Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020.

BACKGROUND: Both cancer diagnosis/treatment modality and surgical technique for the spine have been developed recently. Nationwide trends in the surgical treatment for metastatic spinal tumors have not been reported in the last decades. This study aimed to examine recent trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes using nationwide administrative hospital discharge data. METHODS: The Diagnosis Procedure Combination database from 2012 to 2020 was used to extract data from patients who underwent surgical procedures for spinal metastasis with the number of non-metastatic spinal surgery at the institutions that have performed metastatic spine surgeries at least one case in the same year. Trends in the surgical treatment for spinal metastasis, patients' demographics, and in-hospital mortality/outcomes were investigated. RESULTS: This study analyzed 10,321 eligible patients with spinal metastasis. The surgical treatment for spinal metastasis increased 1.68 times from 2012 to 2020, especially in fusion surgery, whereas the proportion of metastatic spinal surgery retained with a slight increase in the 2%s. Distributions of the primary site did not change, whereas age was getting older. In-hospital mortality and length of stay decreased over time (9.9-6.8%, p < 0.001; 37-30 days, p < 0.001). Postoperative complication and unfavorable ambulatory retained stable and slightly decreased, respectively. CONCLUSION: During the last decade, surgical treatment for spinal metastasis, especially fusion surgery, has increased in Japan. In-hospital mortality and length of stay decreased. Recent advances in cancer treatment and surgical techniques might influence this trend.

Factors associated with proximal femoral fractures in older adults during hospital stay: a cross-sectional study.

BACKGROUND: Proximal femoral fractures in older adults affect prognosis, quality of life and medical expenses. Therefore, identifying patients with an elevated risk for proximal femoral fractures and implementing preventive measures to mitigate their occurrence are crucial. OBJECTIVE: This study aimed to develop an accurate in-hospital fracture prediction model that considers patients' daily conditions and medical procedure status. Additionally, it investigated the changes in their conditions associated with fractures during hospital stays. DESIGN: A retrospective observational study. SETTINGS: Acute care hospitals in Japan. PARTICIPANTS: Participants were 8 514 551 patients from 1321 medical facilities who had been discharged between April 2018 and March 2021 with hip and proximal femoral fractures. METHODS: Logistic regression analysis determined the association between patients' changes in their ability to transfer at admission and the day before fracture, and proximal femoral fracture during hospital stays. RESULTS: Patients were classified into fracture and non-fracture groups. The mean ages were 77.4 (SD: 7.7) and 82.6 (SD: 7.8), and the percentages of women were 42.7% and 65.3% in the non-fracture and fracture groups (p<0.01), respectively. Model 4 showed that even if a patient required partial assistance with transfer on the day before the fracture, the fracture risk increased in each category of change in ability to transfer in the following order: 'declined', 'improved' and 'no change'. CONCLUSIONS: Patients showing improved ability to transfer during their hospitalisation are at a higher risk for fractures. Monitoring patients' daily conditions and tracking changes can help prevent fractures during their hospital stays.

Relationship Between Unit Characteristics and Fall Incidence: A Cross-Sectional Survey Using Administrative Data in Japan.

BACKGROUND: Falls are the most frequent accident experienced by inpatients in hospitals. As falls affect patient outcomes, high fall risk factors should be studied to prevent falls and improve patient safety. However, the relationship between hospital unit characteristics and fall risk has never been assessed. PURPOSE: This study was designed to identify the unit characteristics significantly related to fall risk. METHODS: A cross-sectional study was conducted on the medical records of patients hospitalized in a Japanese academic hospital between 2018 and 2019. This study quantified unit activities and utilized Diagnosis Procedure Combination data to examine unit characteristics related to falls based on unit day. RESULTS: Data on 16,307 patients were included in the analysis, and 355 unit days were certified as fall events. Based on patient condition and medical treatment, the results identified antineoplastic injections, radiation therapy, aseptic treatment room, and functional status of partly assisted transfers, meals, and oral care as unit characteristics associated with increased fall events. Decreased nursing time per patient at night (odds ratio [OR] = 0.75, p = .04) and higher numbers of partially assisted transfer patients were also identified as unit characteristics associated with higher fall incidence rates (OR = 5.56, p = .01). CONCLUSIONS: The results of this study are expected to assist nurses to predict falls based on unit characteristics; reducing nursing time in the units was found to be a factor associated with higher fall risk. Nurse managers must understand the unit-related fall risk factors, appropriately assign nurse staffing numbers, and demonstrate nursing leadership to prevent falls in their units.

