United States Nationwide Inpatient Sample Research Articles

Obesity-associated outcomes after ACL reconstruction: a propensity-score-matched analysis of the US Nationwide Inpatient Sample 2005–2018

BackgroundAnterior cruciate ligament (ACL) injuries are common among physically active individuals, and obesity may increase the risk of such injuries due to factors like biomechanical stress on the knee. We aimed to determine if obesity affects postoperative outcomes after ACL reconstruction.MethodsData from adults aged 20 years and older with ACL injuries who underwent inpatient reconstruction from 2005 to 2018 were extracted from the United States (US) Nationwide Inpatient Sample (NIS) database. Patients were divided into two groups based on the presence of co-existing obesity, defined as a body mass index (BMI) ≥ 30 kg/m2. Propensity-score matching (PSM) was employed to balance between-group differences. Associations between obesity and concomitant meniscus injury, length of stay (LOS), post-procedural complications, and non-routine discharge were examined using univariate and multivariable logistic and linear regressions.ResultsAfter PSM, data from 1323 patients (representing 6396 individuals in the US) were analyzed. Of these, 441 (33%) were classified as obese, while 882 (67%) were not obese. After adjustment, obesity was significantly associated with a longer LOS (adjusted beta (aBeta) = 0.32, 95% confidence interval (CI) 0.31–0.321) and an increased likelihood of non-routine discharge (adjusted OR (aOR) = 2.18, 95% CI 1.47–3.22). There were no significant associations between obesity and concomitant meniscus injury (aOR = 1.04, 95% CI 0.81–1.32) or post-procedural complications (aOR = 0.97, 95% CI 0.74–1.27).ConclusionsIn patients undergoing ACL reconstruction in the US, obesity is independently associated with a longer LOS and a higher risk of non-routine discharge. Nevertheless, obesity does not appear to be associated with concomitant meniscus injury or post-procedural complications.

Effect of malnutrition on cirrhotic patients with hepatocellular carcinoma: A nationwide study.

e16250 Background: Liver cancer is the sixth most common cancer and the third leading cause of cancer mortality worldwide. There are two main types of primary liver cancers; hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma. HCC accounts for around 80% of primary liver cancer cases. Generally, HCC develops in genetically susceptible individuals with risk factors, especially in the presence of cirrhosis. Cirrhosis is a systemic disease, and malnutrition is a key feature as well as an important complication which can be associated with worse outcomes. In this study, we aim to characterize the potential effects of malnutrition on HCC patients with underlying cirrhosis. Methods: The United States Nationwide Inpatient Sample (NIS) was used to extract hospitalization data of patients admitted between 2016 to 2018. Using ICD10 revision codes, we identified adults with the diagnosis of cirrhosis who have HCC with concomitant malnutrition, including sarcopenia. The control group included cirrhotic HCC patients without malnutrition. The primary outcome was the in-hospital mortality. Secondary outcomes included encephalopathy, ascites, variceal bleed, hepatorenal syndrome (HRS) and length of stay (LOS). Multivariate logistic regression was used to adjust for relevant variables. Results: We identified 423,158 patients admitted with cirrhosis. 20,582 had HCC, and of those, 2560 patients had the diagnosis of malnutrition. In this group of patients, the mean age was 59.85 years. 30% were females and 62% were Caucasians. When adjusted to other relevant variables, malnutrition was associated with increased in-hospital mortality (OR 1.40; P-value 0.000). It was also associated with an increased chance of developing encephalopathy (OR 1.42; P-value 0.000), ascites (OR 1.62; P-value 0.000), and HRS (OR 1.33; P-value 0.000). Moreover, it was associated with increased LOS (OR 1.99; P-value 0.001). Other factors associated with increased in-hospital mortality in cirrhotic HCC patients are described in the table. Conclusions: Malnutrition is a common complication in patients with cirrhosis. If identified, it can be treated efficiently. In this study, cirrhotic HCC patients with malnutrition had an increased chance of mortality. Further, they were at increased risk for cirrhosis decompensation and other in-hospital complications, which in turn can lead to increased LOS and therefore increased financial burden. We recommend that clinicians pay attention to patients with malnutrition and to treat them in order to prevent these complications. [Table: see text]

Potential impact of malnutrition on patients with hepatocellular carcinoma undergoing liver transplantation: A nationwide analysis.

