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Mujadzic H, Noorani S, Riddle PJ, Wang Y, Metts G, Yacu T, Abougergi MS. Ulcer Bleeding in the United States: Epidemiology, Treatment Success, and Resource Utilization. Dig Dis Sci 2024:10.1007/s10620-024-08322-y. [PMID: 38446313 DOI: 10.1007/s10620-024-08322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/09/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND AND GOALS Peptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different treatment modalities in this setting. METHODS Retrospective cohort study using the National Inpatient Sample. Non-elective adult admissions with a principal diagnosis of ulcer bleeding were included. The primary outcome was endoscopic, radiologic and surgical hemostasis success rate. Secondary outcomes were patients' demographics, in-hospital mortality and resource utilization. On subgroup analysis, gastric and duodenal ulcers were studied separately. Confounders were adjusted for using multivariate regression analysis. RESULTS A total of 136,425 admissions (55% gastric and 45% duodenal ulcers) were included. The mean patient age was 67 years. The majority of patients were males, Caucasians, of lower income and high comorbidity burden. The endoscopic, radiological and surgical therapy and hemostasis success rates were 33.6, 1.4, 0.1, and 95.1%, 89.1 and 66.7%, respectively. The in-hospital mortality rate was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis, respectively. Duodenal ulcers were associated with lower adjusted odds of successful endoscopic hemostasis, but higher odds of early and multiple endoscopies, endoscopic therapy, overall and successful radiological therapy, in-hospital mortality, longer length of stay and higher total hospitalization charges and costs. CONCLUSIONS The ulcer bleeding endoscopic hemostasis success rate is 95.1%. Rescue therapy is associated with lower hemostasis success and more than a ten-fold increase in mortality rate. Duodenal ulcers are associated with worse treatment outcomes and higher resource utilization compared with gastric ulcers.
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Affiliation(s)
- Hata Mujadzic
- Department of Internal Medicine, Prisma Health Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Shayan Noorani
- Department of Internal Medicine, Prisma Health Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Philip J Riddle
- Department of Internal Medicine, Prisma Health Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA, USA
| | - Gracelyn Metts
- Department of Health Sciences, Clemson University, Clemson, SC, USA
| | - Tania Yacu
- Department of Health Sciences, Clemson University, Clemson, SC, USA
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Huntingdon Valley, PA, USA.
- Division of Gastroenterology, Department of Internal Medicine, INOVA Fairfax Hospital, INOVA Health, 3300 Gallows Road, Falls Church, VA, 22042, USA.
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Kruger AJ, Abougergi MS, Jalil S, Sobotka LA, Wellner MR, Porter KM, Conteh LF, Kelly SG, Mumtaz K. Outcomes of Nonvariceal Upper Gastrointestinal Bleeding in Patients With Cirrhosis: A National Analysis. J Clin Gastroenterol 2023; 57:848-853. [PMID: 35960536 DOI: 10.1097/mcg.0000000000001746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/26/2022] [Indexed: 12/10/2022]
Abstract
GOALS We sought to evaluate hospital outcomes of cirrhosis patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). BACKGROUND NVUGIB is common in patients with cirrhosis. However, national outcome studies of these patients are lacking. STUDY We utilized the 2014 Nationwide Readmission Database to evaluate NVUGIB in patients with cirrhosis, further stratified as no cirrhosis (NC), compensated cirrhosis (CC), or decompensated cirrhosis (DC). Validated International Classification of Diseases, Ninth Revision, Clinical Modification codes captured diagnoses and interventions. Outcomes included 30-day readmission rates, index admission mortality rates, health care utilization, and predictors of readmission and mortality using multivariable regression analysis. RESULTS Overall, 13,701 patients with cirrhosis were admitted with NVUGIB. The 30-day readmission rate was 20.8%. Patients with CC were more likely to undergo an esophagogastroduodenoscopy (EGD) within 1 calendar day of admission (74.1%) than patients with DC (67.9%) or NC (69.4%). Patients with DC had longer hospitalizations (4.1 d) and higher costs of care ($11,834). The index admission mortality rate was higher in patients with DC (6.2%) than in patients with CC (1.7%, P <0.001) or NC (1.4%, P <0.001). Predictors of 30-day readmission included performing an EGD >1 calendar day from admission (OR: 1.21; 95% CI, 1.00 to 1.46) and DC (OR: 1.78; 95% CI, 1.54 to 2.06). DC was a predictor of index admission mortality (OR: 3.68; 95% CI, 2.67 to 5.05). CONCLUSIONS NVUGIB among patients with DC is associated with higher readmission rates, mortality rates, and health care utilization compared with patients with CC and NC. Early EGD is a modifiable variable associated with reduced readmission rates. Early identification of high-risk patients and adherence to guidelines may improve clinical outcomes.
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Affiliation(s)
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC
| | - Sajid Jalil
- Division of Gastroenterology, Hepatology, and Nutrition
| | | | | | - Kyle M Porter
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Sean G Kelly
- Division of Gastroenterology, Hepatology, and Nutrition
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology, and Nutrition
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Wang Y, Huang X, Cheryala M, Aloysius M, Zheng B, Yang K, Chen B, Fang Q, Chowdary SB, Abougergi MS, Chen S. Global increase of colorectal cancer in young adults over the last 30 years: an analysis of the Global Burden of Disease Study 2019. J Gastroenterol Hepatol 2023; 38:1552-1558. [PMID: 37211529 DOI: 10.1111/jgh.16220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/25/2023] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES The US Preventive Services Task Force lowered the recommended starting age for colorectal cancer (CRC) screening in average-risk adults from 50 to 45 years. We aimed to estimate the global burden and trends of colorectal cancer in adults aged 20-49 years (early-onset CRC). METHODS This is an analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). The GBD 2019 estimation methods were used to describe the incidence, mortality, and disability-adjusted life years (DALYs) of early CRC from 1990 to 2019. Data from 204 countries and geographic areas were available. RESULTS The global incidence rate of early-onset CRC increased from 4.2/100 000 to 6.7/100 000 from 1990 to 2019. Mortality and DALYs of early-onset CRC also increased. The CRC incidence rate increased faster in younger adults (1.6%) than in adults aged 50-74 years (0.6%) as measured by the annual percentage change. The increase in early-onset CRC incidence was consistently observed in all five socio-demographic index (SDI) regions and 190 out of 204 countries and territories. Middle and high-middle SDI regions had faster annual increases in early-onset CRC, which warrants further attention. CONCLUSIONS The global incidence, mortality, and DALYs of early-onset CRC increased from 1990 to 2019. The increase in early-onset CRC incidence was prevalent worldwide. Several countries were found to have higher incidence rates than the United States or fast increase in early-onset CRC, which warrants further attention.
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Affiliation(s)
- Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Xiaoquan Huang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mahesh Cheryala
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Mark Aloysius
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Beishi Zheng
- Department of Internal Medicine Woodhull Medical Center New York, New York City, New York, USA
| | - Keming Yang
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Bing Chen
- New York University Grossman School of Medicine, New York City, New York, USA
| | - Qianqian Fang
- Division of Gastroenterology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | | | - Marwan S Abougergi
- Division of Gastroenterology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Shiyao Chen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
- Center of Evidence-Based Medicine, Fudan University, Shanghai, China
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Wang Y, Murphy D, Li S, Chen B, Peluso H, Sondhi V, Abougergi MS. Thirty-Day Readmission Among Patients With Uncomplicated Choledocholithiasis: A Nationwide Readmission Database Analysis. J Clin Gastroenterol 2023; 57:624-630. [PMID: 35648885 DOI: 10.1097/mcg.0000000000001724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/21/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM We aimed to determine the rate of 30-day hospital readmissions of uncomplicated choledocholithiasis and its impact on mortality and health care use in the United States. METHODS Nonelective admissions for adults with uncomplicated choledocholithiasis were selected from the Nationwide Readmission Database 2016-2018. The primary outcome was the all-cause 30-day readmission rate. Secondary outcomes were reasons for readmission, readmission mortality rate, procedures, and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using Cox regression analysis. RESULTS The 30-day rate of readmission was 9.3%. Biliary and pancreatic disorders and postprocedural complications accounted for 36.6% and 10.3% of readmission, respectively. The mortality rate among patients readmitted to the hospital was higher than that for index admissions (2.0% vs. 0.4%, P <0.01). Readmitted patients were less likely to receive endoscopic retrograde cholangiopancreatography (61% vs. 69%, P <0.01) and laparoscopic cholecystectomy (12.5% vs. 26%, P <0.01) during the index admissions. A total of 42,150 hospital days was associated with readmission, and the total health care in-hospital economic burden was $112 million (in costs) and $470 million (in charges). Independent predictors of readmission were male sex, Medicare (compared with private) insurance, higher Elixhauser Comorbidity Index score, no endoscopic retrograde cholangiopancreatography or laparoscopic cholecystectomy, postprocedural complications of the digestive system, hemodynamic or respiratory support, urban hospitals, and lower hospital volume of uncomplicated choledocholithiasis. CONCLUSIONS The uncomplicated choledocholithiasis 30-day readmission rate is 9.3%. Readmission was associated with higher mortality, morbidity, and resource use. Multiple independent predictors of readmission were identified.
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Affiliation(s)
- Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA
| | - Dermot Murphy
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA
| | - Si Li
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, PA
| | - Bing Chen
- Department of Medicine, Mount Sinai Morningside and West, New York City, NY
| | - Heather Peluso
- Department of Surgery, Prisma Health Upstate, Greenville
| | - Vikram Sondhi
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia
- Catalyst Medical Consulting, Simpsonville, SC
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Huang X, Abougergi MS, Sun C, Murphy D, Sondhi V, Chen B, Zheng X, Chen S, Wang Y. Incidence and outcomes of thromboembolic and bleeding events in patients with liver cirrhosis in the USA. Liver Int 2023; 43:434-441. [PMID: 35635760 DOI: 10.1111/liv.15325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Understanding the epidemiology of bleeding and thromboembolism (clotting) in liver cirrhosis provides important data for future studies and policymaking; however, head-to-head comparisons of bleeding and clotting remain limited. METHODS This is a populational retrospective cohort study using the US National Readmission Database of 2018 to compare the incidence and outcomes of bleeding and clotting events in patients with liver cirrhosis. The primary outcomes were the 11-month incidence proportion of bleeding and clotting events. RESULTS Of 1 304 815 participants, 26 569 had liver cirrhosis (45.0% women, mean age 57.2 [SD, 12.7] years). During the 11-month follow-up, in patients with cirrhosis, for bleeding and clotting events, the incidence proportions was 15.3% and 6.6%; the risk-standardized all-cause mortality rates were 2.4% and 1.0%; the rates of intensive care intervention were 4.1% and 1.9%; the rates of rehabilitation transfer were .2% and .2%; the cumulative length of stays were 45 100 and 23 566 days; total hospital costs were 147 and 84 million US dollars; total hospital charges were 620 and 365 million US dollars. Compared to non-cirrhosis, liver cirrhosis was associated with higher rates of bleeding (adjusted hazard ratio, 3.02 [95% CI, 2.85-3.20]) and portal vein thrombosis (PVT) (18.46 [14.86-22.92]), and slightly lower risks of other non-PVT venous thromboembolic events (.82 [.75-.89]). CONCLUSIONS Bleeding is more common than thromboembolism in patients with liver cirrhosis, causes higher morbidity, mortality and resource utilization. Liver cirrhosis is an independent risk factor for bleeding and PVT, but not non-PVT thromboembolism including venous thromboembolism, acute myocardial infarction and ischemic stroke.
