Long-Term Water Vapor Thermal Therapy Outcomes Across a Broad Range of Prostate Volumes.

INTRODUCTION: Water vapor thermal therapy (WVTT) is a minimally invasive therapy designed to treat lower urinary tract symptoms associated with benign prostatic hyperplasia. Long-term outcomes with large (>80 cc) and small (<30 cc) prostate volumes (PVs) remain limited. We report 48-month outcomes for a multiethnic cohort of WVTT-treated men, stratified by PV. METHODS: In this single-center retrospective study, patients were stratified by PV: < 30 cc, 30 to 80 cc, or > 80 cc. Outcome measures, including International Prostate Symptom Score, quality of life, International Index of Erectile Function, medication usage, and adverse events, were analyzed at baseline and at 1-, 3-, 6-, 12-, 24-, 36-, and/or 48-month follow-up. RESULTS: Two hundred fifty-two patients met inclusion; 35 (13.9%) had PVs < 30 cc, 196 (77.8%) had PVs 30 to 80 cc, and 21 (8.3%) had PVs > 80 cc. Most patients were Asian (33.7%) or non-Hispanic Black (29.4%). International Prostate Symptom Score and quality of life improved in all cohorts from baseline at all follow-ups (all P < .05), with no differences between cohorts. International Index of Erectile Function-Orgasmic Function and -Erectile Function domains improved in 30 to 80 cc patients at 48 months. Alpha blocker and/or 5-alpha reductase inhibitor usage decreased at all follow-ups in < 30 cc and 30 to 80 cc patients and remained durable to only 6 months for > 80 cc patients. No significant differences in adverse events or reoperation rates were observed between cohorts. CONCLUSIONS: Our study suggests WVTT to be efficacious, durable, and safe in managing lower urinary tract symptoms across PVs, although PV > 80 cc patients may require benign prostatic hyperplasia medication at long-term follow-up. Further research is desired to clarify WVTT's role regarding sexual function and in treating men with larger PVs.

Pudendal nerve block decreases narcotic requirements and time spent in post-anesthesia care units in patients undergoing primary inflatable penile prosthesis implantation.

Efforts to minimize narcotic usage following inflatable penile prosthesis (IPP) implantation are vital, considering the current opioid epidemic in the United States. We aimed to determine whether pudendal nerve block (PNB) utilization in a multiethnic population undergoing primary IPP implantation can decrease rates of post-operative opiate usage. A single-institution, retrospective study was conducted on patients who underwent primary IPP implantation between December 2015 and June 2022. PNB usage and intra- and post-operative outcomes were analyzed using multivariate binary logistic regression. 449 patients were included, with 373 (83.1%) in the PNB group. Median time (minutes) spent in the post-anesthesia care unit (PACU) (1499 [119-198] vs. 235 [169-322], p < 0.001) was significantly lower in the PNB group. There were no significant differences in intra-operative and PACU morphine milligram equivalents or post-operative safety outcomes between groups. However, fewer patients in the PNB group called for pain medications post-operatively (10.2% vs 19.7%, p = 0.019). Multivariate analysis revealed a significantly decreased operative time (B -6.23; 95%CI -11.28, -1.17; p = 0.016) and decreased time in recovery (B: -81.62; 95%CI: -106.49, -56.76, p < 0.001) in the PNB group. PNB decreases post-operative opioid analgesic requirements and time spent in PACU in patients undergoing a primary IPP implantation and thus may represent an attractive, non-opioid adjunct.

Implementation of a shared research database to increase medical student awareness and involvement in urology research A pilot study.

INTRODUCTION: We aimed to assess the effect of a shared institutional research database on medical students' scholarly work, perceived research competency, and self-reported satisfaction. METHODS: An institutional inventory database was created on Google Sheets with a listing of available mentors and a description of their ongoing research projects. The inventory database was shared with interested students and faculty. Students who agreed to participate were surveyed pre- and post-inventory. Survey questions assessed student demographics, prior research experience, and their perception of research competency and satisfaction. The number of presentations, publications, and articles pre- and post-inventory were also abstracted. Survey responses were compared using the Mann-Whitney U test. RESULTS: A total of 20 students were surveyed pre-inventory and at a median followup of six months (5-7) post-inventory. There was a significant increase in scholarly presentations and publications post-inventory (p<0.05 for all). Furthermore, post-inventory, students reported feeling more confident in establishing an academic career, finding good mentors, managing their relationship with their mentor, managing professional challenges, and effectively showcasing themselves professionally and describing their research (p<0.05 for all). More than 65% of students agreed or strongly agreed that the database was easy to use, accessible, transparent, and would like a similar database created for other specialty departments. CONCLUSIONS: After performing mentorship-guided research through an institutional research database, medical students felt more confident in their ability to perform research and produced more scholarly work. Therefore, we recommend a research database be created across all institutional departments to foster interest in conducting research.

