Risk factors for potentially avoidable readmissions following gynecologic oncology surgery.

OBJECTIVE: Determine the incidence and identify factors associated with potentially avoidable hospital readmissions due to uncontrolled symptoms or minor complications after surgery for gynecologic cancers. METHODS: Women who underwent major abdominal or pelvic surgery for a gynecologic malignancy between 2015 and 2017 were identified from the National Surgical Quality Improvement Program targeted hysterectomy dataset. Hospital readmissions within 30 days of surgery were categorized as indicated readmissions or potentially avoidable readmissions by three independent reviewers. Demographic, clinical, and operative covariates were evaluated to determine their association with type of readmission using bivariable tests and adjusted multinomial logistic regression models. RESULTS: A total of 20,986 women were identified. 19,814 (94.4%) were not readmitted, 894 (4.3%) were indicated readmissions, and 278 (1.3%) were potentially avoidable readmissions. Among those readmitted, 24% were potentially avoidable readmissions. Presence of ascites, increasing length of stay, and discharge to facility were associated with an increased risk of indicated and potentially avoidable readmissions. Age < 60 years old (RR 1.4, 95%CI 1.1-1.8), BMI ≥ 30 (RR 1.7, 95%CI 1.3-2.3), history of abdominal/pelvic surgery (RR 1.6, 95%CI 1.2-2.1), cervical cancer (RR 2.1, 95%CI 1.4-3.1), and open surgery (RR 2.1, 95%CI 1.4-3.2) were associated with an increased risk of a potentially avoidable readmission but not with increased risk of an indicated readmission. Median time to readmission did not differ between the two readmission groups (indicated = 8 days; avoidable = 7 days; p = .72). CONCLUSIONS: Among women with gynecologic cancer, 24% of all unplanned readmissions were attributed to uncontrolled symptoms or minor complications that were potentially avoidable. Age <60 years old, history of previous abdominal/pelvic surgery, obesity, cervical cancer, and open surgery were associated with an increase in risk of a potentially avoidable readmission.

High proportion of extrapulmonary tuberculosis in a low prevalence setting: a retrospective cohort study.

OBJECTIVES: The proportion of extrapulmonary tuberculosis (EPTB) cases in the United States (US) has been rising due to a slower rate of decline in EPTB compared to pulmonary tuberculosis (PTB). The purpose of this study was to characterise the clinical and treatment differences between EPTB and PTB patients, and identify patient factors associated with EPTB. STUDY DESIGN: We performed a retrospective cohort study of active tuberculosis (TB) cases treated at the Baltimore City Health Department between 2008 and 2013. METHODS: We categorised patients as having 'only PTB' (infection in the lung parenchyma), 'EPTB/PTB' (infection in the lung and an additional site), and 'only EPTB' (infection not involving the lung). Pearson's chi-squared tests were used to evaluate categorical variables and compare clinical and demographic differences between only PTB, only EPTB, and EPTB/PTB patients. Student t-tests and one-way analysis of variance tests were utilised to assess continuous variables and to compare treatment differences. RESULTS: One hundred and sixty-three patients were treated for TB; 39.3% had some form of EPTB (either EPTB/PTB or only EPTB). There was no difference found between EPTB, PTB, and EPTB/PTB patients with respect to HIV status, gender, race, foreign-born status, or mean age. Patients with only EPTB were less likely than patients with some form of PTB (only PTB or EPTB/PTB) to present with cough (30.4% vs 61.5%; P < 0.001), night sweats (10.9% vs 39.3%; P < 0.001), and weight loss (28.3% vs 47.9%; P = 0.023). Patients with some form of EPTB were also more likely to be hospitalised postdiagnosis compared to patients with only PTB (39.1% vs 20.2%; P = 0.009), and to have longer mean durations of treatment (37.9 weeks [SD = 11.1] vs 31.8 weeks [SD = 8.1]; P < 0.001). CONCLUSIONS: EPTB patients present with atypical symptoms, undergo prolonged treatment, and experience increased hospitalisations. In order to improve diagnostic algorithms and treatment modalities, EPTB must be further characterised.

Susceptibility-weighted imaging in pediatric arterial ischemic stroke: a valuable alternative for the noninvasive evaluation of altered cerebral hemodynamics.

BACKGROUND AND PURPOSE: SWI provides information about blood oxygenation levels in intracranial vessels. Prior reports have shown that SWI focusing on venous drainage can provide noninvasive information about the degree of brain perfusion in pediatric arterial ischemic stroke. We aimed to evaluate the influence of the SWI venous signal pattern in predicting stroke evolution and the development of malignant edema in a large cohort of children with arterial ischemic stroke. MATERIALS AND METHODS: A semiquantitative analysis of venous signal intensity on SWI and diffusion characteristics on DTI was performed in 16 vascular territories. The mismatch between areas with SWI-hypointense venous signal and restricted diffusion was correlated with stroke progression on follow-up. SWI-hyperintense signal was correlated with the development of malignant edema. RESULTS: We included 24 children with a confirmed diagnosis of pediatric arterial ischemic stroke. Follow-up images were available for 14/24 children. MCA stroke progression on follow-up was observed in 5/6 children, with 2/8 children without mismatch between areas of initial SWI hypointense venous signal and areas of restricted diffusion on DTI. This mismatch showed a statistically significant association (P = .03) for infarct progression. Postischemic malignant edema developed in 2/10 children with and 0/14 children without SWI-hyperintense venous signal on initial SWI (P = .07). CONCLUSIONS: SWI-DTI mismatch predicts stroke progression in pediatric arterial ischemic stroke. SWI-hyperintense signal is not useful for predicting the development of malignant edema. SWI should be routinely added to the neuroimaging diagnostic protocol of pediatric arterial ischemic stroke.