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Thomas L, Chung JH, Lu S, Essilfie A. Machine learning used to determine features of importance linked to overnight stay after patellar tendon repair. J Orthop 2024; 57:55-59. [PMID: 38973967 PMCID: PMC11225721 DOI: 10.1016/j.jor.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/09/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose The purpose of this study is to determine if machine learning is an effective method to identify features of patients who may need a longer postoperative stay following a patellar tendon repair. Methods The American College of Surgeons National Quality Improvement Program (ACS-NSQIP) was used to collect 1173 patients who underwent patellar tendon repair. Machine learning (ML) was then applied to determine features of importance in this patient population. Several algorithms were used: Random Forest, Artificial Neural Network, Gradient Boosting, and Support Vector Machine. These were then compared to the American Society of Anesthesiologists (ASA) classification system based logistic regression as a control. Results Random Forest (RF) was determined to be the best performing algorithm, with an AUC of 0.72, accuracy of 77.66 %, and precision of 0.79, and recall of 0.96. All other algorithms performed similarly to the control. RF gave the highest permutation feature importance to age (PFI 0.25), BMI (PFI 0.19), ASA classification (PFI 0.14), hematocrit (PFI 0.12), and height (PFI 0.11). Conclusions This study shows that machine learning can be used as a tool to identify features of importance for length of postoperative stay in patients undergoing patellar tendon repair. RF was found to be a better performing model than logistic regression at determining patients predisposed to longer length of stay as determined by AUC. This supported the study's hypothesis that ML can provide an effective method for identifying features of importance in patients requiring a longer postoperative stay after patellar tendon repair.
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Affiliation(s)
- Luke Thomas
- School of Medicine, Loma Linda University, Loma Linda, CA, 92354, USA
| | - Jun Ho Chung
- School of Medicine, Loma Linda University, Loma Linda, CA, 92354, USA
| | - Sarah Lu
- California University of Science and Medicine, Colton, CA, 92324, USA
| | - Anthony Essilfie
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
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2
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Tarantino B, Wood M, Hancock D, Shah K. Does pre-injury anticoagulation make chest tubes any less safe? A nationwide retrospective analysis. Am J Emerg Med 2024; 82:47-51. [PMID: 38788529 DOI: 10.1016/j.ajem.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/26/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Oral anticoagulation is becoming more common with the aging population, which raises concern for the risk of invasive procedures that can cause bleeding, such as chest tube placement (thoracostomy). With the increase in CT imaging, more pneumothoraces and hemothoraces are being identified. The relative risk of thoracostomy in the presence of anticoagulation is not well-established. The objective of this study was to determine whether pre-injury anticoagulation affects the relative risk of tube thoracostomy following significant chest trauma. METHODS This retrospective cohort study used data from the 2019 American College of Surgeons-Trauma Quality Program (ACS-TQP) database using R version 4.2.2. Data from the database was filtered based on inclusion and exclusion criteria. Outcomes were then assessed with the population of interest. Demographics, vitals, comorbidities, and injury parameters were also collected for each patient. This study included all adult patients (≥18 years) presenting with traumatic hemothorax, pneumothorax, or hemopneumothorax. Patients with missing data in demographics, vitals, comorbidities, injury parameters, or outcomes, as well as those with no signs of life upon arrival, were excluded from the study. Patients were stratified into groups based on whether they had pre-injury anticoagulation and whether they had a chest tube placed in the hospital. The primary outcome was mortality, and the secondary outcome was hospital length of stay (LOS). Logistic and standard regressions were used by a statistician to control for age, sex, and Injury Severity Score (ISS). RESULTS Our study population included 72,385 patients (4250 with pre-injury anticoagulation and 68,135 without pre-injury anticoagulation). Pre-injury anticoagulation and thoracostomy were each independently associated with increased mortality and LOS. However, there was a non-significant interaction term between pre-injury anticoagulation and thoracostomy for both outcomes, indicating that their combined effects on mortality and LOS did not differ significantly from the sum of their individual effects. CONCLUSION This study suggests that both pre-injury anticoagulation and thoracostomy are risk factors for mortality and increased LOS in adult patients presenting with hemothorax, pneumothorax, or hemopneumothorax, but they do not interact with each other. We recommend further study of this phenomenon to potentially improve clinical guidelines. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
| | - Myles Wood
- Weill Cornell Medicine, United States of America
| | | | - Kaushal Shah
- Weill Cornell Medicine, United States of America
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3
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Kim DK, Feuer GB, Warner PE, Ascherman JA. Predictors of extended length of stay following outpatient reduction mammaplasty. J Plast Reconstr Aesthet Surg 2024; 94:141-149. [PMID: 38781834 DOI: 10.1016/j.bjps.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/16/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Reduction mammaplasty has transitioned into a largely outpatient procedure in the United States. Following planned outpatient procedures, patients may still be admitted for additional inpatient care, incurring clinical and economic burden. Prior literature has not explored the preoperative and perioperative determinants of extended lengths of stay (LOS) after breast reduction surgery. METHODS Patients who underwent scheduled outpatient reduction mammaplasty were identified via current procedural terminology code from the 2013 to 2021 National Surgical Quality Improvement Program databases. The primary outcome was extended LOS, defined as an LOS greater than 1 day. The most significant predictor variables were identified through bivariate association, and a binary logistic regression model was used to characterize predictive associations (p < 0.05). RESULTS In this study, 33,924 patients were included in the final cohort of planned outpatient reduction mammaplasty cases. Among them 325 (1.0%) patients had extended LOS. Concurrent liposuction, body contouring, and increased operative time were the most significant predictors of extended LOS (p < 0.001), followed by older age, higher body mass index, bleeding disorder, history of diabetes, higher American Society of Anesthesiologists class, and White race (p < 0.05). When adjusted for other confounding variables, extended LOS was also a significant predictor of increased risk of postoperative complications after discharge (OR: 1.85, 95% confidence intervals: 1.27-2.69, p = 0.0012). CONCLUSION Extended LOS after planned outpatient reduction mammaplasty is associated with specific comorbidities, and is a significant predictor of postoperative complications following hospital discharge. DATA AVAILABILITY STATEMENT The data that support the findings of this study are publicly available.
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Affiliation(s)
- Dylan K Kim
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, 161 Fort Washington Ave. - Ste. 511, New York 10032, NY, USA
| | - Grant B Feuer
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, 161 Fort Washington Ave. - Ste. 511, New York 10032, NY, USA
| | - Paige E Warner
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, 161 Fort Washington Ave. - Ste. 511, New York 10032, NY, USA
| | - Jeffrey A Ascherman
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, 161 Fort Washington Ave. - Ste. 511, New York 10032, NY, USA.
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Kolwaite AR, Edwards JA, Higgins M, Kandaswamy S, Orenstein E, Boughton D, Zinyandu T, Brasher S, Shashidharan S, Thompson LM, Chanani NK. Associations between Child Opportunity Index and Pediatric Cardiac Surgical Outcomes. J Pediatr 2024; 270:114000. [PMID: 38432295 DOI: 10.1016/j.jpeds.2024.114000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To assess the relationship between the Child Opportunity Index (COI), a comprehensive measurement of social determinants of health, and specific COI domains on patient-specific outcomes following congenital cardiac surgery in the metropolitan region of Atlanta, Georgia. STUDY DESIGN In this retrospective chart review, we included patients who underwent an index operation for congenital heart disease between 2010 and 2020 in a single pediatric health care system. Patients' addresses were geocoded and mapped to census tracts. Descriptive statistics, univariable analysis, and multivariable regression models were employed to assess associations between variables and outcomes. RESULTS Of the 7460 index surgeries, 3798 (51%) met eligibility criteria. Presence of an adverse outcome, defined as either mortality or 1 of several other major postoperative morbidities, was significantly associated with COI in the univariable model (P = .008), but not the multivariable regression model (P = .39). Postoperative hospital length of stay was significantly associated with COI (P < .001) in univariable and multivariable regression models. There was no significant association between COI and readmission within 30 days of hospital discharge in univariable (P < .094) and multivariable (P = .49) models. CONCLUSION COI is associated with postoperative hospital length of stay but not all outcomes in patients after congenital heart surgery. By understanding the role of COI in outcomes related to cardiac surgery, targeted interventions can be developed to improve health equity.
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Affiliation(s)
- Amy R Kolwaite
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
| | - Johnathan A Edwards
- Rollins School of Public Health, Emory University, Atlanta, GA; University of Lincoln, School of Health and Social Care, Lincolnshire, UK
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Evan Orenstein
- Rollins School of Public Health, Emory University, Atlanta, GA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, GA; Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Dawn Boughton
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Tawanda Zinyandu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Susan Brasher
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
| | - Nikhil K Chanani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Taylor SV, Loo GT, Richardson LD, Legome E. Patient Factors Associated With Prolonged Length of Stay After Traumatic Brain Injury. Cureus 2024; 16:e59989. [PMID: 38774459 PMCID: PMC11107954 DOI: 10.7759/cureus.59989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 05/24/2024] Open
Abstract
Background For traumatic brain injury (TBI) survivors, recovery can lead to significant time spent in the inpatient/rehabilitation settings. Hospital length of stay (LOS) after TBI is a crucial metric of resource utilization and treatment costs. Risk factors for prolonged LOS (PLOS) after TBI require further characterization. Methodology We conducted a retrospective analysis of patients with diagnosed TBI at an urban trauma center. PLOS was defined as the 95th percentile of the LOS of the cohort. Patients with and without PLOS were compared using clinical/injury factors. Analyses included descriptive statistics, non-parametric analyses, and multivariable logistic regression for PLOS status. Results The threshold for PLOS was >24 days. In the cohort of 1,343 patients, 77 had PLOS. PLOS was significantly associated with longer mean intensive care unit (ICU) stays (16.4 vs. 1.5 days), higher mean injury severity scores (18.6 vs. 13.8), lower mean Glasgow coma scale scores (11.3 vs. 13.7) and greater mean complication burden (0.7 vs. 0.1). PLOS patients were more likely to have moderate/severe TBI, Medicaid insurance, and were less likely to be discharged home. In the regression model, PLOS was associated with ICU stay, inpatient disposition, ventilator use, unplanned intubation, and inpatient alcohol withdrawal. Conclusions TBI patients with PLOS were more likely to have severe injuries, in-hospital complications, and Medicaid insurance. PLOS was predicted by ICU stay, intubation, alcohol withdrawal, and disposition to inpatient/post-acute care facilities. Efforts to reduce in-hospital complications and expedite discharge may reduce LOS and accompanying costs. Further validation of these results is needed from larger multicenter studies.
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Affiliation(s)
- Shameeke V Taylor
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Emergency Medicine, Mount Sinai Morningside, New York, USA
| | - George T Loo
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Lynne D Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Eric Legome
- Department of Emergency Medicine, Mount Sinai Morningside, New York, USA
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6
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Al Harbi S, Aljohani B, Elmasry L, Baldovino FL, Raviz KB, Altowairqi L, Alshlowi S. Streamlining patient flow and enhancing operational efficiency through case management implementation. BMJ Open Qual 2024; 13:e002484. [PMID: 38423585 PMCID: PMC10910643 DOI: 10.1136/bmjoq-2023-002484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Improving patient flow in hospitals represents a worldwide healthcare challenge. The objective of this project was to depict the effectiveness of case management in improving patient flow in a tertiary hospital setting. METHODS Quality improvement methods, including quantitative pre-Lean and post-Lean design, the Plan-Do-Check-Act concept, the Single Minute Exchange of Dies and the 'demand and supply approach' of the Institute of Healthcare Improvement, were adapted to examine and modify factors influencing hospital patient flow. RESULTS This study (conducted from the last quarter of 2019 through September 2022) resulted in a remarkable improvement in patient flow, as evident from the reduction in average hospital length of stay (from 11.5 to 4.4 days) and average emergency department boarding time (from 11.9 to 1.2 hours) and the improvement of bed turnover rate (from 0.57 to 0.93), (p<0.001, p=0.017, p=0.038, respectively), with net cost savings of 123 130 192 million Saudi Riyals (US$32 821 239). CONCLUSION Implementing a well-structured case management programme can enhance care coordination, streamlilne transitions, boost patient outcomes, and increase revenues within hospital settings.
