Objective:Cesarean hysterectomy for placenta accreta spectrum (PAS) is associated with significant morbidity. The role of adjunctive procedures, including tranexamic acid administration, ureteral stent placement, and endoarterial embolization or balloon placement, in mitigating surgical morbidity during cesarean hysterectomy for PAS is currently under active investigation. This study aimed to assess temporal trends, characteristics, and outcomes associated with adjunctive procedures during cesarean hysterectomy for PAS. Study Design:This retrospective study used the Premier Perspective database in the United States. The study population included pregnant patients who underwent cesarean hysterectomies for PAS between 2016 and 2023. Targeted adjunctive procedures included tranexamic acid administration, ureteral stent placement, and endoarterial embolization or balloon placement. A multivariate model was created to assess the association between adjunctive procedures and surgical morbidity. Results:Among 4,337 cesarean hysterectomies for PAS, 39.3%, 24.6%, and 16.1% received tranexamic acid, ureteral stent placement, and endoarterial embolization or balloon placement, respectively. During the 8-year study period, tranexamic acid administration increased 5.7-fold from 11.7% to 66.4%, and ureteral stent placement increased 1.6-fold from 19.2% to 30.3% (both p-trend <0.001). Nearly two-thirds of patients had postpartum hemorrhage (62.6%), and nearly one in five had urinary tract injury (18.7%). These three adjunctive procedures were not associated with decreased postpartum hemorrhage or urinary tract injury. Conclusion:These data suggest that the utilization of tranexamic acid and ureteral stent placement is increasing during cesarean hysterectomy for PAS in the United States. Reflecting the increases in real-world practice, whether these adjunctive procedures improve surgical morbidity of cesarean hysterectomy for PAS warrants further investigation with prospective studies. Key Points:· Tranexamic acid and ureteral stent use increased during PAS cesarean hysterectomy.. · Endoarterial procedures showed no significant temporal increase.. · Surgical morbidity remained substantial despite adjunctive procedure use..

OBJECTIVE:Malignant ovarian germ cell tumors (MOGCTs) are rare non-epithelial ovarian malignancies. Although comprehensive surgical staging, including lymphadenectomy, is recommended by current guidelines, the prognostic benefit in early-stage disease remains uncertain. We evaluated patterns of lymphadenectomy use and its association with survival in stage T1 MOGCTs. METHODS:Using the National Cancer Database, we identified women with stage T1 MOGCTs diagnosed between 2018 and 2022. Multivariable log-linear regression was used to identify factors associated with lymphadenectomy. Propensity score inverse probability of treatment weighting (IPTW) was applied to estimate the association between lymphadenectomy and survival using weighted Kaplan-Meier and Cox proportional-hazards models. RESULTS:Among 740 patients, 47.3% underwent lymphadenectomy, with use declining from 53.3% in 2018 to 36.2% in 2022 (P = 0.02). Dysgerminoma histology (aRR 1.78, 95% CI: 1.19-2.66), larger tumor size (>150 mm, aRR 1.44, 95% CI: 1.03-2.01), and performance of hysterectomy (aRR 1.40, 95% CI: 1.04-1.87) were associated with increased likelihood of undergoing lymphadenectomy. The median number of nodes examined was 9 (IQR 4-16), with nodal metastases identified in 6.6% of cases, most commonly among dysgerminomas. After PS IPTW, patients who underwent lymphadenectomy were more likely to receive adjuvant chemotherapy (52.8% vs. 44.7%; SMD = 0.16), and lymphadenectomy was not associated with improved survival (aHR 1.23, 95% CI: 0.38-4.06). CONCLUSIONS:In stage T1 MOGCTs, lymphadenectomy was not associated with improved survival but was associated with higher rates of adjuvant chemotherapy use. Given the low rate of nodal metastasis and excellent survival outcomes, a selective approach to lymphadenectomy may be appropriate.

