1
|
Ramser B, Coleoglou Centeno A, Ferre A, Thomas S, Brooke M, Pieracci F, Morton A. Laparoscopic common bile duct exploration is an effective, safe, and less-costly method of treating choledocholithiasis. Surg Endosc 2024:10.1007/s00464-024-11139-5. [PMID: 39138682 DOI: 10.1007/s00464-024-11139-5] [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: 04/19/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Advancements in laparoscopic techniques led to the adoption of laparoscopic common bile duct exploration (LCBDE) as an alternative to endoscopic retrograde cholangiopancreatography (ERCP) for management of choledocholithiasis (CD). The goal of this study was to describe the initial experience at a safety net hospital with acute care surgeons performing LCBDE for suspected CD. We hypothesized LCBDE would reduce length of stay and hospital costs compared to laparoscopic cholecystectomy (LC) and ERCP performed in the same hospital admission. METHODS This was a retrospective case-control study from 2019 to 2023 comparing LCBDE to LC/ERCP among patients diagnosed with CD. Statistical analyses were performed using Mann-Whitney U tests for continuous variables and Chi-square tests for categorical variables. Data reported as median [interquartile range] or research subjects with condition (percentage). RESULTS A total of 110 LCBDE were performed, while 121 subjects underwent LC and ERCP. Patients in the LCBDE group were more likely to be female with a total of 87 female subjects (77.6%) compared to 76 male subjects (62.8%) (95% CI 1.14-3.74). Initial WBC was lower in the LCBDE group at 8.4 [6.9-11.8] compared to the LC/ERCP group at 10.9 [7.9-13.5] (p = 0.0013). Remaining demographics and lab values were similar between the two groups. Patients who underwent LCBDE had a significantly shorter length of stay at 2 days [1-3] compared to those in the LC/ERCP group at 4 days [3-6] (p < 0.001). Hospital charges for the LCBDE group were $46,685 [$38,687-$56,703] compared to $60,537 [$47,527-$71,739] for the LC/ERCP group (p < 0.001). CONCLUSION LCBDE is associated with significantly lower hospital costs and shorter length of stay with similar post-operative complication and 30-day readmission rates. Our results show that LCBDE is safe and should be considered as a first-line approach in the management of CD.
Collapse
Affiliation(s)
- Benjamin Ramser
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA.
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Adrian Coleoglou Centeno
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandra Ferre
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sany Thomas
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Magdalene Brooke
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Fredric Pieracci
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexander Morton
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
2
|
Shahzad H, Bhatti N, Sheldon A, Veliky C, Singh VK, Kanu G, Khan SN. Incidence and predictive factors of double crush syndrome in patients undergoing cervical surgery: a database study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3082-3086. [PMID: 39030320 DOI: 10.1007/s00586-024-08356-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/29/2024] [Accepted: 06/02/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Double crush syndrome (DCS) is characterized by multiple compression sites along a single peripheral nerve. It commonly presents with persistent distal symptoms despite surgical treatment for cervical radiculopathy. Management typically involves nerve release of the most symptomatic site. However, due to overlapping symptoms with cervical radiculopathy, patients may undergo cervical surgery prior to DCS diagnosis. Due to its rarity and frequent misdiagnosis, the authors aim to utilize a large national database to investigate the incidence and associations of DCS. METHODS The Pearldiver database was utilized to identify patients undergoing cervical surgery for the management of cervical radiculopathy. Patients were stratified into three cohorts based on their clinical course before and after cervical surgery. The primary outcome was the prevalence of DCS, and secondary outcomes included an evaluation of predictive factors for each Group, using a significance level of P < 0.05. RESULTS Among 195,271 patients undergoing cervical surgery for cervical radiculomyelopathy, 97.95% were appropriately managed, 1.42% had potentially mids-diagnosed DCS, and 0.63% were treatment-resistant. Diabetes and obesity were significant predictors of potentially misdiagnosed DCS (P < 0.05). CONCLUSION This study presents data indicating that 1.42% of patients who receive cervical surgery may have underlying DCS and potentially benefit from nerve release prior to undergoing surgery. A concurrent diagnosis of diabetes and obesity may predict an underlying DCS.