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Affiliation(s)
- Sultanah Al Harbi
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Baker Aljohani
- Medical Administration, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Lamiaa Elmasry
- Quality Improvement and Patient Safety Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Frenk Lee Baldovino
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Kamille Bianca Raviz
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Lama Altowairqi
- Admission Office Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Seetah Alshlowi
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
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Aljuhani O, Korayem GB, Altebainawi AF, AlMohammady D, Alfahed A, Altebainawi EF, Aldhaeefi M, Badreldin HA, Vishwakarma R, Almutairi FE, Alenazi AA, Alsulaiman T, Alqahtani RA, Al Dhahri F, Aldardeer N, Alenazi AO, Al Harbi S, Kensara R, Alalawi M, Al Sulaiman K. Dexamethasone versus methylprednisolone for multiple organ dysfunction in COVID-19 critically ill patients: a multicenter propensity score matching study. BMC Infect Dis 2024; 24:189. [PMID: 38350878 PMCID: PMC10863167 DOI: 10.1186/s12879-024-09056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Dexamethasone usually recommended for patients with severe coronavirus disease 2019 (COVID-19) to reduce short-term mortality. However, it is uncertain if another corticosteroid, such as methylprednisolone, may be utilized to obtain better clinical outcome. This study assessed dexamethasone's clinical and safety outcomes compared to methylprednisolone. METHODS A multicenter, retrospective cohort study was conducted between March 01, 2020, and July 31, 2021. It included adult COVID-19 patients who were initiated on either dexamethasone or methylprednisolone therapy within 24 h of intensive care unit (ICU) admission. The primary outcome was the progression of multiple organ dysfunction score (MODS) on day three of ICU admission. Propensity score (PS) matching was used (1:3 ratio) based on the patient's age and MODS within 24 h of ICU admission. RESULTS After Propensity Score (PS) matching, 264 patients were included; 198 received dexamethasone, while 66 patients received methylprednisolone within 24 h of ICU admission. In regression analysis, patients who received methylprednisolone had a higher MODS on day three of ICU admission than those who received dexamethasone (beta coefficient: 0.17 (95% CI 0.02, 0.32), P = 0.03). Moreover, hospital-acquired infection was higher in the methylprednisolone group (OR 2.17, 95% CI 1.01, 4.66; p = 0.04). On the other hand, the 30-day and the in-hospital mortality were not statistically significant different between the two groups. CONCLUSION Dexamethasone showed a lower MODS on day three of ICU admission compared to methylprednisolone, with no statistically significant difference in mortality.
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Affiliation(s)
- Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghazwa B Korayem
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ali F Altebainawi
- Pharmaceutical Care Services, King Salman Specialist Hospital, Hail Health Cluster, Ministry of Health, Hail, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Daniah AlMohammady
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amjaad Alfahed
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Elaf F Altebainawi
- Department of Medicine, King Khalid Hospital, Hail Health Cluster, Hail, Saudi Arabia
| | - Mohammed Aldhaeefi
- Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, DC, 20059, USA
| | - Hisham A Badreldin
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ramesh Vishwakarma
- Norwich clinical trial unit, Norwich medical school, University of east Anglia, Norwich, UK
| | - Faisal E Almutairi
- Clinical Pharmacy Department, Pharmacy Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abeer A Alenazi
- Pharmaceutical Care Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Thamer Alsulaiman
- Family Medicine Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Rahaf Ali Alqahtani
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Fahad Al Dhahri
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Namareq Aldardeer
- Pharmaceutical Care Services, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed O Alenazi
- Pharmaceutical Care Department, King Abdulaziz Medical City, Dammam, Saudi Arabia
| | - Shmeylan Al Harbi
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Raed Kensara
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mai Alalawi
- Pharmaceutical Care Services, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Khalid Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
- King Abdulaziz Medical City (KAMC) - Ministry of National Guard Health Affairs (MNGHA), King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, Riyadh, 11426, Saudi Arabia.
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Tornese D, Robustelli A, Ricci G, Rancoita PMV, Maffulli N, Peretti GM. Predictors of postoperative hospital length of stay after total knee arthroplasty. Singapore Med J 2024; 65:68-73. [PMID: 34688227 PMCID: PMC10942137 DOI: 10.11622/smedj.2021142] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We aimed to collect and analyse clinical and functional variables of patients undergoing rehabilitation after total knee arthroplasty (TKA), to identify the variables that influence the postoperative hospital length of stay (LOS). METHODS We conducted a retrospective analysis of prospectively collected data of 1,082 consecutive patients (746 females and 336 males) who underwent primary TKA and rehabilitation in our orthopaedic institute between January 2013 and July 2017. Clinical and anthropometric data were analysed using a multivariate linear regression model. RESULTS The average LOS was 5.08 ± 2.52 days in the Department of Orthopaedic Surgery and 12.67 ± 5.54 days in the Sports Rehabilitation Unit. Factors such as age, female sex and the presence of comorbidities were predictive of a longer stay. The presence of caregiver assistance at home was associated with shorter LOS. There was no evidence of a statistically significant positive association between body mass index and LOS. CONCLUSION An in-depth and early knowledge of factors that influence LOS may enable the multidisciplinary team to plan a patient-tailored rehabilitation path and better allocate resources to maximise patients' functional recovery, while reducing LOS and the overall cost of the procedure.
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Affiliation(s)
- Davide Tornese
- Center for Sports Rehabilitation, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Alessandro Robustelli
- Residency Program in Physical Medicine and Rehabilitation, University of Milan, Milan, Italy
| | - Gabriele Ricci
- Center for Sports Rehabilitation, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Nicola Maffulli
- Faculty of Medicine and Psychology, University of Rome La Sapienza, Rome, Italy
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke-on-Trent, England
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England
| | - Giuseppe Michele Peretti
- University Equipe of Regenerative and Reconstructive Orthopaedics (EUORR), IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Gandra S, Singh SK, Chakravarthy M, Moni M, Dhekane P, Mohamed Z, Shameen F, Vasudevan AK, Senthil P, Saravanan T, George A, Sinclair D, Stwalley D, van Rheenen J, Westercamp M, Smith RM, Leekha S, Warren DK. Epidemiology and preventability of hospital-onset bacteremia and fungemia in 2 hospitals in India. Infect Control Hosp Epidemiol 2024; 45:157-166. [PMID: 37593953 PMCID: PMC10877540 DOI: 10.1017/ice.2023.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Studies evaluating the incidence, source, and preventability of hospital-onset bacteremia and fungemia (HOB), defined as any positive blood culture obtained after 3 calendar days of hospital admission, are lacking in low- and middle-income countries (LMICs). DESIGN, SETTING, AND PARTICIPANTS All consecutive blood cultures performed for 6 months during 2020-2021 in 2 hospitals in India were reviewed to assess HOB and National Healthcare Safety Network (NHSN) reportable central-line-associated bloodstream infection (CLABSI) events. Medical records of a convenience sample of 300 consecutive HOB events were retrospectively reviewed to determine source and preventability. Univariate and multivariable logistic regression analyses were performed to identify factors associated with HOB preventability. RESULTS Among 6,733 blood cultures obtained from 3,558 hospitalized patients, there were 409 and 59 unique HOB and NHSN-reportable CLABSI events, respectively. CLABSIs accounted for 59 (14%) of 409 HOB events. There was a moderate but non-significant correlation (r = 0.51; P = .070) between HOB and CLABSI rates. Among 300 reviewed HOB cases, CLABSIs were identified as source in only 38 (13%). Although 157 (52%) of all 300 HOB cases were potentially preventable, CLABSIs accounted for only 22 (14%) of these 157 preventable HOB events. In multivariable analysis, neutropenia, and sepsis as an indication for blood culture were associated with decreased odds of HOB preventability, whereas hospital stay ≥7 days and presence of a urinary catheter were associated with increased likelihood of preventability. CONCLUSIONS HOB may have utility as a healthcare-associated infection metric in LMIC settings because it captures preventable bloodstream infections beyond NHSN-reportable CLABSIs.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
| | | | | | - Merlin Moni
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - Zubair Mohamed
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | | | | | | | - Anu George
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Dorothy Sinclair
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
| | - Dustin Stwalley
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
| | - Jacaranda van Rheenen
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
| | - Matthew Westercamp
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Rachel M. Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Surbhi Leekha
- Division of Infectious Diseases, Department of Internal Medicine, University of Maryland Medical School, Baltimore, Maryland, United States
| | - David K. Warren
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
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Nasr SS, Sherif GM, Wahab MA, Aboelkasem H. Targeting average length of hospital stay as a control measure to decrease COVID-19 hospital-acquired infection in surgical cancer patients. J Egypt Natl Canc Inst 2023; 35:36. [PMID: 37981621 DOI: 10.1186/s43046-023-00199-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND The global spread of coronaviruses had a great impact on the economic and social situation of most countries. As the backbone of any society, the health sector made a significant contribution through applying emergency risk management plans in order to control the pandemic. Monitoring the average length of hospital stay (ALOS) was an effective way to release the capacity of the health system during this time. The aim was to evaluate the effect of applying risk assessment/management strategies on ALOS and the impact of this ALOS on COVID-19 infection rates among cancer patients. METHODS This is a prospective cohort study. All admitted cancer patients in 6 surgical departments from January to June 2021 were included. RESULTS A total of 1287 patients were admitted to 6 surgical departments during the selected period. About 46% of them had surgery (n = 578), while 54% did not have surgery (n = 700). Among surgical patients, admission rates were highest in February and head and neck department (24% and 22.1%, respectively), and lowest in April and chest department (12.4% and 8%, respectively). ALOS was significantly different across the 6 months (p value < 0.001) with lower ALOS in (April, May, and June) than in (January-February, and March). No significant difference was found across the 6 surgical departments (p value = 0.423). Twenty-eight patients became COVID-19 positive after admission, 25 of them (89%) were infected from March to June-during the time of the third wave-and a significant decreasing linear trend (p value = 0.009) was found. CONCLUSION ALOS had significantly reduced with commitment to infection control (IC) interventions and recommendations. The significant decreasing trend of COVID-19 infection from March to June (unlike the rising curve of the 3rd COVID-19 wave by that time) could be explained by improvement in ALOS.
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Affiliation(s)
- Sarah S Nasr
- Cancer Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Ghada M Sherif
- Cancer Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Maha Abdel Wahab
- Anesthesia Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hatem Aboelkasem
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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11
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Patel KP, Mukhopadhyay S, Bedford K, Richards R, Queenan H, Jerrum M, Banton J, Ozkor M, Mathur A, Kennon S, Baumbach A, Mullen MJ. Rapid Assessment and Treatment In Decompensated Aortic Stenosis (ASTRID-AS study)- A pilot study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:724-730. [PMID: 36378116 PMCID: PMC10627808 DOI: 10.1093/ehjqcco/qcac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/01/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute decompensated aortic stenosis (ADAS) is common and associated with higher mortality, acute kidney injury (AKI) and longer hospital length of stay (LoS) compared with electively treated stable AS. The aim of this study was to assess the impact of a dedicated pathway that reduces time to transcatheter aortic valve implantation (TAVI) in ADAS, hypothesizing that LoS can be reduced without compromising patient safety. METHODS AND RESULTS Using a prospective, open label, cluster design, patients from 5 referring centres were allocated to the ASessment and TReatment In Decompensated Aortic Stenosis (ASTRID-AS) pathway where the diagnosis, referral, investigations and treatment of ADAS were prioritised and expedited. 15 hospitals remained on the conventional pathway that followed the same process, albeit according to a waiting list. The primary efficacy endpoint was hospital LoS and the secondary safety endpoint, a composite of death or AKI at 30 days post-TAVI. 58 conventional patients and 25 ASTRID-AS patients were included in this study. Time to TAVI in the conventional vs. ASTRID-AS cohort was 22 (15-30) vs. 10 (6-12) days; P < 0.001, respectively. Length of hospital stay was 24 (18-33) vs. 13 (8-18) days; P < 0.001, respectively. 13.4 bed days were saved per patient using the ASTRID-AS pathway. Secondary safety endpoint occurred in 12 (20.7%) vs. 1 (4.0%) patients; P = 0.093, respectively. Procedural complications were similar between the two cohorts. CONCLUSION A dedicated pathway for ADAS that shortens time to TAVI demonstrated reduced hospital LoS without compromising patient safety and a trend towards improving clinical outcomes.
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Affiliation(s)
- Kush P Patel
- Institute of Cardiovascular science, University College London, London, EC1E 6BT, UK
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | | | - Kerry Bedford
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Rhian Richards
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Helen Queenan
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Melanie Jerrum
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Judy Banton
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Mick Ozkor
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Anthony Mathur
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
- The William Harvey Research Institute, London, E1 4NS, UK
| | - Simon Kennon
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Andreas Baumbach
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
- The William Harvey Research Institute, London, E1 4NS, UK
- Yale University School of Medicine, New Haven, CT 06510. USA
| | - Michael J Mullen
- Institute of Cardiovascular science, University College London, London, EC1E 6BT, UK
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
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12
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Aiesh BM, Qashou R, Shemmessian G, Swaileh MW, Abutaha SA, Sabateen A, Barqawi AK, AbuTaha A, Zyoud SH. Nosocomial infections in the surgical intensive care unit: an observational retrospective study from a large tertiary hospital in Palestine. BMC Infect Dis 2023; 23:686. [PMID: 37833675 PMCID: PMC10576355 DOI: 10.1186/s12879-023-08677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Nosocomial infections or hospital-acquired infections are a growing public health threat that increases patient morbidity and mortality. Patients at the highest risk are those in intensive care units. Therefore, our objective was to provide a pattern analysis of nosocomial infections that occurred in an adult surgical intensive care unit (ICU). METHODS This study was a retrospective observational study conducted in a 6-bed surgical intensive care unit (SICU) at An-Najah National University Hospital (NNUH) to detect the incidence of nosocomial infections from January 2020 until December 2021. The study group included 157 patients who received antibiotics during their stay in the SICU. RESULTS The incidence of nosocomial infections, either suspected or confirmed, in the SICU was 26.9% (95 out of 352 admitted patients). Pneumonia (36.8%) followed by skin and soft tissue infections (35.8%) were the most common causes. The most common causative microorganisms were in the following order: Pseudomonas aeruginosa (26.3%), Acinetobacter baumannii (25.3%), extended-spectrum beta lactamase (ESBL)-Escherichia coli (23.2%) and Klebsiella pneumonia (15.8%). The average hospital stay of patients with nosocomial infections in the SICU was 18.5 days. CONCLUSIONS The incidence of nosocomial infections is progressively increasing despite the current infection control measures, which accounts for an increased mortality rate among critically ill patients. The findings of this study may be beneficial in raising awareness to implement new strategies for the surveillance and prevention of hospital-acquired infections in Palestinian hospitals and health care centers.
