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OBJECTIVE: To investigate the extent of extraskeletal manifestations along with inpatient outcomes and complications associated with osteogenesis imperfecta (OI). STUDY DESIGN: This cross-sectional study utilized the Kids' Inpatient Database as a part of the Healthcare Cost and Utilization Project to investigate inpatient hospital outcomes and management in patients with OI from 1997 through 2016. Data regarding hospital characteristics, cost of treatment, inpatient outcomes, and procedures were collected and analyzed. RESULTS: There were 7291 admissions that listed OI as a diagnosis in the Kids' Inpatient Database from 1997 through 2016. Unexpectedly, more than one-third of all admissions in these children with OI presented with an extraskeletal manifestation. The rate of major complications was 3.85%. The rate of minor complications was 19.4%, most commonly respiratory problems. The mortality rate was 18.2% in the neonatal period and 1.0% in all other admissions. Total charges of hospital stay increased over the years. CONCLUSIONS: We identified a striking prevalence of extraskeletal manifestations in OI along with inpatient outcomes and complications associated with OI, of which respiratory complications were predominant. We observed a significant financial burden for patients with OI and identified additional risks for financial crisis, in addition to disparities in care identified among socioeconomic groups. These data contribute to a more holistic understanding of OI from diagnosis to management.

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BACKGROUND: Prior reports indicate that modulation of the endocannabinoid system (ECS) may have a protective benefit for Covid-19 patients. However, associations between cannabis use (CU) or CU not in remission (active cannabis use (ACU)), and Covid-19-related outcomes among hospitalized patients is unknown. METHODS: In this multicenter retrospective observational cohort analysis of adults (≥ 18 years-old) identified from 2020 National Inpatient Sample database, we utilize multivariable regression analyses and propensity score matching analysis (PSM) to analyze trends and outcomes among Covid-19-related hospitalizations with CU and without CU (N-CU) for primary outcome of interest: Covid-19-related mortality; and secondary outcomes: Covid-19-related hospitalization, mechanical ventilation (MV), and acute pulmonary embolism (PE) compared to all-cause admissions; for CU vs N-CU; and for ACU vs N-ACU. RESULTS: There were 1,698,560 Covid-19-related hospitalizations which were associated with higher mortality (13.44% vs 2.53%, p ≤ 0.001) and worse secondary outcomes generally. Among all-cause hospitalizations, 1.56% of CU and 6.29% of N-CU were hospitalized with Covid-19 (p ≤ 0.001). ACU was associated with lower odds of MV, PE, and death among the Covid-19 population. On PSM, ACU(N(unweighted) = 2,382) was associated with 83.97% lower odds of death compared to others(N(unweighted) = 282,085) (2.77% vs 3.95%, respectively; aOR:0.16, [0.10-0.25], p ≤ 0.001). CONCLUSIONS: These findings suggest that the ECS may represent a viable target for modulation of Covid-19. Additional studies are needed to further explore these findings.

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Background: A specific cause of superior vena cava (SVC) syndrome, SVC thrombosis, is a rare but known complication in cancer patients. Early identification and management of SVC thrombosis in lung cancer patients may lead to improved patient outcomes and a reduction in healthcare costs. Methods: We studied the racial and socioeconomic differences, length of stay, total hospital charges, and all-cause mortality outcomes in patients with lung cancer with and without SVC thrombosis using data from the National Inpatient Sample. Statistical analysis was performed on STATA. Results: A total of 480,750 patients were hospitalized for lung cancer; 720 (0.15%) of these patients had SVC thrombosis. The lung cancer with SVC thrombosis cohort had a statistically higher proportion of Black patients. Patients with lung cancer presenting with SVC thrombosis had an increased hospital length of stay (10 vs 6 days, P < 0.001) and cost ($117,320 vs $80,806, P < 0.005) compared to those without SVC thrombosis. All-cause mortality in patients with lung cancer was 7.7% and the presence of SVC thrombosis significantly increased the odds of inpatient mortality (18.0%). Nonwhite races were associated with higher odds of mortality in lung cancer admissions. Conclusion: Race, insurance type, and comorbidities impacted the likelihood of developing SVC thrombosis in patients with lung cancer. SVC thrombosis is a poor prognostic factor for patients with lung cancer. Further studies to evaluate these disparities are warranted.