Collapse
Affiliation(s)
- Hania Shahzad
- Department of Orthopaedics, UC Davis Health, Sacramento, CA, USA
| | - Nazihah Bhatti
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Cole Veliky
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Varun K Singh
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Goyal Kanu
- Department of Orthopaedics, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Safdar N Khan
- Department of Orthopaedics, UC Davis Health, Sacramento, CA, USA.
| |
Collapse
|
3
|
Tan SS, Tan WY, Zheng LS, Adinugraha P, Wang HY, Kumar S, Gulati A, Khurana S, Lam W, Aye T. Multi-year population-based analysis of Asian patients with acute decompensated heart failure and advanced chronic kidney disease. Curr Probl Cardiol 2024; 49:102618. [PMID: 38735349 DOI: 10.1016/j.cpcardiol.2024.102618] [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] [Received: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Data on disparities in outcomes and risk factors in Asian patients with advanced chronic kidney disease admitted for heart failure are scare. METHODS This was a retrospective cohort study that utilized data from the National Inpatient Sample between January 2016 and December 2019. Patients who had a primary diagnosis of acute decompensated heart failure and a concomitant diagnosis of advanced CKD were included. The primary outcome of interest was in-hospital mortality. Secondary outcomes include hospital cost, length of stay, and other clinical outcomes. Weighted multivariable logistic regression was used to adjust for comorbidities. RESULTS There were 251,578 cases of ADHF with advanced CKD, out of which 2.6 % were from individuals of Asian ethnicity. Asian patients exhibited a higher burden of comorbidities in comparison to other UREM patients, but a lower burden than White patients. Regardless of differences in comorbidity burden, Asian patients exhibited a higher likelihood of experiencing severe consequences. After adjusting for comorbidies, White (OR:1.11; 95 % CI 1.03-1.20;0.009) patients had higher odds of mortality than Asian patients. However, Blacks (OR: 0.58; 95 % CI 0.53 to 0.63; p < 0.001) and Hispanics (OR: 0.69; 95 % CI 0.62 to 0.78; p < 0.001) had lower odds of mortality. CONCLUSION This first population-based studies shows that Asian patients with advanced CKD admitted for ADHF have greater comorbidity burden and poorer outcomes Black and Hispanic patients. This data underscores the importance of comprehensive approaches in phenotyping, and ethnic specific interventions.
Collapse
Affiliation(s)
- Samuel S Tan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel, New York, New York, USA.
| | - Wenchy Yy Tan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel, New York, New York, USA; Department of Population Health Sciences, Weill Cornell, New York, New York, USA
| | - Lucy S Zheng
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel, New York, New York, USA
| | - Paulus Adinugraha
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel/West, New York, New York, USA
| | - Hong Yu Wang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel, New York, New York, USA
| | - Shasawat Kumar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel, New York, New York, USA
| | - Amit Gulati
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel/West, New York, New York, USA
| | - Sakshi Khurana
- Department of Radiology, Columbia University, New York, New York, USA
| | - Wan Lam
- Department of Medicine, Lenox Hill Hospital, New York, New York, USA
| | - Thida Aye
- Department of Medicine, Lenox Hill Hospital, New York, New York, USA
| |
Collapse
|
4
|
Thompson MP, Hou H, Likosky DS, Pagani FD, Falvey J, Bowles KH, Wadhera RK, Sterling MR. Home Health Care Use and Outcomes After Coronary Artery Bypass Grafting Among Medicare Beneficiaries. Circ Cardiovasc Qual Outcomes 2024; 17:e010459. [PMID: 38770653 PMCID: PMC11251853 DOI: 10.1161/circoutcomes.123.010459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Home health care (HHC) has been increasingly used to improve care transitions and avoid poor outcomes, but there is limited data on its use and efficacy following coronary artery bypass grafting. The purpose of this study was to describe HHC use and its association with outcomes among Medicare beneficiaries undergoing coronary artery bypass grafting. METHODS Retrospective analysis of 100% of Medicare fee-for-service