Utilization Project National Inpatient Sample Research Articles

Clinical outcomes and healthcare utilization among young adults with colon cancer on Medicaid vs private insurance.

22 Background: The incidence of colon cancer in young adults has been increasing. The role of insurance on the outcomes of young adults diagnosed with colon cancer is unclear. In this study we sought to study the impact of Private insurance vs Medicaid on the outcomes of colon cancer in young adults (<50 years). Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2016-2019 was queried to identify young adult patients (Age <50 years) admitted for colon cancer using the ICD-10 (International Classification of Diseases) codes. Study population was stratified based on the insurance (private vs Medicaid). Primary outcomes included mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes included prevalence of pulmonary embolism (PE), ICU admission, acute kidney injury (AKI), acute respiratory failure (ARF), blood transfusion, and sepsis. Statistics were performed using multivariate linear and logistic regression using STATA v17. Results: 59,065 young adult admissions were identified with a principal diagnosis of colon cancer between 2016-2019. Among them 36,765 (62.2%) were on private insurance while 13,480 (22.8%) were on Medicaid. Medicaid patients were significantly younger, female, Black and Hispanic with a higher Charlson comorbidity index (p<0.05). Of the 870 (1.5%) patients that died during the admission, 46.5% (N= 405) had private insurance whereas 26.4% (N= 230) had Medicaid. There was no significant difference in the odds of mortality between private insurance and Medicaid (adjusted OR 1.07, 95% CI 0.69-1.67; p=0.77). The LOS was increased by 1.5 days for Medicaid patients compared to private insurance (95% CI 1.15-1.90; p<0.001). There was no significant difference in total hospitalization charges among both groups. Medicaid patients had higher odds of sepsis (OR 1.5, 95% CI 1.09-1.94; p=0.012), requiring blood transfusion (OR 1.6, 95% CI 1.32-1.83; p<0.000) and less likely to undergo colectomy (OR 0.61, 95% CI 0.55-0.67; p<0.000). There were no significant differences in ICU admission, AKI and ARF. Conclusions: Compared to private insurance, Medicaid patients had similar healthcare outcomes and hospital charges despite a longer LOS. In an era where the country explores options for healthcare reform including single payor system, our study provides insight into similar effectiveness of Medicaid in caring for young colon cancer patients compared to Private Insurance despite higher comorbidities in Medicaid patients.

Traumatic brain injuries in paediatric patients: individual vs. team sports-related hospitalizations

ABSTRACT Paediatric sport participation continues to increase in the United States, with a corresponding increase in sports-related concussions or traumatic brain injuries (TBIs). It is important to recognize which sports are at elevated risk and identify risk factors for hospital admission and length of stay (LOS). Paediatric patients (ages 5–18) from 2008 to 2014 were identified from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS). Eight hundred and ninety-four patients included those who were hospitalized with a TBI resulting from participation in an individual (451 patients) or team (443 patients) sport. We evaluated the differences in LOS and total charges between individual and team sports and found that compared to team sports, TBI patients in individual sports had significantly longer hospital stays compared to team sports (1.75 days versus 1.34 days, p < 0.001) and costlier ($27,333 versus $19,069, p < 0.001) hospital stays. This may be due to reduced awareness and reduced compliance with return-to-play protocols in individual sports. Safety education information at a young age, increased awareness of TBIs, and additional medical support for individual sports as well as team sports may help mitigate these findings.

Medicaid Expansion: the impact of health policy on bariatric surgery.

Underutilization of bariatric surgery in uninsured and marginalized communities is well-documented. When discussing population health, healthcare access and equity are crucial components often influenced by health policy. This study aims to determine if disparities in the use of bariatric surgery were influenced by changes in healthcare policy from the Affordable Care Act's 2014 expansion of Medicaid. A retrospective analysis of the 2012-2018 Healthcare Cost and Utilization Project National Inpatient Sample was performed for elective Roux-en-Y gastric bypass and sleeve gastrectomy surgeries performed within the United States. States were grouped into regions as defined by the U.S. Census Bureau. Medicaid as the primary payor for bariatric surgery was compared by region and year, as well as utilization by marginalized populations. Analysis included 212,776 bariatric surgeries. Medicaid as the primary payor increased from 9% to 19% from 2012 to 2018. A greater share of bariatric surgeries with Medicaid as the primary payor was located in the Northeast and West, as compared with those located in the Midwest and South. Medicaid beneficiaries in marginalized communities (Black race, Hispanic race, lowest income quartile, rural communities) made up a larger share of the bariatric surgery population over time. The Affordable Care Act's Medicaid Expansion improved health coverage and access to care, including bariatric surgery. An increase in bariatric surgeries among Medicaid beneficiaries correlated with the 2014 expansion of Medicaid. Social and economic disparities regarding bariatric surgery have improved though more progress may be seen with the adoption of Medicaid Expansion by the remaining U.S. states.

