surveillance endomyocardial biopsies (EMBs) post-orthotopic heart transplant (OHT) now available (such as gene expression profiling), we evaluated the current utilization of EMBs for hospitalized patients post-OHT. Both surveillance EMBs (in patients without complications) and in the setting of graft complications were evaluated. Methods The 2004-2014 National Inpatient Sample database was used to assess trends of inpatient EMB (ICD-9 code 37.25) in OHT patients (ICD-9 V42.1, excluding the transplant procedure itself). ICD-9 996.83 was used to identify OHT complications including rejection. Annual trends in in-hospital mortality, length of stay (LOS), and cost of care were determined. Results There was no significant change in the number of EMBs performed over the study period (p=0.44). Of 37,955 EMBs, 2283 (6%) were in the setting of OHT complications. EMBs in OHT complications did not showed a significant increase in LOS (p=0.06), but had a significant increase in cost over time (P=0.001) (Fig 1). However, LOS on average was 5 days longer (p<0.001) and $88,816 higher cost compared to hospitalizations in non-complication EMB (p<0.001). In-patient mortality decreased over time for both groups (p<0.001), with higher odds of inpatient mortality with OHT complications (odds ratio 1.87; 95%CI, 1.70-2.05). Conclusion The vast majority of in-hospital EMBs were not related to OHT complications. Nevertheless, EMB hospitalizations with OHT complications including rejection showed significantly greater LOS and cost compared to those without complications. Furthermore, cost has increased over the study period. With alternatives to surveillance endomyocardial biopsies (EMBs) post-orthotopic heart transplant (OHT) now available (such as gene expression profiling), we evaluated the current utilization of EMBs for hospitalized patients post-OHT. Both surveillance EMBs (in patients without complications) and in the setting of graft complications were evaluated. The 2004-2014 National Inpatient Sample database was used to assess trends of inpatient EMB (ICD-9 code 37.25) in OHT patients (ICD-9 V42.1, excluding the transplant procedure itself). ICD-9 996.83 was used to identify OHT complications including rejection. Annual trends in in-hospital mortality, length of stay (LOS), and cost of care were determined. There was no significant change in the number of EMBs performed over the study period (p=0.44). Of 37,955 EMBs, 2283 (6%) were in the setting of OHT complications. EMBs in OHT complications did not showed a significant increase in LOS (p=0.06), but had a significant increase in cost over time (P=0.001) (Fig 1). However, LOS on average was 5 days longer (p<0.001) and $88,816 higher cost compared to hospitalizations in non-complication EMB (p<0.001). In-patient mortality decreased over time for both groups (p<0.001), with higher odds of inpatient mortality with OHT complications (odds ratio 1.87; 95%CI, 1.70-2.05). The vast majority of in-hospital EMBs were not related to OHT complications. Nevertheless, EMB hospitalizations with OHT complications including rejection showed significantly greater LOS and cost compared to those without complications. Furthermore, cost has increased over the study period.

Utilization of Combined Mechanical Circulatory Support Devices in Cardiogenic Shock: Insights from the National Inpatient Sample

Purpose Percutaneous mechanical circulatory support (MCS) devices are used in patients with cardiogenic shock (CS). In cases of incessant ventricular arrhythmias or biventricular failure these devices are used in combination. We studied the trend and mortality outcome of single vs combined MCS devices in patients with CS from the National Inpatient Sample (NIS). Methods We queried the NIS database from 2010 to 2015 for patients admitted with CS, and divided them in ischemic (ICM) and non-ischemic etiology (NICM). Implantation of MCS [Intra-aortic Balloon Pump (IABP), Extracorporeal membrane oxygenation (ECMO), Impella or Tandem Heart pVAD] were identified using appropriate ICD-9 codes. Each cohort was divided into 2 subgroups: single device (IABP or pVAD or ECMO) vs combined (or sequential) MCS (IABP+ECMO or IABP+pVAD or pVAD+ECMO) use. We analyzed trends in use and in-hospital mortality with different type of combined MCS. Results Total of 6,11,170 patients were admitted with diagnosis of CS; out of which 21.9% underwent single MCS and 1.3% underwent combined MCS device. In-hospital mortality was higher in combined MCS vs single MCS use in both ischemic (51.1% vs 20.1%; p Conclusion We observed an increase in utilization of ECMO+pVAD during the study period 2010-2015. Combined use of MCS was associated with higher in-hospital mortality in both ICM and NICM in comparison to single MCS use. Further studies are needed to validate these outcomes and to determine associated risk factors.

