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Yeates EO, Nahmias J, Gabriel V, Luo X, Ogunnaike B, Ahmed MI, Melikman E, Moon T, Shoultz T, Feeler A, Dudaryk R, Navas-Blanco J, Vasileiou G, Yeh DD, Matsushima K, Forestiere M, Lian T, Dominguez OH, Ricks-Oddie JL, Kuza CM. A Prospective Multicenter Comparison of Trauma and Injury Severity Score, American Society of Anesthesiologists Physical Status, and National Surgical Quality Improvement Program Calculator's Ability to Predict Operative Trauma Outcomes. Anesth Analg 2024; 138:1260-1266. [PMID: 38091502 DOI: 10.1213/ane.0000000000006802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Trauma outcome prediction models have traditionally relied upon patient injury and physiologic data (eg, Trauma and Injury Severity Score [TRISS]) without accounting for comorbidities. We sought to prospectively evaluate the role of the American Society of Anesthesiologists physical status (ASA-PS) score and the National Surgical Quality Improvement Program Surgical Risk-Calculator (NSQIP-SRC), which are measurements of comorbidities, in the prediction of trauma outcomes, hypothesizing that they will improve the predictive ability for mortality, hospital length of stay (LOS), and complications compared to TRISS alone in trauma patients undergoing surgery within 24 hours. METHODS A prospective, observational multicenter study (9/2018-2/2020) of trauma patients ≥18 years undergoing operation within 24 hours of admission was performed. Multiple logistic regression was used to create models predicting mortality utilizing the variables within TRISS, ASA-PS, and NSQIP-SRC, respectively. Linear regression was used to create models predicting LOS and negative binomial regression to create models predicting complications. RESULTS From 4 level I trauma centers, 1213 patients were included. The Brier Score for each model predicting mortality was found to improve accuracy in the following order: 0.0370 for ASA-PS, 0.0355 for NSQIP-SRC, 0.0301 for TRISS, 0.0291 for TRISS+ASA-PS, and 0.0234 for TRISS+NSQIP-SRC. However, when comparing TRISS alone to TRISS+ASA-PS ( P = .082) and TRISS+NSQIP-SRC ( P = .394), there was no significant improvement in mortality prediction. NSQIP-SRC more accurately predicted both LOS and complications compared to TRISS and ASA-PS. CONCLUSIONS TRISS predicts mortality better than ASA-PS and NSQIP-SRC in trauma patients undergoing surgery within 24 hours. The TRISS mortality predictive ability is not improved when combined with ASA-PS or NSQIP-SRC. However, NSQIP-SRC was the most accurate predictor of LOS and complications.
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Affiliation(s)
- Eric Owen Yeates
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
| | - Jeffry Nahmias
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
| | - Viktor Gabriel
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
| | - Xi Luo
- Department of Anesthesiology, University of Texas Southwestern, Dallas, Texas
| | - Babatunde Ogunnaike
- Department of Anesthesiology, University of Texas Southwestern, Dallas, Texas
| | - M Iqbal Ahmed
- Department of Anesthesiology, University of Texas Southwestern, Dallas, Texas
| | - Emily Melikman
- Department of Anesthesiology, University of Texas Southwestern, Dallas, Texas
| | - Tiffany Moon
- Department of Anesthesiology, University of Texas Southwestern, Dallas, Texas
| | - Thomas Shoultz
- Division of Burns, Trauma and Critical Care, Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Anne Feeler
- Division of Burns, Trauma and Critical Care, Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Roman Dudaryk
- Department of Anesthesiology and Pain Management, University of Miami, Miami, Florida
| | - Jose Navas-Blanco
- Department of Anesthesiology and Pain Management, University of Miami, Miami, Florida
| | | | - D Dante Yeh
- Department of Surgery, University of Miami, Miami, Florida
| | - Kazuhide Matsushima
- Department of Surgery, University of Southern California, Los Angeles, California
| | - Matthew Forestiere
- Department of Surgery, University of Southern California, Los Angeles, California
| | - Tiffany Lian
- Department of Surgery, University of Southern California, Los Angeles, California
| | - Oscar Hernandez Dominguez
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
- Department of General Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio
| | - Joni Ladawn Ricks-Oddie
- Center for Statistical Counseling, University of California, Irvine, Irvine, California
- Institute for Clinical and Translation Sciences, Biostatistics, Epidemiology, and Research Design Unit, University of California, Irvine, Irvine, California
| | - Catherine M Kuza
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Kim JY, Lee HY, Lee J, Oh DK, Lee SY, Park MH, Lim CM, Lee SM. Pre-Sepsis Length of Hospital Stay and Mortality: A Nationwide Multicenter Cohort Study. J Korean Med Sci 2024; 39:e87. [PMID: 38469963 PMCID: PMC10927387 DOI: 10.3346/jkms.2024.39.e87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/08/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Prolonged length of hospital stay (LOS) is associated with an increased risk of hospital-acquired conditions and worse outcomes. We conducted a nationwide, multicenter, retrospective cohort study to determine whether prolonged hospitalization before developing sepsis has a negative impact on its prognosis. METHODS We analyzed data from 19 tertiary referral or university-affiliated hospitals between September 2019 and December 2020. Adult patients with confirmed sepsis during hospitalization were included. In-hospital mortality was the primary outcome. The patients were divided into two groups according to their LOS before the diagnosis of sepsis: early- (< 5 days) and late-onset groups (≥ 5 days). Conditional multivariable logistic regression for propensity score matched-pair analysis was employed to assess the association between late-onset sepsis and the primary outcome. RESULTS A total of 1,395 patients were included (median age, 68.0 years; women, 36.3%). The early- and late-onset sepsis groups comprised 668 (47.9%) and 727 (52.1%) patients. Propensity score-matched analysis showed an increased risk of in-hospital mortality in the late-onset group (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.69-5.34). The same trend was observed in the entire study population (aOR, 1.85; 95% CI, 1.37-2.50). When patients were divided into LOS quartile groups, an increasing trend of mortality risk was observed in the higher quartiles (P for trend < 0.001). CONCLUSION Extended LOS before developing sepsis is associated with higher in-hospital mortality. More careful management is required when sepsis occurs in patients hospitalized for ≥ 5 days.
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Affiliation(s)
- Joong-Yub Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Yeul Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Yeon Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Hyeon Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea.
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3
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Silver CM, Thomas AC, Reddy S, Kirkendoll S, Nathens AB, Issa N, Patel PP, Plevin RE, Kanzaria HK, Stey AM. Morbidity and Length of Stay After Injury Among People Experiencing Homelessness in North America. JAMA Netw Open 2024; 7:e240795. [PMID: 38416488 PMCID: PMC10902734 DOI: 10.1001/jamanetworkopen.2024.0795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/08/2024] [Indexed: 02/29/2024] Open
Abstract
Importance Traumatic injury is a leading cause of hospitalization among people experiencing homelessness. However, hospital course among this population is unknown. Objective To evaluate whether homelessness was associated with increased morbidity and length of stay (LOS) after hospitalization for traumatic injury and whether associations between homelessness and LOS were moderated by age and/or Injury Severity Score (ISS). Design, Setting, and Participants This retrospective cohort study of the American College of Surgeons Trauma Quality Programs (TQP) included patients 18 years or older who were hospitalized after an injury and discharged alive from 787 hospitals in North America from January 1, 2017, to December 31, 2018. People experiencing homelessness were propensity matched to housed patients for hospital, sex, insurance type, comorbidity, injury mechanism type, injury body region, and Glasgow Coma Scale score. Data were analyzed from February 1, 2022, to May 31, 2023. Exposures People experiencing homelessness were identified using the TQP's alternate home residence variable. Main Outcomes and Measures Morbidity, hemorrhage control surgery, and intensive care unit (ICU) admission were assessed. Associations between homelessness and LOS (in days) were tested with hierarchical multivariable negative bionomial regression. Moderation effects of age and ISS on the association between homelessness and LOS were evaluated with interaction terms. Results Of 1 441 982 patients (mean [SD] age, 55.1 [21.1] years; (822 491 [57.0%] men, 619 337 [43.0%] women, and 154 [0.01%] missing), 9065 (0.6%) were people experiencing homelessness. Unmatched people experiencing homelessness demonstrated higher rates of morbidity (221 [2.4%] vs 25 134 [1.8%]; P < .001), hemorrhage control surgery (289 [3.2%] vs 20 331 [1.4%]; P < .001), and ICU admission (2353 [26.0%] vs 307 714 [21.5%]; P < .001) compared with housed patients. The matched cohort comprised 8665 pairs at 378 hospitals. Differences in rates of morbidity, hemorrhage control surgery, and ICU admission between people experiencing homelessness and matched housed patients were not statistically significant. The median unadjusted LOS was 5 (IQR, 3-10) days among people experiencing homelessness and 4 (IQR, 2-8) days among matched housed patients (P < .001). People experiencing homelessness experienced a 22.1% longer adjusted LOS (incident rate ratio [IRR], 1.22 [95% CI, 1.19-1.25]). The greatest increase in adjusted LOS was observed among people experiencing homelessness who were 65 years or older (IRR, 1.42 [95% CI, 1.32-1.54]). People experiencing homelessness with minor injury (ISS, 1-8) had the greatest relative increase in adjusted LOS (IRR, 1.30 [95% CI, 1.25-1.35]) compared with people experiencing homelessness with severe injury (ISS ≥16; IRR, 1.14 [95% CI, 1.09-1.20]). Conclusions and Relevance The findings of this cohort study suggest that challenges in providing safe discharge to people experiencing homelessness after injury may lead to prolonged LOS. These findings underscore the need to reduce disparities in trauma outcomes and improve hospital resource use among people experiencing homelessness.
