Discharge destination and readmissions among patients with head and neck cancer

The impact of skeletal muscle index at the third lumbar spine on nosocomial deterioration and short-term prognosis in acute pancreatitis: a retrospective observational study

Objective

To investigate the impact of the third lumbar skeletal muscle index (L3-SMI) assessed by CT on the in-hospital severity and short-term prognosis of acute pancreatitis.

Methods

A total of 224 patients with severe acute pancreatitis admitted to Yantaishan Hospital from January 2021 to June 2022 were selected as the subjects. Based on the in-hospital treatment outcomes, they were divided into a mortality group of 59 cases as well as a survival group of 165 cases. Upon admission, general information such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, along with the abdominal CT images of each patient, were analyzed. The L3-SMI was calculated, and the Modified CT Severity Index (MCTSI) and Balthazar CT grade were used to assess the severity of in-hospital complications of acute pancreatitis. The evaluation value of L3-SMI for the prognosis of severe acute pancreatitis was analyzed, as well as the factors influencing the prognosis of severe acute pancreatitis.

Results

No statistically significant differences in gender, age, BMI, etiology, duration of anti-inflammatory drug use, and proportion of surgical patients between the survival and mortality groups were observed. But the mortality group showed higher proportions of patients with an elevated APACHE II score upon admission, mechanical ventilation, and renal replacement therapy, compared to the survival group, with statistically significant differences (P < 0.001). Furthermore, the mortality group had higher MCTSI scores (6.42 ± 0.69) and Balthazar CT grades (3.78 ± 0.45) than the survival group, with statistically significant differences (P < 0.001). The mortality group also had a lower L3-SMI (39.68 ± 3.25) compared to the survival group (42.71 ± 4.28), with statistically significant differences (P < 0.001). L3-SMI exhibited a negative correlation with MCTSI scores and Balthazar CT grades (r = -0.889, -0.790, P < 0.001). Logistic regression analysis, with mortality of acute pancreatitis patients as the dependent variable and MCTSI scores, Balthazar CT grades, L3-SMI, APACHE II score upon admission, mechanical ventilation, and renal replacement therapy as independent variables, revealed that MCTSI scores and L3-SMI were risk factors for mortality in acute pancreatitis patients (P < 0.001). Logistic regression analysis using the same variables confirmed that all these factors were risk factors for mortality in acute pancreatitis patients.

Conclusion

This study confirmed that diagnosing muscle depletion using L3-SMI is a valuable radiological parameter for predicting in-hospital severity and short-term prognosis in patients with acute pancreatitis.

Predictive value of the Rothman index for unplanned 90-day readmission rates following hospital discharge in oral cancer patients

This study aims to evaluate the predictive capability of the Rothman Index in determining unplanned readmissions within 90 days after discharge for oral cancer patients. The consecutive recruitment was carried out from May 1, 2020, to May 31, 2023, at the outpatient department of Ruijin Hospital of Medical College of Shanghai Jiao Tong University Shanghai Hospital. The evaluation is based on internationally recognized clinical evaluation indicators. A total of 125 recruited patients were grouped as per the presence (n=13) or absence (n=112) of unplanned readmissions within 90 days after discharge. Electronic medical records and patient follow-up records were used to collect details, including gender, age, body mass index, associated conditions such as diabetes and hypertension, treatment approach, and pathological type. In addition, the Rothman Index, postoperative complications, and rates of unplanned readmissions within 90 days post-discharge were assessed following previous literature. Although there was no significant difference in gender, body mass index, and length of hospital stay between the groups (P > 0.05), age, smoking and alcohol consumption history, and the Rothman Index exhibited significant variations (P < 0.05). The Rothman Index was found to be the most strongly correlated with unplanned readmissions within 90 days and could be incorporated in a prediction model. The area under the curve (AUC), as highlighted in the receiver operating characteristic (ROC) curve analysis, for predicting unplanned readmissions within 90 days post-discharge was 0.930, using Rothman Index. This suggests that the Rothman Index could be an effective tool in managing risk in clinical settings due to its potential to accurately predict the rate of unplanned readmissions for oral cancer patients within 90 days of discharge.