Trends in In-Hospital Mortality, Length of Stay, Nonroutine Discharge, and Cost Among End-Stage Renal Disease Patients on Dialysis Hospitalized With Heart Failure (2001–2014)

Heart failure (HF) is a common cause of morbidity and mortality among end-stage renal disease (ESRD) patients on dialysis. We aimed to assess the trends and outcomes in primary and secondary HF hospitalizations among ESRD patients with the use of a nationally representative database. We analyzed data from the National Inpatient Sample and the US Census Bureau to calculate annual national rates of in-hospital mortality, length of stay, disposition with a focus on nonroutine discharge (discharge to a health care facility rather than to home), and adjusted median cost among patients with ESRD on dialysis with primary or secondary HF admissions from 2001 to 2014. An estimated 812,090 primary and 2,887,432 secondary HF admissions occurred from 2001 to 2014. The prevalence of comorbidities increased during the study period. Primary HF admission rates increased from 2001 to 2006 and decreased from 2007 to 2014, whereas secondary HF admissions increased significantly during the study period (P < .001). We found statistically significant declines of primary and secondary admission in-hospital mortality, with annual percentage changes of -3.1% and -2.6% respectively (P < .001 for both). In addition, the lengths of stay decreased significantly for primary and secondary HF admissions (P < .001 for both). However, nonroutine discharges increased significantly for both. Subgroup analysis showed higher in-hospital mortality for men, patients >65 years of age, whites, and those on peritoneal dialysis. The cost of hospitalization did not change significantly for primary and secondary HF admissions. Among ESRD patients on dialysis with primary or secondary HF admission diagnosis, comorbidity prevalence increased but in-hospital mortality and length of stay decreased significantly from 2001 to 2014.

Trends in utilization, mortality, major complications, and cost after total artificial heart implantation in the United States (2009-2015)

ObjectiveTotal artificial heart (TAH) is a viable bridge to transplant (BTT) strategy for patients with severe biventricular failure or complex congenital heart disease. These patients have higher mortality and morbidity than patients undergoing left ventricular assist device (LVAD) implantation. To assess national trends in in-hospital mortality, major complications, cost, length of stay, and disposition of patients undergoing TAH implantation. MethodsData from the National Inpatient Sample, the largest all-payer inpatient data set in the United States, and the US Census Bureau, for the years 2009 to 2015 were analyzed. Participants included all adult patients who received TAH from 2009 to 2015. Endpoints included in-hospital mortality, in-hospital complications, heart transplantation (HT) in the same admission, length of stay, cost, and disposition at the time of discharge. ResultsWe identified a total of 143 (weighted = 703) TAH implantations. The number of TAH implants increased during the study period (average annual change +5.8%, p = 0.03). Rates of in-hospital mortality and major complications including ischemic stroke, major bleeding, postoperative infections, acute kidney injury requiring dialysis, and HT did not change significantly over the study period. Although the length of stay and disposition patterns did not change over time, we found a significant increase in cost of hospitalization (average annual change +44,362, p = 0.01). The number of HT during the same hospital stay decreased significantly (average annual change −8.1%, p = 0.02). ConclusionIn-hospital mortality and complication rates associated with TAH implantation remain increased and did not change in the era of continuous flow LVADs.

