Obstructive sleep apnea: Risk factor for arrhythmias, conduction disorders, and cardiac arrest.
mortality; arrhythmia; conduction disorder; national inpatient sample; obstructive sleep apnea
Background Obstructive sleep apnea (OSA) has been described as a risk factor for cardiac arrhythmias. Its association with atrial fibrillation has been established. However, relationships with other arrhythmias and conduction disorders have not been fully studied. Methods We used the National Inpatient Sample database from 2009 to 2011 to explore the relationship between OSA and arrhythmias and conduction disorders. The presence of diagnosis was determined based on the International Classification of Disease-9 (ICD-9) codes. Univariate and multivariate logistic regressions were used to establish mortality risks among all groups. Results Multivariate logistic regression showed increased mortality in patients with OSA in comparison to patients without OSA and patients across all categories of arrhythmias and conduction disorders. One significant finding was the increased association of cardiac arrest in patients with OSA versus patients without OSA (OR: 95.72; CI: 89.13-105.81, p < 0.001). Conclusions OSA is significantly associated with non-atrial fibrillation arrhythmias, conduction disorders, and sudden cardiac arrest. Awareness regarding this association is important for early screening for OSA in obese patients to prevent cardiovascular morbidity and mortality. The use of continuous positive airway pressure (CPAP) might be beneficial against all kinds of arrhythmias and sudden cardiac death. (Copyright © 2020, Acharya et al.)
Acharya R;Basnet S;Tharu B;Koirala A;Dhital R;Shrestha P;Poudel D;Ghimire S;Kafle S
Cureus
2020
2020-08-24
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.7759/cureus.9992" target="_blank" rel="noreferrer noopener">10.7759/cureus.9992</a>
Occurrence of never events after total joint arthroplasty in the United States.
Total knee arthroplasty; Hospital-acquired condition; Medical quality; National Inpatient Sample; Never events; Total hip arthroplasty; Total joint arthroplasty
BACKGROUND: Total joint arthroplasty (TJA) is a major orthopedic procedure associated with substantial morbidity and mortality. Never events (NEs) are harmful hospital-acquired conditions (HACs) that are preventable. METHODS: Information on hospital admissions with TJA was collected from the National Inpatient Sample (NIS) from 2003 to 2012. NIS was queried to identify NE applicable to TJA patients based on the HAC definition listed by the Centers for Medicare and Medicaid Services (CMS). NEs were further compared before and after 2008 to evaluate the effect of the new CMS non-reimbursement policy on their incidence. RESULTS: A total of 8,176,774 patients were admitted with TJA from 2003 to 2012. 108,668 patients of these (1.33%) had >/= 1 NE. The most prevalent NE was fall and trauma (0.7%). Significant multivariable predictors with higher odds of developing at least one NE included weekend admission [odds ratio (99.9% CI), 4.3 (3.1, 5.8), p < 0.001] and weight loss [odds ratio (99.9% CI), 2.8 (2.2, 3.5), p < 0.001]. A temporal comparison of NE before and after 2008 revealed a decrease in total NE occurrence after 2008 when the CMS announced discontinuing payment for NE (1.39% vs. 1.25%, p < 0.001). After adjustment for potential confounding risk factors, NE after TJA was significantly associated with an increased mortality (p < 0.001), a longer hospital stay (p < 0.001), and higher total hospitalization charges (p < 0.001). CONCLUSIONS: These data demonstrated that NE in TJA patients was predictive of an increased mortality, length of hospital stay, and hospitalization costs. This study established baseline NE rates in the TJA patient population to use as benchmarks and identified target areas for quality improvement in US.
Tsai Allen J
Archives of orthopaedic and trauma surgery
2019
2019-03
<a href="http://doi.org/10.1007/s00402-019-03156-0" target="_blank" rel="noreferrer noopener">10.1007/s00402-019-03156-0</a>