e16233 Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer mortality worldwide. Liver transplantation is the ideal treatment for HCC, and the Milan criteria, which has been the international gold standard, provided the opportunity for HCC patients to undergo liver transplantation with favorable outcomes. On the other hand, malnutrition is a prevalent condition, and carries a substantial burden on health and social-care systems. In this study, we aim to look at the potential impact of malnutrition on in-hospital mortality and other outcomes in HCC patients undergoing liver transplantation. Methods: The United States Nationwide Inpatient Sample (NIS) was used to extract hospitalization data of patients admitted between 2016 to 2018. Using ICD10 revision codes, we identified adults with a diagnosis of HCC, with or without cirrhosis, who underwent liver transplantation with concomitant malnutrition. The control group included HCC patients without malnutrition. The primary outcome was the in-hospital mortality. Secondary outcomes included length of stay (LOS), acute kidney injury (AKI) and hyponatremia. Multivariate logistic regression was used to adjust for relevant variables. Results: An estimated 33,321 patients were admitted with HCC during the study period. 503 of them underwent liver transplantation, and of those, 75 patients had the diagnosis of malnutrition. In this group of patients, the mean age was 60.3 years. 30% were females and 60% were Caucasians. When adjusted to other relevant variables, malnutrition was associated with increased in-hospital mortality (OR 2.42; P-value 0.033). It was also associated with increased chance of developing an AKI (OR 1.95; P-value 0.014). Moreover, it was associated with increased LOS (OR 1.18) and increased chance of liver transplant rejection (OR 1.47), however, these were not statistically significant. Other factors associated with increased in-hospital mortality in HCC patients undergoing liver transplantation are described in the table. Conclusions: Malnutrition is a potentially treatable condition, however, when untreated it may contribute to poor health and economic outcomes. In this study, HCC patients with malnutrition who underwent liver transplantation, have an increased chance of in-hospital mortality. Furthermore, they had an increased odds of developing an AKI which in turn can prolong the hospital length of stay and total charges. We recommend that clinicians pay more attention to identify patients with or at increased risk for malnutrition in order to treat and optimize them prior to liver transplantation, and therefore to prevent such complications. [Table: see text]

Impact of obstructive sleep apnea on clinical outcomes of hospitalization due to influenza in children: A propensity score-matched analysis of the US Nationwide Inpatient Sample 2005-2018.

Previous studies have explored the association between obstructive sleep apnea (OSA) and clinical outcomes of influenza in adults, whereas limited research examined this relationship in pediatric populations. This study aimed to evaluate the clinical impact of OSA on the outcomes of pediatric influenza hospitalizations. This was a population-based, retrospective study. Data of children aged 1-19 years hospitalized for influenza infection were extracted from the United States (US) Nationwide Inpatient Sample Database 2005-2018. Univariable and multivariable regression analyses determined associations between OSA, length of stay (LOS), total hospital costs, pneumonia, and life-threatening events. After propensity-score matching, a total of 2100 children were analyzed. The logistic analysis revealed that children with OSA had a significantly increased LOS (β = 2.29 days; 95% confidence interval,CI: 1.01-3.57, p < .001) and total hospital costs (β = 26.06 thousand dollars; 95% CI: 6.62-45.51, p = .009), and higher odds of pneumonia (aged 6-10 years: odds ratio [OR] = 1.52; 95% CI: 1.01-2.27, p = .043; aged ≥ 11 years: OR = 1.83; 95% CI: 1.33-2.53, p < .001). During influenza admissions, children with OSA had longer LOS, higher hospital costs, and an increased risk of pneumonia compared to those without OSA. These findings underscore the importance of recognizing and managing OSA in influenza-related infections among children.

Incidence of Atrial Fibrillation and Related Outcomes among Hospitalized Patients with Systemic Lupus Erythematosus: Analysis of United States Nationwide Inpatient Sample Database 2016-2019.