Delivery-associated sepsis: trends in prevalence and mortality

Sepsis is a leading cause of pregnancy-related mortality. Previous studies have reported an increased prevalence of sepsis during pregnancy. Despite national campaigns to increase sepsis awareness, there is a lack of pregnancy-specific guidelines. We aimed to provide updated national estimates of the prevalence and trends of sepsis, sepsis-related in-hospital mortality, and factors associated with in-hospital mortality among women with sepsis at delivery. We conducted a serial, cross-sectional analysis using data from the 2002-2015 National Inpatient Sample, the largest publicly available all-payer inpatient database in the United States. We used International Classification of Diseases, ninth edition, Clinical Modification diagnosis and procedure codes to identify the study sample of delivery-associated hospitalizations and to capture diagnoses of sepsis (defined as infection with associated end-organ dysfunction). The primary outcome was in-hospital mortality. Obstetric comorbidities and pregnancy-related outcomes were also analyzed. Logistic regression was used to explore factors associated with sepsis during pregnancy and, among those with sepsis, to identify predictors of in-hospital mortality. Joinpoint regression was used to estimate the temporal trends in both sepsis and in-hospital mortality. Of the more than 55 million delivery-associated hospitalizations, 13,129 women met criteria for sepsis, corresponding to a rate of 2.4 per 10,000 deliveries. This rate increased from 1.2 to 3.7 per 10,000 over the study period, representing an annual increase of 6.6% (95% confidence interval, 4.2-9.1). The highest crude rates of sepsis (per 10,000) were among deliveries paid for by Medicare (14.8), deliveries to women aged 40 years or older (8.0), and deliveries to non-Hispanic black women (4.6). Compared with women without sepsis, women with sepsis had a greater than 10-fold increased prevalence of most selected obstetric comorbidities. One in 11 women with sepsis died prior to discharge, compared with 1 death in every 15,411 deliveries without sepsis. The sepsis-related mortality rate decreased 21.8% each year from 2010 through 2015. Maternal age greater than 40 years and nonprivate insurance demonstrated the highest odds of sepsis-related in-hospital mortality. While rates of delivery-associated sepsis have increased, case fatality has decreased.

Temporal trends in survival following ward-based NIV for acute hypercapnic respiratory failure in patients with COPD.

Non-invasive ventilation (NIV) is recommended for treatment of acute hypercapnic respiratory failure (AHRF) in acute exacerbations of COPD. National UK audit data suggests that mortality rates are rising in COPD patients treated with NIV. To investigate temporal trends in in-hospital mortality in COPD patients undergoing a first episode of ward-based NIV for AHRF. Retrospective study of hospitalised COPD patients treated with a first episode of ward-based NIV at a large UK teaching hospital between 2004 and 2017. Patients were split into two cohorts based on year of admission, 2004-2010 (Cohort 1) and 2013-2017 (Cohort 2), to facilitate comparison of patient characteristics. In total, 547 unique patients were studied. There was no difference in in-hospital mortality rate between the time periods studied (17.6% vs 20.5%, P=.378). In Cohort 2 there were more females, a higher rate of co-morbid bronchiectasis and pneumonia on admission and more severe acidosis, hypercapnia and hypoxia. More patients in Cohort 2 had NIV as the ceiling of treatment. Patients in Cohort 2 experienced a longer time from AHRF diagnosis to application of NIV, higher maximum inspiratory positive airway pressure, lower maximum oxygen and shorter duration of NIV. Finally, patients in Cohort 2 experienced a shorter hospital length of stay (LOS), with no differences observed in rate of transfer to critical care or intubation. In-hospital mortality remained stable and LOS decreased over time, despite greater comorbidity and more severe AHRF in COPD patients treated for the first time with ward-based NIV.

Amputation rates of the lower limb by amputation level \u2013 observational study using German national hospital discharge data from 2005 to 2015

BackgroundIn international comparisons, rates of amputations of the lower limb are relatively high in Germany. This study aims to analyze trends in lower limb amputations over time, as well as outcomes of care concerning in-hospital mortality and reamputation rates during the same hospital stay which might indicate the quality of surgical and perioperative health care processes.MethodsThis work is an observational population-based study using complete national hospital discharge data (Diagnosis-Related Group Statistics (DRG Statistics)) from 2005 to 2015. All inpatient cases with lower limb amputation were identified and stratified by eight amputation levels. Time trends of case numbers and in-hospital mortality were studied age-sex standardized. For inpatient cases with reamputation during the same hospital stay, first and last amputation levels were cross tabulated.ResultsA total of 55,595 amputations of the lower limb in 2015 (52,096 in 2005) were identified. After age-sex standardization to the demographic structure of 2005, a relative decrease of − 11.1% was revealed (men − 2.6%, women − 25.0%). The stratified analysis by amputation levels showed that the decreases were induced by higher amputation levels, whereas the amputation levels of toe/foot ray after standardization still showed a relative increase of + 12.8%. In-hospital mortality of all cases with lower limb amputation fell from 19.8% in 2005 to 17.4% in 2015 (SMR 0.89 [95% CI 0.86; 0.92]). The percentage of reamputations during the same hospital stay declined from 13.2 to 10.2%.ConclusionsThe number of lower limb amputations declined in Germany, however distinctly stronger in women than in men. The observed decreases of in-hospital mortality as well as of reamputation rates point to improvements in perioperative health care. Despite these indications of improvements, the distinct increase in case numbers at the level of toe/foot ray calls for additional targeted prevention efforts, especially for patients with diabetes.