Comparison of the effects of sugammadex versus neostigmine for reversal of neuromuscular block on hospital costs of care

BackgroundSugammadex reversal of neuromuscular block facilitates recovery of neuromuscular function after surgery, but the drug is expensive. We evaluated the effects of sugammadex on hospital costs of care. MethodsWe analysed 79 474 adult surgical patients who received neuromuscular blocking agents and reversal from two academic healthcare networks between 2016 and 2021 to calculate differences in direct costs. We matched our data with data from the Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP–NIS) to calculate differences in total costs in US dollars. Perioperative risk profiles were defined based on ASA physical status and admission status (ambulatory surgery vs hospitalisation). ResultsBased on our registry data analysis, administration of sugammadex vs neostigmine was associated with lower direct costs (–1.3% lower costs; 95% confidence interval [CI], –0.5 to –2.2%; P=0.002). In the HCUP-NIS matched cohort, sugammadex use was associated with US$232 lower total costs (95% CI, –US$376 to –US$88; P=0.002). Subgroup analysis revealed that sugammadex was associated with US$1042 lower total costs (95% CI, –US$1198 to –US$884; P<0.001) in patients with lower risk. In contrast, sugammadex was associated with US$620 higher total costs (95% CI, US$377 to US$865; P<0.001) in patients with a higher risk (American Society of Anesthesiologists physical status ≥3 and preoperative hospitalisation). ConclusionsThe effects of using sugammadex on costs of care depend on patient risk, defined based on comorbidities and admission status. We observed lower costs of care in patients with lower risk and higher costs of care in hospitalised surgical patients with severe comorbidities.

Cost of Pediatric Trauma: A Comparison of Non-Accidental and Accidental Trauma in Pediatric Patients

BackgroundNonaccidental trauma (NAT) affects >100,000 children in the United States every year and is associated with significant mortality and morbidity. Little is known about the financial burden of NAT, particularly in comparison to accidental trauma (AT). We sought to compare hospital charges and outcomes between children presenting with NAT and AT. MethodsPediatric (<16 y) trauma hospitalizations from 2006 to 2018 were identified using the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and Kid’s Inpatient Sample (KID) databases. Hospitalizations were identified as NAT or AT based on ICD codes. Discharge weights were used to obtain national estimates and standardize them across the different sampling structures. Outcomes (hospital charges, length of stay (LOS), and mortality) were compared, and multivariate regression analyses were used to assess independent predictors of hospital charges and mortality. ResultsFifty-eight Thousand Two Hundred Seventy-five pediatric hospitalizations were included with 17,954 (0.3%) categorized as NAT. Children with NAT were younger, more female, less likely to identify as White, and more under public insurance than those with AT. Hospital charges were significantly higher in patients with NAT ($27,100 versus $19,900, P < 0.0001). Mortality (4.9% versus 0.0%, P < 0.0001) and LOS (3.2 d versus 1.5 d, P < 0.0001) were significantly higher among patients with NAT. Multivariable regression analyses identified NAT as a predictor of higher hospital charges, mortality, and LOS. ConclusionsNonaccidental trauma in pediatric patients is associated with significantly higher hospital charges, mortality, and LOS than accidental trauma. Ongoing research focused on the relative impact of known risk factors and resource utilization is needed.

Impact of the Affordable Care Act on Disparities in Access to and Outcomes After Coronary Artery Bypass Grafting

ObjectivesThe aim of this study was to examine the effect of implementation of the Affordable Care Act’s Medicaid expansion on access to and outcomes after coronary artery bypass grafting (CABG) surgery.MethodsRetrospective observational study utilizing the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2011 to 2016. The southern region of the USA was used as a control and the western region as the implementation group. Univariate regression models and interrupted time series models were created to evaluate and assess the impact of the Affordable Care Act’s Medicaid expansion on mortality after CABG with respect to patient race.ResultsFrom 2011 to 2016, a total of 117,819 isolated CABG operations were identified in the specified regions using the HCUP NIS. Of these, 89,918 were performed in the southern region, and the remainder were performed in the western region. The proportion of African American patients with Medicaid increased significantly in the western region after the ACA Medicaid expansion, from 13.1 to 17.6%, p = 0.034. There was no significant increase seen in the number of African American patients with Medicaid in the southern region. We found that overall, Black patients had higher mortality after CABG as compared to white patients (OR 1.15, p = 0.02); however, when broken down by region we found higher mortality among African American patients in the southern region only, with no statistically significant difference in mortality between white and Black patients in the western region.ConclusionsImplementation of the Affordable Care Act increased access to Medicaid among Black Americans but did not necessarily decrease the disparity in access to CABG or mortality after CABG between Black and white patients. When it comes to racial disparities in mortality after CABG, there are significant regional and geographic variations which have not been previously described. This finding has important implications for the development of policy and other strategies that aim to reduce these disparities.

