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1.
Artigo em Inglês | MEDLINE | ID: mdl-32156420
3.
Artigo em Inglês | MEDLINE | ID: mdl-32125502

RESUMO

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.

4.
Crit Care Med ; 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32044841

RESUMO

OBJECTIVES: Previous studies have suggested that vasodilator therapy may be beneficial for patients with nonocclusive mesenteric ischemia. However, robust evidence supporting this contention is lacking. We examined the hypothesis that vasodilator therapy may be effective in patients diagnosed with nonocclusive mesenteric ischemia. DESIGN: Retrospective cohort study. SETTING: The Japanese Diagnosis Procedure Combination inpatient database. PATIENTS: A total of 1,837 patients with nonocclusive mesenteric ischemia from July 2010 to March 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We compared patients who received vasodilator therapy (vasodilator group; n = 161) and those who did not (control group; n = 1,676) using one-to-four propensity score matching. Vasodilator therapy was defined as papaverine and/or prostaglandin E1 administered via venous and/or arterial routes within 2 days of admission. Only patients who did not receive abdominal surgery within 2 days of admission were analyzed. The main outcomes were in-hospital mortality and abdominal surgery performed greater than or equal to 3 days after admission. After propensity score matching, in-hospital mortality was significantly lower in the vasodilator group (risk difference, -11.6%; p = 0.005). The proportion of patients who received abdominal surgery at greater than or equal to 3 days after admission was also significantly lower in the vasodilator group (risk difference, -10.2%; p = 0.002). CONCLUSIONS: Vasodilator therapy with papaverine and/or prostaglandin E1 is associated with lower in-hospital mortality and prevalence of abdominal surgery in patients with nonocclusive mesenteric ischemia.

5.
Neurol Med Chir (Tokyo) ; 60(3): 156-163, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32009125

RESUMO

Intravenous (i.v.) phenytoin/fosphenytoin is recommended as the second-line therapy of antiepileptic drugs in patients with status epilepticus (SE). i.v. Levetiracetam is regarded as an effective and safe equivalent with i.v. phenytoin/fosphenytoin. However, i.v. levetiracetam is not covered by public health insurance for SE in most countries. For this study, we performed the real-world practice pattern survey of antiepileptic drugs for status epilepticus using the nationwide inpatient database. We used the Japanese Diagnosis Procedure Combination inpatient database in Japan and identified all cases of emergency admission attributable to status epilepticus from March 2011 through March 2018. We described the patient characteristics and practice pattern of antiepileptic drugs. The analysis conducted for this study examined 31,472 cases. As the second-line therapy, the use of i.v. levetiracetam increased rapidly from 2016; 35% of cases received i.v. levetiracetam in 2017. By contrast, the use of i.v. phenytoin/fosphenytoin decreased from 2016. In-hospital mortality decreased year-by-year. No year-by-year change was observed for deaths within 24 h, length of hospital stay, drug-induced hepatitis, or drug-induced eruption. Although the use of levetiracetam for treatment of SE is not compensated by public health insurance in Japan, i.v. levetiracetam use is increasing dramatically as the second-line SE therapy. We propose that health insurance coverage be extended to include i.v. levetiracetam treatment for SE.

6.
Artigo em Inglês | MEDLINE | ID: mdl-32086848

RESUMO

PURPOSE: This study was performed to investigate the association between the use of pregabalin and injury. METHODS: The study was based on a predefined cohort of patients aged ≥20 years who had been registered for ≥6 months and contributed to the Japan Medical Data Center claims database. All patients (cases) had been treated for injuries from January 2014 to December 2016. One-to-four case-control matching was performed for age, sex, calendar day of injury (index date), and follow-up duration. A conditional logistic regression analysis was performed to calculate the odds ratio (OR) for pregabalin use within 180 days prior to the index date between the matched cases and controls, with adjustment for comorbidities and relevant drug categories associated with a risk of injury. To minimize within-individual confounding, we also performed a case-crossover analysis to compare the odds of pregabalin use between a 30-day hazard period immediately before the injury and five consecutive 30-day control periods within individuals with injury. RESULTS: Among the 2 324 974 people in the nested cohort, we identified 18 084 cases with injury and 71 885 matched controls. The proportion of pregabalin use was 1.7% (304/18 084) and 1.1% (803/71 885), respectively. The adjusted OR for injury was 1.22 (95% confidence interval [CI], 1.06-1.40). In the case-crossover analysis (n = 304), pregabalin use was also significantly associated with an increased risk of injury (adjusted OR, 1.48; 95% CI, 1.10-2.00). CONCLUSION: This large database study using two different study designs consistently suggested that the use of pregabalin may be associated with an increased risk of injury.

