Gagan Kumar

Publications (23) View all

• Article: Outcomes of Patients Receiving Maintenance Dialysis Admitted Over Weekends.

  Ankit Sakhuja, Jesse D Schold, Gagan Kumar, Aaron Dall, Puneet Sood, Sankar D Navaneethan
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  ABSTRACT: BACKGROUND: Hospital admissions over weekends have been associated with worse outcomes in different patient populations. The cause of this difference in outcomes remains unclear; however, different staffing patterns over weekends have been speculated to contribute. We evaluated outcomes in patients on maintenance dialysis therapy admitted over weekends using a national database. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: We included nonelective admissions of adult patients (≥18 years) on maintenance dialysis therapy (n = 3,278,572) identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for 2005-2009 using the Nationwide Inpatient Sample database. PREDICTOR: Weekend versus weekday admission. OUTCOMES: The primary outcome measure was all-cause in-hospital mortality. Secondary outcomes included mortality by day 3 of admission, length of hospital stay, time to death, and discharge disposition. MEASUREMENTS: We adjusted for patient and hospital characteristics, payer, year, comorbid conditions, and primary discharge diagnosis common to maintenance dialysis patients. RESULTS: There were an estimated 704,491 admissions over weekends versus 2,574,081 over weekdays. Unadjusted all-cause in-hospital mortality was 40,666 (5.8%) for weekend admissions in comparison to 138,517 (5.4%) for weekday admissions (P < 0.001). In a multivariable model, patients admitted over weekends had higher all-cause in-hospital mortality (OR, 1.06; 95% CI, 1.01-1.10) in comparison to those admitted over weekdays and higher mortality during the first 3 days of admission (OR, 1.18; 95% CI, 1.10-1.26). Patients admitted over weekends were less likely to be discharged to home, had longer hospital stays, and had shorter times to death compared with those admitted over weekdays on adjusted analysis. LIMITATIONS: Use of ICD-9-CM codes to identify patients, defining weekend as midnight Friday to midnight Sunday. CONCLUSIONS: Maintenance dialysis patients admitted over weekends have increased mortality rates and longer lengths of stay compared with those admitted over weekdays. Further studies are needed to identify the reasons for worse outcomes for weekend admissions in this patient population.
  American Journal of Kidney Diseases 05/2013; · 5.43 Impact Factor
• Article: Seasonal variations in atrial fibrillation related hospitalizations.

  Abhishek J Deshmukh, Sadip Pant, Gagan Kumar, Kevin Hayes, Apurva O Badheka, Kaustubh C Dabhadkar, Hakan Paydak
  International journal of cardiology 02/2013; · 7.08 Impact Factor
• Article: Seasonal variation of takotsubo cardiomyopathy.

  Abhishek Deshmukh, Sadip Pant, Apurva Badheka, Awani A Deshmukh, Gagan Kumar
  The American journal of cardiology 02/2013; 111(4):627-8. · 3.58 Impact Factor
• Article: Trends in survival after in-hospital cardiac arrest.

  Gagan Kumar, Rahul Nanchal
  New England Journal of Medicine 02/2013; 368(7):680. · 53.30 Impact Factor
• Article: Outcomes of Morbidly Obese Patients Receiving Invasive Mechanical Ventilation: A Nationwide Analysis.

  Gagan Kumar, Tilottama Majumdar, Elizabeth Jacobs, Valerie Danesh, Gaurav Dagar, Abhishek Deshmukh, Amit Taneja, Rahul Nanchal
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  ABSTRACT: ABSTRACT CONTEXT: Critically ill, morbidly obese patients, (BMI ≥40) are at high risk of respiratory failure requiring invasive mechanical ventilation (IMV). It is not clear if outcomes of critically ill obese patients are affected by obesity. Due to limited cardio-pulmonary reserve they may also have poor outcomes. However, literature to this effect is limited and conflicted. OBJECTIVE: We used Nationwide Inpatient Sample from 2004 to 2008 to examine the outcomes of morbidly obese persons receiving IMV and compared them to non-obese persons. We identified hospitalizations requiring IMV and morbid obesity using ICD9CM codes. Primary outcomes studied were in-hospital mortality, rates of prolonged mechanical ventilation (≥96hrs) and tracheostomy. Multivariable logistic regression was used to adjust for potential confounding variables. We also examined outcomes stratified by number of organs failing. RESULTS: Of all hospitalized morbidly obese persons, 2.9% underwent IMV. Mean age, co-morbidity score and severity of illness were lower in morbidly obese persons. The adjusted mortality was not significantly different in morbidly obese persons (OR 0.89; 95%CI: 0.74 to 1.06). When stratified by severity of disease, there was a stepwise increase in risk of mortality amongst morbidly obese persons - 0.77 (95% CI 0.58 to 1.01) for only respiratory failure to OR 4.14 (95% CI 1.11 to 15.3) for ≥4 organs failing. Rates of prolonged mechanical ventilation was similar, but rate of tracheostomy (OR 2.19; 95% CI 1.77 to 2.69) were significantly higher in the morbidly obese. CONCLUSION: Morbidly obese persons undergoing IMV have similar risk of death than non obese persons if only respiratory failure is present. When more organs fail, they have increased mortality.
  Chest 01/2013; · 5.25 Impact Factor