11147 Background: Opioid use disorder is increasingly prevalent among cancer patients. Since mid-2010s, heightened attention to the opioid crisis has led to restrictive opioid prescribing policies; however, national trends in opioid-related hospitalizations (ORH) among cancer patients following these policies remain underreported. This study examines ORH trends from 2000 to 2022 and associated factors among adult cancer patients. Methods: We identified hospitalizations among adult patients (age ≥18 years) with any cancer in the National Inpatient Sample (2000-2022). Outcomes included: 1) primary ORH (PORH), defined as admissions with a primary diagnosis indicating opioid poisoning, dependence or abuse, and 2) any ORH (AORH), capturing these conditions in any diagnostic field. The risks of PORH and AORH were calculated as the number of cases per 10,000 hospitalizations, respectively. Join-point regression assessed trends in risks of PORH and AORH, reporting annual percentage changes (APCs). Multivariable logistic regression identified factors associated with PORH and AORH, with adjusted odds ratio (aORs) reported. Results: Overall, among 59,682,271 weighted hospitalizations in cancer patients (median age 66.8 years, IQR 56.5-76.3), PORH occurred in 5.5 per 10,000 hospitalizations (n = 32,641) and AORH in 200 per 10,000 hospitalizations (n = 1,192,358). The risk of PORH increased non-significantly from 2.2 per 10,000 hospitalizations in 2000 to 4.8 in 2014 (APC = 5.6, p > 0.05), then rose sharply to 10.6 in 2017 (APC = 25.1, p < .001), before declining significantly to 6.8 in 2022 (APC = -9.7, p < .001). The risk of AORH also increased non-significantly from 45 per 10,000 hospitalizations in 2000 to 60.8 in 2014 (APC = 0.2, p > 0.05), then rose to 594.4 in 2019 (APC = 118.2 for 2013-2016 and 11.7 for 2016-2019; both p < .001), before decreasing non-significantly to 476.8 in 2022 (APC = -7.8, p > .05). Higher PORH risk was associated with younger age ( < 65 vs. ≥ 65: aOR = 2.53, p < .001), race and ethnicity (Native American: aOR = 2.07, Black: aOR = 1.85, White: aOR = 1.79, relative to Asian/Pacific Islanders; all p < .001), public or no health insurance, lower income, co-occurring substance use disorders (SUD) (e.g., sedative aOR = 35.19, cocaine aOR = 3.57, both p < .001), depression (aOR = 2.46, p < .001), anxiety, chronic pain, metastases, and care in small, non-teaching, rural hospitals and the West region. Similarly, AORH were associated with younger age, race and ethnicity, insurance, low income, co-occurring SUD, mental health condition, chronic pain, metastases, comorbidity burden, and the West region. Conclusions: Opioid-related hospitalizations decreased substantially in recent years following heightened attention and clinical/policy efforts in the mid-2010s. Elevated risks were primarily associated with patient demographics, co-occurring substance use disorder, mental health conditions, and chronic pain.

OBJECTIVE:To examine real-world patterns of systemic hormone therapy (HT) initiation and continuation among women with a diagnosis of menopause. METHODS:Using the Merative™ MarketScan® Research Databases (2009-2022), we identified women aged 45-60 years with menopause-related claims and at least 12 months of continuous enrollment. Patients with bilateral oophorectomy, breast or gynecologic cancers, or HT contraindications were excluded. Multivariable regression analyzed factors associated with HT initiation, formulation, and duration. RESULTS:Of 318,621 eligible women, 21.7% initiated systemic HT within 1 year. Predictors of HT initiation included younger age (adjusted odds ratio [aOR] 2.17; 95% CI, 2.12-2.23), prior hysterectomy (aOR 1.98; 95% CI, 1.77-2.21), and local hormone use (aOR 3.25; 95% CI, 3.05-3.47). Initiation was significantly lower among women with obesity (aOR 0.78; 95% CI, 0.75-0.81), diabetes (aOR 0.69; 95% CI, 0.66-0.72), and Black racial identification (aOR 0.78; 95% CI, 0.68-0.89). Initial formulations were estrogen plus progestogen (52.5%), estrogen-alone (32.4%), and progestogen-alone (15.1%). The median first-episode duration was 6.6 months; 38.8% of patients continued at 12 months. Black racial (adjusted hazard ratio [aHR] 1.52; 95% CI, 1.34-1.73) and Hispanic ethnic (aHR 1.43; 95% CI, 1.14-1.80) identities predicted faster discontinuation. Conversely, prior hysterectomy (aHR 0.75; 95% CI, 0.68-0.83) and concurrent local hormone use (aHR 0.84; 95% CI, 0.80-0.89) reduced discontinuation risk. CONCLUSION:Although one-fifth of women initiated systemic HT shortly after their diagnosis, low persistence and racial disparities among those who initiated reveal critical gaps in long-term menopause management. Furthermore, true real-world utilization is likely even lower due to underdocumentation in clinical coding. These findings underscore an urgent need for targeted, equitable interventions to improve treatment adherence and ensure consistent, comprehensive care for menopausal women.

