Kavelin Rumalla

Recreational marijuana use and acute ischemic stroke: A population-based analysis of hospitalized patients in the United States

BACKGROUND Recreational marijuana use is considered to have few adverse effects. However, recent evidence has suggested that it precipitates cardiovascular and cerebrovascular events. Here, we investigated the relationship between marijuana use and hospitalization for acute ischemic stroke (AIS) using data from the largest inpatient database in the United States. METHODS The Nationwide Inpatient Sample was queried from 2004 to 2011 for all patients (age 15-54) with a primary diagnosis of AIS. The incidence of AIS hospitalization in marijuana users and non-marijuana users was determined. We utilized multivariable logistic regression analyses to study the independent association between marijuana use and AIS. RESULTS Overall, the incidence of AIS was significantly greater among marijuana users compared to non-users (Relative Risk [RR]: 1.13, 95% CI: 1.11-1.15, P<0.0001) and had the greatest difference in the 25-34 age group (RR: 2.26, 95% CI: 2.13-2.38, P<0.0001). Marijuana use was more prevalent among younger patients, males, African Americans, and Medicaid enrollees (P<0.0001). Marijuana users were more likely to use other illicit substances but had less overall medical comorbidity. In multivariable analysis, adjusted for potential confounders, marijuana (Odds Ratio [OR]: 1.17, 95% CI: 1.15-1.20), tobacco (OR: 1.76, 95% CI: 1.74-1.77), cocaine (OR: 1.32, 95% CI: 1.30-1.34), and amphetamine (OR: 2.21, 95% CI: 2.12-2.30) usage were found to increase the likelihood of AIS (all P<0.0001). CONCLUSION Among younger adults, recreational marijuana use is independently associated with 17% increased likelihood of AIS hospitalization.

Association of Recreational Marijuana Use with Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE Our objective was to evaluate the effect of cannabis use on hospitalizations for aneurysmal subarachnoid hemorrhage (aSAH). METHODS The Nationwide Inpatient Sample (2004-2011) was used to identify all patients (age 15-54) with a primary diagnosis of aSAH (International Classification of Diseases, Ninth Edition, Clinical Modification 430). We identified patients testing positive for cannabis use using all available diagnosis fields. The incidence and characteristics of aSAH hospitalizations among cannabis users were examined. Bivariate and multivariate analyses were performed to determine the effect of cannabis use on aSAH and in-hospital outcomes. RESULTS Prior to adjustment, the incidence of aSAH in the cannabis cohort was slightly increased relative to the noncannabis cohort (relative risk: 1.07, 95% confidence interval [CI]: 1.02-1.11). Cannabis use in aSAH was more frequent among younger patients (40.44 ± 10.17 versus 43.74 ± 8.68, P < .0001), males (53.3% versus 40.76%, P < .0001), black patients (35.92% versus 19.10%, P < .0001), and Medicaid enrollees (31.13% versus 18.31%, P < .0001). The cannabis use cohort had greater overall illicit drug use but fewer medical risk factors for aSAH. Cannabis use (odds ratio: 1.18, 95% CI: 1.12-1.24) was found to be an independent predictor of aSAH when adjusting for demographics, substance use, and risk factors. Cannabis use was not associated with symptomatic cerebral vasospasm, inpatient mortality, or adverse discharge disposition. CONCLUSIONS Our analysis suggests that recreational marijuana use is independently associated with an 18% increased likelihood of aSAH. Further case-control studies may analyze inpatient outcomes and other understudied mechanisms behind cannabis-associated stroke.