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Affiliation(s)
- Banan M Aiesh
- Infection Control Department, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Raghad Qashou
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Genevieve Shemmessian
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Mamoun W Swaileh
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Shatha A Abutaha
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Ali Sabateen
- Infection Control Department, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Abdel-Karim Barqawi
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of General Surgery, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Adham AbuTaha
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Pathology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine
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13
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Moore MC, Dubin JA, Bains SS, Douglas S, Hameed D, Nace J, Delanois RE. Inpatient vs outpatient arthroplasty: A in-state database analysis of 90-day complications. J Orthop 2023; 44:1-4. [PMID: 37601159 PMCID: PMC10432695 DOI: 10.1016/j.jor.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction An increase in the number of policy initiatives, such as alternative payment models, have prompted healthcare providers to examine health-care expenditures while seeking to improve quality of care. Performing total joint arthroplasty (TJA) in the outpatient setting is an attractive option in driving costs down and providing psychological benefits to patients. Concerns regarding the safety and effectiveness of same-day discharge protocols warrants further investigation, especially on the state level. Due to the lack of consensus, we aimed to compare: (1) risk factors for outpatient arthroplasty and (2) incidences of postoperative complications between inpatient vs outpatient arthroplasty using an in-state database. Methods Patients who underwent total knee or hip arthroplasty between January 1, 2022 and December 31, 2022 were identified. Data was drawn from the Maryland State Inpatient Database (SID) and Maryland State Ambulatory Surgery and Services Database (SASD). A total of 7817 patients had TJA within this time. Patients were divided into inpatient arthroplasty (n = 1429) and outpatient arthroplasty (n = 6338). Demographic variables, medical comorbidities, and 90-day complication rates were compared between inpatient and outpatient procedures. Additional independent variables included: marital status, primary language, race, and median household income. A multivariate logistic regression analysis was performed to identify independent risk factors for complications following TJA after controlling for risk factors and patient comorbidities. Results Arthroplasty in the outpatient setting were more likely to be married (61.3% vs. 51.2%, p < 0.001), white (75.5% vs. 60.9%, <0.001), speak English as primary language (98.7% vs. 88.6%, p < 0.001), and have lower rates of diabetes (4.8% vs. 9.7%, p < 0.001), chronic obstructive pulmonary disease (16.3% vs. 21.8%, p < 0.001), and obesity (30.0% vs. 45.2%, p < 0.001) compared to arthroplasty in the inpatient setting, respectively. There were lower incidences of acute kidney injury (0.2 vs. 0.8%, p < 0.001) and infection (0.3% vs. 1.1%, p < 0.001) in the outpatient cohort compared to the inpatient cohort, respectively. Inpatient arthroplasty (Odds Ratio (OR) 1.98, 95% CI 1.30-3.02, p = 0.002) and hypertension (OR 2.12, 95% CI 1.23-3.64, p = 0.007) were independent risk factors for total complications following TJA. Conclusion Arthroplasty in the outpatient setting showed fewer complications than compared to patients in the inpatient setting. Although multiple factors should guide the decision for arthroplasty, outpatient arthroplasty may be a safe option for select, healthier patients without the increased burden of increased complications.
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Affiliation(s)
- Mallory C. Moore
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy A. Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Scott Douglas
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - James Nace
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E. Delanois
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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El-Qushayri AE, Reda A. Surgical versus interventional coronary revascularization in kidney transplant recipients: a systematic review and meta-analysis. Int Urol Nephrol 2023; 55:2493-2499. [PMID: 36906876 PMCID: PMC10499735 DOI: 10.1007/s11255-023-03546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/02/2023] [Indexed: 03/13/2023]
Abstract
AIM To study the most beneficial coronary revascularization strategy in kidney transplant recipients (KTR). METHODS In 16th June 2022 and updated on 26th February 2023, we searched in five databases including PubMed for relevant articles. The odds ratio (OR) together with the 95% confidence interval (95%CI) were used to report the results. RESULTS Percutaneous coronary intervention (PCI) was significantly associated with significant lower in-hospital mortality (OR 0.62; 95%CI 0.51-0.75) and 1-year mortality (OR 0.81; 95%CI 0.68-0.97), but not overall mortality (mortality at the last follow-up point) (OR 1.05; 95%CI 0.93-1.18) rather than coronary artery bypass graft (CABG). Moreover, PCI was significantly associated with lower acute kidney injury prevalence (OR 0.33; 95%CI 0.13-0.84) compared to CABG. One study indicated that non-fatal graft failure prevalence did not differ between the PCI and the CABG group until 3 years of follow up. Moreover, one study demonstrated a short hospital length of stay in the PCI group rather than the CABG group. CONCLUSION Current evidence indicated the superiority of PCI than CABG as a coronary revascularization procedure in short- but not long-term outcomes in KTR. We recommend further randomized clinical trials for demonstrating the best therapeutic modality for coronary revascularization in KTR.
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Affiliation(s)
| | - Abdullah Reda
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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15
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Gröger M, Loth A, Helbig S, Stöver T, Leinung M. Bilateral simultaneous cochlear implantation is a safe method of hearing rehabilitation in adults. Eur Arch Otorhinolaryngol 2023; 280:4445-4454. [PMID: 37191916 PMCID: PMC10477109 DOI: 10.1007/s00405-023-07977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Bilateral cochlear implantation is an effective treatment for patients with bilateral profound hearing loss. In contrast to children, adults mostly choose a sequential surgery. This study addresses whether simultaneous bilateral CI is associated with higher rates of complications compared to sequential implantation. METHODS 169 bilateral CI surgeries were analyzed retrospectively. 34 of the patients were implanted simultaneously (group 1), whereas 135 patients were implanted sequentially (group 2). The duration of surgery, the incidence of minor and major complications and the duration of hospitalization of both groups were compared. RESULTS In group 1, the total operating room time was significantly shorter. The incidences of minor and major surgical complications showed no statistically significant differences. A fatal non-surgical complication in group 1 was particularly extensively reappraised without evidence of a causal relationship to the chosen mode of care. The duration of hospitalization was 0.7 days longer than in unilateral implantation but 2.8 days shorter than the combined two hospital stays in group 2. CONCLUSION In the synopsis of all considered complications and complication-relevant factors, equivalence of simultaneous and sequential cochlear implantation in adults in terms of safety was found. However, potential side effects related to longer surgical time in simultaneous surgery must be considered individually. Careful patient selection with special consideration to existing comorbidities and preoperative anesthesiologic evaluation is essential.
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Affiliation(s)
- Maximilian Gröger
- University Hospital Frankfurt, Dept. of Otorhinolaryngology, Frankfurt am Main, Germany.
| | - Andreas Loth
- University Hospital Frankfurt, Dept. of Otorhinolaryngology, Frankfurt am Main, Germany
| | - Silke Helbig
- University Hospital Frankfurt, Dept. of Otorhinolaryngology, Frankfurt am Main, Germany
| | - Timo Stöver
- University Hospital Frankfurt, Dept. of Otorhinolaryngology, Frankfurt am Main, Germany
| | - Martin Leinung
- University Hospital Frankfurt, Dept. of Otorhinolaryngology, Frankfurt am Main, Germany
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Quiroga TN, Bachar N, Voigt W, Danino N, Shafran I, Shtrichman R, Shuster G, Lambrecht N, Eisenmann S. Changes in tidal breathing biomarkers as indicators of treatment response in AECOPD patients in an acute care setting. Adv Med Sci 2023; 68:176-185. [PMID: 37146372 DOI: 10.1016/j.advms.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/01/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a complication of COPD that typically necessitates intensified treatment and hospitalization. It is linked to higher morbidity, mortality and healthcare spending. Assessment of therapy response for AECOPD is difficult due to the variability of symptoms and limitations in current measures. Hence, there is a need for new biomarkers to aid in the management of AECOPD in acute care settings. MATERIALS AND METHODS Fifteen hospitalized AECOPD patients (GOLD 3-4) were enrolled in this study. Treatment response was assessed daily through clinical evaluations and by monitoring tidal breathing biomarkers (respiratory rate [RR], expiratory time [Tex], inspiratory time [Tin], expiratory pause [Trst], total breath time [Ttot]), using a novel, wearable nanosensor-based device (SenseGuard™). RESULTS Patients who showed significant clinical improvement had substantial changes in ΔTex/Ttot (+14%), ΔTrst/Ttot (-18%), and ΔTin/Tex (+0.09), whereas patients who showed mild or no clinical improvement had smaller changes (+5%, +3%, and -0.03, respectively). Linear regression between change in physician's assessment score and the median change in tidal breathing parameters was significant for Tin/Tex (R2 = 0.449, ∗p = 0.017), Tex/Ttot (R2 = 0.556, ∗p = 0.005) and Trst/Ttot (R2 = 0.446, ∗p = 0.018), while no significant regression was observed for RR, Tin/(Trst + Tex) and Tin/Ttot. CONCLUSIONS Our study demonstrates the potential of the SenseGuard™ to monitor treatment response in AECOPD patients by measuring changes in tidal breathing biomarkers, which were shown to be associated with significant changes in the patients' respiratory condition as evaluated by physicians. However, further large-scale clinical studies are needed to confirm these findings.
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Affiliation(s)
- Tess Nuñez Quiroga
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
| | | | - Wieland Voigt
- NanoVation-GS LTD, Haifa, Israel; Medical Innovation and Management, Steinbeis University Berlin, Berlin, Germany
| | | | | | | | | | - Nina Lambrecht
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
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Nimmagadda K, Pancrazi S, Martino A, Coleman E, Madam N, Goekler N, Rodriguez C, Kramer S, Magu B, Aders D. Virtual Multidisciplinary Rounds to Reduce Length of Stay, Decrease Variation, and Promote Accountability. Jt Comm J Qual Patient Saf 2023; 49:450-457. [PMID: 37193611 DOI: 10.1016/j.jcjq.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Evidence suggests in-person multidisciplinary rounds can help reduce length of stay (LOS) and improve throughput, but there are limited studies about the effectiveness of virtual multidisciplinary rounds on these measures. The authors hypothesized that virtual multidisciplinary rounds could help reduce LOS, improve throughput, promote accountability, and reduce provider variation. METHODS The research team designed and implemented virtual multidisciplinary rounds by a phone conference call with key stakeholders, including hospitalists, case managers, the clinical documentation improvement team, physical and occupational therapy, and nursing leaders. To track progress in real time, dashboards were created using data from electronic medical records. After several months, unit-based discharge huddles were also implemented to supplement the process and sustain the improvement. RESULTS The interventions led to more than 60% of discharges below geometric mean LOS after starting the initiative, compared to approximately 52% before the initiative. Mean observation hours went from around 44 hours to 31.9 hours, and the change was sustained for more than a year. In fiscal year 2021, 3,813 excess days were reduced in 10 months, resulting in combined savings of $6.7 million. A decrease in hospitalist provider variation is noted with the initiative, which is a crucial contributor to the results. CONCLUSION Virtual multidisciplinary rounds combined with other interventions can effectively reduce LOS and observation hours. Decreasing variation among hospitalists and improved key stakeholder engagement can be achieved with virtual multidisciplinary rounds. More studies to test the effectiveness of virtual multidisciplinary rounds in various patient care settings would provide more insights.
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Tompkins LS, Tien V, Madison AN. Getting to zero: Impact of a device to reduce blood culture contamination and false-positive central-line-associated bloodstream infections. Infect Control Hosp Epidemiol 2023; 44:1386-1390. [PMID: 36539993 PMCID: PMC10507495 DOI: 10.1017/ice.2022.284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the impact of initial specimen diversion device (ISDD) on inpatient and emergency department blood culture contamination (BCC), central-line-associated bloodstream infection (CLABSI) standardized infection ratios (SIRs), and antibiotic administration. DESIGN Single-center quasi-experimental prospective cohort study wherein phlebotomists used traditional venipuncture with or without the ISDD while registered nurses (RNs) used traditional venipuncture. METHOD BCC events among phlebotomists and RNs were observed and compared from March 17, 2019, through January 21, 2020, defined by contaminant detection in 1 of 4 bottles for matched sets or 1 of 2 bottles in both subsets for coagulase negative staphylococci. CLABSIs throughout this period were recorded and SIRs were calculated. Enhanced oversight took place through July 21, 2019, with chart review assessing antibiotic use for patients with possible BCC. RESULTS Overall, 24% of blood cultures obtained were from patients in intensive care. Phlebotomists using traditional venipuncture (n = 4,759) had a 2.3% BCC rate; phlebotomists using the ISDD (n = 11,202) had a 0% BCC rate. RNs drew 7,411 BCs with a 0.8% BCC rate. The CLABSI SIR was decreased from 1.103 in 2017 and 0.658 in 2018 to 0.439 in 2019. The CLABSI incidence was 33%-64% of predicted value for each 2019 quarter. This range fell to 18%-37% after the exclusion of likely false-positive results. Among 42 patients with possible BCC under enhanced oversight, 2 patients were treated with prolonged antibiotic courses. CONCLUSIONS ISDD use by phlebotomists was associated with BCC reduction and reduced false-positive CLABSI results. This patient-care quality improvement could constitute sustainable antibiotic stewardship expansion.