files identified 77 331 beneficiaries undergoing coronary artery bypass grafting and discharged to home between July 2016 and December 2018. The primary exposure of HHC use was defined as the presence of paid HHC claims within 30 days of discharge. Hierarchical logistic regression identified predictors of HHC use and the percentage of variation in HHC use attributed to the hospital. Propensity-matched logistic regression compared mortality, readmissions, emergency department visits, and cardiac rehabilitation enrollment at 30 and 90 days after discharge between HHC users and nonusers. RESULTS A total of 26 751 (34.6%) of beneficiaries used HHC within 30 days of discharge, which was more common among beneficiaries who were older (72.9 versus 72.5 years), male (79.4% versus 77.4%), White (90.2% versus 89.2%), and not Medicare-Medicaid dual eligible (6.7% versus 8.8%). The median hospital-level rate of HHC use was 31.0% (interquartile range, 13.7%-54.5%) and ranged from 0% to 94.2%. Nearly 30% of the interhospital variation in HHC use was attributed to the discharging hospital (intraclass correlation coefficient, 0.296 [95% CI, 0.275-0.318]). Compared with non-HHC users, those using HHC were less likely to have a readmission or emergency department visit, were more likely to enroll in cardiac rehabilitation, and had modestly higher mortality within 30 or 90 days of discharge. CONCLUSIONS A third of Medicare beneficiaries undergoing coronary artery bypass grafting used HHC within 30 days of discharge, with wide interhospital variation in use and mixed associations with clinical outcomes and health care utilization.
Collapse
Affiliation(s)
- Michael P. Thompson
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Hechuan Hou
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Donald S. Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis D. Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason Falvey
- Department of Physical Therapy and Rehabilitation Science, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathryn H. Bowles
- University of Pennsylvania School of Nursing, Philadelphia, PA
- VNS Health, New York, NY
| | - Rishi K. Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | |
Collapse
|
5
|
Silverstein ML, Shah JK, Cevallos P, Liu F, Sheckter C, Nazerali R. Associations between prior COVID-19 infection and venous thromboembolism following common plastic surgery operations. J Plast Reconstr Aesthet Surg 2024; 94:198-209. [PMID: 38810360 DOI: 10.1016/j.bjps.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION SARS-CoV-2 (COVID-19) infection has been described as a cause of systemic hypercoagulability and a risk factor for the development of venous thromboembolism (VTE). Whereas some multispecialty studies have proposed a link between COVID-19 and postoperative thrombosis, other single-specialty studies have found no such association. We utilized a large national database to determine whether prior COVID-19 infection was associated with the incidence of VTE following common plastic surgery operations. METHODS The Merative™ MarketScan® Research Databases were used to identify female patients who underwent index abdominal panniculectomy, breast reduction, autologous breast reconstruction, or implant-based breast reconstruction procedures between 2020 and 2021. International Classification of Disease, tenth edition (ICD-10) codes were used to identify patients diagnosed with COVID-19 preoperatively and those who experienced a VTE in the 90 days postoperatively. Propensity score matching and multivariable logistic regression were used to determine any independent association between COVID-19 and postoperative VTE. RESULTS Twenty-four thousand two hundred and twenty-eight patients met inclusion criteria. Mean age at time of surgery was 44 years. Six percent carried a preoperative COVID-19 diagnosis, and postoperative VTE occurred in 1.3%. In a propensity-score-matched analysis of 2754 patients, COVID-19 did not significantly correlate with incidence of postoperative VTE (P = 0.463). Compared with a matched prepandemic cohort (14,151 patients), the incidence of VTE did not increase following any of the four studied procedures during the COVID-19 pandemic. CONCLUSION This analysis of a national insurance claims database provides evidence against a link between resolved COVID-19 infection and VTE within 90 days of four common plastic surgery operations.