Background: While patients with systemic lupus erythematosus (SLE) are known to have an increased risk of developing atrial fibrillation (AF), there is a scarcity of national population-based studies that evaluate the impact of AF on SLE. Methods: In this study, we use the 2016 to 2019 National Inpatient Sample (NIS) to determine the impact of AF on inpatient outcomes among adults hospitalized with systemic lupus erythematosus (SLE). Among a total of 41,004 SLE hospitalizations, 1495 (3.65%) patients had a concurrent diagnosis of AF. The baseline hospital and patient characteristics for both cohorts (SLE with AF and SLE without AF) were compared using the chi-square test and Student's t-test while univariate and multivariate regression analysis were used to calculate the unadjusted and adjusted odds ratios (aOR) for in-hospital outcomes for both cohorts. Results: Our data revealed that among SLE patients, AF was associated with higher in-hospital mortality (aOR 2.07), length of stay (9.03 days), and hospital costs (USD 100,190.50) along with increased incidence of non-ST-elevation myocardial infarction (NSTEMI) (aOR 2.79), pericardial effusion (aOR 2.38), cardiac tamponade (aOR 3.33), and cardiogenic shock (aOR 8.19). Conclusion: Our findings suggest that patients hospitalized with SLE and underlying AF may be at risk for poor clinical outcomes.

Short-Term Outcomes of Conventional Laparoscopic versus Robot-Assisted Distal Pancreatectomy for Malignancy: Evidence from US National Inpatient Sample, 2005-2018.

The primary treatment for pancreatic cancer is surgical resection, and laparoscopic resection offers benefits over open surgery. This study aimed to compare the short-term outcomes of robot-assisted vs. conventional laparoscopic distal pancreatectomy. Data of adults ≥ 20 years old with pancreatic cancer who underwent conventional laparoscopic or robot-assisted laparoscopic distal pancreatectomy were extracted from the United States (US) Nationwide Inpatient Sample (NIS) 2005-2018 database. Comorbidities and complications were identified through the International Classification of Diseases (ICD) codes. Short-term outcomes were compared using logistic regression and included length of hospital stay (LOS), perioperative complications, in-hospital mortality, unfavorable discharge, and total hospital costs. A total of 886 patients were included; 27% received robot-assisted, and 73% received conventional laparoscopic surgery. The mean age of all patients was 65.3 years, and 52% were females. Multivariable analysis revealed that robot-assisted surgery was associated with a significantly reduced risk of perioperative complications (adjusted odds ratio (aOR) = 0.61, 95% confidence interval (CI): 0.45-0.83) compared to conventional laparoscopic surgery. Specifically, robot-assisted surgery was associated with a significantly decreased risk of VTE (aOR = 0.35, 95% CI: 0.14-0.83) and postoperative blood transfusion (aOR = 0.37, 95% CI: 0.23-0.61). Robot-assisted surgery was associated with a significantly shorter LOS (0.76 days shorter, 95% CI: -1.43--0.09) but greater total hospital costs (18,284 USD greater, 95% CI: 4369.03-32,200.70) than conventional laparoscopic surgery. Despite the higher costs, robot-assisted distal pancreatectomy is associated with decreased risk of complications and shorter hospital stays than conventional laparoscopic distal pancreatectomy.

Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma

IntroductionAs the population of elderly patients continues to rise, the number of these individuals presenting with thoracolumbar trauma is expected to increase. Research questionTo investigate thoracolumbar fusion outcomes for patients with vertebral fractures as stratified by decade. Secondarily, we examined the variability of cost across age groups by identifying drivers of cost of care. Materials and methodsWe queried the United States Nationwide Inpatient Sample(NIS) for adult patients undergoing spinal fusion for thoracolumbar fractures between 2012 and 2017. Patients were stratified by decade 60–69(sexagenarians), 70–79(septuagenarians) and 80–89(octogenarians). Bivariable analysis followed by multivariable regression was performed to assess independent predictors of length of stay(LOS), hospital cost, and discharge disposition. ResultsA total of 2767 patients were included, of which 46%(N = 1268) were sexagenarians, 36% septuagenarians and 18%(N = 502) octogenarians. Septuagenarians and octogenarians had shorter LOS compared to sexagenarians(ß = −0.88 days; p = 0.012) and(ß = -1.78; p < 0.001), respectively. LOS was reduced with posterior approach(-2.46 days[95% CI: 3.73–1.19]; p < 0.001), while Hispanic patients had longer LOS(+1.97 [95% CI: 0.81–3.13]; p < 0.001). Septuagenarians had lower total charges $12,185.70(p = 0.040), while the decrease in charges in octogenarians was more significant, with a decrease of $26,016.30(p < 0.001) as compared to sexagenarians. Posterior approach was associated with a decrease of $24,337.90 in total charges(p = 0.026). Septuagenarians and octogenarians had 1.72 higher odds(p < 0.001) and 4.16 higher odds(p < 0.001), respectively, of discharge to a skilled nursing facility. Discussion and conclusionsHealthcare utilization in geriatric thoracolumbar trauma is complex. Cost reductions in the acute hospital setting may be offset by unaccounted costs after discharge. Further research into this phenomenon and observed racial/ethnic disparities must be pursued.

