Factors Associated With Health Care Utilization of Recurrent Clostridium difficile Infection in New York State.

BACKGROUND: The incidence of infection due to Clostridium difficile infection (CDI) and subsequent economic burden are substantial. GOALS: The impact of changing practice patterns on demographics at risk and utilization of health care resources for recurrence of CDI remains unclear. STUDY: A total of 291,163 patients hospitalized for CDI were identified from 1995 to 2014 from the New York SPARCS database. The χ test, the Welch t test, and multivariable logistic regression analysis were performed to evaluate factors related to readmission. RESULTS: Hospital admissions and readmissions for CDI peaked in 2008 at 20,487 and 13,795, respectively, and have since decreased (linear trend, 0.9706 and 0.9464, respectively; P<0.0001). In total, 60,077 (21%) patients required ≥2 admissions. Risk factors for readmission included: age 55 to 74, government insurance, hypertension, diabetes, anemia, hypothyroidism, chronic pulmonary disease, rheumatoid arthritis, renal failure, peripheral vascular disease, and depression (all P<0.05). Trends in surgery showed a similar peak in 2008 at 165 and have since decreased (linear trend, 0.8660; P<0.0001). A total of 1830 (0.63%) patients with CDI underwent surgery, with emergent being more common than elective (71% vs. 29%). CONCLUSIONS: Hospital admissions and readmissions for CDI peaked in 2008 and have since been steadily declining. These trends may be secondary to improved diagnostic capabilities and evolving antibiotic regimens. More than 1 in 5 hospitalized patients had at least 1 readmission. Numerous risk factors for these patients have been identified. Although <1% of all patients with CDI undergo surgery, these rates have also been declining.

Recurrent Gastrointestinal Near-Tetraploid Diffuse Large B-Cell Lymphoma Causing Intussusception and Ileal Ulceration.

Polyploid karyotypes in diffuse large B-cell lymphoma (DLBCL) are rare and carry a poor prognosis. Extranodal polyploid lymphoma is uncommon. A 71-year-old man with back pain was found to have ileal intussusception. He underwent surgical resection and was diagnosed with DLBCL with a near-tetraploid karyotype. Despite rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, he developed recurrent disease for which he started a clinical trial. He then developed dark stools from an ileal ulcer due to progressive disease and died 2 weeks later. This is the first reported case of gastrointestinal DLBCL with polyploidy. These karyotypes require attention to extranodal disease and prompt initiation of therapy.

Patient Acuity and Operative Technique Associated with Post-Colectomy Mortality Across New York State: an Analysis of 160,792 Patients over 20 years.

This study sought to characterize in-hospital post-colectomy mortality in New York State. One hundred sixty thousand seven hundred ninety-two patients who underwent colectomy from 1995 to 2014 were analyzed from the all-payer New York Statewide Planning and Research Cooperative System (SPARCS) database. Linear trends of in-hospital mortality rate over 20 years were calculated using log-linear regression models. Chi-square tests were used to compare categorical variables between patients. Multivariable regression models were further used to calculate risk of in-hospital mortality associated with specific demographics, co-morbidities, and perioperative complications. From 1995 to 2014, 7308 (4.5%) in-hospital mortalities occurred within 30 days of surgery. Over this time period, the rate of overall in-hospital post-colectomy mortality decreased by 3.3% (6.3 to 3%, p < 0.0001). The risk of in-hospital mortality for patients receiving emergent and elective surgery decreased by 1% (RR 0.99 [0.98-1.00], p = 0.0005) and 5% (RR 0.95 [0.94-0.96], p < 0.0001) each year, respectively. Patients who underwent open surgeries were more likely to experience in-hospital mortality (adjusted OR 3.65 [3.16-4.21], p < 0.0001), with an increased risk of in-hospital mortality each year (RR 1.01 [1.00-1.03], p = 0.0387). Numerous other risk factors were identified. In-hospital post-colectomy mortality decreased at a slower rate in emergent versus elective surgeries. The risk of in-hospital mortality has increased in open colectomies.

Factors Associated with Repeated Health Resource Utilization in Patients with Diverticulitis.

Conservative management trends in diverticulitis may lead to increased hospitalizations secondary to repeated attacks. The study aimed to characterize trends in management and risk-assess patients with diverticulitis that required multiple admissions to identify high utilizers. A total of 265,724 patients with diverticulitis were identified from 1995 to 2014 from the New York SPARCS database. Patients with ≥2 hospital admissions were stratified across demographics, comorbidities, insurance status, and surgical intervention. In total, 42,850 patients had ≥2 hospital admissions. Risk factors for ≥2 admissions included younger age, White race, obesity, hypertension, pulmonary disease, hypothyroidism, rheumatoid arthritis, and depression. Fifty-two percent of these patients went on to have surgery. The percentage of elective cases increased from 59 to 70 %, while emergent cases conversely decreased from 41 to 30 %. One in five patients admitted with diverticulitis required two or more admissions. Numerous patient factors were correlated with increased risk of readmission. These factors may be used to guide treatment decisions and help reduce economic burden in frequent utilizers. Trends in surgery rates for these patients could reflect improved treatment options and/or changing clinical practice patterns.

20-Year Trends in the Management of Diverticulitis Across New York State: an Analysis of 265,724 Patients.

INTRODUCTION: Management of acute diverticulitis (AD) has considerably changed over time. This study evaluates practice patterns for diverticulitis across demographic populations in New York State. METHODS: Two hundred sixty-five thousand seven hundred twenty-four patients with acute diverticulitis were analyzed from 1995 to 2014 from the New York-Statewide Planning and Research Cooperative System database. The likelihood of having surgery over time was compared across patient demographic subgroups using logistic regression models to calculate estimated odds ratio with their 95 % confidence intervals. Using Chi-square test and Welch's t test, categorical and continuous variables were compared. RESULTS: From 1995 to 2014, there was an increase in newly diagnosed diverticulitis patients while the proportion of those patients undergoing operative management steadily decreased (31 to 10 %, p < 0.0001). Of those receiving surgery, emergent surgeries decreased (58 to 47 %, p < 0.0001) while elective surgeries increased (42 to 53 %, p < 0.0001) with the odds of having emergency surgery decreasing by 4 % annually (OR 0.96 (0.95-0.97), p < 0.0001). With the exception of patients greater than 80 years old, these linear trends were substantiated across patient subgroups. CONCLUSIONS: Over the past 20 years in New York State, there has been an increase in diverticulitis diagnoses and hospital admissions, with a decrease in surgeries performed reflecting a shift towards conservative management and more effective antibiotic treatment.