Real-world four-year functional and surgical outcomes of Rezum therapy in younger versus elderly men.

BACKGROUND: Management of urinary symptoms in elderly patients with benign prostatic hyperplasia (BPH) is complex given challenges with medications and invasive surgeries. Rezum, a minimally invasive water vapor therapy, is an emerging alternative. We compare real-world Rezum outcomes between young and elderly patients over 4 years. METHODS: We retrospectively analyzed a multiethnic population treated with Rezum at a single center between 2017-2019. Patients were stratified into young (<65 years) or elderly (≥65 years) cohorts. International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), decisional regret scores, and adverse events (AEs) were assessed at baseline, 1-, 3-, 6-, 12-, and/or 48-months. Descriptive statistics were compared using t-tests, Chi-squared, or Mann-Whitney U tests. Changes in outcomes were assessed using Wilcoxon signed-rank tests, stratified by age. RESULTS: 256 patients - 146 (57%) young and 110 (43%) elderly - were included. The majority were Asian (33.2%) or non-Hispanic Black (28.9%). Significant improvements were observed in the combined cohort at 4-years in IPSS, QoL, and Qmax when compared to baseline (all p < 0.05). Between the age cohorts, there were no significant differences in IPSS, QoL, or Qmax at any follow-up. Within both cohorts, significant improvements in IPSS and QoL were found from baseline to all follow-ups. In the young cohort, Qmax was significantly improved from baseline to all follow-ups while in the elderly cohort, this was observed only at the 3-month follow-up. No significant differences in AEs or regret was found between cohorts. There was no significant difference in 4-year surgical retreatment rates between cohorts (elderly 4.0% vs young 4.4%, p = 0.86). CONCLUSIONS: There were no significant differences in IPSS, QoL, or AEs between elderly and younger men over 4 years following Rezum, suggesting comparable benefits and risks. Future research is warranted to clarify the impact of Rezum on Qmax in elderly men.

Electronic Health Record Usage Patterns Across Surgical Subspecialties.

OBJECTIVES: This study aimed to utilize metrics from physician action logs to analyze surgeon clinical, volume, electronic health record (EHR) efficiency, EHR proficiency, and workload outside scheduled time as impacted by physician characteristics such as years of experience, gender, subspecialty, academic title, and administrative title. METHODS: We selected 30 metrics from Epic Signal, an analytic tool in Epic that extracts metrics related to clinician documentation. Metrics measuring appointments, messages, and scheduled hours per day were used as a correlate for volume. EHR efficiency, and proficiency were measured by scores built into Epic Signal. Metrics measuring time spent in the EHR outside working hours were used as a correlate for documentation burden. We analyzed these metrics among surgeons at our institution across 4 months and correlated them with physician characteristics. RESULTS: Analysis of 133 surgeons showed that, when stratified by gender, female surgeons had significantly higher EHR metrics for time per day, time per appointment, and documentation burden, and significantly lower EHR metrics for efficiency when compared to male surgeons. When stratified by experience, surgeons with 0 to 5 years of experience had significantly lower EHR metrics for volume, time per day, efficiency, and proficiency when compared to surgeons with 6 to 10 and more than 10 years of experience. On multivariate analysis, having over 10 years of experience was an independent predictor of more appointments per day, greater proficiency, and spending less time per completed message. Female gender was an independent predictor of spending more time in notes per appointment and time spent in the EHR outside working hours. CONCLUSION: The burden associated with volume, proficiency, efficiency, and workload outside scheduled time related to EHR use varies by gender and years of experience in our cohort of surgeons. Evaluation of physician action logs could help identify those at higher risk of burnout due to burdensome medical documentation.

