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Patel J, Sohal A, Chaudhry H, Kalra S, Kohli I, Singh I, Dukovic D, Yang J. Predictors and impact of aspiration pneumonia in patients undergoing esophagogastroduodenoscopy: national inpatient sample 2016-2020. Eur J Gastroenterol Hepatol 2024; 36:298-305. [PMID: 38179867 DOI: 10.1097/meg.0000000000002698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Aspiration pneumonia is a rare but feared complication among patients undergoing esophagogastroduodenoscopy (EGD). Our study aims to assess the incidence as well as risk factors for aspiration pneumonia in patients undergoing EGD. METHODS National Inpatient Sample 2016-2020 was used to identify adult patients undergoing EGD. Patients were stratified into two groups based on the presence of aspiration pneumonia. Multivariate logistic regression analysis was performed to identify the risk factors associated with aspiration pneumonia. We adjusted for patient demographics, Elixhauser comorbidities and hospital characteristics. RESULTS Of the 1.8 million patients undergoing EGD, 1.9% of the patients developed aspiration pneumonia. Patients with aspiration pneumonia were mostly males (59.54%), aged >65 years old (66.19%), White (72.2%), had Medicare insurance (70.5%) and were in the lowest income quartile (28.7%). On multivariate analysis, the age >65 group, White race, congestive heart failure (CHF), neurological disorders and chronic obstructive pulmonary disease were associated with higher odds of aspiration pneumonia. This complication was associated with higher in-hospital mortality (9% vs. 0.8%; P < 0.001) and longer length of stay (10.54 days vs. 4.85 days; P < 0.001). CONCLUSION Our study found that rates of post-EGD aspiration pneumonia are increasing. We found a significant association between various comorbidities and aspiration pneumonia. Our data suggests that we need to optimize these patients before EGD, as the development of aspiration is associated with worsened outcomes. Further prospective studies are needed to clarify these associations.
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Affiliation(s)
- Jay Patel
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, Washington
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco-Fresno, California, USA
| | - Shivam Kalra
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Isha Kohli
- Department of Graduate Public Health, Icahn School of Medicine, Mount Sinai, New York
| | - Ishandeep Singh
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Dino Dukovic
- Department of Internal Medicine, Ross University School of Medicine, Bridgetown, Barbados
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, The University of Texas Medical Branch, Galveston, Texas, USA
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Gangu K, Basida S, Awan RU, Butt MA, Reed A, Afzal R, Shekhar R, Chela HK, Daglilar ES, Sheikh AB. July effect in clinical outcomes of esophagogastroduodenoscopy performed at teaching hospitals in the United States. Proc AMIA Symp 2023; 36:478-482. [PMID: 37334097 PMCID: PMC10269412 DOI: 10.1080/08998280.2023.2204804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background Esophagogastroduodenoscopy (EGD) is a common procedure used for both diagnosis and treatment, but carries risks such as bleeding and perforation. The "July effect"-described as increased complication rates during the transition of new trainees-has been studied in other procedures, but has not been thoroughly evaluated for EGD. Methods We used the National Inpatient Sample database for 2016 to 2018 to compare outcomes in EGD performed between July to September and April to June. Results Approximately 0.91 million patients in the study received EGD between July to September (49.35%) and April to June (50.65%), with no significant differences between the two groups in terms of age, gender, race, income, or insurance status. Of the 911,235 patients, 19,280 died during the study period following EGD, 2.14% (July-September) vs 1.95% (April-June), with an adjusted odds ratio of 1.09 (P < 0.01). The adjusted total hospitalization charge was $2052 higher in July-September ($81,597) vs April to June ($79,023) (P < 0.005). The mean length of stay was 6.8 days (July-September) vs 6.6 days (April-June) (P < 0.001). Conclusions The results of this study are reassuring as the July effect on inpatient outcomes for EGDs was not significantly different according to our study. We recommend seeking prompt treatment and improving new trainee training and interspecialty communication for better patient outcomes.
