Correlations Between Psychiatric Disorders and Perioperative Outcomes after Lumbar Fusions: An Analysis of the National Inpatient Sample (2009-2020).

BACKGROUND: Preoperative diagnoses of psychiatric disorders have a demonstrated association with higher rates of perioperative complications. However, recent studies examining the influence of psychiatric disorders on lumbar fusion outcomes are scarce. Our objective was to determine the relationship between the most common psychiatric disorders and perioperative outcomes after lumbar fusion. METHODS: Demographic and perioperative data for patients who underwent lumbar spine fusion between 2009 and 2020 were collected from the National Inpatient Sample (NIS) database. These patients were divided into two groups: those who were previously diagnosed with depression, bipolar disorder, or anxiety, and those who were not. Univariable and multivariable linear and logistic regression models were utilized to analyze the data. RESULTS: Of 2,877,241 patients identified in the NIS database as having undergone lumbar fusion, 647,951 had diagnosed psychiatric disorders, and the remaining 2,229,290 were the unaffected cohort. On multivariable analysis, patients diagnosed with psychiatric disorders had significantly increased odds of respiratory (odds ratio [OR]:1.09) and urinary (OR:1.08) complications, and experienced higher odds of mechanical injury (OR:1.27), fusion disorders (OR:1.62), dural tears (OR:1.08), postprocedure anemia (OR:1.29), longer hospital stays, and higher total costs, (p<0.001). Conversely, patients with psychiatric disorders had lower odds of neurologic injury (OR:0.8) and wound complications (OR:0.91) (p<0.05). CONCLUSION: Patients with depression, bipolar disorder, or anxiety exhibited higher rates of certain types of complications. However, they appeared to have fewer neurological injuries and wound complications than patients without these psychiatric disorders. These findings highlight the necessity for additional studies to elucidate underlying reasons for these disparities.

Predictors and inpatient outcomes of aspiration pneumonia in patients with percutaneous endoscopic gastrostomy tube: An analysis of national inpatient sample.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tubes are commonly inserted to provide a route for enteral feeding in patients who are unlikely to have adequate oral intake for prolonged periods of time. This study aims to determine the incidence of aspiration pneumonia among PEG tube patients. METHODS: We conducted a retrospective analysis of NIS database records (October 2015 to December 2020) for patients with PEG. Primary and secondary outcomes were assessed using ICD-10-CM/PCS codes. RESULTS: We identified a total of 2,053,560 weighted hospitalizations involving patients with PEG tube. Those with aspiration pneumonia were older (mean age 67.01 vs. 63.85, p<0.01) and were predominantly male. At baseline, the aspiration pneumonia group had higher rates of dementia (AOR 1.22, 95% CI: 1.19-1.24), malnutrition (AOR 1.13, 95% CI: 1.11-1.15), cerebrovascular disease (AOR 1.29, 95% CI 1.25-1.33), cardiac arrhythmias (AOR 1.05, 95% CI 1.03-1.08), congestive heart failure (AOR 1.20, 95% CI 1.17-1.24), COPD (AOR 1.18, 95% CI 1.15-1.20), paralysis (AOR 1.06, 95% CI 1.03-1.09), alcohol abuse (AOR 1.12, 95% CI 1.07-1.17), and psychoses (AOR 1.07, 95% CI 1.02-1.13). Those with aspiration pneumonia exhibited increased mortality (p<0.01, AOR 1.59, 95% CI 1.54-1.65), higher incidence of severe sepsis (AOR 2.03, 95% CI 1.98-2.07) and longer hospital stays, and accrued greater hospital charges (p<0.01). Notably, while GERD is typically considered a risk factor for AP, our findings indicated that GERD was associated with a decreased risk of AP in this patient population. CONCLUSION: Patients with a PEG tube who develop aspiration pneumonia experience increased mortality rates, extended hospitalizations, a higher frequency of septic shock, and augmented healthcare consumption. Notably, old male, congestive heart failure, cerebrovascular disease, dementia, and COPD play a pivotal role in predicting these outcomes.

The impact of liver cirrhosis on in-hospital outcomes among patients hospitalized for cardiogenic shock: A propensity score matched retrospective cohort study.

