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Background and Aim: Data are lacking on predicting inpatient mortality (IM) in patients admitted for inflammatory bowel disease (IBD). IM is a critical outcome; however, difficulty in its prediction exists due to infrequent occurrence. We assessed IM predictors and developed a predictive model for IM using machine‐learning (ML). Methods: Using the National Inpatient Sample (NIS) database (2005–2017), we extracted adults admitted for IBD. After ML‐guided predictor selection, we trained and internally validated multiple algorithms, targeting minimum sensitivity and positive likelihood ratio (+LR) ≥ 80% and ≥ 3, respectively. Diagnostic odds ratio (DOR) compared algorithm performance. The best performing algorithm was additionally trained and validated for an IBD‐related surgery sub‐cohort. External validation was done using NIS 2018. Results: In 398 426 adult IBD admissions, IM was 0.32% overall, and 0.87% among the surgical cohort (n = 40 784). Increasing age, ulcerative colitis, IBD‐related surgery, pneumonia, chronic lung disease, acute kidney injury, malnutrition, frailty, heart failure, blood transfusion, sepsis/septic shock and thromboembolism were associated with increased IM. The QLattice algorithm, provided the highest performance model (+LR: 3.2, 95% CI 3.0–3.3; area‐under‐curve [AUC]:0.87, 85% sensitivity, 73% specificity), distinguishing IM patients by 15.6‐fold when comparing high to low‐risk patients. The surgical cohort model (+LR: 8.5, AUC: 0.94, 85% sensitivity, 90% specificity), distinguished IM patients by 49‐fold. Both models performed excellently in external validation. An online calculator (https://clinicalc.ai/im‐ibd/) was developed allowing bedside model predictions. Conclusions: An online prediction‐model calculator captured > 80% IM cases during IBD‐related admissions, with high discriminatory effectiveness. This allows for risk stratification and provides a basis for assessing interventions to reduce mortality in high‐risk patients. [ABSTRACT FROM AUTHOR]

Background and Aim: Acute kidney injury (AKI) is used as a marker of severity in Clostridium difficile infection (CDI) patients. We estimated the true effect of AKI in inpatient mortality of CDI patients, as there are no large-scale, population-based, propensity-matched studies evaluating AKI's effect in this patient cohort. Methods: A retrospective observational study utilizing the National Inpatient Sample from years 2003 to 2012, including all adults with CDI, excluding cases missing data on age, inpatient mortality or gender. Trends and CDI-related complications as mortality predictors were assessed using survey-weighted multivariable regression. We estimated AKI's independent effect by propensity-matching, post-stratifying by chronic kidney disease status, allowing for multiple comorbidity adjustment. Results: A total of 2 859 599 patients with CDI were included, of which 896 122 (31.3%) had principal diagnosis of CDI. AKI prevalence was 22%. Mortality rate was 8.4%, while among AKI patients was higher (18.2%). In multivariable regression, AKI was associated with higher mortality (odds ratio [OR] = 3.16, 95% confidence interval [CI]: 3.02-3.30; P < 0.001), while after propensity matching, AKI increased mortality by 86% (OR = 1.86, 95% CI: 1.79-1.94; P < 0.001). CDI incidence increased by 1.8, together with the rate of AKI (12.6% in 2003 to 28.8% in 2012, P-trend < 0.001). Despite increasing hospitalizations, mortality over the study period decreased to 7.2% (2012) from 9.0% (2003); P-trend < 0.001. Conclusion: Hospital admissions of patients with CDI and concomitant AKI are increasing, but their inpatient mortality has improved over the study period. AKI is a significant contributor to mortality, independently of other comorbidities, complications, and hospital characteristics, emphasizing the need for early diagnosis and aggressive management in such patients. [ABSTRACT FROM AUTHOR]

Background: Operative choices for aortic root disease include traditional root replacement with a composite valved graft as well as various valve-sparing and root repair procedures.Objectives: To report our experience with traditional composite graft aortic root replacement by a single surgeon over a 25-year period in 449 patients, focusing on long-term survival and freedom from late reoperation and adverse events.Methods: The coronary button technique was used in all patients. Mean age was 56.1 ± 14.0 years (range 14-87) with 83% males (373/449). Valve prosthesis was mechanical in 343 (76%) and bioprosthetic in 106 (24%). A modified Cabrol procedure (Dacron coronary graft) was employed in 10% (45/449) and concomitant coronary artery bypass graft in 10.9% (49/449). There were 15.8% (71/449) urgent/emergent and 8.2% (37/449) redo procedures. Survival follow-up was 100%. Mean follow-up was 7.0 ± 5.1 years (range 0.1-24.8).Results: Operative mortality occurred in 14 patients (3.1%) and was 2.2% (9/418) in non-dissection and 1.9% (7/361) in elective first-time operations. Stroke and re-exploration for bleeding occurred in nine (2.0%) and 20 (4.5%) patients, respectively. Major late events included bleeding in 2.5% (11/435) and thromboembolism in 1.1% (5/435). At 5, 10, and 20 years, freedom from major events and reoperations on the root were 97.8, 95.4, and 94.39%, and 99.0, 99.0, and 97.9%, respectively. Survival in patients aged <60 years was 92.0, 90.1, and 79.8% at five, 10, and 20 years versus 88.4, 67.9, and 42.6% in patients aged ≥60 years (p = 0.001). Compared with age- and gender-matched controls, survival was not significantly different (p = 0.20).Conclusions: Composite graft aortic root replacement is associated with low operative risk, excellent long-term survival, and low incidence of reoperation and late events. [ABSTRACT FROM AUTHOR]

A bstract Background The combination of descending aortic aneurysm (DAA) with concomitant coronary artery disease (CAD) is associated with increased morbidity and mortality. We review the surgical management for patients with this combined disease. Methods From January 2000 to January 2014, we performed 268 elective surgeries on the descending or thoracoabdominal aorta. Sixty-six patients (24.7%) had significant CAD. Indications for aortic intervention included thoracoabdominal aortic aneurysm (TAAA) in 28 (42.4%), DAA in 36 (54.5%), and coarctation and ulcer in one each. Fifty-two (78.8%) patients had prior CAD, with remote coronary intervention in 32 (48.5%). Results Sixteen (24.2%) patients required coronary intervention prior to aortic surgery, percutaneous coronary intervention in three and coronary artery bypass grafting (CABG) in 13 (six off-pump). We used the right internal thoracic artery (ITA) because of vulnerability of the left ITA during DAA clamping; the left ITA as a free graft or in situ when disease was distant to the left subclavian artery; and off-pump CABG to avoid manipulation and embolization. Mean duration between coronary intervention and aortic surgery was 37.2 days. There was no mortality or major adverse cardiac events (MACE) following coronary intervention or during interim to aortic surgery. There were two (3%) cardiac mortalities following DAA/TAAA repair. Conclusion CAD is common among patients with DAA/TAAA. We recommend aggressive evaluation and prior treatment of CAD to minimize perioperative MACE. doi: 10.1111/jocs.12596 (J Card Surg 2015;30:701-706) [ABSTRACT FROM AUTHOR]