OBJECTIVE:To estimate the real-world incidence of abnormal uterine bleeding after oral anticoagulant initiation with a large national claims database, stratified by agent and age group. METHODS:We conducted a nested matched case-control study using the MarketScan Research Databases (2008-2022). Women 18 years of age or older initiating oral anticoagulants (warfarin, apixaban, rivaroxaban, dabigatran, and edoxaban) for deep venous thrombosis, pulmonary embolism, or atrial fibrillation or flutter were matched 1:5 to anticoagulant nonusers. The primary outcome was abnormal uterine bleeding (AUB) within 1 year. Secondary outcomes included the risk of hospitalizations, emergency department visits, and outpatient encounters related to AUB. All estimates were derived from conditional logistic regression models adjusted for matching factors and baseline clinical covariates. RESULTS:Among 276,911 anticoagulant users and 1,384,555 matched controls, the incidence of AUB was significantly higher in anticoagulant users (6.1% vs 3.0%, adjusted odds ratio [AOR] 1.81, 95% CI, 1.69-1.93). Anticoagulant users had higher odds of AUB-related hospitalization (0.8% vs 0.01%, AOR 62.32, 95% CI, 30.94-125.53), emergency department visits (0.9% vs 0.2%, AOR 5.78, 95% CI, 4.02-8.31), and outpatient encounters (4.6% vs 2.8%, AOR 1.42, 95% CI, 1.32-1.52). Women younger than 50 years of age had a greater relative increase in AUB (19.7% vs 9.2%, AOR 1.96, 95% CI, 1.79-2.14) compared with women 50 years of age or older (3.8% vs 2.0%, AOR 1.63, 95% CI, 1.50-1.78). Among all agents, rivaroxaban was associated with the highest risk of AUB. CONCLUSION:Oral anticoagulant therapy is associated with significantly increased odds of AUB, particularly among younger women. Rivaroxaban conferred the highest AUB risk.