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Affiliation(s)
- Xiaoquan Huang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA.,Catalyst Medical Consulting, Simpsonville, South Carolina, USA
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois, USA
| | - Dermot Murphy
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Vikram Sondhi
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Bing Chen
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Xin Zheng
- Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Shiyao Chen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
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Wang Y, Huang X, Abougergi MS, Sun C, Murphy D, Sondhi V, Chen B, Zheng X, Chen S. Response to 'Queries Regarding Medication Information and Influences on Bleeding and Clotting Events'. Liver Int 2022; 42:2917. [PMID: 36121101 DOI: 10.1111/liv.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Xiaoquan Huang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, USA.,Catalyst Medical Consulting, Simpsonville, South Carolina, USA
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois, USA
| | - Dermot Murphy
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Vikram Sondhi
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Bing Chen
- Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Xin Zheng
- Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Shiyao Chen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
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Abougergi MS. The role of COVID-19 symptom and exposure screening and SARS-CoV-2 nucleic acid amplification testing in risk stratification before endoscopy. Gastrointest Endosc 2022; 96:433-435. [PMID: 35850863 PMCID: PMC9287593 DOI: 10.1016/j.gie.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA; Catalyst Medical Consulting, Simpsonville, South Carolina, USA
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Peluso H, Mujadzic H, Abougergi MS, Mujadzic T, Azefor TB, Caffrey J. Opioid dependence and treatment outcomes among patients with burn injury. Burns 2022; 48:774-784. [PMID: 34922783 DOI: 10.1016/j.burns.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/24/2021] [Accepted: 07/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with burn injuries cause significant healthcare economic burden, often utilising extra-hospital resources, caregiving, and specialized care. METHODS We present a retrospective cohort analysis of the hospitalized patients in the USA with a primary diagnosis of burn injury. Opioid dependence was identified using ICD-10 CM codes. The 30-day all-cause readmission rate was the main outcome while secondary outcomes were inhospital mortality rate, resource utilization which included hospital length of stay, total hospitalization costs and charges and surgical procedures for burn injury treatment as well as the most important five principal diagnoses for admission and readmission. RESULTS Out of 22,348 patients included in the study, 597 had opioid dependence. Older patients (43 years, range: 38.6-47.2 years) as well as males (70.8%) were more likely to be opioid dependent. Opioid dependence was associated with higher 30-day readmission rates (aOR: 1.83, 95% confidence interval (CI): 1.30-2.57, p-value: <0.01), higher total hospitalization costs (aMD: $14,981, CI: $3820-$26,142, p-value: 0.01), total hospitalization charges (aMD: $47,078, CI: -$5093 to $89,063, p-value: 0.03), and a shorter mean length of stay (aMD: 5.13 days, CI: 2.60-7.66, p-value: <0.01). However, patients with and without opioid dependence had similar in-hospital mortality rates (aOR: 0.27, CI: 0.06-1.28, p-value: 0.10). CONCLUSION We are the first to our knowledge to report the association of treatment outcomes and opioid dependence in patients hospitalized at the national level with a burn injury. We show that there were higher 30-day all-cause readmission rates and in-hospital resource utilization among patients with opioid-dependence.
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Affiliation(s)
- Heather Peluso
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Temple University Hospital and Lewis Katz School of Medicine, Philadelphia, PA, USA; Catalyst Medical Consulting, 722 Elmbrook Drive, Simpsonville, SC 29681, USA.
| | - Hata Mujadzic
- Department of Internal Medicine, Prisma Health Midlands, 5 Medical Park Road, Columbia, SC 29203, USA.
| | - Marwan S Abougergi
- Catalyst Medical Consulting, 722 Elmbrook Drive, Simpsonville, SC 29681, USA; Division of Gastroenterology, Department of Internal Medicine, Prisma Health Midlands, 5 Medical Park Road, Columbia, SC 29203, USA.
| | - Tariq Mujadzic
- Department of Surgery, Division of Plastic Surgery, Prisma Health Midlands, 5 Medical Park Road, Columbia, SC 29203, USA.
| | - Tangwan B Azefor
- Department of Anesthesia & Critical Care Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, Baltimore, MD 21224, USA.
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University Medical Center, Burn Unit, Bayview Campus, 4940 Eastern Ave, Baltimore, MD 21224, USA.
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Kolkailah AA, Abougergi MS, Desai PV, Patel A, Fugar S, Okoh AK, Al-Ogaili A, Hirji SA, Kaneko T, Volgman AS, Doukky R, Grodin JL, McGuire DK. Does the “July effect” of new trainees at teaching hospitals impact outcomes for patients hospitalized with heart failure? Real-world analyses of more than half a million US admissions. American Heart Journal Plus: Cardiology Research and Practice 2022; 13. [PMID: 35720432 PMCID: PMC9205541 DOI: 10.1016/j.ahjo.2021.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: The “July effect” refers to the potential of adverse clinical outcomes related to the annual turnover of trainees. We investigated whether this impacts inpatient heart failure (HF) outcomes. Methods: Data from all adults (≥18 years) admitted with a primary diagnosis of HF at US teaching hospitals from the 2012–2014 National Inpatient Sample were analyzed. Non-teaching hospital admissions were excluded. The primary outcome was in-hospital mortality. Secondary metrics included hospital length of stay (LOS) and total cost adjusted for inflation. Logistic and linear regression models were used to adjust for confounders. Admissions were classified into 4 quarters (Q1–Q4), based on the academic calendar. Q1 and Q4 were designated to assess the effect of novice (July effect) versus experienced trainees, respectively. Results: There were 699,675 HF admissions during Q1 and Q4 in the study period. Mean age was 71 ± 15 years and 48% were females. There were 20,270 in-hospital deaths, with no difference between Q1 and Q4; crude odds ratio (OR) 1.00, 95% confidence interval (CI) 0.94–1.07, p = 0.95. After risk adjustment, there was no in-hospital mortality difference between Q1 and Q4 admissions; adjusted OR 0.96, 95% CI 0.89–1.03, p = 0.23. There was no difference in hospital LOS or total cost; 5.8 versus 5.8 days, p = 0.66 and $13,755 versus $13,586, p = 0.46, in Q1 and Q4, respectively. Conclusions: In this nationally representative sample, there was no evidence of a “July effect” on inpatient HF outcomes in the US. This suggests that HF patients should not delay seeking care during trainee transitions at teaching hospitals.
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Wang Y, Bansal P, Li S, Iqbal Z, Cheryala M, Abougergi MS. Dieulafoy's lesion of the upper GI tract: a comprehensive nationwide database analysis. Gastrointest Endosc 2021; 94:24-34.e5. [PMID: 33359438 DOI: 10.1016/j.gie.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS We sought to determine the incidence, risk factors, and treatment outcomes of Dieulafoy's lesion of the upper GI tract (UDL) hemorrhage among adult patients in the United States. METHODS UDL and non-Dieulafoy upper GI bleeding (UGIB) were identified from the Nationwide Inpatient Sample and Nationwide Readmission Database using International Classification of Diseases, Tenth Revision, Clinical Modification and Procedure Coding System codes. Multivariate logistic (binary) and linear (continuous) regressions were used to model dependent variables. RESULTS The incidence of UDL hemorrhage was 1.6 of 100,000 persons. Patients with UDL and UGIB who required endoscopic therapeutic intervention had similar in-hospital (adjusted odds ratio [aOR], .77; 95% confidence interval [CI], .42-1.43; P = .41) mortality rates. UDL was associated with more severe systemic illness, including higher rates of mechanical ventilation (aOR, 1.52; 95% CI, 1.07-2.15; P < .05), hypovolemic shock (aOR, 1.50; 95% CI, 1.08-2.08; P < .05), acute kidney injury (aOR, 1.25; 95% CI, 1.02-1.54; P < .05), and multiple endoscopies (aOR, 1.57; 95% CI, 1.28-1.93; P < .05) compared with other UGIB patients who required endoscopic therapeutic intervention. UDL was also associated with higher 30-day all-cause (aOR, 1.23; 95% CI, 1.12-1.35; P < .05) and recurrent bleeding-related (aOR, 1.73; 95% CI, 1.45-2.06; P < .05) readmissions. The rate of successful endoscopic treatment was 96.81%. CONCLUSIONS UDL hemorrhage is an uncommon but highly morbid condition. Current UDL treatment modalities are effective in reducing mortality. Further investigations are warranted to lower recurrent bleeding rates.
