Factors affecting in-hospital mortality in patients with miliary tuberculosis: A retrospective cohort study.

BACKGROUND: Miliary tuberculosis (TB) is a fatal disease; thus, prompt diagnosis and immediate intervention are indispensable. However, the risk factors for in-hospital mortality in patients with miliary TB remain unclear. Therefore, this study aimed to identify the factors associated with in-hospital mortality in patients with miliary TB using a Japanese nationwide inpatient database. METHODS: Patients diagnosed with miliary TB between July 2010 and March 2022 were enrolled from the Diagnosis Procedure Combination database. Multivariate logistic regression analyses were performed to identify the factors associated with in-hospital mortality in patients with miliary TB. RESULTS: In total, 2817 patients with miliary TB and 637 (22.6%) in-hospital deaths were identified. Older age; male sex (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.04-1.64); low body weight (OR, 1.41; 95% CI, 1.14-1.76); altered consciousness; a low Barthel index score; chronic respiratory failure (OR, 3.85; 95% CI, 1.61-9.19); hematologic malignancy (OR, 2.60; 95% CI, 1.26-5.35); conditions requiring oxygenation (OR, 1.70; 95% CI, 1.37-2.10) or high-flow nasal cannula therapy (OR, 2.78; 95% CI, 1.01-7.62); or the administration of vasopressors (OR, 2.25; 95% CI, 1.39-3.63) or antibiotics (OR, 1.40; 95% CI, 1.14-1.74) were associated with higher in-hospital mortality. CONCLUSIONS: This study identified the factors affecting in-hospital mortality among patients with miliary TB. The findings of this study will aid clinicians in identifying patients who may benefit from aggressive therapeutic interventions.

Endobronchial silicone spigot in prolonged air leaks: Nationwide study on outcomes and risk factors for treatment failure.

BACKGROUND: The endobronchial silicone spigot, also known as the endobronchial Watanabe spigot, is used in bronchoscopic interventions to manage prolonged pulmonary air leakage. However, the outcomes of this procedure have not been thoroughly investigated. METHODS: Using a Japanese national inpatient database from April 2014 to March 2022, we assessed the clinical characteristics and outcomes of all eligible patients who received the endobronchial spigot. We also investigated risk factors associated with treatment failure. Treatment failure was defined as in-hospital death or the need for surgery after bronchial occlusion. RESULTS: We analyzed data of 1095 patients who underwent bronchial occlusion using the endobronchial spigot. Among them, 252 patients (23.0%) died during hospitalization, and 403 patients (36.8%) experienced treatment failure. Factors associated with treatment failure included age between 85 and 94 years (odds ratio [OR] 1.83; 95% confidence intervals [CI], 1.04-3.21); male sex (OR 2.43; 95% CI, 1.44-4.11); low Barthel index score; comorbidities of interstitial pneumonia (OR 1.71; 95% CI, 1.18-2.48); antibiotics treatment (OR 1.45; 95% CI, 1.02-2.07); steroids treatment (OR 1.59; 95% CI, 1.07-2.36); and surgery prior to bronchial occlusion (OR 2.08; 95% CI, 1.29-3.35). In contrast, pleurodesis after bronchial occlusion (OR 0.49; 95% CI, 0.32-0.75), and admission to high-volume hospitals were inversely associated with treatment failure (OR 0.58; 95% CI, 0.37-0.90). CONCLUSIONS: The endobronchial Watanabe spigot could be a nonsurgical treatment option for patients with prolonged pulmonary air leaks. Our findings will help identify patients who may benefit from such bronchial interventions.

Proteinuria screening and risk of bone fracture: a retrospective cohort study using a nationwide population-based database.