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Introduction Diffuse large B-cell lymphoma (DLBCL) may be complicated by hypercalcemia at various stages of treatment. The impact of hypercalcemia on chemotherapy admission outcomes in DLBCL is not well described.  Methods In a retrospective analysis, using the National Inpatient Sample database (2018 - 2020), patients with DLBCL admitted for chemotherapy were dichotomized based on the presence of hypercalcemia. Our primary outcome was all-cause mortality. Secondary outcomes included length of stay (LOS), total charge, rate of acute kidney injury (AKI), tumor lysis syndrome (TLS), hyperkalemia, metabolic acidosis, acute encephalopathy, septic shock, Clostridiodes difficile infection, acute respiratory failure, and venous thromboembolic events (VTE). Results We identified 78,955 patients, among whom 1,375 (1.74%) had hypercalcemia. Hypercalcemia was associated with higher odds of all-cause mortality (aOR:3.05, p-value:0.020), TLS (aOR:8.81, p-value<0.001), acute metabolic encephalopathy (aOR:4.89, p-value<0.001), AKI (aOR:5.29, p-value<0.001), hyperkalemia (aOR:2.84, p-value:0.002), metabolic acidosis (aOR:3.94, p-value<0.001) and respiratory failure (aOR:2.29, p-value:0.007) and increased LOS by 1 day and total charge by 12, 501 USD. Conclusions In patients with DLBCL admitted for inpatient chemotherapy, those with hypercalcemia compared to a cohort without had higher odds of; all-cause mortality, TLS, AKI, acute encephalopathy, acute metabolic acidosis, hyperkalemia, and acute respiratory failure as well as higher LOS and total charge.

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BACKGROUND: Ruptured abdominal aortic aneurysm (AAA) is a medical emergency that requires immediate surgical intervention. The aim of this analysis was to identify the sex- and race-specific disparities that exist in outcomes of patients hospitalized with this condition in the United States using the National Inpatient Sample (NIS) to identify targets for improvement and support of specific patient populations. METHODS: In this descriptive, retrospective study, we analyzed the patients admitted with a primary diagnosis of ruptured AAA between January 1, 2016, and December 31, 2020, using the NIS database. We compared demographics, comorbidities, and in-hospital outcomes in AAA patients, and compared these results between different racial groups and sexes. RESULTS: A total of 22,395 patients with ruptured AAA were included for analysis. Of these, 16,125 patients (72.0%) were male, and 6270 were female (28.0%). The majority of patients (18,655 [83.3%]) identified as Caucasian, with the remaining patients identifying as African American (1555 [6.9%]), Hispanic (1095 [4.9%]), Asian or Pacific Islander (470 [2.1%]), or Native American (80 [0.5%]). Females had a higher risk of mortality than males (OR, 1.7; 95% confidence interval [CI], 1.45-1.96; P < .001) and were less likely to undergo endovascular aortic repair (OR, 0.70; 95% CI, 0.61-0.81; P < .001) or fenestrated endovascular aortic repair (OR, 0.71; 95% CI, 0.55-0.91; P = .007). Relative to Caucasian race, patients who identified as African American had a lower risk of inpatient mortality (OR, 0.50; 95% CI, 0.37-0.68; P < .001). CONCLUSIONS: In this retrospective study of the NIS database from 2016 to 2020, females were less likely to undergo endovascular intervention and more likely to die during their initial hospitalization. African American patients had lower rates in-hospital mortality than Caucasian patients, despite a higher burden of comorbidities. Future studies are needed to elucidate the potential factors affecting racial and sex disparities in ruptured AAA outcomes, including screening practices, rupture risk stratification, and more personalized guidelines for both elective and emergent intervention.

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Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Bases de Datos Factuales , Disparidades en Atención de Salud , Mortalidad Hospitalaria , Pacientes Internos , Humanos , Masculino , Femenino , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/etnología , Rotura de la Aorta/mortalidad , Rotura de la Aorta/cirugía , Rotura de la Aorta/etnología , Estudios Retrospectivos , Estados Unidos/epidemiología , Anciano , Mortalidad Hospitalaria/etnología , Factores de Riesgo , Factores Sexuales , Disparidades en Atención de Salud/etnología , Anciano de 80 o más Años , Medición de Riesgo , Persona de Mediana Edad , Pacientes Internos/estadística & datos numéricos , Disparidades en el Estado de Salud , Resultado del Tratamiento , Factores de Tiempo , Procedimientos Endovasculares/mortalidad , Factores Raciales