7.
Am J Surg ; 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32067706

RESUMO

BACKGROUND: Perioperative glucocorticoid supplementation has been suggested as a potentially effective precaution against perioperative adrenal crisis in patients on long-term glucocorticoid medication. METHODS: This retrospective cohort study used a national inpatient database in Japan. We included patients who underwent general surgery and those who received long-term glucocorticoid medication before surgery. A one-to-one propensity score-matched analysis was performed to compare patients who received 100 mg hydrocortisone during surgery with those who received no supplementation. The primary outcome was use of vasopressor agents on the day of surgery. The secondary outcomes included bleeding, perioperative infection, wound dehiscence, postoperative length of stay, and in-hospital mortality. RESULTS: Among the 807 propensity score-matched pairs, there was no significant difference in use of vasopressor agents between patients with and without glucocorticoid supplementation (24.5% vs. 21.9%; P = 0.22) and no significant differences in any secondary outcomes. CONCLUSIONS: Perioperative glucocorticoid supplementation was not associated with decreased morbidity or mortality.

8.
Urol Int ; : 1-7, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31955168

RESUMO

OBJECTIVES: We examined the advantages of tubeless percutaneous nephrolithotomy (PCNL) and totally tubeless PCNL over standard PCNL. MATERIALS AND METHODS: Using a nationwide inpatient database in Japan, we gathered data on patients undergoing PCNL from July 2010 to March 2016 and extracted eligible patients who were candidates for tubeless PCNL. Eligible patients were divided into 4 groups: tubeless, totally tubeless, standard, and standard PCNL with ureteral stent (US). Multivariable analyses compared postoperative hospital stay, duration of analgesic use, urinary tract infection (UTI), and blood transfusion among the 4 groups. RESULTS: Analyses were conducted on patients in the standard (n = 954), tubeless (n = 98), totally tubeless (n = 146), and standard PCNL with US (n = 389) groups. Postoperative hospital stay was significantly shorter in the tubeless group than in the standard group (1.6 days [-2.9 to 0.4]). With reference to the standard PCNL group, there was no significant difference in the number of days of analgesic use or the proportions of postoperative UTIs or blood transfusion among the groups. Postoperative UTIs developed significantly more often in women than in men regardless of the PCNL method. CONCLUSIONS: Our multivariable analyses showed that tubeless PCNL was associated with shorter postoperative hospital stays, but totally tubeless PCNL was not.

9.
Hepatol Res ; 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31943593

RESUMO

AIM: Previous randomized controlled trials of branched-chain amino acid infusion for hepatic encephalopathy involved a small number of patients, and the effectiveness of branched-chain amino acid infusion has not been clarified. We evaluated whether branched-chain amino acid infusion in addition to lactulose treatment was associated with short-term outcomes in a large population of patients. METHODS: Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified inpatients with hepatic encephalopathy who received lactulose within 2 days of admission from July 2011 to March 2017. We divided the patients into those who received branched-chain amino acid infusion within 2 days of admission in addition to lactulose treatment and those who did not. We conducted propensity-score inverse probability of treatment weighting analyses to compare in-hospital mortality, consciousness at discharge, in-hospital complications, length of stay, and total hospitalization costs between the groups. RESULTS: We identified 8051 patients with hepatic encephalopathy treated with lactulose, including 7560 patients who received lactulose plus branched-chain amino acid infusion and 491 who received lactulose alone. The lactulose plus branched-chain amino acid infusion group had a significantly lower mortality than the lactulose alone group (9.6% vs. 15.0%, odds ratio 0.60, 95% confidence interval 0.44-0.82). The lactulose plus branched-chain amino acid infusion group also had a lower proportion of patients with impaired mental status at discharge, and lower total hospitalization costs than the lactulose alone group. CONCLUSIONS: Branched-chain amino acid infusion together with lactulose may improve the prognosis of hepatic encephalopathy.

