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OBJECTIVES To assess the prevalence and outcomes of spontaneous intestinal perforation (SIP) in very low birth weight infants. STUDY DESIGN This cross-sectional study utilized the National Inpatient Sample dataset for the years 2002-2017. All premature infants with birth weight (BW)

OBJECTIVE The use of supplemental oxygen in premature infants is essential for survival. However, its use has been associated with unintended complications. The restricted use of oxygen is associated with increased mortality and necrotizing enterocolitis (NEC), whereas its liberal use is associated with increased risk for retinopathy of prematurity (ROP). Although there is no clear consensus on the acceptable oxygen saturation range, clinicians have recently become more liberal with the use of oxygen. We aim to assess (1) the national trends for ROP in very low birth weight preterm infants, and (2) the associated trends in mortality, NEC, intraventricular hemorrhage (IVH), and length of hospital stay (LOS). METHODS We analyzed deidentified patient data from the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) from 2002 to 2017. All infants with gestational age ≤32 weeks and birth weight

We aimed to assess the prevalence and outcomes of esophageal perforation in very low birth weight infants. This retrospective cohort study utilized the US National Inpatient Sample dataset for the years 2000 to 2017. A total of 1,755,418 very low birth weight infants were included; of them, 861 (0.05%) were diagnosed with esophageal perforation. The majority (77.9%) of infants were in the birth weight category < 1000 g and 77.7% in infants ≤ 28 weeks of gestation. The majority (73%) of infants were tracheally intubated and received mechanical ventilation; of them, 24 infants (2.8%) had tracheostomy. Mortality associated with esophageal perforation was 25.8%. Regression analysis did not show an association between esophageal perforation and increased mortality in preterm infants (aOR = 1.0, CI: 0.83-1.20, p = 0.991). Procedures encountered in these infants include thoracentesis (10.8%), laparotomy (4.1%), percutaneous abdominal drainage (4.1%), and gastrostomy tube insertion (6.2%), whereas the rest of the infants were managed conservatively. There was a significant trend for increasing prevalence of esophageal perforation over the years.Conclusion: Esophageal perforation does not independently increase the risk for mortality in very low birth weight infants. The increasing prevalence is possibly related to increased care offered to infants at limits of viability in recent years. What is Known: • Knowledge about esophageal perforation is derived from anecdotal single-center case reports. • Esophageal perforation in neonates is mostly iatrogenic. • It is considered a critical complication that is associated with high mortality. What is New: • This is the first and largest national study on prevalence of esophageal perforation in preterm infants. • Esophageal perforation does not independently increase the risk for mortality. • Septicemia and pneumothorax are frequent complications to esophageal perforation.

Background: Prophylactic platelet transfusion has been adopted as a ubiquitous practice in management of thrombocytopenia in preterm infants to reduce the risk of bleeding. Objectives: The objectives of this study were to report the prevalence of platelet transfusion among preterm infants with thrombocytopenia and to assess the association of platelet transfusion with mortality and morbidity in this population. Methods: A cross-sectional study that utilized National Inpatient Sample for the years 2000–2017 was conducted. All preterm infants delivered nationally with birth weight (BW) Results: The study included 1,780,299 infants; of them, 22,609 (1.27%) were diagnosed with thrombocytopenia and 5,134 (22.7%) received platelet transfusion. Platelet transfusion was associated with significant increase in mortality (24.8 vs. 13.8%), retinopathy of prematurity (22.3 vs. 19.2%), severe intraventricular hemorrhage (18.3 vs. 10.1%), median length of hospital stays (51 vs. 47 days), and cost of hospitalization (USD 298,204 vs. USD 219,760). Increased mortality was noted in p < 0.001) and 1,000–1,499-g infants (aOR = 2.02, CI: 1.62–2.53, p < 0.001). Platelet transfusion increased over the years in infants with BW p = 0.001) and in infants with BW 1,000–1,499 g (p < 0.001). Conclusions: Platelet transfusion is associated with increased mortality and comorbidities in premature infants. There is a trend for increased utilization of platelet transfusions over the study period.

