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Objectives: Though ablation is a relatively safe procedure for atrial fibrillation (AF) treatment, a rare but potentially fatal complication in the form of cardiac perforation could occur. The aim of this study was to examine the underlying predictors associated with cardiac perforation. Methods: The 2013-2018 Centers for Medicare & Medicaid Services (CMS) Medicare Standard Analytic Files (SAF) data was used for this study. Patients aged $65 years who underwent ablation procedure with a primary diagnosis of AF were identified, with first such occurrence classified as index procedure. The main outcome of interest was the occurrence of cardiac perforation within 30 days of the index ablation. Baseline demographic, comorbid, and procedure-related characteristics were examined. Univariate logistic regression followed by generalized estimating equation (GEE) with logit link and binomial distribution were used to assess the underlying predictors of cardiac perforation. Sensitivity analysis was performed by controlling for hospital ablation volume. Results: The final sample included 102,389 patients. The average age was 71 years, 43.8% were female, and 94.2% were white. Cardiac perforation occurred in 0.61% (n=623) of patients within 30 days of the index ablation procedure. From univariate logistic regression, female gender, prior history of cardiac surgery, non-use of intracardiac echocardiography (ICE), hypothyroidism, obesity, and fluid and electrolyte disorders were identified as significant predictors. When examining these factors together in a GEE model, prior cardiac surgery (odds ratio [OR] 0.15; 95% confidence interval [CI] 0.08-0.26), obesity (OR 1.35; 95% CI 1.10-1.65), non-use of ICE (OR 5.06; 95% CI 4.16-6.15), and female gender (OR 1.34; 95% CI 1.15-1.57) emerged as significant predictors of cardiac perforation. Results: were consistent when controlling for hospital ablation volume. Conclusions: One of the strongest predictors of cardiac perforation during ablation for AF was a modifiable factor, i.e., the non-use of ICE.

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Background Acute myocardial infarction complicated by cardiogenic shock (AMICS) occurs in up to 10% of acute myocardial infarction admissions and is associated with high mortality, frequent adverse outcomes, prolonged hospitalizations, extensive medical resource utilization, and major cost. Using hospital cost data for Medicare Fee‐for‐Service (FFS) patients with AMICS, we sought to evaluate in hospital and 45‐day outcomes and cost, comparing patients treated with percutaneous ventricular assist device (pVAD) versus extracorporeal membrane oxygenation (ECMO). The goal of this study was to better understand clinical and economic outcomes of AMICS to help clinicians and hospitals optimize outcomes most economically for AMICS patients. Methods A retrospective claims analysis identified patients from the full census Medicare Standard Analytic Files compiled by the Center for Medicare and Medicaid (CMS) including: Inpatient, Outpatient, Skilled Nursing Facility and Home Health files for Medicare FFS beneficiaries. Study costs were defined as the total costs incurred by providers for treating a population with AMICS. Medicare FFS beneficiaries who experienced an inpatient admission during the index period (January 1, 2015 to March 31, 2017) with a diagnosis of AMICS were eligible for study inclusion and were identified by the presence of appropriate International Classification of Diseases, Ninth and Tenth Versions (ICD‐9 and ICD‐10) diagnosis and procedure codes. To create a matched sample and control for any baseline differences, a 1:1 Propensity Score Matching (PSM) was performed based on criteria such as age, gender, race, geographic distribution, and 11 high‐cost comorbidities (e.g., congestive HF, coronary artery disease, diabetes, etc.). Index length of stay (LOS), index costs, discharge disposition (including mortality), post‐index utilization, and episode‐of‐care (EOC) costs were reviewed. EOC was defined as index admission for all patients plus a 45‐day post index period for patients who survived the index admission. Results Each cohort included 338 patients. Index in‐hospital mortality rates were 53% for pVAD versus 64% for ECMO (178 vs. 217; p = .0023), and total EOC in‐hospital mortality rates were 66% for pVAD versus 74% for ECMO (222 vs. 250; p = .0160). Index LOS for pVAD was 27% lower versus ECMO (12.12 vs. 16.59; p = .0006). The index LOS for patients discharged alive was 25% lower for pVAD versus ECMO (17.73 vs. 23.62; p = .0016). For patients that experienced in‐hospital mortality during their index stay, pVAD had a 44% lower LOS compared to ECMO (7.08 vs. 12.66; p < .0001). Following index hospitalization, the average cost savings with additional inpatient care was 31% lower for pVAD patients ($62,188 vs. $90,087; p = NS). During the EOC, pVAD patients incurred 32% lower costs compared to ECMO patients ($117,849 vs. $172,420; <.0001). Conclusions This study of Medicare FFS patients demonstrates that hospitals utilizing pVAD for appropriately selected AMICS patients have reduced mortality r...

Aim: Determine the clinical utility and economic differences over a 90-day period between robotic arm-assisted total hip arthroplasty (RATHA) and manual total hip arthroplasty (MTHA). Methods: Leveraging a nationwide commercial payer database, pre-covid THA procedures were identified. Following a 1:5 propensity score match, 1732 RATHA and 8660 MTHA patients were analyzed. Index costs, index lengths of-stay, and 90-day episode-of-care utilization and costs were evaluated. Results: Episode of care costs for RATHA was found to be $1573 lower compared with MTHA (p < 0.0001). Post-index hospital utilization was significantly less likely to occur for RATHA compared with MTHA. Total index costs were also significantly lower for RATHA versus MTHA (p < 0.0001). Conclusion: Index and post-index EOC hospital utilization and costs were lower for RATHA compared with MTHA.