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Affiliation(s)
- Yichen Wang
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Pardeep Bansal
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA; Division of Gastroenterology, Regional Hospital and Moses Taylor Hospital, Scranton, Pennsylvania, USA
| | - Si Li
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Zaid Iqbal
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Mahesh Cheryala
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, South Carolina, USA; Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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Abstract
BACKGROUND The impact of hospital readmission reduction program (HRRP) on heart failure (HF) outcomes has been debated. Limited data exist regarding trends of HF readmission rates beyond 30 days from all-payer sources. The aim of this study was to investigate temporal trends of 30- and 90-day HF readmissions rates from 2010 to 2017 in patients from all-payer sources. METHODS The National Readmission Database was utilized to identify HF hospitalizations between 2010 and 2017. In the primary analysis, a linear trend in 30-day and 90-day readmissions from 2010 to 2017 was assessed. While in the secondary analysis, a change in aggregated 30- and 90-day all-cause and HF-specific readmissions pre-HRRP penalty phase (2010-2012) and post-HRRP penalties (2013-2017) was compared. Subgroup analyses were performed based on (1) Medicare versus non-Medicare insurance, (2) low versus high HF volume, and (3) HF with reduced versus preserved ejection fraction (heart failure with reduced ejection fraction and heart failure with preserved ejection fraction). Multiple logistic and adjusted linear regression analyses were performed for annual trends. RESULTS A total of 6 669 313 index HF hospitalizations for 30-day, and 5 077 949 index HF hospitalizations for 90-day readmission, were included. Of these, 1 213 402 (18.2%) encounters had a readmission within 30 days, and 1 585 445 (31.2%) encounters had a readmission within 90 days. Between 2010 and 2017, both 30 and 90 days adjusted HF-specific and all-cause readmissions increased (8.1% to 8.7%, P trend 0.04, and 18.3% to 19.9%, P trend <0.001 for 30-day and 14.8% to 16.0% and 30.9% to 34.6% for 90-day, P trend <0.001 for both, respectively). Readmission rates were higher during the post-HRRP penalty period compared with pre-HRRP penalty phase (all-cause readmission 30 days: 18.6% versus 17.5%, P<0.001, all-cause readmission 90 days: 32.0% versus 29.9%, P<0.001) across all subgroups except among the low-volume hospitals. CONCLUSIONS The rates of adjusted HF-specific and all-cause 30- and 90-day readmissions have increased from 2010 to 2017. Readmissions rates were higher during the HRRP phase across all subgroups except the low-volume hospitals.
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Affiliation(s)
| | - Jayakumar Sreenivasan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY (J.S.)
| | - Noman Lateef
- Department of Medicine, Creighton University, Nebraska, Omaha (N.L.)
| | - Marwan S Abougergi
- Department of Medicine, University of South Carolina School of Medicine, Columbia (M.S.A.)
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC (S.J.G.)
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (T.A.)
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Germany (S.D.A.)
| | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan-UCLA Medical Center (G.C.F.)
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson (J.B., M.S.K.)
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12
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Finianos A, Mujadzic H, Peluso H, Mujadzic T, Taher A, Abougergi MS. Temporal trends and outcome of splenectomy in adults with immune thrombocytopenia in the USA. Ann Hematol 2021; 100:941-952. [PMID: 33560468 DOI: 10.1007/s00277-021-04449-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
Splenectomy is one of the treatments of immune thrombocytopenia (ITP) with a high response rate. However, it is an irreversible procedure that can be associated with morbidity in this setting. Our aim was to study the trends of splenectomy in adults with ITP, and the factors associated with splenectomy and resource utilization during these hospitalizations. We used the National (Nationwide) Inpatient Sample (NIS) to identify hospitalizations for adult patients with a principal diagnosis of ITP between 2007 and 2017. The primary outcome was the splenectomy trend. Secondary outcomes were (1) incidence of ITP trend, (2) in-hospital mortality, length of stay, and total hospitalization costs after splenectomy trend, and (3) independent predictors of splenectomy, length of stay, and total hospitalization costs. A total of 36,141 hospitalizations for ITP were included in the study. The splenectomy rate declined over time (16% in 2007 to 8% in 2017, trend p < 0.01) and so did the in-hospital mortality after splenectomy. Of the independent predictors of splenectomy, the strongest was elective admissions (adjusted odds ratio [aOR]: 22.1, 95% confidence interval [CI]:17.8-27.3, P < 0.01), while recent hospitalization year, older age, and Black (compared to Caucasian) race were associated with lower odds of splenectomy. Splenectomy tends to occur during elective admissions in urban medical centers for patients with private insurance. Despite a stable ITP hospitalization rate over the past decade and despite listing splenectomy as a second-line option for management of ITP in major guidelines, splenectomy rates consistently declined over time.
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Affiliation(s)
- Antoine Finianos
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut School of Medicine, Beirut, Lebanon
| | - Hata Mujadzic
- Department of Medicine, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Heather Peluso
- Division of Surgery, Prisma Health Upstate, Greenville, SC, USA
| | - Tarik Mujadzic
- Division of Plastic Surgery, Department of Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Ali Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut School of Medicine, Beirut, Lebanon
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA. .,Catalyst Medical Consulting, Simpsonville, SC, USA.
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13
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Dolan RD, Abougergi MS, Schulman AR. Morbid Obesity Increases 30-Day Readmission and Morbidity in Clostridiodes difficile Infection. Obes Surg 2021; 31:2168-2173. [PMID: 33544330 DOI: 10.1007/s11695-021-05245-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Readmission for patients hospitalized with Clostridioides difficile infections (CDIs) carries high morbidity, mortality, and burden on healthcare resources. This study aims to determine if morbid obesity is risk factor for 30-day readmission in patients hospitalized with CDI. METHODS This retrospective cohort study used the 2014 National Readmission Database. Included patients had a principal diagnosis of CDI and excluded if younger than 18 years of age or admitted during the month of December. Readmissions to any hospital for non-trauma diagnoses within 30 days of the index admission were included. The primary outcome was 30-day all cause readmission. Secondary outcomes were (1) in-hospital mortality; (2) morbidity, initiation of dialysis, or total parenteral nutrition; and (3) resource utilization during index admissions. RESULTS A total of 91,265 subjects were included in this study, 4388 of whom were morbidly obese. Morbid obesity was associated with significantly higher odds of readmission and was associated with higher adjusted mean total hospitalization charges and costs, higher odds of PMV, and acute renal failure requiring dialysis in individuals that develop CDI. CONCLUSIONS Morbid obesity is an independent risk factor for 30-day readmission in patients hospitalized for CDI. Morbidly obese patients admitted for CDI experienced higher morbidity and increased resource utilization.
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Affiliation(s)
- Russell D Dolan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC, Ann Arbor, MI, 5362, USA
| | - Marwan S Abougergi
- Division of Gastroenterology, University of South Carolina School of Medicine, Columbia, SC, USA.,Catalyst Medical Consulting, LLC, Baltimore, MD, USA
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC, Ann Arbor, MI, 5362, USA.
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14
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Bilal M, Samuel R, Khalil MK, Singh S, Parupudi S, Abougergi MS. Response. Gastrointest Endosc 2021; 93:270-271. [PMID: 33353622 DOI: 10.1016/j.gie.2020.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Mohammad Bilal
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ronald Samuel
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | | | - Shailendra Singh
- Division of Gastroenterology, West Virginia University, Charleston Area Medical Center, Charleston, West Virginia
| | - Sreeram Parupudi
- Division of Gastroenterology and Hepatology, The University of Texas Medical Branch, Galveston, Texas
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, South Carolina; Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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15
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Mumtaz K, Lee-Allen J, Porter K, Kelly S, Hanje J, Conteh LF, Michaels AJ, El-Hinnawi A, Washburn K, Black SM, Abougergi MS. Thirty-day readmission rates, trends and its impact on liver transplantation recipients: a national analysis. Sci Rep 2020; 10:19254. [PMID: 33159123 PMCID: PMC7648628 DOI: 10.1038/s41598-020-76396-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 09/28/2020] [Indexed: 12/17/2022] Open
Abstract
Reduction of early hospital readmissions is a declared goal in the United States economic and quality improvement agenda. A retrospective study was performed using the Nationwide Readmissions Database from 2010 to 2014. Our primary aim was to study the rate of early readmissions and its predictors in liver transplant recipients (LTRs). Our secondary aims were to determine the trends of LT, reasons for readmission, costs and predictors of calendar year mortality. Multivariable logistic regression and Cox proportional hazards models were utilized. The 30-day readmission rate was 30.6% among a total of 25,054 LTRs. Trends of LT were observed to be increased in patients > 65 years (11.7-17.8%, p < 0.001) and decreased in 40-64 years (78.0-73.5%, p = 0.001) during study period. The majority of 30-day readmissions were due to post transplant complications, with packed red blood cell transfusions being the most common intervention during readmission. Medicaid or Medicare insurance, surgery at low and medium volume centers, infections, hemodialysis, liver biopsy, and length of stay > 10 days were the predictors of 30-day readmission. Moreover, number of early readmission, age > 64 years, non-alcoholic cirrhosis, and length of stay > 10 days were significant predictor of calendar year mortality in LTRs. Approximately one third of patients require early admission after LT. Early readmission not only increases burden on healthcare, but is also associated with calendar year mortality. Strategies should be implemented to reduce readmission in patients with high risk of readmission identified in our study.
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Affiliation(s)
- Khalid Mumtaz
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA.
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Jannel Lee-Allen
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Sean Kelly
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James Hanje
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lanla F Conteh
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anthony J Michaels
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Ave., 3rd Floor, Columbus, OH, 43210, USA
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ashraf El-Hinnawi
- Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Ken Washburn
- Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Sylvester M Black
- Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina, Columbia, SC, USA
- Catalyst Medical Consulting, Simpsonville, USA
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Abstract
BACKGROUND To study the relationship between race and outcomes of patients with firearm injuries hospitalized in the United States. METHODS The 2016 National Inpatient Sample was used. Patients were included if they had a principal diagnosis of firearm injury. Exclusion criteria were age <16 years and elective admissions. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (traumatic shock, prolonged mechanical ventilation, acute respiratory distress syndrome [ADRS], and ventilator-associated pneumonia [VAP]), and resource utilization (length of stay and total hospitalization charges and costs). RESULTS The sample included 31 335 patients; 52% were Black and 29% were Caucasian. The mean age was 32 years and 88% were male. Black patients had lower odds of mortality (adjusted odds ratio (aOR): 0.41 (95% CI: 0.32-0.53), P < .01). However, compared with Caucasians, Blacks had higher mean total hospitalization charges (adjusted mean difference (aMD) : $14 052 (CI: $1469-$26 635), P = .03) and costs (aMD: $3248 (CI: $654-$5842), P = .01) despite similar mean length of stay (aMD: 0.70 (CI: -0.05-1.45), P = .07). Both racial groups had similar rates of traumatic shock (aOR: 0.91 (0.72-1.15), P = .44), prolonged mechanical ventilation (aOR: 0.82 (0.63-1.09), P = .17), ARDS (aOR: 1.18 (0.45-3.07), P = .74) and VAP (aOR: 1.27 (0.47-3.41), P = .63). DISCUSSION Black patients with firearm injuries had a lower adjusted odds of in-hospital mortality compared with other races. However, despite having a similar hospital length of stay and in-hospital morbidity, -Black patients had higher total hospitalization costs and charges.