Demographic Characteristics and Outcomes in Patients with ALL and Previous Diagnosis of CML or MDS

Introduction: Acute Lymphocytic Leukemia (ALL) is a malignancy of lymphocytes characterized by uncontrolled proliferation of immature cells which ultimately leads to the replacement of bone marrow and other lymphoid organs. Typically, ALL develops in a previously healthy person however, it can rarely progress from an existing Myelodysplastic syndrome (MDS) or Chronic Myeloid Leukaemia (CML). In this study, we highlight the baseline characteristics and outcomes in patients with ALL and previous diagnoses of MDS or CML. Methodology: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) was queried to identify all ALL admissions between 2016-2019 in adult patients with a secondary diagnosis of MDS or CML using International Classification of Disease 10th Revision (ICD-10) codes. We evaluated baseline characteristics including Age, Sex, Race, Insurance type, Median household income, Region of hospital, Hospital Bed size, and Location/teaching status of hospital, in addition to mortality as the primary outcome and length of the hospital stay (LOS) and total hospital charges (THC) as secondary outcomes. Results: A total of 27385 patients with ALL were hospitalized and among them, 195 (0.7%) had a secondary diagnosis of CML. The mean age of the CML group was non-significantly higher (51.3 vs. 48.5) compared to those without CML. In patients with ALL and previous CML, there was a higher proportion of female sex, black race, Medicaid insurance, hospitalizations in south and west region, small sized hospitals in comparison to those with ALL without previous CML. though not statistically significant as reflected in Table (1). There was no difference in, Charlson comorbidity index, and household income. CML group had non-significantly lower odds of mortality in comparison to patients without CML (5.1% vs 5.8 % P=0.84) with adjusted odds ratio (AOR) of 0.79 (p=0.75 CI 0.18-3.34). Patients with a higher Charlson comorbidity index had significantly higher odds of mortality (1.68 with P=0.022). Among secondary outcomes, the CML group had a higher mean length of stay (20.3 vs 18) and lower THC ($240161 vs $279386) although this did not reach statistical significance. Out of all patients admitted with ALL, 180 (0.6%) had a secondary diagnosis of MDS, and the mean age of the MDS group was higher (62.6 vs. 48.4) compared to the other group. In ALL patients with previous MDS group, there was a significantly higher proportion of people with Medicare insurance, and hospitalization in the south and west region. There was a trend towards an increased proportion of Female sex, white Race, lower median household income, small sized hospitals in comparison to ALL without previous MDS group though it was not statistically significant (Table1). Patients with ALL and a previous Diagnosis of MDS had non-significantly higher odds of mortality (11% vs 6 %) in comparison to patients without MDS (AOR 1.7 p=0.32 CI 0.60-6.65). Among the secondary outcomes, the MDS group had a non-significantly lower mean LOS (12 vs 18) and lower THC ($243389 vs $ 279112). Conclusion: In this analysis, we found that sex, race, insurance type, median household income, and region of the hospitalization impacts the risk of developing ALL after MDS or CML. Prospective studies are required to look into the cause of these differences as it can be related to the socioeconomic disparities or specific gene mutations more prevalent in certain races of regions. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 14579: Predictors of In-Hospital Mortality in Coronary Artery Dissection Patients: An Insight From the National Inpatient Sample Database

Background: There is a paucity of data on predictors of mortality in all-cause coronary artery dissection patients. The purpose was to study the baseline characteristics, associated co-morbidities, and in-hospital mortality in coronary artery dissection patients using the Healthcare Cost and Utilization Project National Inpatient Sample database. Methods: The Healthcare Cost and Utilization Project administrative longitudinal database contains encounter-level information on inpatient stays, emergency department visits, and ambulatory surgery in all U.S. hospitals. We performed a cross-sectional analysis on 25005 patients diagnosed with coronary artery dissection during hospitalization from January 2016 to December 2018. The primary outcome was in-hospital mortality. Results: Of the total patient population, 25005 patients were found to have coronary artery dissection. All patients with ages ≥ 18 were included in the study (24980). The observed overall in-hospital mortality was 6.0% (1498 patients out of 24980). The higher mortality was observed in age group &gt;80 years when compared to the age group &lt;40 years (adjusted odds ratio: 8.5; 95% confidence interval: 5.7 to 12.4; p-value &lt; 0.01). Patients with peripheral vascular disease (adjusted odds ratio: 2.0; 95% confidence interval: 1.7 to 2.3; p-value &lt; 0.01) and cardiogenic shock (adjusted odds ratio: 10.8; 95% confidence interval: 9.5 to 12.2; p-value &lt; 0.01) showed higher mortality (Table 1,2). Conclusion: To the best of our knowledge, this is the largest population-based study investigating the predictors of in-hospital mortality in all-cause coronary artery dissection patients. Our analysis showed higher mortality with increasing age and in patients who developed cardiogenic shock and those with peripheral vascular disease.