Risk Factors for Postoperative Unfavorable Ambulatory Status After Spinal Surgery for Metastatic Spinal Tumor.

STUDY DESIGN: A retrospective comparative study. OBJECTIVE: This study aimed to investigate factors associated with postoperative unfavorable ambulatory status following surgery for metastatic spinal tumors using a nationwide in-hospital database. SUMMARY OF BACKGROUND DATA: Surgical treatment for metastatic spinal tumors can improve the ambulatory status and quality of life. However, some patients fail to regain the ability to walk, thereby resulting in poor quality of life. No large-scale study has previously evaluated factors associated with postoperative poor ambulatory status in this clinical context. MATERIALS AND METHODS: The Diagnosis Procedure Combination database from 2018 to 2019 was used to extract data from patients who underwent surgical procedures for spinal metastasis. Postoperative unfavorable ambulatory status was defined as (1) nonambulatory at discharge or (2) a decreased mobility score of the Barthel Index between admission and discharge. Multivariable logistic regression was used to evaluate factors associated with postoperative unfavorable ambulatory status while adjusting for confounders. RESULTS: This study analyzed 1786 eligible patients. Of whom, 1061 (59%) patients were ambulatory on admission and 1249 (70%) on discharge. Postoperative unfavorable ambulatory status was observed in 597 (33%) patients, with a significantly lower rate of discharge to home (41%/81%, P <0.001) and a longer postoperative hospital stay (46.2 days/31.4 days, P <0.001). Multivariable regression analysis revealed male sex [odds ratio (OR): 1.43, P =0.002], laminectomy without fusion (OR: 1.55, P =0.034), Charlson Comorbidity Index of ≥7 (OR: 1.37, P =0.014), and preoperative nonambulatory status (OR: 6.61, P <0.001) as factors associated with postoperative unfavorable ambulatory status. CONCLUSIONS: Our large-scale database analysis revealed that 33% of patients experienced unfavorable ambulatory status following spinal metastasis surgery. Laminectomy without fusion and preoperative nonambulatory status were among several factors influencing the prospect of unfavorable ambulatory status following surgery.

Fractures within 2 years of an obstetric hospitalization: analysis of nationwide administrative data in Japan.

INTRODUCTION: Pregnancy- and lactation-associated osteoporosis (PLO) is a condition in which young women develop fractures during pregnancy or breastfeeding. Though PLO is a severely debilitating disease, its pathophysiology and epidemiology have not been clarified and its treatment has not been established. We aimed to identify the incidence and factors associated with fractures occurring within 2 years following an obstetric hospitalization. MATERIALS AND METHODS: We extracted data on fractures occurring within 2 years of an obstetric hospitalization from the Japanese Diagnosis Procedure Combination database. We analyzed the implementation of bone mineral density and bone metabolism marker tests, prescription status, and factors associated with fractures occurring within 2 years of an obstetric hospitalization. RESULTS: Among 837,347 patients with a history of obstetric hospitalization from 2010 to 2014, 379 patients had a history of hospitalization due to a fracture occurring within 2 years (4.5/10,000 pregnancies). Among the patients with fractures occurring within 2 years of an obstetric hospitalization, 6.7% underwent bone mineral quantification or a bone metabolism marker test, and 7.5% were prescribed a lactation inhibitor or osteoporosis treatment. Factors associated with fractures occurring within 2 years following an obstetric hospitalization identified included Cushing syndrome, Charlson Comorbidity Index score ≥ 1, age ≥ 40 years old at pregnancy, smoking history, and steroid administration. CONCLUSION: We investigated fracture cases occurring within 2 years of an obstetrics hospitalization. This finding may be useful in selecting preventative measures for patients at risk of fractures within 2 years after obstetric hospitalization, including PLO.

