National Hospital Care Survey Demonstration Projects: Examination of Inpatient Hospitalization and Risk of Mortality Among Patients Diagnosed With Pneumonia.

Objective-This report demonstrates the ability of data from the National Hospital Care Survey (NHCS) linked to the National Death Index (NDI) to provide information on inpatient hospitalizations and in-hospital and post-acute mortality among patients hospitalized for a specific condition, in this case pneumonia.

National Hospital Care Survey Demonstration Projects: Severe Maternal Morbidity in Inpatient and Emergency Departments.

Objective-This report demonstrates the ability of the National Hospital Care Survey (NHCS) to examine delivery hospitalizations involving severe maternal morbidity (SMM). These data are unweighted and not nationally representative, so the results are intended to illustrate the unique capability of NHCS to track patients across hospitalizations and emergency department (ED) visits rather than provide nationally representative estimates of these outcomes.

Respiratory Illness Emergency Department Visits in the National Hospital Care Survey and the National Hospital Ambulatory Medical Care Survey.

Purpose-This report compares emergency department (ED) visits for respiratory illness between the 2014 National Hospital Care Survey (NHCS) and the 2014 National Hospital Ambulatory Medical Care Survey (NHAMCS) to determine the potential of researching respiratory illness in EDs with non-nationally representative NHCS data. The 2014 NHCS data linked to records in the 2014-2015 National Death Index (NDI) are also described to provide results on mortality after ED visits for respiratory illness. Methods-For both surveys, encounters with respiratory illness were identified using diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Weighted NHAMCS percentage estimates and their 95% confidence intervals (CIs) are shown for all demographic characteristics. Unweighted NHCS percentages are presented for all demographic and health care characteristics and are compared with weighted NHAMCS percentage estimates and used to report NHCS-only results. Standard errors and CIs are also presented for the NHCS unweighted percentages as a measure of variability. Results-The percentage of NHCS ED visits for respiratory illness fell within NHAMCS measures of statistical variation for overall and specific respiratory illnesses. Additionally, respiratory illness by sex, older age groups, older men, and female patients of all ages fell within these measures. Compared with NHAMCS, NHCS had a higher percentage of ED visits for respiratory illness for both infants (under 1 year) and children (1-17 years) but a lower percentage for adults aged 18-44. NHCS data show that 15.2% of patients with ED visits for respiratory illness were hospitalized and of those hospitalized, 6.6% died within 90 days post-discharge. However, 11.1% of patients admitted to the intensive care unit died within 90 days. Conclusion-Although the 2014 NHCS data are not nationally representative, the data may be used for exploratory analyses and have analytical capabilities that are not available in other hospital surveys.

Pulmonary barotrauma in mechanically ventilated coronavirus disease 2019 patients: A case series.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may result in hypoxic respiratory failure necessitating mechanical ventilation. Barotrauma is a well-documented complication of mechanical ventilation. OBJECTIVE: To describe the presentation, characteristics, and management of mechanically ventilated patients with COVID-19 who developed barotrauma. METHODS: Retrospective case series study of 13 adult, mechanically ventilated, laboratory-confirmed COVID-19 positive patients admitted between 3/15/2020 and 4/14/2020 to a community hospital in New York City. Patient demographics, clinical course, ventilatory parameters, and radiographic results were obtained from electronic medical records. Barotrauma was defined as pneumomediastinum, subcutaneous emphysema, and or pneumothorax on chest X-ray. Descriptive analyses and Mann-Whitney U test were performed, where appropriate. RESULTS: Of the 574 COVID-19 positive patients, 139 (24.2%) needed mechanical ventilation and 13 (9.4%) of those developed barotrauma. Majority of patients were Black race (92.3%), older than age 65 (56.8%), male (69.2%), and had comorbidities (76.9%). Most common presenting symptoms were cough (84.6%) and dyspnea (76.9%). Barotrauma presentations included 3/13 pneumothoraces and pneumomediastinum, 12/13 pneumomediastinum and subcutaneous emphysema, and 1/13 pneumothorax alone. The average days on ventilator was 3.4, average positive expiratory-end pressure 15.5 cmH2O, dynamic compliance 33.8 mL/cmH2O, and P/F ratio 165. Interventions were 4/13 chest tubes and 2/13 pigtail catheters. CONCLUSIONS: Barotrauma is a common complication of mechanical ventilation of COVID-19 patients. Despite high ventilatory pressures, tension pneumothorax is rare and barotrauma could potentially be managed conservatively. Further studies are needed to evaluate the indication and outcome of thoracostomies and conservative management.

