PROTOCOL: New York State Race, Ethnicity, and Insurance Disparities in Follow-up Prostate Cancer Screening

Using de-identified reports from the Statewide Planning and Research Cooperative System (SPARCS) data, this descriptive study will identify the impact of socioeconomic status (SES) metrics on the follow-up prostate cancer screening care within 3 years of index prostate cancer screening test in NYS. The socioeconomic status metrics will be subclassified into race, insurance, and ethnicity and each of these sub-components will be evaluated for its impact on the follow-up cancer screening care. The exclusion criteria for this study includes patients records with unknown age, age \u3c55 or \u3e75, previous history of prostate cancer or radical prostatectomy, previous prostate biopsy, female sex, lives outside NYS, unknown or missing data on race, ethnicity, or insurance status, or multi-ethnic patients. For the included patients, initial prostate cancer screening, follow-up screening, characteristics (e.g., age, SES), and risk profiles will be evaluated. Moreover, patients diagnosed with prostate cancer or receiving prostatectomy will be reported. Additionally, the following hypotheses will be tested: H(0): Among patients with a baseline PSA test, socioeconomic status (SES) metrics (i.e., vulnerability based upon race/insurance/ethnicity) may pose as barriers to follow-up prostate cancer screening care within 3 years of index prostate cancer screening test (e.g., Vulnerability = V = Black, Hispanic, and Self-pay Insurance) o H(0): Among patients with a baseline PSA test, race does not impact the likelihood of follow-up prostate cancer screening care within 3 years of index prostate cancer screening test (e.g., R-FC) o H(0): Among patients with a baseline PSA test, insurance does not impact the likelihood of follow-up prostate cancer screening care within 3 years of index prostate cancer screening test (e.g., I-FC) o H(0): Among patients with a baseline PSA test, ethnicity does not impact the likelihood of follow-up prostate cancer screening care within 3 years of index prostate cancer screening test (e.g., E-FC

Single Versus Multi-Center Surgeons\u27 Risk-Adjusted Mitral Valve Repair Procedural Outcomes

The purpose of this study is to explore strategies to improve mitral valve repair (MVr) outcomes. This research explores postoperative outcomes of patients undergoing MVr surgery by single center surgeons versus patients of multicenter surgeons. Specific outcomes of interest include 30-day operative mortality, major operative complications (e.g., deep sternal wound infection, permanent stroke, renal dysfunction requiring dialysis, reoperation, and prolonged ventilation), length of stay, and 30-day readmissions. In brief, the serisk-adjusted outcome rates for surgeons that perform mitral valve repair procedures will be compared for surgeons that operate at a single center [i.e. SC surgeons] versus multiple centers [i.e. MC surgeons]. The overarching study hypothesis is: H(0) There will be no difference in the risk-adjusted outcome rates between surgeons that operate at a single center [i.e. SC surgeons] versus multiple centers [i.e. MC surgeons]. Based on prior research, however, it is anticipated that single center surgeons may have superior outcomes compared to multi-center surgeons

Trends Over Time in Incidence of Bicuspid Aortic Valve Patients with Thoracic Aortic Aneurysms in New York

Aim: Bicuspid aortic valve (BAV) is one of the most common congenital cardiac malformations, with increased risk for early onset thoracic aortic aneurysms (TAA). This study aims to examine the trends over time in incidence of BAV patients with TAA, given imaging advancements and increased frequency of imaging. Methods: Using administrative billing codes, this retrospective cohort study analyzed New York Statewide Planning and Research Cooperative System records from January 2007- December 2018, evaluating BAV+TAA incidence trends. Subgroups based on index admission were evaluated with a pre-identified 2014 inflection time point using an interrupted time series (ITS) analysis. Results: Using a New York State-wide billing database, 3,294 BAV and TAA first-time encounters were classified into three diagnosis-related patient sub-groups, as patients with: historical BAV + new TAA diagnoses (24.74%); new BAV + historical TAA diagnoses (27.57%); and new BAV + new TAA diagnoses (47.69%). Total BAV and TAA diagnostic incidence increased from 7.93/1,000,000 residents in 2007, to 24.75/1,000,000 residents in 2018 (overall annual rate of 17.91/1,000,000, p\u3c .001). With a pre-established 2014 inflection point, the incidence rate dramatically changed for new BAV+ new TAA patients (slope = 0.7592, 95% CI 0.2332-1.2851)

Thoracic Aortic Aneurysm Patients’ Diagnosis, Treatments, and Outcomes: The New York Experience

