In-hospital outcomes of transapical versus surgical aortic valve replacement: from the U.S. national inpatient sample

OBJECTIVE To compare the outcomes of transapical transcatheter aortic valve replacement(TA-TAVR)and surgical aortic valve replacement(SAVR)using a large US population sample.METHODS The U.S.National Inpatient Sample was queried for all patients who underwent TA-TAVR or SAVR during the years2016-2017.The primary outcome was all-cause in-hospital mortality.Secondary outcomes were in-hospital stroke,pericardiocentesis,pacemaker insertion,mechanical ventilation,vascular complications,major bleeding,acute kidney injury,length of stay,and cost of hospitalization.Outcomes were modeled using multi-variable logistic regression for binary outcomes and generalized linear models for continuous outcomes.RESULTS A total of 1560 TA-TAVR and 44,280 SAVR patients were included.Patients who underwent TA-TAVR were older and frailer.Compared to SAVR,TA-TAVR correlated with a higher mortality(4.5%vs.2.7%,effect size(SMD)=0.1)and higher periprocedural complications.Following multivariable analysis,both TA-TAVR and SAVR had a similar adjusted risk for in-hospital mortality.TA-TAVR correlated with lower odds of bleeding with(adjusted OR(aOR)=0.26;95%CI:0.18-0.38;P<0.001),and a shorter length of stay(adjusted mean ratio(aMR)=0.77;95%CI:0.69-0.84;P<0.001),but higher cost(aMR=1.18;95%CI:1.10-1.28;P<0.001).No significant differences in other study outcomes.In subgroup analysis,TA-TAVR in patients with chronic lung disease had higher odds for mortality(aOR=3.11;95%CI:1.37-7.08;P=0.007).CONCLUSION The risk-adjusted analysis showed that TA-TAVR has no advantage over SAVR except for patients with chronic lung disease where TA-TAVR has higher mortality.

Liver Transplantation Outcomes of HBV-,HCV-,and Alcohol-induced Hepatocellular Carcinoma in the United States:Analysis of National Inpatient Samples

Objective Liver transplantation is a current treatment option for hepatocellular carcinoma(HCC).The United States National Inpatient Sample database was utilized to identify risk factors that influence the outcome of liver transplantation,including locoregional recurrence,distant metastasis,and in-hospital mortality,in HCC patients with concurrent hepatitis B infection,hepatitis C infection,or alcoholic cirrhosis.Methods This retrospective cohort study included HCC patients(n=2391)from the National Inpatient Sample database who underwent liver transplantation and were diagnosed with hepatitis B or C virus infection,co-infection with hepatitis B and C,or alcoholic cirrhosis of the liver between 2005 and 2014.Associations between HCC etiology and post-transplant outcomes were examined with multivariate analysis models.Results Liver cirrhosis was due to alcohol in 10.5%of patients,hepatitis B in 6.6%,hepatitis C in 10.8%,and combined hepatitis B and C infection in 24.3%.Distant metastasis was found in 16.7%of patients infected with hepatitis B and 9%of hepatitis C patients.Local recurrence of HCC was significantly more likely to occur in patients with hepatitis B than in those with alcohol-induced disease.Conclusion After liver transplantation,patients with hepatitis B infection have a higher risk of local recurrence and distant metastasis.Postoperative care and patient tracking are essential for liver transplant patients with hepatitis B infection.

Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt

AIM: To evaluate and validate the national trends and predictors of in-patient mortality of transjugular intrahepatic portosystemic shunt (TIPS) in 15 years.METHODS: Using the National Inpatient Sample which is a part of Health Cost and Utilization Project, we identified a discharge-weighted national estimate of 83884 TIPS procedures performed in the United States from 1998 to 2012 using international classification of diseases-9 procedural code 39.1. The demographic, hospital and co-morbility data were analyzed using a multivariant analysis. Using multi-nominal logistic regression analysis, we determined predictive factors related to increases in-hospital mortality. Comorbidity measures are in accordance to the Comorbidity Software designed by the Agency for Healthcare Research and Quality.RESULTS: Overall, 12.3% of patients died during hospitalization with downward trend in-hospital mortality with the mean length of stay of 10.8 &#x000b1; 13.1 d. Notable, African American patients (OR = 1.809 vs Caucasian patients, P &#x0003c; 0.001), transferred patients (OR = 1.347 vs non-transferred, P &#x0003c; 0.001), emergency admissions (OR = 3.032 vs elective cases, P &#x0003c; 0.001), patients in the Northeast region (OR = 1.449 vs West, P &#x0003c; 0.001) had significantly higher odds of in-hospital mortality. Number of diagnoses and number of procedures showed positive correlations with in-hospital death (OR = 1.249 per one increase in number of procedures). Patients diagnosed with acute respiratory failure (OR = 8.246), acute kidney failure (OR = 4.359), hepatic encephalopathy (OR = 2.217) and esophageal variceal bleeding (OR = 2.187) were at considerably higher odds of in-hospital death compared with ascites (OR = 0.136, P &#x0003c; 0.001). Comorbidity measures with the highest odds of in-hospital death were fluid and electrolyte disorders (OR = 2.823), coagulopathy (OR = 2.016), and lymphoma (OR = 1.842).CONCLUSION: The overall mortality of the TIPS procedure is steadily decreasing, though the length of stay has remained relatively constant. Specific patient ethnicity, location, transfer status, primary diagnosis and comorbidities correlate with increased odds of TIPS in-hospital death.

National trends in total hip arthroplasty for traumatic hip fractures:An analysis of a nationwide all-payer database

BACKGROUND Hemiarthroplasty(HA)has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures.Ideal treatment for younger,ambulatory patients is not as clear.Total hip arthroplasty(THA)has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.AIM To examine what patient characteristics are associated with undergoing THA or HA.To determine if outcomes differ between the groups.METHODS We queried the Nationwide Inpatient Sample(NIS)for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014.The NIS comprises a large representative sample of inpatient hospitalizations in the United States.International Classifications of Disease,Ninth Edition(ICD-9)codes were used to identify patients in our sample.Demographic variables,hospital characteristics,payer status,medical comorbidities and mortality rates were compared between the two procedures.Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.RESULTS Of the total 502060 patients who were treated for femoral neck fracture,51568(10.3%)underwent THA and the incidence of THA rose from 8.3%to 13.7%.Private insurance accounted for a higher percentage of THA than hemiarthroplasty.THA increased most in urban teaching hospitals relative to urban non-teaching hospitals.Mean length of stay(LOS)was longer for HA.The mean charges were less for HA,however charges decreased steadily for both groups.HA had a higher mortality rate,however,after adjusting for age and comorbidities HA was not an independent risk factor for mortality.Interestingly,private insurance was an independent predictor for treatment with THA.CONLUSION There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States,most notably in urban hospitals.HA and THA are decreasing in total charges and LOS.

National trends in resection of the distal pancreas

AIM:To investigate national trends in distal pancreatectomy(DP) through query of three national patient care databases.METHODS:From the Nationwide Inpatient Sample(NIS,2003-2009),the National Surgical Quality Improvement Project(NSQIP,2005-2010),and the Surveillance Epidemiology and End Results(SEER,2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal pancreatectomy.Utilization of laparoscopy was defined in NIS by the International Classification of Diseases,Ninth Revision correspondent procedure code;and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology codes.In SEER,patients were identified by the International Classification of Diseases for Oncology,Third Edition diagnosis codes and the SEER Program Code Manual,third edition procedure codes.We analyzed the databases with respect to trends of inpatient outcome metrics,oncologic outcomes,and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative resection.RESULTS:NIS,NSQIP and SEER identified 4242,2681 and 11 082 DP resections,respectively.Overall,laparoscopy was utilized in 15%(NIS) and 27%(NSQIP).No significant increase was seen over the course of the study.Resection was performed for malignancy in 59%(NIS) and 66%(NSQIP).Neither patient Body mass index nor comorbidities were associated with operative approach(P = 0.95 and P = 0.96,respectively).Mortality(3% vs 2%,P = 0.05) and reoperation(4% vs 4%,P = 1.0) was not different between laparoscopy and open groups.Overall complications(10% vs 15%,P < 0.001),hospital costs [44 741 dollars,interquartile range(IQR) 28 347-74 114 dollars vs 49 792 dollars,IQR 13 299-73 463,P = 0.02] and hospital length of stay(7 d,IQR 4-11 d vs 7 d,IQR 6-10,P < 0.001) were less when laparoscopy was utilized.One and two year survival after resection for malignancy were unchanged over the course of the study(ductal adenocarinoma 1-year 63.6% and 2-year 35.1%,P = 0.53;intraductal papillary mucinous neoplasm and nueroendocrine 1-year 90% and 2-year 84%,P = 0.25).The majority of resections were performed in teaching hospitals(77% NIS and 85% NSQIP),but minimally invasive surgery(MIS) was not more likely to be used in teaching hospitals(15% vs 14%,P = 0.26).Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles(88% vs 43%,P < 0.001),but were no more likely to utilize MIS at resection.Complication rate in teaching and the top decile hospitals was not significantly decreased when compared to non-teaching(15% vs 14%,P = 0.72) and lower volume hospitals(14% vs 15%,P = 0.99).No difference was seen in the median number of lymph nodes and lymph node ratio in N1 disease when compared by year(P = 0.17 and P = 0.96,respectively).CONCLUSION:There appears to be an overall underutilization of laparoscopy for DP.Centralization does not appear to be occurring.Survival and lymph node harvest have not changed.