Background: Patent ductus arteriosus (PDA) is frequently encountered in premature infants. Optimal management of PDA remains undefined. We aim to assess the national trend for PDA ligation over 18 years and evaluate mortality and associated morbidities. Methods: We used data from the National Inpatient Sample (NIS) and KID of the Healthcare Cost and Utilization Project (HCUP) from 1998 to 2015. All infants with gestational age 24–32 weeks and birth weight

OBJECTIVE The objective of this study was to identify patient and hospitalization characteristics associated with in-hospital mortality in infants with truncus arteriosus. METHODS We conducted a retrospective analysis of a large administrative database, the National Inpatient Sample data set of the Healthcare Cost and Utilization Project for the years 2002 to 2017. We also sought to evaluate the resource utilization in the subgroup of subjects with truncus arteriosus and 22q11.2 deletion syndrome. Neonates with truncus arteriosus were identified by ICD-9 and ICD-10 codes. Hospital and patient factors associated with inpatient mortality were analyzed. RESULTS Overall, 3009 neonates met inclusion criteria; a total of 326 patients died during the hospitalization (10.8%). Extracorporeal membrane oxygenation utilization was 7.1%. Univariate and multivariate logistic regression analyses were used to identify risk factors for in-hospital mortality. Significant risk factors for mortality were prematurity (adjusted odds ratio [aOR] = 2.43; 95% confidence interval [CI]: 1.40-4.22; P = .002), diagnosis of stroke (aOR = 26.2; 95% CI: 10.1-68.1; P

Children affected with acute myocarditis may progress rapidly into profound ventricular dysfunction and ventricular arrhythmias. The objective of this study is to assess the impact of ventricular arrhythmias on in-hospital mortality and the use of mechanical circulatory support in patients with myocarditis. Pediatric patients (age 0–18 years) admitted with myocarditis were identified from the National Inpatient Sample dataset for the years 2002–2015. A total of 12,489 patients with myocarditis were identified. Of them, 1627 patients were with ventricular arrhythmias and 10,862 patients without ventricular arrhythmias. Mortality was higher in those with ventricular arrhythmias (19.5% vs. 2.8%, OR = 8.47; 95% CI 7.16–10.04; p

OBJECTIVES Transposition of the great arteries is the most common cyanotic congenital heart defect. Surgical correction usually occurs in the first week of life; presence of restrictive interatrial communication and severe hypoxemia warrants urgent intervention with balloon atrial septostomy and medical stabilization prior to surgery. The main objective of this study is to compare the characteristics, outcomes, and mortality risks in patients with transposition of the great arteries who underwent balloon atrial septostomy during their hospitalization versus transposition of the great arteries patients who have not undergone this procedure. DESIGN Retrospective analysis of administrative data. SETTING Data from Kids' Inpatient Database complemented with the National Inpatient Sample dataset for the years 1998-2014, this includes data from participating hospitals in 47 U.S. States and the District of Columbia. PATIENTS Neonates admitted with transposition of the great arteries. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 17,392 neonates with diagnosis of transposition of the great arteries were captured in the databases we used. Male-to-female ratio was 2:1. The rate of balloon atrial septostomy in patients with transposition of the great arteries was 27.7% without significant change over the years. There was no significant difference in mortality between balloon atrial septostomy and no balloon atrial septostomy (6.3% vs 6.7%; p = 0.29). Neonates with balloon atrial septostomy had a two-fold increase in their length of stay compared with no balloon atrial septostomy (16 d vs 7 d; p < 0.0001). Stroke was present in 1.1% of balloon atrial septostomy group versus 0.6% in those who did not have balloon atrial septostomy (odds ratio, 1.85; 95% CI, 1.29-2.65; p < 0.0001). Extracorporeal membrane oxygenation was used more in balloon atrial septostomy group (5.1% vs 3.1%; p < 0.0001). CONCLUSIONS There was no difference in mortality rate between balloon atrial septostomy and no balloon atrial septostomy patients. The prevalence of the diagnosis of stroke in this study was higher in patients who underwent balloon atrial septostomy. Furthermore, comparison of in-hospital mortality in balloon atrial septostomy and no balloon atrial septostomy revealed increased mortality risk in no balloon atrial septostomy patients transferred from other institution, no balloon atrial septostomy patients supported with extracorporeal membrane oxygenation, and balloon atrial septostomy patients diagnosed with stroke. Finally, length of stay and charges were higher in balloon atrial septostomy patients.