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Affiliation(s)
- Lucy S. Tompkins
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Infection Prevention and Control, Stanford Health Care, Stanford, California
| | - Vivian Tien
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Alexandra N. Madison
- Department of Infection Prevention and Control, Stanford Health Care, Stanford, California
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Bodla ZH, Hashmi M, Niaz F, Farooq U, Khalid F, Abdullahi AH, Luu SW. Timing matters: An analysis of the relationship between red cell transfusion timing and hospitalization outcomes in sickle cell crisis patients using the National Inpatient Sample database. Ann Hematol 2023:10.1007/s00277-023-05275-6. [PMID: 37249608 DOI: 10.1007/s00277-023-05275-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023]
Abstract
Vaso-occlusive pain crisis is a debilitating complication of sickle cell disease (SCD) and it is the most common cause of hospitalization among these individuals. We studied the inpatient outcomes among patients admitted with sickle cell crisis based on the timing of red blood cell transfusion. In this retrospective study, we used the United States National Inpatient Sample (NIS) data for the year 2019, to identify adult patients hospitalized with the principal diagnosis of sickle cell crisis who received simple red blood cell transfusion during their hospitalization. Patients were divided into two groups. Those who received simple red cell transfusion within 24 hours of admission were classified as early transfusion. After adjusting for confounders, the mean adjusted length of stay for patients with early transfusion was significantly lower than those who received a late blood transfusion by 3.51 days (p-value < 0.001) along with a decrease in mean adjusted hospitalization charges and cost, by 25,487 and 4,505 United States Dollar (USD) respectively. The early red cell transfusion was also associated with a decrease in inpatient mortality, demonstrated by an adjusted odds ratio (aOR) of 0.19 (p-value 0.036), and a reduction in in-hospital sepsis, with an aOR of 0.28 (p-value < 0.001), however, no statistically significant difference was found between the two groups regarding acute respiratory failure requiring intubation, vasopressors requirement, acute kidney injury requiring dialysis and intensive care unit (ICU) admission. We recommend timely triage and reassessment to identify sickle cell crisis patients requiring blood transfusion. This intervention can notably affect the inpatient length of stay, resource utilization, and hospitalization outcomes.
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Affiliation(s)
- Zubair Hassan Bodla
- University of Central Florida College of Medicine, Graduate Medical Education/HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA.
| | - Mariam Hashmi
- University of Central Florida College of Medicine, Graduate Medical Education/HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA
| | - Fatima Niaz
- King Edward Medical University, Lahore, Punjab, Pakistan
- Mayo Hospital, Lahore, Punjab, Pakistan
| | - Umer Farooq
- Rochester Regional Health, Rochester, NY, USA
| | | | - Abdullahi Hussein Abdullahi
- University of Central Florida College of Medicine, Graduate Medical Education/HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA
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Infections in Glucose-6-Phosphate Dehydrogenase G6PD-Deficient Patients; Predictors for Infection-Related Mortalities and Treatment Outcomes. Antibiotics (Basel) 2023; 12:antibiotics12030494. [PMID: 36978361 PMCID: PMC10044656 DOI: 10.3390/antibiotics12030494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Disturbances in the count or maturity of blood cells weaken their microbial defensive capacity and render them more susceptible to infections. Glucose-6-phosphate deficient patients are affected by a genetic disease that affects cell integrity with increased liability to infections and death. We aimed to investigate the risk factors for infection mortality in this patient population. We retrospectively examined the records of G6PD adult patients with confirmed infections and collected data related to demographics, infections (pathogens, types, and treatment regimens) in addition to mortality and length of stay outcomes. Data were statistically analyzed using R Programming language to identify contributing factors to mortality and treatment regimens association with outcomes. Records of 202 unique patients over 5 years were included, corresponding to 379 microbiologically and clinically confirmed infections. Patients > 60 years [p = 0.001, OR: 5.6], number of comorbidities 4 (2–5) [p < 0.001, OR: 1.8], patients needed blood transfusion [p = 0.003, OR: 4.3]. Respiratory tract infections [p = 0.037, OR: 2.28], HAIs [p = 0.002, OR: 3.9], polymicrobial infections [p = 0.001, OR: 10.9], and concurrent infection Gram-negative [p < 0.001, OR: 7.1] were significant contributors to 28-day mortality. The history of exposure to many antimicrobial classes contributed significantly to deaths, including β-lactam/β-lactamase [p = 0.002, OR: 2.5], macrolides [p = 0.001, OR: 3.34], and β-lactams [p = 0.012, OR: 2.0]. G6PD patients are a unique population that is more vulnerable to infections. Prompt and appropriate antimicrobial therapy is warranted to combat infections. A strict application of stewardship principles (disinfection, shortening the length of stay, and controlling comorbid conditions) may be beneficial for this population. Finally, awareness of the special needs of this patient group may improve treatment outcomes.
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Zheng J, Tisdale RL, Heidenreich PA, Sandhu AT. Disparities in Hospital Length of Stay Across Race and Ethnicity Among Patients With Heart Failure. Circ Heart Fail 2022; 15:e009362. [PMID: 36378760 PMCID: PMC9673157 DOI: 10.1161/circheartfailure.121.009362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reducing hospital length of stay (LOS) has been identified as an important lever for minimizing the burden of heart failure hospitalization, yet the impact of social and structural determinants of health on LOS has received little attention. We investigated disparities in LOS across race/ethnicity and their possible drivers. METHODS We analyzed patients hospitalized for heart failure from 2017 to 2020 using the Get With The Guidelines-Heart Failure registry. We characterized LOS differences across race/ethnicity by insurance and disposition, adjusting for demographics, comorbidities, and clinical severity. Effects of hospital-level clustering on LOS across race/ethnicity were assessed using hierarchical mixed-effects models. We evaluated the association between LOS and discharge rates of guideline-directed medical therapy. RESULTS Three thousand three seven hundred thirty patients hospitalized for heart failure were identified. After excluding inpatient deaths, the adjusted LOS for Black (5.72 days [95% CI, 5.62-5.82]), Hispanic (5.94 days [95% CI, 5.79-6.08]), and Indigenous American/Pacific Islander (6.06 days [95% CI, 5.85-6.27]) patients remained significantly longer compared with non-Hispanic White patients (5.32 days [95% CI, 5.25-5.39]). This pattern was driven by LOS differences among patients discharged to hospice or nursing facilities. After accounting for variability between hospitals, associations of race/ethnicity with LOS either were attenuated or reversed in direction. Guideline-directed medical therapy rates on discharge did not differ significantly across race/ethnicity despite longer LOS for Black, Hispanic, and Indigenous American/Pacific Islander patients. CONCLUSIONS Differences between hospitals drive LOS disparities across race/ethnicity. Longer LOS among Black, Hispanic, and Indigenous American/Pacific Islander patients was not associated with improved quality of care.
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Affiliation(s)
| | - Rebecca L Tisdale
- Department of Health Policy, Stanford University School of Medicine, Stanford, California
- Veteran’s Affairs Palo Alto Healthcare System, Palo Alto, CA
| | - Paul A Heidenreich
- Veteran’s Affairs Palo Alto Healthcare System, Palo Alto, CA
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA
| | - Alexander T Sandhu
- Veteran’s Affairs Palo Alto Healthcare System, Palo Alto, CA
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA
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Povroznik MD. Initial Specimen Diversion Device Utilization Mitigates Blood Culture Contamination Across Regional Community Hospital and Acute Care Facility. Am J Med Qual 2022; 37:405-412. [PMID: 35353719 PMCID: PMC9426727 DOI: 10.1097/jmq.0000000000000055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A West Virginia regional community hospital incorporated an initial specimen diversion device (ISDD) into conventional blood culture protocol with the objective to bring the hospital-wide blood culture contamination (BCC) rate from a 3.06% preintervention rate to a target performance level below 1%. Emergency department staff, laboratory phlebotomists, and nursing staff on acute-critical care floors were trained on ISDD (Steripath Gen2, Magnolia Medical Technologies, Inc., Seattle, WA) operating procedure and utilized the device for blood culture sample collection with adult patients from September 2020 through April 2021. Of 5642 blood culture sets collected hospital-wide, 4631 were collected with the ISDD, whereas the remaining sets were collected via the conventional method. The ISDD BCC rate of 0.78% differed from the conventional method BCC rate of 4.06% observed during the intervention period (chi-squared test P < 0.00001). The ISDD group attained a sub-1% BCC rate to satisfy the intervention objective.
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Affiliation(s)
- Mark D. Povroznik
- Department of Quality, WVU Medicine: United Hospital Center, Bridgeport, WV
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Levy HA, Karamian BA, Vijayakumar G, Gilmore G, Canseco JA, Radcliff KE, Kurd MF, Rihn JA, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. The impact of case order and intraoperative staff changes on spine surgical efficiency. Spine J 2022; 22:1089-1099. [PMID: 35121151 DOI: 10.1016/j.spinee.2022.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite concerted efforts toward quality improvement in high-volume spine surgery, there remains concern that increases in case load may compromise the efficient and safe delivery of surgical care. There is a paucity of evidence to describe the effects of spine case order and operating room (OR) team structure on measures of intraoperative timing and OR efficiency. PURPOSE This study aims to determine if intraoperative staff changes and surgical case order independently predict extensions in intraoperative timing after spinal surgery for spondylotic diseases. STUDY DESIGN/ SETTING Retrospective cohort analysis PATIENT SAMPLE: All patients over age 18 who underwent primary or revision decompression and/or fusion for degenerative spinal diseases between 2017 to 2019 at a single academic institution were retrospectively identified. Exclusion criteria included absence of descriptive data and intraoperative timing parameters as well as surgery for traumatic injury, infection, and malignancy. OUTCOME MEASURES Intraoperative timing metrics including total theater time, wheels in to induction, induction start to cut, cut to close, and close to wheels out. Postoperative outcomes included length of hospital stay and 90-day hospital readmissions. METHODS Surgical case order and intraoperative changes in staff (circulator and surgical scrub nurse or technician) were determined. Patient demographics, surgical factors, intraoperative timing and postoperative outcomes were recorded. Extensions in each operative stage were determined as a ratio of the actual duration of the parameter divided by the predicted duration of the parameter. Univariate and multivariate analyses were performed to compare outcomes within case order and staff change groups. RESULTS A total of 1,108 patients met the inclusion criteria. First, second, and third start cases differed significantly in intraoperative extensions of total theater time, wheels in to induction, induction start to cut, cut to close, and close to wheels out. On regression, decreasing case order predicted extension in wheels in to induction time. Surgeries with intraoperative staff changes were associated with increases in total theater time, induction start to cut time, cut to close time, close to wheels out time, and length of hospital stay. Switch in primary circulator predicted extended theater time and cut to close time. Relief of primary circulator or scrub predicted extended total theater time, induction start to cut time, cut to close time, and close to wheels out time. CONCLUSIONS Intraoperative staff change in spine surgery independently predicted extended operative duration. However, higher case order was not significantly associated with procedural time.
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Affiliation(s)
- Hannah A Levy
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A Karamian
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Gayathri Vijayakumar
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Griffin Gilmore
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kris E Radcliff
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark F Kurd
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey A Rihn
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K Kepler
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Edelstein B, Scandiffio J. Predictors of Functional Improvement, Length of Stay, and Discharge Destination in the Context of an Assess and Restore Program in Hospitalized Older Adults. Geriatrics (Basel) 2022; 7:geriatrics7030050. [PMID: 35645273 PMCID: PMC9149926 DOI: 10.3390/geriatrics7030050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
Assess and restore programs such as Humber’s Elderly Assess and Restore Team (HEART) provide short-term restorative care to prevent functional decline in hospitalized older adults. The aim of this retrospective observational study was to determine which HEART participant characteristics are predictive of functional improvement, decreased length of stay, return to home, and decreased readmission to hospital. Electronic health records were retrospectively examined to gather predictor data. Differences in functional status, excessive length of stay, discharge destination, and hospital readmissions were compared in 547 HEART patients and 547 matched eligible non-participants using ANOVAs, Mann–Whitney, and chi-square tests. The greatest functional improvements (percent Barthel change) were seen in those requiring a one-person assist (M = 39.56) and using a walker (M = 46.07). Difference in excessive length of stay between HEART and non-HEART participants was greatest in those who used a walker (Mdn = 3.80), required a one-person assist (Mdn = 2.00), had a high falls risk (Mdn = 1.80), and had either a lower urinary tract infection (Mdn = 2.25) or pneumonia (Mdn = 1.70). Predictor variables did not affect readmission to the hospital nor return to home. Predictive characteristics should be considered when enrolling patients to assess and restore programs for optimal clinical outcomes.