Study on myocardial infarction based on nationwide inpatient sample database:a bibliometric analysis from 2000 to 2022

Background:Studies on myocardial infarction(MI)based on large medical databases have become popular in recent years.The influence of the National Inpatient Sample(NIS),the largest collection of administrative healthcare data across the United States,on the field of MI has not been well investigated.This study aimed to quantify the contribution of NIS to MI research using bibliometric methods.Methods:We searched the Web of Science Core Collection database to identify publications on MI using NIS from 2000 to 2022.Bibliometric indicators,such as the number of publications,citations,and Hirsch index(H-index),were summarized by years,authors,organizations,and journals.VOSviewer and CiteSpace software were used to analyze the keywords and trends of the hot spots.Results:A total of 342 articles on MI based on NIS were included.A significant growth in outputs related to MI using the NIS from 2000 to 2020 was observed.The publications were mainly from the United States.The Mayo Clinic was the most prolific institution and had the most citations and the highest H-index.The American Journal of Cardiology ranked first among journals with the highest number of publications,citations,and H-index.Mortality and healthcare management are the main focuses of this field.Personalized risks and care are receiving increased attention.Conclusion:This study suggests that NIS significantly contributes to high-quality output in MI research.More efforts are needed to improve the impact of knowledge gained from the NIS on MI.

Link between irritable bowel syndrome,depression,and colorectal cancer risk in young patients:Age-matched nationwide populationbased study

BACKGROUND There exists a link between irritable bowel syndrome(IBS)and depression.Similarly,chronic depression is known to increase the risk of cancer in general.In this population-based analysis,we investigated the prevalence and the odds of colorectal cancer(CRC)in young-depressed patients with IBS.AIM To investigate the relationship between IBS and CRC in young,depressed patients using a nationally representative United States inpatient sample.METHODS The 2019 National Inpatient Sample was used to identify young(18-44 years)patients admitted with comorbid depression in the presence vs absence of IBS using relevant International Classification of Diseases,Tenth Revision,Clinical Modification codes.Primary endpoint was the prevalence and odds of CRC in age matched(1:1)youngdepressed cohort hospitalized with IBS(IBS+)vs without IBS(IBS-).Multivariable regression analysis was performed adjusting for potential confounders.RESULTS Age-matched(1:1)young-depressed IBS+(83.9%females,median age 36 years)and IBS-(65.8%females,median age 36 years)cohorts consisted of 14370 patients in each group.IBS+cohort had higher rates of hypertension,uncomplicated diabetes,hyperlipidemia,obesity,peripheral vascular disease,chronic obstructive pulmonary disease,hypothyroidism,prior stroke,prior venous thromboembolism,anxiety,bipolar disorder,and borderline personality disorder(P<0.005)vs the IBS-cohort.However,prior myocardial infarction,acquired immunodeficiency syndrome,dementia,smoking,alcohol abuse,and drug abuse(P<0.005)are high in IBS-cohort.The rate of CRC was comparable in both cohorts[IBS+n=25(0.17%)vs IBS-n=35(0.24%)].Compared to the IBS-cohort,the odds ratio(OR)of developing CRC was not significantly higher[OR 0.71,95% confidence interval(CI)0.23-2.25]in IBS+cohort.Also,adjusting for baseline sociodemographic and hospital characteristics and relevant comorbidities,the OR was found to be non-significant(OR 0.89,95%CI 0.21-3.83).CONCLUSION This nationwide propensity-matched analysis revealed comparable prevalence and risk of CRC in youngdepressed patients with vs without IBS.Future large-scale prospective studies are needed to evaluate the long-term effects of depression and its treatment on CRC risk and outcomes in IBS patients.