Background and hypothesis: Proteinuria is associated with an increased risk of kidney function deterioration, cardiovascular disease, or cancer. Previous reports suggesting an association between kidney dysfunction and bone fracture may be confounded by concomitant proteinuria and were inconsistent regarding the association between proteinuria and bone fracture. Therefore, we aimed to evaluate the association using a large administrative claims database in Japan. Methods: Using the DeSC database, we retrospectively identified individuals with laboratory data including urine dipstick test between August 2014 and February 2021. We evaluated the association between proteinuria and vertebral or hip fracture using multivariable Cox regression analyses adjusted for various background factors including kidney function. We also performed subgroup analyses stratified by sex and kidney function and sensitivity analyses with Fine & Gray models considering death as a competing risk. Results: We identified 603 766 individuals and observed 21 195 fractures. With reference to the negative proteinuria group, the hazard ratio for hip or vertebral fracture was 1.10 [95% confidence interval (CI), 1.05-1.14] and 1.16 (95%CI, 1.11-1.22) in the trace and positive proteinuria group, respectively, in the Cox regression analysis. The subgroup analyses showed similar trends. The Fine & Gray model showed a subdistribution hazard ratio of 1.09 (95%CI, 1.05-1.14) in the trace proteinuria group and 1.15 (95% CI, 1.10-1.20) in the positive proteinuria group. Conclusions: Proteinuria was associated with an increased risk of developing hip or vertebral fractures after adjustment for kidney function. Our results highlight the clinical importance of checking proteinuria for predicting bone fractures.

Comparison of prophylactic antibiotics for endonasal transsphenoidal surgery using a national inpatient database in Japan.

BACKGROUND: The choice of prophylactic antibiotics for use in endonasal transsphenoidal surgery (ETSS) lacks universal standards. This study aimed to investigate the effectiveness of cefazolin, ampicillin and third-generation cephalosporins for preventing postoperative meningitis and secondary outcomes (in-hospital death and the combination of pneumonia and urinary tract infection) in patients who have undergone ETSS. METHODS: The study used data from the Diagnosis Procedure Combination database in Japan. Data from 10 688 patients who underwent ETSS between April 2016 and March 2021 were included. Matching weight analysis based on propensity scores was conducted to compare the outcomes of patients receiving cefazolin, ampicillin or third-generation cephalosporins as prophylactic antibiotics. RESULTS: Of the 10 688 patients, 9013, 102 and 1573 received cefazolin, ampicillin and third-generation cephalosporins, respectively. The incidence of postoperative meningitis did not significantly differ between the cefazolin group and the ampicillin group (OR, 1.02; 95% CI, 0.14-7.43) or third-generation cephalosporins group (OR, 0.81; 95% CI, 0.10-6.44). Similarly, in-hospital death and the composite incidence of pneumonia and urinary tract infection did not differ between the cefazolin group and the ampicillin or third-generation cephalosporins group. CONCLUSIONS: Cefazolin, ampicillin and third-generation cephalosporins as perioperative prophylactic antibiotics for ETSS do not differ significantly in terms of preventing meningitis.

Endoscopic surgery versus craniotomy for spontaneous intracerebral hemorrhage in the late elderly patients.

OBJECTIVES: To compare the prognosis of late elderly patients with spontaneous intracerebral hemorrhage (ICH) treated by endoscopic evacuation and craniotomy MATERIALS AND METHODS: Using the Diagnosis Procedure Combination database, we identified patients aged ≥ 75 years who underwent surgery for spontaneous ICH within 48 hours after admission between April 2014 and March 2018. Eligible patients were classified into two groups according to the type of surgery (endoscopic surgery and craniotomy). Propensity-score matching weight analysis was conducted to compare the good neurological outcome modified Rankin Scale (mRS) score (0-4) at discharge as the primary endpoint between the two groups. Secondary endpoints were postoperative meningitis, tracheostomy, reoperation within 3 days and total hospitalization costs. RESULTS: Among the 5,396 eligible patients, endoscopic surgery and craniotomy were performed in 895 and 4,501 patients, respectively. In the propensity-score matching weight analysis, all covariates were well balanced. The proportions of patients with a good prognosis (mRS score at discharge: 0-4) did not significantly differ between the surgical procedures (42.1% vs. 42.8%, p = 0.828). The proportions of meningitis, tracheostomy and reoperation were not significantly different between the two groups. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (25,536 vs. 29,603 US dollars, p = 0.012). CONCLUSIONS: Inhospital outcomes did not differ between endoscopic and open surgeries for spontaneous ICH in the late-stage elderly patients aged ≥75 years. Hospitalization costs were significantly higher in the craniotomy group, suggesting that endoscopic surgery may be more acceptable.

Comparison of bleeding complications after pediatric kidney biopsy between intravenous sedation and general anesthesia: a nationwide cohort study.