10.
Resuscitation ; 148: 49-56, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31931094

RESUMO

AIM: We examined whether outcomes of paediatric out-of-hospital cardiac arrest (OHCA) are associated with a hospital characteristic defined by the annual number of invasive mechanical ventilation cases, suggesting hospitals' experience in caring for severely ill paediatric patients. METHOD: We analysed the Japanese Diagnosis Procedure Combination database from 2010 to 2017. We identified children (<18 years) with OHCA and post-resuscitation intensive care (defined as invasive mechanical ventilation and/or catecholamine infusion). Hospitals were divided into four groups by mean annual number of paediatric cases involving invasive mechanical ventilation. The primary outcome was in-hospital mortality, and the secondary outcome was unfavourable outcomes (death or medical care dependency at discharge). Multivariable logistic regression analyses were conducted to examine the relationship between hospitals' experience and outcomes. RESULTS: We included 2540 paediatric OHCA patients from 385 institutions. Overall in-hospital mortality was 62.4%, with rates of 69.6%, 61.3%, 61.8%, and 57.0% in hospitals with low (≤48 cases/year), low-intermediate (48-110), high-intermediate (110-164), and high (>164) experience levels (P < .001), respectively. Compared to hospitals with low experience, adjusted odds ratios (95% confidence interval) for hospitals with low-intermediate, high-intermediate, and high experience were as follows: primary outcome: 0.64 (0.40-1.01), 0.67 (0.42-1.05), and 0.46 (0.31-0.70), respectively; secondary outcome: 0.93 (0.55-1.57), 0.95 (0.63-1.43), and 0.67 (0.46-0.96), respectively. CONCLUSION: Japanese hospitals with higher experience in caring for severely ill paediatric patients showed lower mortality for paediatric OHCA. This fact should be considered by the Emergency Medical Systems when deciding transport strategy.

11.
World Neurosurg ; 136: e371-e379, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931237

RESUMO

BACKGROUND: This study aimed to compare the functional outcome at discharge for unruptured cerebral aneurysms (UCAs) between surgical clipping and endovascular coiling in total, nonelderly (<65 years), and elderly (≥65 years) patients by nonbiased analysis based on a national database in Japan. METHODS: A total of 15,671 patients with UCA were registered in the Diagnosis Procedure Combination, the nationwide database, from 2010 to 2015 in Japan. The outcome of the Barthel Index (BI) at discharge was investigated, and propensity score-matched analysis was conducted in total, nonelderly, and elderly patient groups. RESULTS: Propensity score-matched analysis found no significant difference for in-hospital mortality between the 2 treatment methods in the total and both age-groups. The rate of morbidity of BI <90 at discharge was higher after surgical clipping than after endovascular coiling in the total (4.9% vs. 3.9%; P = 0.040; risk difference, -1.0%; 95% confidence interval, -3.6 to 2.3%) and the elderly age-group (8.1% vs. 5.0%; P < 0.001; risk difference, -3.1%; -4.8% to 1.5%), however, no significant association between the 2 treatment methods (2.4% vs. 2.6%; P = 0.67; risk difference, 0.22%; -0.79 to 1.22%) was found in the nonelderly group. CONCLUSIONS: In elderly patients with UCA, a better outcome at discharge after endovascular coiling was found. However, no significantly different functional outcome at discharge between surgical clipping and endovascular coiling for UCA in nonelderly patients was confirmed by propensity score-matched analysis from a nationwide database in Japan.