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Affiliation(s)
- Casey M. Silver
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Arielle C. Thomas
- American College of Surgeons, Chicago, Illinois
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Susheel Reddy
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Avery B. Nathens
- American College of Surgeons, Chicago, Illinois
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nabil Issa
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Purvi P. Patel
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | | | - Hemal K. Kanzaria
- Department of Emergency Medicine, University of California, San Francisco
| | - Anne M. Stey
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Wah W, Berecki-Gisolf J, Walker-Bone K. In-hospital complications of work-related musculoskeletal injuries. Injury 2024; 55:111211. [PMID: 37984014 DOI: 10.1016/j.injury.2023.111211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND, OBJECTIVES Work-related musculoskeletal (MSK) injuries are a major contributor to morbidity worldwide and frequently result in hospitalisation. Hospital complications are common, costly, and largely preventable, but relevant data is required to address this. This study aimed to identify the incidence and factors associated with in-hospital complications of work-related MSK injuries. METHODS This study is based on work-related MSK hospital admission data from Victorian Admitted Episodes Database, 2016-2022. Complications were identified based on ICD-10-AM coding using CHADx (Classification of Hospital Acquired Diagnoses). Negative binomial and logistic regression analyses were performed to identify factors related to in-hospital complications. RESULTS In-hospital complications occurred in 6.3 % of work-related MSK injury admissions. In the adjusted models, ages ≥45 years, female sex, and area-level disadvantage were associated with in-hospital complications. Stay at public (vs private) hospitals, comorbidity, emergency admissions, and general anaesthesia were also associated. Complication rates were higher in hospitalised workers with direct head, neck, and trunk injuries and cumulative MSK disorders than those with direct extremities injuries and acute MSK conditions. The most common complications were cardiovascular, gastrointestinal complications and adverse drug events. CONCLUSION This study identified patient, injury and hospital-related characteristics associated with in-hospital complications of work-related MSK injuries for informing prevention strategies and risk estimation by hospital staff and workers' compensation schemes. The results demonstrate a sizable rate of complications given the relatively young and healthy study population.
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Affiliation(s)
- Win Wah
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia.
| | - Janneke Berecki-Gisolf
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia; Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, 21 Alliance Ln, Clayton, Melbourne, Victoria 3168, Australia
| | - Karen Walker-Bone
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia
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5
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Santos J, Kuza CM, Luo X, Ogunnaike B, Ahmed MI, Melikman E, Moon T, Shoultz T, Feeler A, Dudaryk R, Navas J, Vasileiou G, Yeh DD, Matsushima K, Forestiere M, Lian T, Grigorian A, Ricks-Oddie J, Nahmias J. Comparison of National Surgical Quality Improvement Program Surgical Risk Calculator and Trauma and Injury Severity Score Risk Assessment Tools in Predicting Outcomes in High-Risk Operative Trauma Patients. Am Surg 2023; 89:4038-4044. [PMID: 37173283 DOI: 10.1177/00031348231175488] [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] [Indexed: 05/15/2023]
Abstract
BACKGROUND The Trauma and Injury Severity Score (TRISS) uses anatomic/physiologic variables to predict outcomes. The National Surgical Quality Improvement Program Surgical Risk Calculator (NSQIP-SRC) includes functional status and comorbidities. It is unclear which of these tools is superior for high-risk trauma patients (American Society of Anesthesiologists Physical Status (ASA-PS) class IV or V). This study compares risk prediction of TRISS and NSQIP-SRC for mortality, length of stay (LOS), and complications for high-risk operative trauma patients. METHODS This is a prospective study of high-risk (ASA-PS IV or V) trauma patients (≥18 years-old) undergoing surgery at 4 trauma centers. We compared TRISS vs NSQIP-SRC vs NSQIP-SRC + TRISS for ability to predict mortality, LOS, and complications using linear, logistic, and negative binomial regression. RESULTS Of 284 patients, 48 (16.9%) died. The median LOS was 16 days and number of complications was 1. TRISS + NSQIP-SRC best predicted mortality (AUROC: .877 vs .723 vs .843, P = .0018) and number of complications (pseudo-R2/median error (ME) 5.26%/1.15 vs 3.39%/1.33 vs 2.07%/1.41, P < .001) compared to NSQIP-SRC or TRISS, but there was no difference between TRISS + NSQIP-SRC and NSQIP-SRC with LOS prediction (P = .43). DISCUSSION For high-risk operative trauma patients, TRISS + NSQIP-SRC performed better at predicting mortality and number of complications compared to NSQIP-SRC or TRISS alone but similar to NSQIP-SRC alone for LOS. Thus, future risk prediction and comparisons across trauma centers for high-risk operative trauma patients should include a combination of anatomic/physiologic data, comorbidities, and functional status.
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Affiliation(s)
- Jeffrey Santos
- Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Catherine M Kuza
- Department of Anesthesiology, University of Southern California, Los Angeles, CA, USA
| | - Xi Luo
- Department of Anesthesiology, University of Texas Southwestern, Dallas, TX, USA
| | - Babatunde Ogunnaike
- Department of Anesthesiology, University of Texas Southwestern, Dallas, TX, USA
| | - M Iqbal Ahmed
- Department of Anesthesiology, University of Texas Southwestern, Dallas, TX, USA
| | - Emily Melikman
- Department of Anesthesiology, University of Texas Southwestern, Dallas, TX, USA
| | - Tiffany Moon
- Department of Anesthesiology, University of Texas Southwestern, Dallas, TX, USA
| | - Thomas Shoultz
- Division of Burns, Trauma and Critical Care, University of Texas Southwestern, Dallas, TX, USA
| | - Anne Feeler
- Division of Burns, Trauma and Critical Care, University of Texas Southwestern, Dallas, TX, USA
| | - Roman Dudaryk
- Department of Anesthesiology and Pain Management, University of Miami, Miami, FL, USA
| | - Jose Navas
- Department of Anesthesiology and Pain Management, University of Miami, Miami, FL, USA
| | | | - D Dante Yeh
- Department of Surgery, University of Miami, Miami, FL, USA
| | - Kazuhide Matsushima
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Matthew Forestiere
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Tiffany Lian
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Areg Grigorian
- Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Joni Ricks-Oddie
- Institute for Clinical and Translation Sciences and Center for Statistical Consulting, University of California, Irvine, Orange, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
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Barrie U, Montgomery EY, Ogwumike E, Pernik MN, Luu IY, Adeyemo EA, Christian ZK, Edukugho D, Johnson ZD, Hoes K, El Tecle N, Hall K, Aoun SG, Bagley CA. Household Income as a Predictor for Surgical Outcomes and Opioid Use After Spine Surgery in the United States. Global Spine J 2023; 13:2124-2134. [PMID: 35007170 PMCID: PMC10538313 DOI: 10.1177/21925682211070823] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-Sectional Study. OBJECTIVES Socioeconomic status (SES) is a fundamental root of health disparities, however, its effect on surgical outcomes is often difficult to capture in clinical research, especially in spine surgery. Here, we present a large single-center study assessing whether SES is associated with cause-specific surgical outcomes. METHODS Patients undergoing spine surgery between 2015 and 2019 were assigned income in accordance with the national distribution and divided into quartiles based on the ZIP code-level median household income. We performed univariate, chi-square, and Analysis of Variance (ANOVA) analysis assessing the independent association of SES, quantified by household income, to operative outcomes, and multiple metrics of opioid consumption. RESULTS 1199 patients were enrolled, and 1138 patients were included in the analysis. Low household income was associated with the greatest rates of 3-month opioid script renewal (OR:1.65, 95% CI:1.14-2.40). In addition, low-income was associated with higher rates of perioperative opioid consumption compared to higher income including increased mean total morphine milligram equivalent (MME) 252.25 (SD 901.32) vs 131.57 (SD 197.46) (P < .046), and inpatient IV patient-controlled analgesia (PCA) MME 121.11 (SD 142.14) vs 87.60 (SD 86.33) (P < .023). In addition, household income was independently associated with length of stay (LOS), and emergency room (ER) revisits with low-income patients demonstrating significantly longer postop LOS and increasing postoperative ER visits. CONCLUSIONS Considering the comparable surgical management provided by the single institution, the associated differences in postoperative outcomes as defined by increased morbidities and opioid consumption can potentially be attributed to health disparities caused by SES.