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Affiliation(s)
- Heather Peluso
- Department of Surgery, Prisma Health Upstate, Greenville, SC, USA
| | - John D Cull
- Department of Surgery, Prisma Health Upstate, Greenville, SC, USA
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, SC, USA.,Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
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Affiliation(s)
- Mohammad Bilal
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, South Carolina, USA; Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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18
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Bilal M, Samuel R, Khalil MK, Singh S, Parupudi S, Abougergi MS. Nonvariceal upper GI hemorrhage after percutaneous coronary intervention for acute myocardial infarction: a national analysis over 11 months. Gastrointest Endosc 2020; 92:65-74.e2. [PMID: 32017916 DOI: 10.1016/j.gie.2020.01.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Nonvariceal upper GI hemorrhage (NVUGIH) is a feared adverse event after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). We aimed to determine the incidence of NVUGIH after PCI for AMI and its impact on mortality, morbidity, and health care resource utilization over 11 months. METHODS We used the Nationwide Readmission Database 2014. Inclusion criteria were (1) a principal diagnosis of ST or non-ST-elevation myocardial infarction, (2) in-hospital PCI, and (3) admission in January. Exclusion criteria were age less than 18 years and elective admission. The primary outcome was the 11-month incidence of NVUGIH. Secondary outcomes were 11-month mortality rate, prolonged mechanical ventilation, shock, upper endoscopy, length of stay, and total hospitalization costs and charges. Independent risk factors for NVUGIH were identified using multivariate logistic regression analysis. RESULTS A total of 22,669 patients were included in the study. The mean age was 63.8 years (range, 63.4-64.1 years), and 31.7% of patients were female. The 11-month incidence of NVUGIH was 1.6%. The onset of NVUGIH was associated with an increase in the 11-month mortality rate (adjusted odds ratio, 1.94; 95% confidence interval, 1.01-3.72; P =.04). The upper endoscopy, shock, and prolonged mechanical ventilation rates were 72%, 6.2%, and 1.9%, respectively. In total, 26,532 days were associated with NVUGIH, with a total health care in-hospital economic burden of U.S.$17.6 million. Independent predictors of NVUGIH were female gender, Charlson comorbidity score, and length of stay. CONCLUSIONS The 11-month incidence of NVUGIH among patients who undergo PCI for AMI is 1.6%. NVUGIH has a substantial impact on mortality, morbidity, and in-hospital health care resource utilization.
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Affiliation(s)
- Mohammad Bilal
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, Texas; Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ronald Samuel
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Shailendra Singh
- Division of Gastroenterology, West Virginia University, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Sreeram Parupudi
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, Texas
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, South Carolina, USA; Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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Wang Y, Abougergi MS, Li S, Kazmierski D, Patel P, Sharma N, Ochieng P. Recurrence Prophylaxis in Secondary Spontaneous Pneumothorax: A Nationwide Readmission Database Analysis. Chest 2020; 158:2474-2484. [PMID: 32599067 DOI: 10.1016/j.chest.2020.06.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/20/2020] [Accepted: 06/11/2020] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Secondary spontaneous pneumothorax (SSP) is defined as a pneumothorax presenting as a complication of underlying lung disease. Due to the high recurrence rate and the possibility of life-threatening complications, same-admission recurrence prophylaxis (SARP) following the first occurrence of SSP is recommended by many experts. The rate of SARP in SSP admissions has not been reported. RESEARCH QUESTION How often were SARP procedures performed in SSP admissions in the United States? How did outcomes differ between SSP admissions with SARP vs those without SARP? STUDY DESIGN AND METHODS This study used the Nationwide Readmission Database to analyze 71,451,419 inpatient admissions in the United States in 2016 and 2017. SSP admissions with patients aged ≥ 18 years were included, and admissions with documented traumatic or iatrogenic causes of pneumothorax were excluded. Outcomes were compared between SSP admissions with and without SARP. Multivariate logistic analysis was used to model binary-dependent variables. RESULTS There were 21,838 SSP admissions in 2016 and 2017 (30.56 per 100,000 admissions per year), among which 7,366 (33.73%) received SARP. SARP was associated with lower odds of in-hospital mortality (adjusted OR [aOR], 0.48; 95% CI, 0.34-0.70), 30-day mortality (aOR, 0.52; 95% CI, 0.35-0.77), 90-day mortality (aOR, 0.56; 95% CI, 0.40-0.79), and 1-year mortality (aOR, 0.28; 95% CI, 0.10-0.74). SARP was also associated with lower all-cause readmission at 30 days (aOR, 0.40; 95% CI, 0.40-0.49), 90 days (aOR, 0.47; 95% CI, 0.40-0.55), and 1 year (aOR, 0.46; 95% CI, 0.30-0.68), as well as lower rates of postdischarge pneumothorax recurrence in 30 days (aOR, 0.22; 95% CI, 0.11-0.44), 90 days (aOR, 0.26; 95% CI, 0.20-0.33), and 1 year (aOR, 0.22; 95% CI, 0.11-0.44). INTERPRETATION The rate of SARP in SSP admissions was 33.73% in the United States in 2016 and 2017. SARP was associated with lower mortality, all-cause readmission, and pneumothorax recurrence in SSP admissions.
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Affiliation(s)
- Yichen Wang
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, PA.
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, SC; Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC
| | - Si Li
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, PA
| | - Daniel Kazmierski
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, PA
| | - Palakkumar Patel
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY
| | - Nishant Sharma
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, PA
| | - Pius Ochieng
- Department of Pulmonology and Critical Care, Geisinger Medical Center, Danville, PA
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20
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Kröner PT, Bilal M, Samuel R, Umar S, Abougergi MS, Lukens FJ, Raimondo M, Carr-Locke DL. Use of ERCP in the United States over the past decade. Endosc Int Open 2020; 8:E761-E769. [PMID: 32490161 PMCID: PMC7247893 DOI: 10.1055/a-1134-4873] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background and study aims With newer imaging modalities, indications for use of endoscopic retrograde cholangiopancreatography (ERCP) have changed in the last decade. Despite advances in ERCP, paucity in recent literature regarding utilization and outcomes of ERCP exists. Thus, the aim of this study was to assess the inpatient use of ERCP, outcomes, and most common indications.
Patients and methods Retrospective-cohort study using the Nationwide Inpatient Sample 2007–2016. All patients with ICD9–10CM procedural codes for ERCP were included. The primary outcome was the use of ERCP. Secondary outcomes included determining procedural specifics (stenting, sphincterotomy and dilation), complications (post-ERCP pancreatitis [PEP], bile duct perforation), hospital length of stay, total hospital costs and charges. Multivariate regression analysis was used to adjust for confounders.
Results A total of 1,606,850 patients underwent inpatient ERCP. The mean age was 59 years (60 % female). The total number of ERCPs increased over the last decade. Patients undergoing ERCP in 2016 had greater odds of undergoing bile duct stent placement, pancreatic duct (PD) stenting, biliary dilation, pancreatic sphincterotomy, PEP and biliary perforation. Inpatient mortality decreased. Hospital charges increased, while length of stay (LOS) decreased.
Conclusions The number of ERCPs increased in the past decade. Odds of therapeutic interventions and complications increased. The most common principal diagnoses were choledocholithiasis and gallstone-related AP. Hence, physicians must be aware to promptly diagnose and treat complications. These findings may reflect the increased case complexity and fact that ERCP continues to evolve into an increasingly interventional tool, contrasting from its former role as a predominantly diagnostic and gallstone extraction tool.
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Affiliation(s)
- Paul T. Kröner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Boston, Massachusetts, United State
| | - Ronald Samuel
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, United States
| | - Shifa Umar
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Marwan S. Abougergi
- Division of Gastroenterology, Palmetto Health, Columbia, South Carolina, United States
| | - Frank J. Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Massimo Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - David L. Carr-Locke
- Division of Gastroenterology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, United States
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Schulman AR, Dolan R, Abougergi MS, Telem D, Cohen-Mekelburg S. Impact of fragmentation on rehospitalization after bariatric surgery. Surg Endosc 2020; 35:291-297. [DOI: 10.1007/s00464-020-07395-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/28/2020] [Indexed: 01/20/2023]
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22
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Peluso H, Cull JD, Abougergi MS. The Effect of Opioid Dependence on Firearm Injury Treatment Outcomes: A Nationwide Analysis. J Surg Res 2019; 247:241-250. [PMID: 31718813 DOI: 10.1016/j.jss.2019.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/28/2019] [Accepted: 10/05/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Both the opioid and gun violence epidemics are recurrent public health issues in the United States. We sought to determine the effect of opioid dependence on gunshot injury treatment outcomes. MATERIALS AND METHODS Using the 2016 National Readmission Database, patients were included if they had a principal diagnosis of firearm injury. Opioid dependence was identified using appropriate International Classification of Diseases, 10th Revision, Clinical Modification codes. The primary outcome was 30-day all-cause readmission. Secondary outcomes were in-hospital and 1-year mortality, resource utilization, and most common reasons for admission and readmission. Confounders were adjusted for using multivariate regression analysis. RESULTS A total of 31,303 patients were included, 695 of whom were opioid dependent. Opioid-dependent patients were more likely to be young (35.1 y, range: 33.4-36.7 y) and male (89.9%) compared with patients without opioid dependence. Opioid dependence was associated with higher 30-day readmission rates (adjusted odds ratio [aOR]: 1.67, 95% confidence interval [CI]: 1.12-2.50, P = 0.01). However, opioid dependence was associated with lower in-hospital (aOR: 0.16, CI: 0.07-0.38, P < 0.01) and 1-year (aOR: 0.15, CI: 0.06-0.38, P < 0.01) mortality, longer mean length of stay (adjusted mean difference [aMD]: 2.09 d, CI: 0.43-3.76, P = 0.03), and total hospitalization costs (aMD: $6,318, CI: $ 257-$12,380, P = 0.04). Both groups had similar total hospitalization charges (aMD: $$10,491, CI: -$12,618-$33,600, P-value = 0.37). CONCLUSIONS Opioid dependence leads to higher rates of 30-day readmission and resource utilization among patients with firearm injuries. However, the in-hospital and 1-year mortality rates are lower among patients with opioid dependence secondary to lower injury acuity.
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Affiliation(s)
| | - John D Cull
- Department of surgery, Greenville, South Carolina
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, South Carolina; Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina.