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Affiliation(s)
- Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Sanket Basida
- Department of Internal Medicine, University of Missouri System, Columbia, Missouri
| | - Rehmat Ullah Awan
- Department of Internal Medicine, Ochsner Rush Medical Center, Meridian, Mississippi
| | - Mohammad Ali Butt
- Department of Internal Medicine, Allegheny General Hospital – Western Pennsylvania Hospital Medical Education Consortium, Pittsburgh, Pennsylvania
| | - Austin Reed
- Department of Internal Medicine, University of Missouri System, Columbia, Missouri
| | - Rao Afzal
- Department of Internal Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Harleen Kaur Chela
- Department of Internal Medicine, West Virginia University Health Sciences Center Charleston Division, Charleston, West Virginia
| | - Ebubekir S. Daglilar
- Department of Internal Medicine, West Virginia University Health Sciences Center Charleston Division, Charleston, West Virginia
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Olaiya B, Renelus BD, Filon M, Saha S. Trends in Morbidity and Mortality Following Colectomy Among Patients with Ulcerative Colitis in the Biologic Era (2002-2013): A Study Using the National Inpatient Sample. Dig Dis Sci 2021; 66:2032-2041. [PMID: 32676826 DOI: 10.1007/s10620-020-06474-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 07/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Total abdominal colectomy (TAC) is a treatment modality of last recourse for patients with severe and/or refractory ulcerative colitis (UC). The goal of this study is to evaluate temporal trends and treatment outcomes following TAC among hospitalized UC patients in the biologic era. METHODS We queried the National Inpatient Sample (NIS) to identify patients older than 18 years with a primary diagnosis of ulcerative colitis (UC) who underwent TAC between 2002 and 2013. We evaluated postoperative morbidity and mortality as outcomes of interest. Logistic regression was used to explore factors associated with postoperative morbidity and mortality after TAC. RESULTS A weighted total of 307,799 UC hospitalizations were identified. Of these, 27,853 (9%) resulted in TAC. Between 2002 and 2013, hospitalizations for UC increased by over 70%; however, TAC rates dropped significantly from 111.1 to 77.1 colectomies per 1000 UC admissions. Overall, 2.2% of patients died after TAC. Mortality rates after TAC decreased from 3.5% in 2002 to 1.4% in 2013. Conversely, morbidity rates were stable throughout the study period. UC patients with emergent admissions, higher comorbidity scores and who had TAC in low volume colectomy hospitals had poorer outcomes. Regardless of admission type, outcomes were worse if TAC was performed more than 24 h after admission. CONCLUSIONS Despite increased hospitalizations for UC, rates of TAC have declined during the post-biologic era. For UC patients who undergo TAC, mortality has declined significantly while morbidity remains stable. Older age, race, emergent admissions and delayed surgery are predictive factors of both postoperative morbidity and mortality.
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Affiliation(s)
- Babatunde Olaiya
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA.
| | - Benjamin D Renelus
- Department of Gastroenterology, Brooklyn Methodist, New York-Presbyterian Hospital, Brooklyn, NY, USA
| | - Mikolaj Filon
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Kabaria S, Mutneja H, Makar M, Ahlawat S, Patel AV, Rustgi VK, Bhurwal A. Timing of endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis without cholangitis: a nationwide inpatient cohort study. Ann Gastroenterol 2021; 34:575-581. [PMID: 34276198 PMCID: PMC8276366 DOI: 10.20524/aog.2021.0615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/06/2020] [Indexed: 01/08/2023] Open
Abstract
Background The timing of endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute biliary pancreatitis without cholangitis is unclear. We accessed a national database to analyze the outcomes of urgent (<24 h) and early (24-72 h) ERCP in this cohort. Methods The cohort was extracted from the Nationwide Inpatient Sample database. Hospital ERCP volumes were generated using unique hospital identifiers. Multivariate regression modeling was used to analyze the predictors of urgent vs. early ERCP use, and to determine various outcome variables between the 2 cohorts. Results Overall, 105,433 admissions were evaluated. There was a significant rise in urgent ERCP performed over the study period. Older patients, males, patients with comorbidities, African American and Hispanic patient populations were less likely to receive urgent ERCP. High ERCP volume hospitals, teaching hospitals, and hospitals in the Midwest and West were more likely to perform urgent ERCP. There were no differences in mortality rates or complication rates between the 2 cohorts. However, there were significant differences in length of stay and healthcare cost analysis. Conclusions The increasing use of urgent ERCP did not result in a clinically significant benefit in terms of mortality, length of stay, or healthcare cost analysis. The use of urgent ERCP is also not uniform across various demographic and hospital cohorts. Urgent ERCP may be over-utilized, and it may be reasonable to perform ERCP in this patient population based on the physician’s suspicion about the severity of disease.
