Abdominal Aortic Aneurysm Repair Readmissions and Disparities of Socioeconomic Status: A Multistate Analysis, 2007-2014.

OBJECTIVE(S): To determine differences in perioperative abdominal aortic aneurysm (AAA) repair outcomes based on patient sociodemographics. DESIGN: A retrospective analysis of patient hospitalization and discharge records. SETTING: All-payer patients in nonpsychiatric hospitals in New York, Maryland, Florida, Kentucky, and California. PARTICIPANTS: A total of 92,028 patients from the State Inpatient Databases Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality from January 2007 to December 2014 (excluding California, ending December 2011) who underwent AAA repair. INTERVENTIONS: Data extraction and univariate and multivariate regression analysis. MEASUREMENTS AND MAIN RESULTS: Patients in the highest income quartile were less likely to be readmitted compared with those in the poorest income quartile at both 30 days (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.83-0.95) and 90 days (OR 0.85, 95% CI 0.81-0.91). Hospital readmissions were significantly greater for African American (OR 1.32, 95% CI 1.20-1.44) and Hispanic patients (OR 1.14, 95% CI 1.04-1.25) compared with white patients 30 days after AAA repair. These results were consistent 90 days after AAA repair. Patients insured with Medicare (OR 1.25, 95% CI 1.17-1.34) or Medicaid (OR 1.46, 95% CI 1.30-1.64) were more likely to be readmitted after both time points as compared with those with private insurance. The authors also found that patients with lower income, African American and Hispanic patients, and patients without private insurance were all significantly more likely to undergo emergency rather than elective repair. CONCLUSIONS: Lower socioeconomic status is shown to be an independent risk factor for increased postoperative morbidity in AAA repair. The authors believe the present study demonstrates the importance of socioeconomic status as a factor in perioperative risk stratification.

White matter abnormalities in 22q11.2 deletion syndrome: preliminary associations with the Nogo-66 receptor gene and symptoms of psychosis.

BACKGROUND: This study utilized diffusion tensor imaging (DTI) to analyze white matter tractography in the anterior limb of the internal capsule (ALIC), fornix, and uncinate fasciculus (UF) of individuals with 22q11.2 deletion syndrome and controls. Aberrations in these tracts have been previously associated with schizophrenia. With up to 25% of individuals with 22q11.2DS developing schizophrenia in adulthood, we hypothesized reduction in structural integrity of these tracts, including an association with prodromal symptoms of psychosis. We further predicted an association between allelic variation in a functional polymorphism of the Nogo-66 receptor gene and 22q11.2DS white matter integrity. METHODS: Tractography was conducted using fiber assignment by streamline tracking algorithm in DTI Studio. Subjects were genotyped for the rs701428 SNP of the Nogo-66 receptor gene, and assessed for presence of prodromal symptoms. RESULTS: We found significant group differences between 22q11.2DS and controls in DTI metrics for all three tracts. DTI metrics of ALIC and UF were associated with prodromal symptoms in 22q11.2DS. Further, ALIC DTI metrics were associated with allelic variation of the rs701428 SNP of the Nogo-66 receptor gene in 22q11.2DS. CONCLUSIONS: Alterations in DTI metrics suggest white matter microstructural anomalies of the ALIC, fornix, and UF in 22q11.2DS. Structural differences in ALIC appear to be associated with the Nogo-66 receptor gene, which has been linked to myelin-mediated axonal growth inhibition. Moreover, the association between psychosis symptoms and ALIC and UF metrics suggests that the Nogo-66 receptor gene may represent a susceptibility gene for psychosis through its disruption of white matter microstructure and myelin-associated axonal growth.