Embryo donation: national trends and outcomes, 2000-2013

While the assisted reproductive technologies have been available for several decades, there still exists a great divergence in legal frameworks regulating reproductive donation. 
 The article discusses legal regulations on embryo and gamete (sperm and oocytes) donation in Europe, Americas, Canada and Australia. The search for publications was carried out in all available bibliographic and abstract databases (RSCI, Scopus, Web of Science, CyberLeninka, eLibrary, PubMed) containing reports on the subject of the article. The main search restrictions were the language of publications (English and Russian) and the date of reports (not earlier than 2000). We seek to chart global trends and identify major legislative “gaps”; the latter emerge because each type of reproductive donation causes specific conflicts and calls for specific regulations. There is a visible trend towards open gamete donation across the globe as more and more governments insist on deanonymization of donors. Legislators intend to protect children’s interests and to secure their right to identify their biological parents. Financial remuneration is perceived differently, and regulations diverge across the globe. Many governments permit reimbursements, but do not allow any commercial payoffs. Yet, issues of parenthood and donor-recipient obligations remain quite controversial, which results in divergent legal frameworks. Sperm donation is the least controversial and safest procedure; therefore, it is legal in all countries and is allowed in non-medical setting. On the other hand, informal sperm donation requires targeted legal regulations. Parenthood and anonymity in sperm donation also cause concern and require specific legislation. In some countries, oocyte donation is illegal while in others it is under severe limitations. Currently medical treatment and observation of oocyte donors after ART cycles is not yet legally regulated, which leaves women unprotected from post-donation health issues. Embryo donation hinges on the status of the embryo. Specific definition will determine the consequences including from adoption to research use. There remains a problem of authority over embryo’s future in cases of a spouse’s death or divorce.

Embryo donation: national trends and outcomes, 2004–2019

Surrogacy is one of the most complex assisted reproductive technologies, both in terms of the interaction of all participants in the process, and in terms of the attitude of society. The motivation of surrogate motherhood, as well as its barriers, have been studied much less than the issues of legal regulation of this process. In addition, the motives of surrogate mothers have been studied much less than the motives of donors of gametes and embryos. The main factor influencing non-surrogate motherhood and its motivation is the legislative framework, which varies from a complete ban on surrogate motherhood in some European countries, to a loyal attitude in developing countries. The review analyzes the main motives of surrogate motherhood: altruism and financial reward, as well as cases of polymotivation. An important aspect of the expectations of surrogate mothers is the hope that the intended parents will tell the child about the participation of the surrogate mother in his birth and that they will be able to keep in touch with the parents and the child after the end of the contract. The main barriers to surrogate motherhood can be considered: the stigmatization of surrogate motherhood in society; negative attitude of the closest environment and family of the surrogate mother; conflict situations in case of multiple pregnancy or diagnosed fetal anomalies; possible risks to a woman’s health and fertility.

Introduction: Patients with uncontrolled DM can present to the hospital with life threatening complications: DKA, hyperosmolar syndrome and coma. There is a paucity of data on the contemporary trends and outcomes of uncontrolled diabetes related hospitalizations (UDH). Methods: We analyzed the 2003 to 2011 Nationwide Inpatient Sample database (https://www.hcup-us.ahrq.gov) to examine the trends and in-hospital outcomes in patients with UDH aged ≥18 years in the U.S. All patients with primary diagnosis of uncontrolled DM were identified using ICD-9 CM codes- 250.02-250.03, 250.10 -250.13, 250.20 -250.23 and 250.3. Results: From 2003 to 2011; 1,690,457 patients had UDH. The yearly hospitalization increased from 171,408 (2003) to 216,965 (2011)(ptrend <0.001). Breakdown by sex, race, income and insurance status are in Table 1. The in-hospital mortality decreased from 0.8% to 0.4% (adjusted odds ratio [per year] 0.90; 95% confidence interval 0.89 to 0.91; ptrend <0.001). The average hospital charges increased from $14,370 to $22,897 (ptrend <0.001), whereas the average length of stay decreased from 3.9 to 3.4 days (ptrend <0.001). Conclusion: Hospitalizations with UDH increased by ∼25% in all U.S demographic groups between 2003 and 2011. However, outcomes improved during the same period, with decreases in length of stay and risk-adjusted in-hospital mortality. Disclosure N. Jain: None. M. Agarwal: None. D. Kadaria: None. H.O. Steinberg: None. S. Dagogo-Jack: None.

National Trends and Outcomes in Isolated Tricuspid Valve Surgery

National trends, outcomes and costs of radiation therapy in the management of low- and high-intermediate risk endometrial cancer

Stoneover: The Observed Lessons and Unanswered Questions of Cannabis Legalization examines the political and social entrepreneurs that champion marijuana decriminalization efforts, their constituents’ attitudes toward legalization, the specific successful reform measures at the state level, and the consequent market dynamics in cannabis commerce. Each chapter presents a unique dataset with specific contributions in understanding local and national trends and outcomes of more than two decades of cannabis legalization efforts. Using detailed analyses of user data, the contributors tackle such social issues as legalization activism in the context of calls to defund the police, the impact of reforms on immigrant communities, the demographic and economic characteristics of legal dispensary customers, medical administrative structures, youth usage, and mortality related to marijuana and other drug use. Stoneover offers policy makers information for future policy designs with a goal to decrease negative externalities and social inequity.