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Physical Therapists. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kenneally AM, Warriner Z, VanHoose JD, Ali D, McCleary EJ, Davenport DL, Parli SE. Evaluation of Antibiotic Duration after Surgical Debridement of Necrotizing Soft Tissue Infection. Surg Infect (Larchmt) 2022; 23:357-363. [PMID: 35262418 DOI: 10.1089/sur.2021.256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Necrotizing soft tissue infection (NSTI) is known to be a medical emergency with high morbidity and mortality. Guidelines do not specify the optimal duration of antibiotic agents after completion of surgical debridements of NSTI, which has created variable practice. It was hypothesized that patients with NSTI who receive 48 hours or less of post-operative antibiotic agents after final debridement have similar rates of subsequent intervention or infection recurrence, suggesting that a shorter duration of antibiotic agents may treat NSTI adequately after final surgical debridement. Patients and Methods: This was a retrospective study including adults with NSTI identified through International Classification of Diseases, Ninth Revision (ICD-9), International Classification of Diseases, Tenth Revision (ICD-10), and Current Procedural Terminology (CPT) codes admitted to one academic institution between January 1, 2010 and July 31, 2020. Demographics, surgical practices, antibiotic practices, and clinical outcomes including inpatient mortality, hospital length of stay (LOS), intensive care unit (ICU) LOS, total antibiotic days, necrotizing infection clinical composite end point (NICCE) success, and infection recurrence were compared based on the duration of antibiotic agents after final debridement. Results: Three hundred twenty-two patients with NSTI were included and baseline characteristics and clinical severity markers were well balanced between the two groups. In 71 patients (22%) who received less than 48 hours of antibiotic agents after final debridement there was no difference in recurrence (1.4% vs. 3.6%; p = 0.697), mortality (1.4% vs. 4.4%; p = 0.476), or ICU LOS (1 vs. 2 days; p = 0.300], but they did have a shorter hospital LOS (7 vs. 10 days; p = 0.011). Conclusions: Shorter duration of antibiotic therapy after final surgical debridement of NSTI may be appropriate in patients without another indication for antibiotic agents.
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Affiliation(s)
- Allison M Kenneally
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Zachary Warriner
- Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Jeremy D VanHoose
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Dina Ali
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA.,Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Emily J McCleary
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Dan L Davenport
- Division of Healthcare Outcomes and Optimal Patient Services, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Sara E Parli
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA.,Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
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Edelstein B, Scandiffio J. Effectiveness of an assess and restore program in treating older adults with physiological and functional decline: The HEART program. Arch Gerontol Geriatr 2022; 99:104609. [DOI: 10.1016/j.archger.2021.104609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/11/2021] [Accepted: 12/09/2021] [Indexed: 11/02/2022]
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Fabry N, Hendrickson MJ, Arora S, Vavalle JP. Five-year trends in cause-specific readmissions and cost burden of mitral transcatheter edge-to-edge repair. Catheter Cardiovasc Interv 2022; 99:1251-1256. [PMID: 35181978 DOI: 10.1002/ccd.30121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The study aimed to evaluate cost trends associated with mitral valve transcatheter edge-to-edge repair (TEER). BACKGROUND TEER is a treatment option for patients at prohibitive surgical risk with moderate to severe mitral valve regurgitation and NYHA class III or IV symptoms. The 30-day costs and causes of readmission following TEER have not been well studied. METHODS Patients undergoing mitral TEER in the United States from 2014 to 2018 were identified in the Nationwide Readmission Database. Patient characteristics, cause-specific readmission, and costs of the index hospitalization and readmissions were analyzed. Costs were trended over years using general linear regression. RESULTS A total of 10,196 patients underwent mitral TEER during the study period. Thirty-day readmissions were stable over time at around 16%. The mean length of stay following TEER decreased from 7 days in 2014 to 5 days in 2018. There was a significant decline in the cost of the index hospitalization of $1311 per year, and a significant decline in the total 30-day cost of $1588 per year (p < 0.001). This was strictly due to a reduction in the cost of the index hospitalization without a change in readmission costs over time (p = 0.23). Infectious causes of readmissions significantly decreased while total cardiovascular readmissions, including heart failure, remained constant. CONCLUSION The decreasing 30-day cost burden of TEER is primarily driven by the shorter index length of stay, as experience in TEER has grown and, length of stay has declined. However, cardiovascular readmissions, and consequently readmission costs, have remained steady.
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Affiliation(s)
- Nicholas Fabry
- Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - John P Vavalle
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Alsinglawi B, Alshari O, Alorjani M, Mubin O, Alnajjar F, Novoa M, Darwish O. An explainable machine learning framework for lung cancer hospital length of stay prediction. Sci Rep 2022; 12:607. [PMID: 35022512 PMCID: PMC8755804 DOI: 10.1038/s41598-021-04608-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 12/28/2021] [Indexed: 12/19/2022] Open
Abstract
This work introduces a predictive Length of Stay (LOS) framework for lung cancer patients using machine learning (ML) models. The framework proposed to deal with imbalanced datasets for classification-based approaches using electronic healthcare records (EHR). We have utilized supervised ML methods to predict lung cancer inpatients LOS during ICU hospitalization using the MIMIC-III dataset. Random Forest (RF) Model outperformed other models and achieved predicted results during the three framework phases. With clinical significance features selection, over-sampling methods (SMOTE and ADASYN) achieved the highest AUC results (98% with CI 95%: 95.3-100%, and 100% respectively). The combination of Over-sampling and under-sampling achieved the second-highest AUC results (98%, with CI 95%: 95.3-100%, and 97%, CI 95%: 93.7-100% SMOTE-Tomek, and SMOTE-ENN respectively). Under-sampling methods reported the least important AUC results (50%, with CI 95%: 40.2-59.8%) for both (ENN and Tomek- Links). Using ML explainable technique called SHAP, we explained the outcome of the predictive model (RF) with SMOTE class balancing technique to understand the most significant clinical features that contributed to predicting lung cancer LOS with the RF model. Our promising framework allows us to employ ML techniques in-hospital clinical information systems to predict lung cancer admissions into ICU.
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Affiliation(s)
- Belal Alsinglawi
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Rydalmere, 2116, NSW, Australia
| | - Osama Alshari
- Oncology Division, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Alorjani
- Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar Mubin
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Rydalmere, 2116, NSW, Australia
| | - Fady Alnajjar
- College of Information Technology, UAE University, Al-Ain, UAE.
| | - Mauricio Novoa
- The School of Engineering, Design and Built Environment, Western Sydney University, Rydalmere, 2116, NSW, Australia
| | - Omar Darwish
- Department of Information Security and Applied Computing, Eastern Michigan University, Michigan, 48197, USA
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Birgy A, Madhi F, Jung C, Levy C, Cointe A, Bidet P, Hobson CA, Bechet S, Sobral E, Vuthien H, Ferroni A, Aberrane S, Cuzon G, Beraud L, Gajdos V, Launay E, Pinquier D, Haas H, Desmarest M, Dommergues MA, Cohen R, Bonacorsi S. Clavulanate combinations with mecillinam, cefixime or cefpodoxime against ESBL-producing Enterobacterales frequently associated with blaOXA-1 in a paediatric population with febrile urinary tract infections. J Antimicrob Chemother 2021; 76:2839-2846. [PMID: 34453533 DOI: 10.1093/jac/dkab289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Oral treatment of febrile urinary tract infections (FUTIs) can be impaired by MDR Enterobacterales often combining ESBL and inhibitor-resistant genes. We studied the impact of β-lactamases and Enterobacterales' genotypes on the cefixime, cefpodoxime and mecillinam ± amoxicillin/clavulanate MICs. MATERIALS AND METHODS In this multicentric study, we included 251 previously whole-genome-sequenced ESBL-producing Enterobacterales, isolated in French children with FUTIs. The MICs of cefixime, cefpodoxime, mecillinam alone and combined with amoxicillin/clavulanate were determined and analysed with respect to genomic data. We focused especially on the isolates' ST and their type of β-lactamases. Clinical outcomes of patients who received cefixime + amoxicillin/clavulanate were also analysed. RESULTS All isolates were cefixime and cefpodoxime resistant. Disparities depending on blaCTX-M variants were observed for cefixime. The addition of amoxicillin/clavulanate restored susceptibility for cefixime and cefpodoxime in 97.2% (MIC50/90 of 0.38/0.75 mg/L) and 55.4% (MIC50/90 of 1/2 mg/L) of isolates, respectively, whatever the ST, the blaCTX-M variants or the association with inhibitor-resistant β-lactamases (34.2%). All isolates were susceptible to mecillinam + amoxicillin/clavulanate with MIC50/90 of 0.19/0.25 mg/L, respectively. Neither therapeutic failure nor any subsequent positive control urine culture were reported for patients who received cefixime + amoxicillin/clavulanate as an oral relay therapy (n = 54). CONCLUSIONS Despite the frequent association of ESBL genes with inhibitor-resistant β-lactamases, the cefixime + amoxicillin/clavulanate MICs remain low. The in vivo efficacy of this combination was satisfying even when first-line treatment was ineffective. Considering the MIC distributions and pharmacokinetic parameters, mecillinam + amoxicillin/clavulanate should also be an alternative to consider when treating FUTIs in children.
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Affiliation(s)
- André Birgy
- Université de Paris, IAME, INSERM, F-75018 Paris, France
- AP-HP, Hôpital Robert Debré, Service de Microbiologie, F-75019 Paris, France
| | - Fouad Madhi
- Service de Pédiatrie Générale, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, ACTIV France
| | - Camille Jung
- Service de Pédiatrie Générale, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
- Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
| | - Corinne Levy
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France
- Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
- Association Clinique Thérapeutique Infantile du Val de Marne (ACTIV), Saint Maur des Fossés, France
| | - Aurélie Cointe
- Université de Paris, IAME, INSERM, F-75018 Paris, France
- AP-HP, Hôpital Robert Debré, Service de Microbiologie, F-75019 Paris, France
| | - Philippe Bidet
- Université de Paris, IAME, INSERM, F-75018 Paris, France
- AP-HP, Hôpital Robert Debré, Service de Microbiologie, F-75019 Paris, France
| | | | - Stéphane Bechet
- Association Clinique Thérapeutique Infantile du Val de Marne (ACTIV), Saint Maur des Fossés, France
| | - Elsa Sobral
- Association Clinique Thérapeutique Infantile du Val de Marne (ACTIV), Saint Maur des Fossés, France
| | - Hoang Vuthien
- AP-HP, HU-Est Parisien site Trousseau, Service de Bactériologie, F-75012 Paris, France
| | - Agnès Ferroni
- AP-HP, Hopital Necker, Service de Microbiologie, University Paris Descartes, Paris, France
| | - Saïd Aberrane
- Microbiology Laboratory, Créteil Hospital, 94000 Créteil, France
| | - Gaëlle Cuzon
- Bacteriology-Hygiene Unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Université Paris Sud, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
- Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur, APHP-Université Paris Sud, Paris, France
| | - Laetitia Beraud
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Vincent Gajdos
- Service de Pédiatrie, Antoine Béclère University Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France
- Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Elise Launay
- Service de Pédiatrie Générale et Infectiologie Pédiatrique, Hôpital Femme-Enfant-Adolescent, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Didier Pinquier
- Unité de Pneumologie et Allergologie pédiatriques & CRCM mixte, Pédiatrie Médicale, CHU Charles Nicolle, Rouen, France
| | - Hervé Haas
- Hôpitaux pédiatriques CHU Lenval, Nice, France
| | - Marie Desmarest
- Service d'Accueil des Urgences Pédiatriques, AP-HP, Hôpital Robert Debré, Paris, France
| | - Marie-Aliette Dommergues
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France
- Service de pédiatrie, centre hospitalier de Versailles, Le Chesnay, France
| | - Robert Cohen
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, ACTIV France
- Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
- Association Clinique Thérapeutique Infantile du Val de Marne (ACTIV), Saint Maur des Fossés, France
- Unité Court Séjour, Petits Nourrisson, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil France
| | - Stéphane Bonacorsi
- Université de Paris, IAME, INSERM, F-75018 Paris, France
- AP-HP, Hôpital Robert Debré, Service de Microbiologie, F-75019 Paris, France
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Felice Tong YY, Karunaratne S, Youlden D, Gupta S. The Impact of Room-Sharing on Length of Stay After Total Hip or Knee Arthroplasty: A Retrospective Study. Arthroplast Today 2021; 8:289-294.e2. [PMID: 34095406 PMCID: PMC8167312 DOI: 10.1016/j.artd.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/24/2022] Open
Abstract
Background Prolonged length of stay (LOS) after elective total hip (THA) and knee (TKA) arthroplasty is often associated with worse patient outcomes. Social support through room-sharing has been identified as a factor that may reduce LOS in a hospital setting, but has not yet been examined in an orthopedic population. The aim of this study was to evaluate the effect of single- vs shared-room accommodation after elective TKA or THA on hospital LOS. Method A retrospective study was conducted using data from hospital medical records at our institution. Patients receiving unilateral, elective THA or TKA over a 2-year period were eligible. Patients were allocated to either a single room or four-bed shared room. The primary outcome was LOS; secondary outcomes included complications, discharge destination, and return to operating theater. Results One hundred eighty-five patients (70 THA, 115 TKA; mean age 65.74 ± 10.38, 59% female) were included, of whom 82 were allocated to a single room and 103 to a shared room. There was no statistically significant difference in LOS between the 2 groups (5.18 ± 2.21 days [single] vs 4.88 ± 2.12 days [shared]; mean difference −0.29 [95% CI −0.92-0.33], P = .36). Analysis modeling for multiple confounders found no association among room allocation, LOS, and discharge destination. However, more patients in single rooms required discharge to rehabilitation (27% vs 9%) and return to theater (7% vs 1%). Conclusions Room allocation did not correlate with a difference in LOS in patients undergoing elective THA or TKA.