BACKGROUND:It is unknown to what extent the surgical management of endometriosis occurs in the outpatient settings and which factors are associated with ambulatory vs inpatient surgical care. OBJECTIVE:The objective of this study was to perform a nationwide analysis comparing trends, clinical factors, disease manifestations, surgical approaches, and hospital charges between ambulatory and inpatient surgical cases for endometriosis. STUDY DESIGN:This serial cross-sectional study analyzed inpatient and ambulatory surgeries from 2016 to 2022 with a primary diagnosis of endometriosis. Inpatient surgeries were analyzed using the National Inpatient Sample, a nationally representative inpatient database. Ambulatory surgeries were analyzed using the Nationwide Ambulatory Surgery Sample, a nationally representative ambulatory surgical database. Surgical trends were analyzed using joinpoint regression and presented as the average annual percent change. Demographic and clinical characteristics associated with inpatient vs ambulatory surgery were reported. Surgical procedures, endometriosis involvement sites, and surgical complications were also compared between inpatient and ambulatory surgeries. RESULTS:A nationwide total of 70,535 weighted inpatient and 561,894 weighted ambulatory surgical encounters for endometriosis were identified between 2016 and 2022. Over the study period, inpatient surgical volume decreased by 49% from 14,080 cases in 2016 to 7110 cases in 2022 (average annual percent change, -11.5% [95% confidence interval, -14.4% to -8.7%]), whereas outpatient surgical volume increased by 17% from 73,270 cases in 2016 to 85,896 cases in 2022 (average annual percent change, 2.8% [95% confidence interval, 0.2%-5.4%]). Inpatient surgical cases were more likely to occur among patients who were older (median age, 40 vs 37 years), who had a higher Elixhauser comorbidity index, who were more likely to be enrolled in Medicaid insurance (20% vs 16%), and who lived in the lowest median income ZIP code quartile (26% vs 21%). Ovarian involvement (37% vs 26%), bowel involvement (10% vs 3%), multiorgan involvement (40% vs 30%), concurrent pelvic infection (3.0% vs 1.4%), and intraoperative complications were all more common among patients undergoing inpatient compared with ambulatory surgery. Hysterectomy with salpingo-oophorectomy was most frequent in the inpatient setting but also accounted for a large proportion of ambulatory procedures (61% vs 47%), with a significant shift of this operation from inpatient to ambulatory care over the study period. CONCLUSION:An increasing proportion of surgeries for endometriosis, including hysterectomy, is now being performed in the outpatient setting. Inpatient surgical cases are more common among medically complex patients and those with distinct socioeconomic characteristics.

BACKGROUND:With evolving prescription policies, the clinical utility of patient-centered opioid prescribing remains unclear. We evaluated whether a patient-centered opioid prescribing approach improves outcomes compared to default strategies: "treat all" (emulating opioid over-prescribing practices in the late 1990s and 2000s) or "treat none" (reflecting prescribing restrictions in Centers for Disease Control and Prevention 2016 guideline). METHODS:We conducted a decision curve analysis using electronic medical data from 1136 adult patients undergoing laparoscopic cholecystectomy for benign indications (October 2015 - December 2018) at an urban tertiary care center. Perioperative opioid needs were categorized as "none/low" or "medium/high" based on pain scores and opioid prescriptions/administrations from 30 days pre-operative to two weeks postoperative. RESULTS:Of 803 patients in the training dataset, 63.9 % required medium/high opioid levels. Key predictors included sex, preoperative medication use (opioids, acetaminophen, other nonsteroidal anti-inflammatory drug, antidepressants), emergent surgery, anesthesia type, and surgical indications. The prediction model's c-statistic was 0.65 (95 %CI: 0.58-0.71) and Brier score was 0.20 (95 % CI: 0.009-0.71) in the testing dataset. At an optimal threshold probability of 0.60, the prediction model correctly identified 16 more true positive cases per 100 patients needing medium/high opioid prescriptions than the "treat all" strategy, accounting for false positives. Across a threshold range of 0.18-0.91, the model-based strategy constantly outperformed both default strategies. CONCLUSION:Prediction-based, patient-centered opioid prescribing provides greater clinical utility across most thresholds.