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Affiliation(s)
- Savan Kabaria
- Internal Medicine, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences (RBHS), Rutgers University, New Brunswick, NJ (Savan Kabaria, Michael Makar, Sushil)
| | - Hemant Mutneja
- Gastroenterology and Hepatology, John H. Stroger Cook County Hospital, Chicago, Il (Hemant Mutneja)
| | - Michael Makar
- Internal Medicine, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences (RBHS), Rutgers University, New Brunswick, NJ (Savan Kabaria, Michael Makar, Sushil)
| | - Sushil Ahlawat
- Division of Gastroenterology & Hepatology, New Jersey Medical School, Rutgers Biomedical and Health Sciences (RBHS), Rutgers University, Newark, NJ (Sushil Ahlawat)
| | - Anish V Patel
- Division of Gastroenterology and Hepatology, Robert Wood Johnson School of Medicine, Rutgers Biomedical and Health Sciences (RBHS), Rutgers University, New Brunswick, NJ, (Anish V. Patel, Vinod K. Rustgi, Abhishek Bhurwal), USA
| | - Vinod K Rustgi
- Division of Gastroenterology and Hepatology, Robert Wood Johnson School of Medicine, Rutgers Biomedical and Health Sciences (RBHS), Rutgers University, New Brunswick, NJ, (Anish V. Patel, Vinod K. Rustgi, Abhishek Bhurwal), USA
| | - Abhishek Bhurwal
- Division of Gastroenterology and Hepatology, Robert Wood Johnson School of Medicine, Rutgers Biomedical and Health Sciences (RBHS), Rutgers University, New Brunswick, NJ, (Anish V. Patel, Vinod K. Rustgi, Abhishek Bhurwal), USA
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Adverse Events After Inpatient Colonoscopy in Octogenarians: Results From the National Inpatient Sample (1998-2013). J Clin Gastroenterol 2020; 54:813-818. [PMID: 31764488 DOI: 10.1097/mcg.0000000000001288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIM Colonoscopy is commonly performed in the elderly who have a higher proportion of lower gastrointestinal (GI) tract disorders. However, few studies have evaluated the safety of colonoscopy specifically in the octogenarian population. The goal of this study is to examine the safety of colonoscopy among octogenarians over a 16-year period. We also examine risk factors associated with morbidity and mortality in octogenarians after inpatient colonoscopy. MATERIALS AND METHODS We queried the National Inpatient Sample to identify octogenarians who had a colonoscopy during hospitalization from 1998 to 2013. We examined inpatient GI-related adverse events including colonic perforation, postcolonoscopy bleeding, and splenic injury. We also examined all-cause mortality rates after colonoscopy. RESULTS About a quarter of inpatient colonoscopies performed annually were in octogenarians. Of 296,385 colonoscopies included in our study, colon perforation, postcolonoscopy bleeding, and splenic injury occurred in 11, 9, and 0.22 per 1000 colonoscopies, respectively. Overall mortality rate was 2.8%, most (2.5%) dying within 30 days of colonoscopy. After controlling for covariates, those who had colon perforation, postcolonoscopy bleeding, or splenic injury were at a much higher risk of inpatient mortality. CONCLUSIONS There seems to be a higher risk of adverse GI-related events after colonoscopy in octogenarians as compared with the general population. Furthermore, occurrence of adverse GI-related events increased the risk of mortality among octogenarians regardless of comorbid status.