BACKGROUND: An increasing number of studies are evaluating the safety of intravenous sedation compared with that of general anesthesia; however, data on bleeding complications after pediatric percutaneous renal biopsy performed under intravenous sedation or general anesthesia are lacking. We aimed to examine differences in bleeding complications between intravenous sedation and general anesthesia in pediatric patients. METHODS: Data of pediatric patients aged ≤ 15 years undergoing percutaneous kidney biopsy for kidney disease between July 2007 and March 2019 were retrieved from a national inpatient database in Japan. We examined differences in bleeding complications after renal biopsy performed under intravenous sedation, defined by the absence of the record of general anesthesia with intubation but by the presence of intravenous sedation during biopsy, and general anesthesia, defined by the presence of the record of general anesthesia with intubation during biopsy, among pediatric patients admitted for percutaneous renal biopsy. We performed binomial regression using overlap weights based on propensity scores for patients receiving intravenous sedation. Analyses stratified by age or sex, a sensitivity analysis using generalized estimating equations considering cluster effects by hospital among a propensity score-matched cohort, and another sensitivity analysis using the instrumental variable method were performed to confirm the robustness of the results. RESULTS: We identified 6,560 biopsies performed in 5,999 children aged 1-15 years from 328 hospitals and 178 events. Only three severe complications and no death were observed. No significant difference in the proportion of bleeding complications was observed between procedures performed under intravenous sedation and those performed under general anesthesia (unadjusted proportions, 2.8% and 2.3%; adjusted proportions, 2.5% and 2.2%), with an unadjusted relative risk of 1.21 (95% confidence interval, 0.80-1.81) and adjusted relative risk of 1.13 (95% confidence interval, 0.74-1.73). Both age- and sex-stratified analyses yielded similar results. The analysis using generalized estimating equation and the instrumental variable method showed relative risks of 0.95 (95% confidence interval, 0.48-1.88) and 1.18 (95% confidence interval, 0.74-1.89), respectively. CONCLUSION: This retrospective cohort study using a national database revealed that the risk of biopsy-related bleeding was comparable between intravenous sedation and general anesthesia during pediatric percutaneous kidney biopsy, suggesting that intravenous sedation alone and general anesthesia may have a similar bleeding risk in pediatric percutaneous kidney biopsies.

Outcomes After Endoscopic Evacuation Versus Evacuation Using Craniotomy or Stereotactic Aspiration for Spontaneous Intracerebral Hemorrhage: Analysis Using a Japanese Nationwide Database.

BACKGROUND: Various surgical methods are available for managing large intracerebral hemorrhage. This study compared the prognosis of patients with spontaneous intracerebral hemorrhage who underwent endoscopic evacuation, stereotactic aspiration, and craniotomy by using a nationwide inpatient database in Japan. METHODS: Using the Diagnosis Procedure Combination database, we identified patients who underwent surgery for spontaneous intracerebral hemorrhage within 48 h after admission between April 2014 and March 2018. Eligible patients were classified into three groups according to the type of surgery (endoscopic surgery, stereotactic surgery, and craniotomy). Propensity score matching weight analysis was conducted to compare poor modified Rankin Scale score at discharge (severe disability or death) and hospitalization cost among the groups. RESULTS: Among 17,860 eligible patients, craniotomy, stereotactic surgery, and endoscopic surgery were performed in 14,354, 474, and 3,032 patients, respectively. In the matching weight analysis, all covariates were well balanced. Compared with the endoscopic surgery group, the proportion of poor prognosis (modified Rankin Scale score at discharge of 5 or 6) was significantly higher in craniotomy groups (odds ratio 2.51, 95% confidence interval 1.11-5.68; p = 0.028). Subgroup analysis based on hemorrhage location and consciousness level at the time of admission showed no significant difference between the surgical procedures. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (difference US $9,724, 95% confidence interval 2,169-17,259; p = 0.011). CONCLUSIONS: Endoscopic surgery for spontaneous intracerebral hemorrhage was associated with improved prognosis compared with craniotomy at the hospital discharge. Future large-scale clinical trials are needed to evaluate the optimal surgical techniques for intracerebral hemorrhage.

Trends in surgical procedures for spontaneous intracerebral hemorrhage in Japan.