Background: In October 2019, the Prevent Recurrent Preterm Birth in Singleton Gestations (PROLONG) Trial was published, showing no impact of 17-α-hydroxyprogesterone caproate (17-OHP) on reducing recurrent preterm birth (PTB). This analysis evaluated interventions for recurrent PTB prevention before and after publication of PROLONG. Methods: This retrospective cohort study identified women aged 15-54 years with a singleton delivery hospitalization, a history of PTB, and continuous healthcare enrollment during pregnancy in the 2017-2022 MarketScan Research Databases. Vaginal progesterone (VP) and 17-OHP pharmacy receipts were analyzed pre- and post-PROLONG. An adjusted interrupted time series analysis was performed to assess changes in VP and 17-OHP use, comparing the pre- and post-PROLONG periods (January 2017-September 2019: pre-PROLONG; October 2019-March 2020: transition period; April 2020-December 2022: post-PROLONG). Preterm birth rates were similarly compared across periods. Findings: A total of 70,578 deliveries with a history of PTB were included (41,030 pre-PROLONG and 29,548 post-PROLONG). Compared with the pre-PROLONG period, 17-OHP use declined from 24·4% to 10·7% (p<0·0001), while VP use increased from 7·3% to 11·2% (p<0·0001). Recurrent PTB rates remained unchanged at both <37 weeks (25·1% vs 25·5%, p=0·23) and <35 weeks (10·0% vs 9·9%, p=0·59). In adjusted interrupted time series analyses, publication of PROLONG was associated with an immediate decrease in 17-OHP prescribing (β2=−4·99, p<0·0001) followed by continued monthly decline (β3=−0·31, p<0·0001), with adjusted 17-OHP use decreasing from 16·7% immediately before publication to 4·3% by the end of the study period. Conversely, VP prescribing increased immediately following PROLONG publication (β2=1·13, p=0·006) and continued to rise over time (β3=0·19, p<0·0001), reaching 13·8% by the final study months compared with 7·5% pre-PROLONG. Interpretation: The study findings indicate that clinical practice shifted rapidly following the publication of PROLONG. The use of 17-OHP declined substantially without an accompanying change in recurrent PTB rates. Conversely, VP use increased nearly twofold during the same period.

Objective:The objectives of this study were to analyze trends in obstetric pulmonary embolism (PE) and to determine how clinical risk factors have contributed to changes in PE risk over the study period. Study Design:The 2000-2021 National Inpatient Sample was used for this cross-sectional analysis. Delivery hospitalizations of patients aged 15 to 54 years were identified. Trends in pulmonary embolism and associated risk factors were estimated with joinpoint regression, which calculated trends as the average annual percent change (AAPC) with 95% CIs. Risk factors analyzed included chronic conditions such as thrombophilia, prior venous thromboembolism events, obesity, and chronic heart disease as well as a range of obstetric complications. A multivariate logit decomposition model analysis was performed to determine the contribution of individual risk factors to increasing risk for PE over the study period. Results:The rate of PE increased significantly over the study period among both vaginal deliveries (AAPC 6.4%, 95% CI 5.0%, 7.6%) and cesarean deliveries (AAPC 5.3%, 95% CI 4.1%, 6.8%). In decomposition analysis, the increasing prevalence of chronic conditions and obstetric complications accounted for 39.2% of the increased PE risk among vaginal deliveries and 54.4% of the increased PE risk among cesarean deliveries. Among vaginal deliveries, growing obesity prevalence accounted for the most increased risk (15.3%). Among cesarean deliveries, increase in chronic heart disease (12.8%), hypertensive disorders of pregnancy (10.5%), blood transfusion (9.8%), and obesity (8.8%) accounted for the most increased risk. A decrease in postpartum infections among cesarean deliveries accounted for decreased PE risk (-11.3%). Conclusion:PE increased significantly over a 22-year study period in this analysis of nationally representative obstetric delivery data. A large portion of the increase in PE could be accounted for by the increasing prevalence of PE risk factors, although risk associated with postpartum cesarean infections decreased over the study period. Key Points:· PE increased significantly over 22 years among both vaginal and cesarean deliveries.. · Rising risk factor prevalence, especially obesity, explains much of the increased PE risk.. · Cesarean PE increase reflects genuine clinical trends, not ICD-9 to ICD-10 coding transition artifact..