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STUDY OBJECTIVES: This study examined in-hospital outcomes for patients with both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), also known as COPD-OSA overlap syndrome, during hospitalizations for acute exacerbation of COPD. METHODS: The National Inpatient Sample was used to examine in-hospital mortality, length of stay, costs, and utilization of supportive ventilation in patients with COPD-OSA overlap during acute exacerbation of COPD hospitalizations. A 1-to-1 matched case-control design was utilized to match patients with and without OSA. Multivariate logistic regression modeling was used to examine mortality and ventilatory support, while controlling for potentially confounding diagnoses. RESULTS: COPD-OSA overlap was associated with longer median length of stay (4 days OSA, 3 days non-OSA; P < .001), higher mean costs ($32,197 OSA, $29,011 non-OSA; P < .001), increased utilization of noninvasive positive-pressure ventilation (13.92% OSA, 6.78% non-OSA; P < .001), and when required for greater than 96 hours, earlier initiation of mechanical ventilation (2.53 days OSA, 3.35 days non-OSA; P = .001). However, COPD-OSA overlap was associated with reduced mortality (0.81% OSA, 1.05% non-OSA; P < .001). These differences in mortality (adjusted odds ratio: 0.650; 95% confidence interval: 0.624-0.678) and noninvasive positive-pressure ventilation usage (adjusted odds ratio: 1.998; 95% confidence interval: 1.970-2.026) remained when adjusted for confounders. CONCLUSIONS: Patients with COPD-OSA overlap have higher utilization of supportive ventilation and longer length of stay during acute exacerbation of COPD hospitalizations, contributing to higher costs. The diagnosis of OSA is associated with reduced mortality in these hospitalizations, which may be related to greater utilization of supportive ventilation when OSA is recognized. CITATION: De la Fuente JRO, Greenberg P, Sunderram J. The overlap of chronic obstructive pulmonary disease and obstructive sleep apnea in hospitalizations for acute exacerbation of chronic obstructive pulmonary disease. J Clin Sleep Med. 2024;20(6):863-870.

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Mortalidad Hospitalaria , Hospitalización , Enfermedad Pulmonar Obstructiva Crónica , Apnea Obstructiva del Sueño , Humanos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/economía , Masculino , Femenino , Apnea Obstructiva del Sueño/terapia , Apnea Obstructiva del Sueño/mortalidad , Apnea Obstructiva del Sueño/economía , Anciano , Estudios de Casos y Controles , Hospitalización/estadística & datos numéricos , Hospitalización/economía , Persona de Mediana Edad , Tiempo de Internación/estadística & datos numéricos , Progresión de la Enfermedad

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Transcatheter aortic valve replacement (TAVR) is a transformative option for severe aortic stenosis, especially in elderly patients. obesity's impact on TAVR outcomes is limited. Using the National Inpatient Sample from 2016 to 2020, We analyzed 217,300 TAVR hospitalizations across BMI groups. No difference in in-hospital mortality was observed, class III obesity experienced longer hospital stays (adjusted ß: 0.43 days, P < 0.05), higher costs (adjusted ß: $3,126, P < 0.05), increased heart failure exacerbation (adjusted odds ratio [aOR]: 2.68, 95% confidence interval [CI]: [1.03-7.01], p < 0.05), vascular access complications (aOR: 1.29, 95% CI: [1.07-1.52], P < 0.05), and post-operative pulmonary complications (Pneumonia (aOR: 1.42, 95% CI: [1.16-1.74], p < 0.05), acute hypoxic respiratory failure (aOR: 1.99, 95% CI: [1.67-2.36], p < 0.05), and non-invasive ventilation (aOR: 1.62, 95% CI: [1.07-2.44], p < 0.05). Complete heart block and permanent pacemaker requirement were higher in both class II and class III ((aOR: 1.30, 95% CI: [1.11-1.51], P < 0.05), (aOR:1.25, 95% CI: [1.06-1.46], P < 0.05) and ((aOR: 1.18, 95% CI: [1.00-1.40], P < 0.05), (aOR:1.22, 95% CI: [1.02-1.45], P < 0.05)) respectively. Understanding these links is crucial for optimizing TAVR care in obesity, ensuring enhanced outcomes, and procedural safety.

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Estenosis de la Válvula Aórtica , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Anciano , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Pacientes Internos , Factores de Riesgo , Resultado del Tratamiento , Obesidad/complicaciones , Obesidad/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología

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Background: Acute cholangitis (AC) is an infection of the biliary tract superimposed on stasis. This study aimed to investigate the effects of smoking on inpatient outcomes of AC. Methods: We identified primary AC hospitalizations using the National Inpatient Sample database (2017-2020). Using a 1:1 matching method, we created a matched comparison cohort of AC patients who were non-smokers, based on demographics, hospital characteristics and comorbidities. Results: We matched 3960 smoker patients with 3960 non-smoker patients within the AC population. Non-smokers were older than smokers (70 vs. 59 years, P<0.001). Smokers had a stronger association with bile duct calculi (74.37% vs. 69.29%, P<0.001) and other bile duct disorders (clots, parasites, extrinsic compression and other rare disorders) (6.82% vs. 5.05%, P=0.011). No significant difference in inpatient mortality, median length of stay (LOS), or median inpatient cost (MIC) was found between the matched cohorts (P>0.05). However, smoking was associated with higher odds of complications, including sepsis without shock (0.88% vs. 0.51%, P=0.042), sepsis with shock (1.26% vs. 0.51%, P<0.001), biliary pancreatitis (6.57% vs. 4.42%, P<0.001) and myocardial infarction (6.19% vs. 3.54%, P<0.001), as well as a greater need for inpatient endoscopic retrograde cholangiopancreatography (ERCP) (72.85% vs. 63.76%, P<0.001) and early ERCP (50.76% vs. 42.32%, P<0.001) compared to non-smokers. Conclusions: This study found no difference in mortality, LOS, or MIC in acute cholangitis-related hospitalizations associated with smoking. However, smoking was associated with a higher risk of complications and a greater need for ERCP and early ERCP.