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Affiliation(s)
- Yui Yee Felice Tong
- Sydney Medical Program, University of Sydney, Camperdown, New South Wales, Australia.,Department of Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Department of Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel Youlden
- Department of Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sanjeev Gupta
- Department of Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Warren M, Knecht J, Verheijde J, Tompkins J. Association of AM-PAC "6-Clicks" Basic Mobility and Daily Activity Scores With Discharge Destination. Phys Ther 2021; 101:6124779. [PMID: 33517463 DOI: 10.1093/ptj/pzab043] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/25/2020] [Accepted: 11/29/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective was to use the Activity Measure for Post-Acute Care "6-Clicks" scores at initial physical therapist and/or occupational therapist evaluation to assess (1) predictive ability for community versus institutional discharge, and (2) association with discharge destination (home/self-care [HOME], home health [HHA], skilled nursing facility [SNF], and inpatient rehabilitation facility [IRF]). METHODS In this retrospective cohort study, initial "6-Clicks" Basic Mobility and/or Daily Activity t scores and discharge destination were obtained from electronic health records of 17,546 inpatient admissions receiving physical therapy/occupational therapy at an academic hospital between October 1, 2015 and August 31, 2018. For objective (1), postacute discharge destination was dichotomized to community (HOME and HHA) and institution (SNF and IRF). Receiver operator characteristic curves determined the most predictive Basic Mobility and Daily Activity scores for discharge destination. For objective (2), adjusted odds ratios (OR) from multinomial logistic regression assessed association between discharge destination (HOME, HHA, SNF, IRF) and cut-point scores for Basic Mobility (≤40.78 vs >40.78) and Daily Activity (≤40.22 vs >40.22), accounting for patient and clinical characteristics. RESULTS Area under the curve for Basic Mobility was 0.80 (95% CI = 0.80-0.81) and Daily Activity was 0.81 (95% CI = 0.80-0.82). The best cut-point for Basic Mobility was 40.78 (raw score = 16; sensitivity = 0.71 and specificity = 0.74) and for Daily Activity was 40.22 (raw score = 19; sensitivity = 0.68 and specificity = 0.79). Basic Mobility and Daily Activity were significantly associated with discharge destination, with those above the cut-point resulting in increased odds of discharge HOME. The Basic Mobility scores ≤40.78 had higher odds of discharge to HHA (OR = 1.7 [95% CI = 1.5-1.9]), SNF (OR = 7.8 [95% CI = 6.8-8.9]), and IRF (OR = 7.5 [95% CI = 6.3-9.1]), and the Daily Activity scores ≤40.22 had higher odds of discharge to HHA (OR = 1.8 [95% CI = 1.7-2.0]), SNF (OR = 8.9 [95% CI = 7.9-10.0]), and IRF (OR = 11.4 [95% CI = 9.7-13.5]). CONCLUSION 6-Clicks at physical therapist/occupational therapist initial evaluation demonstrated good prediction for discharge decisions. Higher scores were associated with discharge to HOME; lower scores reflected discharge to settings with increased support levels. IMPACT Initial Basic Mobility and Daily Activity scores are valuable clinical tools in the determination of discharge destination.
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Affiliation(s)
- Meghan Warren
- Patient Centered Outcomes Research Institute, Washington, DC, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
| | - Jeff Knecht
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
| | - Joseph Verheijde
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
| | - James Tompkins
- Department of Rehabilitation Services, Bayhealth, Dover, Delaware, USA
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Probasco WV, Lee D, Lee R, Bell J, Labaran L, Stein BE. Differences in 30-day complications associated with total ankle arthroplasty and ankle arthrodesis: A matched cohort study. Foot (Edinb) 2021; 46:101750. [PMID: 33278810 DOI: 10.1016/j.foot.2020.101750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 10/13/2020] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objective of this study was to identify whether total ankle arthroplasty (TAA) was associated with greater risk for 30-day complications and/or greater financial burden in comparison to ankle arthrodesis (AA). METHODS The PearlDiver Patient Records Database was queried to identify all patients who underwent an arthroscopic/open AA or TAA from 2006 to 2013. The two cohorts were then matched in a 1:1 manner to control for comorbidities and demographics. Postoperative complications were compared between the two cohorts, in addition to the associated costs with respect to each procedure. RESULTS No significant differences in risk for postoperative complications were noted between the two procedures with the numbers available. Significant differences were demonstrated in total length of hospital stay (LOS), with a mean of 2.13 days for the TAA cohort and 2.42 days for the AA cohort (p < 0.001). Higher mean total hospital costs were noted for TAA (x¯ = $62,416.62) compared to AA (x¯ = $37,737.43, p < 0.001); however, TAA was associated with a higher mean total reimbursement (x¯ = $12,254.43) than AA (x¯ = $7915.72, p < 0.001). CONCLUSION With no notable differences in 30-day complication rates, TAA remains a viable alternative to AA in the appropriately selected patient and provides the ability to preserve tibiotalar motion resulting in superior functional scores. Additionally, TAA demonstrated higher total costs to implant, but also greater reimbursement, in line with the recent literature suggesting TAA to be a cost-effective alternative to AA. LEVEL OF EVIDENCE III Retrospective study.
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Affiliation(s)
- William V Probasco
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, United States.
| | - Danny Lee
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, United States.
| | - Ryan Lee
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, United States
| | - Joshua Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, United States
| | - Lawal Labaran
- Department of Orthopaedic Surgery, University of Illinois School of Medicine, Chicago, IL, United States
| | - Benjamin E Stein
- Department of Orthopaedic Surgery, Johns Hopkins Sibley Memorial Hospital, Washington, DC, United States
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Alenezi AO, Tai E, Jaberi A, Brown A, Mafeld S, Roche-Nagle G. Adverse Outcomes after Advanced EVAR in Patients with Sarcopaenia. Cardiovasc Intervent Radiol 2021; 44:376-383. [PMID: 33388870 DOI: 10.1007/s00270-020-02721-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/19/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine whether low total psoas muscle area (tPMA), as a surrogate for sarcopaenia, is a predictor of adverse outcomes in patients undergoing advanced EVAR. MATERIALS AND METHODS A retrospective review of medical records was performed for 257 patients who underwent advanced EVAR (fenestrated or branched technique) in a single tertiary centre from 1 January 2008 to 1 September 2019. The study cohort was divided into tertiles based on tPMA measurement performed independently by two observers from a peri-procedural CT scan at the level of mid-L3 vertebral body. The low tertile was considered sarcopaenic. Logistic regression analysis was used to assess the association of tPMA with 30-day mortality and post-procedural complications. Univariable analysis and adjusted multivariable Cox regression were used to assess the association of tPMA with all-cause mortality. RESULTS A total of 257 patients comprised 193 males and 64 females with the mean age of 75.4 years (± 6.8) were included. Adjusted multivariable Cox regression revealed an 8% reduction in all-cause mortality for every 1 cm2 increase in tPMA, P < 0.05. TPMA was associated with 30-day mortality (OR 0.85, 95% CI 0.75-0.96, P < 0.05) and spinal cord ischaemia (SCI) (OR 0.89, 95% CI 0.82-0.97, P < 0.05). For remaining post-procedural complications, tPMA was not a useful predictive tool. TPMA correlated negatively with hospital stay length (rs-0.26, P < 0.001). Patients with lower tPMA were more likely to be discharged to a rehabilitation center (OR 0.93, 95% CI 0.87-0.98 , P < 0.05). CONCLUSION Measurement of tPMA can be a useful predictive tool for adverse outcomes after advanced EVAR. LEVEL OF EVIDENCE Level 3, Retrospective cohort study.
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Affiliation(s)
- Abdullah O Alenezi
- Joint Department of Medical Imaging, University Health Network - Toronto General Hospital, Toronto, ON, Canada.
| | - Elizabeth Tai
- Joint Department of Medical Imaging, University Health Network - Toronto General Hospital, Toronto, ON, Canada
| | - Arash Jaberi
- Joint Department of Medical Imaging, University Health Network - Toronto General Hospital, Toronto, ON, Canada
| | | | - Sebastian Mafeld
- Joint Department of Medical Imaging, University Health Network - Toronto General Hospital, Toronto, ON, Canada
| | - Graham Roche-Nagle
- Department of Vascular Surgery, University Health Network - Toronto General Hospital, Toronto, ON, Canada
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Khor WP, Olaoye O, D’Arcy N, Krockow EM, Elshenawy RA, Rutter V, Ashiru-Oredope D. The Need for Ongoing Antimicrobial Stewardship during the COVID-19 Pandemic and Actionable Recommendations. Antibiotics (Basel) 2020; 9:antibiotics9120904. [PMID: 33327430 PMCID: PMC7764884 DOI: 10.3390/antibiotics9120904] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic, which has significant impact on global health care delivery, occurs amid the ongoing global health crisis of antimicrobial resistance. Early data demonstrated that bacterial and fungal co-infection with COVID-19 remain low and indiscriminate use of antimicrobials during the pandemic may worsen antimicrobial resistance It is, therefore, essential to maintain the ongoing effort of antimicrobial stewardship activities in all sectors globally.
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Affiliation(s)
- Wei Ping Khor
- Commonwealth Pharmacists Association, London E1W 1AW, UK; (W.P.K.); (O.O.); (N.D.); (V.R.)
| | - Omotayo Olaoye
- Commonwealth Pharmacists Association, London E1W 1AW, UK; (W.P.K.); (O.O.); (N.D.); (V.R.)
| | - Nikki D’Arcy
- Commonwealth Pharmacists Association, London E1W 1AW, UK; (W.P.K.); (O.O.); (N.D.); (V.R.)
| | - Eva M. Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7RH, UK;
| | | | - Victoria Rutter
- Commonwealth Pharmacists Association, London E1W 1AW, UK; (W.P.K.); (O.O.); (N.D.); (V.R.)
| | - Diane Ashiru-Oredope
- Commonwealth Pharmacists Association, London E1W 1AW, UK; (W.P.K.); (O.O.); (N.D.); (V.R.)
- Correspondence:
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Chndan MN, Khakholia M, Bhuyan K. Enhanced Recovery after Surgery (ERAS) Versus Standard Care in Patients Undergoing Emergency Surgery for Perforated Peptic Ulcer. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02195-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Santos CAD, Rosa CDOB, Franceschini SDCC, Firmino HH, Ribeiro AQ. Nutrition Risk Assessed by STRONGkids Predicts Longer Hospital Stay in a Pediatric Cohort: A Survival Analysis. Nutr Clin Pract 2020; 36:233-240. [PMID: 33175423 DOI: 10.1002/ncp.10589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/20/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND We evaluated the impact of Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) classification in time to discharge and verify whether the nutrition risk assessed by this method is an independent predictor of hospital length of stay (LOS) in pediatric inpatients. METHODS A cohort study was conducted in a Brazilian hospital from February 2014 to July 2018. The outcome in the survivor analysis was hospital discharge. Kaplan-Meier curves were used to estimate the cumulative survival time according to STRONGkids categories. Multivariable Cox proportional hazard models were fitted, and the adjusted hazard ratio (aHR), with respective 95% CI, was used to measure the strength of association. The discriminatory ability of STRONGkids was verified by a receiver operating characteristic curve RESULTS: A total 641 patients were included in the study: 54.9% males, median age of 2.8 years. The frequencies of low, moderate, and high nutrition risk were 15.6%, 63.7%, and 20.7%, respectively. The mean LOS was 5.9 days. Survival curves differed significantly according to nutrition-risk categories. Patients classified as high risk had a 52% less chance of hospital discharge when compared with low-risk patients (aHR: 0.48; 95% CI, 0.35-0.65). STRONGkids score ≥ 3 showed the best discriminatory power to identify LOS. From this score, there was a significant increase in the days of hospitalization. CONCLUSION The nutrition risk assessed by STRONGkids independently predicts LOS in pediatric patients. For this outcome, patients with 3 points (moderate risk) should be treated with the same priority as those with high risk.
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Affiliation(s)
| | | | | | - Heloísa Helena Firmino
- Multidisciplinary Nutritional Therapy Team, São Sebastião Hospital, Viçosa, Minas Gerais, Brazil
| | - Andréia Queiroz Ribeiro
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
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Pradelli L, Klek S, Mayer K, Omar Alsaleh AJ, Rosenthal MD, Heller AR, Muscaritoli M. Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:634. [PMID: 33143750 PMCID: PMC7607851 DOI: 10.1186/s13054-020-03356-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/23/2020] [Indexed: 12/26/2022]
Abstract
Background Omega-3 (ω-3) fatty acid (FA)-containing parenteral nutrition (PN) is associated with significant improvements in patient outcomes compared with standard PN regimens without ω-3 FA lipid emulsions. Here, we evaluate the impact of ω-3 FA-containing PN versus standard PN on clinical outcomes and costs in adult intensive care unit (ICU) patients using a meta-analysis and subsequent cost-effectiveness analysis from the perspective of a hospital operating in five European countries (France, Germany, Italy, Spain, UK) and the US.
Methods We present a pharmacoeconomic simulation based on a systematic literature review with meta-analysis. Clinical outcomes and costs comparing ω-3 FA-containing PN with standard PN were evaluated in adult ICU patients eligible to receive PN covering at least 70% of their total energy requirements and in the subgroup of critically ill ICU patients (mean ICU stay > 48 h). The meta-analysis with the co-primary outcomes of infection rate and mortality rate was based on randomized controlled trial data retrieved via a systematic literature review; resulting efficacy data were subsequently employed in country-specific cost-effectiveness analyses. Results In adult ICU patients, ω-3 FA-containing PN versus standard PN was associated with significant reductions in the relative risk (RR) of infection (RR 0.62; 95% CI 0.45, 0.86; p = 0.004), hospital length of stay (HLOS) (− 3.05 days; 95% CI − 5.03, − 1.07; p = 0.003) and ICU length of stay (LOS) (− 1.89 days; 95% CI − 3.33, − 0.45; p = 0.01). In critically ill ICU patients, ω-3 FA-containing PN was associated with similar reductions in infection rates (RR 0.65; 95% CI 0.46, 0.94; p = 0.02), HLOS (− 3.98 days; 95% CI − 6.90, − 1.06; p = 0.008) and ICU LOS (− 2.14 days; 95% CI − 3.89, − 0.40; p = 0.02). Overall hospital episode costs were reduced in all six countries using ω-3 FA-containing PN compared to standard PN, ranging from €-3156 ± 1404 in Spain to €-9586 ± 4157 in the US. Conclusion These analyses demonstrate that ω-3 FA-containing PN is associated with statistically and clinically significant improvement in patient outcomes. Its use is also predicted to yield cost savings compared to standard PN, rendering ω-3 FA-containing PN an attractive cost-saving alternative across different health care systems.
Study registration PROSPERO CRD42019129311.
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Affiliation(s)
- Lorenzo Pradelli
- AdRes-Health Economics and Outcome Research, Via Vittorio Alfieri 17, 10121, Turin, Italy.
| | - Stanislaw Klek
- Department of General and Oncology Surgery With Intestinal Failure Unit, Stanley Dudrick's Memorial Hospital, Tyniecka 15, 32-050, Skawina, Poland
| | - Konstantin Mayer
- Medical Clinic 4, Pneumology and Sleep Medicine, ViDia Hospitals Karlsruhe, Südendstr. 32, 76137, Karlsruhe, Germany
| | | | - Martin D Rosenthal
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610-0019, USA
| | - Axel R Heller
- Department of Anesthesiology and Intensive Care Medicine, University of Augsburg, Universitätsstraße 2, 86159, Augsburg, Germany
| | - Maurizio Muscaritoli
- Department of Clinical Medicine, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, RM, Italy
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Starring H, Waddell WH, Steward W, Schexnayder S, McKay J, Leonardi C, Bronstone A, Dasa V. Total Knee Arthroplasty Outcomes in Patients with Medicare, Medicare Advantage, and Commercial Insurance. J Knee Surg 2020; 33:919-926. [PMID: 31121632 DOI: 10.1055/s-0039-1688785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As more commercial insurance companies adopt a bundled reimbursement model, similar to the Comprehensive Care for Joint Replacement (CJR) algorithm for Medicare beneficiaries, accurate risk adjustment of patient-reported outcomes (PROs) is critical to ensure success. With this movement toward bundled reimbursement, it is unknown if a formula adjusting for similar risks in the Medicare population could be applied to PROs in commercially insured and Medicare Advantage populations undergoing total knee arthroplasty (TKA). This study was performed to compare PROs after TKA in these insurance groups after adjusting for proposed risks. Demographics and clinical data were abstracted from medical records of 302 patients who underwent TKA performed by a single surgeon at a university-based orthopaedic practice during 2013 to 2017. Differences in PROs between commercially insured, Medicare Advantage, and Medicare patients during the 6 months following surgery were evaluated while controlling for demographics, clinical data, and baseline PRO scores. Medicare and Medicare Advantage patients were older (p < 0.001) and had more comorbidities (p = 0.001) than commercial patients. During the first 3 months following TKA, patients in all three groups experienced similar rates of recovery. At 6 months after surgery, outcomes began to diverge by insurance group. Medicare patients reported significantly less ability to perform activities of daily living (78.6 vs. 63.2; p = 0.001), worse physical function (39.6 vs. 44.9; p = 0.003), and more pain interference (57.9 vs. 52.4; p = 0.018) at day 180 than commercially insured patients. There were no statistically significant differences between Medicare Advantage patients and either commercially insured or Medicare patients. Therefore, commercial insurance companies that intend to apply a risk-adjusted equation similar to the CJR algorithm to commercial populations should be cautioned since the postoperative outcomes in this investigation differed after adjusting for the same risk factors that have been proposed for inclusion in the CJR algorithm. Nonetheless, further studies should be performed to ensure that companies participating in bundled reimbursement models have a positive influence on comprehensive health care for patients and providers. This is a level III, retrospective prognostic study.
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Affiliation(s)
- Hunter Starring
- Department of Medicine, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - William H Waddell
- Department of Medicine, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - William Steward
- Department of Medicine, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Stuart Schexnayder
- Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jack McKay
- Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Claudia Leonardi
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Amy Bronstone
- Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Vinod Dasa
- Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Pradelli L, Klek S, Mayer K, Omar Alsaleh AJ, Rosenthal MD, Heller AR, Muscaritoli M. Cost-Effectiveness of Parenteral Nutrition Containing ω-3 Fatty Acids in Hospitalized Adult Patients From 5 European Countries and the US. JPEN J Parenter Enteral Nutr 2020; 45:999-1008. [PMID: 32713007 PMCID: PMC8451886 DOI: 10.1002/jpen.1972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 01/17/2023]
Abstract
Background ω‐3 Fatty acid (FA)–containing parenteral nutrition (PN) is associated with improvements in patient outcomes and with reductions in hospital length of stay (HLOS) vs standard PN regimens (containing non–ω‐3 FA lipid emulsions). We present a cost‐effectiveness analysis of ω‐3 FA–containing PN vs standard PN in 5 European countries (France, Germany, Italy, Spain, UK) and the US. Methods This pharmacoeconomic model was based on estimates of ω‐3 efficacy reported in a recent meta‐analysis and data from country‐specific sources. It utilized a probabilistic discrete event simulation model to compare ω‐3 FA–containing PN with standard PN in a population of critically ill and general ward patients. The influence of model parameters was evaluated using probabilistic and deterministic sensitivity analyses. Results Overall costs were reduced with ω‐3 FA–containing PN in all 6 countries compared with standard PN, ranging from €1741 (±€1284) in Italy to €5576 (±€4193) in the US. Expenses for infections and HLOS were lower in all countries for ω‐3 FA–containing PN vs standard PN, with the largest cost differences for both in the US (infection: €825 ± €4001; HLOS: €4879 ± €1208) and the smallest savings in the UK for infections and in Spain for HLOS (€63 ± €426 and €1636 ± €372, respectively). Conclusion This cost‐effectiveness analysis in 6 countries demonstrates that the superior clinical efficacy of ω‐3 FA–containing PN translates into significant decreases in mean treatment cost, rendering it an attractive cost‐saving alternative to standard PN across different healthcare systems.
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Affiliation(s)
| | - Stanislaw Klek
- Department of General and Oncology Surgery with Intestinal Failure Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Konstantin Mayer
- ViDia Hospitals, Department of Pulmonary and Sleep Medicine, Karlsruhe, Germany
| | | | - Martin D Rosenthal
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Axel R Heller
- Department of Anesthesiology and Intensive Care Medicine, University of Augsburg, Augsburg, Germany
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Javanbakht M, Trevor M, Rezaei Hemami M, Rahimi K, Branagan-Harris M, Degener F, Adam D, Preissing F, Scheier J, Cook SF, Mortensen E. Ticagrelor Removal by CytoSorb ® in Patients Requiring Emergent or Urgent Cardiac Surgery: A UK-Based Cost-Utility Analysis. PHARMACOECONOMICS - OPEN 2020; 4:307-319. [PMID: 31620999 PMCID: PMC7248150 DOI: 10.1007/s41669-019-00183-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Acute coronary syndrome patients receiving dual antiplatelet therapy who need emergent or urgent cardiac surgery are at high risk of major bleeding, which can impair postoperative outcomes. CytoSorb®, a blood purification technology based on adsorbent polymer, has been demonstrated to remove ticagrelor from blood during on-pump cardiac surgery. OBJECTIVE The aim of this study was to evaluate the cost utility of intraoperative removal of ticagrelor using CytoSorb versus usual care among patients requiring emergent or urgent cardiac surgery in the UK. METHODS A de novo decision analytic model, based on current treatment pathways, was developed to estimate the short- and long-term costs and outcomes. Results from randomised clinical trials and national standard sources such as National Health Service (NHS) reference costs were used to inform the model. Costs were estimated from the NHS and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSAs) explored the uncertainty surrounding the input parameters. RESULTS In emergent cardiac surgery, intraoperative removal of ticagrelor using CytoSorb was less costly (£12,933 vs. £16,874) and more effective (0.06201vs. 0.06091 quality-adjusted life-years) than cardiac surgery without physiologic clearance of ticagrelor over a 30-day time horizon. For urgent cardiac surgery, the use of CytoSorb was less costly than any of the three comparators-delaying surgery for natural washout without adjunctive therapy, adjunctive therapy with short-acting antiplatelet agents, or adjunctive therapy with low-molecular-weight heparin. Results from the PSAs showed that CytoSorb has a high probability of being cost saving (99% in emergent cardiac surgery and 53-77% in urgent cardiac surgery, depending on the comparators). Cost savings derive from fewer transfusions of blood products and re-thoracotomies, and shorter stay in the hospital/intensive care unit. CONCLUSIONS The implementation of CytoSorb as an intraoperative intervention for patients receiving ticagrelor undergoing emergent or urgent cardiac surgery is a cost-saving strategy, yielding improvement in perioperative and postoperative outcomes and decreased health resource use.
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Affiliation(s)
- Mehdi Javanbakht
- Optimax Access UK Ltd, Market Access Consultancy, 20 Forth Banks Tower, Newcastle upon Tyne, NE1 3PN, UK.
- Device Access UK Ltd, Market Access Consultancy, University of Southampton Science Park, Chilworth Hampshire, UK.
| | | | | | - Kazem Rahimi
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Michael Branagan-Harris
- Device Access UK Ltd, Market Access Consultancy, University of Southampton Science Park, Chilworth Hampshire, UK
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Santos CAD, Rosa CDOB, Franceschini SDCC, Firmino HH, Ribeiro AQ. Usefulness of the StrongKids Screening Tool in Detecting Anemia and Inflammation in Hospitalized Pediatric Patients. J Am Coll Nutr 2020; 40:155-163. [PMID: 32281910 DOI: 10.1080/07315724.2020.1750072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To assess whether the nutritional risk classified by StrongKids is associated with anemia and inflammation (total leukocytes and C-reactive protein (CRP)), as well as to compare the ability of StrongKids with anthropometry in identifying these changes in hospitalized pediatric patients.Methods: Cross-sectional study with patients admitted to the pediatric ward of a public hospital in Brazil, from 2014 to 2018. The experimental protocol included: nutritional risk screening by StrongKids; weight and height measurements; and biochemical tests (complete blood count and C-reactive protein - CRP). Sensitivity, specificity, positive predictive value and negative predictive value were calculated to assess the ability of StrongKids and anthropometry to identify patients with the biochemical changes.Results: The study included 482 patients (54.2% male), with a median age of 2.7 years. The frequency of nutritional risk (medium or high) was 85.9% and the prevalence of malnutrition (acute and/or chronic) was 20.2%. Overall, of the patients evaluated, 40.2% had anemia, 28.2% leukocytosis, and 78.0% high CRP. Children and adolescents classified as at nutritional risk (moderate/high) had lower levels of hemoglobin and higher levels of CRP and total leukocytes, as well as a higher frequency of leukocytosis, high CRP and the three alterations combined when compared with individuals at low risk. No association was found between anthropometric variables and biochemical alterations. The sensitivity of nutritional screening was high to detect all biochemical alterations and was superior to the anthropometric assessment.Conclusion: StrongKids was associated with alterations in biochemical parameters with a better performance than anthropometry.
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Affiliation(s)
| | | | | | - Heloísa Helena Firmino
- Nutrition Support Team, Department of Dietetics, São Sebastião Hospital, Viçosa, Minas Gerais, Brazil
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Are Invasive Procedures and a Longer Hospital Stay Increasing the Risk of Healthcare-Associated Infections among the Admitted Patients at Hiwot Fana Specialized University Hospital, Eastern Ethiopia? Adv Prev Med 2020; 2020:6875463. [PMID: 32292604 PMCID: PMC7150733 DOI: 10.1155/2020/6875463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 11/17/2019] [Accepted: 01/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background Healthcare-associated infection is a major public health problem, in terms of mortality, morbidity, and costs. Majorities of the cause of these infections were preventable. Understanding the potential risk factors is important to reduce the impact of these avoidable infections. The study was aimed to identify factors associated with healthcare-associated infections among patients admitted at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. Methods A cross-sectional study was carried out among 433 patients over a period of five months at Hiwot Fana Specialized University Hospital. Sociodemographic and clinical data were obtained from a patient admitted for 48 hours and above in the four wards (surgical, medical, obstetrics/gynecology, and pediatrics) using a structured questionnaire. A multivariate logistic regression model was applied to identify predictors of healthcare-associated infections. A p value <0.05 was considered statistically significant. Results Fifty-four (13.7%) patients had a history of a previous admission. The median length of hospital stay was 6.1 days. Forty-six (11.7%) participants reported comorbid conditions. Ninety-six (24.4%) participants underwent surgical procedures. The overall prevalence of healthcare-associated infection was 29 (7.4%, 95% CI: 5.2–10.6). Cigarette smoking (AOR: 5.18, 95% CI: 2.15–20.47), staying in the hospital for more than 4 days (AOR: 4.29, 95% CI: 2.31–6.15), and undergoing invasive procedures (AOR: 3.58, 95% CI: 1.11–7.52) increase the odds of acquiring healthcare-associated infections. Conclusion The cumulative prevalence of healthcare-associated infections in this study was comparable with similar studies conducted in developing countries. Cigarette smoking, staying in the hospital for more than 4 days, and undergoing invasive procedures increase the odds of healthcare-associated infections. These factors should be considered in the infection prevention and control program of the hospital.
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Merrigan SD, Johnson-Davis KL. A 6 Second Analytical Method for Quantitation of Tacrolimus in Whole Blood by Use of Laser Diode Thermal Desorption Tandem Mass Spectrometry. J Appl Lab Med 2019; 3:965-973. [PMID: 31639688 DOI: 10.1373/jalm.2018.027243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/19/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Therapeutic drug monitoring of immunosuppressive drugs is imperative for organ transplant recipients. High-performance LC-MS/MS is considered gold standard; however, immunoassays provide rapid turnaround time. New technology was developed to reduce mass spectrometry analytical run-time. The laser diode thermal desorption source coupled with tandem mass spectrometry (LDTD-MS/MS) eliminates chromatographic separation to increase analytical throughput. METHODS A rapid, 6 second, LDTD-MS/MS analytical method was developed for the quantification tacrolimus in whole blood. Whole blood samples were lysed, followed by protein precipitation and solid-phase extraction. Extracted samples with desorption solution were spotted onto a LazWell plate then dried and loaded into the LDTD source for analysis with an AB SCIEX 5500 mass spectrometer in positive multiple reaction monitoring mode. The LDTD laser profile ramps from 0% to 65% of full power over 3 s and is held at 65% for 1 s before returning to initial conditions for 2 s. RESULTS Data presented include tacrolimus by LDTD-MS/MS comparison to LC-MS/MS, sensitivity, imprecision, interference, linearity, and stability. Method comparison between LDTD-MS/MS and a validated in-house LC-MS/MS assay yielded the following: (LDTD-MS/MS) = 1.119 (LC-MS/MS) + 0.23 ng/mL, Sy/x = 1.26, r = 0.9871 (n = 122). The limit of quantification by LDTD-MS/MS for tacrolimus was <0.3 ng/mL and total imprecision was <10%. CONCLUSIONS Laser diode thermal desorption tandem mass spectrometry technology can provide rapid turnaround time to result for tacrolimus. The analytical time for LDTD-MS/MS was 6 s compared to 135 s by LC-MS/MS, a >95% decrease in analytical time.
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Affiliation(s)
- Stephen D Merrigan
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Kamisha L Johnson-Davis
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; .,Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT
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Jablonka EM, Lamelas AM, Kanchwala SK, Rhemtulla I, Smith ML. A Simplified Cost-Utility Analysis of Inpatient Flap Monitoring after Microsurgical Breast Reconstruction and Implications for Hospital Length of Stay. Plast Reconstr Surg 2019; 144:540e-549e. [PMID: 31568278 DOI: 10.1097/prs.0000000000006010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The number of free flap take-backs and successful salvages following microsurgical breast reconstruction decreases as time from surgery increases. As a result, the cost of extended inpatient monitoring to achieve a successful flap salvage rises rapidly with each postoperative day. This study introduces a simplified cost-utility model of inpatient flap monitoring and identifies when cost-utility exceeds the thresholds established for other medical treatments. METHODS A retrospective review of a prospectively maintained database was performed of patients who underwent microsurgical breast reconstruction to identify flap take-back and salvage rates by postoperative day. The number of patients and flaps that needed to be kept on an inpatient basis each day for monitoring to salvage a single failing flap was determined. Quality-of-life measures and incremental cost-effectiveness ratios for inpatient flap monitoring following microsurgical breast reconstruction were calculated and plotted against a $100,000/quality-adjusted life-year threshold. RESULTS A total of 1813 patients (2847 flaps) were included. Overall flap take-back and salvage rates were 2.4 percent and 52.3 percent, respectively. Of the flaps taken back, the daily take-back and salvage rates were 56.8 and 60.0 percent (postoperative day 0 to 1), 13.6 and 83.3 percent (postoperative day 2), 11.4 and 40.0 percent (postoperative day 3), 9.1 and 25.0 percent (postoperative day 4), and 9.1 and 0.0 percent (>postoperative day 4), respectively. To salvage a single failing flap each day, the number of flaps that needed to be monitored were 121 (postoperative day 0 to 1), 363 (postoperative day 2), 907 (postoperative day 3), 1813 (postoperative day 4), and innumerable for days beyond postoperative day 4. The incremental cost-effectiveness ratio of inpatient flap monitoring begins to exceed a willingness-to-pay threshold of $100,000/quality-adjusted life-year by postoperative day 2. CONCLUSION The health care cost associated with inpatient flap monitoring following microsurgical breast reconstruction begins to rise rapidly after postoperative day 2.
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Affiliation(s)
- Eric M Jablonka
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pennsylvania; the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwell Health System
| | - Andreas M Lamelas
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pennsylvania; the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwell Health System
| | - Suhail K Kanchwala
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pennsylvania; the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwell Health System
| | - Irfan Rhemtulla
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pennsylvania; the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwell Health System
| | - Mark L Smith
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pennsylvania; the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwell Health System
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Young NA, Brown MP, Peng J, Kline D, Reider C, Deogaonkar M. Predicting extended hospital stay after deep brain stimulation surgery in Parkinson's patients. J Clin Neurosci 2019; 69:241-244. [PMID: 31431404 DOI: 10.1016/j.jocn.2019.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The goal of deep brain stimulation (DBS) is to achieve maximal benefit for the patient while minimizing the likelihood of adverse effects. Currently, no standardized criteria exist that predicts extended hospital stay in DBS patients, although careful patient selection is recognized as a very important step for successful DBS therapy. OBJECTIVES AND METHODS The objective of this study was to identify eight key factors that predicted extended post-operative hospital stay following DBS lead implantation, in an effort to better identify patients that would require minimal hospital stay, resulting in reduced cost and reduced exposure to hospital- related problems. Univariate logistic regression models were used to examine associations between each factor and patients' post-surgical outcomes. RESULTS Using data collected from 183 patients, we found that 53 patients required a hospital stay longer than two days within one month post-procedure. Those who were 70 years or older and those who had frequent falls were significantly more likely to require extended post-surgical care. Patients that scored three points or higher on our eight-factor assessment scale had a greater likelihood of experiencing an event that would require an extended hospital stay following DBS lead placement, regardless of what three factors were present. CONCLUSIONS Any PD patient who is 70 years or older, incurring frequent falls, or with more than three points on our scale, should be carefully screened and cautioned about likely prolonged recovery and extended post-operative hospital stay.
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Affiliation(s)
- Nicole A Young
- Department of Neuroscience, Center for Neuromodulation, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Matthew P Brown
- Department of Neurological Surgery, Center for Neuromodulation, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Juan Peng
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David Kline
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carson Reider
- Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Milind Deogaonkar
- Department of Neurological Surgery, Center for Neuromodulation, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Ketorolac Use Shortens Hospital Length of Stay After Bariatric Surgery: a Single-Center 5-Year Experience. Obes Surg 2019; 29:2360-2366. [DOI: 10.1007/s11695-018-03636-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Raza A, Sime FB, Cabot PJ, Maqbool F, Roberts JA, Falconer JR. Solid nanoparticles for oral antimicrobial drug delivery: a review. Drug Discov Today 2019; 24:858-866. [PMID: 30654055 DOI: 10.1016/j.drudis.2019.01.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/15/2018] [Accepted: 01/08/2019] [Indexed: 01/11/2023]
Abstract
Most microbial infectious diseases can be treated successfully with the remarkable array of antimicrobials current available; however, antimicrobial resistance, adverse effects, and the high cost of antimicrobials are crucial health challenges worldwide. One of the common efforts in addressing this issue lies in improving the existing antibacterial delivery systems. Solid nanoparticles (SNPs) have been widely used as promising strategies to overcome these challenges. In addition, oral delivery is the most common method of drug administration with high levels of patient acceptance. Formulation into NPs can improve drug stability in the harsh gastrointestinal (GI) tract environment, providing opportunities for targeting specific sites in the GI tract, increasing drug solubility and bioavailability, and providing sustained release in the GI tract. Here, we discuss SNPs for the oral delivery of antimicrobials, including solid lipid NPs (SLNs), polymeric NPs (PNs), mesoporous silica NPs (MSNs) and hybrid NPs (HNs). We also discussed about the role of nanotechnology in IV to oral antimicrobial therapy development as well as challenges, clinical transformation, and limitations of SNPs for oral antimicrobial drug delivery.
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Affiliation(s)
- Aun Raza
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia; Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Fekade Bruck Sime
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia; Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Peter J Cabot
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia
| | - Faheem Maqbool
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia
| | - Jason A Roberts
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia; Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia; Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - James Robert Falconer
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia.
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Rocha HAL, Santos AKLDC, Alcântara ACDC, Lima CSSDC, Rocha SGMO, Cardoso RM, Cremonin JR. Bed management team with Kanban web-based application. Int J Qual Health Care 2018; 30:708-714. [PMID: 29767742 DOI: 10.1093/intqhc/mzy108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 04/29/2018] [Indexed: 01/05/2023] Open
Abstract
Objective To measure the effectiveness of the bed management process that uses a web-based application with Kanban methodology to reduce hospitalization time of hospitalized patients. Design Before-after study was performed. Setting The study was conducted between July 2013 and July 2017, at the Unimed Regional Hospital of Fortaleza, which has 300 beds, of which 60 are in the intensive care unit (ICU). It is accredited by International Society for Quality in Healthcare. Population Patients hospitalized in the referred period. Intervention Bed management with an application that uses color logic to signal at which stage of high flow the patients meet, in which each patient is interpreted as a card of the classical Kanban theory. It has an automatic user signaling system for process movement, and a system for monitoring and analyzing discharge forecasts. Main Outcome Measures Length of hospital stay, number of customer complaints related to bed availability. Results After the intervention, the hospital's overall hospital stay time was reduced from 5.6 days to 4.9 days (P = 0.001). The units with the greatest reduction were the ICUs, with reduction from 6.0 days to 2.0 (P = 0.001). The relative percentage of complaints regarding bed availability in the hospital fell from 27% to 0%. Conclusion We conclude that the use of an electronic tool based on Kanban methodology and accessed via the web by a bed management team is effective in reducing patients' hospital stay time.
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Affiliation(s)
- Hermano Alexandre Lima Rocha
- Community Health Department, Federal University of Ceará, Rua Prof Costa Mendes, 1608, 60.430-130, Fortaleza, Ceará, Brazil.,Public Health, Centro Universitário Unichristus, ISEC. R. João Adolfo Gurgel, 133, Cocó, Fortaleza, CE
| | - Ana Kelly Lima da Cruz Santos
- Research Unit Department, Hospital Regional Unimed Fortaleza. Av. Visconde do Rio Branco, 4000-São João do Tauape, Fortaleza-CE, Fortaleza, Ceará, Brazil
| | - Antônia Celia de Castro Alcântara
- Research Unit Department, Hospital Regional Unimed Fortaleza. Av. Visconde do Rio Branco, 4000-São João do Tauape, Fortaleza-CE, Fortaleza, Ceará, Brazil
| | - Carmen Sulinete Suliano da Costa Lima
- Research Unit Department, Hospital Regional Unimed Fortaleza. Av. Visconde do Rio Branco, 4000-São João do Tauape, Fortaleza-CE, Fortaleza, Ceará, Brazil
| | | | - Roberto Melo Cardoso
- Research Unit Department, Hospital Regional Unimed Fortaleza. Av. Visconde do Rio Branco, 4000-São João do Tauape, Fortaleza-CE, Fortaleza, Ceará, Brazil
| | - Jair Rodrigues Cremonin
- Research Unit Department, Hospital Regional Unimed Fortaleza. Av. Visconde do Rio Branco, 4000-São João do Tauape, Fortaleza-CE, Fortaleza, Ceará, Brazil
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