Hospital teaching status on the outcomes of patients with esophageal variceal bleeding in the United States

BACKGROUND Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis.There is limited data on the outcomes of patients with esophageal variceal bleeding in teaching versus nonteaching hospitals.Because esophageal variceal bleeding requires complex management,it may be hypothesized that teaching hospitals have lower mortality.AIM To assess the differences in mortality,hospital length of stay(LOS)and cost of admission for patients admitted for variceal bleed in teaching versus nonteaching hospitals across the US.METHODS The National Inpatient Sample is the largest all-payer inpatient database consisting of approximately 20%of all inpatient admissions to nonfederal hospitals in the United States.We collected data from the years 2008 to 2014.Cases of variceal bleeding were identified using the International Classification of Diseases,Ninth Edition,Clinical Modification codes.Differences in mortality,LOS and cost were evaluated for patients with esophageal variceal bleed between teaching and nonteaching hospitals and adjusted for patient characteristics and comorbidities.RESULTS Between 2008 and 2014,there were 58362 cases of esophageal variceal bleeding identified.Compared with teaching hospitals,mortality was lower in nonteaching hospitals(8.0%vs 5.3%,P<0.001).Median LOS was shorter in nonteaching hospitals as compared to teaching hospitals(4 d vs 5 d,P<0.001).A higher proportion of non-white patients were managed in teaching hospitals.As far as procedures in nonteaching vs teaching hospitals,portosystemic shunt insertion(3.1%vs 6.9%,P<0.001)and balloon tamponade(0.6%vs 1.2%)were done more often in teaching hospitals while blood transfusions(64.2%vs 59.9%,P=0.001)were given more in nonteaching hospitals.Using binary logistic regression models and adjusting for baseline patient demographics and comorbid conditions the mortality,LOS and cost in teaching hospitals remained higher.CONCLUSION In patients admitted for esophageal variceal bleeding,mortality,length of stay and cost were higher in teaching hospitals versus nonteaching hospitals when controlling for other confounding factors.

Mortality and health care burden of Budd Chiari syndrome in the United States:A nationwide analysis(1998-2017)

The Budd Chiari syndrome(BCS)is a rare and potentially fatal disease,but there is a paucity of data on the in-hospital mortality as well its economic burden on the health care system.AIM To evaluate trends in mortality,length of hospital stays and resource utilization among inpatients with BCS.METHODS Data on all adult patients with a diagnosis of BCS were extracted from the National Inpatient Sample(NIS)from 1998 to 2017.To make inferences regarding the national estimates for the total number of BCS discharges across the study period,sample weights were applied to each admission per recommendations from the NIS.RESULTS During the study period,there were 3591(8.73%)in-patient deaths.The overall inhospital mortality rates among BCS patients decreased from 18%in 1998 to 8%in 2017;the mortality decreased by 4.41%(P<0.0001)every year.On multivariate analysis,older age,higher comorbidity score,acute liver failure,acute kidney injury,acute respiratory failure,hepatic encephalopathy,hepatorenal syndrome,inferior vena cava thrombosis,intestinal infarct,sepsis/septic shock and cancer were associated increased risk of mortality.The average of length of stay was 8.8 d and it consistently decreased by 2.04%(95%CI:-2.67%,-1.41%,P<0.001)from 12.7 d in 1998 to 7.6 d in 2017.The average total charges after adjusted for Medical Care Consumers Price Index to 2017 dollars during the time period was$94440 and the annual percentage change increased by 1.15%(95%CI:0.35%,1.96%,P=0.005)from$95515 in 1998 to$103850 in 2017.CONCLUSION The in-hospital mortality rate for patients admitted with BCS in the United States has reduced between 1998 and 2017 and this may a reflection of better management of these patients.