12.
Blood Purif ; : 1-8, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31940608

RESUMO

INTRODUCTION: Sepsis is a systemic inflammatory response syndrome caused by infectious diseases, with cytokines possibly having an important role in the disease mechanism. Acrylonitrile-co-methallyl sulfonate surface-treated (AN69ST) membrane is expected to improve the outcomes of patients with sepsis through cytokine adsorption. OBJECTIVE: This study aimed to investigate the clinical effect of the AN69ST membrane in comparison to standard continuous renal replacement therapy (CRRT) membranes for panperitonitis due to lower gastrointestinal perforation. METHODS: Using the Diagnosis Procedure Combination database, we identified adult patients with sepsis due to panperitonitis receiving any CRRT. Propensity score matching was used to compare patients who received CRRT with the AN69ST membrane (AN69ST group) and those who received CRRT with other membranes (non-AN69ST group). The primary outcome measure was in-hospital mortality. RESULTS: A total of 528 and 1,445 patients were included in the AN69ST group and in the non-AN69ST group, respectively. Propensity score matching resulted in 521 pairs. There was no significant difference in in-hospital mortality (32.1 vs. 35.5%; p = 0.265) and 30-day mortality (41.3 vs. 42.8%, p = 0.074) between the AN69ST group and the non-AN69ST group. CONCLUSION: There is no significant difference in-hospital mortality between CRRT with the AN69ST membrane and CRRT with standard CRRT membranes for panperitonitis due to lower gastrointestinal perforation. These results indicate that the AN69ST membrane is not superior to the standard CRRT membrane.

14.
Emerg Med J ; 37(1): 19-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31666333

RESUMO

OBJECTIVE: Focused assessment with sonography in trauma (FAST) examination is a widely known initial evaluation for patients with trauma. However, it remains unclear whether FAST contributes to patient survival in patients with haemodynamically stable trauma. In this study, we compared in-hospital mortality and length of stay between patients undergoing initial FAST vs initial CT for haemodynamically stable torso trauma. METHODS: This was a retrospective cohort study using data from 264 major emergency hospitals in the Japan Trauma Data Bank between 2004 and 2016. Patients were included if they had torso trauma with a chest or abdomen abbreviated injury scale score of ≥3 and systolic blood pressure of ≥100 mm Hg at hospital arrival. Eligible patients were divided into those who underwent initial FAST and those who underwent initial CT. Multivariable logistic regression analysis for in-hospital mortality and multivariable linear regression for length of stay were performed to compare the initial FAST and initial CT groups with adjustment for patient backgrounds while also adjusting for within-hospital clustering using a generalised estimating equation. RESULTS: There were 9942 patients; 8558 underwent initial FAST and 1384 underwent initial CT. Multivariable logistic regression showed no significant difference in in-hospital mortality between the initial FAST and initial CT groups (OR 1.37, 95% CI 0.94 to 1.99, p=0.10). Multivariable linear regression revealed that the initial FAST group had a significantly longer length of stay than the initial CT group (difference: 3.5 days; 95% CI 1.0 to 5.9, p<0.01). CONCLUSIONS: In-hospital mortality was not significantly different between the initial FAST and initial CT groups for patients with haemodynamically stable torso trauma. Initial CT should be considered in patients with haemodynamically stable torso trauma.

16.
World Neurosurg ; 134: e55-e67, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31521760

RESUMO

OBJECTIVE: There has been no precise guide for treatment management of aneurysmal subarachnoid hemorrhage (aSAH) based on the patient's age and treatment method. This study clarifies each risk management for aSAH according to age and treatment method listed in a nationwide database. METHODS: We compared 2 groups of patients (nonelderly, <65 years; elderly, ≥65 years) who underwent surgical clipping or endovascular coiling and were registered in a nationwide database in Japan from 2010 to 2015. The odds ratio (OR) and 95% confidence interval (CI) of each risk factor were calculated through multivariate logistic regression analysis for poor outcome according to a modified Rankin Scale score >2 at discharge for each group. RESULTS: In all groups, the risk factors for poor outcome were older age, male sex, neurologic grade on admission, diabetes mellitus, and use of anticoagulation drugs. Inverse risk factors were a high-volume hospital, academic hospital, hypertension, and use of an antiplatelet drug (OR, 0.63-0.81; 95% CI, 0.56-0.88). Chronic heart disease was also a risk factor, but use of a statin drug (OR, 0.85-0.87; 95% CI, 0.76-0.97) and location other than on the anterior communicating artery (OR, 0.74-0.80; 95% CI, 0.67-0.91) were inverse risks in both the elderly and the endovascular coiling groups. CONCLUSIONS: Management for patients with aneurysmal subarachnoid hemorrhage was recommended in high-volume and academic institutes with the administration of antiplatelet drugs and consideration of several risk factors. Elderly patients undergoing endovascular coiling might be better given a statin drug, and patients with chronic heart failure or an anterior communicating artery aneurysm should be treated more carefully.