BACKGROUND: Cardiogenic shock poses a critical challenge characterized by diminished cardiac output and organ perfusion. Timely recognition and risk stratification are essential for effective intervention. Liver cirrhosis adds complexity due to its diverse systemic manifestations. The effect of liver cirrhosis on in-hospital outcomes in cardiogenic shock remains underexplored. METHODS: We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2020, matching cirrhotic patients with non-cirrhotic counterparts using propensity scores. The Cochran-Mantel-Haenszel method was used to assess the impact of cirrhosis on in-hospital mortality and complications. Simple linear regression models were used to assess differences in length of stay and cost of hospitalization. RESULTS: There were a total of 44,288 patients in the cohort, evenly distributed between the group with and without liver cirrhosis. Mean age of the cohort was 64 years (SD 12.5), 69.7 % were males, and 61.3 % were white. The overall in-hospital mortality rate in the cohort was 37.2 % with higher odds of in-hospital mortality in cirrhotic patients [OR = 1.3; 95 % CI (1.25, 1.35)]. Patients with cirrhosis exhibited increased risks of bowel ischemia, acute kidney injury, and sepsis compared to those without cirrhosis. Additionally, they had a heightened overall risk of major bleeding, particularly gastrointestinal bleeding, but a lower risk of intracranial hemorrhage and access site bleeding. Conversely, patients with cirrhosis had lower odds of deep vein thrombosis and pulmonary embolism, as well as arterial access site thrombosis and dissection, leading to reduced odds of peripheral angioplasty, thrombectomy, and amputation. Cirrhotic patients also had increased length of stay and cost of hospitalization. CONCLUSION: Liver cirrhosis exacerbates outcomes in cardiogenic shock, necessitating tailored management strategies. Further research is warranted to optimize patient care and understand the underlying mechanisms.

Frailty in elderly patients with acute colonic diverticulitis is associated with worse in-hospital outcomes: a nationwide analysis.

Background: Frailty has been identified as an independent predictor of mortality in the elderly. We investigated the effects of frailty status on in-hospital outcomes of acute colonic diverticulitis (ACD) in the elderly, using the Hospital Frailty Risk Score. Methods: We used the National Inpatient Sample (NIS) databases from 2016-2020 to identify patients aged ≥75 years hospitalized with ACD. Using a 1:1 matching method, we created propensity-matched cohorts of frail (Hospital Frailty Risk Score ≥5) and non-frail (Hospital Frailty Risk Score ≤4) patients within the ACD population. Results: We identified 53.3% ACD patients as frail. We matched 21,720 frail ACD patients to an equal number of non-frail ACD patients using propensity score matching. Frail patients exhibited significantly higher mortality rates, longer hospital stays, and greater median inpatient costs. Frail patients also experienced a greater number of complications, including abscess formation, intestinal perforation, gastrointestinal fistula formation, sepsis without shock, sepsis with shock, acute kidney injury, hypovolemic or hemorrhagic shock, need for blood transfusion, cardiac arrest, and need for intensive care (all P-values <0.001). Additionally, frail patients underwent open colectomy and colostomy procedures more frequently, while laparoscopic colectomies were performed less frequently (all P-values <0.001). Conclusions: In this nationwide analysis, frailty in ACD is strongly associated with worse mortality, longer hospital stays and higher costs, as well as a greater incidence of local and systemic complications. Furthermore, frailty is linked to a greater need for open colectomy and colostomy procedures.

Hormone replacement therapy and risk of pancreatic cancer in postmenopausal women: Evidence from the US National Inpatient Sample 2008-2018.

Background: Pancreatic cancer is a serious, usually fatal disease and one of the most aggressive malignancies. Research into whether hormone replacement therapy (HRT) might protect against pancreatic cancer has yielded mixed results. This study aimed to investigate the potential association between HRT and the risk of pancreatic cancer in postmenopausal women. Methods: This population-based, retrospective study extracted data from the US National Inpatient Sample (NIS) 2008-2018. Hospitalized females aged ≥55 years were eligible for inclusion. Associations between HRT, other study variables, and pancreatic cancer diagnosis were determined using univariate and multivariable regression analyses. Results: After 1:4 matching by age, data of postmenopausal women with (n = 35,309) and without (n = 141,236) HRT were included in the analysis. The mean age was 73.4 years. Multivariable analyses showed that women with HRT had significantly decreased odds of pancreatic cancer (adjusted OR [aOR], 0.69, 95 % CI: 0.53-0.90). Compared to patients without HRT, patients with HRT in the 55-64-year-old group (aOR 0.48, 95 % CI: 0.32-0.74), 65-74-year-old group (aOR 0.49, 95 % CI: 0.34-0.71), non-hypertensive group (aOR 0.55, 95 % CI: 0.38-0.79), and non-hyperlipidemia group (aOR 0.59, 95 % CI: 0.42-0.82) had significantly decreased odds of pancreatic cancer. Conclusions: In US postmenopausal women, HRT is associated with a reduced risk of pancreatic cancer, especially those aged 55-74 year. Further study is needed to clarify the mechanisms underlying the associations.