Role of regenerating islet-derived proteins in inflammatory bowel disease.

Inflammatory bowel disease (IBD) is an inflammatory disorder of the gastrointestinal tract that affects millions of patients worldwide. It has a complex and multifactorial etiology leading to excessive exposure of intestinal epithelium to microbial antigens, inappropriate activation of the immune system and ultimately to the damage of intestinal tissues. Although numerous efforts have been made to improve the disease management, IBD remains persistently recurring and beyond cure. This is due largely to the gaps in our understanding of the pathogenesis of IBD that hamper the development of timely diagnoses and effective treatment. However, some recent discoveries, including the beneficial effects of interleukin-22 (IL-22) on the inflamed intestine, have shed light on a self-protective mechanism in IBD. Regenerating islet-derived (REG/Reg) proteins are small secretory proteins which function as IL-22's downstream effectors. Mounting studies have demonstrated that IBD patients have significantly increased REG expressions in the injured intestine, but with undefined mechanisms and roles. The reported functions of REG/Reg proteins in intestinal homeostasis, such as those of antibacterial, anti-inflammatory and tissue repair, lead us to discuss their potential mechanisms and clinical relevance in IBD in order to advance IBD research and management.

Real-Time, Intraoperative Doppler/Ultrasound Monitoring of Islet Infusion During Total Pancreatectomy With Islet Autotransplant: A First Report.

Chronic pancreatitis (CP), secondary to a wide variety of etiologies, is a progressive and irreversible disease. Initially, CP is managed with endoscopic interventions, long-term analgesia for its associated chronic abdominal pain syndrome and pancreatic enzyme replacement for exocrine dysfunction. As the disease advances, pancreatic drainage procedures and partial resections are considered, but they leave diseased tissue behind and usually result in short-term relief only. Total pancreatectomy alone is widely viewed as a last resort treatment option because it causes brittle diabetes mellitus. However, total pancreatectomy with islet autotransplantation (TPIAT) can prevent the development of diabetes and cure the chronic pain syndrome. One serious, albeit rare, complication of TPIAT is (partial) portal vein thrombosis. Its incidence is probably about 5%. To prevent the occurrence of portal vein thrombosis, we propose herein, and have successfully performed, continuous real-time Doppler ultrasonography during the islet infusion to study portal vein and intrahepatic flow patterns, as well as changes in Doppler signals. Flow and signal changes may allow for timely adjustment of the infusion rate, before a marked increase in portal vein pressure is noted and decrease the risk of portal vein thrombosis.

Emergency Department Visits by Patients Aged 45 and Over With Diabetes: United States, 2015.

An estimated 30 million Americans have diabetes, of whom 26 million are aged 45 and over (1). Healthy eating and exercise can prevent diabetes progression (1,2). Around 12 million emergency department (ED) visits in 2015 were by patients aged 45 and over with diabetes, representing 24% of ED visits by patients aged 45 and over and 80% of diabetes ED visits by patients of all ages (3). This report presents data on ED visits by patients aged 45 and over with diabetes, defined as visits for which diabetes is mentioned as either a diagnosis or as one of a set of conditions that the patient is reported to have.

The utilization of fluorescent cholangiography during robotic cholecystectomy at an inner-city academic medical center.