A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States

BACKGROUND Palliative care(PC)has been shown to be beneficial in end stage liver disease(ESLD),yet the hospitalization data for PC utilization is unknown.AIM To identify the trend of PC utilization for the special population of alcoholassociated ESLD patients,factors affecting its use and ascertain its impact on healthcare utilization.METHODS We analyzed around 78 million discharges from the 2007-2014 national inpatient sample and 2010-2014 national readmission database including adult patients admitted for decompensated alcohol-associated cirrhosis.We identified patients with PC consultation as a secondary diagnosis.Odds ratios(OR)and means were adjusted for confounders using multivariate regression analysis models.RESULTS Out of the total 1421849 hospitalizations for decompensated liver cirrhosis,62782(4.4%)hospitalizations had a PC consult,which increased from 0.8%(1258)of all alcohol-associated ESLD hospitalizations in 2007 to 6.6%in 2014(P<0.01).Patient and hospital characteristics associated with increased odds of PC utilization were advanced age,lower income,Medicaid coverage,teaching institution,urban location,length of stay>3 d,prolonged ventilation,and administration of total parenteral nutrition(all P<0.01).Palliative encounters in alcohol-associated ESLD and acute-onchronic liver failure(ACLF)score were associated with increased odds of discharge to a rehabilitation facility,but significantly lower odds of 30-d readmissions(aOR:0.35,95%CI:0.31-0.41),lower total hospitalization charges and lower mean hospitalization days(all P<0.01).CONCLUSION Inpatient PC is sparingly used for patients with decompensated alcohol related liver disease,however it has increased over the past decade.PC consultation is associated with lower 30-d readmission rates on multivariate analysis,and lower hospitalization cost and length of stay in patients with ACLF score≥2.

Is cirrhosis associated with lower odds of ischemic stroke:A nationwide analysis?

AIMTo determine the association between cirrhosis and ischemic stroke in a large nationally representative sample. METHODSA retrospective cross-sectional study of all hospitalized patients during 2012 and 2013 in the United States was performed using the National Inpatient Sample database. Hospitalizations with acute stroke, cirrhosis and other risk factors were identified using ICD-9-CM codes. RESULTSThere were a total of 72082638 hospitalizations in the United States during the years 2012 and 2013. After excluding hospitalizations with missing demographic variables, that there were a total of 1175210 (1.6%) out of these were for acute ischemic stroke. Cirrhosis was present among 5605 (0.4%) cases of ischemic stroke. Mean age among the cirrhotic and non-cirrhotic groups with ischemic stroke were 66.4 and 70.5 years, respectively. Prevalence of risk factors among the two groups was also calculated. After adjusting for various known risk factors the odds of having an ischemic stroke (OR = 0.28, P CONCLUSIONOur study suggests that in a large, nationally representative sample of the United States population, cirrhosis is associated with a lower likelihood of stroke.

Clinical outcomes in patients with native valve infective endocarditis and diabetes mellitus

BACKGROUND There is a lack of data on the clinical outcomes in patients with native valve infective endocarditis(NVIE)and diabetes mellitus(DM).AIM To investigate(1)trends in the prevalence of DM among patients with NVIE;and(2)the impact of DM on NVIE outcomes.METHODS We identified 76385 with NVIE from the 2004 to 2014 National Inpatient Sample,of which 22284(28%)had DM.We assessed trends in DM from 2004 to 2014 using the Cochrane Armitage test.We compared baseline comorbidities,microorganisms,and in-patients procedures between those with vs without DM.Propensity match analysis and multivariate logistic regression were used to investigate study outcomes in in-hospital mortality,stroke,acute heart failure,cardiogenic shock,septic shock,and atrioventricular block.RESULTS Crude rates of DM increased from in 22%in 2004 to 30%in 2014.There were significant differences in demographics,comorbidities and NVIE risk factors between the two groups.Staphylococcus aureus was the most common organism identified with higher rates in patients with DM(33.1%vs 35.6%;P<0.0001).After propensity matching,in-hospital mortality(11.1%vs 11.9%;P<0.0001),stroke(2.3%vs 3.0%;P<0.0001),acute heart failure(4.6%vs 6.5%;P=0.001),cardiogenic shock(1.5%vs 1.9%;P<0.0001),septic shock(7.2%vs 9.6%;P<0.0001),and atrioventricular block(1.5%vs 2.4%;P<0.0001),were significantly higher in patients with DM.Independent predictors of mortality in NVIE patients with DM include hemodialysis,congestive heart failure,atrial fibrillation,staphylococcus aureus,and older age.CONCLUSION There is an increasing prevalence of DM in NVIE and it is associated with poorer outcomes.Further studies are crucial to identify the clinical,and sociodemographic contributors to this trend and develop strategies to mitigate its attendant risk.