Impact of COVID-19 infection on the in-hospital outcome of patients hospitalized for heart failure with comorbid atrial fibrillation: Insight from the National Inpatient Sample (NIS) database 2020.

Introduction: Atrial fibrillation (AF) and heart failure (HF) commonly coexist, resulting in adverse health and economic consequences such as declining ventricular function, heightened mortality, and reduced quality of life. However, limited information exists on the impact of COVID-19 on AF patients that hospitalized for HF. Methods: We analyzed the 2020 U.S. National Inpatient Sample to investigate the effects of COVID-19 on AF patients that primarily hospitalized for HF. Participants aged 18 and above were identified using relevant ICD-10 CM codes. Adjusted odds ratios for outcomes were calculated through multivariable logistic regression. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications. Results: We identified 322,090 patients with primary discharge diagnosis of HF with comorbid AF. Among them, 0.73% (2355/322,090) also had a concurrent diagnosis of COVID-19. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 3.17; 95% CI 2.25, 4.47, p < 0.001), prolonged length of stay (ß LOS 2.82; 95% CI 1.71, 3.93, p < 0.001), acute myocarditis (aOR 6.64; 95% CI 1.45, 30.45, p 0.015), acute kidney injury (AKI) (aOR 1.48; 95% CI 1.21, 1.82, p < 0.001), acute respiratory failure (aOR 1.24; 95% CI 1.01, 1.52, p 0.045), and mechanical ventilation (aOR 2.00; 95% CI 1.28, 3.13, p 0.002). Conclusion: Our study revealed that COVID-19 is linked to higher in-hospital mortality and increased adverse outcomes in AF patients hospitalized for HF.

Frailty predicts adverse outcomes in older patients with pulmonary embolism.

AIM: This study aims to evaluate the impact of frailty on the outcomes of older patients with pulmonary embolism (PE). METHODS: Using the National Inpatient Sample database, we identified 288 070 patients aged 65 or older who were admitted with a primary diagnosis of PE from 2017 to 2019. Frailty was assessed using the Hospital Frailty Risk Score (HFRS), and patients were categorized into low-, intermediate-, and high-frailty-risk groups. Multivariate logistic regression was used to calculate adjusted odds ratios for all outcomes. RESULTS: These patients were categorized into low-risk (57.6%, 161 420), medium-risk (39.9%, 111 805), and high-risk (2.5%, 7075) groups. High-risk patients, predominantly females with multiple comorbidities, exhibited significantly higher mortality rates and adverse outcomes. The HFRS showed a good discriminating ability in predicting mortality (area under the receiver operating characteristic curve = 0.7796). Frailty was associated with increased use of advanced therapeutic interventions and critical care resources such as thrombolysis, catheter-directed therapies, inferior vena cava filter placement, mechanical ventilation, vasopressor use, and intensive care unit admission. CONCLUSION: Frailty markedly affects outcomes in older PE patients. The HFRS offers a valuable prognostic tool in this population, suggesting that integrating frailty assessments into clinical practice could enhance care strategies and improve patient outcomes. Our findings underscore the need for further research to refine frailty-based care paradigms. Geriatr Gerontol Int 2024; ••: ••-••.

Impact of Rheumatoid Arthritis on Hospitalized Inflammatory Bowel Disease Patients: Study of Demographics, Clinical Characteristics and Outcomes.

Background Inflammatory bowel disease (IBD), comprising ulcerative colitis and Crohn's disease gives rise to chronic intestinal inflammation. Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by joint and systemic inflammation. IBD is often linked with various autoimmune diseases, with RA being one of the most common. The coexistence of IBD and RA results in an increased inflammatory state, significantly compromising quality of life. Understanding the epidemiological and clinical characteristics of IBD patients with RA is essential for optimizing their management and improving outcomes. Methodology This retrospective observational study utilized data from the National Inpatient Sample (NIS) database from 2016 to 2020. Patients aged 18 years and older with a primary discharge diagnosis of IBD were included. This population was subdivided into two groups based on the presence and absence of RA. The primary objective was to compare outcomes between hospitalized IBD patients with and without RA. Key outcomes assessed included mortality rates, hospital length of stay (LOS), and total hospital charges. Secondary outcomes included the prevalence of comorbidities and IBD-related complications. Results From 2016 to 2020, a total of 455,655 hospitalized IBD patients were identified, among whom 10,590 (2.32%) had an underlying diagnosis of RA. Patients with both IBD and RA were significantly older than those without RA (mean age 52.21 vs. 45.72 years, p < 0.001) and had a higher proportion of females (72.51% vs. 53.27%, p < 0.01). RA patients exhibited a greater risk of cardiovascular risk factors compared to non-RA patients, including diabetes [adjusted odd ratio (aOR ) 1.12 (1.09-1.16)], hypertension [aOR 1.19 (1.07-1.33)], hyperlipidemia [aOR 1.61 (1.60-1.63)], chronic kidney disease stage 1-4 [aOR 1.35 (1.29-1.41)], coronary artery disease [aOR 1.67 (1.65-1.69)], and heart failure [aOR 1.45 (1.43-1.48)]. However, there were no significant differences in the rates of IBD-related complications or in-hospital mortality between the two groups. The mean hospital LOS was 5.15 days for RA patients and 4.95 days for non-RA patients (p = 0.08), with similar total hospital charges ($48,442.7 vs. $48,720.3, p = 0.88). Conclusion This study shows hospitalized IBD patients with and without RA have similar hospitalization outcomes, however, patients with RA have a higher cardiovascular risk. The findings emphasize the importance of integrated, multidisciplinary management approaches for these patients, addressing not only their gastrointestinal and rheumatologic conditions but also their associated comorbidities.