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Peluso H, Abougergi MS. Readmission for Opioid Dependence after Firearm Injury: A Nationwide Analysis. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Mumtaz K, Issak A, Porter K, Kelly S, Hanje J, Michaels AJ, Conteh LF, El-Hinnawi A, Black SM, Abougergi MS. Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database. Hepatology 2019; 70:630-639. [PMID: 30218583 DOI: 10.1002/hep.30274] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022]
Abstract
Early readmission in patients with decompensated liver cirrhosis leads to an enormous burden on health care use. A retrospective cohort study using the 2013 and 2014 Nationwide Readmission Database (NRD) was conducted. Patients with a diagnoses of cirrhosis and at least one feature of decompensation were included. The primary outcome was to develop a validated risk model for early readmission. Secondary outcomes were to study the 30-day all-cause readmission rate and the most common reasons for readmission. A multivariable logistic regression model was fit to identify predictors of readmissions. Finally, a risk model, the Mumtaz readmission risk score, was developed for prediction of 30-day readmission based on the 2013 NRD and validated on the 2014 NRD. A total of 123,011 patients were included. The 30-day readmission rate was 27%, with 79.6% of patients readmitted with liver-related diagnoses. Age <65 years; Medicare or Medicaid insurance; nonalcoholic etiology of cirrhosis; ≥3 Elixhauser score; presence of hepatic encephalopathy, ascites, variceal bleeding, hepatocellular carcinoma, paracentesis, or hemodialysis; and discharge against medical advice were independent predictors of 30-day readmission. This validated model enabled patients with decompensated cirrhosis to be stratified into groups with low (<20%), medium, (20%-30%), and high (>30%) risk of 30-day readmissions. Conclusion: One third of patients with decompensated cirrhosis are readmitted within 30 days of discharge. The use of a simple risk scoring model with high generalizability, based on demographics, clinical features, and interventions, can bring refinement to the prediction of 30-day readmission in high-risk patients; the Mumtaz readmission risk score highlights the need for targeted interventions in order to decrease rates of readmission within this population.
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Affiliation(s)
- Khalid Mumtaz
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH.,Department of Internal Medicine, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Abdulfatah Issak
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH.,Department of Internal Medicine, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
| | - Sean Kelly
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH.,Department of Internal Medicine, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - James Hanje
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH.,Department of Internal Medicine, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Anthony J Michaels
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH.,Department of Internal Medicine, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Lanla F Conteh
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH.,Department of Internal Medicine, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Ashraf El-Hinnawi
- Department of Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sylvester M Black
- Department of Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC.,Catalyst Medical Consulting, Simpsonville, SC
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Ochoa Chaar CI, Gholitabar N, Goodney P, Dardik A, Abougergi MS. One-Year Readmission after Open and Endovascular Revascularization for Critical Limb Ischemia. Ann Vasc Surg 2019; 61:25-32.e2. [PMID: 31376536 DOI: 10.1016/j.avsg.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/07/2019] [Accepted: 07/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lower extremity revascularization for critical limb ischemia (CLI) remains a subject of clinical equipoise. Readmissions and repeat lower extremity revascularization increase the cost of care and decrease the value of initial treatment. This study examines readmissions and repeat inpatient revascularization and major amputation up to 1 year after initial open and endovascular lower extremity revascularization. METHODS The 2014 Nationwide Readmissions Database (NRD) was reviewed. The NRD provides all subsequent readmissions of any hospitalization for the calendar year. A cohort of patients undergoing lower extremity revascularization in January only was selected based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients were divided into open and endovascular groups. Readmissions for repeat lower extremity revascularization (RFR) were identified based on procedural codes. Open and endovascular lower extremity revascularization were compared in terms of patient characteristics as well as readmissions, RFR, major amputation, and inpatient mortality at 1 year. Risk-adjusted outcomes accounting for differences in age, gender, income, and Charlson Comorbidity Index (CCI) were derived using regression analysis. RESULTS There were 1,668 open and 1,410 endovascular lower extremity revascularizations. Patients in the endovascular group were significantly older (P < 0.01), more likely to be women (P < 0.01), and had higher CCI (P < 0.01). Patients undergoing endovascular lower extremity revascularization had significantly higher readmission rate (49 vs. 33.7, P < 0.01) and higher mortality (10.4 vs. 5.3, P < 0.01). Readmitted patients after endovascular lower extremity revascularization had significantly higher mean number of repeat readmissions compared to open lower extremity revascularization (2.49 ± 0.12 vs. 2.13 ± 0.08, P = 0.01). There was no difference in RFR (P = 0.82) or major amputation (P = 0.19). Open revascularization was independently associated with decreased readmission (odds ratio = 0.55 [0.43-0.71]) compared to endovascular. However, there was no significant association between the type of lower extremity revascularization and major amputation or RFR. CONCLUSIONS Endovascular lower extremity revascularization for CLI is performed on older and sicker patients and seems to be associated with increased readmission at 1 year compared to open lower extremity revascularization. Regardless of the initial modality of treatment, patients are likely to undergo at least 1 revascularization during readmissions.
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Affiliation(s)
- Cassius Iyad Ochoa Chaar
- Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT.
| | - Navid Gholitabar
- Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Philip Goodney
- Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Alan Dardik
- Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Clinical Research Consulting Firm, Columbia, SC
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Bilal M, Kline KT, Trieu JA, Saraireh H, Desai M, Parupudi S, Abougergi MS. Trends in same-admission cholecystectomy and endoscopic retrograde cholangiopancreatography for acute gallstone pancreatitis: A nationwide analysis across a decade. Pancreatology 2019; 19:524-530. [PMID: 31036491 DOI: 10.1016/j.pan.2019.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/05/2019] [Accepted: 04/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Gallstones are the leading cause of acute pancreatitis in developed countries. National and international guidelines recommend that a cholecystectomy should be performed during the index hospitalization for acute gallstone pancreatitis. We aimed to delineate the national trends for same-admission cholecystectomy and ERCP for acute gallstone pancreatitis over the last ten years. METHODS We used the 2004, 2009 and 2014 National Inpatient Sample database including patients with a principal diagnosis of acute pancreatitis and a secondary diagnosis of choledocholithiasis or cholelithiasis. Exclusion criteria were age <18 years and elective admission. Primary outcome was the trend in incidence rate of same admission cholecystectomy from 2004 to 2014. The secondary outcomes were: 10-year trend in 1) Incidence of gallstone pancreatitis, 2) proportion of gallstone pancreatitis compared to all other etiologies of acute pancreatitis, 3) incidence rate of same-admission ERCP, 4) length of hospital stay, and 5) total hospitalization costs and charges. RESULTS The proportion of admissions during which a same-admission cholecystectomy was performed decreased from 48.7% in 2004 to 46.9% in 2009 to 45% in 2014 (trend p < 0.01). During the same time interval, the percentage of admissions during which an ERCP was performed decreased from 25.1% to 18.7% (Trend p < 0.01). CONCLUSIONS Adherence to the guidelines for same-admission cholecystectomy for patients admitted with acute gallstone pancreatitis have been declining over the past decade. On the other hand, decline in rate of ERCP in patients with acute gallstone pancreatitis and no signs of cholangitis demonstrates adherence to guidelines in this regard.
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Affiliation(s)
- Mohammad Bilal
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Kevin T Kline
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Judy A Trieu
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Hamzeh Saraireh
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA, USA
| | - Madhav Desai
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Sreeram Parupudi
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, SC, USA; University of South Carolina School of Medicine, Columbia, SC, USA
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Kotwal S, Abougergi MS, Wright S. Differences in healthcare outcomes between teaching and non teaching hospitals for patients with delirium: a retrospective cohort study. Int J Qual Health Care 2019; 31:378-384. [PMID: 30165567 DOI: 10.1093/intqhc/mzy182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/22/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The physician workforce at teaching hospitals differs compared to non-teaching hospitals, and data suggest that patient outcomes may also be dissimilar. Delirium is a common, costly disorder among hospitalized patients and approaches to care are not standardized. OBJECTIVE This study set out to explore differences in healthcare outcomes between teaching and non-teaching hospitals for patients admitted with delirium. DESIGN Retrospective cohort analysis. SETTING AND PARTICIPANTS We used the 2014 Nationwide Inpatient Sample database. Adult patients (≥18 years of age) hospitalized in acute-care hospitals in the USA with delirium (defined with ICD-9 code) were studied. MAIN OUTCOME MEASURES The primary outcome was in-hospital all-cause mortality. Secondary outcomes were discharge status and several measures of healthcare resource utilization: length of stay, total hospitalization costs and multiple procedures performed. RESULTS In 2014, out of 57 460 adult patients admitted to hospitals with delirium, 58.4% were hospitalized at teaching hospitals and the remainder 41.6% at non-teaching hospitals. The in-hospital mortality of delirium patients in teaching hospitals was 1.33% (95% CI 1.08%-1.63%), and 1.26% (95% CI 0.97%-1.63%) in non-teaching hospitals. The mean total hospital costs were $7642 (95% CI 7384-7900) in teaching hospitals, and $6650 (95% CI 6460-6840) in non-teaching hospitals. After adjustment for confounders, total hospitalization costs were statistically significantly different between the hospitals types-with non-teaching providing less expensive care. CONCLUSIONS Patients with delirium admitted to non-teaching hospitals had comparable clinical and process outcomes achieved at lower costs. Further research can be conducted to explore the contextual issues and reasons for these differences in healthcare costs.
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Affiliation(s)
- Susrutha Kotwal
- Department of Medicine, Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marwan S Abougergi
- Catalyst Medical Consulting, LLC 722 Elmbrook Drive Simpsonville, SC, USA.,Division of Gastroenterology, Department of Medicine, University of South Carolina, Columbia, SC, USA
| | - Scott Wright
- Department of Medicine, Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Harris CM, Albaeni A, Thorpe RJ, Norris KC, Abougergi MS. Racial factors and inpatient outcomes among patients with diabetes hospitalized with foot ulcers and foot infections, 2003-2014. PLoS One 2019; 14:e0216832. [PMID: 31141534 PMCID: PMC6541346 DOI: 10.1371/journal.pone.0216832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background In patients with diabetes, foot amputations among Black patients have been historically higher compared with White patients. Using the National Inpatient Sample database, we sought to determine if disparities in foot amputations and resource utilization have improved over time. We hypothesized there would be improvements and reduced differences in foot amputations between the two races as quality of care and access to healthcare has improved. Methods and findings Patients over 18 years old with a principal diagnosis of diabetic foot complications and secondary diagnosis of Diabetes Mellitus were selected. We compared the primary outcome of foot amputations between Black and White patients. Adjusted rates, odds ratios (aOR) and trends of foot amputations among Black and White patients were studied. Healthcare utilization was measured via length of hospital stay (LOS). Of 262,924 patients, 18% were Black. Following adjustment for confounders, major foot amputations decreased among Whites (1.5% in 2003 to 1.1% in 2014) and Blacks (2.1% in 2003 to 0.9% in 2014). On pooled analysis, Black patients had higher adjusted odds of major foot amputations in 2003–2004 [aOR 1.7; (1.16–2.57), p<0.01]. Disparities in major foot amputations disappeared in 2013–2014 [aOR: 0.92 (0.58–1.44), p = 0.70]. Black patients had declining but persistently longer LOS (adjusted mean difference (aMD): 1.1 days (0.52–1.6) p<0.01 in 2003–2004 and 0.46 days (0.18–0.73) p<0.01 in 2013–2014). The main limitation of the study was that the NIS uses ICD-9 and ICD-10 CM codes, and hence prone to incorrect or missing codes. Conclusions Major foot amputations declined among Black and White patients hospitalized with Diabetic foot complications between 2003 and 2014. The observed difference for amputations in 2003–2004 was absent by 2013–2014. Future research to determine specific contributors for this reduction in health disparities is needed for ongoing improvements and sustainability.