In recent years, fluorescent cholangiography using Indocyanine green (ICG) dye has been used to aid identification of structures during robotic cholecystectomy. We sought to compare cholecystectomy with ICG dye versus laparoscopic cholecystectomy at an inner-city academic medical center. Between January 2013 and July 2016, we identified 287 patients of which 191 patients underwent laparoscopic cholecystectomy and 96 patients underwent robotic cholecystectomy with ICG dye. Preoperative risk variables of interest included age, sex, race, body mass index (BMI), and acute cholecystitis. Primary outcome of interest was conversion to open procedures while secondary outcome was length of stay. The two groups were similar in their BMI (31.98 vs. 31.10 kg/m2 for the laparoscopic and robotic, respectively, p = 0.32). The laparoscopic group had a greater mean age compared to the robotic group (47.77 vs. 43.61 years, p = 0.04). There was no significant difference in sex and emergency surgery between the two groups. Fewer open conversions were found in the robotic than the laparoscopic group [2 (2.1%) vs. 17 (8.9%), p = 0.03]. In multiple logistic regression, robotic cholecystectomy with ICG also showed a lower risk of conversion compared to laparoscopic cholecystectomy, but the difference did not reach statistical significance (OR 0.42, 95% CI 0.11-1.65, p = 0.22). ICG fluorescent cholangiography during robotic cholecystectomy may contribute to proper identification of biliary structures and may reduce the rates of open conversion. The preliminary results of fewer open conversions are promising. Further studies with a large randomized prospective controlled study should be taken for further evaluation.

Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010.

Objectives-This report presents national estimates of surgical and nonsurgical ambulatory procedures performed in hospitals and ambulatory surgery centers (ASCs) in the United States during 2010. Patient characteristics, including age, sex, expected payment source, duration of surgery, and discharge disposition are presented, as well as the number and types of procedures performed in these settings. Methods-Estimates in this report are based on ambulatory surgery data collected in the 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS has collected outpatient department and emergency department data since 1992 and began gathering ambulatory surgery data from both hospitals and ASCs in 2010. Sample data were weighted to produce annual national estimates. Results-In 2010, 48.3 million surgical and nonsurgical procedures were performed during 28.6 million ambulatory surgery visits to hospitals and ASCs combined. For both males and females, 39% of procedures were performed on those aged 45-64. For females, about 24% of procedures were performed on those aged 15-44 compared with 18% for males, whereas the percentage of procedures performed on those under 15 was lower for females than for males (4% compared with 9%). About 19% of procedures were performed on those aged 65-74, while about 14% were performed on those aged 75 and over. Private insurance was listed as the principal expected source of payment for 51% of ambulatory surgery visits, Medicare for 31% of visits, and Medicaid for 8% of visits. The most frequently performed procedures included endoscopy of large intestine (4.0 million), endoscopy of small intestine (2.2 million), extraction of lens (2.9 million), insertion of prosthetic lens (2.6 million), and injection of agent into spinal canal (2.9 million). Only 2% of visits with a discharge status were admitted to the hospital as an inpatient.

Single-Site Robotic Cholecystectomy at an Inner-City Academic Center.

INTRODUCTION: We investigate the safety and efficacy of single-site robotic cholecystectomy compared to laparoscopic cholecystectomy at an inner-city academic medical center. MATERIALS AND METHODS: Retrospective analysis comparing single-site robotic to laparoscopic cholecystectomies from August 1, 2013, to January 31, 2015, was conducted. Age, gender, race, body mass index (BMI), total operative time (docking and console time for robotic cases), length of stay, comorbidities, and conversion to open procedures were examined. The χ(2) and Student's t test were used for categorical and continuous data, respectively. A P ≤ 0.05 was considered statistically significant. RESULTS: From August 2013 to January 2015, 70 single-site robotic cholecystectomies and 70 laparoscopic cholecystectomies were performed. Patients were older (mean age, 40.3 years vs 47.6 years; P = .0084), had a higher mean BMI (29.5 vs 32.4 kg/m(2); P = .011), and had a higher assigned ASA (American Society of Anesthesiologists) classification (P = .024) in the laparoscopic than in the single-site group. Hypertension was more common in the laparoscopic group (P = .0078). Average docking time was 11.5 (SD 5.7) minutes, and the average console time was 52.8 (SD 22.5) minutes in the single-site group. Total operating time for the laparoscopic and single-site groups was not significantly different (111.5 minutes vs 106.0 minutes; P = .38). There were more conversions to open procedures in the laparoscopic compared to the single-site group (11 vs 1; P = .007). There were no biliary tree injuries and no deaths in either group. CONCLUSION: Single-site robotic cholecystectomy is safe to perform in an inner-city academic hospital setting. Surgical resident involvement does not adversely affect outcomes.