The objective of this study was to identify patient and hospitalization characteristics associated with in-hospital mortality in infants with hypoplastic left heart syndrome (HLHS). We conducted a retrospective analysis of a large administrative database, the National Inpatient Sample dataset of the Healthcare Cost and Utilization Project for the years 2002–2016. Neonates with HLHS were identified by ICD-9 and ICD-10 codes. Hospital and patient factors associated with inpatient mortality were analyzed. Overall, 18,867 neonates met the criteria of inclusion; a total of 3813 patients died during the hospitalization (20.2%). In-hospital mortality decreased over the years of the study (27.0% in 2002 vs. 18.3% in 2016). Extracorporeal membrane oxygenation utilization was 8.1%. Univariate and multivariate logistic regression analyses were used to identify risk factors for in-hospital mortality in infants with hypoplastic left heart syndrome. Independent non-modifiable risk factors for mortality were birth weight

Neonates with hypoplastic left heart syndrome (HLHS) were identified from the National Inpatient Sample dataset for the years 1998-2014. These patients were stratified into two chronological groups, past group (1998-2005) and recent group (2006-2014). A total of 20,649 neonates with HLHS were identified. Of them, 9179 (44.5%) were born in the past group and 11,470 (55.5%) in the recent group. Median birth weight was significantly less in the recent group (2967 g vs. 3110 g, p = 0.005). The patients in the recent group had more patients with low birth weight (2.5 kg) and prematurity (8.7% vs 7.6% and 12.7% vs. 4.3%., respectively). In addition, recent group had more comorbidities including chromosomal anomalies, total anomalous pulmonary venous return, and kidney anomalies (5.6% vs. 3.6%, 2.3% vs. 1.7%, and 5.6% vs. 3.6%, respectively, p0.001); these were associated with a higher rate of extracorporeal membrane oxygenation utilization (9.2% vs. 4.5%, p0.001). Consequently, median length of stay was longer in the recent group (8 vs. 6 days, p0.001).Conclusion: Despite the higher frequency of comorbidities in recent group, the mortality rates decreased by 20% (from 25.3% to 20.6%, p0.001). Balloon atrial septostomy was performed less frequently in the recent group (23.3% vs. 16.1%, p0.001).What is known:• Hypoplastic left heart syndrome has the highest mortality among congenital cardiac defects during the first year of life.• Limited studies on patients' comorbidities and mortality rates trends over last two decades.What is new:• The study utilized a national database to compare in-hospital mortality and length of stay between the two time periods 1998-2005 and 2006-2014.• The recent group had more comorbidities (prematurity, chromosomal anomalies, total anomalous pulmonary venous return, and kidney anomalies), and there was higher rate of ECMO and longer length of stay, while mortality rates decreased by 20%.

The objective of this study was to use current national data to evaluate the characteristics and survival trends of preterm infants born with CDH from 2004 to 2014. Data was queried from the National Inpatient Sample (NIS) and KID database from 2004 to 2014. Infants were included if diagnosed with CDH by ICD-9 coding and gestational age

We report on in-hospital cardiac arrest outcomes in the United States. The data were obtained from the National (Nationwide) Inpatient Sample datasets for the years 2000–2017, which includes data from participating hospitals in 47 US states and the District of Columbia. We included pediatric patients (< 18 years of age) with cardiac arrest and we excluded patients with no cardiopulmonary resuscitation during the hospitalization. Primary outcome of the study was in-hospital mortality after cardiac arrest. A multivariable logistic regression was performed to identify factors associated with survival. A total of 20,654 patients were identified, 8226 (39.82%) patients survived to discharge. The median length of stay and cost of hospitalization were significantly higher in the survivors vs. Non- survivors (LOS 18 days vs. 1 day, and cost $187,434 vs. $45,811, respectively, p < 0.001). In a multivariable model, patients admitted to teaching hospitals, elective admissions and those admitted on weekdays had higher survival (aOR=1.19, CI: 1.06–1.33, aOR=2.65, CI: 2.37–2.97 and aOR=1.17, CI: 1.07–1.27, respectively). Acute renal failure was associated with decrease in survival (aOR=0.66, CI: 0.60–0.73). There was no difference in mortality between patients with Extracorporeal CardioPulmonary Resuscitation (E-CPR) and those with conventional CardioPulmonary Resuscitation. E-CPR patients were likely to have congenital heart surgery (51.0% vs. 20.8%). In conclusion, we highlighted the survival predictors in these events, which can guide future studies aimed at improving outcomes in pediatric cardiac arrest.