Abstract 14294: Patients With Chronic Kidney Disease Have a Lower Odds of Ventricular Tachycardia Than General Population

Introduction: Monomorphic ventricular tachycardia (VT) often results from scar formation secondary to chronic ischemia or myocardial infarction. Microvascular disease is a known risk factor for myocardial dysfunction as it can lead to focal scar formation and thus increase the risk for VT. Chronic kidney disease (CKD) is characterized by microvascular dysfunction on the basis of animal studies through metabolic, endocrine, and immune pathways and therefore was suspected to be a risk factor for developing VT. Methods: We conducted a retrospective cohort study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2019 database to investigate hospitalizations for patients aged 18 years old or older with VT based on stage of CKD. Comorbidities were identified through their international classification of diseases, 10th revision (ICD-10 codes) recorded in the discharge record for each hospitalization. Records having cocaine or other stimulants were excluded. An alpha (p) value less than 0.05 was considered statistically significant. Results: A total of 456,925 patients were identified based on the inclusion and exclusion criteria above. The number of patients that had VT with and without CKD was 163,760 (3%) and 293,165 (1%), respectively. However, after an adjusted analysis was performed we discovered that the odds ratio of VT in patients with CKD was 0.735 (95% CI 0.720-0.751). Conclusions: In our retrospective cohort study, patients with CKD were found to have a lower risk of developing VT. This is suspected to be due to electrolyte derangements, such as hyperkalemia and hypermagnesemia, commonly seen in these patients and thus creating a cardioprotective electrolyte balance.

Abstract 13504: The New Cigarette? Cannabis Use as a Potential Risk Factor for Acute Coronary Syndrome

Introduction: With new legislation becoming more lenient regulating recreational cannabis use in the United States, the prevalence of cannabis has doubled since 2002 and continues to rise. While there have been some reports of the benefits of cannabis, medical literature has identified several adverse cardiovascular events. Cannabis as a significant risk factor for the acute coronary syndrome (ACS) has been suspected to be attributed to vascular inflammation and platelet activation as well as elevation in heart rate and blood pressure through sympathetic stimulation. Methods: We conducted a case-control study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2019 database to investigate hospitalizations for patients aged 18 years old or older with the primary diagnosis of ACS. Comorbidities were identified through their international classification of diseases, 10th revision (ICD-10 codes) recorded in the discharge record for each hospitalization. Records having cocaine or other stimulants were excluded. An alpha (p) value less than 0.05 was considered statistically significant. Results: Of the 34,948,093 records included in the study, 225,275 had a primary diagnosis of ACS, and 767,525 had evidence of cannabis use. The rate of cannabis use in the ACS group (2%, n= 4,490) was lower than the non-ACS group (2.2%, n=763,035, p&lt;0.001), while the rate of smoking was higher in the ACS group [49.5% (n=111,405) vs 31.2% (n=10,840,496), p&lt;0.001] . However, after adjusting for other cardiovascular risk factors in a multivariable logistic regression model, the odds of cannabis use were comparable to smoking (Table 1). Conclusions: In this retrospective case-control study, the odds of cannabis use were similar to the odds of smoking in the records with a primary admission diagnosis of ACS, highlighting cannabis as a strong potential cardiovascular risk factor. Prospective cohort studies are warranted to establish the causality.

Abstract 14785: Predictors of In-Hospital Mortality in Coronary Artery Aneurysm Patients: An Insight From the National Inpatient Sample Database