Factors Influencing Medical Students' Pursuit of Urology: Results From the AUA Census (2019-2021).

INTRODUCTION: Growing interest in urology among medical students highlights the need to understand factors influencing their specialty choice in today's context. We also investigate COVID-19's impact on these factors and any disparities among female and underrepresented in medicine (URiM) students. METHODS: From 2019 to 2021, the AUA Annual Census survey included medical student-focused questions on demographics, career interests, and decision factors. Responses were analyzed. RESULTS: One hundred ninety-two medical students participated. Thirty-six (24%) identified as female and 19 (13%) as URiM. Common reasons students would choose urology included surgical procedures (93%) and "good lifestyle" among surgical careers (85%), with no differences across gender or URiM status. Compared to pre-COVID (2019), during COVID (2020-2021), a greater proportion of students cited cutting-edge technology (90.1% vs 73.1%, P = .008) and surgical procedures (98.6% vs 87.2%, P = .008) as reasons to choose urology. Reasons for not choosing urology included competitiveness (48%) and poor lifestyle (26%). Female and URiM students expressed concern related to the combined "male dominated/gender discrimination/lack of diversity" aspect (female 33% vs male 3%, P < .001; URiM 25% vs non-URiM 7%, P = .04). CONCLUSIONS: The AUA Census survey highlights factors influencing medical students' decisions regarding urology. Interest in procedural and technological aspects grew during COVID. Students expressed concern over the field's competitiveness and poor lifestyle, while also acknowledging that urology offers a favorable lifestyle compared to other surgical careers. Female and URiM students expressed ongoing concerns over the combined aspect of gender discrimination and/or the lack of existing diversity in the field.

Efficacy and safety of the Rezum system for the treatment of catheter-dependent urinary retention: Three-year real-world outcomes in a multimorbid, multiethnic population.

OBJECTIVES: To evaluate the long-term real-world efficacy and safety of Rezum for the treatment of catheter-dependent urinary retention in a multimorbid, multiethnic population. METHODS: A single-office, retrospective study was conducted on patients treated with Rezum between 2017 and 2019. Patients were included if they had catheter-dependent urinary retention prior to treatment and at least one follow-up within 36 months postoperatively. Patient demographics, procedural characteristics, adverse events (AEs), and outcome measures, including benign prostate hyperplasia (BPH) medication usage and postvoid residual (PVR), were collected at 3, 6, 12, and/or 36 months postoperatively. Regret was assessed at 36 months using the 5-item Decisional Regret Scale (DRS). RESULTS: A total of 27 patients met the inclusion criteria, with the majority being Asian (29.6%), followed by non-Hispanic Black (26.0%) and Hispanic (22.2%). Most patients (77.8%) had at least one comorbidity. Trial of void (TOV) was attempted at a median of 8 days (7, 13). Fourteen patients (51.9%) failed their initial TOV. Median time until catheter independence was 13.5 days (8.5, 28.8). Common AEs included urinary retention (51.9%), urinary tract infections (UTIs) (25.9%), and dysuria (25.9%). All cases of UTIs (7/7) and most cases of dysuria (6/7) occurred in patients who failed their initial TOV. At 36 months, there was a significant median percentage change in PVR (-100.0% [-100.0, -36.7], p = .049), and 40.4% of patients discontinued their BPH medications (p = .001). Of the 11 patients who filled out the DRS, 10 (90.9%) agreed/strongly agreed that they made the right decision. By 36 months, 4 patients (14.8%) underwent reoperation and 24 (88.9%) remained catheter-independent. CONCLUSIONS: At long-term follow-up, Rezum effectively treated catheter-dependent urinary retention with minimal decisional regret. In patients with urinary retention, urologists should consider delaying TOV until 2 weeks postoperatively to maximize the likelihood of a successful TOV and minimize the risk of AEs.

Evaluating the American Urologic Association (AUA) dietary recommendations for kidney stone management using the National Health And Nutritional Examination Survey (NHANES).