OBJECTIVES: Minimally invasive surgery for spontaneous intracerebral hemorrhage (ICH) has become increasingly popular in recent years. However, there are no reports on the recent trends in surgical procedures for spontaneous ICH. To investigate current trends in surgical methods for spontaneous ICH using a nationwide inpatient database from Japan. MATERIALS AND METHODS: Patients who underwent surgery for spontaneous ICH between April 2014 and March 2018 were identified in a nationwide inpatient database from Japan. We examined patient characteristics, diagnoses, types of surgery, complications, and discharge status. RESULTS: We identified 21,129 inpatients who underwent surgery for spontaneous ICH. The procedures were as follows: 16,256 (76.9%) transcranial hemorrhage evacuations, 3722 (17.6%) endoscopic hemorrhage evacuations, and 1151 (5.4%) stereotactic aspirations of hemorrhage. Patients tended to receive transcranial hemorrhage evacuations in hospitals with fewer surgical cases. The proportions of endoscopic hemorrhage evacuations increased annually, whereas those of stereotactic surgery decreased. The proportions of transcranial surgery remained almost unchanged. Tracheostomy and hospitalization costs were lower in the stereotactic aspirations of hemorrhage group, and the proportions of reoperation were higher in the endoscopic hemorrhage evacuations group. CONCLUSIONS: The use of endoscopic surgery for spontaneous ICH has increased in Japan. This study can form the basis of future clinical investigations into spontaneous ICH surgery.

Postoperative outcomes of cancer surgery in patients with and without kidney failure with dialysis therapy: a matched-pair cohort study.

Background: The difference in outcomes of cancer surgery between patients with and without kidney failure with dialysis therapy (KFDT) remains uncertain. Methods: Using 2010-18 data in a national inpatient database in Japan, we identified patients who had undergone resection of colorectal, lung, gastric or breast cancer. We matched selected patient characteristics, type of cancer, surgical procedure and hospital of up to four patients without KFDT to each patient with KFDT. We assessed 30-day mortality and postoperative complications. Results: Through matching, we identified 2248 patients with KFDT (807 with colorectal, 579 with lung, 500 with gastric and 362 with breast cancer) and 8210 patients without KFDT (2851 with colorectal, 2216 with lung, 1756 with gastric and 1387 with breast cancer). Postoperative complications occurred in a higher proportion of patients with KFDT than of those without KFDT after colorectal {20.3% versus 14.6%; risk difference (RD): 5.7% [95% confidence interval (95% CI) 2.6%-8.8%]}, lung [18.0% versus 12.9%; RD: 5.1% (95% CI 1.6%-8.4%)], gastric [25.0% versus 13.2%; RD: 11.8% (95% CI 7.6%-16.2%)] and breast cancer surgery [7.5% versus 3.5%; RD: 3.9% (95% CI 1.1%-6.9%)]. Patients with KFDT had a higher 30-day mortality than those without KFDT after gastric cancer surgery [1.6% versus 0.3%; RD: 1.3% (95% CI 0.1%-2.3%)]. Heart failure and ischemic heart disease occurred more frequently in patients with KFDT. Conclusions: Patients with KFDT had higher rates of postoperative complications and 30-day mortality; however, RDs varied between cancer types. The higher rates of postoperative complications in patients with KFDT were mainly attributable to cardiovascular complications.

Association Between Diabetes and Major Bleeding Complications of Renal Biopsy.

INTRODUCTION: Nephrologists have recently recognized the heterogeneity of kidney diseases among patients with diabetes and begun to actively perform percutaneous renal biopsies (PRBs). Nevertheless, the association between diabetes and major bleeding complications of PRB remains unclear. METHODS: In this retrospective cohort study using the Diagnosis Procedure Combination database in Japan, we identified patients who underwent an elective PRB from July 2010 to March 2018. The primary outcome was the occurrence of major bleeding complications, defined as red blood cell transfusion within 7 days after PRB or invasive hemostasis after PRB. Multivariable regression analysis was performed to analyze the association between diabetes and major bleeding complications with adjustment for patient and hospital characteristics. RESULTS: We identified 76,302 patients, including 8245 with diabetes. The proportion of PRBs performed for patients with diabetes continuously increased over time. Major bleeding complications occurred in 678 patients (0.9%), including 622 (0.8%) with red blood cell (RBC) transfusion and 109 (0.1%) with invasive hemostasis. Diabetes was significantly associated with major bleeding complications (relative risk [RR] = 2.41; 95% CI 2.00-2.90). Among patients with diabetes, multiagent or insulin treatment had significant association with major bleeding complications (RR = 1.57; 95% CI 1.18-2.10), compared with single-agent diabetes treatment. CONCLUSION: Diabetes is significantly associated with major bleeding complications of PRBs. Moreover, severity of diabetes has association with increases in major bleeding complications. Thus, nephrologists should carefully judge whether the anticipated benefits outweigh the relatively high risk of major bleeding complications when considering PRB for patients with diabetes.