The changing landscape of geriatric care in acute myeloid leukemia: a 5-year analysis of inpatient mortality predictors, trends in mortality, and chemotherapy use.

Background: This study examined inpatient mortality factors in geriatric patients with acute myeloid leukemia (AML) using data from the 2016 to 2020 National Inpatient Sample. Methods: Identifying patients through ICD-10 codes, a total of 127,985 individuals with AML were classified into age categories as follows: 50.58% were 65 to 74 years, 37.74% were 75 to 84 years, and 11.68% were 85 years or older. Statistical analysis, conducted with STATA, involved Fisher's exact and Student's t tests for variable comparisons. Mortality predictors were identified through multivariate logistic regression. Results: Various hospital and patient-level factors, including an increase in age, race, a higher Charlson Comorbidity Index score, insurance status, and specific comorbidities such as atrial fibrillation and protein-calorie malnutrition, independently elevated the risk of inpatient mortality. Asthma, hyperlipidemia, and inpatient chemotherapy were linked to lower mortality. Although there was no statistically significant mortality rate change from 2016 to 2020, a decline in chemotherapy use in the eldest age group was noted. Conclusion: This study highlights the complexity of factors influencing inpatient mortality among geriatric patients with AML, emphasizing the need for personalized clinical approaches in this vulnerable population.

The Intersectionality of Race and Gender in Palliative Care Services Utilization Among Critically-Ill Necrotizing Pancreatitis Patients: Analysis of a Large Nationwide Database in the United States.

OBJECTIVE: Necrotizing pancreatitis (NP) is a severe form of pancreatitis that often necessitates intensive care and can result in significant morbidity and mortality. This study aimed to investigate racial and gender disparities in palliative care (PC) utilization among mechanically-ventilated patients with NP. METHODS: In this retrospective analysis using the National Inpatient Sample from 2016 to 2020, we investigated 84 335 patients with NP requiring invasive mechanical ventilation, and the utilization of PC services and their disparities based on gender and race. To adjust for potential confounding factors, we employed multivariable logistic regression, ensuring that our findings account for various influencing variables and provide a robust analysis of the data. RESULTS: Among the patients studied, 15.4% utilized PC consultations. Notably, female patients were 12% more likely to utilize PC than their male counterparts (OR 1.1, 95% CI: 1.003-1.2; P = .008). Racial disparities were pronounced: African Americans (OR 0.8, 95% CI 0.7-0.9, P < .001), Hispanic (OR 0.8, 95% CI 0.7-0.9, P = .001), and Asian or Pacific Islander patients (OR 0.74, 95% CI 0.57-0.97; P = .03) had significantly lower odds of utilizing PC compared to White patients. The cohort utilizing PC had a higher in-hospital mortality rate (74.7% vs 24.8%; OR 8.2, 95% CI 7.7-9.2) but a shorter mean hospital stays and lower associated costs. CONCLUSIONS: Our findings indicate significant racial and gender disparities in the utilization of PC for intubated patients with NP, with lower utilization among males and minority populations. These findings emphasize the urgent requirement for comprehensive changes in healthcare protocols.

Celiac disease is associated with increased risk of deep vein thrombosis and hypotensive shock in patients admitted with acute pancreatitis.