Abstract Objective This study aimed to evaluate trends in breast cancer diagnoses among delivery hospitalizations and to determine the degree to which individual risk factors contributed to changes in breast cancer prevalence over time. Methods We conducted a serial cross‐sectional study using data from the Nationwide Inpatient Sample. Delivery hospitalizations among women aged 15–54 years from 2006 to 2022 were included. The primary outcome was a breast cancer diagnosis associated with a delivery hospitalization identified using ICD‐9 and ICD‐10 diagnosis codes. Joinpoint regression was used to evaluate temporal trends in breast cancer, and logistic regression models were employed to identify factors associated with breast cancer prevalence. Multivariate logistic regression decomposition was applied to quantify the contribution of risk factors to the difference in breast cancer prevalence between 2006–2008 and 2020–2022. Results A total of 13 million delivery hospitalizations were identified. Breast cancer prevalence increased from 6.4 per 100,000 births in 2006 to 12.3 per 100,000 in 2022 with an average annual percentage change of 4.8% (95% confidence interval [CI], 3.4%, 6.4%). Older maternal age, chronic hypertension, family history of breast cancer, and genetic susceptibility to breast cancer were associated with increased odds of breast cancer diagnoses during delivery hospitalization. From 2006 to 2022, there were significant increases in the proportion of women with older maternal age and chronic conditions. Multivariate logistic regression decomposition analysis indicated that changes in maternal age were the most important determinant of increased prevalence. If maternal age distributions were the same in 2020–2022 as they were in 2006–2008, breast cancer prevalence would be expected to be 58% lower in 2020–2022. Conclusion Breast cancer prevalence among the obstetric population has increased over time, with advanced maternal age accounting for more than half of the increase in breast cancer occurrence.

Background:Changes in opioid prescribing practices have evolved, including perioperative settings. However, computerized clinical decision support systems to guide opioid prescribing remain limited. This study aimed to develop and validate prediction models for perioperative opioid needs among patients undergoing laparoscopic cholecystectomy (LC) and to create a risk-scoring tool. Methods:This was a retrospective cohort study. Using electronic medical records (EMR), we identified patients aged 18-64 years who underwent LC for benign conditions between October 2015 and December 2018. Demographic, clinical, and surgical data were collected. Perioperative opioid needs were classified as none/low (0-3 days), medium (4-6 days), or high (≥7 days), based on self-reported pain scores and prescription duration. The cohort was split into training (70%) and testing (30%) datasets. Prediction models were developed using random forest, Least Absolute Shrinkage and Selection Operator (LASSO), and subject-matter expertise, with performance evaluated by discrimination, calibration, accuracy, precision, recall, and F1 score. Results:A total of 1136 patients were identified. In the training dataset (n = 803), 36.1% of patients were in the none/low group, 22.1% in the medium group, and 41.8% in the high group. In testing dataset (n = 333), LASSO outperformed random forest with better calibration. The revised LASSO model, incorporating subject-matter knowledge, improved interpretability, achieving an AUC of 0.64 and Brier score of 0.20. Key predictors included gender, pre-operative medication, emergency surgery, anesthesia type, and surgical indications. A nomogram was developed for visual prediction. Conclusions:Prediction of perioperative opioid needs using EMR and machine-learning is feasible and may support individualized pain management, though further refinement of model performance is warranted.

OBJECTIVE:To evaluate the association between medication for opioid use disorder (MOUD) and surgical complications and health care utilization among patients with opioid use disorder (OUD) undergoing hysterectomy. METHODS:Using MarketScan Research Databases (2016-2021), we identified patients with OUD who underwent hysterectomy for benign indications. Use of MOUD (methadone or buprenorphine) was assessed within 1 year preoperatively, distinguishing among prior MOUD use (365 to 31 days preoperatively), current MOUD use (30 to 1 days preoperatively), and nonuse of MOUD. The primary outcomes included perioperative surgical complications. The secondary outcome included perioperative and postoperative opioid prescription, 30-day readmissions, and emergency department (ED) visits within 30 and 90 days. Propensity scores inverse probability of treatment weighting was used to evaluate the association between current MOUD and outcomes. RESULTS:Of 1,715 patients with preoperative OUD who underwent hysterectomy, 491 (28.6%, 95% CI, 26.5-30.8%) reported current MOUD use. Current MOUD use was associated with fewer perioperative complications than nonuse of MOUD (27.7% vs 33.9%, adjusted risk ratio 0.86, 95% CI, 0.76-0.97), including surgical site (12.8% vs 16.9%) and medical (17.5% vs 22.8%) complications. Current MOUD use was also associated with fewer ED visits within 30 days (19.1% vs 27.7%) and 90 days (32.6% vs 42.8%). Buprenorphine and methadone had similar outcomes. Patients on MOUD for more than 90 days had lower risks of complications and health care utilization than those on MOUD for 90 days or less. CONCLUSION:Among patients with OUD undergoing hysterectomy, MOUD use was associated with reduced perioperative complications and health care utilization. Findings support methadone and buprenorphine use to improve hysterectomy surgical outcomes, particularly with more than 90 days of MOUD.