We report on in-hospital cardiac arrest outcomes in the USA. The data were obtained from the National (Nationwide) Inpatient Sample datasets for the years 2000-2017, which includes data from participating hospitals in 47 US states and the District of Columbia. We included pediatric patients (< 18 years of age) with cardiac arrest, and we excluded patients with no cardiopulmonary resuscitation during the hospitalization. Primary outcome of the study was in-hospital mortality after cardiac arrest. A multivariable logistic regression was performed to identify factors associated with survival. A total of 20,654 patients were identified, and 8226 (39.82%) patients survived to discharge. The median length of stay and cost of hospitalization were significantly higher in the survivors vs. non-survivors (LOS 18 days vs. 1 day, and cost $187,434 vs. $45,811, respectively, p < 0.001). In a multivariable model, patients admitted to teaching hospitals, elective admissions, and those admitted on weekdays had higher survival (aOR=1.19, CI: 1.06-1.33; aOR=2.65, CI: 2.37-2.97; and aOR=1.17, CI: 1.07-1.27, respectively). There was no difference in mortality between patients with extracorporeal cardiopulmonary resuscitation (E-CPR) and those with conventional cardiopulmonary resuscitation. E-CPR patients were likely to have congenital heart surgery (51.0% vs. 20.8%).Conclusion: We highlighted the survival predictors in these events, which can guide future studies aimed at improving outcomes in pediatric cardiac arrest. What is Known: • In-hospital cardiac arrest occurs in 2-6% of pediatric intensive care admissions. • Cardiac arrests had a significant impact on hospital resources and a significantly high mortality rate. What is New: • Factors associated with higher survival rates in patients with cardiac arrest: admission to teaching hospitals, elective admissions, and week-day admissions. • The use of rescue extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest has increased by threefold over the last two decades.

Background Outcomes of patients with implanted left ventricular assist device (LVAD) implantation experiencing a cardiac arrest (CA) are not well reported. We aimed at defining the in-hospital outcomes of patients with implanted LVAD experiencing a CA. Methods The national inpatient sample (NIS) was queried using ICD9/ICD10 codes for patients older than 18 years with implanted LVAD and CA between 2010–2018. We excluded patients with orthotropic heart transplantation, biventricular assist device (BiVAD) implantation and do not resuscitate (DNR) status. Results A total of 93,153 hospitalisations between 2010 and 2018 with implanted LVAD were identified. Only 578 of these hospitalisations had experienced CA and of those, 173 (33%) hospitalisations underwent cardiopulmonary resuscitation (CPR). The mean age of hospitalisations that experienced a CA was 60.61±14.85 for non-survivors and 56.23±17.33 for survivors (p=0.14). The in-hospital mortality was 60.8 % in hospitalisations with CA and 74.33% in hospitalisations in whom CPR was performed. In an analysis comparing survivors with non-survivors, non-survivors had more diabetes mellitus (DM) (p=0.01), and ischaemic heart disease (IHD) (p=0.04). Age, female sex, peripheral vascular disease and history of coronary artery bypass graft (CABG) were independently associated with increased mortality in our cohort. Also, ventricular tachycardia (VT) and CPR were independently associated with in-hospital mortality. During the study period, there was a significantly decreasing trend in performing CPR in LVAD hospitalisations with CA. Conclusion In conclusion, age, female sex, peripheral vascular disease, history of CABG, VT and CPR were independently associated with in-hospital mortality in LVAD hospitalisations who experienced CA.

To assess prevalence and outcomes of acute kidney injury (AKI) in very-low-birth-weight infants. This cross-sectional study utilized the National Inpatient Sample (NIS) dataset for years 2000–2017. All premature infants with birth weight (BW)