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Affiliation(s)
- Umaru Barrie
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Eric Y. Montgomery
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Erica Ogwumike
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Mark N. Pernik
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Ivan Y. Luu
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Emmanuel A. Adeyemo
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Zachary K. Christian
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Derrek Edukugho
- Department of Neurological Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Zachary D. Johnson
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Kathryn Hoes
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Najib El Tecle
- Department of Neurological Surgery, Saint Louis University School of Medicine, St Louis, MI, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Salah G. Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Carlos A. Bagley
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
- Department of Orthopedic Surgery Dallas, University of Texas Southwestern Medical School, Texas, USA
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7
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Gokhale S, Taylor D, Gill J, Hu Y, Zeps N, Lequertier V, Prado L, Teede H, Enticott J. Hospital length of stay prediction tools for all hospital admissions and general medicine populations: systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1192969. [PMID: 37663657 PMCID: PMC10469540 DOI: 10.3389/fmed.2023.1192969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/19/2023] [Indexed: 09/05/2023] Open
Abstract
Background Unwarranted extended length of stay (LOS) increases the risk of hospital-acquired complications, morbidity, and all-cause mortality and needs to be recognized and addressed proactively. Objective This systematic review aimed to identify validated prediction variables and methods used in tools that predict the risk of prolonged LOS in all hospital admissions and specifically General Medicine (GenMed) admissions. Method LOS prediction tools published since 2010 were identified in five major research databases. The main outcomes were model performance metrics, prediction variables, and level of validation. Meta-analysis was completed for validated models. The risk of bias was assessed using the PROBAST checklist. Results Overall, 25 all admission studies and 14 GenMed studies were identified. Statistical and machine learning methods were used almost equally in both groups. Calibration metrics were reported infrequently, with only 2 of 39 studies performing external validation. Meta-analysis of all admissions validation studies revealed a 95% prediction interval for theta of 0.596 to 0.798 for the area under the curve. Important predictor categories were co-morbidity diagnoses and illness severity risk scores, demographics, and admission characteristics. Overall study quality was deemed low due to poor data processing and analysis reporting. Conclusion To the best of our knowledge, this is the first systematic review assessing the quality of risk prediction models for hospital LOS in GenMed and all admissions groups. Notably, both machine learning and statistical modeling demonstrated good predictive performance, but models were infrequently externally validated and had poor overall study quality. Moving forward, a focus on quality methods by the adoption of existing guidelines and external validation is needed before clinical application. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021272198.
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Affiliation(s)
- Swapna Gokhale
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
- Eastern Health, Box Hill, VIC, Australia
| | - David Taylor
- Office of Research and Ethics, Eastern Health, Box Hill, VIC, Australia
| | - Jaskirath Gill
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Yanan Hu
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Nikolajs Zeps
- Monash Partners Academic Health Sciences Centre, Clayton, VIC, Australia
- Eastern Health Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, VIC, Australia
| | - Vincent Lequertier
- Univ. Lyon, INSA Lyon, Univ Lyon 2, Université Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Luis Prado
- Epworth Healthcare, Academic and Medical Services, Melbourne, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
- Monash Partners Academic Health Sciences Centre, Clayton, VIC, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
- Monash Partners Academic Health Sciences Centre, Clayton, VIC, Australia
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Krajewski S, Furtak J, Zawadka-Kunikowska M, Kachelski M, Soboń J, Harat M. Functional State and Rehabilitation of Patients after Primary Brain Tumor Surgery for Malignant and Nonmalignant Tumors: A Prospective Observational Study. Curr Oncol 2023; 30:5182-5194. [PMID: 37232851 DOI: 10.3390/curroncol30050393] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 05/27/2023] Open
Abstract
The aim of this study was to compare the pre- and postoperative function of patients qualifying for resection of malignant and nonmalignant primary brain tumors to determine the relationship among tumor type, function, and the course of rehabilitation after surgery. This single-center, prospective, observational study recruited 92 patients requiring prolonged postoperative rehabilitation during their inpatient stay, who were divided into a nonmalignant tumor group (n = 66) and a malignant tumor group (n = 26). Functional status and gait efficiency were assessed using a battery of instruments. Motor skills, postoperative complications, and length of hospital stay (LoS) were recorded and compared between groups. The frequency and severity of postoperative complications, the time needed to attain individual motor skills, and the proportion of patients losing independent gait (~30%) were similar between groups. However, paralysis and paresis were more frequent in the malignant tumor group before surgery (p < 0.001). While nonmalignant tumor patients deteriorated more according to all scales after surgery, patients with malignant tumors were still characterized by worse ADL, independence, and performance at discharge. Worse functional outcomes in the malignant tumor group did not affect LoS or rehabilitation. Patients with malignant and nonmalignant tumors have similar rehabilitation needs, and patient expectation-especially those with nonmalignant tumors-should be appropriately managed.
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Affiliation(s)
- Stanisław Krajewski
- Department of Physiotherapy, University of Bydgoszcz, Unii Lubelskiej 4, 85-059 Bydgoszcz, Poland
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
| | - Jacek Furtak
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
- Department of Neurooncology and Radiosurgery, Franciszek Łukaszczyk Oncology Center, 85-796 Bydgoszcz, Poland
| | - Monika Zawadka-Kunikowska
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Michał Kachelski
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
| | - Jakub Soboń
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
| | - Marek Harat
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
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Rosenthal MA, Ranji SR, Kanzaria HK, Ortiz GM, Chase J, Chodos AH, Nguyen OK, Rodriguez EG, Makam AN. Characterizing patients hospitalized without an acute care indication: A retrospective cohort study. J Hosp Med 2023; 18:294-301. [PMID: 36757173 DOI: 10.1002/jhm.13061] [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: 09/20/2022] [Revised: 01/04/2023] [Accepted: 01/25/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Hospitalizations by patients who do not meet acute inpatient criteria are common and overburden healthcare systems. Studies have characterized these alternate levels of care (ALC) but have not delineated prolonged (pALC) versus short ALC (sALC) stays. OBJECTIVE To descriptively compare pALC and sALC hospitalizations-groups we hypothesize have unique needs. DESIGNS, SETTINGS, AND PARTICIPANTS A retrospective study of hospitalizations from March-April 2018 at an academic safety-net hospital. MAIN OUTCOME AND MEASURES Levels of care for pALC (>3 days) and sALC (1-3 days) were determined using InterQual©, an industry standard utilization review tool for determining the clinical appropriateness of hospitalization. We examined sociodemographic and clinical characteristics. RESULTS Of 2365 hospitalizations, 215 (9.1%) were pALC, 277 (11.7%) were sALC, and 1873 (79.2%) had no ALC days. There were 17,683 hospital days included, and 28.3% (n = 5006) were considered ALC. Compared to patients with sALC, those with pALC were older and more likely to be publicly insured, experience homelessness, and have substance use or psychiatric comorbidities. Patients with pALC were more likely to be admitted for care meeting inpatient criteria (89.3% vs. 66.8%, p < .001), had significantly more ALC days (median 8 vs. 1 day, p < .001), and were less likely to be discharged to the community (p < .001). CONCLUSIONS Patients with prolonged ALC stays were more likely to be admitted for acute care, had greater psychosocial complexity, significantly longer lengths of stay, and unique discharge needs. Given the complexity and needs for hospitalizations with pALC days, intensive interdisciplinary coordination and resource mobilization are necessary.