IMPORTANCE: Traditionally, thoracic aortic aneurysms (TAA) were diagnosed upon complications arising or post-mortem examination. Following 2014, asymptomatic new TAA diagnoses noticeably rose at increasing rates. In parallel, reductions in the rates of urgent/emergent TAA-related treatments and adverse risk-adjusted short-term outcomes were observed. OBJECTIVES: For New York State adult residents, the trends from 2005 to 2018 in new thoracic aortic aneurysm (TAA) diagnoses, surgical treatments, percutaneous treatments, and risk-adjusted outcomes were examined. DESIGN: This retrospective cohort study documented the quality of TAA care provided to New York adult residents. SETTING: Using the 2005 to 2018 New York Statewide Planning and Research Cooperative System (SPARCS) database, billing codes detected 74,118 newly diagnosed TAA patients; of these, 84.06% (n = 62,307) were non-ruptured diagnoses. PARTICIPANTS: Overall, TAA patients’ mean age was 71.00 years + 19.00 years; 62.47% were male. EXPOSURES: TAA patients’ baseline characteristics, TAA-related interventions, and adverse outcomes were reported. MAIN OUTCOMES: Trends over time were evaluated for TAA diagnosis rates, TAA surgical and percutaneous treatment rates, and adverse clinical outcomes (e.g., 30-day mortality, and 30-day readmission). RESULTS: Overall, new TAA diagnoses increased from 19.8/100,000 residents (2005) to 75.73/100,000 residents (2018); starting in 2014, a dramatic rise in detection of new non-ruptured TAA diagnoses was observed. In contrast, treatment rates decreased for surgical (19.33% in 2005 to 6.54% in 2018) and percutaneous (4.17% in 2006 to 1.53% in 2018) procedures. Comparing pre-2014 versus post-2014, TAA patients had greater chances of having an open surgery (odds ratio [OR] = 1.77; p \u3c 0.0001) or percutaneous procedure (OR = 1.79; p \u3c 0.0001). Over time, 30-day operative mortality decreased (OR = 0.94; p-value \u3c 0.0001). As an “at risk” patient sub-group, however, elderly women had very high 30-day mortality risk (OR: 1.87; p \u3c 0.0001). CONCLUSIONS: Post-2014, the New York State rates of new non-rupture TAA diagnoses radically increased; serendipitously, the TAA-related treatment and short-term adverse outcome rates decreased. Given expanded chest imaging due (in part) to new lung cancer guidelines and transcatheter aortic valve procedures, the enhanced TAA diagnosis rates post-2014 appear to have resulted in overall TAA patients’ quality of care improvements

End-Stage Acute Thoracic Aortic Care Patients’ Interventions and Two-Year Survival: the New York State Experience

BACKGROUND: Scarce US-based regional or State-specific reports exist recording the incidence, prevalence, or post-diagnosis clinical outcomes for end-stage thoracic aortic aneurysmal (TAA) disease. This retrospective cohort study of New York State (NYS) patients with newly diagnosed ruptured or dissected thoracic aortic aneurysms (TAA-RD) documents two-year follow-up after elective and emergent procedures. METHODS: Using hospital billing codes, NYS first-time TAA-RD encounters were extracted. As the primary study endpoint, the two-year composite included all-cause death, subsequent rupture or dissection, or non-elective intervention; individual composite sub-components were secondary study endpoints. Multivariable logistic regression models estimated two-year intervention and composite outcome risks. Using multivariable regression models created for the composite endpoints, post-discharge elective TAA procedural impact was evaluated. RESULTS: Of the 5,789 NYS residents identified, 49.92% reached the two-year composite endpoint with 23.98% two-year deaths. Only 1902 (32.86%) of TAA-RD patients had an index intervention. Post-discharge elective TAA interventions dramatically reduced adverse outcome risk (odds ratio [O.R.] = 0.36; 95% confidence interval [C.I.] = 0.26 - 0.51). Multivariable regression models identified patient characteristics associated with the two-year adverse composite outcome including urgent/emergent status, increased Elixhauser comorbidity score, non-rheumatic aortic regurgitation, and carotid disease. CONCLUSIONS: Nearly 50% of NYS TAA-RD patients reached the two-year adverse endpoint. Post-2014, the TAA-RD diagnosis rates increased but emergent thoracic aortic surgery rates decreased. Surprisingly, under 50% of NYS TAA-RD patients received an index admission procedure; this rate is lower than anticipated. Beyond traditional morphologic metrics, “at risk” TAA patient-characteristics were identified. Post-discharge survivors had excellent post-procedural two-year durability rates

Risk factors adversely impacting post coronary artery bypass grafting longer-term vs. shorter-term clinical outcomes

Aim: Coronary artery bypass grafting (CABG) patients’ characteristics and surgical techniques associated with short-term (ST; < 1 year) mortality are well documented; however, the literature pinpointing factors predictive of longer-term (LT; ≥ 1 year) death rates are more limited. Thus, the CABG factors associated with ST vs. LT mortality were compared.Methods: Using advanced PubMed search techniques, the factors associated with improved post-CABG mortality were compared for ST vs. LT prediction models; ST vs. LT models’ results were compared across three time periods: until 1997, 1998-2007, and 2007-2017.Results: Of 156 post-CABG mortality risk models (n = 125 publications), 133 ST and 23 LT models were evaluated. Important predictors consistently included age, ejection fraction, and renal dysfunction/dialysis. The ST models more commonly identified surgical priority, gender, and prior cardiac surgery; however, the LT models more frequently included diabetes and peripheral arterial disease. Compared to ST mortality, patterns also emerged for cerebrovascular disease and chronic lung disease predicting LT mortality. As modifiable risks, body mass index or another marker of body habitus appeared in 31/133 (23%) of ST models; smoking or tobacco use was considered in only 4/133 (3%). No models evaluated compliance with ischemic heart disease guidelines. No time period-related differences were found.Conclusion: Different risk factors predicted ST vs. LT post-CABG mortality; for LT death, debilitating chronic/complex comorbidities were more often reported. As few models focused on identifying modifiable patient risks or ischemic heart disease guideline compliance, future CABG LT risk modeling should address these knowledge gaps