Effectiveness of surgical fixation for rib fractures in relation to its timing: a retrospective Japanese nationwide study.

PURPOSE: The effectiveness of surgical rib fixation is currently controversial, partly because of differences in timing. We used a Japanese nationwide database to investigate the effectiveness of surgical rib fixation in relation to its timing. METHODS: We used the Japanese Diagnosis Procedure Combination database to identify patients with rib fractures who underwent mechanical ventilation from 1 July 2010 to 31 March 2018. We performed overlap weight analysis to compare in-hospital outcomes between patients who had and had not undergone surgical rib fixation within 3, 6 or 10 days after admission. The primary outcomes were duration of mechanical ventilation and post-rib fixation length of hospital stay. The secondary outcomes were tracheostomy, post-admission pneumonia and all-cause 28-day in-hospital mortality. RESULTS: We identified 8922 eligible patients. Surgical rib fixation within 3 days after admission was associated with shorter duration of mechanical ventilation (percent difference, - 42.9%; 95% confidence interval, - 57.4 to - 23.3) and shorter hospital stay (percent difference, - 19.6%; 95% confidence interval, - 31.8 to - 5.2). There were no significant differences between the groups in tracheostomy (risk difference, - 0.04; 95% confidence interval, - 0.15 to 0.07), post-admission pneumonia (risk difference, - 0.04; 95% confidence interval, - 0.13 to 0.05) or all-cause 28-day in-hospital mortality (risk difference, - 0.02; 95% confidence interval, - 0.07 to 0.03). However, there were no significant differences in any in-hospital outcomes between those who had and had not undergone rib fixation within 6 or 10 days after admission. CONCLUSION: Early surgical rib fixation was associated with better in-hospital outcomes, whereas later surgical rib fixation was not.

Associations between early parenteral nutrition and in-hospital outcomes in underweight patients with gastrointestinal surgery.

BACKGROUND & AIMS: Guidelines recommend early parenteral nutrition for malnourished patients. However, the effectiveness of early parenteral nutrition in underweight patients has not been established. This study aimed to determine whether in-hospital outcomes were associated with early parenteral nutrition in underweight gastrointestinal surgery patients with short-term contraindications to early enteral nutrition. METHODS: We identified underweight adult gastrointestinal surgery patients with short-term contraindications to early enteral nutrition using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2018. We performed propensity-score overlap weighting to compare in-hospital outcomes between patients with and without early parenteral nutrition. The primary outcome was length of hospital stay. The secondary outcomes were total hospitalization cost, hospital-acquired pneumonia, hospital-acquired urinary tract infection, central line-associated bloodstream infection, and all-cause 28-day in-hospital mortality. RESULTS: We identified 31,898 eligible patients. Early parenteral nutrition was associated with longer hospital stay (19.2 vs. 18.4 days; difference, 0.7 days; 95% CI, 0.1 to 1.4). There were no differences between the patients with and without early parenteral nutrition in total hospitalization cost (difference, US$60; 95% CI, -277 to 397), hospital-acquired pneumonia (risk difference, -0.11%; 95% CI, -0.78 to 0.55), hospital-acquired urinary tract infection (risk difference, 0.03%; 95% CI, -0.08 to 0.14), central line-associated bloodstream infection (risk difference, 0.08%; 95% CI, -0.02 to 0.18), and all-cause 28-day in-hospital mortality (risk difference, 0.31%; 95% CI, -0.07 to 0.69). CONCLUSIONS: Early parenteral nutrition for underweight gastrointestinal surgery patients with short-term contraindications to early enteral nutrition was associated with longer hospital stay.

