4 research outputs found
Hospital teaching status and trascatheter aortic valve replacement outcomes in the United States: Analysis of the national inpatient sample
BackgroundEvidence suggests that medical service offerings vary by hospital teaching status. However, little is known about how these translate to patient outcomes. We therefore sought to evaluate this gap in knowledge in patients undergoing Transcatheter aortic valve replacement (TAVR) in the United States.MethodsThis study was conducted using the National Inpatient Sample (NIS) in the United States from 2011 to 2014. Teaching status was classified, as teaching vs. nonteaching and endpoints were clinical outcomes, length of stay and cost. Procedureâ related complications were identified via ICDâ 9 coding and analysis was performed via mixed effect model.ResultsAn estimated 33,790 TAVR procedures were performed in the U.S between 2011 and 2014, out of which 89.3% were in teaching hospitals. Mean (SD) age was 81.4 (8.5) and 47% were females. There was no significant difference between teaching versus nonteaching hospitals in regards to the primary outcome of inâ hospital mortality and secondary outcomes of several cardiovascular and other end points except for a high rates of acute kidney injury (AKI) (OR: 1.34 [95% CI, 1.04â 1.72]) and lower rate for use of mechanical circulatory support devices in teaching vs. nonteaching centers. The mean length of stay was significantly higher in teaching hospitals (7.7 days) vs. nonteaching hospitals (6.8 days) (Pâ =â 0.002) and so was the median cost of hospitalization (USD 50,814 vs. USD 48, 787, Pâ =â 0.02) for teaching vs. nonteaching centers.ConclusionMost TAVR related shortâ term outcomes including all cause inâ hospital mortality are about the same in teaching and nonteaching hospitals. However, AKI, length of hospital stay and TAVR related cost were significantly higher in teaching than nonteaching hospitals. There was more use of mechanical circulatory support in nonteaching than teaching hospitals.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141703/1/ccd27236.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141703/2/ccd27236_am.pd
Statins and Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis
Contrast-induced nephropathy (CIN) is a type of acute kidney injury
associated with intravascular administration of iodinated contrast,
usually reversible. Contrast agents are an essential component of
invasive and noninvasive coronary angiography. These agents have been
modified over time to enhance patient safety and tolerability, but
adverse reactions still occur. CIN has been variably defined, as a rise
in serum creatinine of 0.5 mg/dl, or a 25% increase in serum creatinine
above baseline within 24-72 hours after the procedure. The incidence of
CIN varies based on the definition used and risk profile of the
patients. CIN is rare among patients with normal renal function at
baseline. In low-risk patients, CIN occurs in 1-5%, whereas in
higher-risk populations, the incidence can be as high as 30%. CIN is
also associated with a 5-to 20-fold increased risk of other early
adverse events including in-hospital myocardial infarction, target
vessel occlusion, and early mortality. The main prevention strategies
are adequate intravenous hydration before, during and after the
procedure as well as restriction of contrast load with maximum volume
approximately no more than three times the serum creatinine clearance.
Recent observational and small prospective randomized trials demonstrate
the reduction of CIN incidence with HMG-CoA enzyme inhibitors. In this
systematic review and meta-analysis we explore the effects of statin
administration in prevention of CIN