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Affiliation(s)
- Molly A Rosenthal
- Department of General Internal Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Sumant R Ranji
- Department of Medicine, Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Hemal K Kanzaria
- Department of Emergency Medicine, University of California, San Francisco, California, USA
- Department of Care Coordination, San Francisco Department of Public Health, San Francisco, California, USA
- Center for Vulnerable Populations, University of California, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Gabriel M Ortiz
- Department of Medicine, Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Jack Chase
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Anna H Chodos
- Department of Medicine, Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Oanh K Nguyen
- Department of Medicine, Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
- Center for Vulnerable Populations, University of California, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Eric G Rodriguez
- Department of Care Coordination, San Francisco Department of Public Health, San Francisco, California, USA
| | - Anil N Makam
- Department of Medicine, Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
- Center for Vulnerable Populations, University of California, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
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Hispanic Farmers Experience Shorter EMS Response Times but Longer Emergency Department Length of Stay Following Occupational Injuries. World J Surg 2022; 46:2872-2881. [PMID: 36161352 DOI: 10.1007/s00268-022-06729-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Agriculture has the highest rate of fatal injuries by sector. Hispanic workers also experience more fatal work injuries than every other minority group combined. Pre-hospital and initial trauma evaluation represent an important marker to understand the impact of a trauma system. We sought to investigate whether Hispanic agricultural workers in the United States (US) experience disparities following traumatic occupational injuries in terms of pre-hospital and emergency department care. METHODS We retrospectively analyzed the National Trauma Data Bank from 2012-2016 to understand differences between Hispanic and non-Hispanic farmers in Emergency Medical Services (EMS) response and transport times (minutes), transport mode, transfer rates, presentation to University or Level I trauma hospitals, Injury Severity Scores (ISS), length of stay (LOS) in the emergency department (ED, minutes) or hospital (days), need for the operating room (OR), admittance to the Intensive Care Unit (ICU), and mortality. RESULTS A total of 6,161 farmers were included in our analyses (median age 47 years, females 7.0%). Multivariable analyses indicate differences regarding EMS response, EMS transport, and LOS in the ED. Rates of admission to the ICU, surgical operations, days on a ventilator, discharge from the hospital with supportive care, and mortality did not differ between groups. CONCLUSIONS Non-Hispanic patients have longer median EMS response and total transport times. Hispanic patients have longer median LOS in the ED. However, the lack of significant differences in management variables other than EMS times and ED LOS indicate an equitable delivery of trauma care once patients were transferred from the ED.
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Yue JK, Krishnan N, Chyall L, Haddad AF, Vega P, Caldwell DJ, Umbach G, Tantry E, Tarapore PE, Huang MC, Manley GT, DiGiorgio AM. Predictors of Extreme Hospital Length of Stay After Traumatic Brain Injury. World Neurosurg 2022; 167:e998-e1005. [PMID: 36058487 DOI: 10.1016/j.wneu.2022.08.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Hospital length of stay (HLOS) after traumatic brain injury (TBI) is an important metric of injury severity, resource utilization, and access to post-acute care services. Risk factors for protracted HLOS after TBI require further characterization. METHODS Data regarding adult inpatients admitted to a single U.S. level 1 trauma center with a diagnosis of acute TBI between August 1, 2019, and April 1, 2022, were extracted from the electronic health record. Patients with extreme HLOS (XHLOS, >99th percentile of institutional TBI HLOS) were compared with those without XHLOS. Socioeconomic status (SES), clinical/injury factors, and discharge disposition were analyzed. RESULTS In 1638 patients, the median HLOS was 3 days (interquartile range [IQR]: 2-8 days). XHLOS threshold was >70 days (N = 18; range: 72-146 days). XHLOS was associated with younger age (XHLOS/non-XHLOS: 50.4/59.6 years; P = 0.042) and greater proportions with severe TBI (55.6%/11.4%; P < 0.001), low SES (72.2%/31.4%; P < 0.001), and Medicaid insurance (77.8%/30.1%; P < 0.001). XHLOS patients were more likely to die in hospital (22.2%/8.1%) and discharge to post-acute facility (77.8%/16.3%; P < 0.001). No XHLOS patients were discharged to home. In XHLOS patients alive at discharge, medical stability was documented at median 39 days (IQR: 28-58 days) and were hospitalized for another 56 days (IQR: 26.5-78.5 days). CONCLUSIONS XHLOS patients were more likely to have severe injuries, low SES, and Medicaid. XHLOS is associated with in-hospital mortality and need for post-acute placement. XHLOS patients often demonstrated medical stability long before placement, underscoring complex relationships between SES, health insurance, and outcome. These findings have important implications for quality improvement and resource utilization at acute care hospitals and await validation from larger trials.
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Affiliation(s)
- John K Yue
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
| | - Nishanth Krishnan
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Lawrence Chyall
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Alexander F Haddad
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Paloma Vega
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - David J Caldwell
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Gray Umbach
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Evelyne Tantry
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Phiroz E Tarapore
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Michael C Huang
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Anthony M DiGiorgio
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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Fardi K, Ghanizadeh G, Bahadori M, Chaharbaghi S, Hosseini Shokouh SM. Location selection criteria for field hospitals: A systematic review. Health Promot Perspect 2022; 12:131-140. [PMID: 36276411 PMCID: PMC9508390 DOI: 10.34172/hpp.2022.17] [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: 11/22/2021] [Accepted: 05/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Establishing field hospitals is a critical task for governments to complete following disasters, with the first step being to identify suitable locations. Although field hospitals are similar to permanent hospitals and temporary shelters, no research in English has been conducted to extract the location selection criteria for field hospitals from those for hospitals and temporary shelters. Methods: A meta-synthetic approach was used to review all related qualitative, quantitative, and mixed studies published in English between January 2010 and June 2020 to identify new field hospital site selection criteria distinct from those used to select a permanent hospital and temporary sheltering sites. Results: From 4317 screened records, 24 articles were eventually identified as eligible studies, through which 151 open codes, 21 axial codes, and nine themes were identified. The top three axes included proximity to main roads, proximity/distance to permanent hospitals, and proximity/distance to other medical centers. Conclusion: By considering a field hospital as a facility with certain characteristics similar to permanent hospitals and temporary shelters, it is possible to identify specific new criteria and sub-criteria by extracting items common to permanent hospitals and temporary shelter site selection studies.
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Affiliation(s)
- Keyvan Fardi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ghader Ghanizadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Samaneh Chaharbaghi
- Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sayyed Morteza Hosseini Shokouh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Stanbouly D, Kocaelli H, Arce K, Selvi F. Risk factors for increased length of hospital stay among young pediatric patients who suffer facial fractures. Dent Traumatol 2022; 38:457-465. [PMID: 35877474 DOI: 10.1111/edt.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM It is not known whether the mechanism of facial trauma influences the associated length of hospitalization. The aim of this study was to determine whether the mechanism of injury influenced the length of hospital stay (LOS) among pediatric patients who sustained facial fractures. MATERIALS AND METHODS This retrospective cohort study was completed using the Kids' Inpatient Database (KID). The primary predictor variable was the mechanism of injury. The primary outcome variable was LOS. Linear regression was used to determine independent predictors of increased/decreased length of stay. A p-value of less than .05 was considered statistically significant. RESULTS The final sample consisted of 2865 subjects aged 12 years or younger who had suffered facial fractures. The most common mechanism of injury was motor vehicle accidents (MVA) (58.6%). Facial fractures due to MVA added 1.20 days (95% CI, 0.02, 2.38; p < .05) when compared to those due to a fall. CONCLUSIONS MVA significantly prolonged the LOS among young pediatric patients who sustained facial fractures, reflecting the exceptional amount of force involved. Having a chronic condition was also a significant factor for longer LOS. Four or more fractures also led to a longer LOS.
