We investigated the incidence of and risk factors for persistent pain after caesarean delivery. Over a 12-month period, women having caesarean delivery were recruited prospectively at an Australian tertiary referral centre. Demographic, anaesthetic and surgical data were collected and at 24 hour follow-up, women were assessed for immediate postoperative pain and preoperative expectations of pain. Long-term telephone follow-up was conducted at two and 12 months postoperatively. Complete data were obtained from 426 of 469 women initially recruited (90.6%). The incidence of persistent pain at the abdominal wound at two months was 14.6% (n=62) but subsequently reduced to 4.2% (n=18) at 12 months. At two months, 33 patients (7.8%) experienced constant or daily pain. At 12 months, five patients (1.1%) continued to have constant or daily pain which was mild. There was no apparent increase in incidence of persistent pain associated with general versus regional anaesthesia (relative risk [RR] 0.89, 95% confidence interval [CI] 0.49 to 1.6); emergency vs elective procedure (RR 0.65, 95% CI 0.39 to 1.07); higher acute pain scores (RR 1.1, 95% CI 0.69 to 1.75); or history of previous caesarean delivery (RR 0.81, 95% CI 0.50 to 1.33). Persistent pain, usually of a mild nature, is reported by some women two months after their caesarean delivery, but by 12 months less than 1% of women had pain requiring analgesia or affecting mood or sleep. All declined a pain clinic review. Clinicians and patients can be reassured that caesarean delivery is unlikely to lead to severe persistent pain in the long-term.

Background and Objectives: With the growing recreational cannabis use and recent reports linking it to hypertension, we sought to determine the risk of hypertensive crisis (HC) hospitalizations and major adverse cardiac and cerebrovascular events (MACCE) in young adults with cannabis use disorder (CUD+). Material and Methods: Young adult hospitalizations (18–44 years) with HC and CUD+ were identified from National Inpatient Sample (October 2015–December 2017). Primary outcomes included prevalence and odds of HC with CUD. Co-primary (in-hospital MACCE) and secondary outcomes (resource utilization) were compared between propensity-matched CUD+ and CUD- cohorts in HC admissions. Results: Young CUD+ had higher prevalence of HC (0.7%, n = 4675) than CUD- (0.5%, n = 92,755), with higher odds when adjusted for patient/hospital-characteristics, comorbidities, alcohol and tobacco use disorder, cocaine and stimulant use (aOR 1.15, 95%CI:1.06–1.24, p = 0.001). CUD+ had significantly increased adjusted odds of HC (for sociodemographic, hospital-level characteristics, comorbidities, tobacco use disorder, and alcohol abuse) (aOR 1.17, 95%CI:1.01–1.36, p = 0.034) among young with benign hypertension, but failed to reach significance when additionally adjusted for cocaine/stimulant use (aOR 1.12, p = 0.154). Propensity-matched CUD+ cohort (n = 4440, median age 36 years, 64.2% male, 64.4% blacks) showed higher rates of substance abuse, depression, psychosis, previous myocardial infarction, valvular heart disease, chronic pulmonary disease, pulmonary circulation disease, and liver disease. CUD+ had higher odds of all-cause mortality (aOR 5.74, 95%CI:2.55–12.91, p < 0.001), arrhythmia (aOR 1.73, 95%CI:1.38–2.17, p < 0.001) and stroke (aOR 1.46, 95%CI:1.02–2.10, p = 0.040). CUD+ cohort had fewer routine discharges with comparable in-hospital stay and cost. Conclusions: Young CUD+ cohort had higher rate and odds of HC admissions than CUD-, with prevalent disparities and higher subsequent risk of all-cause mortality, arrhythmia and stroke.