Background and Aim: Celiac disease (CD) was shown to be associated with increased risk of developing acute pancreatitis (AP). There is a paucity of literature critically analyzing the association of CD with AP outcomes. We aimed to evaluate the impact of CD on outcomes and complications of AP in recent years. Methods: A population-based analysis was performed using the National Inpatient Sample (NIS) between 2016 and 2019. Multivariable logistic regression was conducted to identify the independent impact of CD on AP outcomes while controlling for demographics and comorbidities and all patients refined diagnosis-related groups (APR-DRG) risk of severity subclass. Results: From 2016 to 2019, a total of 2 253 730 inpatients with AP were identified, of which 4640 (0.2%) had CD. On multivariable analysis, while controlling for demographics, comorbidities, and severity of illness, CD patients had significantly decreased odds for mortality (OR = 0.387), pseudocyst formation (OR = 0.786), sepsis (OR = 0.707), respiratory failure (OR = 0.806), acute kidney injury (AKI) (OR = 0.804), and myocardial infarction (OR = 0.217), (P < 0.05). However, CD patients were at significantly increased odds for deep vein thrombosis (DVT) (OR = 2.240) and hypotensive shock (OR = 1.718) (P < 0.05). Patients with CD had shorter lengths of stay by 0.4 days and lower total charges by $12 690. Conclusions: Our nationwide study evaluating AP outcomes in patients with CD suggests that patients with CD admitted for AP tend to have better mortality and several other outcomes compared to non-CD patients. We also show that CD patients admitted for AP have a greater risk for DVT and hypotensive shock. Future studies are warranted to validate the revealed findings in CD patients admitted for AP.

Outcomes among patients with non-ST-elevation myocardial infarction on chronic anticoagulation: Insights from the National Inpatient Sample.

BACKGROUND: Chronic systemic anticoagulation use is prevalent for various thromboembolic conditions. Anticoagulation (usually through heparin products) is also recommended for the initial management of non-ST-elevation myocardial infarction (NSTEMI). AIMS: To evaluate the in-hospital outcomes of patients with NSTEMI who have been on chronic anticoagulation. METHODS: Using the National Inpatient Sample (NIS) years 2016-2020, NSTEMI patients and patients with chronic anticoagulation were identified using the appropriate International Classification of Diseases, 10th version (ICD-10) appropriate codes. The primary outcome was all-cause in-hospital mortality while the secondary outcomes included major bleeding, ischemic cerebrovascular accident (CVA), early percutaneous coronary intervention (PCI) (i.e., within 24 h of admission), coronary artery bypass graft (CABG) during hospitalization, length of stay (LOS), and total charges. Multivariate logistic or linear regression analyses were performed after adjusting for patient-level and hospital-level factors. RESULTS: Among 2,251,914 adult patients with NSTEMI, 190,540 (8.5%) were on chronic anticoagulation. Chronic anticoagulation use was associated with a lower incidence of in-hospital mortality (adjusted odds ratio [aOR]: 0.69, 95% confidence interval [CI]: 0.65-0.73, p < 0.001). There was no significant difference in major bleeding (aOR: 0.95, 95% CI: 0.88-1.0, p = 0.15) or ischemic CVA (aOR: 0.23, 95% CI: 0.03-1.69, p = 0.15). Chronic anticoagulation use was associated with a lower incidence of early PCI (aOR: 0.78, 95% CI: 0.76-0.80, p < 0.001) and CABG (aOR: 0.43, 95% CI: 0.41-0.45, p < 0.001). Chronic anticoagulation was also associated with decreased LOS and total charges (adjusted mean difference [aMD]: -0.8 days, 95% CI: -0.86 to -0.75, p < 0.001) and (aMD: $-19,340, 95% CI: -20,692 to -17,988, p < 0.001). CONCLUSIONS: Among patients admitted with NSTEMI, chronic anticoagulation use was associated with lower in-hospital mortality, LOS, and total charges, with no difference in the incidence of major bleeding.

Predictors of arrhythmias in the population hospitalized for SARS-CoV-2.

BACKGROUND: Studies exploring predictors of arrhythmias in the population primarily hospitalized for SARS-CoV-2 (COVID-19) are scarce. Understanding this is crucial for risk stratification and appropriate management. METHODS: Using the 2020 National Inpatient Sample (NIS) database, we identified primary admissions for COVID-19. A 'greedy neighbor' 1:1 propensity-score matching (PSM) accounted for baseline differences. Then, multivariable logistic regression models were employed to account for confounders and estimate the probability of arrhythmia. RESULTS: There were a total of 1,058,815 admissions for COVID-19 (mean age 64.3 years ±16.8), 47.2% female, 52.5% (107698) White, 18.5% (37973) Blacks, and 20.7% (42,447) Hispanics. Atrial fibrillation was the most prevalent arrhythmia, 15.1% (31,942). After PSM, 166,405 arrhythmia hospitalizations were matched to 166,405 hospitalizations without arrhythmia. Sick sinus syndrome 4.9 (4.4-5.5), dyslipidemia 1.2 (1.2-1.3), cardiac arrest 1.3 (1.1-1.4), invasive mechanical ventilation 1.9 (1.8-2.0) and obesity 1.3 (1.2-1.4), (p<0.0001, all) were all independent predictors of arrhythmias. CONCLUSIONS: Our analysis revealed a notable proportion of hospitalized COVID-19 patients with arrhythmias. Dyslipidemia, obesity, sick sinus syndrome, invasive mechanical ventilation, and cardiac arrest were independent predictors of arrhythmias.