Collapse
Affiliation(s)
- Max L Silverstein
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer K Shah
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Farrah Liu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Clifford Sheckter
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Rahim Nazerali
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
6
|
Hayes CJ, Bin Noor N, Raciborski RA, Martin B, Gordon A, Hoggatt K, Hudson T, Cucciare M. Development and validation of machine-learning algorithms predicting retention, overdoses, and all-cause mortality among US military veterans treated with buprenorphine for opioid use disorder. J Addict Dis 2024:1-18. [PMID: 38946144 DOI: 10.1080/10550887.2024.2363035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND Buprenorphine for opioid use disorder (B-MOUD) is essential to improving patient outcomes; however, retention is essential. OBJECTIVE To develop and validate machine-learning algorithms predicting retention, overdoses, and all-cause mortality among US military veterans initiating B-MOUD. METHODS Veterans initiating B-MOUD from fiscal years 2006-2020 were identified. Veterans' B-MOUD episodes were randomly divided into training (80%;n = 45,238) and testing samples (20%;n = 11,309). Candidate algorithms [multiple logistic regression, least absolute shrinkage and selection operator regression, random forest (RF), gradient boosting machine (GBM), and deep neural network (DNN)] were used to build and validate classification models to predict six binary outcomes: 1) B-MOUD retention, 2) any overdose, 3) opioid-related overdose, 4) overdose death, 5) opioid overdose death, and 6) all-cause mortality. Model performance was assessed using standard classification statistics [e.g., area under the receiver operating characteristic curve (AUC-ROC)]. RESULTS Episodes in the training sample were 93.0% male, 78.0% White, 72.3% unemployed, and 48.3% had a concurrent drug use disorder. The GBM model slightly outperformed others in predicting B-MOUD retention (AUC-ROC = 0.72). RF models outperformed others in predicting any overdose (AUC-ROC = 0.77) and opioid overdose (AUC-ROC = 0.77). RF and GBM outperformed other models for overdose death (AUC-ROC = 0.74 for both), and RF and DNN outperformed other models for opioid overdose death (RF AUC-ROC = 0.79; DNN AUC-ROC = 0.78). RF and GBM also outperformed other models for all-cause mortality (AUC-ROC = 0.76 for both). No single predictor accounted for >3% of the model's variance. CONCLUSIONS Machine-learning algorithms can accurately predict OUD-related outcomes with moderate predictive performance; however, prediction of these outcomes is driven by many characteristics.
Collapse
Affiliation(s)
- Corey J Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Institute for Digital Health and Innovation, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Nahiyan Bin Noor
- Institute for Digital Health and Innovation, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rebecca A Raciborski
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Evidence, Policy, and Implementation Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Bradley Martin
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Adam Gordon
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Katherine Hoggatt
- San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Teresa Hudson
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Center for Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Emergency Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Center for Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| |
Collapse
|
7
|
Nikiema JN, Thiam D, Bayani A, Ayotte A, Sourial N, Bally M. Assessing the impact of transitioning to 11th revision of the International Classification of Diseases (ICD-11) on comorbidity indices. J Am Med Inform Assoc 2024; 31:1219-1226. [PMID: 38489540 PMCID: PMC11105143 DOI: 10.1093/jamia/ocae046] [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] [Received: 10/10/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES This study aimed to support the implementation of the 11th Revision of the International Classification of Diseases (ICD-11). We used common comorbidity indices as a case study for proactively assessing the impact of transitioning to ICD-11 for mortality and morbidity statistics (ICD-11-MMS) on real-world data analyses. MATERIALS AND METHODS Using the MIMIC IV database and a table of mappings between the clinical modification of previous versions of ICD and ICD-11-MMS, we assembled a population whose diagnosis can be represented in ICD-11-MMS. We assessed the impact of ICD version on cross-sectional analyses by comparing the populations' distribution of Charlson and Elixhauser comorbidity indices (CCI, ECI) across different ICD versions, along with the adjustment in comorbidity weighting. RESULTS We found that ICD versioning could lead to (1) alterations in the population distribution and (2) changes in the weight that can be assigned to a comorbidity category in a reweighting initiative. In addition, this study allowed the creation of the corresponding ICD-11-MMS codes list for each component of the CCI and the ECI. DISCUSSION In common with the implementations of previous versions of ICD, implementation of ICD-11-MMS potentially hinders comparability of comorbidity burden on health outcomes in research and clinical settings. CONCLUSION Further research is essential to enhance ICD-11-MMS usability, while mitigating, after identification, its adverse effects on comparability of analyses.
