Introduction: Difficult airway patients presenting with upper gastrointestinal bleeding present unique challenge due to increased risk of respiratory complications such as from aspiration or from airway obstruction during anesthesia for urgent upper endoscopy. Limited data are available regarding clinical outcomes in difficult airway patients presenting with Upper gastrointestinal bleed. Methods: Using National Inpatient Sample databases from 2016 to 2019, we identified patients presenting with Upper gastrointestinal bleed, the population were then divided based on the presence and absence of difficult airway using appropriate ICD-10-CM/PCS codes. STATA 17.0 software (3) was used for the analysis. Pearson's Chi-Square test was used to analyze categorical variable, whereas the student t-test was used to analyze continuous variables. Univariate and multivariate logistic regression was used to adjust for potential confounders. Primary outcome was in hospital mortality due to upper gastrointestinal bleed in patients with and without difficult airway. Results: Amongst total of 1555580 patients admitted with upper gastrointestinal bleed, 140 patients had diagnosis of difficult airway and 1555440 patients did not have difficult airway diagnosis, male gender and white ethnicity was predominant in both populations. The mean LOS was 6.03565.02 days in difficult airway group, 4.28864.45 in non-airway group, this result was statistically significant. The mean total hospitalization charges in difficult airway group were 27111$, in the non-difficult airway group were 13183$ and this was found to be statistically significant. There were 45(32.14%) and 36708(2.36%) mortality in patients with and without difficult airway diagnosis. The difference is statistically significant with OR:5.06, 95% CI: 1.62-15.81, and p , 0.001. Odds of using IR intervention and ICU admissions were higher and EGD were lower in difficult airway group, found to be statistically significant. (Table ) Conclusion: Patient with diagnosis of difficult airway presenting with upper gastrointestinal bleed symptoms were younger, had higher healthcare utilization and were associated with higher inpatient mortality and complications.[0668] Figure 1. a) mortality rate, b) rate of refractory bleeding, c) rate of endoscopic intervention.
Introduction:The pathogenesis of nonalcoholic fatty liver disease (NAFLD) has not been clearly understood, but several studies suggest intestinal bacteria may play a role. Similarly, diverticulitis is associated with changes in the gut microbiome. However, there is a lack of studies on how NAFLD affects the outcomes of diverticulitis. Thus, this study aims to assess the outcomes of diverticulitis among patients with NAFLD. Methods: Adult patients hospitalized with diverticulitis from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality 2014 were selected. Diagnoses were identified by using ICD-9 CM codes. Patient demographics and outcomes of diverticulitis were compared between the groups with and without NAFLD. The outcomes of interest were inpatient mortality, length of stay, total hospital charge, shock/hypotension, colectomy, abscess, obstruction, fistula, and perforation. Chi-squared tests and independent t-tests were used to compare proportions and means, respectively. Multivariate logistic regression analysis was performed to determine if NAFLD is an independent predictor for the outcomes, adjusting for age, sex, race, and the Charlson Comorbidity Index. Results: Among 48,214 patients with diverticulitis, 1,184 patients had a history of NAFLD. Patients with NAFLD had shorter length of stay (4.2 days vs. 4.7 days, p , 0.05), lower hospital charge ($34,392 vs. $38,652, p , 0.05), and lower mortality (0.0% vs. 0.4%, p , 0.05). After adjusting for age, sex, race, and the Charlson Comorbidity Index, NAFLD was an independent protective factor for colectomy (OR 0.44, 95% CI: 0.34-0.57, p , 0.05) and intestinal abscess (OR 0.67, 95% CI: 0.55-0.81, p , 0.05). Adjusted odds ratios of other outcomes were not statistically significant. Conclusion: Our study indicates that NAFLD is associated with better outcomes of diverticulitis, such as lower rates of colectomy and intestinal abscess among patients hospitalized with diverticulitis, in contrast with worse outcomes associated with NAFLD in many other conditions. The limitation of this study using the NIS database is the difficulty in comparing the severity of diverticulitis between the groups and exact treatment methods, which may have affected the results. Future studies to assess the potential protective effect of NAFLD on outcomes of diverticulitis and understand the pathophysiology of NAFLD and diverticulitis are warranted.
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