The impact of group II pulmonary hypertension on congestive heart failure patients admitted with ST elevation myocardial infarction, a nationwide study.

Background: Pulmonary hypertension (PH) is a condition where the blood pressure increases in the pulmonary arteries, leading to reduced oxygen delivery to the body's tissues due to increased blood flow resistance. This condition can result in right ventricular hypertrophy, low cardiac output, and ischemia. In this study, the authors aim to investigate the impact of group II PH (GIIPH) on patients with congestive heart failure who were admitted with ST elevation myocardial infarction (STEMI) through a retrospective cohort study. Methods: Using the National Inpatient Sample (NIS) database from 2017 to 2020, a retrospective cross-sectional study of adult patients with a principal diagnosis of STEMI with a secondary diagnosis with or without GIIPH according to ICD-10 (International Classification of Disease, 10th edition) codes. Several demographics, including age, race, and gender, were analyzed. The primary endpoint was mortality, while the secondary endpoints included cardiogenic shock, mechanical intubation, length of stay in days, and patient charge in dollars. Multivariate logistic regression model analysis was used to adjust for confounders, with a P value less than 0.05 considered statistically significant. Results: The study included 26,925 patients admitted with a STEMI, 95 of whom had GIIPH. The mean age for patients with and without PH was 66.6 and 67.5 years, respectively. In the PH group, 37% were females compared to 34% in the non-PH group. The in-hospital mortality rate was higher in the PH group (31.6% vs. 9.6%, P<0.001, adjusted odds ratio (aOR) =3.33, P=0.02). The rates and adjusted odds of cardiogenic shock and mechanical ventilation were higher in the PH groups (aOR =1.15 and 2.14, respectively) but not statistically significant. Patients with PH had a longer length of stay and a higher total charge. Conclusions: GIIPH was associated with worse clinical and economic outcomes in heart failure patients admitted with STEMI.

Gender Disparity of Automatic Implantable Cardioverter-Defibrillator Placement for Primary Prevention: National Inpatient Sample Analysis.

INTRODUCTION: Automatic implantable cardioverter-defibrillators (AICDs) for the primary prevention of sudden cardiac death have become standard care for patients with systolic heart failure (sHF) and ejection fraction ≤35%. While the prevalence of sHF and rates of hospitalization are higher in men, one would expect equivalent rates of implantation in women. METHODS: We used the Healthcare Cost and Utilization Project's National Inpatient Sample (NIS) from 2009 to 2018 to identify patient visits with sHF and AICD implantation. The comorbidities and outcomes were compared based on gender. RESULTS: There were 15,247,854 inpatient admissions for sHF, of which 60.3% were males (95% CI: 60.1%-60.4%) and 39.8% females (95% CI: 39.7%-39.9%). Approximately 2% of patients (294,726) underwent the insertion of an AICD for primary prevention: 72.3% males (95% CI: 71.9%-72.7%) and 27.72% females (95% CI: 27.3%-28.1%). There was no significant difference in age (p = 0.29), length of stay (p = 0.09), and inpatient mortality (p = 0.18). CONCLUSION: In this study, women accounted for approximately 40% of patients admitted with the diagnosis of sHF; however, they accounted for less than 30% of patients who underwent the insertion of an AICD. Further research is needed to better understand this gender disparity and identify reasons for the lower rates of AICD placement in women.

Inpatient Complication Rates of Bronchoscopic Lung Volume Reduction in the United States.