Trends and safety of robot-assisted partial nephrectomy during the initial 2-year period after government approval in Japan: A nationwide database study from 2016 to 2018.

OBJECTIVES: To evaluate the trends and safety of robot-assisted partial nephrectomy during the initial 2-year period after government approval for this type of procedure in April 2016. METHODS: This nationwide retrospective study included 3722 received robot-assisted partial nephrectomy cases carried out from April 2016 to March 2018 in 124 participating institutions. The institutions were divided into lower- and higher-volume institutions according to the median of 19 robot-assisted partial nephrectomy cases during the study period. Surgical outcomes between 616 cases from lower-volume institutions and 3106 cases from higher-volume institutions were compared using propensity score matching. RESULTS: During the study period, both the number of robot-assisted partial nephrectomy surgeries and the number of institutions in which the surgery was carried out steadily increased. Overall, the median anesthesia time was 217 min, the median postoperative length of stay was 9 days, and the proportion of blood transfusions, complications and readmissions were 0.8%, 5.1% and 1.0%, respectively. There were no significant differences in anesthesia time, incidence of blood transfusions, and complication rates between the lower-volume and higher-volume institutions. However, a slightly, but significantly, longer postoperative length of stay and a lower incidence of readmission were observed in lower-volume institutions both before and after propensity score matching. CONCLUSIONS: Robot-assisted partial nephrectomy has become widespread during the initial 2-year period after government approval with an acceptable safety profile, regardless of the institutional caseloads. This technique has become a standard of care for stage 1 renal cancer patients in Japan.

Prevention of surgical site infection via antibiotic administration according to guidelines after gynecological surgery.

AIM: We modified the antimicrobial prophylaxis of surgical site infection (SSI) according to the guidelines of the Japanese Society of Chemotherapy and Japan Society of Infectious Diseases (hereinafter referred to as optimization) and measured outcomes. METHODS: From April 2016 to March 2017, we performed cesarean section and open hysterectomy with optimization, and compared the outcome to that of surgery performed without optimization between April 2014 and March 2016. We measured the rates of antibiotic discontinuation, appropriate antibiotic selection, SSI incidence, resumption of antibiotic therapy and fever incidence, as well as the length of postoperative hospital stay and medical expenses for antibiotics to evaluate the appropriateness and outcomes of antibiotic prophylaxis. RESULTS: Optimization resulted in a change in the method of selecting antibiotics for cesarean section, but there was no change in SSI incidence rate (0.74% vs 0.0%, P = 0.36). Optimization reduced the use of antibiotics and medical expenses of hysterectomy (median reduction of 50% and 78% for hysterectomy without or with lymphadenectomy, respectively). However, there was no change in outcome regarding SSI incidence (5.7% vs 0.0%, P = 0.11 and 7.8% vs 9.5%, P = 0.77, respectively). CONCLUSION: Appropriate use of antibiotics according to guidelines reduced antibiotic dose and medical expenses, but there was no change in outcome regarding SSI incidence rate. These findings suggested that implementation of dosing regimens according to the guidelines would be useful to reduce antibiotic medicine costs and prevent resistant bacteria and complications associated with antibiotics.

Is there a differential impact of parity on factors regulating maternal peripheral resistance?