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Abbas A, Sethi S, Vidyarthi G, Taunk P. Predictors of postendoscopic retrograde cholangiopancreatography pancreatitis, analysis of more than half a million procedures performed nationwide over the last 15 years. JGH Open 2020; 4:736-742. [PMID: 32782964 PMCID: PMC7411627 DOI: 10.1002/jgh3.12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 02/25/2020] [Accepted: 03/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND AIM Post-ERCP pancreatitis (PEP) is the most common complication following endoscopic retrograde cholangiopancreatography (ERCP). It is still controversial whether the presence of a trainee would increase the risk of PEP. Additionally, the effects of demographic factors and comorbidities on the risk and severity of PEP are not fully understood. Our aim was to evaluate these factors using national database. METHODS Nationwide Inpatient Sample 2000-2014 was used to identify adult patients admitted with biliary obstruction without acute pancreatitis and had an inpatient ERCP. PEP was defined as having a subsequent diagnosis of acute pancreatitis. The presence of major organs failure marked moderate-severe PEP. Demographic information, hospital characteristics, and ERCP intervention types were collected. RESULTS We included 654 394 patients. Overall PEP rate was 5.4%. The PEP rate was lower in teaching (4.8%) compared with nonteaching (6.2%, P < 0.001) hospitals. The highest PEP rate was observed among patients undergoing Sphincter of Oddi Manometry (15.1%, odds ratio [OR] = 2.5, P < 0.001) as compared to diagnostic cholangiography (4.4%). Asians and Hispanics had higher rate of PEP (10% and 7.9%, respectively) compared with Caucasians and African Americans (4.9% and 5%, respectively, P < 0.001). Multivariate analysis showed that after controlling for the ERCP intervention types, Asians and Hispanics continued to have higher odds of PEP (OR = 1.3, P < 0.001). Seventeen percent of patients were classified as moderate-severe PEP. Older patients (OR = 3.2, P < 0.001), males (OR = 1.4, P < 0.001), and high comorbidities (1.3, P < 0.001) were major predictors of moderate-severe PEP. CONCLUSION No evidence of higher PEP rates in teaching hospitals. Asians and Hispanics had higher PEP rates. Although ERCP intervention type is the major PEP predictor, its severity is dependent on patient characteristics.
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Affiliation(s)
- Ali Abbas
- Section of GastroenterologyUSF Health Morsani College of MedicineTampaFloridaUSA
| | - Sajiv Sethi
- Section of GastroenterologyUSF Health Morsani College of MedicineTampaFloridaUSA
| | | | - Pushpak Taunk
- Division of Digestive Diseases and NutritionUniversity of South Florida Morsani College of MedicineTampaFloridaUSA
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Kwak MJ, Lal LS, Swint JM, Du XL, Chan W, Akkanti B, Dhoble A. Early tracheostomy in acute heart failure exacerbation. Heart Lung 2020; 49:646-650. [PMID: 32457003 DOI: 10.1016/j.hrtlng.2020.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The optimal timing for tracheostomy among patients with acute heart failure (AHF) exacerbation has been controversial, despite multiple studies assessing the utility of early tracheostomy. Our objective was to assess the trend of utilization and outcomes of early tracheostomy among patients with AHF exacerbation in the United States. METHODS AND RESULTS A retrospective cohort study using the National Inpatient Sample from 2005 to 2014 was conducted. Among those who were admitted with AHF exacerbation (n = 1,390,356), 0.26% of patients underwent tracheostomy (n = 2,571), and among them, 19.4% received early tracheostomy (n = 496). There was no significant shift in the percentage of early tracheostomy from 2008 to 2014. We used propensity score matching to compare the clinical and economic outcomes between the early tracheostomy group and late tracheostomy group. In-hospital mortality did not show any difference between the two groups (13.97% in early group vs. 18.04% in late group; p =0.163). The median total hospital cost ($53,466), total hospital length of stay (19 days), and length of stay after intubation (16 days) in the early tracheostomy group were significantly lower than in the late tracheostomy group ($73,680; 26 days; 23 days, respectively). CONCLUSION Early tracheostomy showed economic benefit with lower hospital costs and shorter length of stay, without a difference in in-hospital mortality compared to late tracheostomy.
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Affiliation(s)
- Min Ji Kwak
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Lincy S Lal
- Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX, United States
| | - John M Swint
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX, United States
| | - Xianglin L Du
- Department of Epidemiology, The University of Texas School of Public Health, Houston, TX, United States
| | - Wenyaw Chan
- Department of Biostatistics, The University of Texas School of Public Health, Houston, TX, United States
| | - Bindu Akkanti
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Abhijeet Dhoble
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.