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PURPOSE: This study aimed to quantify the impact of pre-existing psychiatric illness on inpatient outcomes after major trauma and to assess acuity of psychiatric presentation as a predictor of outcomes. METHODS: A retrospective single-center cohort study identified adult trauma patients with an Injury Severity Score (ISS) ≥ 16 between January 2018 and December 2019. Bivariate analysis assessed patient characteristics, injury characteristics, and injury outcomes between patients with and without psychiatric comorbidity. A sub-group analysis explored further effects of psychiatric history and need for inpatient psychiatric consultation on outcomes. RESULTS: Of 640 patients meeting inclusion criteria, 99 patients (15.4%) had at least one psychiatric comorbidity. Patients with psychiatric comorbidity sustained distinct mechanisms of injury and higher in-hospital morbidity (44% vs. 26%, OR 1.97, 95% CI 1.17-3.3, p = 0.01), including pulmonary morbidity (31% vs. 21%, p < 0.01), neurologic morbidity (18% vs 7%, p < 0.01), and deep wound infection (8% vs. 2%, p < 0.01) than the control cohort. Psychiatric patients also had significantly greater median intensive care unit (ICU), length of stay (LOS) (1 day vs. 0 days, p = 0.04), median inpatient ward LOS (10 days vs. 7 days, p = 0.02), and median overall hospital LOS (16 days vs. 11 days, p < 0.01). In sub-group analysis, patients with a history of psychiatric illness alone had comparable outcomes to the control group. CONCLUSIONS: Psychiatric comorbidity negatively impacts inpatient morbidity and inpatient LOS. This effect is most pronounced among acute psychiatric episodes with or without a history of mental illness.

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BACKGROUND: With the advancement in device technology, the use of durable left ventricular assist devices (LVADs) has increased significantly in recent years. However, there is a dearth of evidence to conclude whether patients who undergo LVAD implantation at high-volume centers have better clinical outcomes than those receiving care at low- or medium-volume centers. METHODS: We analyzed the hospitalizations using the Nationwide Readmission Database for the year 2019 for new LVAD implantation. Baseline comorbidities and hospital characteristics were compared among low- (1-5 procedures/year), medium- (6-16 procedures/year) and high-volume (17-72 procedures/year) hospitals. The volume/outcome relationship was analyzed using the annualized hospital volume as a categorical variable (tertiles) as well as a continuous variable. Multilevel mixed-effect logistic regression and negative binomial regression models were used to determine the association of hospital volume and outcomes, with tertile 1 (low-volume hospitals) as the reference category. RESULTS: A total of 1533 new LVAD procedures were included in the analysis. The inpatient mortality rate was lower in the high-volume centers compared with the low-volume centers (9.04% vs 18.49%, aOR 0.41, CI0.21-0.80; P = 0.009). There was a trend toward lower mortality rates in medium-volume centers compared with low-volume centers; however, it did not reach statistical significance (13.27% vs 18.49%, aOR 0.57, CI0.27-1.23; P = 0.153). Similar results were seen for major adverse events (composite of stroke/transient ischemic attack and in-hospital mortality). There was no significant difference in bleeding/transfusion, acute kidney injury, vascular complications, pericardial effusion/hemopericardium/tamponade, length of stay, cost, or 30-day readmission rates between medium- and high-volume centers compared to low-volume centers. CONCLUSION: Our findings indicate lower inpatient mortality rates in high-volume LVAD implantation centers and a trend toward lower mortality rates in medium-volume LVAD implantation centers compared to lower-volume centers.