The objective of this study is to evaluate the conventional dietary recommendations for stone prevention among patients in the National Health and Nutritional Examination Survey (NHANES) and compare dietary components and special diets between stone formers and non-stone formers. We analyzed the NHANES 2011-2018 dietary and kidney condition questionnaires, among 16,939 respondents who were included in this analysis. Dietary variables were selected based on the American Urological Association (AUA) guideline for Medical Management of Kidney Stones and from other studies on kidney stone prevention. Weighted multivariate logistic regression models were used to assess the relationship of dietary food components (categorized into quartiles) and dietary recommendations with kidney stone formation (yes vs no), adjusted for total caloric intake, comorbidities, age, race/ethnicity, and sex. The prevalence of kidney stones was 9.9%. Our results showed association of kidney stones with lower levels of potassium (p for trend = 0.047), which was strongest for < 2000 mg (OR = 1.35; 95% CI 1.01-1.79). Higher vitamin C intake was inversely associated with stone formation (p for trend = 0.012), particularly at daily intake levels between 60 and 110 mg (OR = 0.76; 95% CI 0.60-0.95) and above 110mcg (OR = 0.80; 95% CI 0.66-0.97). There were no associations between other dietary components and kidney stone formation. Higher levels of dietary vitamin C and potassium intake may be indicated for stone prevention and warrants further investigation.

Low risk is low risk, regardless of race or ethnicity: Outcomes of prostate cancer active surveillance and factors associated with reclassification in a racially diverse cohort.

INTRODUCTION: Active surveillance (AS) is the standard for very low- and low-risk prostate cancer. Although risk factors for pathologic reclassification while on AS have been identified, results are mixed for non-Hispanic Black (NHB) and Hispanic ethnicity. We aim to further explore how race and ethnicity may be affecting AS participation and outcomes in a primarily urban, diverse, and vulnerable population. MATERIALS AND METHODS: Patients eligible for AS from 2005-2020 were reviewed. Demographics, race/ethnicity, prostate specific antigen (PSA), prostate volume, and pathologic characteristics were analyzed between patients enrolled in AS and those that underwent immediate therapy. Kaplan-Meier survival analysis was used to compare biochemical recurrence (BCR) rates. Cox proportional hazards models were used to develop prediction models for clinical reclassification. RESULTS: A total of 471 men were eligible for AS. Of those, 188 (39.9%) enrolled in AS while 283 (60.1%) underwent immediate radical therapy. No significant differences were found in racial/ethnic composition between the AS and immediate treatment groups. In our AS cohort, 79 (42.0%) experienced clinical reclassification and underwent deferred treatment. BCR rates were similar between treatment groups. Race/ethnicity were not found to be predictors of clinical reclassification, while metrics at diagnostic biopsy such as elevated PSA, higher PSA density, and lower prostate volume increased reclassification odds. CONCLUSIONS: In our diverse population, NHB race and Hispanic ethnicity were not significant predictors of adverse reclassification while on AS. Our findings support utilizing other metrics taken at initial biopsy to identify high-risk patients such as PSA, prostate volume, and PSA density.

Risk Factors and Real-World Short-Term Outcomes of a Failed Trial of Void After Rezum Therapy in a Multiethnic Population.

Background: Postoperative urinary retention is a common complication following surgery for benign prostatic hyperplasia. We aimed to identify risk factors for a failed trial of void (TOV) following treatment with the Rezum system and assess the impact of a failed TOV on short-term outcomes. Methods: A single-office retrospective study was conducted on patients treated with Rezum therapy between 2017 and 2019. A urinary catheter was placed in all patients following Rezum therapy. Demographic data and outcome measures, including the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), and adverse events, were analyzed at baseline and 1, 3, and/or 6 months postoperatively. Risk factors were identified through multivariate logistic regression analysis. Results: A total of 289 patients were included. Thirty-five patients (12.1%) failed a TOV, while 254 (87.9%) had an effective TOV. All patients were given a TOV after a median of 5 days (4-5). Those who failed the TOV spent an additional mean of 13.7 ± 13.3 days with a catheter. Patients who failed the TOV were more likely to get a urinary tract infection compared with those who had an effective TOV (20.0% vs 4.7%, p < 0.001). All patients experienced significant improvements in IPSS, QoL, and Qmax at 1, 3, and/or 6 months. On multivariate analysis, a high baseline PVR was the only independent predictor of a failed TOV (odds ratio: 1.01, 95% confidence interval 1.00-1.01). A greater proportion of patients with a baseline PVR >200 mL failed the TOV (40.0%) compared with patients with a baseline PVR <200 mL (10.9%, p = 0.008). Conclusions: Approximately one in eight patients failed the TOV following Rezum therapy. Baseline PVR was the only independent risk factor for a failed TOV. Nevertheless, all patients experienced significant relief of urinary symptoms. Patients with high baseline PVR, particularly >200 mL, may require a catheter for an extended duration.