Objective:The objective of this study is to evaluate trends, risk factors, and outcomes associated with anorexia and/or bulimia nervosa diagnoses during delivery hospitalizations in the United States. Study Design:The 2000 to 2022 National Inpatient Sample was used for this repeated-cross sectional analysis. Delivery hospitalizations of patients aged 15 to 54 with anorexia and/or bulimia nervosa diagnoses were identified. Temporal trends were analyzed with joinpoint regression reporting the average annual percent change (AAPC). The associations between anorexia and/or bulimia nervosa diagnoses and adverse outcomes including (1) transfusion, (2) nontransfusion severe maternal morbidity, (3) postpartum hemorrhage, (4) hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia), (5) cesarean delivery, (6) preterm delivery at <37 and <32 weeks, and (7) anemia were analyzed with unadjusted and adjusted logistic regression models with unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) as measures of association. Results:Of 87,151,598 delivery hospitalizations identified, 6,309 (7.2 per 100,000) had an anorexia nervosa and/or bulimia nervosa diagnosis, including 3,308 diagnoses of bulimia (3.8 per 100,000) and 3,324 diagnoses of anorexia (3.8 per 100,000). Diagnoses increased significantly over the study period for bulimia (AAPC: 6.6%, 95% confidence interval [CI]: 5.0%, 8.8%), anorexia (AAPC: 11.3%, 95% CI: 9.4%, 14.6%), and either diagnosis (AAPC: 9.2%, 95% CI: 7.8%, 11.4%). Anorexia nervosa and/or bulimia nervosa diagnoses were associated with increased adjusted odds of transfusion (aOR: 1.55, 95% CI: 1.02, 2.34), nontransfusion severe maternal morbidity (aOR: 1.79, 95% CI: 1.17, 2.73), preterm delivery at <37 weeks (aOR: 1.65, 95% CI: 1.34, 2.04) and <32 weeks (aOR: 1.65, 95% CI: 1.05, 2.59) and anemia (aOR: 1.55, 95% CI: 1.35, 1.77). Conclusion:Anorexia nervosa and bulimia nervosa diagnoses increased in a representative sample of U.S. delivery hospitalizations over a 23-year study period and were associated with a range of adverse obstetrical outcomes. Key Points:· Eating disorder diagnoses increased among delivery hospitalizations on a population basis.. · Eating disorder diagnoses were associated with a range of adverse obstetrical outcomes.. · Diagnoses increased significantly for both bulimia and anorexia..

OBJECTIVE:To evaluate the pattern of use and clinical outcomes associated with neoadjuvant chemotherapy (NACT) compared with primary debulking surgery (PDS) in patients with stage IV endometrial cancer. METHODS:We utilized the National Cancer Database to identify individuals diagnosed with stage IV endometrial cancer, and categorized them according to receipt of NACT or PDS. Propensity score weighting using inverse probability of treatment weighting was applied. Survival outcomes were evaluated using both an intention-to-treat (ITT) analysis, which included all eligible patients, and a per-protocol (PP) analysis restricted to those who underwent chemotherapy and surgery. RESULTS:Among 18,205 patients, NACT utilization rose from 30.3% in 2010 to 73.8% in 2021 (p < 0.0001). In the multivariable analysis, patients diagnosed in more recent years, Black and Hispanic race and ethnicity, Medicaid insurance, serous histology, and greater comorbidities were associated with NACT (p < 0.05). In the ITT analysis, there was no mortality difference within 4 months after diagnosis between NACT patients and PDS patients (aHR = 1.03; 95% CI: 0.96-1.11); however, after 4 months, patients treated with NACT experienced higher mortality than those undergoing PDS (aHR = 1.58; 95% CI: 1.51-1.64). In the PP analysis, NACT patients had lower mortality compared to PDS patients within 24 months after diagnosis (aHR = 0.93; 95% CI, 0.88-0.99) but a 34% higher mortality after 24 months (aHR = 1.34; 95% CI, 1.23-1.47). CONCLUSION:Utilization of NACT has expanded among patients with metastatic endometrial cancer. Primary debulking surgery with postoperative chemotherapy is linked to higher early mortality but improved long-term outcomes relative to treatment strategies beginning with NACT followed by surgery.