Trends in Hospitalizations for Sickle Cell Disease Related-Complications in USA 2004 - 2012.

BackgroundSickle cell disease (SCD) affects 100,000 patients in the USA. However, no recent data was available for annual national trends in hospitalization rates, in-hospital mortality, hospital length of stay (LOS) and costs of SCD admissions due to its complications.MethodsThis study was conducted to study the trends of hospitalization rates, in-hospital mortality, LOS and hospital charges due to SCD-related complications in African American (AA) patients from 2004 to 2012 in the USA. Complications included acute chest syndrome, splenic sequestration, bacterial pneumonia, sepsis, stroke, deep vein thrombosis (DVT) or pulmonary embolism, retinal circulation complications, priapism, disorders related to biliary stones, or those required blood transfusions. We obtained the study population from the Nationwide Inpatient Sample.ResultsHospital admission rate rose steadily from 106 per 100,000 AA population in 2004 to 137 in 2012. Seasonal and trend decomposition revealed the highest hospitalization rate in January. Hospital LOS decreased from 7.1 ± 7.65 days in 2004 to 6.23 ± 6.42 days in 2012. Hospital charges increased from 15.35 (8.99 - 27.57) thousand dollars per admission in 2004 to 24.78 (14.37 - 45.24) in 2012. Medicaid remained the primary payer in the highest number of patients in 9 years. In-hospital mortality did not change significantly, being 1.03% in 2004 and 1.02% in 2012, with no significant seasonal variation in mortality. Most common complications were acute pain crisis and blood transfusion requirement. Biliary pathology was the only complication that decreased over time. Admissions for each complication were initially uprising with a decline from 2010 to 2012, except for DVT/pulmonary embolism with a significant uptrend.ConclusionsOverall, from 2004 to 2012, hospital admission rates and charges increased, and hospital LOS decreased, while in-hospital mortality remained unchanged.

Trends in morbidity and mortality from COPD in Brazil, 2000 to 2016.

ABSTRACTObjective:To examine the trends in overall COPD mortality, as well as trends in in-hospital morbidity and mortality due to COPD, in Brazil, and to validate predictive models. Methods:This was a population-based study with a time-series analysis of cause-specific morbidity and mortality data for individuals ≥ 40 years of age, obtained from national health information systems for the 2000-2016 period. Morbidity and mortality rates, stratified by gender and age group, were calculated for the same period. We used regression analyses to examine the temporal trends and double exponential smoothing in our analysis of the predictive models for 2017. Results:Over the study period, COPD mortality rates trended downward in Brazil. For both genders, there was a downward trend in the southern, southeastern, and central-western regions. In-hospital morbidity rates declined in all regions, more so in the south and southeast. There were significant changes in the number of hospitalizations, length of hospital stay, and hospital expenses. The predictive models for 2017 showed error rates below 9% and were therefore validated. Conclusions:In Brazil, COPD age-adjusted mortality rates have declined in regions with higher socioeconomic indices, where there has been an even sharper decrease in all in-hospital morbidity and mortality variables. In addition to factors such as better treatment adherence and reduced smoking rates, socioeconomic factors appear to be involved in controlling COPD morbidity and mortality. The predictive models estimated here might also facilitate decision making and the planning of health policies aimed at treating COPD.