Background: There is limited literature on the mortality outcome of coronary artery aneurysms (CAA). The purpose was to study the baseline characteristics, associated co-morbidities, and in-hospital mortality in CAA patients using the Healthcare Cost and Utilization Project National Inpatient Sample database. Methods: The Healthcare Cost and Utilization Project administrative longitudinal database contains encounter-level information on inpatient stays, emergency department visits, and ambulatory surgery in all U.S. hospitals. We performed a cross-sectional analysis on 10230 patients diagnosed with CAA during hospitalization from January 2016 to December 2018. The primary outcome was in-hospital mortality. Results: Of the total patient population, 10230 patients were found to have CAA. All patients with ages ≥ 18 were included in the study (8660). Hypertension, diabetes mellitus, and peripheral vascular disease were predominant co-morbidities. The observed overall in-hospital mortality was 2.9% (251 patients out of 8660). The highest mortality was observed in patients with acute myocardial infarction (adjusted odds ratio: 80.9; 95% confidence interval: 51.9 to 126.1; p-value &lt; 0.01). The age group &gt;80 years had higher mortality when compared to the age group &lt;40 years (adjusted odds ratio: 9.1; 95% confidence interval: 2.9 to 29.3; p-value &lt; 0.00). Smoking (adjusted odds ratio: 46.6; 95% confidence interval: 31.3 to 69.2; p-value &lt; 0.01) and peripheral vascular disease (adjusted odds ratio: 4.0; 95% confidence interval: 2.7 to 6.0; p-value &lt; 0.01) also had a significant impact on mortality (Table 1,2). Conclusion: Our analysis showed higher mortality in CAA with increasing age and in patients who developed acute myocardial infarction, with smoking and peripheral vascular disease also having a significant impact.

Abstract 10093: Association Between B-Thalassemia and Atrial Fibrillation: Insights From the United States National Inpatient Sample

Introduction: β-thalassemia (BT) disease requires a lifelong blood transfusion. Despite improved prognosis with transfusion and chelation therapy, the iron overload can predispose to atrial fibrillation (AF). We sought to study the impact of AF on BT patients through large database analysis. Methods: The study used the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) for 2016-2019. Adult BT admissions were included. BT admissions were identified using ICD-10 code (D56.1). Admissions were stratified according to AF presence. A series of multivariate logistic regression was performed to evaluate the impact of atrial fibrillation on BT and to account for potential confounders. Continuous variables were compared using Student t-test, and categorical variables were compared using ꭓ2 tests. Subgroup analysis according to sex was performed. Outcomes evaluated were in-hospital mortality and prolonged length of stay (LOS) ≥ 75th percentile. Results: A total of 17,150 admissions were included, of which 2,100 (12.2%) had an associated diagnosis of AF. Admissions with AF were older (72.1 vs 47.3, P&lt;0.001), white race (66% vs 41%), and more likely to have congestive heart failure (CHF), hypertension, valvular heart disease, and renal disease. BT was associated with higher AF prevalence than non-BT admissions across all age groups. AF was not associated with increased risk of in-hospital mortality in the general cohort nor increased LOS (adjusted odds ratio [aOR]: 1.36 [0.67-2.78], P=0.398, and 1.00 [0.78-1.29], P=0.997, respectively). In subgroup analysis, including only female admissions, AF was associated with increased in-hospital mortality (aOR: 2.73 [1.09-6.8], P=0.031) but not with prolonged LOS (P=0.218). Predictors of in-hospital mortality were age, CHF, and liver disease, while predictors of prolonged LOS were Diabetes Mellitus in addition to CHF and age. Conclusions: We reported significant findings. First, AF is more common in BT compared to the general population, irrespective of age. Second, AF was independently associated with increased mortality in BT females. Third, CHF, liver disease, diabetes, and increased age are poor outcome predictors.

Changes in Insurance Coverage and Emergency Surgery Rates Associated with Medicare Eligibility

INTRODUCTION: For millions of Americans with common surgical conditions, lack of health insurance may delay care until their condition requires an emergency operation. However, the direct effects of gaining health insurance on reducing emergency surgery rate have not been well described. METHODS: Using data from the 2010 to 2018 Healthcare Cost and Utilization Project National Inpatient Sample, we identified patients 50 to 80 years of age who underwent colectomy, ventral hernia repair, or abdominal aortic aneurysm repair. Outcomes of interest were uninsured rate and emergency (vs elective) surgery rate. We performed regression discontinuity (RD) analyses using a second order polynomial design to evaluate for changes associated with aging into Medicare eligibility at age 65. Models were adjusted for sex, race/ethnicity, income, rurality, weekend admission, operation, and year. RESULTS: Our weighted sample included 1,974,240 admissions. For patients ages 64 years vs 66 years the unadjusted uninsured rates were 3.8% vs 0.4% and the unadjusted emergency surgery rates were 36.3% vs 33.3% (p < 0.01 for both). On adjusted regression discontinuity analysis, aging into Medicare eligibility was associated with a 3.9 percentage-point drop in the uninsured rate and a corresponding 3.6 percentage-point drop in the emergency surgery rate (Figure; p < 0.01 for both). These findings were robust to alternative specifications of the RD model.CONCLUSION: Increased rate of insured patients was correlated with a subsequent decrease in emergency surgery rate for major abdominal operation. While access to high-quality surgical care is multifaceted, these results suggest that efforts to improve health insurance coverage may reduce rate of potentially preventable emergency surgery.

