Re-hospitalizations within 30-days and mortality outcomes among severely visually impaired and blind patients: analysis of the National Readmission Database

BACKGROUND

Readmissions and in-hospital mortality among patients with severe vision impairment or blindness (SVI/B) has not been fully studied. We investigated hospital outcomes for adults with SVI/B in the United States.

METHODS

Using the Nationwide Readmission Database year 2017, we analyzed primary outcomes for thirty-day readmission rates for patients with and without SVI/B. Secondary outcomes were in-hospital mortality rates for readmitted patients, in-hospital mortality rates for index patients, the five most common principal diagnoses for readmission, and resource utilization.

RESULTS

34,558 patients had an index admission for SVI/B vs. 24,600,000 who did not. Patients with SVI/B had a 13.3% [4,383] readmission rate within 30 days compared to 8.4% [2,033,329] without SVI/B. Compared to readmitted patients without SVI/B patients, those with SVI/B were older (mean [SD] age: 64.4 [SD ± 19] vs. 61.4 [SD ± 20] years) and had more comorbidities (Charlson comorbidity score ≥ 3: 79.2% [ 3,471] vs. 60.9% [1,238,299]). The mortality rate among patients readmitted with SVI/B was 5.38% [236] vs. 4.02% [81,740] for patients without SVI/B, p-value = 0.016. Top reasons for readmissions among patients with SVI/B included sepsis 12% [526], heart failure 10.5% [460)], acute renal failure 4.4% [193], complications due to type II diabetes mellitus 4.1% [178], and pneumonia 2.7% [118]. The mean length of stay for readmitted patients with SVI/B was 6.3 days (confidence interval [CI]: 6.0-6.7 days), vs. 5.6 days for patients without SVI/B (CI: 5.5-5.8 days), p-value < 0.01. The mean hospital charges for readmitted patients with SVI/B was $57,202 (CI: $53,712-$61,292) vs. $51,582 (CI: $49,966-$53,198), p-value < 0.01.

CONCLUSION

Patients with SVI/B had higher readmission rates and greater mortality on readmissions than those without SVI/B. Interventional studies for optimal discharge strategies are critically needed to improve clinical and resource utilization outcomes in patients with SVI/B.

A Case of Acute Chest Pain After Acetazolamide to Treat Uncontrolled Increased Intraocular Pressure

A 61-year-old man with uncontrolled increased intraocular pressure after cataract surgery was treated with acetazolamide. Three days later, he developed acute chest pain requiring emergency treatment. What would you do next?

Abstract PO-089: Profiling of salivary proteome specific for the diagnosis of head and neck cancer among African Americans

Head and Neck Squamous Cell Carcinoma (HNSCC) is one the types of Cancer in The United States with inequality in the mortality rate among Black patients when compared to White patients. Patients of European dissent (Whites) are more likely to be diagnosed with any type of HNSCC but patients of African dissents (Blacks) are more likely to die from ant type of HNSCC when all patients are HPV negative. The difference in survival based on race and ethnicity prompted the need for a better and early diagnostic marker for HNSCC among Blacks and other groups with poor prognosis of HNSCC. The present research seeks to identify a specific and safe salivary proteome marker for the early diagnosis of HNSCC. The hypothesis of this article is that there is a significant difference in the salivary proteome of AA patients with HNSCC when compared to WA patients which is specific to cancer site. Eight patient samples with confirmed diagnosis of Laryngeal cancer at Nashville General hospital (IRB Protocol Number 14-03-172) were collected with appropriate informed consent. Patient samples were pooled together and analyzed using IHC for the presence of shared protein expression. Each protein sample was later analyzed individually using IHC in order to obtain specific proteins expressed by each patient’s salivary proteome. A Multidimensional Protein Identification Technology (MUDPIT) was used to analyze salivary samples to increase resolution for identifying proteins and peptides. MUDPIT was used to increase resolution of analyzed proteins and was compared with other proteins associated with LaCa using a known online protein database called WebGestalt. The most highly expressed proteins in each of the samples were further analyzed using The Human Protein Atlas in order to study the location of the salivary proteome and its function when expressed. 20 unique protein genes obtained from Label Free Quantification (LFQ) analysis was further analyzed for the function of the genes and gene co-localization in the body using an online database known as GeneMANIA. Finally, PEAKS was used to ascertain the effect of proteins. Result shows differences in the salivary proteome of AA patients compared to WA’s. Specifically, proteins involved in transcriptional mis-regulation were over- represented in AA&gt;WA patients which included some proteins associated with metastasis (JUP), dis-functional immune cells (CD14), over-expressed tumor- suppressor proteins (DMBT1 and DRB2) and elevated level of antimicrobial innate immunity (His 1 & 3) are all higher than the normal values in healthy patients without LaCa both among AA and WA. Future research is required to expand on these identified proteins to help provide a safe and specific biomarker for the diagnosis of LaCa among AA patients. Future research can also provide direction as to where therapeutics can be directed and how they can be safely administered to generate the most effective treatment that can improve the prognosis of the disease among AA patients and others with groups with poor prognosis.

Citation Format: Oyinloye A. Jose, Oladipupo Anibire, Derek Wagner, Dana Marshall, Billy Ballard, Siddharth Pratap, Victor Paramov. Profiling of salivary proteome specific for the diagnosis of head and neck cancer among African Americans [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-089.