Collapse
Affiliation(s)
- Jean Noel Nikiema
- Systèmes de soins et de santé publique, Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, H3N 1X9, Canada
- Laboratoire Transformation Numérique en Santé (LabTNS), Montréal, Québec, H2X 0A9, Canada
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, H3N 1X9, Canada
| | - Djeneba Thiam
- Systèmes de soins et de santé publique, Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, H3N 1X9, Canada
- Laboratoire Transformation Numérique en Santé (LabTNS), Montréal, Québec, H2X 0A9, Canada
| | - Azadeh Bayani
- Systèmes de soins et de santé publique, Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, H3N 1X9, Canada
- Laboratoire Transformation Numérique en Santé (LabTNS), Montréal, Québec, H2X 0A9, Canada
| | - Alexandre Ayotte
- Systèmes de soins et de santé publique, Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, H3N 1X9, Canada
- Laboratoire Transformation Numérique en Santé (LabTNS), Montréal, Québec, H2X 0A9, Canada
| | - Nadia Sourial
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, H3N 1X9, Canada
- Carrefour de l'innovation, Research Center, Centre hospitalier de l’Université de Montréal, Montréal, Québec, H2X 0A9, Canada
| | - Michèle Bally
- Carrefour de l'innovation, Research Center, Centre hospitalier de l’Université de Montréal, Montréal, Québec, H2X 0A9, Canada
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, H3T 1J4, Canada
- Département de Pharmacie, Centre hospitalier de l’Université de Montréal, Montréal, Québec, H2X 0C1, Canada
| |
Collapse
|
8
|
Igwe JK, Alaribe U. Cannabis use associated with lower mortality among hospitalized Covid-19 patients using the national inpatient sample: an epidemiological study. J Cannabis Res 2024; 6:18. [PMID: 38582889 PMCID: PMC10998318 DOI: 10.1186/s42238-024-00228-w] [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: 11/09/2023] [Accepted: 03/20/2024] [Indexed: 04/08/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Joseph-Kevin Igwe
- Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
| | - Ugo Alaribe
- Caribbean Medical University School of Medicine, 5600 N River Rd Suite 800, Rosemont, IL, 60018, USA
| |
Collapse
|
9
|
Niu J, Rosales O, Oluyomi A, Lew SQ, Winkelmayer WC, Chertow GM, Erickson KF. The Use of Telemedicine by US Nephrologists for In-Center Hemodialysis Care During the Pandemic: An Analysis of National Medicare Claims. Kidney Med 2024; 6:100798. [PMID: 38645734 PMCID: PMC11026969 DOI: 10.1016/j.xkme.2024.100798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Rationale & Objective Because of coronavirus disease 2019 (COVID-19), the US government issued emergency waivers in March 2020 that removed regulatory barriers around the use of telemedicine. For the first time, nephrologists were reimbursed for telemedicine care delivered during in-center hemodialysis. We examined the use of telemedicine for in-center hemodialysis during the first 16 months of the pandemic. Study Design We ascertained telemedicine modifiers on nephrologist claims. We used multivariable regression to examine time trends and patient, dialysis facility, and geographic correlates of telemedicine use. We also examined whether the estimated effects of predictors of telemedicine use changed over time. Setting & Participants US Medicare beneficiaries receiving in-center hemodialysis between March 1, 2020, and June 30, 2021. Exposures Patient, geographic, and dialysis facility characteristics. Outcomes The use of telehealth for in-center hemodialysis care. Analytic Approach Retrospective cohort analysis. Results Among 267,434 Medicare beneficiaries identified, the reported use of telemedicine peaked at 9% of patient-months in April 2020 and declined to 2% of patient-months by June 2021. Telemedicine use varied geographically and was more common in areas that were remote and socioeconomically disadvantaged. Patients were more likely to receive care by telemedicine in areas with higher incidence of COVID-19, although the predictive value of COVID-19 diminished later in the pandemic. Patients were more likely to receive care using telemedicine if they were at facilities with more