National Rates, Causes, Risk Factors, and Outcomes Associated With 30-Day and 90-Day Readmissions Following Degenerative Posterior Cervical Spine Surgery Utilizing the Nationwide Readmissions Database

BACKGROUND: Hospital readmissions have profound financial and clinical impacts. Analyses of 30‐day readmissions following spine surgery have been previously reported utilizing administrative databases. However, time periods outside the initial 30 days have not been well studied. Furthermore, these databases have limitations regarding coding and institutional crossover. OBJECTIVE: The authors sought to analyze 30‐day and 90‐day readmission rates and risk factors using the Nationwide Readmissions Database (NRD) in a retrospective cohort receiving elective, posterior cervical spine surgery for degenerative conditions. METHODS: NRD is a new source containing approximately 50% of US hospitalizations, with patient‐linkage numbers to longitudinally track patients. Patients 18 years of age or older were identified. Preoperative characteristics, demographics, and surgical characteristics were chosen for predictor variables. Thirty‐day and 90‐day readmission rates were calculated. Statistical analysis was completed using SPSS v.23 software via univariate and multivariate analyses. RESULTS: Between January and September 2013, a total of 29 990 patients were identified. Readmission rates for 30‐ and 90‐days were 5.4% and 10.0%, respectively. The most common reason for readmission during 30‐day and 90‐day periods was complications of surgical and/or medical care (31.0% vs 21.9%, respectively). The strongest risk factors for 30‐day readmission included wound dehiscence, weekend admission at index hospitalization, coagulopathy, and incidental durotomy. The strongest risk factors for 90‐day readmission included thromboembolic complications, postoperative hemorrhage, and comorbidities. CONCLUSION: Identification of predictors of readmission is important to allow for changes in perioperative management to potentially reduce readmissions and improve outcomes. Additionally, knowledge about readmission risk factors allows for preoperative counseling.

Subarachnoid Hemorrhage and Readmissions: National Rates, Causes, Risk Factors, and Outcomes in 16,001 Hospitalized Patients

INTRODUCTION The acute complications of aneurysmal subarachnoid hemorrhage (aSAH) often lead to readmissions, which are linked to hospital reimbursement. The national rates, causes, risk factors, and outcomes associated with 30-day and 90-day readmission after aSAH have not previously been reported. METHODS The Nationwide Readmissions Database was queried from January to September 2013 for all patients (age ≥18 years) with a diagnosis of aSAH. Data points included demographics, comorbidities, complications, and discharge outcomes. Causes and risk factors for 30-day and 90-day readmission were identified in univariate and multivariable analysis. RESULTS In 12,777 patients discharged alive after hospitalization for aSAH, 962 (7.5%) were readmitted within 30 days and 2153 (16.7%) within 90 days. Common causes of readmission included stroke, hydrocephalus, septicemia, and headache. At 30-day and 90-day readmission, 39.7% and 51.2% of patients with diagnosis of hydrocephalus underwent ventriculoperitoneal shunt placement, respectively. In multivariable analysis, cannabis use and diabetes were predictors of both 30-day and 90-day readmission and older patients were uniquely susceptible to 30-day readmissions. Risk factors for 90-day readmission included Medicare insurance, hypothyroidism, initial discharge to skilled nursing facility, and several index complications including bowel obstruction, gastrostomy, acute lung injury, and cerebral edema. Average cost and length of stay were calculated at 30-day (

Association of Parkinson's disease with hospitalization for traumatic brain injury

16.647, 7.1 days) and 90-day readmission (

Cervical Total Disc Replacement and Anterior Cervical Discectomy and Fusion: Reoperation Rates, Complications, and Hospital Resource Utilization in 72 688 Patients in the United States

17,926, 6.7 days). Mortality was 2.8% within 30 days and 3.8% within 90 days. CONCLUSIONS Many readmissions occur outside the 30-day follow-up period in patients subarachnoid hemorrhage and possess unique risk factors, which may help identify high-risk patients.

Rates, causes, risk factors, and outcomes of readmission following deep brain stimulation for movement disorders: Analysis of the U.S. Nationwide Readmissions Database

