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Gajjar AA, Covell MM, Prem Kumar R, Tang OY, Ranganathan S, Muzyka L, Mualem W, Rehman I, Patel SV, Lavadi RS, Mitha R, Lieber BA, Hamilton DK, Agarwal N. Evidence Against a Traumatic Brain Injury "July Effect": An Analysis of 3 160 452 Patients From the National Inpatient Sample. Neurosurgery 2024:00006123-990000000-01281. [PMID: 38990004 DOI: 10.1227/neu.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The "July Effect" hypothesizes increased morbidity and mortality after the addition of inexperienced physicians at the beginning of an academic year. However, the impact of newer members on neurosurgical teams managing patients with traumatic brain injury (TBI) has yet to be examined. This study conducted a nationwide analysis to evaluate the existence of the "July Effect" in the setting of patients with TBI. METHODS The Healthcare Cost and Utilization Project Central Distributor's National Inpatient Sample data set was queried for patients with TBI using International Classification of Diseases (ICD)-9 and ICD-10 codes. Discharges were included for diagnoses of traumatic epidural, subdural, or subarachnoid hemorrhages. Only patients treated at teaching hospitals were included to ensure resident involvement in care. Patients were grouped into July admission and non-July admission cohorts. A subgroup of patients with neurotrauma undergoing any form of cranial surgery was created. Perioperative variables were recorded. Rates of different complications were assayed. Groups were compared using χ2 tests (qualitative variables) and t-tests or Mann-Whitney U-tests (quantitative variables). Logistic regression was used for binary variables. Gamma log-linked regression was used for continuous variables. RESULTS The National Inpatient Sample database yielded a weighted average of 3 160 452 patients, of which 312 863 (9.9%) underwent surgical management. Patients admitted to the hospital in July had a 5% decreased likelihood of death (P = .027), and a 5.83% decreased likelihood of developing a complication (P < .001) compared with other months of the year. July admittance to a hospital showed no significant impact on mean length of stay (P = .392) or routine discharge (P = .147). Among patients with TBI who received surgical intervention, July admittance did not significantly affect the likelihood of death (P = .053), developing a complication (P = .477), routine discharge (P = .986), or mean length of stay (P = .385). CONCLUSION The findings suggested that there is no "July Effect" on patients with TBI treated at teaching hospitals in the United States.
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Affiliation(s)
- Avi A Gajjar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael M Covell
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Rohit Prem Kumar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Oliver Y Tang
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Logan Muzyka
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - William Mualem
- Department of General Surgery, Temple University, Philadelphia, Pennsylvania, USA
| | - Inaya Rehman
- Department of Biology, San Jose State University, San Jose, California, USA
| | - Shrey V Patel
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bryan A Lieber
- Department of Neurosurgery, Dr. Kiran C. Patel College of Allopathic Medicine Nova Southeastern University Davie, Fort Lauderdale, Florida, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Vasan V, Dullea JT, Devarajan A, Vasa D, Ali M, Nichols N, Henson P, Porras C, Lopez C, Luna D, Liou L, Iloreta AM, Govindaraj S, Bederson J, Shrivastava RK. Predictors of Prolonged Length of Stay After Pituitary Adenoma Resection: A Large Cohort Analysis Using the National Inpatient Sample (2016-2019). Am J Rhinol Allergy 2023; 37:758-765. [PMID: 37550993 DOI: 10.1177/19458924231193527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE In this nationwide retrospective study, the authors aimed to identify demographic, clinical, and baseline health risk factors predictive of a prolonged length of stay (PLOS) for patients with pituitary adenomas (PAs). METHODS The National Inpatient Sample dataset from 2016 to 2019 was utilized to identify all included hospitalizations for PA resection as identified by the appropriate diagnosis-related group code. Comorbidities were classified based on the Charlson Comorbidity Index mapping of ICD-10 codes, and PLOS was identified as any stay longer than 3 days. Univariable and multivariable logistic regression models, accounting for the sample design, were built to determine factors associated with PLOS and emergent surgery. RESULTS Overall, 30 945 patients were included in this study with 10 535 patients having PLOS. Female patients experienced an increased odds of PLOS (odds ratio [OR]: 1.29; P < .001). Black patients (OR: 1.49; P < .001) and Hispanic patients (OR: 1.30; P = .003) had 1.49 times and 1.30 times the odds of PLOS compared to White patients, respectively. Compared to patients insured by Medicare, patients insured by Medicaid had an increased odds of PLOS (OR: 1.36; P = .007) as well as emergent surgery (OR: 5.40; P < .001). When stratified by emergent surgeries, Black patients (OR: 1.89; P < .001), Hispanic patients, (OR: 2.14; P < .001), and patients on Medicaid insurance (OR: 1.71; P < .001) were at an increased risk of emergent procedures. However, female sex (OR: 0.65; P < .001), upper third quartile (OR: 0.73; P = .017), and fourth quartile (OR: 0.69; P = .014) of patients categorized by zip code income were at decreased odds of an emergent procedure. CONCLUSIONS Black and Hispanic patients, patients with Medicaid insurance, and patients of low socioeconomic status patients are at significantly higher risk of emergent PA resection and PLOS. Efforts to prevent emergent surgeries and shorten hospitalization after pituitary surgery may need to primarily focus on patient groups with select sociodemographic characteristics.