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Affiliation(s)
- Dani Stanbouly
- College of Dental Medicine, Columbia University, New York, New York, USA
| | - Humeyra Kocaelli
- School of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, Istanbul, Turkey
| | - Kevin Arce
- Division of Oral and Maxillofacial Surgery, Section of Head and Neck Oncologic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Firat Selvi
- Division of Oral and Maxillofacial Surgery, Section of Head and Neck Oncologic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Hussein HM, Chrenka EA, Herrmann AA. Rate and Predictors of Acute Care Encounters in the First Month After Stroke. J Stroke Cerebrovasc Dis 2022; 31:106466. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/07/2021] [Accepted: 03/17/2022] [Indexed: 10/18/2022] Open
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15
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Dakroub M, El Hadi D, Hashim I, El Moussawi Z, Ibrahim P, Al-Haddad C. A Comparison of the Long-Term Surgical Outcomes of Horizontal Strabismus Surgery between Resident Clinic and Private Clinic Patients. Semin Ophthalmol 2022; 37:683-689. [DOI: 10.1080/08820538.2022.2070027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mohamad Dakroub
- Ophthalmology Department, American University of Beirut, Beirut, Lebanon
| | - Dalia El Hadi
- Ophthalmology Department, American University of Beirut, Beirut, Lebanon
| | - Ibrahim Hashim
- Ophthalmology Department, American University of Beirut, Beirut, Lebanon
| | - Zeinab El Moussawi
- Ophthalmology Department, American University of Beirut, Beirut, Lebanon
| | - Perla Ibrahim
- Ophthalmology Department, American University of Beirut, Beirut, Lebanon
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Chouairi F, Mercier MR, Alperovich M, Clune J, Prsic A. Preoperative Deficiency Anemia in Digital Replantation: A Marker of Disparities, Increased Length of Stay, and Hospital Cost. J Hand Microsurg 2022; 14:147-152. [PMID: 35983290 PMCID: PMC9381176 DOI: 10.1055/s-0040-1714152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Introduction The effects of preoperative anemia have been shown to be an independent risk factor associated with poor outcomes in both cardiac and noncardiac surgery. Socioeconomic status and race have also been linked to poor outcomes in a variety of conditions. This study was designed to study iron deficiency anemia as a marker of health disparities, length of stay and hospital cost in digital replantation. Materials and Methods Digit replantations performed between 2008 and 2014 were reviewed from the National Inpatient Sample (NIS) database using the ICD-9-CM procedure codes 84.21 and 84.22. Patients with more than one code or with an upper arm (83.24) or hand replantation (84.23) code were excluded. Extracted variables included age, race, comorbidities, hospital type, hospital region, insurance payer type, and median household income quartile. Digit replantations were separated into patients with and without deficiency anemia. Demographics, comorbidities, and access to care were compared between cohorts by chi-squared and t -tests. Multivariate regressions were utilized to assess the effects of anemia on total cost and length of stay. The regression controlled for demographics, region, income, insurance, hospital type, and comorbidities. Beta coefficient was calculated for length of stay and hospital cost. The regression controlled for significant age, race, region, and comorbidities in addition to the above variables. Results In the studied patient population of those without anemia, 59.5% were Caucasian, and in patients with anemia, 46.7% were Caucasian ( p < 0.001). Whereas in the in the studied patient population of those without anemia, 6.7% were Black, and in patients with anemia, 15.7% were Black ( p < 0.001). Median household income, payer information, length of stay and total cost of hospitalization had statistically significant differences. Using regression and β-coefficient, the effect of anemia on length of stay and cost was also significant ( p < 0.001). Regression controlled for age, race, region and comorbidities, with the β-coefficient for effect on cost 37327.18 and on length of stay 3.96. Conclusion These data show that deficiency anemias are associated with a significant increase in length and total cost of stay in patients undergoing digital replantation. Additionally, a larger percentage of patients undergoing digital replantations and who have deficiency anemia belong to the lowest income quartile. Our findings present an important finding for public health prevention and resource allocation. Future studies could focus on clinical intervention with iron supplementation at the time of digital replantation.
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Affiliation(s)
- Fouad Chouairi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - Michael R. Mercier
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - Michael Alperovich
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - James Clune
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - Adnan Prsic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
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Ghosh AK, Unruh MA, Ibrahim S, Shapiro MF. Association Between Patient Diversity in Hospitals and Racial/Ethnic Differences in Patient Length of Stay. J Gen Intern Med 2022; 37:723-729. [PMID: 34981364 PMCID: PMC8904308 DOI: 10.1007/s11606-021-07239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 10/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospitals serving a disproportionate share of racial/ethnic minorities have been shown to have poorer quality outcomes. It is unknown whether efficiencies in inpatient care, measured by length of stay (LOS), differ based on the proportion patients served by a hospital who are minorities. OBJECTIVE To examine the association between the racial/ethnic diversity of a hospital's patients and disparities in LOS. DESIGN Retrospective cross-sectional study. PARTICIPANTS One million five hundred forty-six thousand nine hundred fifty-five admissions using the 2017 New York State Inpatient Database from the Healthcare Cost and Utilization Project. MAIN MEASURE Differences in mean adjusted LOS (ALOS) between White and Black, Hispanic, and Other (Asian, Pacific Islander, Native American, and Other) admissions by Racial/Ethnic Diversity Index (proportion of non-White patients admitted to total patients admitted to that same hospital) in quintiles (Q1 to Q5), stratified by discharge destination. Mean LOS was adjusted for patient demographic, clinical, and admission characteristics and for individual intercepts for each hospital. KEY RESULTS In both unadjusted and adjusted analysis, Black-White and Other-White mean LOS differences were smallest in the most diverse hospitals (Black-White: unadjusted, -0.07 days [-0.1 to -0.04], and adjusted, 0.16 days [95% CI: 0.16 to 0.16]; Other-White: unadjusted, -0.74 days [95% CI: -0.77 to -0.71], and adjusted, 0.01 days [95% CI: 0.01 to 0.02]). For Hispanic patients, in unadjusted analysis, the mean LOS difference was greatest in the most diverse hospitals (-0.92 days, 95% CI: -0.95 to -0.89) but after adjustment, this was no longer the case. Similar patterns across all racial/ethnic groups were observed after analyses were stratified by discharge destination. CONCLUSION Mean adjusted LOS differences between White and Black patients, and White and patients of Other race was smallest in most diverse hospitals, but not differences between Hispanic and White patients. These findings may reflect specific structural factors which affect racial/ethnic differences in patient LOS.
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Affiliation(s)
- Arnab K Ghosh
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA.
| | - Mark A Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Said Ibrahim
- Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Martin F Shapiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
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Gómez-García L, Hidalgo-Solórzano E, Pérez-Núñez R, Jacobo-Zepeda VF, Ascencio-Tene RG, Lunnen JC, Mehmood A. Factors associated with the severity of road traffic injuries from emergency department based surveillance system in two Mexican cities. BMC Emerg Med 2022; 22:20. [PMID: 35120440 PMCID: PMC8815254 DOI: 10.1186/s12873-022-00576-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background Limited data from low- and middle-income countries (LMICs) on the severity of road traffic injuries (RTIs) and their relation to different variables of interest are routinely obtained. Knowledge on this subject relies on evidence from high-income countries, which might not be the same as in LMICs. This information is greatly needed to advance and inform local and regional efforts towards the United Nations’ Decade of Action and the Sustainable Development Goals. Methods From May 2012 to November 2014, a RTI surveillance system was implemented in two referral hospitals in two Mexican cities, León and Guadalajara, with the objective of exploring the relationship between Injury Severity Score (ISS) and different sociodemographic characteristics of the injured as well as different variables related to the event and the environment. All individuals suffering RTIs who visited the Emergency Rooms (ER) were included after granting informed consent. A Zero-Truncated Negative Binomial Model was employed to explore the statistical association between ISS and variables of interest. Results 3024 individuals participated in the study: 2185 (72.3%) patients from León and 839 patients (27.7%) from Guadalajara. Being male, in the 20–59 age-group, having less schooling, events occurring in Guadalajara, on Sundays, at night, and arriving at ER via public/private ambulance were all associated with an increased log count of ISS. Found a significant interaction effect (p-value< 0.05) between type of road user and alcohol intake six hours before the accident on severity of the injury (ISS). The use of illicit drugs, cellphones and safety devices during the event showed no association to ISS. Conclusions Our study contributes to the statistical analysis of ISS obtained through RTI hospital surveillance systems. Findings might facilitate the development and evaluation of focused interventions to reduce RTIs in vulnerable users, to enhance ER services and prehospital care, and to reduce drink driving.
