Decreasing Mortality and Hospitalizations with Rising Costs Related to Gastric Cancer in the USA: An Epidemiological Perspective

BACKGROUND: There is no convincing data on the trends of hospitalizations, mortality, cost, and demographic variations associated with inpatient admissions for gastric cancer in the USA. The aim of this study was to use a national database of US hospitals to evaluate the trends associated with gastric cancer. METHODS: We analyzed the National Inpatient Sample (NIS) database for all patients in whom gastric cancer (ICD-9 code: 151.0, 151.1, 151.2, 151.3, 151.4, 151.5, 151.6, 151.8, 151.9) was the principal discharge diagnosis during the period, 2003-2014. The NIS is the largest publicly available all-payer inpatient care database in the US. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay, and hospital costs over the study period was determined by regression analysis. RESULTS: In 2003, there were 23,921 admissions with a principal discharge diagnosis of gastric cancer as compared to 21,540 in 2014 (P \u3c 0.01). The mean length of stay for gastric cancer decreased by 17% between 2003 and 2014 from 10.9 days to 8.95 days (P \u3c 0.01). However, during this period, the mean hospital charges increased significantly by 21% from $75,341 per patient in 2003 to$ 91,385 per patient in 2014 (P \u3c 0.001). There was a more significant reduction in mortality over a period of 11 years from 2428 (10.15%) in 2003 to 1345 (6.24%) in 2014 (P \u3c 0.01). The aggregate charges (i.e., national bill ) for gastric cancer increased significantly from 1.79 bn $to 1. 96 bn$ (P \u3c 0.001), despite decrease in hospitalization (inflation adjusted). CONCLUSION: Although the number of inpatient admissions for gastric cancer have decreased over the past decade, the healthcare burden and cost related to it has increased significantly. Inpatient mortality is decreasing which is consistent with overall decrease in gastric cancer-related deaths. Cost increase associated with gastric cancer contributed significantly to the national healthcare bill

The Design and Synthesis of New Materials using Nucleophilic Aromatic Substitution Reactions

Abstract The overall objective of this research was to synthesize and study the structure-property relationships of novel polycyclic aromatic compounds capable of producing open crystalline networks based on π-stacking interactions in solid state. In this work, we describe a method of producing polycyclic aromatic compounds bearing electron-rich and electron-poor rings in order to promote cofacial π-stacking in the solid state. These compounds were synthesized from easily accessible molecules using nucleophilic aromatic substitution and copper-catalyzed aryl amination. The scope of phenoxazines bearing N-aryl substituents was explored for the synthesis of various polycyclic aromatic compounds. Interesting characteristics such as luminescence and predictable solid-state packing are displayed by electron-deficient phenoxazines. A focus was placed upon tuning the properties of the compounds by attaching phenoxazine units to different molecular architectures with the goal of producing open crystalline networks based on π-stacking interactions. The orange-colored solid compound 30 N-(4-bromophenyl) di-fluoro-di-cyano-phenoxazine was synthesized. Suzuki cross-coupling was used to attach an additional phenyl ring to compound 30 to produce compound 31. Similarly, compound 32 was synthesized by the reaction of 1, 4- benzenediboronic acid with two equivalents of compound 30. The crystal structure of compound 31revealed the presence of π-stacking interactions between the phenoxazine rings. The synthetic approach was extended to the preparation of heteropentacenes such as 52 and 58. Compound 52, which bears long alkyl chains, showed evidence of liquid crystallinity by polarized optical microscopy. However, the N-aryl heteropentacenes also showed limited stability

Decreasing mortality and hospitalizations with rising costs related to gastric cancer in the USA: an epidemiological perspective

Abstract Background There is no convincing data on the trends of hospitalizations, mortality, cost, and demographic variations associated with inpatient admissions for gastric cancer in the USA. The aim of this study was to use a national database of US hospitals to evaluate the trends associated with gastric cancer. Methods We analyzed the National Inpatient Sample (NIS) database for all patients in whom gastric cancer (ICD-9 code: 151.0, 151.1, 151.2, 151.3, 151.4, 151.5, 151.6, 151.8, 151.9) was the principal discharge diagnosis during the period, 2003–2014. The NIS is the largest publicly available all-payer inpatient care database in the US. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay, and hospital costs over the study period was determined by regression analysis. Results In 2003, there were 23,921 admissions with a principal discharge diagnosis of gastric cancer as compared to 21,540 in 2014 (P < 0.01). The mean length of stay for gastric cancer decreased by 17% between 2003 and 2014 from 10.9 days to 8.95 days (P < 0.01). However, during this period, the mean hospital charges increased significantly by 21% from $75,341 per patient in 2003 to$ 91,385 per patient in 2014 (P < 0.001). There was a more significant reduction in mortality over a period of 11 years from 2428 (10.15%) in 2003 to 1345 (6.24%) in 2014 (P < 0.01). The aggregate charges (i.e., “national bill”) for gastric cancer increased significantly from 1.79 bn $to 1. 96 bn$ (P < 0.001), despite decrease in hospitalization (inflation adjusted). Conclusion Although the number of inpatient admissions for gastric cancer have decreased over the past decade, the healthcare burden and cost related to it has increased significantly. Inpatient mortality is decreasing which is consistent with overall decrease in gastric cancer-related deaths. Cost increase associated with gastric cancer contributed significantly to the national healthcare bill

