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Childhood obesity continues to be a significant public health concern, and metabolic and bariatric surgery (MBS) is a contemporary intervention that remains underutilized. Records from the Kids' Inpatient Database (KID) were analyzed from 2009 to 2016 were analyzed to evaluate utilization characteristics of pediatric MBS. Annual procedure rates increased from 2.98 to 4.94 per 100,000 US adolescents. White children received the highest proportion of MBS at all time points; however, significant increases were seen among Black and Hispanic children. Despite these increases, a disproportionate racial bias persists indicating a need for further provider education and research into the utilization gap for minority patients. [ABSTRACT FROM AUTHOR]

Purpose: To characterize antibiotic utilization for outpatient community‐acquired pneumonia (CAP) in the United States. Methods: We conducted a cohort study among adults 18–64 years diagnosed with outpatient CAP and a same‐day guideline‐recommended oral antibiotic fill in the MarketScan® Commercial Database (2008–2019). We excluded patients coded for chronic lung disease or immunosuppressive disease; recent hospitalization or frequent healthcare exposure (e.g., home wound care, patients with cancer); recent antibiotics; or recent infection. We characterized utilization of broad‐spectrum antibiotics (respiratory fluoroquinolone, β‐lactam + macrolide, β‐lactam + doxycycline) versus narrow‐spectrum antibiotics (macrolide, doxycycline) overall and by patient‐ and provider‐level characteristics. Per 2007 IDSA/ATS guidelines, we stratified analyses by otherwise healthy patients and patients with comorbidities (coded for diabetes; chronic heart, liver, or renal disease; etc.). Results: Among 263 914 otherwise healthy CAP patients, 35% received broad‐spectrum antibiotics (not recommended); among 37 161 CAP patients with comorbidities, 44% received broad‐spectrum antibiotics (recommended). Ten‐day antibiotic treatment durations were the most common for all antibiotic classes except macrolides. From 2008 to 2019, broad‐spectrum antibiotic use substantially decreased from 45% to 19% in otherwise healthy patients (average annual percentage change [AAPC], −7.5% [95% CI −9.2%, −5.9%]), and from 55% to 29% in patients with comorbidities (AAPC, −5.8% [95% CI −8.8%, −2.6%]). In subgroup analyses, broad‐spectrum antibiotic use varied by age, geographic region, provider specialty, and provider location. Conclusions: Real‐world use of broad‐spectrum antibiotics for outpatient CAP declined over time but remained common, irrespective of comorbidity status. Prolonged duration of therapy was common. Antimicrobial stewardship is needed to aid selection according to comorbidity status and to promote shorter courses. [ABSTRACT FROM AUTHOR]

Background Ceftriaxone is a convenient option for methicillin-sensitive Staphylococcus aureus (MSSA) outpatient parenteral antimicrobial therapy (OPAT), but population-based studies for its effectiveness are lacking. Methods In this retrospective cohort, a large insurance claims database was queried from 2010 to 2018 for adults with MSSA bloodstream infection (BSI). Patients discharged on OPAT on cefazolin or oxacillin/nafcillin were compared with ceftriaxone with respect to 90-day hospital readmission with the same infection category and 90-day all-cause readmission using logistic regression models. Results Of 1895 patients with MSSA BSI, 1435 (75.7%) patients received cefazolin, oxacillin, or nafcillin and 460 (24.3%) ceftriaxone. Readmission due to the same infection category occurred in 366 (19.3%), and all-cause readmission occurred in 535 (28.3%) within 90 days. Risk factors significantly associated with readmission with the same infection category were the oldest sampled age group (61–64 years: adjusted odds ratio [aOR], 1.47 [95% confidence interval {CI}, 1.01–2.14]), intensive care unit stay during index admission (aOR, 2.33 [95% CI, 1.81–3.01]), prosthetic joint infection (aOR, 1.96 [95% CI, 1.18–2.23]), central line–associated BSI (aOR, 1.72 [95% CI, 1.33–2.94]), and endocarditis (aOR, 1.63 [95% CI, 1.18–2.23]). Ceftriaxone was not associated with increased risk of readmission with the same infection category (aOR, 0.89 [95% CI,.67–1.18]), or 90-day all-cause readmission (aOR, 0.86 [95% CI,.66–1.10]) when compared with oxacillin/nafcillin/cefazolin. Conclusions In this cohort of MSSA BSI patients discharged on OPAT, there were no differences in outcomes of readmission with the same infection and 90-day all-cause readmission in patients treated with ceftriaxone compared to oxacillin/nafcillin or cefazolin. Patients with complicated BSIs such as endocarditis and epidural abscess were more likely to be prescribed cefazolin or oxacillin/nafcillin. [ABSTRACT FROM AUTHOR]