94: Delivery-associated sepsis: trends in morbidity and mortality

Sepsis is a leading cause of pregnancy-related mortality. We aimed to provide updated national estimates of the prevalence and trends of sepsis, sepsis-related in-hospital mortality, and patient characteristics and comorbid conditions associated with sepsis and mortality at delivery. We conducted a serial, cross-sectional analysis using data from the 2002-15 National Inpatient Sample, the largest all-payer inpatient database in the United States. We used ICD-9-CM diagnosis and procedure codes to identify the study sample of delivery-related hospitalizations, and to capture diagnoses of sepsis (defined as infection with associated end-organ dysfunction), chronic comorbidities, and pregnancy-related outcomes. Logistic regression was used to explore factors associated with sepsis during pregnancy, and among those with sepsis, to identify predictors of in-hospital mortality. Joinpoint regression was used to estimate the temporal trends in both sepsis and in-hospital mortality. Of the more than 55 million delivery-associated hospitalizations, 13,129 women met criteria for sepsis, corresponding to a rate 2.4 per 10,000. This rate increased from 1.2 to 3.7 per 10,000 over the 14-year study period, representing an annual percentage increase of 6.7% (95% CI: 4.2, 9.1). Non-Hispanic black women had higher rates of sepsis than non-Hispanic white women (4.6 vs. 1.9 per 10,000). Women 40 years or older were more likely to have sepsis compared to teenage women (8.0 vs. 2.3 per 10,000). Compared to women without sepsis, women with sepsis had higher rates of preterm delivery (17.7% vs. 7.0%) and cesarean delivery (45.0% vs 31.2%). One in 11 women with sepsis died prior to discharge, compare to 1 death in every 15,390 deliveries without sepsis. The sepsis-related mortality rate remained stable during 2002-2010 but decreased 21.8% each year from 2010-2015. Among women with sepsis, after controlling for socio-demographic, clinical, and hospital-level confounders, age 40 years or older [aOR 2.10 (95%CI 1.30, 3.39)], Medicaid insurance [aOR 1.62 (95%CI 1.16, 2.25)], HIV [aOR 3.96 (1.82, 8.62), and chronic liver disease [aOR 3.27 (1.79, 5.97)] were associated with increased odds of in-hospital death. While rates of delivery-related sepsis have increased, case fatality has decreased.

A Nationwide Analysis of Trends in in-Hospital Mortality in Patients with Sickle Cell Disease from 2000 to 2014

Background:Patients with Sickle cell disease (SCD) have high rates of hospitalizations in the US annually and carry a higher rate of in-hospital mortality compared to the general population. There have been very few therapeutic innovations for the treatment of SCD in the past few decades. Changes in mortality in these patients reflect the availability of healthcare delivery and improvements in management of long term complications of SCD. A nationwide analysis was conducted to study the mortality of patients in SCD over a period of 15 years (2000 to 2014). The national inpatient sample is a database supported by the Agency of Healthcare Research and Quality.Methods:In this study, all patients who were hospitalized between the years 2000 to 2015 were analyzed and mortality was studied in SCD patients. Mortality during hospital stay was studied with respect to hospital size, rural vs. urban location and the most common medical comorbidities. Data pertaining to demographic factors of gender, geographic location and hospital size (measure of expertise and facilities available) were extracted. Access to healthcare was assessed using insurance coverage as a surrogate and its effect on mortality was evaluated. The effect of common medical comorbid conditions such as atrial fibrillation (Afib), hypertension (HTN), hyperlipidemia (HLP), diabetes mellitus (DM), chronic kidney disease (CKD) and tobacco smoking was assessed. Chi-square test analysis was used to validate the statistical significance of difference seen between the groups with a significance identified with a p value< 0.05. Multivariate analysis was used to determine independent predictors of mortality.Results:Out of a total of 1280693 hospitalizations over 15 years there were 9230 deaths of which 4230 were males and 5000 were females. There was no difference in the rate of mortality between hospitals of different sizes (small vs. medium vs. large) teaching and non-teaching hospitals. The mortality/hospitalization ratio was statistically different between Northeast, Midwest, South and West regions (0.63%, 0.65%, 0.76% and 0.89 respectively; p = 0.008). A statistically significant difference was noted between the insurance status (Medicaid vs. Medicare vs. private vs. self) amongst sickle cell patients who died during hospitalization. The odds of dying during hospitalization has gradually decreased from 2000 to 2014 (p = 0.007). The average age of death was 43.8 years and the age group of 35-49 years accounted for the highest amount of mortality (33%). Univariate analysis showed a significant difference in the common medical comorbidities of HTN, HLP, DM, CKD and smoking status in SCD patients who died during hospitalization. Multiple regression analysis revealed females are less likely to suffer from in-hospital mortality than males (OR 0.80; P < 0.04), medical comorbidities of Afib, DM, HTN and CKD are significant risk factors (ORS: 4.3, 1.4, 1.8 and 1.3).Conclusions:In-hospital mortality in SCD patients has improved significantly over the past 2 decades which may reflect some improvements in health care delivery and possibly the usage of hydroxyurea. However, common medical comorbidities such as Afib, HTN, DM and CKD continue to remain significant risk factors for mortality in these patients. Aggressive management of these medical comorbidities may further decrease morbidity and mortality in SCD patients in the future. DisclosuresNo relevant conflicts of interest to declare.