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Insuficiencia Cardíaca , Corazón Auxiliar , Humanos , Corazón Auxiliar/efectos adversos , Insuficiencia Cardíaca/cirugía , Insuficiencia Cardíaca/etiología , Hospitalización , Hospitales , Mortalidad Hospitalaria , Estudios Retrospectivos , Resultado del Tratamiento

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BACKGROUND: Inflammatory bowel disease (IBD) has been associated with an increased risk of thromboembolic vascular complications. Although studies from the National Inpatient Sample (NIS) examined this association to some extent, sub-stratification for Crohn's disease (CD) and ulcerative colitis (UC) in larger studies is lacking. The aims of this study were to utilize the NIS to determine the prevalence of thromboembolic events in inpatients with IBD compared to in patients without IBD and to explore the inpatient outcomes like morbidity, mortality, and resource utilization in patients with IBD and thromboembolic events as stratified by disease subtype. METHODS: This was a retrospective observational study using the NIS 2016. All patients with ICD10-CM codes for IBD were included. Patients with thromboembolic events were identified using diagnostic ICD codes and stratified into 4 categories: (1) Deep vein thrombosis (DVT), (2) Pulmonary embolism (PE), (3) Portal vein thrombosis (PVT), and (4) Mesenteric ischemia, which were then sub-stratified for CD and UC. The primary outcome was the inpatient prevalence and odds of thromboembolic events in patients with IBD compared to without IBD. Secondary outcomes were inpatient morbidity, mortality, resource utilization, colectomy rates, hospital length of stay (LOS), and total hospital costs and charges compared to patients with IBD and thromboembolic events. RESULTS: A total of 331,950 patients with IBD were identified, of who 12,719 (3.8%) had an associated thromboembolic event. For the primary outcome, after adjusting for confounders, inpatients with IBD had higher adjusted odds of DVT (aOR 1.59, p < 0.001), PE (aOR 1.20, p < 0.001), PVT (aOR 3.18, p < 0.001) and mesenteric ischemia (aOR 2.49, p < 0.001) compared to inpatients without IBD, an observation which was confirmed for both patients with CD and UC. Inpatients with IBD and associated DVT, PE and mesenteric ischemia had higher morbidity, mortality, odds of colectomy, cost, and charges. CONCLUSIONS: Inpatients with IBD have higher odds of associated thromboembolic disorders compared to patients without IBD. Furthermore, inpatients with IBD and thromboembolic events have significantly higher mortality, morbidity, colectomy rates and resource utilization. For these reasons, increased awareness and specialized strategies for the prevention and management of thromboembolic events should be considered in inpatients with IBD.

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Colitis Ulcerosa , Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Isquemia Mesentérica , Embolia Pulmonar , Trombosis de la Vena , Humanos , Isquemia Mesentérica/complicaciones , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/epidemiología , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/terapia , Tiempo de Internación , Trombosis de la Vena/etiología , Trombosis de la Vena/complicaciones , Embolia Pulmonar/etiología , Embolia Pulmonar/complicaciones

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IMPORTANCE: Acute myocardial infarction (AMI) is a major health concern among older adults (≥80 years). We analyzed a US national database to evaluate the clinical outcomes, resource utilization, and economic burden of AMI hospitalizations in older patients. METHODS AND RESULTS: We analyzed the National Inpatient Sample data between January 2004 and December 2018. We examined the trends of clinical characteristics, inpatient mortality, and healthcare cost utilization in older US adults for AMI hospitalizations. We identified 2,174,587 weighted AMI hospitalizations. There was a decrease in AMI hospitalizations per 100,000 older US adults from 1,679 in 2004 to 1036 in 2018, with a more profound decrease in ST-elevation myocardial infarction (STEMI). We noted an overall increase in comorbidities (hypertension, heart failure, dyslipidemia, atrial fibrillation, diabetes, peripheral vascular disease). Overall, inpatient mortality was 10.6%; adjusted inpatient mortality decreased from 14% in 2004 to 8% in 2018 (p trend <0.001)- consistent across sexes and races. There was increased percutaneous intervention (PCI) utilization [19.3% (2004-2008) to 24.0% (2014-2018)] with a concomitant increase in bleeding and acute kidney injury (AKI). Black adults and women underwent revascularization less frequently than White adults and men. White patients had higher inpatient mortality compared to black patients. There was a decrease in adjusted mean length of stay (LOS) from 6.2 days in 2004 to 3.9 days in 2018 (p trend <0.001). There was an increase in discharge disposition to home with a concomitant decrease in utilization of rehabilitation facilities at discharge. CONCLUSION: Our study showed that the inpatient mortality and LOS has decreased for AMI hospitalizations in the older patient population in the US. While utilization of revascularization strategies has increased, sex and racial disparities exist in the utilization of PCI.