Children affected with acute myocarditis may progress rapidly into profound ventricular dysfunction and ventricular arrhythmias. The objective of this study is to assess the impact of ventricular arrhythmias on in-hospital mortality and the use of mechanical circulatory support in patients with myocarditis. Pediatric patients (age 0-18 years) admitted with myocarditis were identified from the National Inpatient Sample dataset for the years 2002-2015. A total of 12,489 patients with myocarditis were identified. Of them, 1627 patients were with ventricular arrhythmias and 10,862 patients without ventricular arrhythmias. Mortality was higher in those with ventricular arrhythmias (19.5% vs. 2.8%, OR = 8.47; 95% CI 7.16-10.04; p 0.001). The median length of stay and the median cost of hospitalization were higher in the ventricular arrhythmias group (9 days vs. 4 days, p 0.001 and $121,826 vs. $37,658, p 0.001, respectively). There was a substantial increase in the utilization of extracorporeal membrane oxygenation (ECMO) in patients with ventricular arrhythmias (25.4% vs. 2.7%, OR = 12.40; 95% CI 10.55-14.57; p 0.001). The use of ventricular assist devices (VADs) was higher in patients with ventricular arrhythmias (4.5% vs. 1.3%, OR = 3.76; 95% CI 2.82-5.01; p 0.001). An improvement in discharge survival was observed over the years of study in both VA and non-VA groups; associated with this decline in mortality, there was a rising trend of ECMO utilization.Conclusion: Development of ventricular arrhythmia in children with myocarditis is a strong predictor for mortality and ECMO utilization. What is Known: • The clinical presentation of pediatric myocarditis varies from no symptoms of myocardial dysfunction to a rapidly progressing severe congestive heart failure. • Little is known about the predictors of mortality in children with suspected myocarditis. What is New: • Development of ventricular arrhythmia in children with myocarditis is a strong predictor for mortality and ECMO utilization. • Improvement in discharge survival was observed over the years of study; associated with this decline in mortality, there was a rising trend of ECMO utilization.

Background Cardiac dysrhythmias are a common cause of hospitalization in patients with left ventricular assist device (LVAD). There is limited data on the incidence of VT over time and associated mortality in patients with LVAD. We aimed to identify the incidence of VT post LVAD implant and associated in hospital mortality. Methods Subjects with history of LVAD who had cardiac dysrhythmias as a primary diagnosis were identified from the National Inpatient Sample (NIS) dataset of the Healthcare Cost and Utilization Project (HCUP) for the years 2005-2017 using ICD-9 and10 codes. We also identified the in-hospital outcomes of VT. We excluded patients with history of orthotropic heart transplant and history of biventricular assist device (BiVAD). Associated morbidities and in-hospital outcomes were evaluated. Results A total of 15131 LAVD hospitalizations were identified and 703 patients hospitalized with a primary diagnosis of cardiac dysrhythmias. The median age of patients was 60 years (IQR 51-67), and 57.8% were White. VT was the primary cause of hospitalization in 542 patients (77.5%), followed by atrial fibrillation and flutter, 126(17.9%), then paroxysmal supraventricular tachycardia, 24(3.4%) . Among patients who had VT, 62 patients (11.4%) had cardiac arrest, 2 (0.4%) needed CPR, 17(3.1%) had cardiogenic shock, 4(0.7%) had acute myocardial infarction, 4(0.7%) had acute stroke, 2(0.4%) had brain death, 13 (2.4%) needed mechanical ventilation, 42 (7.7%) had ICD implanted. There was no significant increase in incidence of hospitalization for VT in LVAD patients over the study period.(Std. J-T Statistic 1.371, p = 0.170). Figure 1. The overall in hospital death in these patients was 13(1.8%). Conclusion In LVAD patient VT was found to be most common arrhythmia causing hospitalization but overall mortality was low.

Background Extracorporeal membrane oxygenation (ECMO) utilization in children is recommended in refractory septic shock. However in adults there are no official recommendation to guide this treatment. Most of the existing evidence consists of small observational and single center experiences. We aimed to investigate the trend of use and outcomes of ECMO in patients with combined septic and cardiogenic shock. Methods We queried the unweighted national inpatient sample (NIS) for patients older than 18 years old, who carried both diagnoses of septic shock and cardiogenic shock during index hospitalization and received ECMO treatment for the years 2004-2017 using ICD-9&10 codes. Results We identified 29,178 patients with combined septic and cardiogenic shock in between 2004 and 2017. Of those, 424 (0.1%) patients underwent ECMO. There was a statistically significant increasing trend of ECMO use over the years of study (Std. J-T Statistic 4.338, p Conclusion ECMO is being increasingly used in patients with combined septic and cardiogenic shock, more data is needed to further guide this treatment modality in this patient population.