BACKGROUND: Early randomized controlled trials (RCTs) of bronchoscopic lung volume reduction (BLVR) have shown clinically meaningful benefits in lung function, dyspnea, and quality of life in patients with severe emphysema. Safety outcome data obtained after BLVR in the United States are scarce outside the RCTs. RESEARCH QUESTION: What is the rate of inpatient complications after BLVR in the real world in the United States? STUDY DESIGN AND METHODS: We used The National Inpatient Sample database to identify in-hospital complications after BLVR from 2018 through 2020. Complications were defined as pneumothorax, COPD exacerbation, pneumonia, hemoptysis, acute respiratory failure, and valve removal. We also analyzed all-cause in-hospital mortality and length of stay (LOS). RESULTS: We identified 467 admissions related to BLVR procedures. The number of procedures doubled between 2019 and 2020 (from 153 to 295 procedures). The median age was 67.9 years (interquartile range [IQR], 61.1-72.8 years), 210 patients (45.0%) were female, 401 patients (85.8%) were White, and Medicare was the primary expected payer for 72.8% of patients. Most procedures were performed in urban teaching hospitals (56.9%). The rate of pneumothorax was 26.3%, that of acute respiratory failure was 19.5%, that of COPD exacerbation was 8.8%, that of pneumonia was 7.3%, and that of hemoptysis was 5.3%. Chest tube placement was required in 84 of 123 patients (68.3%) with pneumothorax. The endobronchial valve had to be removed in 69 patients (14.8%). The median LOS was 2.8 days (IQR, 2.3-4.5 days). The number of in-hospital deaths was fewer than 11 (< 2.3%). Overall, the subgroup who experienced in-hospital complications did not differ significantly from the others in terms comorbidities, demographics, and hospital characteristics. INTERPRETATION: The real-world complication rate after BLVR was similar to the published complication rates from early randomized clinical trials. In-hospital mortality was low, suggesting that aside from the commonly anticipated complications, BLVR is a safe treatment option for severe emphysema.

Incidence and risk factors of blood transfusion after total knee arthroplasty: A retrospective nationwide inpatient sample database study.

Introduction: Common postoperative complications of total knee arthroplasty (TKA) include blood transfusion. Although risk factors and incidence of blood transfusion have been studied through national databases, the relative impact of each risk factor needs to be synthesized over a longer time period into a new model need to be revised. Material and methods: Patient data were extracted from the National Inpatient Sample (NIS), which is the largest hospital care database in the US, and analyse patient data retrospectively from 2010 through 2019. The final data included the patients undergoing TKA. The final analysis assessed the demographics of patients, type of insurance, type of hospital, length of stay (LOS), preoperative comorbidities, total charge, inpatient mortality, medical-surgical postoperative complications. Results: After extracting data from the NIS database, a total of 1,250,533 patients with TKA were included in the analysis, and the rate of transfusion was 6.60 %. TKA patients who receive blood transfusion had longer LOS (from 2-3 days to 3-4 days), more preoperative comorbidities, higher inpatient mortality rate, and increased total charge (P < 0.001). Moreover, postoperative complications associated with inpatients included sepsis, acute myocardial infarction and shock. Elective admission and private insurance were also regarded as protective factors. Conclusion: Blood transfusion could bring postoperative complications to patients, which were also linked to health costs and risks. It was also a common preoperative comorbidities for older patients who underwent TKA. Through better blood management strategies, we could reduce patient transfusion rates and improve clinical outcomes.Level of Evidence: Diagnostic Level Ⅲ.

Racial Disparities in Clinical Outcomes of Takotsubo Cardiomyopathy: An Analysis of the National Inpatient Sample 2006 to 2018.

BACKGROUND: This study aimed to evaluate the impact of race on in-hospital outcomes of Takotsubo cardiomyopathy using the National Inpatient Sample. METHODS AND RESULTS: We conducted a retrospective study using data from the National Inpatient Sample database 2006 to 2018. We focused on Takotsubo cardiomyopathy hospitalizations, excluding those with acute coronary syndrome as the primary diagnosis. Two study groups consisted of White patients or Black patients. Univariate and multivariable logistic models evaluated race's effect on death, cardiac arrest, cardiogenic shock, length of stay, while adjusting for potential confounders. The Bayesian model averaging technique was used to further elucidate the factors influencing death within each racial group. Significant differences were observed between the 2 racial groups. Black patients presented at a younger age, had a higher proportion of men, a higher burden of comorbidities, and a lower median household income compared with their White counterparts. In the univariate model, the Black cohort showed an increased risk of cardiac arrest (odds ratio, 1.45 [95% CI, 1.15-1.82]). However, the difference did not reach statistical significance in the multivariable model. Black patients also had a significantly longer hospital stay in both the univariate model (risk ratio, 1.26 [95% CI, 1.22-1.31]) and the multivariable model (risk ratio, 1.06 [95% CI, 1.04-1.07]). No significant difference in all-cause death was observed between the racial groups. CONCLUSIONS: The outcome differences between 2 racial groups in our study are likely influenced by racial disparities in demographics, comorbidities, and socioeconomic factors. Individualized care based on racial group needs is crucial in clinical practice.