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Affiliation(s)
- Ché Matthew Harris
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Division of Hospital Medicine Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States of America
- * E-mail:
| | - Aiham Albaeni
- Department of Medicine, University of Central Florida, Ocala, Florida, United States of America
| | - Roland J. Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Keith C. Norris
- Department of Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Marwan S. Abougergi
- Department of Internal Medicine, Division of Gastroenterology, University of South Carolina School of Medicine, Columbia, South Carolina United States of America
- Catalyst Medical Consulting, Simpsonville, SC, United States of America
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Peluso H, Jones WB, Parikh AA, Abougergi MS. Treatment outcomes, 30‐day readmission and healthcare resource utilization after pancreatoduodenectomy for pancreatic malignancies. J Hepatobiliary Pancreat Sci 2019; 26:187-194. [DOI: 10.1002/jhbp.621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Heather Peluso
- Department of Surgery University of South Carolina Greenville Health System, 701 Grove Road Greenville SC 29605 USA
| | - Wesley B. Jones
- Department of Surgery University of South Carolina Greenville Health System, 701 Grove Road Greenville SC 29605 USA
| | - Alexander A. Parikh
- Division of Surgical Oncology Brody School of Medicine East Carolina UniversityGreenville NC USA
| | - Marwan S. Abougergi
- Catalyst Medical Consulting Simpsonville SC USA
- Division of Gastroenterology Department of Internal Medicine University of South Carolina School of Medicine Columbia SC USA
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Harris CM, Abougergi MS, Wright SM. Clinical outcomes among morbidly obese patients hospitalized with diabetic foot complications. Clin Obes 2019; 9:e12285. [PMID: 30288938 DOI: 10.1111/cob.12285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/15/2018] [Accepted: 08/26/2018] [Indexed: 11/29/2022]
Abstract
The aim of the study is to investigate effects of morbid obesity on patients hospitalized with diabetic foot ulcers and infections (DFU/Is). This retrospective cohort study of hospitalized adults investigated patients with a principal diagnosis of DFU/Is, and compared outcomes based on weight. The primary outcome was lower limb amputations. Secondary outcomes included in-hospital mortality, morbidity (sepsis and discharge disposition), resource utilization (length of stay [LOS] and total hospitalization charges). Multivariate analyses adjusted for confounders. A total of 31 730 admissions were included; 14% were morbidly obese. Patients with morbid obesity had overall lower rates of amputations (adjusted odds ratio [aOR]: 0.60; 95% confidence interval [CI]: 0.45-0.80). There was no difference in mortality rates between those who were morbidly obese and the non-morbidly obese patients (aOR: 3.89 [95% CI: 0.79-19.30]). Combined data from 2010 to 2014 have found higher odds of sepsis in morbidly obese patients compared with non-morbidly obese patients after adjusting for confounders (aOR: 1.49 [1.09-2.02], P = 0.01). Patients with morbid obesity were less likely to be discharged to home (aOR: 0.82 [95% CI: 0.70-0.95]), had longer LOS (adjusted mean difference [aMD]: 0.47 [95% CI: 0.13-0.81]) and higher hospital charges (aMD: $3205 [95% CI: $3373-$6037]). Despite having lower amputation rates compared to those who are not morbidly obese, patients with morbid obesity hospitalized for DFU/Is succumbed to sepsis more frequently and had less favourable utilization metrics. Specialized care pathways may be needed to enhance the value of care delivered to this high-risk population.
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Affiliation(s)
- Che Matthew Harris
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Marwan S Abougergi
- Department on Internal Medicine, Division of Gastroenterology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
- Catalyst Medical Consulting, Simpsonville, South Carolina, USA
| | - Scott Mitchell Wright
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Abougergi MS, Avila P, Saltzman JR. Impact of Insurance Status and Race on Outcomes in Nonvariceal Upper Gastrointestinal Hemorrhage: A Nationwide Analysis. J Clin Gastroenterol 2019; 53:e12-e18. [PMID: 28858945 DOI: 10.1097/mcg.0000000000000909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND GOALS We examined the interaction between race, insurance, and important outcomes in nonvariceal upper gastrointestinal hemorrhage (NVUGIH). STUDY Adults with NVUGIH were selected from the National Inpatient Sample. PRIMARY OUTCOME in-hospital mortality. SECONDARY OUTCOMES treatment modalities [esophagogastroduodenoscopy (EGD), early EGD, and endoscopic or radiologic therapy], and resource utilization (length of hospital stay and total hospitalization charges). RESULTS Mortality was similar for Medicare and private insurance [adjusted odds ratios (aOR): 1.15 95% confidence interval (CI) 0.90 to 1.47), P=0.24], but higher for under/uninsured patients [aOR: 1.84 (CI: 1.42 to 2.40), P<0.01]. Compared with Medicare, patients with private insurance had more EGDs [aOR: 1.35 (CI: 1.23 to 1.48), P<0.01], early EGDs [aOR: 1.29 (CI: 1.21 to 1.38), P<0.01], and endoscopic [aOR: 1.19 (CI: 1.11 to 1.27), P<0.01], or radiologic therapy [aOR:1.35 (CI: 1.06 to 1.71), P=0.01]. Patients who were under/uninsured had less EGDs [aOR: 0.84 (CI: 0.76 to 0.91), P<0.01] or endoscopic therapy [aOR: 0.74 (CI: 0.68 to 0.81), P<0.01], but similar odds of early EGD [aOR: 0.95 (CI: 0.88 to 1.02), P=0.13] or radiologic therapy [aOR: 1.01 (CI: 0.75 to 1.37), P=0.75]. Compared with whites, blacks had lower [aOR: 0.73 (CI: 0.58 to 0.93), P=0.01] and Native Americans higher mortality [aOR: 2.60 (CI: 1.57 to 4.13), P<0.01]. Blacks were less likely [aOR: 0.86 (CI: 0.79 to 0.94), P<0.01] and Asians more likely [aOR: 1.24 (CI: 1.05 to 1.47), P=0.01] to have EGDs. Both blacks and Hispanics had lower, whereas Asians had higher early EGD rates. Patients with private insurance had lower total charges [adjusted mean difference: -$2761 (CI: -$4617 to -$906), P<0.01]. CONCLUSIONS Insurance and race have independent effects on NVUGIH mortality, therapeutic modalities used, and resource utilization. Black and under/uninsured patients have the worst outcomes.
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Affiliation(s)
| | - Patrick Avila
- Department of Gastroenterology, University of California at San Francisco, San Francisco, CA
| | - John R Saltzman
- Division of Gastroenterology, Brigham and Women's Hospital.,Harvard Medical School, Boston, MA
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Abstract
26 Background: Metastatic lung cancer patients are treated with palliative intent. Aggressive inpatient care at the end-of-life is seen as a marker of poor quality care. However, national trends and factors related to aggressive inpatient care at the end-of-life for these patients have not previously been evaluated. Methods: A total of 3,030,866 hospitalizations of metastatic lung cancer patients were identified in the National Inpatient Sample database between 1998 and 2014. Longitudinal analysis was conducted to determine trends in aggressive inpatient care at the end-of-life and multivariate logistic regression was performed to determine associations with age, race, region, and hospital characteristics. Results: From 1998 to 2014, in-hospital mortality for metastatic lung cancer patients decreased from 17% to 11%. However, the proportion admitted to the intensive care unit during the terminal hospitalization increased from 12.9% to 26.4%. Reflecting this aggressive end-of-life care, mean total charges for a terminal hospitalization increased from $29,386 to $72,469, adjusted for inflation. Among patients who died in the inpatient setting, the intensive care unit stay translated into higher total costs (+$18,461 CI: $17,460 to $19,463). Promisingly, palliative care encounters for terminal hospitalizations increased during this period from 8.7% to 53.0% and were correlated with a decrease in aggressive care at the end-of-life. A multivariable model showed variation by patient and hospital characteristics in aggressive inpatient care utilization. Conclusions: Among patients with metastatic lung cancer there has been a substantial increase in intensive care unit use during terminal hospitalizations, resulting in high cost for the health care system.
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Affiliation(s)
- Chebli Mrad
- Department of Medicine, Mount Sinai St. Luke's and Mount Sinai West Hospitals, Icahn School of Medicine, New York, NY
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Daly RM, Abougergi MS. National trends in admissions for potentially preventable conditions among patients with metastatic solid tumors, 2004-2014. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1 Background: The Centers for Medicare and Medicaid Services (CMS) has identified 10 conditions for hospitalization among patients receiving chemotherapy that are potentially preventable through appropriately managed outpatient care. CMS plans to measure hospitals’ performance based on frequency of admission for: anemia, dehydration, diarrhea, emesis, nausea, neutropenia, fever, pain, pneumonia, and sepsis. Our objective was to measure hospital utilization patterns for these conditions. Methods: Nationally representative data from the 2004 and 2014 National Inpatient Sample were analyzed. Adults with stage IV solid tumors admitted with a principal diagnosis of one of the ten conditions were identified using ICD-9 codes provided by CMS. The primary outcome was number of admissions. Secondary outcomes were total hospitalization costs, length of stay (LOS), and in-hospital mortality rate. Proportions and count data were compared using chi-square and binomial test, respectively. Results: Between 2004 and 2014, potentially preventable hospitalizations increased from 64,053 to 85,740 (p < 0.01). The most frequent reason for admission was pneumonia (32%) in 2004 and sepsis (41%) in 2014. Table 1 provides the results for the year 2014 by condition. Hospitalizations for sepsis had the longest mean LOS (p < 0.01), highest mean total costs (p < 0.01) and most frequently resulted in death (p < 0.01). Conclusions: The Department of Health and Human Services states, “Improving patients’ quality of life by keeping patients out of the hospital is a main goal of cancer care.” Despite supportive care advances, the increased frequency of hospitalization demonstrates a need for continued symptom management innovation. Infectious symptoms should be a focus of these technologies given their high prevalence, mortality and resource utilization. [Table: see text]
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Ochoa Chaar CI, Gholitabar N, Goodney P, Dardik A, Abougergi MS. NESVS18. One-Year Readmission After Open and Endovascular Revascularization for Critical Limb Ischemia. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.06.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mrad C, Abougergi MS, Daly B. One Step Forward, Two Steps Back: Trends in Aggressive Inpatient Care at the End of Life for Patients With Stage IV Lung Cancer. J Oncol Pract 2018; 14:e746-e757. [PMID: 30265173 DOI: 10.1200/jop.18.00515] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Patients with metastatic lung cancer are treated with palliative intent. Aggressive care at the end of life is a marker of poor-quality care. National trends and factors related to aggressive inpatient care at the end of life for these patients have not been evaluated. METHODS Patients with stage IV lung cancer and a terminal hospitalization were identified in the National Inpatient Sample database between 1998 and 2014. Longitudinal analysis was conducted to determine trends in aggressive inpatient care at the end of life and multivariate logistic regression was performed to determine associations with patient and hospital characteristics. RESULTS A total of 412,946 patients met the inclusion criteria. From 1998 to 2014, the proportion of patients admitted to the intensive care unit (ICU) during the terminal hospitalization increased from 13.3% to 27.9% (P < .001). The ICU stay translated into a higher mean total cost of care (+$18,461; 95% CI, $17,460 to $19,463). Promisingly, palliative care encounters for terminal hospitalizations also increased during this period from 8.7% to 53.0% (P < .01) and were correlated with a decrease in aggressive care at the end of life. However, this did not offset the trend in increased ICU use; mean total costs for a terminal hospitalization increased from $14,000 to $19,500, adjusted for inflation. A multivariable model demonstrates variation by patient and hospital characteristics in aggressive care use. CONCLUSIONS Among patients with metastatic lung cancer there has been a substantial increase in ICU use during terminal hospitalizations, resulting in high cost for the health care system.