staff, and the use of telemedicine varied by facility ownership type. Limitations Limited reporting of telemedicine on claims could lead to underestimation of its use. Reported telemedicine use was higher in an analysis designed to address this limitation by focusing on patients whose physicians used telemedicine at least once during the pandemic. Conclusions Some US nephrologists continued to use telemedicine for in-center hemodialysis throughout the pandemic, even as the association between COVID-19 incidence and telemedicine use diminished over time. These findings highlight unique challenges and opportunities to the future use of telemedicine in dialysis care.
Collapse
Affiliation(s)
- Jingbo Niu
- Section of Nephrology, Baylor College of Medicine, Houston, Texas
| | - Omar Rosales
- Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas
| | - Abiodun Oluyomi
- Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas
| | - Susie Q. Lew
- Division of Renal Diseases and Hypertension, George Washington University, Washington, DC
| | | | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Kevin F. Erickson
- Section of Nephrology, Baylor College of Medicine, Houston, Texas
- Baker Institute for Public Policy, Rice University, Houston, Texas
| |
Collapse
|
10
|
Krishnamoorthy V, Harris R, Chowdhury AM, Bedoya A, Bartz R, Raghunathan K. Building Learning Healthcare Systems for Critical Care Medicine. Anesthesiology 2024; 140:817-823. [PMID: 38345893 DOI: 10.1097/aln.0000000000004847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Learning healthcare systems are an evolving way of integrating informatics, analytics, and continuous improvement into daily practice in healthcare. This article discusses strategies to build learning healthcare systems for critical care medicine.
Collapse
Affiliation(s)
- Vijay Krishnamoorthy
- Department of Anesthesiology, Division of Critical Care Medicine; Critical Care and Perioperative Population Health Research Program, Department of Anesthesiology; and Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Ronald Harris
- Duke University School of Medicine, Durham, North Carolina
| | - Ananda M Chowdhury
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Armando Bedoya
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Raquel Bartz
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Karthik Raghunathan
- Department of Anesthesiology, Division of Critical Care Medicine; Critical Care and Perioperative Population Health Research Program, Department of Anesthesiology; and Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
11
|
Ho L, Pugh C, Seth S, Arakelyan S, Lone NI, Lyall MJ, Anand A, Fleuriot JD, Galdi P, Guthrie B. Performance of models for predicting 1-year to 3-year mortality in older adults: a systematic review of externally validated models. THE LANCET. HEALTHY LONGEVITY 2024; 5:e227-e235. [PMID: 38330982 DOI: 10.1016/s2666-7568(23)00264-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024] Open
Abstract
Mortality prediction models support identifying older adults with short life expectancy for whom clinical care might need modifications. We systematically reviewed external validations of mortality prediction models in older adults (ie, aged 65 years and older) with up to 3 years of follow-up. In March, 2023, we conducted a literature search resulting in 36 studies reporting 74 validations of 64 unique models. Model applicability was fair but validation risk of bias was mostly high, with 50 (68%) of 74 validations not reporting calibration. Morbidities (most commonly cardiovascular diseases) were used as predictors by 45 (70%) of 64 of models. For 1-year prediction, 31 (67%) of 46 models had acceptable discrimination, but only one had excellent performance. Models with more than 20 predictors were more likely to have acceptable discrimination (risk ratio [RR] vs <10 predictors 1·68, 95% CI 1·06-2·66), as were models including sex (RR 1·75, 95% CI 1·12-2·73) or predicting risk during comprehensive geriatric assessment (RR 1·86, 95% CI 1·12-3·07). Development and validation of better-performing mortality prediction models in older people are needed.