Financial Toxicity of Nephrolithiasis: The First Assessment of the Economic Stresses of Kidney Stone Treatment.

OBJECTIVE: To investigate the financial toxicity (FT) related to kidney stone treatment. METHODS: We performed a cross-sectional cohort study with multi-institutional in-person and online cohorts of stone formers.  Participants were surveyed using the validated COST tool (COmprehensive Score for financial Toxicity). The maximum score is 44 and lower scores indicate increased FT. "Moderate FT" was defined by COST scores between 25 and 14 points and "severe FT" for scores <14. Descriptive statistics, X2 tests, T tests, Spearman correlation, and logistic regression were performed using SPSS v28. RESULTS: Two hundred and forty-one participants were surveyed, including 126 in-person participants and 115 online. A total of 60% of participants reported at least moderate FT (COST score <26) and 26% reported severe FT (COST score <14). Patients who reported moderate to severe FT were younger than those with low FT by a median difference of 8 years (95%CI = 4, 12). There was a significant correlation between out-of-pocket expense and COST scores, such that as out-of-pocket expenses increased, COST scores decreased, (Spearman's rho =-0.406, P = <.001). Participants with moderate to severe FT tended to miss more workdays (P = .002), and their caretakers tended to miss more workdays (P = .007) due to their stone disease. CONCLUSION: Most participants reported moderate to severe FT. As prior studies have shown that patients with "moderate FT" employ cost-coping strategies (i.e., medication rationing) and those with "severe FT" have worse health outcomes, urologists need to be sensitive to the financial burdens of treatment experienced by such patients undergoing kidney stone treatment.

Evaluating the association between food insecurity and risk of nephrolithiasis: an analysis of the National Health and Nutrition Examination Survey.

PURPOSE: This study aimed to investigate the relationship between self-reported food security and kidney stone formation. METHODS: Data were collected from the National Health and Nutrition Examination Survey (NHANES), a database representative of the United States population. Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Characteristics of patients were compared using the Chi-square test and the student t-test. Multivariate logistic regression was performed using a multi-model approach. RESULTS: We analyzed 6,800 NHANES survey respondents. 37.2% of respondents were categorized as having "low food security" (scores 2-4) and 24.0% having "very low food security" (scores 5-6). 8.4% of respondents had a history of kidney stones. We found that people with very low food security had a 42% increased likelihood of developing kidney stones compared to those with high or marginal food security, after controlling for race, age, and comorbidities (OR 1.42; 95% CI 1.01-1.99). Between the different food security groups, no significant differences were observed in age, race/ethnicity, body mass index, gout history, osteoporosis history, or coronary artery disease history. Lower food security was associated with slightly younger age (< 1 year difference, p = 0.001), higher poverty-income ratio (p = 0.001), and many comorbidities, including kidney stones (p = 0.007). CONCLUSION: Our study provides evidence for an association between food access and the risk of kidney stone disease. Given these findings, food insecurity should be investigated as a modifiable risk factor for the development of kidney stone disease.

Clinical Risk Factors Associated With Small Renal Mass Malignant Histology in a Multi-Ethnic Population Undergoing Partial Nephrectomy.

INTRODUCTION: Small renal masses (SRMs) are often incidentally diagnosed, and a large proportion are malignant. However, there is a paucity of data describing predictors of malignancy in minority patients with SRMs. Thus, our goal was to examine clinical risk factors associated with SRM malignant histology in patients undergoing partial nephrectomy (PN) a diverse, urban academic center. MATERIALS AND METHODS: Patients with a SRM undergoing PN at a single institution between 2010 to 2018 were reviewed. Demographic, clinical, and imaging characteristics were compared to pathology results. Logistic regression was used to examine associations between demographic/clinical variables for malignant and high-grade histology. RESULTS: In total, 331 patients who underwent PN for SRM were included. Of those, 264 (79.8%) had malignant histology while 67 (20.2%) had benign histology. The proportions of men and of current smokers were significantly higher among patients with malignant histology. In multivariate models, non-Hispanic Black (NHB) patients had increased odds of having malignant histology (OR 2.46, 95% CI: 1.01-5.99, P = .048) and current smokers (OR = 4.02; 95% CI 1.14-14.18, P = .031). Hispanic patients had a 3-fold increased risk of high-grade RCC (OR 3.06, 95% CI: 1.19-7.87, P = 0.02) compared to Non-Hispanic White patients. CONCLUSION: In our population, male sex, smoking, and NHB race/ethnicity was associated with an increased risk of malignancy in patients undergoing partial nephrectomy for SRM. Older age and Hispanic race/ethnicity were associated with high grade RCC. Our results suggest that urologists should exercise a higher level of vigilance in managing and treating SRM among NHB and Hispanic patients.