Background Atrioventricular block (AVB) is known complication of acute myocarditis. Data is limited on the role of trans-venous pacing in acute myocarditis with atrioventricular block. Aim We aimed to evaluate the clinical characteristics and outcomes of patients requiring temporary trans-venous pacing for AVB in acute myocarditis. Methods We queried the national inpatient sample (NIS) from 2002 through 2015, unweighted, for patients older than 18 years old who carried a diagnosis of acute myocarditis using ICD-9 codes. Outcomes in patient who had trans-venous pacing were evaluated. Results We identified 10,106 patients with acute myocarditis from 2002-2015. Of them, 5573 (55.1%) were idiopathic, 283 (2.8%) were septic, 103 (1.0%) were toxic, 89 (0.9%) were acute rheumatic, and 4058 (40.2%) were unspecified myocarditis. AVB occurred in 393 patients (3.9%) of which 134 (34.1%) patients needed trans-venous pacing (table 1 show distribution of trans-venous pacing according to the types of acute myocarditis). In patient who required trans-venous pacing; median age was 42 years (IQR 29-54), median length of stay was 6 days (IQR 4-9), median cost of hospital charge was $47,520 (IQR $28,265-$103,530), 64.9% were male, and 72.8% were White. In hospital death occurred in 5 patient (3.7%), 12 (9.0%) had septicemia, 2 (1.5%) had cardiac tamponade, 10 (7.5%) had ventricular arrhythmias, 18 (13.4%) needed permanent pacemaker, and 13 (9.7%) had cardiogenic shock. Conclusion Heart block is not uncommon in acute myocarditis and one third of patients require temporary pacing, however AVB is transient in most patient with less than a fifth of patients requiring permanent pacemaker.

Various cardiac malformations would default to a single ventricle physiology. The Glenn bidirectional cavopulmonary connection (BCPC) is the second stage in a multistage surgical palliation pathway. Objective of this study is to compare BCPC outcomes in patients with hypoplastic left heart syndrome

Cardiogenic shock is defined as an acute circulatory failure due to impaired myocardial contractility. Cardiogenic shock is a rare disease in children. Both cardiomyopathy (CMP) and congenital heart disease (CHD) can cause heart failure and lead to cardiogenic shock. There is limited data on

e15737 Background: Chronic pancreatitis (CP) is a known risk factor for pancreatic adenocarcinoma (PA). The aim of this study was to evaluate epidemiology, national trends and clinical associations of PA in hospitalized US patients with CP using the NIS database. Methods: ICD-9 CM codes were used to identify patients with CP and PA between 2002-2014. Age, gender, race, mortality, length of stay (LOS) and commonly associated comorbidities were correlated. Statistical analysis was done using SPSS 25. Results: We identified 1,677,517 patients with CP between 2002-2014. Patients with concurrent PA comprised 1.3 % (21,832) of total patients with CP. During the study period, the prevalence of PA in CP patients remained nearly steady (1.2% in 2002 and 1.3% in 2014). Median LOS was 8 days and decreased from 10 days in 2002 to 6 days in 2014. Overall mortality was 3.5% during hospitalization with the trend of mortality not showing a significant change in the study period (4.2% in 2002 and 4.1% in 2014). Median cost of total hospitalization for CP with PA was 52,116 USD, almost three-folds higher than for CP alone (18,797 USD) and increased from 42,241 USD in 2002 to 55,525 USD in 2014. For patients with CP and PA, 87.5% were above 50-years-old; 55.6% were males; Caucasians and African-Americans represented 72.2% and 12.6% of patients respectively. Interestingly, factors less associated with PA in CP included alcohol (OR 0.27, 95% CI 0.26-0.29, P < .0001), Diabetes Mellitus (DM) (OR 0.78, 95% CI 0.74-0.82, P < 0.0001), Chronic hepatitis C (OR 0.56, 95%CI 0.48-0.66, P < 0.0001) and pancreatic cysts and pseudocyst (OR 0.76, 95%, CI 0.69-0.83, P < 0.0001). Tobacco use, metabolic syndrome, Chronic hepatitis B and H. Pylori infection were not statistically associated with PA. Conclusions: In hospitalized patients with CP, 1.3% had PA. During the study duration, trends of prevalence and mortality did not show significant change, median LOS decreased and hospitalization cost of charge increased. Risk factors for PA like alcohol, DM, chronic hepatitis C, and pancreatic cysts were less associated with PA in patients with CP. Future studies are needed for early detection of PA in patients with CP.