17.
Am J Clin Nutr ; 111(2): 378-384, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31751450

RESUMO

BACKGROUND: Whether enteral nutrition (EN) should be administered early in severe traumatic brain injury (TBI) patients has not been fully addressed. OBJECTIVE: The present study aimed to evaluate whether early EN can reduce mortality or nosocomial pneumonia among severe TBI patients. METHODS: Using the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2017 linked with the Survey for Medical Institutions, we identified patients admitted for intracranial injury with Japan Coma Scale scores ≥30 (corresponding to Glasgow Coma Scale scores ≤8) at admission. We designated patients who started EN within 2 d of admission as the early EN group, and those who started EN at 3-5 d after admission as the delayed EN group. The primary outcome was in-hospital mortality. The secondary outcome was nosocomial pneumonia. Propensity score-matched analyses were performed to compare the outcomes between the 2 groups. RESULTS: We identified 3080 eligible patients during the 36-mo study period, comprising 1100 (36%) in the early EN group and 1980 (64%) in the delayed EN group. After propensity score matching, there was no significant difference in in-hospital mortality (difference: -0.3%; 95% CI: -3.7%, 3.1%) between the 2 groups. The proportion of nosocomial pneumonia was significantly lower in the early EN group than in the delayed EN group (difference: -3.2%; 95% CI: -5.9%, -0.4%). CONCLUSIONS: Early EN may not reduce mortality, but may reduce nosocomial pneumonia in patients with severe TBI.

18.
Ann Surg Oncol ; 27(2): 518-526, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31407172

RESUMO

BACKGROUND: Laparoscopic total gastrectomy is gradually gaining popularity; however, previous studies have produced conflicting results regarding the safety and advantages of the procedure, partly because of small sample sizes. The purpose of this study was to compare short-term outcomes between laparoscopic and open total gastrectomy for gastric cancer. METHODS: We analyzed data for patients undergoing laparoscopic or open total gastrectomy for clinical stage I-III gastric cancer from July 2010 to March 2017, using a Japanese nationwide inpatient database. We performed propensity-matched analyses to compare in-hospital mortality, morbidity, duration of anesthesia, time to first oral intake, and length of postoperative stay between the two groups. RESULTS: Among 58,689 eligible patients, propensity-score matching created 12,229 pairs. Laparoscopic total gastrectomy was associated with higher incidences of anastomotic leakage (2.9% vs. 1.7%, p < 0.001) and stenosis (0.9% vs. 0.6%, p = 0.02), lower incidences of pancreatic injury (1.4% vs. 1.8%, p = 0.01), endoscopic hemostasis (0.9% vs. 1.7%, p < 0.001), blood transfusion (9.9% vs. 17.7%, p < 0.001) and 30-day readmission, a shorter interval from surgery to first oral intake (4 vs. 5 days, p < 0.001), shorter postoperative hospital stay (14 vs. 15 days, p < 0.001), and a longer duration of anesthesia (323 vs. 304 min, p < 0.001). There was no significant difference in in-hospital mortality (0.6% vs. 0.8%, p = 0.58). CONCLUSIONS: Laparoscopic total gastrectomy has some advantages over open surgery for gastric cancer in terms of time to first oral intake and postoperative length of stay, but the incidence of anastomotic leakage was higher than that of open total gastrectomy.