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Affiliation(s)
- Lourdes Gómez-García
- Center for Health Systems Research, National Institute of Public Health, Universidad #655, Colonia Santa María Ahuacatitlán, Cerr los Pinos y Caminera, CP 62100, Cuernavaca, Morelos, Mexico
| | - Elisa Hidalgo-Solórzano
- Center for Health Systems Research, National Institute of Public Health, Universidad #655, Colonia Santa María Ahuacatitlán, Cerr los Pinos y Caminera, CP 62100, Cuernavaca, Morelos, Mexico.
| | - Ricardo Pérez-Núñez
- Center for Health Systems Research, National Institute of Public Health, Universidad #655, Colonia Santa María Ahuacatitlán, Cerr los Pinos y Caminera, CP 62100, Cuernavaca, Morelos, Mexico
| | | | | | - Jeffrey C Lunnen
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amber Mehmood
- University of South Florida College of Public Health, Tampa, FL, USA
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Kozik D, Alsoufi B. Commentary: Length of stay as measure of quality: A misty strategy that might backfire. J Thorac Cardiovasc Surg 2021; 163:1616-1617. [PMID: 34906397 DOI: 10.1016/j.jtcvs.2021.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Deborah Kozik
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Ky
| | - Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Ky.
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Barrenetxea J, Tan KB, Tong R, Chua K, Feng Q, Koh WP, Chen C. Emergency hospital admissions among older adults living alone in the community. BMC Health Serv Res 2021; 21:1192. [PMID: 34732180 PMCID: PMC8567640 DOI: 10.1186/s12913-021-07216-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background Among older adults, living alone is often associated with higher risk of Emergency Department (ED) admissions. However, older adults living alone are very heterogeneous in terms of health. As more older adults choose to live independently, it remains unclear if the association between living alone and ED admissions is moderated by health status. We studied the association between living alone and ED admission outcomes (number of admissions, inpatient days and inpatient costs) among older adults with and without multimorbidity. Methods We used data from 16,785 individuals of the third follow-up of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age: 73(61-96) years). Participants were interviewed face-to-face from 2014 to 2016 for sociodemographic/health factors and followed-up for one year on ED admission outcomes using Singapore Ministry of Health’s Mediclaim Database. We first applied multivariable logistic regression and two-part models to test if living alone is a risk factor for ED admission outcomes. We then ran stratified and joint effect analysis to examine if the associations between living alone and ED admission outcomes were moderated by multimorbidity. Results Compared to living with others, living alone was associated with higher odds of ED admission [Odds Ratio (OR) 1.28, 95 % Confidence Interval(CI) 1.08-1.51)], longer inpatient days (+0.61, 95 %CI 0.25-0.97) and higher inpatient costs (+322 USD, 95 %CI 54-591). The interaction effects of living arrangement and multimorbidity on ED admissions and inpatient costs were not statistically different, whereas the interaction between living arrangements and multimorbidity on inpatient days was borderline significant (p-value for interaction=0.050). Compared to those living with others and without multimorbidity, the relative mean increase was 1.13 inpatient days (95 %CI 0.39-1.86) for those living alone without multimorbidity, and 0.73 inpatient days ( 95 %CI 0.29-1.17) for those living alone with multimorbidity. Conclusions Older adults living alone were at higher risk of ED admission and higher inpatient costs regardless of multimorbidity, while those living alone without multimorbidity had the longest average inpatient days. To enable aging in place while avoiding ED admissions, interventions could provide instrumental support and regular health monitoring to older adults living alone, regardless of their health status.
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Affiliation(s)
- Jon Barrenetxea
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore
| | | | - Kevin Chua
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, SG, Singapore, Singapore
| | - Qiushi Feng
- Department of Sociology & Centre for Family and Population Research, National University of Singapore, Singapore, Singapore
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore. .,Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, 117545, Singapore, Singapore. .,Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore.
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.
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21
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Shorter acute hospital length of stay in hip fracture patients after surgery predicted by early surgery and mobilization. Arch Osteoporos 2021; 16:162. [PMID: 34718871 DOI: 10.1007/s11657-021-01027-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Time to surgery, early mobilization, fracture type, and ASA grades independently affect acute hospital length of stay after hip fracture surgery. Modifiable factors can be audited to reduce length of stay, and non-modifiable factors can be used for consideration of a tiered bundled payment reimbursement model. INTRODUCTION As hip fracture incidence rises with our ageing global population, there will be an increase in consumption of healthcare resources. We hypothesized that hospital management and patient factors can affect healthcare burden load. Using length of stay (LOS) as a surrogate for consumption, the aim of this study is to elucidate the effect of hospital management and patient-related factors on length of stay (LOS) for patients after hip fracture surgery. We studied modifiable and non-modifiable factors influencing LOS, and identification of these modifiable factors accords opportunities for mitigating these factors. METHODS This retrospective study examines hip fracture data from a large tertiary hospital in Singapore over the period of 2017 to 2020. Data collected on the electronic medical record included age, gender, race, marital status, payer type, ASA score, TTS, type of surgery, fracture type, POD1 mobilization, discharge position, and presence of pressure sores, and they were correlated with LOS using binary logistic regression on SAS. RESULTS A total of 1045 patients were included in this study with 704 females and 341 males. The mean age was 79.5 ± 8.57 years (range 60-105) with an average LOS 13.64 ± 10.0 days (range 2-114). On binary logistic regression, ASA and trochanteric fracture remains a significant non-modifiable factor for LOS with OR = 1.486 (95% CI 1.106, 1.996, p = 0.0086) and OR 1.522 (95% CI 1.149, 2.015, p = 0.0034) respectively. Significant modifiable factors were TTS > 48 h (OR = 1.819, 95% CI 1.205, 2.746, p = 0.0044) and POD1 mobilization (OR = 0.441, 95% CI 0.257, 0.756, p = 0.0029). CONCLUSIONS Our analysis showed TTS and POD1 are significant modifiable factors for LOS, and resources can be diverted towards them for the management of hip fracture patients and pre-empting the increasing load on our healthcare system.
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22
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Doetsch JN, Dias V, Indredavik MS, Reittu J, Devold RK, Teixeira R, Kajantie E, Barros H. Record linkage of population-based cohort data from minors with national register data: a scoping review and comparative legal analysis of four European countries. OPEN RESEARCH EUROPE 2021; 1:58. [PMID: 37645179 PMCID: PMC10445839 DOI: 10.12688/openreseurope.13689.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 08/31/2023]
Abstract
Background: The GDPR was implemented to build an overarching framework for personal data protection across the EU/EEA. Linkage of data directly collected from cohort participants, potentially serving as a prominent tool for health research, must respect data protection rules and privacy rights. Our objective was to investigate law possibilities of linking cohort data of minors with routinely collected education and health data comparing EU/EEA member states. Methods: A legal comparative analysis and scoping review was conducted of openly accessible published laws and regulations in EUR-Lex and national law databases on GDPR's implementation in Portugal, Finland, Norway, and the Netherlands and its connected national regulations purposing record linkage for health research that have been implemented up until April 30, 2021. Results: The GDPR does not ensure total uniformity in data protection legislation across member states offering flexibility for national legislation. Exceptions to process personal data, e.g., public interest and scientific research, must be laid down in EU/EEA or national law. Differences in national interpretation caused obstacles in cross-national research and record linkage: Portugal requires written consent and ethical approval; Finland allows linkage mostly without consent through the national Social and Health Data Permit Authority; Norway when based on regional ethics committee's approval and adequate information technology safeguarding confidentiality; the Netherlands mainly bases linkage on the opt-out system and Data Protection Impact Assessment. Conclusions: Though the GDPR is the most important legal framework, national legislation execution matters most when linking cohort data with routinely collected health and education data. As national interpretation varies, legal intervention balancing individual right to informational self-determination and public good is gravely needed for health research. More harmonization across EU/EEA could be helpful but should not be detrimental in those member states which already opened a leeway for registries and research for the public good without explicit consent.