Background Little is known about the clinical and financial consequences of inappropriate antibiotics. We aimed to estimate the comparative risk of adverse drug events and attributable healthcare expenditures associated with inappropriate versus appropriate antibiotic prescriptions for common respiratory infections. Methods We established a cohort of adults aged 18 to 64 years with an outpatient diagnosis of a bacterial (pharyngitis, sinusitis) or viral respiratory infection (influenza, viral upper respiratory infection, nonsuppurative otitis media, bronchitis) from 1 April 2016 to 30 September 2018 using Merative MarketScan Commercial Database. The exposure was an inappropriate versus appropriate oral antibiotic (ie, non-guideline-recommended vs guideline-recommended antibiotic for bacterial infections; any vs no antibiotic for viral infections). Propensity score-weighted Cox proportional hazards models were used to estimate the association between inappropriate antibiotics and adverse drug events. Two-part models were used to calculate 30-day all-cause attributable healthcare expenditures by infection type. Results Among 3 294 598 eligible adults, 43% to 56% received inappropriate antibiotics for bacterial and 7% to 66% for viral infections. Inappropriate antibiotics were associated with increased risk of several adverse drug events, including Clostridioides difficile infection and nausea/vomiting/abdominal pain (hazard ratio, 2.90; 95% confidence interval, 1.31–6.41 and hazard ratio, 1.10; 95% confidence interval, 1.03–1.18, respectively, for pharyngitis). Thirty-day attributable healthcare expenditures were higher among adults who received inappropriate antibiotics for bacterial infections ($18–$67) and variable (−$53 to $49) for viral infections. Conclusions Inappropriate antibiotic prescriptions for respiratory infections were associated with increased risks of patient harm and higher healthcare expenditures, justifying a further call to action to implement outpatient antibiotic stewardship programs. [ABSTRACT FROM AUTHOR]

Background: Evidence is limited about the comparative safety of antibiotic regimens for treatment of community-acquired pneumonia (CAP). We compared the risk of adverse drug events (ADEs) associated with antibiotic regimens for CAP treatment among otherwise healthy, non-elderly adults., Methods: We conducted an active comparator new-user cohort study (2007-2019) of commercially-insured adults 18-64 years diagnosed with outpatient CAP, evaluated via chest x-ray, and dispensed a same-day CAP-related oral antibiotic regimen. ADE follow-up duration ranged from 2-90 days (e.g., renal failure [14 days]). We estimated risk differences [RD] per 100 treatment episodes and risk ratios using propensity score weighted Kaplan-Meier functions. Ankle/knee sprain and influenza vaccination were considered as negative control outcomes., Results: Of 145 137 otherwise healthy CAP patients without comorbidities, 52% received narrow-spectrum regimens (44% macrolide, 8% doxycycline) and 48% received broad-spectrum regimens (39% fluoroquinolone, 7% β-lactam, 3% β-lactam + macrolide). Compared with macrolide monotherapy, each broad-spectrum antibiotic regimen was associated with increased risk of several ADEs (eg, β-lactam: nausea/vomiting/abdominal pain [RD per 1000, 3.20; 95% CI, 0.99–5.73]; non–Clostridioides difficile diarrhea [RD per 1000, 4.61; 95% CI, 2.47–6.82]; vulvovaginal candidiasis/vaginitis [RD per 1000, 3.57; 95% CI, 0.87, 6.88]). Narrow-spectrum antibiotic regimens largely conferred similar risk of ADEs. We generally observed similar risks of each negative control outcome, indicating minimal confounding., Conclusions: Broad-spectrum antibiotics were associated with increased risk of ADEs among otherwise healthy adults treated for CAP in the outpatient setting. Antimicrobial stewardship is needed to promote judicious use of broad-spectrum antibiotics and ultimately decrease antibiotic-related ADEs., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: Despite its widespread prevalence, the cost of cubital tunnel syndrome (CuTS) in the United States to patients and insurers is not well understood. The purpose of this study was to quantify the direct payments associated with operative treatment of CuTS. We hypothesized that CuTS represents a substantial cost to the payer in facility fees, surgeon fees and other expenses., Methods: Utilizing the MarketScan database of insured patients (commercial and Medicaid), we identified a cohort of 41,777 patients aged 18-64 years with surgically treated CuTS from 2006 to 2018. We estimated the median 90-day payments from encounters