Epidemiology of revision shoulder arthroplasty in the United States: incidence, demographics, and projected volume from 2018 to 2030

BackgroundThorough understanding of surgical indications and type of revision shoulder arthroplasty (SA) performed aids policy making decisions, resource allocation, and research into cost and utilization. The purpose of this study was to determine indications for and the type of revision SA performed in the United States. MethodsHealthcare Cost and Utilization Project National Inpatient Sample database was used to analyze clinical, demographic, and economic data from 61,615 revision SA procedures performed from 2012 to 2018. The prevalence of revision procedures was calculated for population subgroups in the United States that were stratified according to age, sex, diagnosis, primary payer class, and type of hospital using the most recent year of data. The indication for revision and average length of stay after revision surgery were also determined for each type of revision arthroplasty procedure. Linear regression was used to estimate procedures through 2030, using incidence values from 2012 to 2018. ResultsAnnual volume of revision SA in the United States increased by 153% from 5650 procedures in 2012 to 14,300 procedures in 2018. Linear regression predicted a continued increase in this annual volume, increasing to 37,329 revision SA procedures by 2030. The most common SA procedure performed in the revision setting was reverse shoulder arthroplasty and the most common indications for revision were for instability (25%) and infection (21%). Revision SA procedures were most commonly performed in patients aged 60-70 years, with a mean age of 66.6 years and with Medicare insurance (66%). The mean length of hospital stay for revision SA was 3.1 days. ConclusionAnnual volume of revision SA increased by 153% from 2012 to 2018 in the United States with a continued predicted increase through 2030. Instability and infection are the most common indications for surgery. Reverse shoulder arthroplasty was the most commonly performed surgery in the revision setting.

1135P Adverse event (AE) burden of nivolumab-based immuno-oncology (IO) therapy with/without chemotherapy (chemo) for first-line (1L) advanced non-small cell lung cancer (aNSCLC)

Nivolumab + ipilimumab (N + I) alone or with limited chemo (LC; up to 6 weeks [wks]) provide new 1L treatment (tx) options for aNSCLC; but the relative contributions of the different agents to the AE profile over time have not been assessed. Here, we quantified the AE rates and associated costs for N + I, N + I + LC, and N + chemo (C; 12+ wks) over time during tx for 1L aNSCLC. Exposure-adjusted event rates (EAERs) were calculated as the number of occurrences of all-cause grade 3–5 AEs per patient-year (PY), using individual patient data from the CheckMate 227 Parts 1 and 2 and CheckMate 9LA trials (minimum follow-up: 48, 38, and 23 months, respectively). EAERs were estimated for the overall trial period and at 5 pre-specified time periods (wks 0–6, 7–12, 13–24, 25–48, and 49+) to assess the impact of tx on AE burden. AE costs per patient were estimated as the rates of grade 3–5 AEs (with any-grade incidence ≥15%) multiplied by the corresponding unit hospitalization costs for AE management obtained from the 2019 US Healthcare Cost and Utilization Project National Inpatient Sample database. EAERs of all-cause grade 3–5 AEs per PY were lower with N + I (4.8) vs N + I + LC (7.0) and N + C (6.1) at wks 0–6 and lower with N + I (4.0) and N + I + LC (3.1) vs N + C (5.2) at wks 7–12, when chemo was administered; EAERs for the total exposure time period were similar in the N + I (2.6), N + I + LC (2.5), and N + C (2.5) tx groups (Table). EAERs continued to decline in subsequent wks in all 3 tx groups. Overall AE costs were lower with N + I ($6560) and N + I + LC ($7492) vs N + C ($11,731); similar trends were seen per time period.Table: 1135PTime period, wksEAERaAE costb, $N 3 mg/kg Q2W + I 1 mg/kg Q6W n = 576N 360 mg Q3W + I 1 mg/kg Q6W + LC Q3W, up to 2 cycles n = 358N 360 mg Q3W + C Q3W, 4+ cycles n = 547N 3 mg/kg Q2W + I 1 mg/kg Q6W n = 576N 360 mg Q3W + I 1 mg/kg Q6W + LC Q3W, up to 2 cycles n = 358N 360 mg Q3W + C Q3W, 4 + cycles n = 5470–64.87.06.12033315537157–124.03.15.216501157332813–242.52.22.79441080237425–481.71.71.210571423118049+1.51.11.08756761134Overall2.62.52.56560749211,731aPer PY (defined as the total exposure time [time between date of first dose and the earliest among last dose date + 30 days, cutoff date, and date of death] for each patient at risk of AE); bPer patient. 1 cycle = 3 wks; Q2W, every 2 wks; Q3W, every 3 wks; Q6W, every 6 wks. Open table in a new tab aPer PY (defined as the total exposure time [time between date of first dose and the earliest among last dose date + 30 days, cutoff date, and date of death] for each patient at risk of AE); bPer patient. 1 cycle = 3 wks; Q2W, every 2 wks; Q3W, every 3 wks; Q6W, every 6 wks. Higher incidence of AEs and AE costs associated with N + I + LC and N + C vs N + I correlated with the time when chemo was administered during tx; toxicities and costs declined over time after chemo was completed. Results imply an overall lower AE cost burden with 1L N + I compared with IO + chemo-based tx regimens for aNSCLC.

