Risk of ACL and Meniscus Injury, and Subsequent Surgical Repair Increased in Tobacco Users: A Case-Controlled Retrospective Cohort Study of over 3 Million Patients

Objective: The purpose of this study was to determine if individuals who use tobacco are at increased odds of: (1) Meniscus or ACL injury; (2) meniscus or ACL reconstructive surgery; and (3) in-hospital lengths of stay (LOS). Background: While literature demonstrates associations between tobacco use and ligament reconstruction complications, there is little data analyzing risks that tobacco use may have on the injury development, need for subsequent surgery, or impact on lengths of stay (LOS). Methods: An insurance claims population was retrospectively analyzed using ICD-9 and ICD-10 codes. Patients who used tobacco were matched to controls according to age and medical comorbidities. Outcomes analyzed included: meniscus or ACL injury; (2) meniscus or ACL reconstructive surgery; and (3) in-hospital LOS. A p-value less than 0.05 was considered statistically significant. Results: Tobacco users had increased odds (3.43 vs. 3.28%; OR: 1.10, pppp Conclusion: This analysis of over 3 million patients demonstrates that tobacco use increases incidence and odds of both meniscus and ACL injury, surgical repair and LOS. Additionally, tobacco use appears to increase the need for subsequent surgical repair after meniscus or ACL injury

Evaluating the Risk of Hydrochlorothiazide and ACE Inhibitor Exposure and Cutaneous Malignant Neoplasm

Objective. This study was conducted to assess the effects of using hydrochlorothiazide (HCTZ) and angiotensin-converting enzyme inhibitors (ACEIs) alone and in combination, and the risk of developing cutaneous malignant neoplasm (CMN). Background. HCTZ and ACEIs are known photosensitizers, which cause phototoxicity following exposure to the drug and either UV or visible radiation, posing a future risk for skin cancer. Previous studies have not examined combined ACEI and HCTZ use and increased risk of malignancy. Methods. The study was conducted through a HIPAA compliant national database in the United States between 2010 and 2018, retrospectively reviewed using diagnostic codes for CMN and generic drug codes for ACEIs and HCTZ. Access to the database was granted by Holy Cross Health, Fort Lauderdale, for the purpose of academic research. Standard statistical tests were used. Results. The query yielded 1,375,562 patients, with 436,377 taking these antihypertensives and 939,185 that were not. CMN occurred in the antihypertensive-consuming population with an incidence of 4,327 (0.99%) and occurred in the control population with an incidence of 6,210 (0.66%). The difference was statistically significant with χ² p=2.2x10-16 and logistic regression odds ratio (OR) = 1.48 (95% CI, 1.42-1.55). Patients taking HCTZ and ACEIs together have an increased risk of developing CMN that is statically significant. Conclusion. The study shows a statistically significant correlation between both HCTZ and ACEI consumption and development of CMN. Further investigation is recommended regarding the potential synergistic adverse effects when HCTZ and ACEIs are used together and the development of CMN

Improving Value in Colorectal Cancer Care: An Economic Analysis of Enhanced Recovery Protocols at a Community Hospital

Background: Enhanced recovery protocols (ERPs) have been shown to improve the outcomes of gastrointestinal cancer care, leading to reduced morbidity of gastrointestinal treatment and reduced delays in systemic therapy. ERP implementation has also previously shown a reduction in length of stay (LOS) without changing the readmission rate; however, the economic cost associated with these measures has not yet been quantified. The aim of this study was to evaluate the economic costs of ERP implementation for colorectal cancer at a community hospital. Methods: The Diagnostic Related Group (DRG) codes were used to assess costs associated with the hospitalizations of cases in the ERP versus non-ERP groups. The American Hospital Association (AHA) Annual Survey from 1999 to 2015 was used to provide the expenses per day for inpatient hospitalization in the United States. Postoperative LOS, average healthcare costs, and postoperative complications between ERP-protocol and non-ERP protocol groups were analyzed using analysis of variance (ANOVA) and independent t-tests

Human Cytomegalovirus (CMV) Infection Associated With Decreased Risk of Bronchogenic Carcinoma: Understanding How a Previous CMV Infection Leads to an Enhanced Immune Response Against Malignancy.

INTRODUCTION:  Cytomegalovirus (CMV) causes a long-lasting, asymptomatic infection that reportedly has both advantageous and deleterious effects on tumor progression. The purpose of this study was to evaluate the correlation between CMV infection and the incidence of bronchogenic carcinoma. METHODS: The study was conducted using a Health Insurance Portability and Accountability Act (HIPAA) compliant national database to identify patients both with and without histories of CMV infection using International Classification of Diseases (ICD-10 and ICD-9) codes. Access to the database was granted by Holy Cross Health, Fort Lauderdale for the purpose of academic research with standard statistical methods used to analyze the data. 14,319 patients were included in both the control and CMV-exposed groups and matched by age range and Charlson Comorbidity Index (CCI) scores. RESULTS: The incidence of bronchogenic carcinoma was 1.69% (243/14,319 patients) in the CMV group and 6.08% (871/14,319 patients) in the control group. The difference was statistically significant by a p-value of less than 2.6x10 CONCLUSION: This study found a statistically significant correlation between a prior CMV infection and a reduced incidence of bronchogenic carcinoma. This study demonstrates the need for further investigation into how the tumor microenvironment and host immune system are altered by the presence of a latent CMV infection