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Affiliation(s)
- Chebli Mrad
- Roswell Park Comprehensive Cancer Center, Buffalo; Memorial Sloan Kettering Cancer Center, New York, NY; University of South Carolina, Greenville, SC
| | - Marwan S Abougergi
- Roswell Park Comprehensive Cancer Center, Buffalo; Memorial Sloan Kettering Cancer Center, New York, NY; University of South Carolina, Greenville, SC
| | - Bobby Daly
- Roswell Park Comprehensive Cancer Center, Buffalo; Memorial Sloan Kettering Cancer Center, New York, NY; University of South Carolina, Greenville, SC
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Peluso H, Abougergi MS, Caffrey J. Impact of primary payer status on outcomes among patients with burn injury: A nationwide analysis. Burns 2018; 44:1973-1981. [PMID: 30005990 DOI: 10.1016/j.burns.2018.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/24/2018] [Accepted: 06/15/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the relationship between insurance provider and important outcomes among patients with burn injury. METHODS Adults with burn injury were selected from the National Inpatient Sample. The primary outcome was inpatient mortality. Secondary outcomes were morbidity (septic shock and prolonged mechanical ventilation (PMV)), treatment metrics (time to surgery and parenteral or enteral nutrition (P/E-nutrition)) and resource utilization (length of stay (LOS) and total hospitalization costs and charges). Confounders were adjusted for using multivariate regression analysis. RESULTS Insurance did not affect in-hospital mortality rate. Compared with private insurance, Medicaid was associated with higher septic shock rate (aOR: 2.14 (1.04-4.39), longer LOS (adjusted mean difference (aMD): 2.79 (0.50-5.08) days) and higher costs (aMD: $16,161 ($4789-$27,534) while uninsured patients has shorter LOS (aMD: -2.57 (-4.59--0.55) days), lower charges (aMD: $-37,792 $(-65,550-$-10,034) and costs (aMD: $-8563 ($15,581-$-1544)). Insurance did not affect PMV rates or time to surgery or P/E-nutrition. CONCLUSIONS Primary payer does not affect in-hospital mortality or treatment metrics among patients admitted for burn injury. However, compared with private insurance, Medicaid was associated with both higher morbidity and resource utilization, whereas uninsured patients had lower resource utilization.
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Affiliation(s)
- Heather Peluso
- Department of surgery, University of South Carolina, Greenville Health System, 701 Grove Road, Greenville, SC, 29605, USA.
| | - Marwan S Abougergi
- Catalyst Medical Consulting, 722 Elmbrook Drive, Simpsonville, SC, 29681, USA; Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, 5 Medical Park Road, Columbia, SC, 29203, USA
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University Medical Center, Johns Hopkins Adult Burn Unit, Johns Hopkins Bayview Medical Center, 4900 Eastern Avenue, Baltimore, MD, 21224, USA
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Abougergi MS, Peluso H, Saltzman JR. Thirty-Day Readmission Among Patients With Non-Variceal Upper Gastrointestinal Hemorrhage and Effects on Outcomes. Gastroenterology 2018; 155:38-46.e1. [PMID: 29601829 DOI: 10.1053/j.gastro.2018.03.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We aimed to determine the rate of hospital readmission within 30 days of non-variceal upper gastrointestinal hemorrhage and its impact on mortality, morbidity, and health care use in the United States. METHODS We performed a retrospective study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2014 (data on 14.9 million hospital stays at 2048 hospitals in 22 states). We collected data on hospital readmissions of 203,220 adults who were hospitalized for urgent non-variceal upper gastrointestinal hemorrhage and discharged. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity (shock and prolonged mechanical ventilation) and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using Cox regression analysis. RESULTS The 30-day rate of readmission was 13%. Only 18% of readmissions were due to recurrent non-variceal upper gastrointestinal bleeding. The rate of death among patients readmitted to the hospital (4.7%) was higher than that for index admissions (1.9%) (P < .01). A higher proportion of readmitted patients had morbidities requiring prolonged mechanical ventilation (1.5%) compared with index admissions (0.8%) (P < .01). A total of 133,368 hospital days was associated with readmission, and the total health care in-hospital economic burden was $30.3 million (in costs) and $108 million (in charges). Independent predictors of readmission were Medicaid insurance, higher Charlson comorbidity score, lower income, residence in a metropolitan area, hemorrhagic shock, and longer stays in the hospital. Older age, private or no insurance, upper endoscopy, and prolonged mechanical ventilation were associated with lower odds for readmission. CONCLUSIONS In a retrospective study of patients hospitalized for non-variceal upper gastrointestinal hemorrhage, 13% are readmitted to the hospital within 30 days of discharge. Readmission is associated with higher mortality, morbidity, and resource use. Most readmissions are not for recurrent gastrointestinal bleeding.
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Affiliation(s)
- Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina; Catalyst Medical Consulting, Simpsonville, South Carolina
| | - Heather Peluso
- Department of General Surgery, University of South Carolina Greenville Memorial Hospital, Greenville, South Carolina
| | - John R Saltzman
- Director of Endoscopy, Division of Gastroenterology, Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Daly RM, Abougergi MS. National trends in admissions for potentially preventable conditions among patients with metastatic solid tumors, 2004-2014. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Affiliation(s)
- Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, SC, USA. .,Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA.
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Brahmandam A, Abougergi MS, Ochoa Chaar CI. National trends in hospitalizations for venous thromboembolism. J Vasc Surg Venous Lymphat Disord 2017; 5:621-629.e2. [DOI: 10.1016/j.jvsv.2017.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/10/2017] [Indexed: 01/29/2023]
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Schulman AR, Abougergi MS, Thompson CC. Assessment of the July effect in post-endoscopic retrograde cholangiopancreatography pancreatitis: Nationwide Inpatient Sample. World J Gastrointest Endosc 2017; 9:296-303. [PMID: 28744341 PMCID: PMC5507820 DOI: 10.4253/wjge.v9.i7.296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/22/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess incidence of post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis in the early (July/August/September) vs the late (April/May/June) academic year and evaluate in-hospital mortality, length of stay (LOS), and total hospitalization charge between these time periods.
METHODS This was a retrospective cohort study using the 2012 Nationwide Inpatient Sample (NIS). Patients with International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) procedure codes for ERCP were included. Patients were excluded from the study if they had an ICD-9 CM code for a principal diagnosis of acute pancreatitis, if the ERCP was performed before or on the day of admission or if they were admitted to non-teaching hospitals. Post-ERCP pancreatitis was defined as an ICD-9 CM code for a secondary diagnosis of acute pancreatitis in patients who received an ERCP as delineated above. ERCPs performed during the months of July, August and September was compared to those performed in April, May and June in academic hospitals. ERCPs performed at academic hospitals during the early vs late year were compared. Primary outcome was incidence of post-ERCP pancreatitis. Secondary outcomes included in-hospital mortality, length LOS, and total hospitalization charge. Proportions were compared using fisher’s exact test and continuous variables using student t-test. Multivariable regression was performed.
RESULTS From the 36480032 hospitalizations in 2012 in the United States, 6248 were included in the study (3065 in July/August/September and 3183 in April/May/June) in the 2012 academic year. Compared with patients admitted in July/August/September, patients admitted in April/May/June had no statistical difference in all variables including mean age, percent female, Charleston comorbidity index, race, median income, and hospital characteristics including region, bed size, and location. Incidence of post-ERCP pancreatitis in early vs late academic year were not statistically significant (OR = 1.03, 95%CI: 0.71-1.51, P = 0.415). Similarly, the adjusted odds ratio of mortality, LOS, and total hospitalization charge in early compared to late academic year were not statistically significant.
CONCLUSION Incidence of post-ERCP pancreatitis does not differ at academic institutions depending on the time of year. Similarly, mortality, LOS, and total hospital charge do not demonstrate the existence of a temporal effect, suggesting that trainee level of experience does not impact clinical outcomes in patients undergoing ERCP.