Opioid Use Is NOT Associated with in-Hospital Mortality Among Patients with Sickle CELL Disease in the United States: Findings from the National Inpatient Sample

BackgroundVaso-occlusive pain crises account for the majority of hospitalizations in patients with sickle cell disease (SCD), and opioids are the mainstay of chronic pain control in SCD. However, a marked increase in opioid-related overdoses and deaths in the United States (US) - ‘the US opioid epidemic’ - has been documented since 2000. We sought to: i) examine temporal trends in hospitalization rates and in-hospital mortality rates among adults with SCD since the onset of the US opioid epidemic, and ii) compare in-hospital mortality rates for SCD with the rates of opioid prescription-related deaths in the non-SCD general population since the onset of the US opioid epidemic.MethodsWe obtained data from the National Inpatient Sample from 1998 through 2013. We identified hospitalizations for patients with sickle cell disease using discharge diagnoses (ICD-9-CM) codes 282.41, 282.42, 282.60, 282.61, 282.62, 282.63, 282.64, 282.68, and 282.69. We examined hospitalization and in-hospital mortality rates and trends for the entire sample of SCD patients, as well as by the following age groups: 0-17 years, 18-44 years, 45-64 years, and ≥65 years. We also examined in-hospital mortality hospitalization trends by U.S Census Bureau regions viz: Northeast, Midwest, South, and West. Survey weights were applied in estimating the population-based hospitalization rates. We utilized annual mid-year population figures provided by the US Census Bureau as the reference population for each year. Survey analysis and trend analyses were performed with Stata 14.2®(StataCorp, College Station, TX), and Joinpoint Regression Program 4.2.02® (National Cancer Institute), respectively.ResultsThere were 1,755,220 hospitalizations among SCD patients in the US from 1998 to 2013. Hospitalization rates for SCD patients initially declined annually by 9.9% (95% CI: 4.0, 15.5) from 39/100,000 persons in 1998 to 27/100,000 persons in 2002, but no significant temporal trends were noted from 2002 to 2013 (figure 1).However, among young adults with SCD (18-44 years), there was a significant annual increase in hospitalization rates by 3.8% (95% CI: 2.4%, 5.2) from 43/100,000 persons in 2002 to 71/100,000 persons in 2013. Elderly SCD patients (≥65 years) also had a significant annual increase in hospitalization rates by 6.5% (95% CI: 2.9%, 10.2%) from 2.7/100,000 persons in 1998 to 5.4/100,000 persons in 2013. The only region with a significant increase in SCD hospitalization rate was the South with an annual increase of 3.5% (95% CI: 0.6, 6.4) from 2001 through 2011.There was no significant increase in-hospital SCD mortality, in contrast to the 350% increase in non-SCD opioid prescription-related death rates in the US from 1999 through 2013 (figure 2).ConclusionHospitalization rates are rising among most age-groups of adults with SCD. The reasons for this finding are unclear but the rising rates may reflect the fragmentation of care for SCD in adults as well as age-related increases in pain-related comorbidities and SCD complications as SCD patients live longer. However, there has been no associated increase in-hospital SCD mortality, supporting extant data which suggest that the rate of opioid-related deaths in SCD is low, and the use of opioids for pain control may be considered relatively safe in the SCD population. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Trends in Hospitalization and In-Hospital Mortality From VTE, 2007 to 2016, in China

VTE has emerged as a major public health problem. However, data on VTE burden in China are seldom reported. This study collected data on patients with a principal diagnosis of VTE, pulmonary embolism (PE), or DVT by using the International Classification of Diseases, 10th Revision, from 90 hospitals across China. The trends in hospitalization rates, mortality, length of stay (LOS), and comorbidities from 2007 to 2016 were analyzed. In total, 105,723 patients with VTE were identified. For patients with VTE, the age- and sex-adjusted hospitalization rate increased from 3.2 to 17.5 per 100,000 population, and in-hospital mortality decreased from 4.7%to 2.1%(P< .001). The mean LOS declined from 14 to 11days (P< .001). In addition, the data in 2016 showed that the hospitalization rate of VTE was higher in elderly male patients (male patients vsfemale patients, 155.3 vs125.4 per 100,000 population in patients aged≥ 85 years; P< .001) and in northern China (north vssouth, 18.4 vs13.4 per 100,000 population; P< .001). Higher mortality rates were found in patients with cancer and Charlson Comorbidity Index scores > 2. Similar trends were also observed in patients with PE and those with DVT. The hospitalization rate in China was much lower than that of the United States or selected sites in Canada and Europe, the LOS was much longer, and the in-hospital mortality rates were similar. The hospitalization rates of VTE increased steadily, and the mortality declined. This study provides important information on the disease burden of VTE in China.