Background and Objectives There is a paucity of data regarding the impact of acute heart failure (AHF) on the outcomes of aspiration pneumonia (AP). Methods Using National Inpatient Sample datasets (2016 to 2019), we identified admissions for AP with AHF vs. without AHF using relevant International Classification of Diseases, Tenth Revision codes. We compared the demographics, comorbidities, and outcomes between the two groups. Results Out of the 121,097,410 weighted adult hospitalizations, 488,260 had AP, of which 13.25% (n=64,675) had AHF. The AHF cohort consisted predominantly of the elderly (mean age 80.4 vs. 71.1 years), females (47.8% vs. 42.2%), and whites (81.6% vs. 78.5%) than non-AHF cohort (all p<0.001). Complicated diabetes and hypertension, dyslipidemia, obesity, chronic pulmonary disease, and prior myocardial infarction were more frequent in AHF than in the non-AHF cohort. AP-AHF cohort had similar adjusted odds of all-cause mortality (adjusted odds ratio [AOR], 0.9; 95% confidence interval [CI], 0.78–1.03; p=0.122), acute respiratory failure (AOR, 1.0; 95% CI, 0.96–1.13; p=0.379), but higher adjusted odds of cardiogenic shock (AOR, 2.2; 95% CI, 1.30–3.64; p=0.003), and use of mechanical ventilation (MV) (AOR, 1.3; 95% CI, 1.17–1.56; p<0.001) compared to AP only cohort. AP-AHF cohort more frequently required longer durations of MV and hospital stays with a higher mean cost of the stay. Conclusions Our study from a nationally representative database demonstrates an increased morbidity burden, worsened complications, and higher hospital resource utilization, although a similar risk of all-cause mortality in AP patients with AHF vs. no AHF.

Introduction: Data on the burden of congestive heart failure (CHF) in aspiration pneumonia (AP) patients is sparse. Our aim is to study the burden, morbidity and outcomes of CHF on AP patients. Methods: We queried the National Inpatient Sample (2015 October-2017) to identify admissions for AP in patients with CHF vs without CHF using relevant ICD-codes. Primary outcomes reported were all-cause mortality and pulmonary morbidity. Secondary outcomes included patient disposition, LOS and utilization of hospital resources. Results: We included 14,38,034 aspiration pneumonia (AP) hospitalizations amongst which 3,33,975 had associated CHF (23.2%). AP-CHF cohort often included older (79 [68-87]), white (74.8% vs 72.6%), male (54.7% vs 45.3%) patients admitted non-electively with Medicare insurance at Urban teaching facilities compared to AP only cohort (p<0.001) (Table 1) . AP-CHF cohort was more often associated with valvular disease, pulmonary circulation disease, peripheral vascular disease, chronic pulmonary disease, hypertension (secondary/complicated), diabetes mellitus, hyperlipidemia and obesity compared to AP-only cohort. AP-CHF cohort had lower rates of alcohol abuse, drug abuse and smoking. AP- CHF cohort had higher adjusted odds of all-cause mortality (aOR 1.14 95% CI 1.13-1.15, p<0.001), ARDS (aOR 2.27), respiratory failure (aOR 1.77), severe sepsis with septic shock (aOR 1.34) and requirement of respiratory support (aOR 1.40) compared to AP only cohort. AP-CHF cohort was more often discharged to short-term or intermediate facility and had longer stay with higher hospital charges compared to AP only cohort. Conclusion: Based on our analysis it can be concluded that nearly one-fourth of AP hospitalizations have concomitant CHF and that is associated with higher morbidity, mortality and complications ultimately leading to higher hospital resource utilization.