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Bresler AY, Bavier R, Kalyoussef E, Baredes S, Park RCW. The “July effect”: Outcomes in microvascular reconstruction during resident transitions. Laryngoscope 2020; 130:893-898. [DOI: 10.1002/lary.27988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Amishav Y. Bresler
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Richard Bavier
- Rutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Evelyne Kalyoussef
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Soly Baredes
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyRutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Richard Chan Woo Park
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark New Jersey U.S.A
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Olaiya B, Adler DG. Air embolism secondary to endoscopy in hospitalized patients: results from the National Inpatient Sample (1998-2013). Ann Gastroenterol 2019; 32:476-481. [PMID: 31474794 PMCID: PMC6686097 DOI: 10.20524/aog.2019.0401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Air embolism is a rare, but potentially catastrophic complication of endoscopic procedures. We herein evaluated the overall incidence of air embolism after endoscopy. We also measured mortality outcomes after air embolism. Methods: Patients who underwent endoscopy as an index procedure during hospitalization were selected from the National Inpatient Sample from 1998-2013. The primary outcome of interest was the incidence of air embolism after endoscopy. All-cause mortality after endoscopy was measured as a secondary outcome and the Charlson Comorbidity Index was calculated. Binary logistic regression was used to explore the effect of air embolism on inpatient mortality, using P<0.05 as level of significance. Results: A total of 2,245,291 patients met the inclusion criteria. Mean age at the time of procedure was 62.5 years. Esophagogastroduodenoscopy (EGD) was the most common endoscopic procedure, accounting for 80% of endoscopic procedures. Air embolism occurred in 13 cases, giving a rate of 0.57 per 100,000 endoscopic procedures. Air embolism was most common after endoscopic retrograde cholangiopancreatography (ERCP), occurring in 3.32 per 100,000 procedures, compared with 0.44 and 0.38 per 100,000 procedures for EGD and colonoscopy, respectively. The case fatality rate for post endoscopic air embolism was 15.4%. After adjusting for covariates, air embolism after endoscopy was independently associated with higher odds of inpatient mortality: odds ratio 10.35, 95% confidence interval 1.21-88.03 (P<0.03). Conclusions: Air embolism is most common after ERCP. It is frequently associated with disorders involving a breach to the gastrointestinal mucosa or vasculature. Though rare, it is an independent predictor of inpatient mortality.
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Affiliation(s)
- Babatunde Olaiya
- Department of Internal Medicine, Marshfield Clinic, Marshfield WI (Babatunde Olaiya)
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah (Douglas G. Adler), USA
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Lee TY, Nakai Y. Is the July Effect Real in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography? Clin Endosc 2019; 52:399-400. [PMID: 31344767 PMCID: PMC6785417 DOI: 10.5946/ce.2019.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tae Yoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Desai R, Patel U, Doshi S, Zalavadia D, Siddiq W, Dave H, Bilal M, Khullar V, Goyal H, Desai M, Shah N. A Nationwide Assessment of the "July Effect" and Predictors of Post-Endoscopic Retrograde Cholangiopancreatography Sepsis at Urban Teaching Hospitals in the United States. Clin Endosc 2019; 52:486-496. [PMID: 31129956 PMCID: PMC6785412 DOI: 10.5946/ce.2018.190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/27/2019] [Indexed: 12/23/2022] Open
Abstract
Background/Aims To analyze the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) sepsis in the early (July to September) and later (October to June) academic months to assess the “July effect”.
Methods The National Inpatient Sample (2010–2014) was used to identify ERCP-related adult hospitalizations at urban teaching hospitals by applying relevant procedure codes from the International Classification of Diseases, 9th revision, Clinical Modification. Post-ERCP outcomes were compared between the early and later academic months. A multivariate analysis was performed to evaluate the odds of post-ERCP sepsis and its predictors.
Results Of 481,193 ERCP procedures carried out at urban teaching hospitals, 124,934 were performed during the early academic months. The demographics were comparable for ERCP procedures performed during the early and later academic months. A higher incidence (9.4% vs. 8.8%, p<0.001) and odds (odds ratio [OR], 1.07) of post-ERCP sepsis were observed in ERCP performed during the early academic months. The in-hospital mortality rate (7% vs. 7.5%, p=0.072), length of stay, and total hospital charges in patients with post-ERCP sepsis were also equivalent between the 2 time points. Pre-ERCP cholangitis (OR, 3.20) and post-ERCP complications such as cholangitis (OR, 6.27), perforation (OR, 3.93), and hemorrhage (OR, 1.42) were significant predictors of higher post-ERCP sepsis in procedures performed during the early academic months.
Conclusions The July effect was present in the incidence of post-ERCP sepsis, and academic programs should take into consideration the predictors of post-ERCP sepsis to lower health-care burden.