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Affiliation(s)
- Julia Nadine Doetsch
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
| | - Vasco Dias
- INESC TEC -Institute for Systems and Computer Engineering, Technology and Science, Campus da Faculdade de Engenharia da Universidade do Porto, Porto, 4050-091, Portugal
| | - Marit S. Indredavik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
| | - Jarkko Reittu
- Finnish Institute for Health and Welfare, Legal Services, Helsinki, Finland
- University of Helsinki, Faculty of Law, Helsinki, Finland
| | - Randi Kallar Devold
- Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
| | - Raquel Teixeira
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
| | - Eero Kajantie
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
- Finnish Institute for Health and Welfare, Population Health Unit, Helsinki and Oulu, Finland
- PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Henrique Barros
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
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Health care utilization and health-related quality of life of injury patients: comparison of educational groups. BMC Health Serv Res 2021; 21:988. [PMID: 34538243 PMCID: PMC8451142 DOI: 10.1186/s12913-021-06913-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Differences in health care utilization by educational level can contribute to inequalities in health. Understanding health care utilization and health-related quality of life (HRQoL) of educational groups may provide important insights into the presence of these inequalities. Therefore, we assessed characteristics, health care utilization and HRQoL of injury patients by educational level. Method Data for this registry based cohort study were extracted from the Dutch Injury Surveillance System. At 6-month follow-up, a stratified sample of patients (≥25 years) with an unintentional injury reported their health care utilization since discharge and completed the EQ-5-Dimension, 5-Level (EQ-5D-5L) and visual analogue scale (EQ VAS). Logistic regression analyses, adjusting for patient and injury characteristics, were performed to investigate the association between educational level and health care utilization. Descriptive statistics were used to analyse HRQoL scores by educational level, for hospitalized and non-hospitalized patients. Results This study included 2606 patients; 47.9% had a low, 24.4% a middle level, and 27.7% a high level of education. Patients with low education were more often female, were older, had more comorbidities, and lived more often alone compared to patients with high education (p < 0.001). Patients with high education were more likely to visit a general practitioner (OR: 1.38; CI: 1.11–1.72) but less likely to be hospitalized (OR: 0.79; CI: 0.63–1.00) and to have nursing care at home (OR: 0.66; CI: 0.49–0.90) compared to their low educated counterparts. For both hospitalized an non-hospitalized persons, those with low educational level reported lower HRQoL and more problems on all dimensions than those with a higher educational level. Conclusion Post-discharge, level of education was associated with visiting the general practitioner and nursing care at home, but not significantly with use of other health care services in the 6 months post-injury. Additionally, patients with a low educational level had a poorer HRQoL. However, other factors including age and sex may also explain a part of these differences between educational groups. It is important that patients are aware of potential consequences of their trauma and when and why they should consult a specific health care service after ED or hospital discharge. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06913-3.
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Siddique SM, Tipton K, Leas B, Greysen SR, Mull NK, Lane-Fall M, McShea K, Tsou AY. Interventions to Reduce Hospital Length of Stay in High-risk Populations: A Systematic Review. JAMA Netw Open 2021; 4:e2125846. [PMID: 34542615 PMCID: PMC8453321 DOI: 10.1001/jamanetworkopen.2021.25846] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Many strategies to reduce hospital length of stay (LOS) have been implemented, but few studies have evaluated hospital-led interventions focused on high-risk populations. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study to further evaluate system-level interventions for LOS reduction. OBJECTIVE To identify and synthesize evidence regarding potential systems-level strategies to reduce LOS for patients at high risk for prolonged LOS. EVIDENCE REVIEW Multiple databases, including MEDLINE and Embase, were searched for English-language systematic reviews from January 1, 2010, through September 30, 2020, with updated searches through January 19, 2021. The scope of the protocol was determined with input from AHRQ Key Informants. Systematic reviews were included if they reported on hospital-led interventions intended to decrease LOS for high-risk populations, defined as those with high-risk medical conditions or socioeconomically vulnerable populations (eg, patients with high levels of socioeconomic risk, who are medically uninsured or underinsured, with limited English proficiency, or who are hospitalized at a safety-net, tertiary, or quaternary care institution). Exclusion criteria included interventions that were conducted outside of the hospital setting, including community health programs. Data extraction was conducted independently, with extraction of strength of evidence (SOE) ratings provided by systematic reviews; if unavailable, SOE was assessed using the AHRQ Evidence-Based Practice Center methods guide. FINDINGS Our searches yielded 4432 potential studies. We included 19 systematic reviews reported in 20 articles. The reviews described 8 strategies for reducing LOS in high-risk populations: discharge planning, geriatric assessment, medication management, clinical pathways, interdisciplinary or multidisciplinary care, case management, hospitalist services, and telehealth. Interventions were most frequently designed for older patients, often those who were frail (9 studies), or patients with heart failure. There were notable evidence gaps, as there were no systematic reviews studying interventions for patients with socioeconomic risk. For patients with medically complex conditions, discharge planning, medication management, and interdisciplinary care teams were associated with inconsistent outcomes (LOS, readmissions, mortality) across populations. For patients with heart failure, clinical pathways and case management were associated with reduced length of stay (clinical pathways: mean difference reduction, 1.89 [95% CI, 1.33 to 2.44] days; case management: mean difference reduction, 1.28 [95% CI, 0.52 to 2.04] days). CONCLUSIONS AND RELEVANCE This systematic review found inconsistent results across all high-risk populations on the effectiveness associated with interventions, such as discharge planning, that are often widely used by health systems. This systematic review highlights important evidence gaps, such as the lack of existing systematic reviews focused on patients with socioeconomic risk factors, and the need for further research.
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Affiliation(s)
- Shazia Mehmood Siddique
- Division of Gastroenterology, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
| | - Kelley Tipton
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Brian Leas
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
| | - S. Ryan Greysen
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Nikhil K. Mull
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Meghan Lane-Fall
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia
| | - Kristina McShea
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Amy Y. Tsou
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
- Division of Neurology, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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25
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Surviving Burn Injury: Drivers of Length of Hospital Stay. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020761. [PMID: 33477442 PMCID: PMC7829802 DOI: 10.3390/ijerph18020761] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/17/2022]
Abstract
With a reduction in the mortality rate of burn patients, length of stay (LOS) has been increasingly adopted as an outcome measure. Some studies have attempted to identify factors that explain a burn patient’s LOS. However, few have investigated the association between LOS and a patient’s mental and socioeconomic status. There is anecdotal evidence for links between these factors; uncovering these will aid in better addressing the specific physical and emotional needs of burn patients and facilitate the planning of scarce hospital resources. Here, we employ machine learning (clustering) and statistical models (regression) to investigate whether segmentation by socioeconomic/mental status can improve the performance and interpretability of an upstream predictive model, relative to a unitary model. Although we found no significant difference in the unitary model’s performance and the segment-specific models, the interpretation of the segment-specific models reveals a reduced impact of burn severity in LOS prediction with increasing adverse socioeconomic and mental status. Furthermore, the socioeconomic segments’ models highlight an increased influence of living circumstances and source of injury on LOS. These findings suggest that in addition to ensuring that patients’ physical needs are met, management of their mental status is crucial for delivering an effective care plan.
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Ghosh AK, Unruh MA, Soroka O, Shapiro M. Trends in Medical and Surgical Admission Length of Stay by Race/Ethnicity and Socioeconomic Status: A Time Series Analysis. Health Serv Res Manag Epidemiol 2021; 8:23333928211035581. [PMID: 34377740 PMCID: PMC8330458 DOI: 10.1177/23333928211035581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Length of stay (LOS), a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES) and longer LOS is associated with adverse health outcomes. Historically, projects to improve LOS efficiency have yielded LOS reductions by 0.3 to 0.7 days per admission. OBJECTIVE To assess differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). METHOD Data were obtained from 2009-2014 Healthcare Cost and Utilization Project State Inpatient Datasets for New York, New Jersey, and Florida. Multivariate generalized linear models were used to examine trends in aALOS differences by race/ethnicity, and by high vs low SES patients (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. RESULTS For those discharged home, racial/ethnic and SES aALOS differences remained stable from 2009 to 2014. However, among those discharged to non-home destinations, Black vs White aALOS differences increased from 0.21 days in Q1 2009, (95% confidence interval (CI): 0.13 to 0.30) to 0.32 days in Q3 2013, (95% CI: 0.23 to 0.40), and for low vs high SES patients from 0.03 days in Q1 2009 (95% CI: -0.04 to 0.1) to 0.26 days, (95% CI: 0.19 to 0.34). Notably, for patients not discharged home, racial/ethnic and SES aALOS differences increased and persisted after Q3 2011, coinciding with the introduction of the Affordable Care Act (ACA). CONCLUSION Further research to understand the ACA's policy impact on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.