Sepsis-induced cardiomyopathy has been increasingly recognized; however, the prevalence and impact of sepsis in peripartum cardiomyopathy (PPCM) patients need further exploration. We aimed to assess the burden and outcomes of PPCMrelated hospitalization with vs. without sepsis in this population-based study in the United States. METHODS:We queried the National Inpatient Sample (2015October-2017) to access PPCM with vs. without sepsis using relevant ICD-10 codes. We compared baseline demographics and comorbidities between the groups (sepsisþ vs. sepsis-). The primary outcomes included all-cause mortality, cardiac arrest including ventricular tachyarrhythmias, cardiogenic shock, respiratory failure, mechanical ventilation/respiratory intubation, and secondary outcomes included patient disposition, length of stay, and hospital charges. A two-tailed p-value<0.05 was considered for statistical significance.RESULTS: Of the 10,275 PPCM admissions, 460 were related to sepsis (0.04%). The PPCM-sepsisþ cohort often consisted of younger (30 [24-36]), white (47.1% vs 39%, p<0.001) patients admitted non-electively (90.2% vs 87.7%, p¼0.109) compared to the PPCM-sepsis-cohort. The PPCM-sepsisþ cohort more frequently comprised of Medicaid enrollees (52.2% vs 51.9%, p<0.001), patients in middle income quartile (27.2% vs 26.0%, p¼0.007), admissions to large bedsized hospitals (64.1% vs 62%, p¼0.588) compared to PPCM-sepsis -cohort. The PPCM-sepsisþ cohort was often associated with congestive heart failure (55.4% vs 48.2%, p¼0.003), coagulopathy (10.9% vs 6.4%, p<0.001), chronic kidney disease (15.2% vs 5.9%, p<0.001), anemias (27.2% vs 20.8%, p<0.001), pulmonary circulation disorder (3.3% vs 1.7%, p¼0.012), and psychoses (4.3% vs 1.9%, p<0.001) compared to PPCM-sepsis-cohort. PPCM-sepsisþ cohort showed lower frequency of hypertension (40.2% vs 59.9%, p<0.001), obesity (16.3% vs 26.3%, p<0.001), chronic pulmonary disease (8.7% vs 14.9%, p<0.001) and valvular heart disease (7.6% vs 13.0%, p<0.001) compared to sepsis-cohort. The PPCM-sepsisþ cohort had significantly higher frequency and odds of all-cause mortality (7.6% vs 1.2%, aOR 7.59, 95% CI 4.35-13.23; p<0.001) along with higher rates of cardiac arrest (5.4% vs 3.0%, p0.003), cardiogenic shock (8.7% vs 5.2%, p<0.001), respiratory failure (56.5% vs 19.8%, p<0.001), mechanical ventilation/respiratory intubation (28.3% vs 10.9%, p<0.001) compared to the PPCM-sepsis-cohort. The PPCM-sepsisþ cohort were less often discharged routinely (63.0% vs. 81.5%, p<0.001), experienced prolonged hospital stay (5 vs 3 days) and higher hospital charges (60,752$ vs 30,554$) as compared to PPCM-sepsis-cohort (p<0.001). CONCLUSIONS:The frequency of sepsis in PPCM-related admissions remains low. However, concomitant sepsis predicted nearly seven times higher all-cause mortality and alarmingly higher rates of cardiopulmonary complications in PPCM. Preventive screening measures and timely management of sepsis in PPCM could prevent worse outcomes.CLINICAL IMPLICATIONS: Sepsis in PPCM patients leads to si...

Background: Cannabis use disorder (CUD) is more prevalent in the young population and cannabis use has been linked to an increased risk of first-time stroke or transient ischemic attack (TIA). Prevalence and risk of recurrent stroke in patients with prior stroke/TIA in cannabis users are not clearly established. Methods: Using weighted data from the National Inpatient Sample (2015 October-2017 December) and pertinent ICD-10 codes, we identified hospitalizations among young (18-44 years) patients with prior history of stroke/TIA grouped into those with CUD+ and those without (CUD-). We compared the frequency (with disparities based on gender, race, hospital region and median household income) and odds of subsequent/recurrent stroke in young adults (18-44 years) with vs without cannabis use (CUD+ vs. CUD-) and prior history of stroke/TIA. Results: Young adult hospitalizations with prior stroke/TIA were 4690 in the CUD+ arm, and 156700 in CUD- arm (median age 37 years in both cohorts). The CUD+ cohort often consisted of males (55.2% vs. 40.2%), African Americans (44.6% vs. 37.2%), and patients with higher rates of concomitant substance abuse, COPD, depression and psychoses, and a lower rate of cardiovascular comorbidities compared to the CUD- cohort (p<0.001) [Table 1a]. The CUD+ arm had considerably higher rate (6.9 vs 5.4%) [Table 1b] and adjusted odds (aOR 1.48, 95 CI 1.28-1.71, p<0.001) of recurrent stroke than CUD- arm [Table 1c] . On subgroup comparison, admission among male (7.7% vs. 5.9%), white (6.6% vs. 5.1%), African American (8.0% vs. 5.2%), and admissions in low household income quartile (7.7% vs. 5.5%) patients, Northeast (6.1% vs. 4.4%) and Southern (7.6% vs. 5.7%) region hospitals showed higher rates of recurrent stroke with CUD+ vs. CUD- (p<0.05). Conclusion: The frequency and risk (~50% higher) of recurrent stroke were found to be significantly increased with disparities in subgroups among young adults with prior history of stroke/TIA and concomitant CUD.