National Trends of Endoscopic Retrograde Cholangiopancreatography Utilization and Outcomes in Decompensated Cirrhosis

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) can be challenging in patients with decompensated cirrhosis (DC) due to increased risk of adverse events related to liver dysfunction. Limited data exist regarding its national utilization in patients with DC. We aim to determine the trends in utilization and outcomes of ERCP among patients with DC in US hospitalizations. METHODS: We identified hospitalizations undergoing ERCP (diagnostic and therapeutic) between 2000 and 2013 from the National Inpatient Sample (NIS) database and used validated ICD9-CM codes to identify DC hospitalizations. We utilized Cochrane-Armitage test to identify changes in trends and multivariable survey regression modeling for adjusted odds ratios (aOR) for adverse outcomes and mortality predictors. RESULTS: There were 43782 cases of ERCPs performed in DC patients during the study period. Absolute number of ERCPs performed in this population from 2000 to 2013 showed an upward trend; however, the proportion of DC patients undergoing ERCP remained stable. We noted significant decrease in utilization of diagnostic ERCP and an increase of therapeutic ERCPs (P \u3c 0.01). There was a significant decrease in the mean length of stay for DC patients undergoing ERCP from 8.2 days in 2000 to 7.2 days in 2013 (P \u3c 0.01) with an increase in the mean cost of hospitalization from $17053 to$19825 (P \u3c 0.001). Mortality rates showed a downward trend from 2000 to 2013 from 13.6 to 9.6% (P \u3c 0.01). Increasing age, Hispanic race, diagnosis of hypertension and diabetes mellitus, and private insurance were related to adverse discharges(P \u3c 0.01). Increasing age, presence of hepatic encephalopathy, and sepsis were associated with higher mortality (P \u3c 0.01). CONCLUSIONS: There is an increasing trend in therapeutic ERCP utilization in DC hospitalizations nationally. There is an overall decrease in mortality in DC hospitalizations undergoing ERCP. This improvement in mortality suggests improvement in both procedural technique and peri-procedural care as well as overall decreasing mortality in cirrhosis

National Landscape of Unplanned 30-Day Readmission Rates for Acute Non-hemorrhagic Diverticulitis: Insight from National Readmission Database

BACKGROUND: Early readmissions are an important indicator of the quality of care. Limited data exist describing hospital readmissions in acute diverticulitis. The study aimed to describe unplanned, 30-day readmissions among adult acute diverticulitis patients and to assess readmission predictors. METHODS: We analyzed the 2013 and 2014 United States National Readmission Database and identified acute diverticulitis admissions using administrative codes in adult patients older than 18 years of age. Our primary outcome was a 30-day, unplanned readmission rate. We used Chi-square tests, t tests, and Wilcoxon rank-sum tests for descriptive analyses and survey logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals for associations with readmissions adjusting for confounders. RESULTS: In the cohort of 364,511 hospitalizations with acute diverticulitis, as the primary diagnosis on index admission, 31,420 (8.6%) had at least one unplanned 30-day readmission. Sixty percent of the readmissions occurred within the first 2 weeks of the index admission. The most common reasons for unplanned 30-day readmission were due to diverticulitis of the colon (41.5%), postoperative infection (4.2%), septicemia (3.6%), intestinal infection due to Clostridium difficile (3%), and other digestive system complications such bleeding or fistula (2.8%). Multivariable analysis showed advance age (\u3e 75 years), discharge against medical advice, comorbidities (renal failure, coronary artery disease, atrial fibrillation, congestive heart failure, hypertension, diabetes, obesity, weight loss, chronic lung disease, malignancy), blood transfusion, Medicare and Medicaid insurance, and increased length of stay (\u3e 3 days) were associated with significantly higher odds for readmission. Patients who have undergone abdominal surgery during index admission were 31% less likely to get readmitted. CONCLUSIONS: On a national level, 1 in 11 hospitalizations for acute diverticulitis was followed by unplanned readmission within 30 days with most admissions occurring in the first 2 weeks. Multiple modifiable and non-modifiable factors influencing readmission rates were noted. Further studies should examine if strategies that address these predictors can decrease readmissions