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Mrad C, Abougergi MS, Daly RM. Trends in aggressive care at the end-of-life for stage IV lung cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6614 Background: Prior studies have demonstrated that high-intensity end-of-life care improves neither survival nor quality of life for cancer patients. The National Quality Forum endorses dying from cancer in an acute care setting, ICU admission in the last 30 days of life, and chemotherapy in the last 14 days of life as markers of poor quality care. Methods: Discharge data from the National Inpatient Sample database was analyzed for 3,030,866 acute care hospitalizations of metastatic lung cancer patients between 1998 and 2014. Longitudinal analysis was conducted to determine trends in aggressive care at the end-of-life and multivariate logistic regression was performed to determine associations with age, race, region, hospital characteristics, and aggressive care. Results: In-hospital mortality for metastatic lung cancer patients decreased from 17% to 11%. Among terminal hospitalizations, utilization of radiation therapy and chemotherapy decreased from 4.6% to 3.0% and from 4.8% to 3.0%, respectively. However, the proportion admitted to the ICU increased from 13.3% to 27.9% and invasive procedures increased from 1.2% to 2.0%. Reflecting this aggressive end-of-life care, mean total charges for a terminal hospitalization rose from $29,386 to $72,469, adjusted for inflation. Among patients who died in the inpatient setting, the ICU stay translated into higher total costs (+$16,962, CI: $15,859 to $18,064) compared to patients who avoided the ICU. Promisingly, palliative care encounters for terminal hospitalizations increased during this period from 8.7% to 53.0% and was correlated with a decrease in inpatient chemotherapy (OR = 0.56, CI: 0.47 to 0.68), radiotherapy (OR = 0.77, CI: 0.65 to 0.92), and ICU admissions (OR = 0.48, CI: 0.45 to 0.53) but had only a modest impact on terminal hospitalization cost (-$2,992, CI: -$3,710 to -$2,275). Multivariable analysis showed variation by patient and hospital characteristics in aggressive care utilization. Conclusions: Among patients with metastatic lung cancer there has been a substantial increase in ICU use during terminal hospitalizations, resulting in high cost for the health care system. Inpatient palliative care has the potential to reduce aggressive end-of-life interventions.
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Affiliation(s)
- Chebli Mrad
- Department of Medicine, Mount Sinai St. Luke's and Mount Sinai West Hospitals, Icahn School of Medicine, New York, NY
| | | | - Robert Michael Daly
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Schulman AR, Abougergi MS, Thompson CC. H. Pylori as a predictor of marginal ulceration: A nationwide analysis. Obesity (Silver Spring) 2017; 25:522-526. [PMID: 28229552 DOI: 10.1002/oby.21759] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/16/2016] [Accepted: 12/08/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Helicobacter pylori has been implicated as a risk factor for development of marginal ulceration following gastric bypass, although studies have been small and yielded conflicting results. This study sought to determine the relationship between H. pylori infection and development of marginal ulceration following bariatric surgery in a nationwide analysis. METHODS This was a retrospective cohort study using the 2012 Nationwide Inpatient Sample (NIS) database. Discharges with ICD-9-CM code indicating marginal ulceration and a secondary ICD-9-CM code for bariatric surgery were included. Primary outcome was incidence of marginal ulceration. A stepwise forward selection model was used to build the multivariate logistic regression model based on known risk factors. A P value of 0.05 was considered significant. RESULTS There were 253,765 patients who met inclusion criteria. Prevalence of marginal ulceration was 3.90%. Of those patients found to have marginal ulceration, 31.20% of patients were H. pylori-positive. Final multivariate regression analysis revealed that H. pylori was the strongest independent predictor of marginal ulceration. CONCLUSIONS H. pylori is an independent predictor of marginal ulceration using a large national database. Preoperative testing for and eradication of H. pylori prior to bariatric surgery may be an important preventive measure to reduce the incidence of ulcer development.
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Affiliation(s)
- Allison R Schulman
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Brahmandam A, Abougergi MS, Ochoa Chaar CI. National Trends in Hospitalizations for Venous Thromboembolism. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abougergi MS, Rai R, Cohen CK, Montgomery R, Solga SF. Trends in Adult-to-Adult Living Donor Liver Transplant Organ Donation: The Johns Hopkins Experience. Prog Transplant 2016; 16:28-32. [PMID: 16676671 DOI: 10.1177/152692480601600107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adult-to-adult living donor liver transplantation is an increasingly important option for 17000 patients awaiting liver transplantation in the United States. However, adult-to-adult living donor liver transplantation volumes peaked in 2001 (N=518), and have gradually fallen in 2002 (N=362), 2003 (N=321), and 2004 (N=323). Recent concerns about donor safety and ethical considerations have made careful analysis of donor availability and selection criteria critically important. We conducted a retrospective review of our active liver transplant recipient registry (N=251) and compared it to our living donor registry (N=231), which included all potential living donors before the selection process. Fifteen percent of recipients accounted for the majority (53%) of donor evaluations, whereas 42% of recipients did not have even a single donor evaluation. Recipient diagnosis appears to have a significant impact on donor availability, with donors rarely evaluated for patients with alcoholic cirrhosis. Careful and stringent selection criteria rule out 67% of potential donors.
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Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endosc 2015; 81:882-8.e1. [PMID: 25484324 DOI: 10.1016/j.gie.2014.09.027] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite major advances in upper GI hemorrhage (UGIH) treatment, UGIH mortality has been reported as unchanged for the past 50 years. OBJECTIVE To measure the UGIH in-hospital mortality rate and other important outcome trends from 1989 to 2009. DESIGN A longitudinal study of UGIH hospitalizations by using the Nationwide Inpatient Sample. SETTING Acute-care hospitals. PATIENTS All patients admitted for UGIH. Patients who bled after admission were excluded. MAIN OUTCOME MEASUREMENTS UGIH in-hospital mortality rate, incidence, in-hospital endoscopy and endoscopic therapy rates, length of hospital stay, and total in-hospital charges. RESULTS The non-variceal UGIH mortality rate decreased from 4.5% in 1989 to 2.1% in 2009. The non-variceal UGIH incidence declined from 108 to 78 cases/100,000 persons in 1994 and 2009, respectively. In-hospital upper endoscopy and endoscopic therapy rates increased from 70% and 10% in 1989 to 85% and 27% in 2009, respectively. The early endoscopy rate increased from 36% in 1989 to 54% in 2009. The median length of hospital stay decreased from 4.5 days in 1989 to 2.8 days in 2009. Median total hospitalization charges increased from $9249 in 1989 to $20,370 in 2009. At the national level, the UGIH direct in-hospital economic burden increased from $3.3 billion in 1989 to $7.6 billion in 2009. Similar trends were found for variceal UGIH. LIMITATIONS Retrospective data, administrative database. CONCLUSION In-hospital mortality from UGIH has been decreasing over the past 2 decades, with a concomitant increase in rate of endoscopy and endoscopic therapy. However, despite decreasing length of stay, the total economic burden of UGIH is increasing.
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Affiliation(s)
- Marwan S Abougergi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne C Travis
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John R Saltzman
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Abougergi MS, Travis AC, Saltzman JR. Impact of day of admission on mortality and other outcomes in upper GI hemorrhage: a nationwide analysis. Gastrointest Endosc 2014; 80:228-35. [PMID: 24674354 DOI: 10.1016/j.gie.2014.01.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 01/23/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Studies have reached varying conclusions regarding the association between day of admission and outcomes in patients with upper GI hemorrhage (UGIH). OBJECTIVES To evaluate whether important outcomes in UGIH, including in-hospital mortality, differ between patients admitted on weekends versus weekdays. DESIGN AND SETTING Retrospective cohort study by using the 2009 Nationwide Inpatient Sample. PATIENTS Patients were included if they were adults with a principal diagnosis of acute UGIH. Patients admitted between midnight Friday and midnight Sunday were classified as weekend admissions. MAIN OUTCOME MEASUREMENTS In-hospital mortality, in-hospital endoscopy, endoscopic therapy, length of stay, and total hospitalization charges. RESULTS The study included 199,008 patients with nonvariceal UGIH and 3251 patients with variceal UGIH. Compared with patients admitted on weekdays, patients with nonvariceal UGIH admitted on weekends had similar adjusted in-hospital mortality rates (odds ratio [OR] 1.11; 95% confidence interval [CI], 0.93-1.30), endoscopic therapy rates (OR 0.98; 95% CI, 0.92-1.04), and length of stay (P = .09), but had lower early endoscopy rates (within 24 hours)(OR 0.64; 95% CI, 0.60-0.67), lower in-hospital endoscopy rates (OR 0.84; 95% CI, 0.78-0.91), and higher hospitalization charges (mean increase, $1558; P = .01). Patients with variceal UGIH admitted on weekends and weekdays did not differ in any of these outcomes. LIMITATIONS Retrospective data, administrative database. CONCLUSIONS Compared with patients admitted on weekdays, patients with nonvariceal UGIH admitted on weekends had similar mortality rates and lengths of stay, but lower endoscopy rates and higher hospitalization charges. Patients with variceal GI hemorrhage had similar outcomes regardless of day of admission.
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Affiliation(s)
- Marwan S Abougergi
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne C Travis
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John R Saltzman
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Abougergi MS, Saltzman JR. Response. Gastrointest Endosc 2013; 78:557-8. [PMID: 23948206 DOI: 10.1016/j.gie.2013.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 05/14/2013] [Indexed: 12/11/2022]
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Hyett BH, Abougergi MS, Charpentier JP, Kumar NL, Brozovic S, Claggett BL, Travis AC, Saltzman JR. The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding. Gastrointest Endosc 2013; 77:551-7. [PMID: 23357496 DOI: 10.1016/j.gie.2012.11.022] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 11/19/2012] [Indexed: 02/06/2023]
Abstract
INTRODUCTION We previously derived and validated the AIMS65 score, a mortality prognostic scale for upper GI bleeding (UGIB). OBJECTIVE To validate the AIMS65 score in a different patient population and compare it with the Glasgow-Blatchford risk score (GBRS). DESIGN Retrospective cohort study. PATIENTS Adults with a primary diagnosis of UGIB. PRIMARY OUTCOME inpatient mortality. SECONDARY OUTCOMES composite clinical endpoint of inpatient mortality, rebleeding, and endoscopic, radiologic or surgical intervention; blood transfusion; intensive care unit admission; rebleeding; length of stay; timing of endoscopy. The area under the receiver-operating characteristic curve (AUROC) was calculated for each score. RESULTS Of the 278 study patients, 6.5% died and 35% experienced the composite clinical endpoint. The AIMS65 score was superior in predicting inpatient mortality (AUROC, 0.93 vs 0.68; P < .001), whereas the GBRS was superior in predicting blood transfusions (AUROC, 0.85 vs 0.65; P < .01) The 2 scores were similar in predicting the composite clinical endpoint (AUROC, 0.62 vs 0.68; P = .13) as well as the secondary outcomes. A GBRS of 10 and 12 or more maximized the sum of the sensitivity and specificity for inpatient mortality and rebleeding, respectively. The cutoff was 2 or more for the AIMS65 score for both outcomes. LIMITATIONS Retrospective, single-center study. CONCLUSION The AIMS65 score is superior to the GBRS in predicting inpatient mortality from UGIB, whereas the GBRS is superior for predicting blood transfusion. Both scores are similar in predicting the composite clinical endpoint and other outcomes in clinical care and resource use.
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Affiliation(s)
- Brian H Hyett
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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