Analysis of Twitter Engagement in a Progressively More Competitive Urology Match: A Mixed Methods Study.

OBJECTIVE: To analyze Twitter engagement in response to the urology match during the COVID-19 pandemic. METHODS: Tweets containing the hashtags "#uromatch" or "#AUAmatch" during the 2021 and 2022 Match Week were reviewed. Date, author type and number of followers, general content, and engagement with each Tweet was collected. Differences in engagement between author type and content were analyzed using the Kruskal-Wallis H test. Tweet characteristics were compared between the 2021 and 2022 Match Cycles using the Chi-Square test. RESULTS: There were 656 Tweets in total, with 272 (43.5%) from 2021 and 353 (56.5%) from 2022. Medical students' and residency programs' posts received significantly more Tweet engagement than those by residents/fellows, attendings, or the AUA (P <.05). Tweets focusing on announcing a new residency class and personal announcements of match results received significantly more engagements than other content categories (P <.05). In 2022, there was a significantly higher percentage of Tweets about advice for unmatched applicants (2.2 vs 12.5; P <.001), match statistics (0.4 vs 2.9; P = .028) and focus on underrepresented groups in urology (0.7 vs 3.4; P = .029). CONCLUSION: The Twitter response to the urology match between 2021 and 2022 mirrored the increase in competitiveness, with greater participation and an increasing focus on the difficulty of matching. During Match Week, Twitter is a readily available source of information for programs, matched students, and unmatched students alike. As we continue to embrace virtual platforms, we believe that Twitter will remain a major source of match-related information and can be an instrumental tool for broader networking in our field.

Analyzing the Effects of Demographic Differences on Patient Outcomes Following Non-pyogenic Intracranial Venous Thrombosis.

OBJECTIVE: To investigate the effect of racial and demographic differences on the short-term outcome of patients following a non-pyogenic cerebral venous thrombosis. METHODS: Data from the National Inpatient Sample were gathered from the years 2013 to 2016. Patients who had a non-pyogenic cerebral venous thrombosis were identified. Admissions of patients between different racial groups were compared. Outcome measures included inpatient mortality, length of stay (LOS), all patients refined diagnosis-related group (APR-DRG) severity and mortality risk scores, non-routine discharges, total charges, sepsis, and urinary tract infections (UTIs). RESULTS: We identified 973 patients who were admitted with a non-pyogenic cerebral venous thrombosis between 2013 and 2016. Of those, 65.7% were classified as White, 15.6% as Black, 14.1% as Hispanic, and 4.6% as Asian or Pacific Islander. Compared to White patients, Black patients were found to have a higher severity score upon admission (2.94 ± 0.818 vs 2.77 ± 0.839; p = 0.025) as well as a longer adjusted LOS (8.085 ± 5.917 vs 6.503 ± 5.552; p = 0.004) and log LOS (0.934 ± 0.507 vs 0.773 ± 0.521; p = 0.001). On initial analysis, we found that older age, elevated WBC count, income group, anemia, and an expected primary payer of Medicare/Medicaid were significantly associated with Black race and also worse outcomes. When controlling for these variables using multivariate regression, older age, lower income group, and elevated WBC count were not significantly associated with any measures of outcome. The race was no longer associated with a higher APR-DRG severity score but was still significant for adjusted LOS (p = 0.001) and adjusted log LOS (p = 0.004). Lastly, we noted that anemia and the expected primary payer of Medicare/Medicaid were both independently and significantly associated with APR-DRG severity score (p = 0.003; p = 0.010) and the adjusted log LOS (p = 0.019; p = 0.035). CONCLUSIONS: Black patients admitted with a non-pyogenic intracranial venous thrombosis have significantly longer LOS compared to White patients. Anemia and Medicare/Medicaid as the primary expected payer also seem to play a role in longer LOS, as well as the severity of the case.