ISOLATED AORTIC VALVE REPLACEMENT: DECADE TRENDS OF IN-HOSPITAL MORTALITY AND CASE-MIX FOLLOWING THE INSTITUTION OF THE HEART TEAM

Background and aim: The concept of Heart Team (HT) has been a major advancement for decision making in cardiovascular medicine. The aim of the study is to analyse trends of in-hospital mortality and case-mix among patients who underwent to isolated aortic valve replacement (iAVR) before and after HT institution. Methods: We analysed data of 1092 adult patients who underwent iAVR at our hospital between January 2005 and December 2016. They represented 12.3% of the overall surgical case-load of the same period. During the second-half of 2008 HT has been implemented at our hospital. Results: During 2005–2016 period in-hospital mortality following iAVR was 1,8%. In-hospital mortality decreased from 3,9% (2005–2008) to 0,8% (2009–2016) (p .0004). Mean number of iAVR/year increased from 75,5 (2005–2008) to 99,1 (2009–2016). The prevalence of octogenarians patients increased from 11,5% (2005–2008) to 16,5% (2009–2016) (p.00001); in-hospital mortality decreased from 8,8% to 1,5% (p .02) among them. Conclusions: Following the institution of HT at our hospital, we observed a significant decrease of in-hospital mortality following iAVR, also in elderly patients. Volume of iAVR and octogenarians patients significantly increased. It is likely that surgical results benefited from the discussion of cases and the availability of transcatheter techniques for high-risk patients.

TRENDS IN THERAPEUTIC APPROACH FOR ACUTE PULMONARY EMBOLISM AND CHANGE IN OUTCOMES: ANALYSIS OF NATIONWIDE INPATIENT SAMPLE

SESSION TITLE: Pulmonary Vascular Disease 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Acute pulmonary embolism (PE) therapeutic strategies have evolved over the past years. The effect of new treatment approaches for patients admitted to hospitals is still uncertain in terms of mortality and length of stay. Our study describes the trend of utilization of thrombolytic interventions across United States hospitals and its impact on outcomes. METHODS: Data on hospitalizations for patients with PE was collected from the Nationwide Inpatient Sample (NIS) over the years 2002-2014. Temporal trends of length of stay, in-hospital mortality and use of interventional/thrombolytic therapies was assessed. RESULTS: Evaluation of 1,506,593 patients hospitalized with primary diagnosis of PE showed a significant reduction trend of in-hospital mortality from 4.2% in the first period (2002-2006) to 3.0% in the second period (2010-2014) (p<0.001). Length of stay also decreased from 6.34 to 5.09 days (20% relative reduction, p<0.001). Trends of therapeutic interventions showed a significant increase in the utilization of catheter-directed thrombolysis from 0.3% (2002-2006) to 0.7% (2010-2014) (p<0.001). Administration of systemic thrombolysis also increased from 1.36% to 1.97% (p<0.001). Surgical embolectomy use remained stable at 0.002%. CONCLUSIONS: Analysis of NIS database from hospitals across the US revealed a temporal increase in the utilization of catheter directed and systemic thrombolysis for hospitalized PE patients. This was accompanied by a reduction of in-hospital mortality and length of stay for this population. Further studies should evaluate the impact of catheter directed and systemic thrombolysis on outcomes compared to different treatment options and over a longer period of time. CLINICAL IMPLICATIONS: Advances in initial management of PE have been accompanied by a trend of in-hospital mortality and length of stay reduction. DISCLOSURES: No relevant relationships by Saqib Abbasi, source=Web Response No relevant relationships by Akshay Avula, source=Web Response No relevant relationships by Michel Chalhoub, source=Web Response No relevant relationships by boutros karam, source=Web Response No relevant relationships by Wissam Mansour, source=Web Response No relevant relationships by Ghassan Samaha, source=Web Response No relevant relationships by Rabih Tabet, source=Web Response