ABSTRACT
Background: This study examined ventilator utilization, ventilator-associated pneumonia (VAP) incidence, and mortality among non-COVID patients requiring mechanical ventilation during 2019 and 2020. Methods: The Nationwide Inpatient Sample database was queried for adult hospitalizations with mechanical ventilation using ICD-10 procedure codes, excluding COVID-19 patients and minors. VAP rates were calculated per 1000 adults ventilated. Outcomes included ventilation rates, VAP incidence, and mortality odds between prepandemic and pandemic-exposed hospitalizations. Results: Analyzing 1,533,775 hospitalizations, the pandemic-exposed had more male patients (57.6% vs 56.2%, P < 0.001) and nonelective admissions (95.4% vs 94.1%; P < 0.001). Non-COVID patients had a 4.5% increase in ventilator utilization in the pandemic compared with the prepandemic period (P < 0.001). Pandemic VAP incidence was 17 cases per 1000 adults ventilated, compared to 11 cases in the prepandemic period (P < 0.001). Mortality rates increased from 26.9% to 31.4%, with 314 mortalities per 1000 ventilated pandemic patients compared with 269 in the prepandemic period (adjusted odds ratio 1.13; 95% confidence interval 1.12-1.15; P < 0.001). Conclusion: Significant ventilator utilization, VAP rates, and mortality increases occurred during the COVID-19 pandemic.
ABSTRACT
Background Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by various clinical manifestations. Despite efforts to improve outcomes, mortality rates remain high, and certain disparities, including gender, may influence prognosis and mortality rates in SLE. This study aims to examine the gender disparities in outcomes of SLE hospitalizations in the US. Methods We conducted a retrospective analysis of the Nationwide Inpatient Sample (NIS) database between 2016 and 2020. The NIS database is the largest publicly available all-payer database for inpatient care in the United States, representing approximately 20% of all hospitalizations nationwide. We selected every other year during the study period and included hospitalizations of adult patients (≥18 years old) with a primary or secondary diagnosis of SLE using International Classification of Diseases, Tenth Revision (ICD-10) codes. The control population consisted of all adult hospitalizations. Multivariate logistic regression was used to estimate the strength of the association between gender and primary and secondary outcomes. The regression models were adjusted for various factors, including age, race, median household income based on patients' zip codes, Charlson comorbidity index score, insurance status, hospital location, region, bed size, and teaching status. To ensure comparability across the years, revised trend weights were applied as the healthcare cost and use project website recommends. Stata version 17 (StataCorp LLC, TX, USA) was used for the statistical analyses, and a two-sided P-value of less than 0.05 was considered statistically significant. Results Among the 42,875 SLE hospitalizations analyzed, women accounted for a significantly higher proportion (86.4%) compared to men (13.6%). The age distribution varied, with the majority of female admissions falling within the 30- to 60-year age range, while most male admissions fell within the 15- to 30-year age category. Racial composition showed a slightly higher percentage of White Americans in the male cohort compared to the female cohort. Notably, more Black females were admitted for SLE compared to Black males. Male SLE patients had a higher burden of comorbidities and were more likely to have Medicare and private insurance, while a higher percentage of women were uninsured. The mortality rate during the index hospitalization was slightly higher for men (1.3%) compared to women (1.1%), but after adjusting for various factors, there was no statistically significant gender disparity in the likelihood of mortality (adjusted odds ratio (aOR): 1.027; 95% confidence interval (CI): 0.570-1.852; P=0.929). Men had longer hospital stays and incurred higher average hospital costs compared to women (mean length of stay (LOS): seven days vs. six days; $79,751 ± $5,954 vs. $70,405 ± $1,618 respectively). Female SLE hospitalizations were associated with a higher likelihood of delirium, psychosis, and seizures while showing lower odds of hematological and renal diseases compared to men. Conclusion While women constitute the majority of SLE hospitalizations, men with SLE tend to have a higher burden of comorbidities and are more likely to have Medicare and private insurance. Additionally, men had longer hospital stays and incurred higher average hospital costs. However, there was no significant gender disparity in the likelihood of mortality after accounting for various factors.
ABSTRACT
BACKGROUND: A large body of research has been conducted on the "weekend effect," which is the reportedly increased risk of adverse outcomes for patients admitted to the hospital on weekends versus those admitted on weekdays. This effect has been researched in numerous patient populations, including sub-populations of end-stage renal disease (ESRD) patients, with varying conclusions. OBJECTIVES: To assess whether differences in in-hospital mortality, access to renal replacement therapy (RRT), time to RRT, and other important outcomes exist in patients with ESRD or patients on RRT admitted on the weekend versus weekdays. DESIGN AND SETTING: A retrospective cohort study was conducted using the 2018 Nationwide Inpatient Sample. Patients were included if they were adults with a principal or secondary diagnosis of ESRD or if they were admitted with a diagnosis related to initiation, maintenance, or complications of RRT. Patients admitted between midnight Friday and midnight Sunday were classified as weekend admissions. Primary outcome measurements included in-hospital mortality, in-hospital dialysis (peritoneal dialysis, hemodialysis, and continuous RRT), and renal transplantation (TP). Secondary outcomes included length of hospital stay (LOS) and total hospitalization charges. RESULTS: The study included 1,144,385 patients who satisfied the inclusion criteria. Compared with patients admitted on weekdays, patients with ESRD admitted on weekends had 8% higher adjusted odds of in-hospital mortality (OR: 1.08; 95% CI: 1.03-1.13; p = 0.002), 9% lower adjusted OR of any RRT over the weekend than on weekdays (OR: 0.91; 95% CI: 0.89-0.93; p = 0.000), lower RRT rates (within 24 hours) (adjusted OR: 0.71; 95% CI: 0.70-0.73; p = 0.000), higher odds of renal TP (adjusted OR: 1.32; 95% CI: 1.20-1.45; p = 0.000), and higher hospitalization charges (mean adjusted increase: $1451; p = 0.07). LIMITATIONS: The limitations of the study include the use of retrospective data and an administrative database. CONCLUSION: Compared with weekday admissions, patients with ESRD admitted on weekends had higher odds of mortality, higher mean hospitalization charges, and higher odds of renal TP. They had lower overall RRT rates, and a longer time to first RRT. However, the average LOS was similar for both weekend and weekday admissions.