19.
Anesth Analg ; 130(2): 367-373, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31124838

RESUMO

BACKGROUND: In myasthenia gravis (MG) patients, postoperative myasthenic crisis, and residual neuromuscular blocking agent (NMBA) can cause respiratory failure that requires mechanical ventilation. However, it remains unclear whether the use of sugammadex for NMBA reversal reduces postoperative myasthenic crisis in MG patients undergoing surgery. We analyzed the association between use of sugammadex and postoperative myasthenic crisis in patients with MG using a national inpatient database. METHODS: Adult patients with MG who received thymectomy under general anesthesia were identified in the Japanese Diagnosis Procedure Combination database from July 1, 2010 to March 31, 2016. Patients who received sugammadex (sugammadex group) were compared with those who did not receive sugammadex (control group). The primary outcome was postoperative myasthenic crisis, and the secondary outcomes were postoperative pneumonia, tracheostomy, 28-day mortality, total hospitalization costs, and length of stay after surgery. Propensity scores were estimated by logistic regression based on the following variables: age; sex; body mass index (BMI); smoking index; history of cancer; Charlson comorbidity index (CCI); type of thymectomy; time from hospital admission to surgery; use of plasma exchange, immunosuppressants, corticosteroids, anticholinesterase, and oral benzodiazepine before surgery; type of hospital; and treatment year. The outcomes were compared using stabilized inverse probability of treatment weighting (IPTW) analyses to obtain good between-group balance. RESULTS: Of 795 patients identified, 506 patients received sugammadex and 289 patients did not. After stabilized IPTW, the sugammadex group was associated with a decrease in postoperative myasthenic crisis (22/507 [4.3%] vs 25/288 [8.7%]; odds ratio [OR], 0.48; 95% confidence interval [CI], 0.25-0.91), but not associated with a decrease in postoperative pneumonia (5/507 [1.0%] vs 7/288 [2.4%]; OR, 0.44; 95% CI, 0.17-1.14) or tracheostomy (7/507 [1.4%] vs 10/288 [3.5%]; OR, 0.38; 95% CI, 0.12-1.22) compared with the control group. The sugammadex group had significantly lower median (interquartile range) total hospitalization costs ($13,186 [$11,250-$16,988] vs $14,119 [$11,713-$20,207]; P < .001) and median length of stay after surgery (10 [8-15] vs 11 [8-18] days; P < .001), compared with the control group. CONCLUSIONS: In this retrospective observational study, sugammadex was associated with reductions in postoperative myasthenic crisis and total hospitalization costs in adult patients with MG who received thymectomy. Given the present findings, sugammadex should be routinely administered for MG patients undergoing thymectomy.

20.
Brain Dev ; 42(1): 48-55, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31522789

RESUMO

BACKGROUND: Treatments for pediatric acute encephalopathy are largely empiric with limited evidence to support. This study investigated recent trends in clinical practice patterns for pediatric acute encephalopathy at a national level. METHOD: Discharge records were extracted for children with acute encephalopathy for the fiscal years 2010-2015 using a national inpatient database in Japan. We ascertained the secular trends in medications, diagnostic and therapeutic procedures, healthcare costs, in-hospital mortality, and length of hospital stays (LOS), using mixed effect linear or logistic regression models. We also ascertained variations and clustering of the practice patterns across different hospitals using hierarchical cluster analyses. RESULTS: A total of 4692 eligible inpatients were identified. From 2010 to 2015, we observed increasing trends in hospitalization costs, corticosteroid and edaravone use and a decreasing trend in LOS. Despite changes in treatments, the rates of home respiratory support and in-hospital mortality were constant during the study period. Hierarchical cluster analyses showed that 6 hospital groups showed largely different therapeutic strategies to the same disease regardless of mortality rates. Hospitals with more intensive treatment practices were likely to have higher mortality, while hospitals with less intensive treatment practices were likely to have the lower mortality. However, hospitals in one group (group 1) had less intensive treatment practice even though they had the highest mortality. CONCLUSIONS: We provided novel insights into the recent trends in treatments for pediatric acute encephalopathy. Therapeutic strategies varied between hospitals, suggesting the importance of pursuing evidence-based treatment strategy and promoting standardized practices to pediatric acute encephalopathy.

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