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Affiliation(s)
| | - Upenkumar Patel
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - Shreyans Doshi
- Department of Internal Medicine, College of Medicine/Hospital Corporation of America Graduate Medicine Education Consortium, University of Central Florida, Gainesville, FL, USA
| | - Dipen Zalavadia
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Wardah Siddiq
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hitanshu Dave
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Mohammad Bilal
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Vikas Khullar
- Division of Gastroenterology, Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Madhav Desai
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Nihar Shah
- Division of Gastroenterology, Department of Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
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Bashjawish B, Patel S, Kılıç S, Hsueh WD, Liu JK, Baredes S, Eloy JA. Examining the "July effect" on patients undergoing pituitary surgery. Int Forum Allergy Rhinol 2018; 8:1157-1161. [PMID: 29905016 DOI: 10.1002/alr.22164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Our aim in this study was to assess the impact of the turnover of residents in July on patients undergoing pituitary surgery. METHODS This work was a retrospective cohort study of cases from the National Inpatient Sample (NIS). Patients who underwent pituitary surgery from 2005 to 2012 were selected in the NIS. Patients undergoing surgery in July and in non-July months were compared to determine differences in demographics, comorbidities, and complications. RESULTS Of the 12,939 patients, 1098 (8.5%) underwent pituitary surgery in July. Patients receiving surgery in July had similar demographics and Agency for Healthcare Research and Quality comorbidity values compared with patients receiving surgery in other months. There were no significant differences in mortality, cerebral edema, cerebrospinal fluid leakage, iatrogenic pituitary complications, iatrogenic cerebrovascular accidents, urinary tract infections, pulmonary edema, pulmonary complications, or acute cardiac complications. There were no differences in the rate of postoperative fistulas, hematomas, perforations, or infections. The use of meningeal suturing, pedicled or free-flap reconstruction, and skin reconstruction was more frequent in July. Finally, hospitalization costs in July were similar to costs in other months. CONCLUSION The turnover of new residents in July showed no change in complication rates for patients undergoing pituitary surgery. Patient care in July is similar to care during other months, demonstrating that hospitals are adequately supervising surgical residents during this transition.
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Affiliation(s)
- Bassel Bashjawish
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Shreya Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Suat Kılıç
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Wayne D Hsueh
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ
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Desai R, Patel U, Goyal H. Does "July effect" exist in colonoscopies performed at teaching hospitals? Transl Gastroenterol Hepatol 2018; 3:28. [PMID: 29971259 DOI: 10.21037/tgh.2018.05.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 12/14/2022] Open
Abstract
Background To compare the outcomes of the colonoscopies between the early (July-September) and the later (April-June) academic year at the urban-teaching hospitals. Methods Our study cluster was derived from the National Inpatient Sample (NIS) database for the years 2010-2014. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) procedure codes were used to identify the adult patients who underwent inpatient colonoscopy at urban-teaching hospitals. Post-colonoscopy outcomes and the complications were recognized using ICD-9 CM codes among any of the secondary diagnoses. Categorical and continuous variables were assessed using Pearson's Chi-square and Student's t-test respectively. Odds of complications during the early vs. later academic year was also evaluated by the two-way hierarchical logistic regression analysis. Results A total of 124,155 (weighted n=617,907) colonoscopy procedures were performed at the urban teaching hospitals in the US from 2010 to 2014. Out of these, 61,272 (weighted n=304,946) and 62,883 (weighted n=312,961) procedures were performed during early (July to September) and later (April to June) academic months, respectively. There was no significant difference in the all-cause mortality (1.4% vs. 1.4%, P=0.208), and the complications such as colonic perforations (3.1% vs. 3.2%, P=0.229) and postoperative infections (0.6% vs. 0.6%, P=0.733) between the two groups. Similarly, the splenic rupture (0.0% vs. 0.0%, P=0.180) was equally infrequent in both the groups. Bleeding/hematoma following colonoscopy (0.9% vs. 0.8%, P=0.004) was marginally higher during the later academic months. There were no statistically distinctions in terms of length of stay (LOS) (days) (7.3±9.1 vs. 7.3±9.1, P=0.918), total hospitalization charges ($60,549.41 vs. $59,918.56, P=0.311) and discharge of patients to other facilities between the early and the later academic months. Colonoscopy performed during the early academic months was not found to be a significant independent predictor for post-colonoscopy complications such as colon perforation (OR =0.99, 95% CI: 0.93-1.06, P=0.760), postoperative bleeding/hematoma (OR =0.92, 95% CI: 0.81-1.04, P=0.196) and postoperative infection (OR =0.99, 95% CI: 0.84-1.15, P=0.850). Conclusions There was no "July effect" on the outcomes of colonoscopies between the early vs. the later academic months.
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Affiliation(s)
- Rupak Desai
- Research Fellow, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Upenkumar Patel
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University, Macon, GA, USA
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