Collapse
Affiliation(s)
- Leonard Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Carys Pugh
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sohan Seth
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK; School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Stella Arakelyan
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazir I Lone
- Royal Infirmary of Edinburgh, National Health Service Lothian, Edinburgh, UK; Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Marcus J Lyall
- Royal Infirmary of Edinburgh, National Health Service Lothian, Edinburgh, UK
| | - Atul Anand
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jacques D Fleuriot
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK; School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Paola Galdi
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
12
|
Cook A, Swindall R, Spencer K, Wadle C, Cage SA, Mohiuddin M, Desai Y, Norwood S. Hospitalization and readmission after single-level fall: a population-based sample. Inj Epidemiol 2023; 10:49. [PMID: 37858271 PMCID: PMC10588028 DOI: 10.1186/s40621-023-00463-4] [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: 06/15/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Single-level falls (SLFs) in the older US population is a leading cause of hospital admission and rates are increasing. Unscheduled hospital readmission is regarded as a quality-of-care indication and a preventable burden on healthcare systems. We aimed to characterize the predictors of 30-day readmission following admission for SLF injuries among patients 65 years and older. METHODS We conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2019. Included patients were 65 and older, admitted emergently following a SLF with a primary injury diagnosis. Hierarchical logit regression was used to model factors associated with readmission within 30 days of discharge. RESULTS Of 1,338,905 trauma patients, 65 years or older, 61.3% had a single-level fall as the mechanism of injury. Among fallers, the average age was 81.1 years and 68.5% were female. SLF patients underwent more major therapeutic procedures (56.3% vs. 48.2%), spent over 2 million days in the hospital and incurred total charges of over $28 billion annually. Over 11% of SLF patients were readmitted within 30 days of discharge. Increasing income had a modest effect, where the highest zip code quartile was 9% less likely to be readmitted. Decreasing population density had a protective effect of readmission of 16%, comparing Non-Urban to Large Metropolitan. Transfer to short-term hospital, brain and vascular injuries were independent predictors of 30-day readmission in multivariable analysis (OR 2.50, 1.31, and 1.42, respectively). Palliative care consultation was protective (OR 0.41). The subsequent hospitalizations among those 30-day readmissions were primarily emergent (92.9%), consumed 260,876 hospital days and a total of $2.75 billion annually. CONCLUSIONS SLFs exact costs to patients, health systems, and society. Transfer to short-term hospitals at discharge, along with brain and vascular injuries were strong predictors of 30-day readmission and warrant mitigation strategy development with consideration of expanded palliative care consultation.
