Venous Thromboembolism in Hospitalized Melanoma Patients: Analysis from the National Inpatient Sample Database.

INTRODUCTION: The association between cancer and hyper-coagulability is well known. However, the association between melanoma and venous thromboembolism (VTE) has not been identified. METHODS: We studied the national inpatient sample (NIS) which compromise 20% of US hospitalization to better characterize melanoma and VTE. We analyzed the data between 2010 and 2014 using ICD-9 codes. RESULTS: Melanoma patients were grouped into presence/absence of VTE. Multiple logistic regression was used to obtain the odds ratio (OR) to compare the mortality of the inpatient, total charges, length of stay (LOS), and disability at discharge. A total of 61,812 melanoma patients were identified, of which 5.2% were hospitalized for VTE. The presence of VTE was associated with a remarkable higher rate of discharge with a moderate to severe disability (57.5% vs 41.4%, P<0.001), in-hospital stroke (7.6% vs 4.9%, P<0.001), and in-hospital mortality (8.8% vs 5.1%, P<0.001). Costs of hospitalization (64,720$ vs 46,606, P<0.001) and LOS (5 vs 3 days, P<0.001) were significantly higher as well in the VTE group. After adjusting for common confounder, VTE was found to be an independent predictor of mortality (OR = 1.596, 95% CI [1.399-1.821], P<0.001). CONCLUSION: In summary, melanoma patients with VTE had higher inpatient mortality, LOS, higher hospital cost, and a higher degree of disability upon discharge.

Preoperative anemia management program reduces blood transfusion in elective cardiac surgical patients, improving outcomes and decreasing hospital length of stay.

BACKGROUND: Anemia is an independent risk factor for hospitalization, readmission, prolonged length of stay (LOS), diminished quality of life, and mortality. A multidisciplinary program was implemented to manage anemia preoperatively as a patient blood management (PBM) initiative. METHODS AND MATERIALS: From March 2016 to August 2018, 240 patients were screened for anemia during their preoperative cardiovascular visit. About 52/240 (22%) were found to be anemic and met out inclusion criteria. Also, 45/52 (87%) had iron deficiency anemia and 7 (13%) had anemia without iron deficiency. A similar historical cohort of patients undergoing elective cardiovascular surgery with hemoglobin (Hb) < 12 g/dl from September 2014 to February /2016 (n = 52) served as control group. The primary outcome was perioperative red blood cell (RBC) transfusion. Secondary outcomes were date-of-surgery Hb, intensive care unit (ICU) and hospital LOS, complication rates, and transfusion cost. RESULTS: The two most common treatments were IV iron ± folate (n = 36/45; 80%) and oral iron (n = 9/45; 20%). As compared to historical patients, study patients had significantly higher day-of-surgery Hb (10.6 ± 1.4 vs. 9.8 ± 1.3 g/dl, p < .001), lower utilization of RBC transfusion (0.86 ± 1.4 vs. 2.78 ± 2.4, p < .001), fewer days in the ICU (2.1 ± 2.0 vs. 4.0 ± 3.5, p = .002), and shorter total LOS (6.9 ± 4.8 vs. 12.9 ± 6.8, p < .0001). Study patients also showed lower overall complication rates (p < .0001). Analysis of RBC acquisition cost and transfusion cost also showed significant saving of 69% ($293 vs. $945 and $656 vs. $2116, respectively). CONCLUSION: When corrected for type of procedures and surgeon, our pilot anemia program in elective cardiovascular surgeries showed higher day-of-surgery Hb and significant reduction in RBC transfusion rates, ICU and hospital LOS, and overall complication rates.

ANCA-associated pauci-immune necrotizing glomerulonephritis during the treatment with pembrolizumab.

Cancer immunotherapy is rapidly changing the treatment paradigm in oncology, and immune checkpoint inhibitors (ICPIs) have been used successfully in a variety of cancer types. Specific side effects termed immune-related adverse events (irAEs) have now been described in various organ systems, including the kidney. Renal complications have rarely been reported compared with other irAEs and mostly consist of acute interstitial nephritis. Only rare cases of ICPI-related glomerulonephritis have been described. Herein, we report the case of an adult patient treated with pembrolizumab (anti-PD-1) for squamous cell carcinoma (SCC), who developed infectious enterocolitis, and ANCA-related with diffuse necrotizing crescentic glomerulonephritis, both conditions potentially linked to treatment with pembrolizumab.