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Infarto del Miocardio , Intervención Coronaria Percutánea , Masculino , Humanos , Femenino , Estados Unidos/epidemiología , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Hospitalización , Comorbilidad , Tiempo de Internación , Mortalidad Hospitalaria

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INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) patients have been reported to have cardiac manifestations, however, arrhythmias have not been characterized in this population. We examined the predictors of arrhythmias and assessed the impact of arrhythmias on inpatient outcomes among DLBCL patients. METHODS: Retrospective cohort analysis was performed using the National Inpatient Sample data collected between 2016 and 2018. Multivariable logistic and linear regression models were used to examine the predictors of arrhythmias and inpatient outcomes among DLBCL patients. RESULTS: 11% of DLBCL patients had a diagnosis of arrhythmias. Patients aged 70 years or older had 2.6 times higher odds (95% CI: 2.37-2.78) of having arrhythmias compared to patients younger than 70 years. Females were 23% (AOR: 0.77; 95% CI: 0.71-0.83) less likely to have a diagnosis of arrhythmias relative to their male counterparts. Compared to non-Hispanic whites, patients who were non-Hispanic blacks (AOR: 0.69; 95% CI: 0.60-0.81), Hispanics (AOR: 0.60; 95% CI: 0.52-0.69) or in the non-Hispanic other category (AOR: 0.80; 95% CI: 0.70-0.91) were significantly less likely to be diagnosed with arrhythmias. Other factors that predicted arrhythmias were patient disposition and comorbidity index. Additionally, arrhythmias were associated with higher inpatient mortality, length of stay and hospital costs. CONCLUSIONS: Older male patients were more likely to be diagnosed with arrhythmias while non-Hispanic blacks and Hispanics were less likely to have arrhythmias. These findings highlight the need for surveillance to enable early detection of arrhythmias in this population.

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Arritmias Cardíacas , Linfoma de Células B Grandes Difuso , Femenino , Humanos , Masculino , Estudios Retrospectivos , Prevalencia , Arritmias Cardíacas/epidemiología , Linfoma de Células B Grandes Difuso/epidemiología , Hospitales , Pacientes Internos

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BACKGROUND: Prior studies show hospital admission volume to be associated with poor outcomes following elective procedures and inpatient medical hospitalizations. However, it is unknown whether hospital volume impacts Inpatient outcomes for status epilepticus (SE) hospitalizations. In this study, we aimed to assess the impact of hospital volume on the outcome of patients with SE and related inpatient medical complications. METHODS: The 2005 to 2013 National Inpatient Sample database was queried using International Classification of Diseases 9th Edition diagnosis code 345.3 to identify patients undergoing acute hospitalization for SE. The National Inpatient Sample hospital identifier was used as a unique facility identifier to calculate the average volume of patients with SE seen in a year. The study cohort was divided into three groups: low volume (0-7 patients with SE per year), medium volume (8-22 patients with SE per year), and high volume (> 22 patients with SE per year). Multivariate logistic regression analyses were used to assess whether medium or high hospital volume had lower rates of inpatient medical complications compared with low-volume hospitals. RESULTS: A total of 137,410 patients with SE were included in the analysis. Most patients (n = 50,939; 37%) were treated in a low-volume hospital, 31% (n = 42,724) were treated in a medium-volume facility, and 18% (n = 25,207) were treated in a high-volume hospital. Patients undergoing treatment at medium-volume hospitals (vs. low-volume hospitals) had higher odds of pulmonary complications (odds ratio [OR] 1.18 [95% confidence interval {CI} 1.12-1.25]; p < 0.001), sepsis (OR 1.24 [95% CI 1.08-1.43] p = 0.002), and length of stay (OR 1.13 [95% CI 1.0 -1.19] p < 0.001). High-volume hospitals had significantly higher odds of urinary tract infections (OR 1.21 [95% CI 1.11-1.33] p < 0.001), pulmonary complications (OR 1.19 [95% CI 1.10-1.28], p < 0.001), thrombosis (OR 2.13 [95% CI 1.44-3.14], p < 0.001), and renal complications (OR 1.21 [95% CI 1.07-1.37], p = 0.002). In addition, high-volume hospitals had lower odds of metabolic (OR 0.81 [95% CI 0.72-0.91], p < 0.001), neurological complications (OR 0.80 [95% CI 0.69-0.93], p = 0.004), and disposition to a facility (OR 0.89 [95% CI 0.82-0.96], p < 0.001) compared with lower-volume hospitals. CONCLUSIONS: Our study demonstrates certain associations between hospital volume and outcomes for SE hospitalizations. Further studies using more granular data about the type, severity, and duration of SE and types of treatment are warranted to better understand how hospital volume may impact care and prognosis of patients.