Preventable Hospitalization Trends Before and After the Affordable Care Act

The Patient Protection and Affordable Care Act aimed to increase the number of individuals with health insurance, which may lead to adequate primary care management and reduced rates of preventable hospitalizations. To investigate the rates of preventable hospitalization after the passing of the Affordable Care Act in 2010 and Medicaid expansion in 2014 across 26 states, a population-based study was conducted using the Healthcare Cost and Utilization Project National Inpatient Sample database from 2005-2017. A logistic regression and trend analysis was performed to assess the changes in preventable hospitalization rates over time and the impact of policy changes on the rate of preventable hospitalization. Individuals were included if they were aged between 18 and 64 years and had a preventable quality indicator International Classification of Diseases, Ninth or Tenth Revision code as determined by the Agency for Healthcare Research and Quality. More than 45 million preventable-hospitalization admissions were reported between 2005 and 2017. There was a significant decrease in preventable hospitalization rates after the passing of the Affordable Care Act from 12.0% to 10.8% (p<0.01) and from 11.5% to 10.6% (p<0.01) after Medicaid expansion. Bacterial pneumonia declined from 1.5% to 0.6% (p<0.01), along with chronic obstructive pulmonary disease and asthma in older adults from 1.9% to 1.7% (p=0.01) after the expansion. States that have not implemented Medicaid expansion should make it a priority because it may lead to a reduction in preventable hospitalization rates. Furthermore, preventable hospitalization rates may be considered a quality measure to examine the accessibility and effectiveness of primary care intervention.

Obstetric outcomes in women with vulvodynia or vaginismus.

Vulvodynia and vaginismus are common chronic vulvar pain disorders for which there is a paucity of literature on pregnancy outcomes of affected women. The study objective was to evaluate the associations between vulvodynia and vaginismus and obstetric outcomes. We performed a retrospective cohort study including all birth-related admissions from 1999 to October 2015 extracted from the Healthcare Cost and Utilization Project-National Inpatient Sample from the United States. Women with vulvodynia or vaginismus were identified using the appropriate ICD-9 codes. Multivariate logistic regression models, adjusted for baseline maternal characteristics, were performed to evaluate the effect of vulvodynia and vaginismus on obstetrical and neonatal outcomes. A total of 879 obstetrical patients with vulvodynia or vaginismus were identified in our cohort of 13,792,544 patients admitted for delivery in US hospitals between 1999 and 2015, leading to an overall prevalence of 6 cases per 100,000 births. Between 1999 and 2015, the annual prevalence of vulvodynia or vaginismus rose from 2 to 16 cases per 100,000. Vulvodynia and vaginismus were associated with increased risks of eclampsia, chorioamnionitis, post-term pregnancy, cesarean delivery, instrumental vaginal delivery, blood transfusions, prolonged hospital stays, congenital anomalies and intrauterine growth restriction. Vulvodynia and vaginismus in pregnancy appears underreported in pregnancy compared to reported population rates. Prevalence of reporting seems to have increased in the last decades and is associated with increased risks of maternal and newborn morbidities. Obstetrical caregivers should be aware of the underreporting of these conditions and the associated adverse effects when counseling obstetrical patients.

Impact of Bariatric Surgery on Outcomes of Patients with Rheumatoid Arthritis: a Propensity Score-Matched Analysis of US Nationwide Inpatient Sample, 2005-2018.

Obesity has been considered one of the risk factors with more critical disease progression and poor treatment response in rheumatoid arthritis (RA). We herein utilized an extensive, nationally representative database to examine the impact of bariatric surgery on clinical outcomes in RA patients. This retrospective analysis utilized nationally representative data of the Healthcare Cost and Utilization Project-National Inpatient Sample database (HCUP-NIS) from 2005 to 2018. Associations between bariatric surgery and in-hospital outcomes of RA patients were determined by the univariate and multivariate logistic regression analyses. After 1:4 propensity score (PS) matching, totally 33,075 hospitalized adults with RA were included as primary cohort for subsequent analyses. Among them, 6615 patients had prior bariatric surgery and 26,460 patients had not. After adjusting for relevant confounders in the multivariate analysis, prior bariatric surgery was significantly and independently associated with reduced odds for any morbidity and in-hospital mortality (aOR: 0.41, 95% CI: 0.27-0.61, p < 0.01) as compared with no prior bariatric surgery. Adults with RA who had prior bariatric surgery also had a significantly lower odds for having unfavorable discharge and prolonged length of stay (LOS) as compared with those without bariatric surgery (aOR: 0.43, 95% CI: 0.39-0.46, p < 0.01). Prior bariatric surgery is associated with better in-patient outcomes among RA, including in-hospital mortality, major morbidities, discharge destination, and LOS.