Objective : To examine the impact of comorbidity on overall survival in ovarian cancer patients and determine whether guideline-concordant care (GCC) mitigates the adverse effects of comorbidity. Design : Retrospective cohort study. Setting : United States. Population : Ovarian cancer patients in the National Cancer Database (2004-2021). Methods : Patients with comorbidities were identified using the Charlson-Deyo Comorbidity index (0, 1, and ≥2) and a GCC metric was developed with patients classified as receiving concordant care if they received all eligible treatments, and discordant care otherwise. We generated Kaplan-Meier curves and Cox proportional hazards models to examine the association between comorbidity, GCC, and overall survival. Multiplicative and additive interactions were examined between comorbidity and GCC. Results : We identified 165,944 ovarian cancer patients. Overall survival decreased with increasing comorbidity score (p<0.001) and was worse for patients receiving discordant vs. concordant care. Patients who received discordant care had worse survival across comorbidity levels compared with those who received concordant care (p<0.001). We observed additive and multiplicative interactions between comorbidity and GCC. Patients with 1 and ≥2 comorbidities with discordant care had a 27% and 65% increased hazard of death (adjusted hazard ratio [aHR]=1.27, 95% CI: 1.23 – 1.32 and aHR=1.65, 95% CI: 1.59 – 1.72), respectively, while those with concordant care had an 11% and 27% increased hazard of death (aHR=1.11, 95% CI: 1.08 – 1.14 and aHR=1.27, 95% CI: 1.22 – 1.33), respectively. Conclusion : Ovarian cancer patients with pre-existing comorbidities have worse survival than patients without comorbidities. Increasing adherence to guideline-directed treatment for all patients may improve outcomes.

INTRODUCTION:Gastric cancer outcomes remain poor in the United States, with 36% 5-year survival and more than a third of cases diagnosed at an advanced stage. This study explores the impact of prior esophagogastroduodenoscopy (EGD) on gastric cancer stage at diagnosis and survival in an older Medicare-enrolled US population. METHODS:The Surveillance, Epidemiology, and End Results-Medicare database was queried from 1999 to 2018 for patients with gastric cancer 68 years of age or older with an EGD claim (Prior EGD) or without an EGD claim (No Prior EGD) 6-36 months before gastric cancer diagnosis. Comparing Prior EGD with No Prior EGD, logistic regression was used to estimate the odds of early-stage ( in situ /local) and regional-stage vs distant-stage gastric cancer. Cox proportional hazards and Fine-Gray subdistribution hazard models were developed to estimate overall and gastric cancer-specific survival, respectively. RESULTS:In 15,871 patients with gastric cancer, 12.1% had Prior EGD (n = 1,916). Patients with Prior EGD had a 2-fold increased odds of early-stage gastric cancer compared with No Prior EGD (adjusted odds ratio: 2.05; 95% confidence interval [CI]: 1.82-2.31). Compared with No Prior EGD, Prior EGD was associated with a lower hazard of death for overall (adjusted hazard ratio: 0.78, 95% CI: 0.74-0.83) and cancer-specific (adjusted subdistribution hazard ratio: 0.64, 95% CI: 0.64-0.69) survival. DISCUSSION:Prior EGD is associated with earlier stage and improved survival in older adults. This study supports further research into endoscopic screening in the United States across younger age groups and diverse populations and healthcare settings.