The burden of cardiovascular disease within the United States is profound, with large volumes of economic and academic resources being utilized to treat patients with cardiovascular diseases. Myocardial infarctions (MI) represent one of the most acute forms of cardiovascular pathology, with a profound mortality rate if prompt treatment and medical attention is not sought out after. While elements of changes in clinical practice and the spurring of new guidelines are responsible for improved health outcomes within year to year, the appraisal of trends in clinical outcomes allows for the scrutiny of methodology in approaching the patient with MI.

Surgical treatment of metastatic spine disease: an update on national trends and clinical outcomes from 2010 to 2014

Background and Objectives: Previous studies have demonstrated superior patient outcomes for thoracic oncology patients treated at high-volume surgery centers compared to low-volume centers. However, the specific role of overall hospital size in open esophagectomy morbidity and mortality remains unclear. Materials and Methods: Patients aged >18 years who underwent open esophagectomy for primary malignant neoplasia of the esophagus between 2002 and 2014 were identified using the National Inpatient Sample. Minimally invasive procedures were excluded. Discharges were stratified by hospital size (large, medium, and small) and analyzed using trend and multivariable regression analyses. Results: Over a 13-year period, a total of 69,840 open esophagectomy procedures were performed nationally. While the proportion of total esophagectomies performed did not vary by hospital size, in-hospital mortality trends decreased for all hospitals (large (7.2% to 3.7%), medium (12.8% vs. 4.9%), and small (12.8% vs. 4.9%)), although this was only significant for large hospitals (P < 0.01). After controlling for patient demographics, comorbidities, admission, and hospital-level factors, hospital length of stay (LOS), total inflation-adjusted costs, in-hospital mortality, and complications (cardiac, respiratory, vascular, and bleeding) did not vary by hospital size (all P > 0.05). Conclusions: After risk adjustment, patient morbidity and in-hospital mortality appear to be comparable across all institutions, including small hospitals. While there appears to be an increased push for referring patients to large hospitals, our findings suggest that there may be other factors (such as surgeon type, hospital volume, or board status) that are more likely to impact the results; these need to be further explored in the current era of episode-based care.

INTRODUCTION: Nearly 40% of women in the United States are obese, presenting unique challenges and considerations for gynecologic surgeons. We sought to examine trends and outcomes of benign hysterectomy in obese women. METHODS: A population-based retrospective study utilizing the National Inpatient Sample was conducted including benign total hysterectomies from 2001–2015 (N=2,680,788). Temporal trends of obesity, perioperative complications, and mortality rates were assessed with piecewise linear regression with log transformation. Pairwise propensity score inverse probability of treatment weighting with a generalized estimating equation was then used to estimate risk of perioperative complications and mortality. RESULTS: Of all women who underwent hysterectomy, 172,517 (6.4%) had Class I-II obesity and 83,513 (3.1%) had Class III (morbid) obesity. During the study period, Class III obesity increased from 0.6% to 6.4% (11.1-fold increase) and Class I-II obesity increased from 1.8% to 11.4% (6.5-fold increase) (both, P&lt;.001). Compared to non-obese women, women with Class I-II (13.2% versus 11.0%, odds ratio [OR] 1.22, 95% confidence interval [CI] 1.18–1.27) and Class III (17.0% versus 11.0%, OR 1.40, 95% CI 1.34–1.47) obesity had significantly increased risk of perioperative complications. Mortality was increased two-fold in women with Class III obesity compared to non-obese women (0.06% versus 0.02%, OR 2.01, 95% CI 1.06–3.81). Over the study period, hysterectomy complication rates increased from 7.4% to 17.0% (2.3-fold increase, P&lt;.001), and there was statistically non-significant increase in surgical mortality (0.01% to 0.03%, 2.4-fold increase, P=.052). CONCLUSION: Obesity, particularly morbid obesity, complicating benign hysterectomy has significantly increased in the United States and is associated with increased perioperative morbidity and mortality.

Impact of Hospital Size on National Trends and Outcomes in Open and Video-Assisted Lobectomy for Non-Small Cell Lung Cancer

CARDIOVASCULAR DISEASE BURDEN OF INFLUENZA SYNDROME: NATIONAL TRENDS AND OUTCOMES FROM A UNITED STATES POPULATION STUDY FROM 2011 TO 2014

National Trends and Outcomes of Patients Bridged to Transplant With Continuous Flow Left Ventricular Assist Devices

National Trends and Outcomes of Pedal Bypass Surgery