Parity may influence cardiovascular adaptations during pregnancy. However, little is known about the influence of parity on maternal hemodynamic adaptations. In this prospective study, we investigated factors regulating peripheral resistance that control hemodynamic adaptations in pregnant women and evaluated differences in these factors between nulliparous and multiparous women. We evaluated 127 patients (nulliparous: 78, multiparous: 49) without any complications and not taking medications and assessed hemodynamics, arterial stiffness, modified flow-mediated dilation (mFMD) and heart rate variability, including power spectral and detrended fluctuation analysis (DFA). Diastolic blood pressure (BP) was significantly higher in nulliparous than multiparous women throughout pregnancy (P<0.05). Diastolic BP was significantly higher in nulliparous than multiparous women in the third trimester (95% confidence interval (CI), 2.43-9.73). A significant difference in high-frequency power was observed between nulliparous and multiparous (P<0.05) women, and was significantly lower in multiparous than nulliparous women in the third trimester (95% CI, 0.74-0.34). The low-frequency/high-frequency ratio was significantly increased in both groups between the first trimester and the third trimester (P<0.05). The DFA value, α2, significantly differed between nulliparous and multiparous (P<0.05), and was significantly lower in nulliparous than multiparous women (95% CI, -0.30 to -0.10). The mFMD and arterial stiffness remained approximately the same for nulliparous and multiparous women for all trimesters. Our results suggested that nulliparous women were characterized by greater autonomic nervous activity than were multiparous women.

Diagnostic possibility of diffusion tensor imaging for the evaluation of myometrial invasion in endometrial cancer: an ex vivo study.

PURPOSE: To investigate the feasibility of magnetic resonance imaging (MRI) diffusion tensor imaging (DTI) for evaluating the myometrial invasion of uterine endometrial cancer. MATERIALS AND METHODS: Twelve specimens of uterine endometrial cancer were obtained. The depth of myometrial invasion was classified as stage E (limited to the endometrium; n = 4), stage S (superficial invasion of less than 50% of the myometrium; n = 5), or stage D (deep invasion of greater than 50% of the myometrium; n = 3). The specimens were fixed in 10% formalin and stored at 4°C before imaging. At 15 hours after fixation, MRI was performed using a 4.7-T experimental imager/spectrometer system. RESULTS: We found a high fractional anisotropy (FA) value zone (anisotropic zone) at the myometrium adjacent to the tumor on FA maps of histopathological stage S and stage D cancers, whereas the anisotropic zone did not exist in stage E cancers. Histopathological analysis showed that compared to the other regions, the anisotropic zone had tightly packed stromal tissue. The disruption of the anisotropic zone was consistent with myometrial invasion. CONCLUSION: Our ex vivo study suggests that DTI might be a useful tool for the diagnosis of myometrial invasion of uterine endometrial cancer ex vivo.

Elevated maternal serum folate in the third trimester and reduced fetal growth: a longitudinal study.

This study aimed to examine the association of fetal growth and elevated third trimester maternal serum folate due to folic acid (FA) supplement intake. Dietary intake, use of FA supplements, weight, and blood biomarkers of B-vitamins (serum folate, pyridoxal, vitamin B(12), and plasma total homocysteine) were observed in 33 healthy pregnant women at the third trimester (average gestational age 35 wk). Birth outcomes were assessed through hospital birth records. Infant anthropometry and maternal blood biomarkers were followed up at 1 mo postpartum. Fourteen women were taking FA supplements at the third trimester. Dietary intake was similar among FA users and non-users, but serum folate and pyridoxal were significantly higher in users (11.6±6.7 vs. 6.1±3.2 ng/mL, and 13.8±21.7 vs. 3.2±1.4 ng/mL, respectively). Plasma total homocystein (tHcy) was higher in non-users compared to users, but not significantly. Nine FA users and eight non-users had low serum vitamin B(12) values (<203 pg/mL). Nine FA users and all non-users had low serum pyridoxal values (<7.0 ng/mL). Infant birthweight was significantly lower in users compared to non-users (2,894±318 vs. 3,154±230 g). At 1 mo postpartum, infant weight and length were similar between FA users and non-users, but infant weight gain was larger in users. Higher serum folate values due to FA use in the third trimester was related to reduced fetal size. Excess FA under low vitamin B(6) and B(12) status may affect fetal growth.