Outcomes of Weekday Versus Weekend Admissions for Heart Block Requiring De Novo Intracardiac Device Implantation.

Even with comparable healthcare structure and staffing, patients presenting on weekends often face poorer outcomes, including longer wait times in the emergency department, extended hospital stays, and delays in major procedures. This discrepancy prompts questions about whether life-saving cardiac procedures, such as permanent pacemaker (PPM) implantation for atrioventricular block, also experience similar delays and differences in outcomes. We researched over 200,000 patients from the National Inpatient Sample (NIS) database to help study whether patients admitted on the weekend truly had worse outcomes than patients admitted on the weekday. Using the International Classification of Diseases, Tenth Revision (ICD-10) using STATA software (StataCorp LLC, College Station, TX), we found that 79.6% of patients were admitted on weekdays. Among these weekday admissions, 56.2% were males, with an average age of 75.8 years. Weekend admissions included 54.4% male patients, with an average age of 76.4 years. Key variables influencing outcomes were renal failure history, non-ST elevation myocardial infarction, diabetes mellitus, and percutaneous coronary intervention. Of the total patients, 1,315 died during hospitalization, with no significant difference in mortality between weekday and weekend admissions. However, weekend admissions had a higher rate of cardiac arrest, a greater likelihood of delayed pacer implantation, and longer hospital stays. Weekend admissions were linked to delays in PPM placement, longer hospital stays, and higher hospitalization costs. Mortality rates did not increase for patients admitted on weekends. Further research is needed to explore this issue in greater depth and to identify the specific factors contributing to the discrepancy between weekend and weekday admissions, which resulted in worse outcomes for weekend patients.

Outcomes of ST-Elevation Myocardial Infarction in Patients With Opioid Dependence: A National Inpatient Sample Study.

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is a critical condition characterized by the sudden obstruction of one or more coronary arteries, resulting in diminished blood flow to the heart muscle. This acute ischemic event demands swift and precise intervention to minimize myocardial damage and preserve cardiac function. Opioids, a class of potent analgesic medications, are frequently utilized in the management of STEMI-related chest pain. Despite their efficacy in alleviating discomfort, their use in this context warrants careful consideration due to potential adverse effects and interactions.  Methods: In this large nationwide retrospective observational study, we evaluated the effect of opioid dependence on inpatient mortality, length of hospitalization, and cost of hospitalization of patients with STEMI. Data was collected for 2019 from various hospitals across the United States using the National Inpatient Sample (NIS) through the Healthcare Cost and Utilization Project (HCUP). Using the International Classification of Diseases-10 codes (ICD-10), we identified a primary diagnosis of STEMI in patients over the age of 18, as well as a secondary diagnosis of opioid dependence.  Complex samples and multivariable logistic and linear regression models were used to determine the association of opioid dependence on inpatient mortality, length of hospitalization, and cost of hospitalization of patients with STEMI. Of the patients who fit our criteria, we identified other comorbidities and diagnoses associated with them as potential confounders including drug abuse, hypertension, diabetes, alcohol use, obesity, peripheral vascular disease, and chronic lung disease. Other confounders that were adjusted for include race, Charlson Comorbidity index, median household income, insurance, hospital region in the US, hospital bed size, and teaching status of the hospital.  Results: A total of 661,990 patients presented to a hospital with a primary diagnosis of STEMI in 2019. The majority of the patients were male with a mean age of 62.5+/-3.4 and were Caucasian American. Patients who were opioid dependent were found to be on average younger, earned less than the 25th percentile household income, had a higher history of illicit drug and alcohol use, and had Medicaid. They were also found to have higher rates of chronic lung disease at 39.2%, compared to 21.4.% in patients who were not opioid-dependent. Patients who were not opioid dependent were found to have higher rates of hypertension and type 2 diabetes mellitus. Inpatient mortality and cost of hospitalization in STEMI patients with opioid dependence were not statistically different compared to those who were not opioid dependent. However, STEMI patients who were opioid dependent did have an associated longer length of hospitalization.  Conclusion: Opioid use for pain relief in acute coronary syndrome, particularly STEMI, is a mainstay of treatment. Our retrospective cohort dived into assessing the relationship between opioid dependence on its effect on inpatient mortality, length of stay, and cost of hospitalization in STEMI patients. Our study showed that opioid dependence has no significant impact on inpatient mortality. However, it was associated with a longer length of hospital stay in STEMI patients. Further studies may be warranted into the effects of opioid dependence on the length of hospitalization in STEMI patients. .