Gram-Negative Ventriculostomy-Associated Infections Predict Shunt Dependency in Stroke Diagnoses and Other Brain Injuries.

BACKGROUND: Several predictors have been studied for shunt dependency after stroke and other brain injuries. However, little is known about the association between ventriculostomy-associated infections (VAIs) and impaired cerebrospinal fluid (CSF) outflow. Moreover, gram-negative (GN) VAIs induce a potent neuroinflammatory process and are clinically challenging to treat. OBJECTIVE: To assess if GN-VAIs predict ventriculoperitoneal shunt (VPS) dependency. METHODS: Retrospective analysis of postprocedure infection rates was performed in 586 patients with external ventricle drainage (EVD) placed on site between 2012 and 2018. We collected sex, age, stroke and nonstroke related, location of EVD placement, type of hospital, EVD duration, and EVD exchange. RESULTS: Among 586 patients requiring an EVD, 55 developed a VAI. Most were caused by gram-positive (GP) pathogens (61.8%). A total of 120 patients required a conversion from EVD to VPS. Patients with VAIs had higher rates of VPS placement (49.09% vs 17.65%, P < .001), whereas patients with GN-VAIs had significantly higher rates of EVD conversion to VPS (77.78% vs 35.29%, P = .012) compared with GP-VAIs. The multivariate analysis showed that GN-VAIs were an independent predictor for shunt dependency (odds ratio = 12.896; 95% CI 3.407-48.82, P < .001). In receiver operating characteristics analysis, those less than 44.5 yr of age and more than 12 d of EVD duration were identified as the best cutoff values to discriminate the development of GN-VAI. CONCLUSION: Patients who experience a GN VAI are in greater risk of impaired CSF outflow, thus requiring VPS placement.

Impact of hospital-acquired complications in long-term clinical outcomes after subarachnoid hemorrhage.

OBJECTIVE: Patients with subarachnoid hemorrhage (SAH) usually have prolonged hospitalizations due to the need to closely monitor their neurological status. Therefore, these patients have higher risk of experiencing hospital-acquired complications (HACs), which can complicate their clinical course and recovery. However, there is no evidence on the impact of HACs of long-term clinical outcomes. We aimed to identify if HACs are independent risk factors for poor clinical outcomes at 12-18 months of follow-up. PATIENTS AND METHODS: Retrospective analysis of 323 patients with SAH diagnosis from 2013 until June 2018. We collected patient-related factors (age, sex, body mass index (BMI), ethnicity), comorbidities (hypertension, smoke status, diabetes, coronary heart diseases, prothrombotic diseases and hypercholesterolemia), clinical variables (Hunt-Hess grade, modified Fisher grade, treatment, delayed cerebral ischemia), aneurysm characteristics (location, size) and HACs (pneumonia, deep vein thrombosis (DVT), urinary tract infection (UTI), external ventricular drainage (EVD) infections, sepsis, hyponatremia and acute respiratory distress syndrome). Poor outcomes were defined as mRS ≥ 3. RESULTS: 204 patients were included in the primary analysis. 82 (40.2%) experienced one or more HACs during their hospital course. Patients that developed HACs have significantly increased ICU (12.1 ±â€¯6.6 vs 24.3 ±â€¯23.6, p < .001) and hospital (18.7 ±â€¯14.2 vs 35.3 ±â€¯26.3, p < .001) length of stays. Moreover, patients with HACs had significant higher rates of delayed cerebral ischemia, non-routine discharge and poor outcomes at 90 days. 177 patients had complete follow-ups at 12-18 months, HACs were independent risk factors for poor functional outcomes at 12-18 months after adjusting for demographic, comorbidities and clinical variables [OR = 3.205, 95% CI 1.231-8.347, p < 0.001]. CONCLUSIONS: HACs are an independent risk factor of sustaining poor clinical outcomes 12-18 months after a SAH. Furthermore, HACs are significantly related with the occurrence of DCI, with non-routine discharge and 90-day poor functional outcomes.