Comorbidity clusters and in-hospital outcomes in patients admitted with acute myocardial infarction in the USA: A national population-based study.

The prevalence of multimorbidity in patients with acute myocardial infarction (AMI) is increasing. It is unclear whether comorbidities cluster into distinct phenogroups and whether are associated with clinical trajectories. Survey-weighted analysis of the United States Nationwide Inpatient Sample (NIS) for patients admitted with a primary diagnosis of AMI in 2018. In-hospital outcomes included mortality, stroke, bleeding, and coronary revascularisation. Latent class analysis of 21 chronic conditions was used to identify comorbidity classes. Multivariable logistic and linear regressions were fitted for associations between comorbidity classes and outcomes. Among 416,655 AMI admissions included in the analysis, mean (±SD) age was 67 (±13) years, 38% were females, and 76% White ethnicity. Overall, hypertension, coronary heart disease (CHD), dyslipidaemia, and diabetes were common comorbidities, but each of the identified five classes (C) included ≥1 predominant comorbidities defining distinct phenogroups: cancer/coagulopathy/liver disease class (C1); least burdened (C2); CHD/dyslipidaemia (largest/referent group, (C3)); pulmonary/valvular/peripheral vascular disease (C4); diabetes/kidney disease/heart failure class (C5). Odds ratio (95% confidence interval [CI]) for mortality ranged between 2.11 (1.89-2.37) in C2 to 5.57 (4.99-6.21) in C1. For major bleeding, OR for C1 was 4.48 (3.78; 5.31); for acute stroke, ORs ranged between 0.75 (0.60; 0.94) in C2 to 2.76 (2.27; 3.35) in C1; for coronary revascularization, ORs ranged between 0.34 (0.32; 0.36) in C1 to 1.41 (1.30; 1.53) in C4. We identified distinct comorbidity phenogroups that predicted in-hospital outcomes in patients admitted with AMI. Some conditions overlapped across classes, driven by the high comorbidity burden. Our findings demonstrate the predictive value and potential clinical utility of identifying patients with AMI with specific comorbidity clustering.

Potential beneficial effects of long-term aspirin use on the prevalence of colorectal cancer: a population-based study of the US Nationwide Inpatient Sample.

Whether long-term aspirin usage is associated with colorectal cancer (CRC) risk needs more evidence. The study evaluated the association between long-term aspirin use and prevalence of CRC in a large, nationally representative database. Hospitalized patients aged ≥ 50years during 2018 were identified in the United States (US) National Inpatient Sample (NIS). Patients without complete information of age, sex, race, income, and insurance status were excluded, as well as those with inflammatory bowel disease (IBD) or malignancies other than CRC. Propensity score matching (PSM) was applied to balance the characteristics between patients with and without long-term aspirin use. Logistic regressions were performed to determine the relationship between long-term aspirin use and the presence of CRC. CRC and aspirin use were identified through the administrative International Classification of Diseases (ICD) codes. Data from 3,490,226 patients were included, in which 688,018 (19.7%) had a record of long-term aspirin use. After 1:1 PSM, there remained 1,376,006 patients, representing 6,880,029 individuals in the US after weighting. After adjusting for confounders, long-term aspirin use was significantly associated with lower CRC odds (adjusted odds ratio [aOR] = 0.64, 95% confidence interval [CI] 0.62, 0.67). This association was not changed when stratified by age, sex, race, body mass index (BMI), and smoking. From a national inpatient dataset, US adults ≥ 50years on long-term aspirin are less likely to have CRC, regardless of age, sex, race, BMI, and smoking status.