e15616 Background: cHCC-CCA represents a rare type of primary liver cancer that was first identified in 1949. The aim of this study is to evaluate epidemiology, clinical outcomes and national trends of cHCC-CCA in hospitalized US patients using the Nationwide Inpatient Sample database (NIS). Methods: NIS database was inquired to identify patients with HCC between 2002 and 2014 using ICD9-CM codes. Patients with HCC were classified into two groups, one group with cholangiocarcinoma (CCA) and the other group without CCA. SPSS version 25 was used for statistical analysis. Results: We identified 525,699 patients with HCC between 2002-2014. Of them, 2,158 patients (0.4%) had CCA. In the cHCC-CCA group, 87.8% of the patients were above 50 years old, 58.1% were male, 63.7% were Caucasian, and 10% were African American. Mortality in patients hospitalized with cHCC-CCA was 8.5% compared to 11.1% in patients with HCC (OR 0.74, 95% CI 0.64-0.86, P < 0.0001). Mortality in cHCC-CCA patients decreased from 19.1% in 2002 to 7.9% in 2014. The median length of stay (LOS) in patients with cHCC-CCA was 6 days compared to 4 days in patients with HCC (P < 0.0001). Median LOS for patients with cHCC-CCA was unchanged between 2002 and 2014. The median hospitalization cost of charge in cHCC-CCA patients was 41,012 USD compared to 28,371 USD in HCC patients. In the cHCC-CCA group, it increased from 17,243 USD in 2002 to 37,234 USD in 2014. Only 0.9% of patients with cHCC-CCA underwent liver transplantation compared to 3.5% of HCC patients (OR 0.26, 95% CI (0.17-0.41), P < 0.0001). Conclusions: Prevalence of cHCC-CCA was 0.4% of patients with HCC during the study period. cHCC-CCA was unexpectedly associated with less mortality; possibly because of limitations in comparison due to the smaller number of patients compared to HCC alone. cHCC-CCA was also associated with lower rates of liver transplantation but more prolonged LOS and higher hospitalization cost of charge compared to HCC patients. In the same period, mortality decreased in cHCC-CCA patients and cost of charge increased while prevalence and LOS were unchanged. Further studies are needed to evaluate and understand cHCC-CCA as a separate entity.

The role of anticoagulation (AC) in patients with infective endocarditis (IE) remains uncertain. There is paucity of information about the efficacy and safety due to lack of randomized control trials and conflicting results reported by observational studies. We aimed to evaluate outcomes of IE with

Ventricular arrhythmia (VA) is common in patients supported with left ventricular assist device (LVAD). Implantable cardioverter-defibrillator (ICD) is a well-established therapy for malignant VA. Observational studies demonstrated improved mortality with using ICD in pulsatile but not in continuous

Cardiac arrhythmia (CA) is a common complication in orthotopic heart transplant (OHT) recipients. We sought to assess the burden and predictors of CA in hospitalized OHT recipients. We used the Nationwide Inpatient Sample 2002-2014 to identify OHT recipients by using ICD-9 codes. We excluded

An antimicrobial agent, benzalkonium chloride (BAC), was added to a chemically cured composite resin, and the antimicrobial benefits and physical properties of the modified composite were evaluated. BAC was added to Reliance Phase II composite to create modified composites with BAC concentrations ranging from 0.25 to 2.50 wt%. Specimen disks of the modified composite were incubated with Streptococcus mutans for 48 hours, and an agar disk diffusion assay was used to measure zones of bacterial inhibition. Larger disks were suspended in brain-heart infusion medium containing 2 x 10(4) colony-forming units/mL Streptococcus sobrinus (10 mL, 2 wt% sucrose, 24 hours) to measure bacterial adherence to the adhesive; adherent cells were removed from the surface with 1 N NaOH, and the optical density of the cells was measured at 550 nanometers. Traction hooks were bonded to bovine teeth with the modified composite, and tensile bond strength was evaluated with a universal testing machine. Diametral tensile stress was also measured. The modified composite samples showed that antimicrobial activity increased with higher BAC content; no antimicrobial activity was measured for the original compound in either the disk diffusion or the bacterial adherence test. There were no significant differences (P.05) in either tensile bond strength or diametral tensile stress among the modified composite groups and the original product. The incorporation of BAC in composite material added antimicrobial properties to the original compound without altering its mechanical properties.