associated with cubital tunnel release (CuTR) and/or ulnar nerve transposition surgery by summing all payments for claims within 90 days after the index surgery. Published estimates of the annual number of cubital tunnel surgeries were used to calculate the annual expenditure., Results: Of 41,777 patients, the median (interquartile range [IQR]) values of total direct payments were $5,522 [$3,426, $9,541]. With an estimated 94,645 cases/year, this leads to an annual payment of more than $522 million. Index facility payments (median[IQR] $2,555 [$1,359, $4,708] were the highest, followed by index provider payments ($1,691 [$1,328, $2,217]). The median index surgeon payment (median[IQR] $905 [$707, $1,184]) represented just over half of the provider payments. Post-operative care had a median [IQR] payment of $377 ($424, $1,987). Limitations of claims databases prevented assessment of other indirect costs associated with cubital tunnel surgery., Conclusions: Payments for the surgical treatment of CuTS from the index surgery to 90 days post-operatively have an estimated median of $5,522 per patient, totaling $52 million annually. Index facility fees are responsible for more than 46% of payments, while index payments to surgeons represent approximately 16%. Defining this data is critical to understanding one component of the economic impact of CuTS., Level of Evidence: Level IV., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Prompt detection of colorectal cancer (CRC) among individuals younger than age 50 years (early-onset CRC) is a clinical priority because of its alarming rise., Methods: We conducted a matched case-control study of 5075 incident early-onset CRC among US commercial insurance beneficiaries (113 million adults aged 18-64 years) with 2 or more years of continuous enrollment (2006-2015) to identify red-flag signs and symptoms between 3 months to 2 years before the index date among 17 prespecified signs and symptoms. We assessed diagnostic intervals according to the presence of these signs and symptoms before and within 3 months of diagnosis., Results: Between 3 months and 2 years before the index date, 4 red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk of early-onset CRC, with odds ratios (ORs) ranging from 1.34 to 5.13. Having 1, 2, or at least 3 of these signs and symptoms were associated with a 1.94-fold (95% confidence interval [CI] = 1.76 to 2.14), 3.59-fold (95% CI = 2.89 to 4.44), and 6.52-fold (95% CI = 3.78 to 11.23) risk (Ptrend < .001), respectively, with stronger associations for younger ages (Pinteraction < .001) and rectal cancer (Pheterogenity = .012). The number of different signs and symptoms was predictive of early-onset CRC beginning 18 months before diagnosis. Approximately 19.3% of patients had their first sign or symptom occur between 3 months and 2 years before diagnosis (median diagnostic interval = 8.7 months), and approximately 49.3% had the first sign or symptom within 3 months of diagnosis (median diagnostic interval = 0.53 month)., Conclusions: Early recognition of red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron-deficiency anemia) may improve early detection and timely diagnosis of early-onset CRC., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Acute compartment syndrome (ACS) is a rare complication following traumatic injuries in pediatric patients, and tibia fractures represent the most common cause of ACS. To determine the incidence and risk factors of developing ACS, State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, were used to retrospectively identify patients 1-18 years of age with tibia fractures from 2006 to 2015 (quarter 3). The HCUP Nationwide Emergency Department Sample for nationwide data was also queried. Multivariable generalized estimating equations models were used to determine risk factors associated with development of ACS. A total of 50 640 patients with tibia fractures were studied, and 309 cases of ACS were identified. The incidence of ACS was 0.6 and 5.5% in the all tibia and open tibia fracture groups, respectively. Twenty-three cases of ACS (7.4% of all ACS) were diagnosed after discharge from the index admission, which was more common in teens treated nonoperatively. Predictors of increased ACS risk in the all tibia fracture group included age 13-18 [relative risk (RR): 4.04)], open fractures (RR: 3.83), and motor vehicle crash (MVC) mechanism (RR: 5.69). Nationwide, open and operatively treated fractures had an increased ACS rate (3.98 and 5.51%, respectively). Teenagers, open fractures, and MVC mechanisms were most strongly associated with ACS. ACS can present in a delayed fashion, as evidenced by postindex cases., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)