Collapse
Affiliation(s)
- Alan Cook
- Trauma Services, UT Health East Texas, 1020 E. Idel St., Tyler, TX, 75701, USA
| | - Rebecca Swindall
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA
| | - Katherine Spencer
- CHRISTUS Health-Texas A&M Spohn Emergency Medicine Residency, Texas A&M University-Corpus Christi, 600 Elizabeth Street, 9B, Corpus Christi, TX, 78404, USA
| | - Carly Wadle
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA
| | - S Andrew Cage
- Department of Sports Medicine, The University of Texas at Tyler, 3900 University Blvd., Tyler, TX, 75799, USA
| | - Musharaf Mohiuddin
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA.
| | - Yagnesh Desai
- Department of Emergency Medicine, UT Health East Texas, 1000 S. Beckham Ave., Tyler, TX, 75701, USA
| | - Scott Norwood
- Trauma Services, UT Health East Texas, 1020 E. Idel St., Tyler, TX, 75701, USA
| |
Collapse
|
13
|
Khanna T, Patel J, Singh I, Kalra S, Dhiman M, Kohli I, Chaudhry H, Dukovic D, Sohal A, Yang J. The Impact of Type 2 Myocardial Infarction in Acute Pancreatitis: Analysis of 1.1 Million Hospitalizations and Review of the Literature. Cureus 2023; 15:e44113. [PMID: 37750110 PMCID: PMC10518190 DOI: 10.7759/cureus.44113] [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] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Introduction Acute pancreatitis (AP) is a common inflammatory disorder with acute onset and rapid progression. Studies have reported cardiac injury in patients with AP. It is often thought that stress cardiomyopathy can induce these changes leading to type 2 myocardial infarction (type 2 MI) in AP. Our study aims to assess the prevalence as well as the impact of type 2 MI on outcomes in patients with AP. Methods National Inpatient Sample (NIS) 2016-2020 was used to identify adult patients (age>18) with acute pancreatitis. We excluded patients with STEMI, NSTEMI, pancreatic cancer, or chronic pancreatitis. Patients with missing demographics and mortality were also excluded. Patients were stratified into two groups, based on the presence of type 2 MI. Multivariate logistic regression analysis was performed to assess the impact of concomitant type 2 MI on mortality, sepsis, acute kidney injury (AKI), ICU admission, deep venous thrombosis (DVT), and pulmonary embolism (PE) after adjusting for patient demographics, hospital characteristics, etiology of AP and the Elixhauser comorbidities. Results Of the 1.1 million patients in the study population, only 2315 patients had type 2 MI. The majority of the patients in the type 2 MI group were aged >65 years (49.2%, p<0.001), males (54.6%, p=0.63), White (67.6%, p=0.19), had Medicare insurance (55.5%, p<0.001), and were in the lowest income quartile (34.8%, p=0.12). Patients in the type 2 MI group had a higher incidence of mortality (5.4% vs 0.6%, p<0.001), sepsis (7.1% vs 3.7%, p<0.001), shock (9.3% vs 0.9%, p<0.001), AKI (42.9% vs. 11.8%, p<0.001) and ICU admission (12.1% vs 1.4%, p<0.001). After adjusting for confounding factors, patients in the type 2 MI group were noted to be at higher odds of mortality (aOR=2.4; 95% CI 1.5-3.8, p<0.001). Patients in the type 2 MI group had a longer length of stay (adjusted coefficient=2.1 days; 95% CI 1.4-2.8; p<0.001) and higher total hospitalization charges (adjusted coefficient=$45,088; 95% CI $30,224-$59,952; p<0.001). Conclusion Although the prevalence of type 2 MI in AP is low, the presence of type 2 MI is associated with increased mortality and worse outcomes. Physicians should be aware of this association and these patients should be monitored carefully to prevent worse outcomes.
Collapse
Affiliation(s)
| | - Jay Patel
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | - Ishandeep Singh
- Internal Medicine, Dayanand Medical College and Hospital, Punjab, IND
| | - Shivam Kalra
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Mukul Dhiman
- Internal Medicine, Punjab Institute of Medical Sciences, Punjab , IND
| | - Isha Kohli
- Public Health Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Hunza Chaudhry
- Internal Medicine, University of California, San Francisco, USA
| | - Dino Dukovic
- Internal Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - Aalam Sohal
- Hepatology, Liver Institute Northwest, Seattle, USA
| | - Juliana Yang
- Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, USA
| |
Collapse
|