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Affiliation(s)
- Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan T Dullea
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alex Devarajan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Devarshi Vasa
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Noah Nichols
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Philip Henson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christian Porras
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christine Lopez
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Diego Luna
- Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Lathan Liou
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alfred Marc Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Ahmed R, Mhina C, Philip K, Patel SD, Aneni E, Osondu C, Lamikanra O, Akano EO, Anikpezie N, Albright KC, Latorre JG, Chaturvedi S, Otite FO. Age- and Sex-Specific Trends in Medical Complications After Acute Ischemic Stroke in the United States. Neurology 2023; 100:e1282-e1295. [PMID: 36599695 PMCID: PMC10033158 DOI: 10.1212/wnl.0000000000206749] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/15/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To test the hypothesis that the age and sex-specific prevalence of infectious (pneumonia, sepsis, and urinary tract infection [UTI]) and noninfectious (deep venous thrombosis [DVT], pulmonary embolism [PE], acute renal failure [ARF], acute myocardial infarction [AMI], and gastrointestinal bleeding [GIB]) complications increased after acute ischemic stroke (AIS) hospitalization in the United States from 2007 to 2019. METHODS We conducted a serial cross-sectional study using the 2007-2019 National Inpatient Sample. Primary AIS admissions in adults (aged 18 years or older) with and without complications were identified using International Classification of Diseases codes. We quantified the age/sex-specific prevalence of complications and used negative binomial regression models to evaluate trends over time. RESULTS Of 5,751,601 weighted admissions, 51.4% were women. 25.1% had at least 1 complication. UTI (11.8%), ARF (10.1%), pneumonia (3.2%), and AMI (2.5%) were the most common complications, while sepsis (1.7%), GIB (1.1%), DVT (1.2%), and PE (0.5%) were the least prevalent. Marked disparity in complication risk existed by age/sex (UTI: men 18-39 years 2.1%; women 80 years or older 22.5%). Prevalence of UTI (12.9%-9.7%) and pneumonia (3.8%-2.7%) declined, but that of ARF increased by ≈3-fold (4.8%-14%) over the period 2007-2019 (all p < 0.001). AMI (1.9%-3.1%), DVT (1.0%-1.4%), and PE (0.3%-0.8%) prevalence also increased (p < 0.001), but that of sepsis and GIB remained unchanged over time. After multivariable adjustment, risk of all complications increased with increasing NIH Stroke Scale (pneumonia: prevalence rate ratio [PRR] 1.03, 95% CI 1.03-1.04, for each unit increase), but IV thrombolysis was associated with a reduced risk of all complications (pneumonia: PRR 0.80, 85% CI 0.73-0.88; AMI: PRR 0.85, 95% CI 0.78-0.92; and DVT PRR 0.87, 95% CI 0.78-0.98). Mechanical thrombectomy was associated with a reduced risk of UTI, sepsis, and ARF, but DVT and PE were more prevalent in MT hospitalizations compared with those without. All complications except UTI were associated with an increased risk of in-hospital mortality (sepsis: PRR 1.97, 95% CI 1.78-2.19). DISCUSSION Infectious complications declined, but noninfectious complications increased after AIS admissions in the United States in the last decade. Utilization of IV thrombolysis is associated with a reduced risk of all complications.
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Affiliation(s)
- Rashid Ahmed
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Carl Mhina
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Karan Philip
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Smit D Patel
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Ehimen Aneni
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Chukwuemeka Osondu
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Oluwatomi Lamikanra
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Emmanuel Oladele Akano
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Nnabuchi Anikpezie
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Karen C Albright
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Julius G Latorre
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Seemant Chaturvedi
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Fadar Oliver Otite
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore.
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