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Pacientes Internos , Estado Epiléptico , Humanos , Hospitalización , Hospitales de Alto Volumen , Bases de Datos Factuales , Estado Epiléptico/epidemiología , Estado Epiléptico/terapia , Tiempo de Internación

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BACKGROUND: Prior observation has shown differences in COVID-19 hospitalization risk between SARS-CoV-2 variants, but limited information describes hospitalization outcomes. METHODS: Inpatients with COVID-19 at 5 hospitals in the eastern United States were included if they had hypoxia, tachypnea, tachycardia, or fever, and SARS-CoV-2 variant data, determined from whole-genome sequencing or local surveillance inference. Analyses were stratified by history of SARS-CoV-2 vaccination or infection. The average effect of SARS-CoV-2 variant on 28-day risk of severe disease, defined by advanced respiratory support needs, or death was evaluated using models weighted on propensity scores derived from baseline clinical features. RESULTS: Severe disease or death within 28 days occurred for 977 (29%) of 3369 unvaccinated patients and 269 (22%) of 1230 patients with history of vaccination or prior SARS-CoV-2 infection. Among unvaccinated patients, the relative risk of severe disease or death for Delta variant compared with ancestral lineages was 1.30 (95% confidence interval [CI]: 1.11-1.49). Compared with Delta, the risk for Omicron patients was .72 (95% CI: .59-.88) and compared with ancestral lineages was .94 (.78-1.1). Among Omicron and Delta infections, patients with history of vaccination or prior SARS-CoV-2 infection had half the risk of severe disease or death (adjusted hazard ratio: .40; 95% CI: .30-.54), but no significant outcome difference by variant. CONCLUSIONS: Although risk of severe disease or death for unvaccinated inpatients with Omicron was lower than with Delta, it was similar to ancestral lineages. Severe outcomes were less common in vaccinated inpatients, with no difference between Delta and Omicron infections.

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COVID-19 , Pacientes Internos , Humanos , SARS-CoV-2/genética , COVID-19/epidemiología , Vacunas contra la COVID-19

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Introduction High consumption of alcohol has an enormous toll on the health status of individuals. A direct affectation of cardiac integrity concerns cardiologists, primary care physicians, and the healthcare system because this increases the disease burden. Alcoholic cardiomyopathy (ACM) results from the enormous consumption of alcohol over a long period of time. The prevalence varies between regions and sex and ranges between 4% and 40%. Viewing the entire spectrum of cardiomyopathies, ACM makes up about 4% of all cardiomyopathies. However, it causes dilated-type cardiomyopathy and is the second most common cause of dilated cardiomyopathy. We sought to explore the outcomes of percutaneous coronary intervention (PCI) among patients with ACM. Methods This was a retrospective, cross-sectional study of the National Inpatient Sample (NIS) for hospital discharges in the United States between 2012 and 2014. We identified the number of patients with a primary or secondary diagnosis of ACM using the International Classification of Diseases, Ninth Revision (ICD-9) code of 4.255. Using the ICD-9 codes for PCI (00.66, 36.01, 36.02, 36.05, 36.06, 36.07, and 17.55), we identified patients diagnosed with ACM who underwent a PCI (ACPCI). The racial and sexual prevalence, hospital length of stay (LOS), mortality, cost of hospitalization, and cardiovascular outcomes (ventricular fibrillation (VF) and atrial fibrillation (AF)) were compared between patients with and without ACM who underwent a PCI. Results A total of 2,488,293 PCIs were performed between 2012 and 2014. Of these, there were a total of 161 admissions for ACM. About 93% (151) of the ACM PCI group were men. Ethnic distribution revealed a majority of Caucasians with 69% (98), and blacks and Asians at 13.4% (19) and 11.3% (16), respectively. The mean age was 59.8 (SD = 9). The patients with ACPCI were likely to stay longer in the hospital, with an average stay of 6.6 days (SD = 6.2) compared to patients without ACM undergoing PCI (NOACPCI) (3.7 days; SD = 5.0) (p = 0.0001). The mean cost of hospital admission for patients with ACPCI was $120,225 (SD = 101,044), while that of those without ACM who underwent PCI (NOACPCI) was $87,936 (SD = 83,947) (p = 0.0001). A higher death rate during hospitalization (3.7%) was recorded in the ACPCI category vs. 2.3% in patients without ACM who underwent PCI (p = 0.0001). Patients with ACPCI had a higher prevalence of AF (30.4%) than VF (7.5%). Conclusion The ACPCI group had overall poorer hospital outcomes. The majority affected were older Caucasian men with an increased prevalence of AF, higher cost of hospitalization, and longer hospital stays. Further studies are needed to explore the burden of long-term alcohol consumption on cardiovascular disease treatment outcomes.