Background: Underrepresentation of females in clinical trials and paucity of data on young-onset stroke incited us to review two national cohorts a decade apart to assess the frequency and odds of stroke admissions and inpatient mortality and associated racial disparities in young females. Methods: We queried weighted data from the National Inpatient Sample (2017 & 2007) to identify stroke admissions in young females (18-44 years). Stroke admissions and mortality rates among young females were compared between different race groups for 2017 vs. 2007. Multivariable regression was performed to determine the difference in risk of stroke admissions and inpatient mortality with associated racial distinctions between 2017 & 2007. Results: Young women's stroke admissions from 2017 and 2007 increased from 0.3% (n=20009/7,746,732) in 2007 to 0.5% (n=28885/6,268,570) in 2017 (p<0.001). Adjusted analysis for covariates showed nearly 50% increased risk of stroke admissions in young women in 2017 vs 2007 (aOR:1.48; 95%CI:1.44-1.51, p<0.001). Comorbidities including hypertension, diabetes, vascular disease, obesity, smoking, atrial fibrillation were more prevalent in 2017 vs 2007 (p<0.001). Notwithstanding the increased admissions, inpatient mortality risk decreased by 35% in 2017 (aOR:0.65; 95%CI:0.60-0.71, p<0.001). Assessing racial disparities in young women, we found that white and Native Americans demonstrated the highest increase in stroke admissions, whereas Hispanic and Asian-Pacific Islanders did not show an improvement in survival odds in 2017 vs. 2007 [Figure 1] . Conclusion: The risk of stroke admissions among young women increased nearly 50% in 2017 vs. 2007 with all races showing a rise in hospitalizations. Reassuringly, advanced therapeutics helped with the overall reduction of inpatient mortality; however, persistent racial disparities in survival odds warrant a more inclusive approach for primary preventive strides and healthcare delivery.

Background: Preliminary reports have suggested a link between cannabis use and heart failure (HF); however, with inconclusive literature on the subject, there exists an unmet need for contemporary data on outcomes of HF patients with cannabis use. The rising prevalence of Heart Failure with Preserved Ejection Fraction (HFpEF) incited us to assess the impact of cannabis use disorder (CUD) on in-hospital outcomes of HFpEF using nationwide multicenter data. Methods: Adult admissions related to HFpEF with vs. without CUD were identified using the National Inpatient Sample (Oct 2015-Dec 2017). Demographically matched cohorts, HFpEF-CUD+ vs. HFpEF-CUD-, were obtained and compared for comorbidities and in-hospital outcomes. Multivariable regression analyses were performed after controlling for confounders (demographic/hospital characteristics, comorbidities and substance abuse) to assess the risk of adverse outcomes including all-cause mortality, arrhythmia (atrial fibrillation/flutter, ventricular arrhythmia & cardiac arrest) and stroke. Results: Of 3,835,473 HFpEF-related admissions, 10980 (0.3%) patients were cannabis users. Matched cohorts, CUD+ and CUD- were comparable for demographics (median age 55 vs. 54 years, >60% male, >80% white/black). The CUD+ cohort had a lower rate of comorbidities including hypertension (87.5% vs 88.5%), diabetes (33.7% vs 43.7%), hyperlipidemia (38.4% vs 42.1%), obesity (26.7% vs 36.2%), and renal failure (32.8% vs 39.8%) (Table 1). Despite a lower comorbidity burden, the CUD+ cohort was often admitted non-electively (95.2% vs. 92.8%) and had considerably higher odds of all-cause mortality (aOR 2.24, 95%CI:1.81-2.78), arrhythmia (aOR 1.15, 95%CI:1.05-1.25) and cardiac arrest (aOR 3.87, 95%CI: 2.88-5.21) (p<0.05) (Fig. 1). Conclusions: This nationwide multicenter analysis revealed HFpEF admissions in patients with CUD had a significantly higher risk of adverse in-hospital outcomes despite a lower CVD risk.