Association between parenteral nutrition in the early phase and outcomes in patients with abdominal trauma undergoing emergency laparotomy: A retrospective nationwide study.

BACKGROUND & AIMS: Parenteral nutrition in the early phase is often performed for patients with trauma who have undergone laparotomy. However, the clinical benefits of parenteral nutrition in the early phase in this population remain unknown. We investigated the association of parenteral nutrition in the early phase with outcomes in patients with trauma who underwent emergency laparotomy. METHODS: Using a Japanese nationwide database from July 2010 to March 2018, we identified patients with trauma who underwent emergency laparotomy on admission to the hospital, required mechanical ventilation on admission, and did not receive enteral nutrition within 2 days after admission. We performed an overlap weights analysis to compare in-hospital outcomes between patients with and without parenteral nutrition in the early phase. The primary outcome was the duration of mechanical ventilation. The secondary outcomes were the length of hospital stay, total hospitalization cost, tracheostomy, hospital-acquired pneumonia, and all-cause 28-day in-hospital mortality. RESULTS: In total, 1700 adult patients were included. There were no significant associations between parenteral nutrition in the early phase and the duration of mechanical ventilation (difference, -0.4 days; 95% confidence interval, -2.9 to 2.2), length of hospital stay (difference, 1.3 days; 95% confidence interval, -5.0 to 7.5), total hospitalization cost (difference, US$ 730; 95% confidence interval, -2911 to 4370), tracheostomy (risk difference, 0.01; 95% confidence interval, -0.03 to 0.05), hospital-acquired pneumonia (risk difference, -0.01; 95% confidence interval, -0.05 to 0.03), or all-cause 28-day in-hospital mortality (risk difference, 0.02; 95% confidence interval, -0.01 to 0.06). CONCLUSIONS: Parenteral nutrition in the early phase for patients with trauma undergoing emergency laparotomy was not associated with better in-hospital outcomes.

Early Versus Late Rib Fixation in Patients With Traumatic Rib Fractures: A Nationwide Study.

BACKGROUND: The appropriate timing of rib fixation remains unclear. We investigated the efficacy of early rib fixation compared with late rib fixation, using data from a Japanese nationwide inpatient database. METHODS: We identified patients who underwent rib fixation and received mechanical ventilation from July 1, 2010, to March 31, 2018, using data from the Diagnosis Procedure Combination database in Japan. The primary outcome was the duration of mechanical ventilation after rib fixation. Secondary outcomes were the length of hospital stay after rib fixation, total hospitalization costs, tracheostomy, pneumonia after admission, and all-cause 28-day in-hospital mortality. We performed propensity score-adjusted analyses to compare outcomes between patients undergoing rib fixation less than or equal to 6 days after admission and those undergoing rib fixation greater than 6 days after admission. RESULTS: We identified 211 patients, including 113 patients undergoing early rib fixation and 98 patients undergoing late rib fixation. In the propensity score-adjusted analyses, early rib fixation was associated with shorter duration of mechanical ventilation (difference, -26.7%; 95% confidence interval [CI], -39.4% to -11.4%), shorter length of hospital stay (difference, -33.3%; 95% CI, -52.8% to -5.6%), and lower total hospitalization costs (difference, -28.7%; 95% CI, -38.4% to -17.5%). There were no significant differences between the groups regarding the proportions of patients receiving tracheostomy (odds ratio [OR], 0.67; 95% CI, 0.31-1.48), pneumonia after admission (OR, 0.74, 95% CI, 0.33-1.65), or all-cause 28-day in-hospital mortality (OR, 0.90, 95% CI, 0.06-12.5). CONCLUSIONS: Early rib fixation was associated with better in-hospital outcomes.

Pituitary surgery's epidemiology using a national inpatient database in Japan.

BACKGROUND: Between 2010 and 2014, microscopic transsphenoidal surgery (mTSS) was performed more frequently than endoscopic TSS (eTSS) in the USA. However, few epidemiological studies on pituitary surgery are currently available. METHODS: We performed a retrospective study on patients who had undergone pituitary surgery between July 2010 and March 2016. To this end, a nationwide inpatient database in Japan was used. Patients' characteristics, diagnoses, types of surgery, complications, and discharge status were examined. RESULTS: A total of 16,253 inpatients who received pituitary surgery were identified. Patients were diagnosed with diseases for insurance claims described below: pituitary adenoma, hyperprolactinemia, other pituitary disorders (e.g., Rathke's cleft cyst), hyperpituitarism, craniopharyngioma, acromegaly, Cushing's disease, and pituitary cancer. Among them, pituitary adenomas, primarily the non-functioning ones, were the most frequent (66.9%). A total of 14,285 (88%) patients underwent TSS, while 1968 (12%) patients were treated using transcranial surgery. The number of patients undergoing TSS increased each year. The number of eTSS operations was 8140 (77%) and that of mTSS operations was 2419 (23%). Of note, eTSS increased each year. We found that high-volume hospitals more frequently selected eTSS. Compared with mTSS, eTSS was associated with a reduction of hyponatremia incidence (odds ratio, 0.69; p = 0.019). Additionally, it was not associated with other major complications. CONCLUSION: The present study showed that both TSS and eTSS increased on a yearly basis. We believe that the present study will be the basis of future epidemiological investigations of pituitary surgery.

Influence of the Fukushima Daiichi Nuclear Power Plant Accident on the Use of Computed Tomography in Children With Mild Head Injuries.

BACKGROUND: Computed tomography (CT) is commonly used in children with mild head injuries. People in Japan are concerned about radiation exposure and radiation-induced cancer because of the Fukushima Daiichi Nuclear Power Plant accident on March 11, 2011. This study investigated whether the accident influenced the use of CT in children with mild head injuries. METHODS: Using the Japan Medical Data Center database, we identified patients aged ≤15 years visiting hospitals because of mild head injuries from January 1, 2008, to December 31, 2013. We excluded patients who were admitted to the hospital or received other medical examinations. Regression discontinuity analysis was used to compare proportions of patients undergoing head CT and having clinically important traumatic brain injury (ciTBI) overlooked before versus after the accident, adjusting for patient characteristics, secular trends, and hospital effect. RESULTS: Eligible patients (n = 40,440) were classified as visiting the hospital before (n = 11,659) or after (n = 28,781) the accident. The regression discontinuity analysis showed that the accident was associated with a reduction in the proportion of patients undergoing head CT (odds ratio [OR] 0.73; 95% confidence interval [CI], 0.63-0.86), whereas the accident was not associated with an increase in cases where ciTBI was overlooked (OR 0.72; 95% CI, 0.13-4.00). CONCLUSIONS: The use of CT in children with mild head injuries declined after the Fukushima Daiichi Nuclear Power Plant accident. Improving awareness of radiation exposure risks among patients and physicians could reduce unnecessary CT.

Disaster-related carbon monoxide poisoning after the Great East Japan Earthquake, 2011: a nationwide observational study.

AIM: To investigate disaster-related carbon monoxide (CO) poisoning after the Great East Japan Earthquake using a nationwide inpatient database in Japan. METHODS: This was a retrospective cohort study. We identified adult patients with CO poisoning who were registered in the Japanese Diagnosis Procedure Combination inpatient database from 2010 to 2017. We evaluated trends in the numbers of patients with CO poisoning each month from disaster (Tohoku region) and non-disaster areas. In the disaster area, we compared the numbers of patients with CO poisoning during pre- and post-earthquake periods. We also compared the numbers of CO poisonings after the earthquake (<30 days) and 1 year later. RESULTS: Eligible patients (n = 7,814) were categorized into disaster area (n = 988) and non-disaster area (n = 6,826) groups. The numbers of CO-poisoned patients in the non-disaster area showed a seasonal variation, and there was a significant peak registered on March 11 in the disaster area. In the disaster area, the number of patients with CO poisoning in the post-earthquake period was significantly higher than that in the pre-earthquake period (135 versus 18; odds ratio, 7.50; 95% confidence interval, 4.59-12.3). The number of patients in the post-earthquake period was also significantly higher than that on April 9, 2012, which was one month after the annual follow-up (135 versus 10; odds ratio, 13.5; 95% confidence interval, 7.10-25.7). CONCLUSION: This study showed that CO poisoning significantly increased in the affected area after the Great East Japan Earthquake, underlining the importance of providing information regarding the hazard of earthquake-related CO poisoning.