Purpose: The goal of our study was to determine if patients with Parkinsons disease (PD) are more susceptible to hospitalization for traumatic brain injury (TBI). Methods: The US Nationwide Inpatient Sample database was queried (2004–2011) to identify cohorts of patients with PD (N = 1 047 656) and without PD (N = 115 95 173). The age range of the study population was 60–89 years. The incidence of TBI among patients with PD was compared to the incidence of TBI in patients without PD. A multivariate logistic regression model, adjusted for all covariates that significantly differed in the bivariate analyses, was used to determine if PD was an independent predictor of TBI hospitalization. Results: The incidence of TBI hospitalization was significantly higher (relative risk: 1.76, 95% CI: 1.73–1.80) in the PD cohort. The PD cohort with TBI had fewer comorbidities and risk factors for falls/TBI compared to the non-PD cohort with TBI. The multivariable analysis, adjusting for other TBI risk factors, revealed that PD status increased the likelihood of TBI hospitalization (odds ratio: 2.99, 95% CI: 2.93–3.05). Conclusion: Our study shows that patients with PD are more susceptible to hospitalization for TBI. A greater proportion of fall-related TBI occurs in patients with PD compared to patients without PD. Further research is needed to prevent falls in PD patients to avoid TBI.

Gastrointestinal Bowel Obstruction in Acute Ischemic Stroke: Incidence, Risk Factors, and Outcomes in a U.S. Nationwide Analysis of 3,998,667 Hospitalizations

BACKGROUND Healthcare readmissions are important causes of increased cost and have profound clinical impact. Thirty-day readmissions in spine surgery have been well documented. However, rates, causes, and outcomes are not well understood outside 30 d. OBJECTIVE To analyze 30- and 90-d readmissions for a retrospective cohort of anterior cervical discectomy and fusions (ACDF) and total disc replacement (TDR) for degenerative cervical conditions. METHODS The Nationwide Readmissions Database approximates 50% of all US hospitalizations with patient identifiers to track patients longitudinally. Patients greater than 18 yr old were identified. Rates of readmission for 30 and 90 d were calculated. Predictor variables, complications, outcomes, and costs were analyzed via univariate and multivariable analyses. RESULTS Between January and September 2013, 72 688 patients were identified. The 30- and 90-d readmission rates were 2.67% and 5.97%, respectively. The most prevalent reason for 30-d readmission was complication of medical/surgical care (20.3%), whereas for 90-d readmission it was degenerative spine etiology (19.2%). Common risk factors for 30- and 90-d readmission included older age, male gender, Medicare/Medicaid, prolonged initial length of stay, and various comorbidities. Unique risk factors for 30- and 90-d readmissions included adverse discharge disposition and mechanical implant-related complications, respectively. When comparing ACDF and TDR, ACDFs were associated with increased 90-d readmissions (6.0% vs 4.3%). The TDR cohort had a shorter length of stay, lower complication rate, and fewer adverse discharge dispositions. CONCLUSION Identification of readmission causes and predictors is important to potentially allow for changes in periperative management. Decreasing readmissions would improve patient outcomes and reduce healthcare costs.

Traumatic subdural hematoma: Is there a weekend effect?

OBJECTIVE Deep brain stimulation (DBS) surgery has proven benefit for several movement disorders and medically-refractory psychiatric conditions and is considered a fairly safe procedure. We sought to determine the national rates, causes, predictors, and outcomes associated with 30-day and 90-day readmission. PATIENTS AND METHODS The Nationwide Readmissions Database was queried (January-September 2013) using ICD-9-CM codes, identifying patients who underwent DBS for movement disorder (Parkinsons disease [PD], essential tremor [ET], or dystonia). Variables included categorical age, gender, insurance, comorbidities, type of movement disorder, length of stay (LOS), total costs, and discharge disposition. RESULTS A total of 3392 DBS patients were identified [PD (70.7%), ET (25.6%), dystonia (3.7%)]. The mean age was 64.8 ± 0.4 years old and 37% were female. The rates of unplanned readmissions was 1.9% at 30-days and 4.3% at 90 days. The overall NRD incidence (all patient populations) of 30-day readmission is 11.6%. Readmissions most frequently resulted from surgical complications including hematoma and attention to surgical wounds. Elderly, obese, and those with comorbidities such as history of stroke or CAD are at highest risk. The average LOS, mean total cost, and rate of adverse discharge were worse for 30-day (9 days,

Letter by Reddy et al Regarding Article, “Cannabis Use and Outcomes in Patients With Aneurysmal Subarachnoid Hemorrhage”

64,520, 71.7%) compared to 90-day readmission (6 days,