Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

0584 Impact of Obstructive Sleep Apnea on Chronic obstructive pulmonary disease Hospitalizations

Abstract Introduction Obstructive sleep apnea (OSA) is a sleep disorder that has been linked to increase the risk for hypertension, ischemic heart failure, arrhythmia and heart failure. There are multiple similarities between OSA and Chronic Obstructive Pulmonary Disease (COPD); both are associated with hypoxia and hypercapnia, with different mechanisms of hypoxia; in COPD its chronic and slow progression, whereas it is suddenly intermittent hypoxia in OSA. Intermittent hypoxia was hypothesized to enhance the protective effect on subsequent hypoxia resulting in cardioprotective effect [1]. There is little data on rates of in-hospital mortality on patients with OSA and COPD using a nationwide study. In this study, we aim to analyze the impact on mortality and length of hospital stay of obstructive sleep apnea in patients with COPD. Methods Adults with principal diagnosis of COPD were selected from the 2019 US National Inpatient Sample, using ICD 10 code primary diagnosis on discharge. We queried the 2019 National Inpatient Sample for OSA, and other secondary diagnoses (hyperlipidemia, hypertension, heart failure, smoking, CKD, electrolytes disturbances). Confounders were adjusted for using multivariable linear regression analysis for other secondary diagnoses. Results In a total of 520,624 adult hospitalizations with COPD primary diagnosis on discharge were included from the 2019 national inpatient sample. 73,705 patients had concomitant secondary diagnosis with OSA. On weighted analysis, hospitalizations with primary diagnosis of COPD and secondary diagnosis of OSA had lower in-hospital mortality rates compared to hospitalizations with COPD alone (0.6% vs 1.08%, p= 0.000), .COPD hospitalizations with OSA had statistically significant lower odds for mortality compared to COPD patients without OSA (adjusted OR 0.73, 95% CI 0.57-0.93; p= 0.009).However, COPD hospitalizations with OSA showed increased in the mean length of stay by 0.21 days (95% CI 0.12-0.30, p=0.000) compared to patients without OSA. Conclusion Our analysis showed better mortality outcomes for COPD patients with OSA , supporting the protective effect hypothesis of intermittent hypoxia. COPD patients with concomitant secondary OSA diagnosis have increased in-hospital length of stay. Support (If Any) 1- Murry CE, Jennings RB, Reimer KA (1986) Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 74:1124–1136 </jats:sec

0589 REM Sleep Behavior Disorder is Associated with Poor Outcomes in Pulmonary Embolism Hospitlizations

Abstract Introduction REM Sleep Behavior Disorder (RBD), is a rare sleep behavior disorder, characterized by loss of skeletal muscle atonia during REM sleep, resulting in prominent motor activity with exhibited behavior mirroring the image of the dreams during sleep. Other sleep disorders were studied before in patients with Pulmonary Embolism (PE). Although, REM sleep behavior disorder association with pulmonary embolism has never been described. In this study we aim to study the prevalence of RBD in patients admitted with PE, and to assess the association between RBD and PE. Methods Adults with principal diagnosis of Pulmonary Embolism (PE) on discharge were selected from the 2019 US National Inpatient Sample, using ICD 10 code primary diagnosis. We queried the 2019 National Inpatient Sample for secondary diagnosis of RBD, Obstructive Sleep Apnea (OSA) and other secondary diagnoses (hyperlipidemia,history of old myocardial infarction, atrial fibrillation, Chronic obstructive pulmonary disease, hypertension, heart failure, smoking, chronic kidney disease , electrolytes disturbances). Confounders were adjusted for using multivariable linear regression analysis for other secondary diagnoses. Results In a total of 188,355 hospitalizations with PE primary diagnosis on discharge were included from the 2019 national inpatient sample, 25 hospitalizations had concomitant secondary diagnosis with RBD. The overall in-hospital mortality for PE was 3.2%. On weighted analysis, Patients with RBD had statistically significant higher odds for mortality compared to patients without [adjusted odds ratio (OR): 17.15; 95% confidence interval (CI): 2.75-106.8, p= 0.002], 20% mortality rate in patients with RBD compared to 0.03% in patients without RBD (p= 0.03). OSA did not show significant result for mortality when compared to without OSA [adjusted odds ratio (OR): 0.83; 95% confidence interval (CI): 0.67-1.04, p= 0.114]. Conclusion Our analysis showed a low number of patients with secondary diagnosis of RBD in hospitalizations with primary diagnosis of PE on discharge. However significant association between RBD and mortality in patients with PE primary diagnosis on discharge. The identification of patients with RBD in patients admitted with PE may help decrease mortality rate. Furthermore, our analysis showed that OSA is an independant variable for mortality in PE hospitalization. Support (If Any)   </jats:sec

Transverse Response of an Axially Moving Beam with Intermediate Viscoelastic Support

This study presented the transverse vibration of an axially moving beam with an intermediate nonlinear viscoelastic foundation. Hamilton’s principle was used to derive the nonlinear equations of motion. The finite difference and state-space methods transform the partial differential equations into a system of coupled first-order regular differential equations. The numerical modeling procedures are utilized for evaluating the effects of parameters, such as axial translation velocity, flexure rigidities of the beam, damping, and stiffness of the support on the transverse response amplitude and frequencies. It is observed that the dimensionless fundamental frequency and magnitude of axial speed had an inverse correlation. Furthermore, increasing the flexure rigidity of the beam reduced the transverse displacement, but at the same instant, fundamental frequency rises. Vibration amplitude is found to be significantly reduced with higher damping of support. It is also observed that an increase in the foundation damping leads to lower fundamental frequencies, whereas increasing the foundation stiffness results in higher frequencies.</jats:p