Hospital Length of Stay in Patients with and without Serious and Persistent Mental Illness: Evidence of Racial and Ethnic Differences.

Background: Prior studies have documented racial and ethnic differences in mental healthcare utilization, and extensively in outpatient treatment and prescription medication usage for mental health disorders. However, limited studies have investigated racial and ethnic differences in length of inpatient stay (LOS) in patients with and without Serious and Persistent Mental Illness. Understanding racial and ethnic differences in LOS is necessary given that longer stays in hospital are associated with adverse health outcomes, which in turn contribute to health inequities. Objective: To examine racial and ethnic differences in length of stay among patients with and without serious and persistent mental illness (SPMI) and how these differences vary in two age cohorts: patients aged 18 to 64 and patients aged 65+. Methods: This study employed a retrospective cohort design to address the research objective, using the 2018 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. After merging the 2018 National Inpatient Sample’s Core and Hospital files, Generalized Linear Model (GLM), adjusting for covariates, was applied to examine associations between race and ethnicity, and length of stay for patients with and without SPMI. Results: Overall, patients from racialized groups were likely to stay longer than White patients regardless of severe mental health status. Of all races and ethnicities examined, Asian patients had the most extended stays in both age cohorts: 8.69 days for patients with SPMI and 5.73 days for patients without SPMI in patients aged 18 to 64 years and 8.89 days for patients with SPMI and 6.05 days for patients without SPMI in the 65+ cohort. For individuals aged 18 to 64, differences in length of stay were significantly pronounced in Asian patients (1.6 days), Black patients (0.27 days), and Native American patients/patients from other races (0.76 days) if they had SPMI. For individuals aged 65 and older, Asian patients (1.09 days) and Native American patients/patients from other races (0.45 days) had longer inpatient stays if they had SPMI. Conclusion: Racial and ethnic differences in inpatient length of stay were most pronounced in Asian patients with and without SPMI. Further studies are needed to understand the mechanism(s) for these differences.

Racial and socioeconomic factors associated with palliative care utilization in pancreatic cancer: An analysis of National Inpatient Sample.

e16296 Background: Palliative care (PC) has been validated as a crucial component in end-of-life quality. Despite the higher PC utilization in cancer patients than other conditions, some studies have raised concern of systemic inequality in PC utilization. PC has a significant role in the care of pancreatic cancer, especially due to the poor prognosis. Here, we investigate the sociodemographic factors associated with the recent trend of PC utilization in pancreatic cancer. Methods: We used the Healthcare Cost and Utilization Project National Inpatient Sample database, all-payer inpatient care database in the United States, with data years 2016-2019. The end-of-life hospitalizations were defined as adult patients (age at least 18 years old) who were hospitalized at least three days and passed away. The cases were identified with International Classification of Diseases (ICD) 10th edition for pancreatic cancer (C25.0-25.9) within the top three diagnoses. Prevalence of PC consultation could be estimated with the billable code Z51.5. The factors that were statistically associated with PC utilization in univariable analysis would be included in the final multivariable logistic regression model. Charlson Comorbidity Index was used to adjust for comorbidities. Hospital factors such as size and base (rural, urban, urban teaching) were included in the analysis. Results: Among 339,318 adult patients who were hospitalized at least three days and passed away, 2,011 cases had pancreatic cancer within top three diagnosis codes. 1576 (78.4%) patients were at least age 60 or above. 1,275 (63.4%) of them had PC consult at their end-of-life. There was a significant yearly trend of increasing PC utilization (Cochran-Armitage test p-value &lt; 0.05). Male, African American, lower income, and rural area were significantly associated with less PC consult in multivariable regression model. The adjusted odds ratio (aOR) of PC consult was 0.66 (p &lt; 0.005) in African American. There was significantly more PC utilization in the top 25% income group (vs the bottom 25% counterpart, aOR 1.35; p &lt; 0.05) and in urban hospitals (vs rural hospitals, aOR 1.80 in nonteaching; aOR 1.88 in teaching; p &lt; 0.001). Conclusions: There was a trend of increasing PC utilization in pancreatic cancer. Nevertheless, racial and socioeconomic factors were still significantly associated with the PC utilization. Further study and systemic policy approach are required to investigate and address such disparities and promote the PC utilization.