S1665 Trends in Bariatric Surgery Utilization Among Morbidly Obese Patients - Evidence from the United States Nationwide Inpatient Sample Database

S1665 Trends in Bariatric Surgery Utilization Among Morbidly Obese Patients - Evidence from the United States Nationwide Inpatient Sample Database

S870 Risk Factors and Mortality of Acute Mesenteric Ischemia in IBD Patients: A United States Nationwide Inpatient Sample Database Study 2009-2018

S870 Risk Factors and Mortality of Acute Mesenteric Ischemia in IBD Patients: A United States Nationwide Inpatient Sample Database Study 2009-2018

Kidney Transplantation and Clinical Outcomes in Patients With Multiple Myeloma: Evidence From the United States Nationwide Inpatient Sample.

Patients with multiple myeloma (MM) are prone to developing persistent renal insufficiency. Novel therapeutic medications have improved long-term survival, making kidney transplantation (KT) a viable treatment option for MM survivors with end-stage renal disease. This study aimed to investigate the clinical outcomes in patients with MM who have received KT. Data from hospitalized patients ≥ 40 years of age with MM in the Nationwide Inpatient Sample 2016-2018 of the United States were queried. Patients were classified as having or not having undergone KT, as well as the stage of chronic kidney disease (CKD) for those who had not received KT. Propensity-score matching (PSM) was applied to balance the characteristics between the groups. Binary logistic regression was utilized to determine the associations between study variables and inhospital mortality, unfavorable discharges, prolonged length of stay (LOS), and major complications. In total, 50,654 hospitalized patients with MM were identified, of whom 165 (0.3%) had received KT and 50,489 had not (5,905 at stage 5 CKD [CKD5D], 11,559 at stage 1-4 CKD [CKD1-4D], and 33,025 who were CKD-free). After PSM, between-group demographic and hospital-related characteristics were balanced. Binary regression analysis revealed that, compared to patients who were CKD-free, patients at CKD5D were significantly more likely to experience a prolonged LOS (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.01-1.70) after adjusting for relevant confounders. Furthermore, compared to CKD-free patients, those who underwent KT were significantly more likely to have sepsis (OR, 1.48; 95% CI, 1.02-2.14). However, KT showed no association with the other adverse inpatient outcomes. Although KT is not common in MM patients, those who had undergone KT had comparable hospital outcomes to CKD-free patients. These data will help clinicians deliver better consultations to MM patients attempting to receive KT.

Rising incidence of acute total hip arthroplasty for primary and adjunctive treatment of acetabular fracture in older and middle-aged adults.

Acute total hip arthroplasty (THA) may be an alternative or an adjuvant to internal fixation for surgical treatment of acetabular fractures. We investigate recent trends in the operative management of acetabular fractures. We hypothesize that the incidence of acute THA for acetabular fractures has increased over time. 4569 middle-aged (45-64years) and older adults (≥ 65years) who received acute operative management of an acetabular fracture within 3weeks of admission between 2010 and 2020 were identified from the United States Nationwide Inpatient Sample database. Treatment was classified as open reduction internal fixation (ORIF), THA, or combined ORIF and THA (ORIF + THA). Patients were stratified by age ≥ 65years old. Associations between demographic factors and the incidence of each procedure over the study period were modeled using linear regression. The relative incidence of treatments was 80.9% ORIF, 12.1% THA, and 7.0% ORIF + THA. Among patients aged 45-64years old, THA increased 4.8% [R2 = 0.62; β1 = 0.6% (95% Confidence Interval (CI) 0.2-0.9%)] and ORIF + THA increased 2.6% [R2 = 0.73; β1 = 0.3% (95% CI 0.2-0.4%)], while the use of ORIF decreased 7.4% [R2 = 0.75; β1 = -0.9% (95% CI -1.2 to -0.5%)]. Among patients ≥ 65years old, THA increased 16.5% [R2 = 0.87; β1 = 1.7% (95% CI 1.2-2.2%)] and ORIF + THA increased 5.0% [R2 = 0.38, β1 = 0.6% (95% CI 0.0-1.3%)], while ORIF decreased 21.5% [R2 = 0.75; β1 = -2.4% (95% CI -3.45 to -1.3%)]. The treatment of acetabular fractures with acute THA has increased in the last decade, particularly among older adults.

Impact of hepatitis virus infection on inpatient outcomes of acute pancreatitis: A population-based study.

This study aimed to investigate the associations between hepatitis virus infection and inpatient outcomes of acute pancreatitis (AP). In this population-based, retrospective study, hospitalized patients with AP were identified in the 2005 to 2018 United States Nationwide Inpatient Sample database. Univariate and multivariable regression analyses were conducted to evaluate the associations between hepatitis virus infection, death/discharge against medical advice (DAMA), prolonged length of stay (LOS), and occurrence of life-threatening complications including ischemia/infarction of the intestine, portal vein thrombosis, acute organ failure, systemic inflammatory response syndrome, and hypovolemic shock. A total of 775,416 patients hospitalized for AP comprised the analytic cohort. Amongst, 26,407 subjects (3.4%) had been diagnosed hepatitis virus infection, whereas 749,009 (96.6%) had not. Mean age of the subjects was 51.4 years. After adjusting for relevant confounders, hepatitis virus infection was significantly and independently associated with increased odds of death/DAMA (aOR = 1.33, 95% CI = 1.26-1.40), prolonged LOS (aOR = 1.12, 95%CI = 1.09-1.16), and acute organ failure (aOR = 1.06, 95% CI = 1.01-1.12). In patients with AP, hepatitis virus infection is an independent predictor of worse inpatient outcomes in terms of more death/DAMA, prolonged LOS, and life-threatening complications. The findings may help risk stratification and the development of proper strategies for managing patients suffered from AP.

Social determinants of health in pulmonary embolism management and outcome in hospitals: Insights from the United States nationwide inpatient sample

BackgroundThe role of social determinants in the treatment and course of acute pulmonary embolism (PE) is understudied. ObjectiveTo investigate the association between social determinants of health with in-hospital management and early clinical outcomes following acute PE. MethodsWe identified hospitalizations of adults with acute PE discharge diagnosis from the nationwide inpatient sample (2016-2018). Multivariable regression was used to investigate the association between race/ethnicity, type of expected primary payer, and income with the use of advanced PE therapies (thrombolysis, catheter-directed treatment, surgical embolectomy, extracorporeal membrane oxygenation), length of stay, hospitalization charges, and in-hospital death. ResultsA total of 1,124,204 hospitalizations with a PE diagnosis were estimated from the 2016–2018 nationwide inpatient sample, corresponding to a hospitalization rate of 14.9/10,000 adult persons-year. The use of advanced therapies was lower in Black and Asian/Pacific Islander (vs. White patients: adjusted odds ratio [ORadjusted], 0.87; 95% confidence interval [CI], 0.81–0.92 and ORadjusted 0.76; 95% CI, 0.59–0.98) and in Medicare- or Medicaid-insured (vs. privately-insured; ORadjusted, 0.73; 95% CI, 0.69–0.77 and ORadjusted, 0.68; 95% CI, 0.63–0.74), although they had the greatest length of stay and hospitalization charges. In-hospital mortality was higher in the lowest income quartile (vs. highest quartile; ORadjusted, 1.09; 95% CI, 1.02–1.17). Among high-risk PE, patients of other than the White race had the highest in-hospital mortality. ConclusionWe observed inequalities in advanced therapies used for acute PE and higher in-hospital mortality in races other than White. Low socioeconomic status was also associated with lesser use of advanced treatment modalities and greater in-hospital mortality. Future studies should further explore and consider the long-term impact of social inequities in PE management.

Outcomes of clostridioides difficile infection in patients with hematopoietic stem cell transplant.

e19054 Background: Hematopoietic stem cell transplantation (HSCT) recipients are at an increased risk for Clostridioides difficile infections (CDI). Despite it being the main cause of nosocomial enterocolitis in this group of patients, diagnosis of CDI remains challenging and carries significant morbidity and mortality. This is usually due to multiple comorbidities, recurrent antibiotics administration, prolonged immunosuppression, and lengthy hospitalization. This study aims to look more into outcomes and predictors of CDI in HSCT patients in terms of incidence, and mortality. Methods: The United States Nationwide Inpatient Sample was used to extract hospitalization data of patients admitted between 2016 to 2019. Using ICD10 revision codes, we identified adults with a discharge diagnosis of CDI and concomitant HSCT. The control group included non-HSCT patients with CDI. The primary outcome was in-hospital mortality. Secondary outcomes were the length of stay (LOS) and hospital charges. Additionally, predictors for developing CDI and dying from CDI were calculated in HSCT patients. Multivariate logistic regression was used to adjust for relevant variables. Results: An estimated 1,235,465 patients were admitted with CDI during the study period. CDI incidence per 100 discharges was higher among HSCT patients at 4.0% vs. 1.0% in the general population. After adjusting for comorbidities and demographic variables, HSCT was independently associated with increased odds of mortality (adjusted odds ratio [AOR] 1.47 (95%CI 1.20-1.80 and P &lt;0.01). Mean length of stay and hospital charges increased by 1.76 days (95%CI 0.90-2.62, P &lt; 0.01) and $59,023 (95%CI $35,940-$82,105, P &lt; 0.01), respectively, in the HSCT group. In the HSCT group, patients with severe liver disease, malnutrition, and graft vs. host disease showed a significantly higher incidence of CDI. Predictors of mortality of HSCT patients and CDI are outlined in the attached table. Conclusions: HSCT recipients are at an increased risk for CDI compared to general population. LOS, total hospital charge, and mortality rate were significantly higher. The risk of CDI was found to be significantly higher in patients with moderate to severe liver disease, graft vs host disease, and malnutrition. The odds of mortality were found to be the highest in patients older than 65 years and those with congestive heart failure, moderate to severe liver disease, graft vs host disease, or malnutrition.[Table: see text]

Clostridioides difficile infection in hospitalized patients with leukemia: A nationwide analysis of incidence and outcomes.

e19042 Background: Clostridioides difficile infection (CDI) is the most common cause of nosocomial diarrhea. The incidence and severity of CDI have increased in adults. However, CDI has not been well studied in leukemia patients in the recent years. This study aims to evaluate incidence, mortality, and health care burden in patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL). Methods: The United States Nationwide Inpatient Sample was used to extract hospitalization data of patients admitted between Jan 1st, 2016, to Dec 31st, 2019. Using International Classification of Diseases 10th revision codes, we identified adults with a discharge diagnosis of CDI and a concomitant leukemia diagnosis. The control group included non-leukemia patients with CDI. Primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS) and hospital charges. Multivariate logistic regression was used to adjust for relevant variables. Results: An estimated 1,235,465 patients were admitted with CDI during the study period. CDI incidence per 100 discharges was higher among leukemia patients, particularly in AML and ALL patients (4.1 and 3.6, respectively) vs. 1 in general population. After adjusting for comorbidities and demographic variables, AML and ALL were independently associated with increased odds of mortality (adjusted odds ratio [AOR] 2.19 and 1.90 respectively: P &lt;0.01). Additionally, both AML and CML had significant mean increase in length of stay (7.2 and 3.1 days respectively; P &lt;0.01) and hospital charges (115,245$ and 87,198$ respectively; P &lt;0.01) compared to non-leukemia patients. Conclusions: Among leukemia patients admitted with CDI, those with AML and ALL have significantly higher adjusted odds of mortality, length of stay, and hospital charges. AML and ALL patients also had the highest incidence of CDI. Applying antibiotic stewardship and appropriately diagnosing and treating CDI is pertinent in these high-risk patients.[Table: see text]

Non-variceal upper gastrointestinal bleeding in patients with acute leukemia.

e19041 Background: Patients with acute leukemia are prone to various hemorrhages, most frequently due to thrombocytopenia from disease activity or chemotherapy. However, there is minimal literature evaluating non-variceal upper gastrointestinal bleeding (NVUGIB) in leukemia patients. This study evaluates the outcomes of NVUGIB in hospitalized acute leukemia patients. Methods: The United States Nationwide Inpatient Sample was used to extract hospitalization data of patients admitted between Jan 1st, 2016, to Dec 31st, 2019. Using International Classification of Diseases 10th revision codes, we identified adults with a discharge diagnosis of NVUGIB and a concomitant acute leukemia diagnosis, acute myelogenous leukemia and acute lymphoblastic leukemia. The control group included non-leukemia patients with NVUGIB. Primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS), hospital charges, and effect of early esophagogastroduodenoscopy (EGD) within the first 24 hours of admission. Multivariate logistic regression was used to adjust for comorbidities and demographic variables. Results: A total of 1,208,885 discharges were identified with NVUGIB. Of those, 1019 had acute leukemia. Leukemia patients had higher mortality than the general population (12.5% vs. 3%, respectively; P &lt;0.01). After adjusting for comorbidities and demographic variables, acute leukemia patients had significantly higher mortality (adjusted odds ratio [AOR] 3.75, 95%CI 2.37-5.94 P &lt;0.01). Mean length of stay and hospital charges increased by 6.87 days (95%CI 3.99-9.75, P &lt; 0.01) and 128,437$ (95%CI 68,633$-188,240$, P &lt; 0.01), respectively, in the acute leukemia group. Additionally, acute leukemia patients who had an early EGD had significantly less mortality, length of stay, and hospital charges compared to delayed EGD as shown in the attached table. Conclusions: Acute leukemia patients admitted with NVUGIB have significantly higher in-hospital mortality and health care burden. Early EGD in these patients is associated with lower in-hospital mortality, shorter length of stay, and lower total hospital costs. However, given the retrospective nature of this study, we cannot determine that early EGD is a causal factor for the improved outcomes. Future prospective studies will be required in acute leukemia patients admitted with NVUGIB to further evaluate these findings.[Table: see text]

Risk-standardized sepsis mortality map of the United States.

ObjectiveSepsis is the leading cause of in-hospital mortality in the United States (US). Quality improvement initiatives for improving sepsis care depend on accurate estimates of sepsis mortality. While hospital 30-day risk-standardized mortality rates have been published for patients hospitalized with acute myocardial infarction, heart failure, and pneumonia, risk-standardized mortality rates for sepsis have not been well characterized. We aimed to construct a sepsis risk-standardized mortality rate map for the United States, to illustrate disparities in sepsis care across the country.MethodsThis cross-sectional study included adults from the US Nationwide Inpatient Sample who were hospitalized with sepsis between 1 January 2010 and 30 December 2011. Hospital-level risk-standardized mortality rates were calculated using hierarchical logistic modelling, and were risk-adjusted with predicted mortality derived from (1) the Sepsis Risk Prediction Score, a logistic regression model, and (2) gradient-boosted decision trees, a supervised machine learning (ML) algorithm.ResultsAmong 1,739,033 adults hospitalized with sepsis, 50% were female, and the median age was 71 years (interquartile range: 58–81). The national median risk-standardized mortality rate for sepsis was 18.4% (interquartile range: 17.0, 21.0) by the boosted tree model, which had better discrimination than the Sepsis Risk Prediction Score model (C-statistic 0.87 and 0.78, respectively). The highest risk-standardized mortality rates were found in Wyoming, North Dakota, and Mississippi, while the lowest were found in Arizona, Colorado, and Michigan.ConclusionsWide variation exists in sepsis risk-standardized mortality rates across states, representing opportunities for improvement in sepsis care. This represents the first map of state-level variation of risk-standardized mortality rates in sepsis.

Outcomes Among Patients With Reversible Cerebral Vasoconstriction Syndrome: A Nationwide United States Analysis

Reversible cerebral vasoconstriction syndrome (RCVS) is a well-established cause of stroke, but its demographics and outcomes have not been well delineated. Analysis of the United States Nationwide Inpatient Sample database (2016-2017) to characterize the frequency of hospitalizations for RCVS, demographic features, inpatient mortality, and discharge outcomes. During the 2-year study period, 2020 patients with RCVS were admitted to Nationwide Inpatient Sample hospitals, representing 0.02 cases per 100 000 national hospitalizations. The mean age at admission was 47.6 years, with 85% under 65 years of age, and 75.5% women. Concomitant neurological diagnoses during hospitalization included ischemic stroke (17.1%), intracerebral hemorrhage (11.0%), subarachnoid hemorrhage (32.7%), seizure disorders (6.7%), and reversible brain edema (13.6%). Overall, 70% of patients were discharged home, 29.7% discharged to a rehabilitation facility or nursing home and 0.3% died before discharge. Patient features independently associated with the poor outcome of discharge to another facility or death were advanced age (odds ratio [OR], 1.04 [95% CI, 1.03-1.04]), being a woman (OR, 2.45 [1.82-3.34]), intracerebral hemorrhage (OR, 2.91 [1.96-4.31]), ischemic stroke (OR, 5.72 [4.32-7.58]), seizure disorders (OR, 2.61 [1.70-4.00]), reversible brain edema (OR, 6.26 [4.41-8.89]), atrial fibrillation (OR, 2.97 [1.83-4.81]), and chronic kidney disease (OR, 3.43 [2.19-5.36]). Projected to the entire US population, >1000 patients with RCVS are hospitalized each year, with the majority being middle-aged women, and about 300 required at least some rehabilitation or nursing home care after discharge. RCVS-related inpatient mortality is rare.