Study habits centered on completing review questions result in quantitatively higher American Board of Surgery In-Training Exam scores.

PURPOSE: The American Board of Surgery In-Training Exam (ABSITE) is administered to all general surgery residents annually. Given the recent changes in the format of the examination and in the material being tested, it has become increasingly difficult for residents to prepare for the ABSITE. This is especially true for incoming postgraduate year (PGY) 1 residents because of the respective variability of the surgical clerkship experience. There have been many studies in the past that support the use of weekly assigned readings and examinations to improve ABSITE scores. Other studies have investigated the study habits of residents to determine those that would correlate with higher ABSITE scores. However, there is a lack of information on whether completing review questions plays an integral role in preparing for the ABSITE. We hypothesize that those residents who completed more review questions performed better on the ABSITE. METHODS: ABSITE scores of current and past general surgery residents at SUNY Downstate Medical Center, a university hospital, were reviewed (2009-2013). These residents were then polled to determine how they prepared for their first in-training examination. RESULTS: Average ABSITE percentile was 46.4. Mean number of review questions completed by residents was 516.7. Regression analysis showed that completion of more review questions was associated with a significantly higher percentile score on the ABSITE (p < 0.0027). Further analysis showed that for every 100 review questions completed by a PGY 1 resident taking the ABSITE for the first time, the ABSITE percentile score should improve by 3.117 ± 0.969. Average reported study time in hours/week was 9.26. Increased study time was also significantly correlated with higher ABSITE percentile scores (p < 0.007). Again, further analysis showed that for every 1h/wk spent studying, ABSITE percentile score should increase by 1.76 ± 0.62. The Kruskal-Wallis H test showed that studying in group vs individual settings had no effect on ABSITE performance (p = 0.20). It was also used to analyze primary study resource, which demonstrated that there was no significant difference in residents' performance based on their primary study source (p = 0.516). CONCLUSION: Recent changes in the format of the ABSITE to a 2-tiered examination in 2006 and subsequent plan to return to a unified test for all PGY levels has made preparation difficult. With a more focused, question-based approach to studying, residents may see a demonstrable improvement in their scores. Our study supports this hypothesis-showing that residents who complete more review questions had higher ABSITE percentile scores. In the past, it has been demonstrated that strong ABSITE scores are associated with higher written board scores. With the widespread adoption of the Surgical Council on Resident Education curriculum, we postulate that residency programs that rely on this review question-based curriculum will report improved ABSITE percentile scores and written board pass rates.

National Hospital Discharge Survey: 2007 summary.

OBJECTIVES: This report presents national estimates of hospital inpatient care in the United States during 2007 and selected trend data. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and by sex. METHODS: The estimates are based on data collected through the 2007 National Hospital Discharge Survey, an annual national probability sample survey of discharges from nonfederal, general, and short-stay hospitals. Sample data are weighted to produce annual estimates of inpatient care, excluding newborns. Diagnoses and procedures are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification. RESULTS: In 2007, there were an estimated 34.4 million hospital discharges, excluding newborns. The total hospitalization rate leveled off from 1995 to 2007 after declining during the period from 1980 to 1995. Throughout the period from 1970 to 2007 the rates for those aged 65 years and over were significantly higher than the rates for the younger groups. Although those aged 65 years and over accounted for only 13 percent of the total population, they comprised 37 percent of hospital discharges and 43 percent of hospital days. One-quarter of inpatients under age 15 years were hospitalized for respiratory diseases. There were 45 million inpatient procedures during 2007 and 15 percent of these were cardiovascular. Males aged 45-64 and 65 years and over had higher cardiac catheterization rates than females in these age groups each year from 1997 to 2007. From 2002 to 2007 the rate of inpatient cardiac catheterization procedures declined.

Endometriosis in the rectus abdominis muscle: case report and literature review.

Endometriosis is characterized by the presence of histologically normal endometrial tissue outside the uterine cavity. Endometriosis occurs most commonly within the pelvis. Extrapelvic endometriosis is less common, but can involve nearly every organ in the body. We present a patient in whom endometriosis was discovered in the rectus abdominis muscle and discuss the imaging findings and histopathology.