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Background Though multiple myeloma (MM) patients have been reported to have the highest risk of atrial fibrillation compared to other cancer patients, studies are lacking on the impact of atrial fibrillation on health outcomes in this population. In this study, we examined the impact of atrial fibrillation on inpatient outcomes among hospitalized patients with MM. Methodology Retrospective cohort analyses were conducted using National Inpatient Sample data from 2016 to 2018. Descriptive analyses were performed to explore the prevalence of atrial fibrillation among MM patients. Multivariable logistic and linear regression models were used to examine the association between atrial fibrillation and inpatient all-cause mortality, length of stay, and total hospital charges among hospitalized patients with MM. Results Overall, 13.1% of the patients reported having atrial fibrillation. MM patients with atrial fibrillation had 1.2 times (adjusted odds ratio (AOR) = 1.16; 95% confidence interval (CI) = 1.05-1.29) higher odds of inpatient all-cause mortality when compared to those without atrial fibrillation. They were also 1.3 times (AOR = 1.29; 95% CI = 1.23-1.35) more likely to have a length of stay of more than five days relative to five days or less. Additionally, MM patients with atrial fibrillation had $8,020 (95% CI = $5,495.2-$10,546.3) higher hospital costs when compared to their counterparts without atrial fibrillation. Stratified results by the use of anticoagulation further showed that MM patients who were not using anticoagulation had bad health outcomes, reporting higher odds of inpatient all-cause mortality (AOR = 1.40; 95% CI = 1.25-1.57), a longer length of hospital stay of more than five days (AOR = 1.44; 95% CI = 1.36-1.53), and total hospital charges (ß = $14,772.5; 95% CI = $11,467.8-$18,077.3). Conclusions Our findings stress the need for monitoring and possible screening to detect atrial fibrillation in MM patients as anticoagulation helps improve mortality in these patients. Medication reconciliation remains a key component of hospital admissions/discharges and may help in decreasing the length of stay and healthcare costs.

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Colorectal cancer is the second leading cause of cancer-related death in the United States, with a rising incidence, especially in young adults. Care for patients with colorectal cancer is associated with significant healthcare costs and expenditures. We retrospectively interrogated the National Inpatient Sample for admissions in patients with colorectal cancer from 2007 to 2017. A total of 1,962,705 admissions were identified: 50.2% were men, 64.4% were white, and the median age was 68. Most admissions (47.8%) that were coded for anatomical location of malignancy were for ascending colon cancer. The average in-hospital mortality was 4.9%, with a lower mortality in admissions with ascending colon cancer (2.9, P < 0.001). The median length of stay was 5 days, with a longer stay in admissions with transverse colon cancer (9 days, P < 0.0001). The median cost of hospitalization was $12,295 and was significantly higher for patients with descending colon malignancy ($16,369, P < 0.0001). The number of annual hospitalizations stayed steady overall but increased by 98.6% for rectosigmoid cancer. Our findings highlight the high costs of hospitalization and the overall economic burden associated with inpatient admissions among patients with colorectal cancer.

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Fibrilación Atrial , Neoplasias de la Mama , Neoplasias de la Mama/radioterapia , Femenino , Mortalidad Hospitalaria , Humanos , Pacientes Internos , Tiempo de Internación

RESUMEN

BACKGROUND: Though hemochromatosis is described as an infiltrative cardiomyopathy that can result in arrhythmias, studies are lacking on the impact of arrhythmias in this population. We examined the prevalence, factors influencing arrhythmias, and impact of arrhythmias on inpatient outcomes among hospitalized patients with hemochromatosis. METHODS: Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS) collected between 2016 and 2018. Descriptive analyses were done to assess the prevalence of arrhythmias in patients with hemochromatosis. Univariate and multivariable logistic and linear regression models were used to examine the factors associated with arrhythmias and hospital-associated outcomes among patients with hemochromatosis. RESULTS: 11.7% of hemochromatosis patients were diagnosed with arrhythmias. Compared to hemochromatosis patients less than 40 years old, those between 40 and 59 years had 2.3 times higher odds (Adjusted Odds Ratio (AOR): 2.35; 95% Confidence Interval (CI): 1.81-3.05) of having arrhythmias relative to no arrhythmias while patients aged 60 and above had 5 times higher odds (AOR: 4.96; 95% CI: 3.74-6.58) of arrhythmias. Compared to male patients, females were significantly less likely to be diagnosed with arrhythmias. Hispanics were 36% (AOR: 0.64; 95% CI: 0.47-0.86) less likely to have arrhythmias when compared to their non-Hispanic white counterparts. Other factors associated with arrhythmias were income, insurance type, and patient disposition. Furthermore, arrhythmias were related to higher hospital mortality, longer hospital stays, and total hospital charges. CONCLUSION: Our findings accentuate the need for close monitoring and early detection of arrhythmias in patients with hemochromatosis to improve their health outcomes. Patients need to be continually educated on their medical diagnoses and the need for treatment adherence, while hospitalist physicians need to ensure good continuity of care between the hospital and primary care setting to drive hospital costs down while keeping patients healthy.

Asunto(s)

Hemocromatosis , Pacientes Internos , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/terapia , Femenino , Hemocromatosis/diagnóstico , Hemocromatosis/epidemiología , Hemocromatosis/terapia , Mortalidad Hospitalaria , Hospitalización , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiología