Severe major depressive disorder readmissions: A national United States population study.

BACKGROUND: National population data are scarce on readmission following hospitalization for severe major depressive disorder (SMDD) in the United States (U.S.). We aim to describe the rates, characteristics, and reasons for readmissions for adults hospitalized for SMDD in the U.S. METHODS: We analyzed the 2018 Nationwide Readmissions Database (NRD). We included index hospitalizations for all adult patients (≥18 years) with a "principal" diagnosis of SMDD using (ICD)-10 codes. We excluded elective readmissions. Chi-square tests were used to compare baseline characteristics between readmissions and index hospitalizations. The 10 most common reasons for readmission were highlighted. RESULTS: A total of 236,284, 185,737, 120,218, and 21,645 index hospitalizations with a principal diagnosis of SMDD discharged alive, were included in the 30-, 90-180- and 330-day readmission analysis. Among these, 27,443 (11.6 %), 36,844 (19.8 %), 32,269 (26.8 %) and 7915 (36.6 %) were readmitted within 30, 90, 180 and 330 days, respectively. 90-day readmissions were older, had more males, greater hospital costs, fewer patients with private insurance, higher comorbidity burden, more patients from lower-income households, present to metropolitan hospitals, and leave against medical advice compared to index admissions. LIMITATIONS: Limitations of our study include possible coding errors, lack of data on race/ethnicity, age of disease onset, duration of illness, medication use, and adherence. CONCLUSIONS: About 1 in 3 patients admitted for SMDD are readmitted within 11 months. Readmissions constitute a significant economic burden and differ from index admissions. SMDD and other psychiatric disorders are common reasons for readmission. Interventions to reduce readmissions are needed.

Gastroparesis with Cannabis Use: A Retrospective Study from the Nationwide Inpatient Sample.

Background: With increasing utilization of cannabis in the United States (US), clinicians may encounter more cases of Gastroparesis (GP) in coming years.Objective: The primary outcome was inpatient mortality for GP with cannabis use. Secondary outcomes included system-based complications and the burden of the disease on the US healthcare system.Methods: From the Nationwide Inpatient Sample (NIS), we identified adult hospitalizations with a primary discharge diagnosis of GP for 2016 and 2017. Individuals ≤18 years of age were excluded. The study population was subdivided based on a secondary diagnosis of cannabis use. The outcomes included biodemographic characteristics, mortality, complications, and burden of disease on the US healthcare system.Results: For 2016 and 2017, we identified 99,695 hospitalizations with GP. Of these hospitalizations, 8,870 had a secondary diagnosis of cannabis use while 90,825 served as controls. The prevalence of GP with cannabis use was 8.9%. For GP with cannabis use, the patients were younger (38.5 vs 48.1 years, p < 0.001) with a Black predominance (Table 1) and lower proportion of females (52.3 vs 68.3%, p < 0.001) compared to the non-cannabis use cohort. Additionally, the cannabis use cohort had higher percentage of patients with co-morbidities like hypertension, diabetes mellitus and a history of smoking. The inpatient mortality for GP with cannabis use was noted to be 0.27%. Furthermore, we noted shorter mean length of stay (LOS) (3.4 vs 4.4 days, aMD: -0.7, 95%CI: -0.9 - [-0.5], p < 0.001), lower mean total hospital charge (THC) ($30,400 vs $38,100, aMD: -5100, 95%CI: -6900 - [-3200], p < 0.001), and lower rates of sepsis (0.11 vs 0.60%, aOR: 0.22, 95% CI: 0.05-0.91, p = 0.036) for GP hospitalizations with cannabis use compared to the non-cannabis use cohort.Conclusion: Inpatient mortality for GP hospitalizations with cannabis use was 0.27%. Additionally, these patients had shorter LOS, lower THC, and lower sepsis rates.

Comparing patient characteristics and outcomes in type 1 versus type 2 diabetes with diabetic ketoacidosis: a review and a propensity-matched nationwide analysis.

Diabetic ketoacidosis (DKA) is a known complication of patients with type 1 diabetes mellitus (T1DM), but less common in type 2 diabetes mellitus (T2DM). The aim of this study was to compare the outcomes of patients admitted to the hospital with DKA in T1DM versus T2DM. This was a population-based, retrospective, cohort study using data from the Nationwide Inpatient Sample. The group of patients hospitalized for DKA was divided based on a secondary diagnosis of either T1DM or T2DM. The primary outcome was inpatient mortality, and the secondary outcomes were rate of complications, length of hospital stay (LOS) and total hospital charge (THC). The inpatient mortality for DKA was 0.27% (650 patients). In T2DM, the adjusted OR (aOR) for mortality was 2.13 (95% CI 1.38 to 3.28, p=0.001) with adjusted increase in mean THC of $6035 (95% CI 4420 to 7652, p<0.001) and mean LOS of 0.5 day (95% CI 0.3 to 0.6, p<0.001) compared with T1DM. Patients with T2DM had significantly higher odds of having septic shock (aOR 2.02, 95% CI 1.160 to 3.524, p=0.013) compared with T1DM. T2DM was associated with higher inpatient mortality, septic shock and increase in healthcare utilization costs compared with T1DM.

Psoriasis does not worsen outcomes in patients admitted for ischemic stroke: an analysis of the National Inpatient Sample.

Psoriasis is a chronic inflammatory state associated with an increased risk of cardiometabolic diseases, stroke, and mortality. Although psoriasis increases the risk of ischemic stroke, whether outcomes, including mortality, are adversely affected is unknown.This study aims to compare inpatient mortality of patients admitted for ischemic stroke with and without psoriasis. The secondary outcome measures were hospital length of stay (LOS), total hospital charges, odds of receiving tissue plasminogen activator (TPA), and mechanical thrombectomy between both groups.Data were obtained from the National Inpatient Sample (NIS) 2016 and 2017 databases using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Multivariable logistic and linear regression analysis were used accordingly to account for confounders of the outcomes.The combined 2016 and 2017 NIS database comprised over 71 million discharges. Of these, ischemic stroke accounted for 525,570 hospitalizations and 2425 (0.5%) had a concomitant diagnosis of psoriasis. Patients hospitalized for ischemic stroke with coexisting psoriasis did not have a difference in inpatient mortality (3.5% vs 5.5%; p=0.285) compared with those without psoriasis. However, psoriasis cohort had shorter LOS (5.0 vs 5.7 days; p=0.029) and lower total hospital charges ($60,471 vs $70,246; p=0.003) compared with the non-psoriasis cohort. The odds of receiving TPA and undergoing mechanical thrombectomy were not different in both groups.Inpatient mortality, odds of receiving TPA, and undergoing mechanical thrombectomy in patients who had an ischemic stroke with or without psoriasis were not different. However, patients with psoriasis had a significantly shorter LOS and lower hospital charges.

Racial Disparities in Outcomes of Adults Hospitalized for Viral Pneumonia.

Background Viral pneumonia is an important cause of respiratory morbidity and mortality. Cases of viral pneumonia are becoming increasingly more common as at-risk populations increase globally. We sought to highlight the racial distribution of hospitalized patients with viral pneumonia and compare their outcomes. Materials and methods Data were obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. The study involved adults who had a principal discharge diagnosis of viral pneumonia. The primary outcome analyzed was inpatient mortality. Secondary outcomes included the development of sepsis, septic shock, acute respiratory failure, acute respiratory distress syndrome, non-ST segment elevation myocardial infarction (NSTEMI), acute kidney failure, deep vein thrombosis, pulmonary embolism, cerebrovascular accident, need for mechanical ventilation, and use of vasopressors as well as mean length of hospitalization and mean total hospital charges. Results Blacks and Hispanics had lower inpatient mortality adjusted odds (aOR: 0.39, 95% CI = 0.229 - 0.662, p<0.001 and aOR: 0.55, 95% CI = 0.347 - 0.858, p=0.009, respectively) compared to Whites. Black and Hispanic patients were also found to have lower adjusted odds ratio of having acute respiratory failure (aOR: 0.54, 95% CI = 0.471 - 0.614, p<0.001, and 0.66, 95% CI = 0.576 - 0.753, p<0.001, respectively). Conclusion Black and Hispanic patients are at lower risk of adverse outcomes when compared to White patients with viral pneumonia.