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Affiliation(s)
- Arnab K. Ghosh
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Mark A. Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Orysya Soroka
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Martin Shapiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
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Bhatia K, Narasimhan B, Aggarwal G, Hajra A, Itagi S, Kumar S, Chakraborty S, Patel N, Jain V, Bandyopadhyay D, Amgai B, Aronow WS. Perioperative pharmacotherapy to prevent cardiac complications in patients undergoing noncardiac surgery. Expert Opin Pharmacother 2020; 22:755-767. [PMID: 33350868 DOI: 10.1080/14656566.2020.1856368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Despite advances in surgical and anesthetic techniques, perioperative cardiovascular complications are a major cause of 30-day perioperative mortality. Major cardiovascular complications after noncardiac surgery include myocardial ischemia, congestive heart failure, arrhythmias, and cardiac arrest. Along with surgical risk assessment, perioperative medical optimization can reduce the rates and clinical impact of these complications.Areas Covered: In this review, the authors discuss the pharmacological basis, existing evidence, and professional society recommendations for drug management in preventing cardiovascular complications in patients undergoing noncardiac surgery.Expert opinion: Perioperative management of cardiovascular disease is an increasingly important and growing area of clinical practice. Societal guidelines regarding the use of most routine cardiovascular medications are based on a number of large clinical studies and provide a basic foundation to guide management. However, the heterogeneous nature of patients, as well as surgeries, makes it practically impossible to devise a 'one size fits all' recommendation in this setting. Thus, the importance of a more individualized approach to perioperative risk stratification and management is being increasingly recognized. The underlying comorbidities and cardiac profile as well as the risk of cardiac complications associated with the planned surgery must be factored in to understand the nuance of the management strategies.
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Affiliation(s)
- Kirtipal Bhatia
- Icahn School of Medicine at Mount Sinai Morningside and Mount Sinai West Hospital Center, New York, NY, USA
| | - Bharat Narasimhan
- Icahn School of Medicine at Mount Sinai Morningside and Mount Sinai West Hospital Center, New York, NY, USA
| | | | - Adrija Hajra
- Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Soumya Itagi
- PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - Shathish Kumar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | | | - Dhrubajyoti Bandyopadhyay
- Icahn School of Medicine at Mount Sinai Morningside and Mount Sinai West Hospital Center, New York, NY, USA
| | | | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Sulley S, Ndanga M. Inpatient Opioid Use Disorder and Social Determinants of Health: A Nationwide Analysis of the National Inpatient Sample (2012-2014 and 2016-2017). Cureus 2020; 12:e11311. [PMID: 33282587 PMCID: PMC7714736 DOI: 10.7759/cureus.11311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ryder C, Mackean T, Hunter K, Towers K, Rogers K, Holland AJA, Ivers R. Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury. Inj Epidemiol 2020; 7:52. [PMID: 33012291 PMCID: PMC7534159 DOI: 10.1186/s40621-020-00278-7] [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: 06/09/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander children have higher incidence, severity and hospital length of stay for their acute burn injuries than other Australian children. We examined factors contributing to longer length of stay for Aboriginal and Torres Strait Islander children with an acute burn injury. METHODS Burns Registry of Australia and New Zealand admissions of children < 16 years of age between October 2009 and July 2018 were analysed. Descriptive statistics explored patient and injury characteristics; Cox-regression models estimated characteristics associated with longer length of stay. Knowledge Interface methodology and Indigenous research methods were used throughout. RESULTS A total of 723 children were identified as Aboriginal and Torres Strait Islander and 6257 as other Australian. The median hospital length of stay for Aboriginal and Torres Strait Islander children (5 days [CI 5-6]) was 4 days longer than other Australian children (1 day [CI 1-2]). Remoteness, flame burns, high percentage total body surface area (%TBSA) and full thickness burns were factors associated with longer length of stay for Aboriginal and Torres Strait Islander children. Similar prognostic factors were identified for other Australian children along with Streptococcus sp. and Staphylococcus sp. infection. CONCLUSION Remoteness, flame burns, %TBSA, and full thickness burns are prognostic factors contributing to extended hospital length of stay for all Australian children. These factors are more prevalent in Aboriginal and Torres Strait Islander children, impacting length of stay. Treatment programs, clinical guidelines, and burns policies should engage with the unique circumstances of Aboriginal and Torres Strait Islander children to mitigate inequities in health.
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Affiliation(s)
- Courtney Ryder
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia. .,Aboriginal and Torres Strait Islander Health, College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Tamara Mackean
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia.,Aboriginal and Torres Strait Islander Health, College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Kate Hunter
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Kurt Towers
- Watto Paruna Aboriginal Health for the Northern Adelaide Local Health Network, Corner of Mark and Oldham Roads, Elizabeth Vale, SA, 5112, Australia
| | - Kris Rogers
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia.,Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Andrew J A Holland
- Sydney Medical School, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia
| | - Rebecca Ivers
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia.,School of Public Health and Community Medicine, UNSW, Sydney, 2052, Australia
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Lim J. Big Data-Driven Determinants of Length of Stay for Patients with Hip Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144949. [PMID: 32659953 PMCID: PMC7400185 DOI: 10.3390/ijerph17144949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
Abstract
It is important that length of stay (LOS) management for alleviating health care financial burdens and improving patient outcomes. The aim of this study was to report the differences of LOS and the factors affecting LOS of hip fracture patients using big data. A total of 463,194 data were collected from 2016 to 2017 KNHDS. Of those, 2238 patients with the hip fracture primary diagnosis were included in the study population. As independent variables were used gender, age, type of insurance, admission route, result of treatment, number of hospital beds, the presence of surgery, and comorbidities. Statistical analysis performed using the IBM SPSS Statistics for Windows, version 25.0. A statistically significant difference was observed in the length of stay of hip fracture patients according to the healthcare insurance type. The difference in LOS associated with comorbidities was statistically significant for hypertension, peptic ulcer disease, coagulopathy, and alcohol abuse (p < 0.05). Independent variables that affected LOS of hip fracture patients with national health insurance were the treatment result, operation presence, comorbidity count, and hospital beds (p < 0.001). The factors associated with the length of stay for hip fracture patients were the difference according to the healthcare insurance type. The results of this study can be used as a basic data for the national health policy for the proper distribution and utilization of medical resources.
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Affiliation(s)
- Jihye Lim
- Department of Healthcare Management, Youngsan University, Yangsan 50510, Korea
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Socioeconomic Status and Days Alive and Out of Hospital after Major Elective Noncardiac Surgery: A Population-based Cohort Study. Anesthesiology 2020; 132:713-722. [PMID: 31972656 DOI: 10.1097/aln.0000000000003123] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Socioeconomic status is an important but understudied determinant of preoperative health status and postoperative outcomes. Previous work has focused on the impact of socioeconomic status on mortality, hospital stay, or complications. However, individuals with low socioeconomic status are also likely to have fewer supports to facilitate them remaining at home after hospital discharge. Thus, such patients may be less likely to return home over the short and intermediate term after major surgery. The newly validated outcome, days alive and out of hospital, may be highly suited to evaluating the impact of socioeconomic status on this postdischarge period. The study aimed to determine the association of socioeconomic status with short and intermediate term postoperative recovery as measured by days alive and out of hospital. METHODS The authors evaluated data from 724,459 adult patients who had one of 13 elective major noncardiac surgical procedures between 2006 and 2017. Socioeconomic status was measured by median neighborhood household income (categorized into quintiles). Primary outcome was days alive and out of hospital at 30 days, while secondary outcomes included days alive and out of hospital at 90 and 180 days, and 30-day mortality. RESULTS Compared to the highest income quintile, individuals in the lowest quintile had higher unadjusted risks of postoperative complications (6,049 of 121,099 [5%] vs. 6,216 of 160,495 [3.9%]) and 30-day mortality (731 of 121,099 [0.6%] vs. 701 of 160,495 [0.4%]) and longer mean postoperative length of stay (4.9 vs. 4.4 days). From lowest to highest income quintile, the mean adjusted days alive and out of hospital at 30 days after surgery varied between 24.5 to 24.9 days. CONCLUSIONS Low socioeconomic status is associated with fewer days alive and out of hospital after surgery. Further research is needed to examine the underlying mechanisms and develop posthospital interventions to improve postoperative recovery in patients with fewer socioeconomic resources.
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Characteristics and outcome of severe traumatic brain injuries based on occupational status. Eur J Trauma Emerg Surg 2020; 47:2035-2041. [PMID: 32306121 PMCID: PMC8629783 DOI: 10.1007/s00068-020-01372-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/06/2020] [Indexed: 11/17/2022]
Abstract
Purpose The association of TBI with socioeconomic characteristics of patients has not been studied extensively. The objective of this study was to analyse the differences in injury characteristics and outcome in TBI patients based on their occupational status. Methods Data on patients from 13 centres based in Austria, Croatia, Slovakia, Bosnia and Herzegovina, and Macedonia were included in the analysis. Demographic characteristics, injury characteristics, treatment and outcome at various post-injury stages were compared according to occupational status. Logistic regression was used to adjust for the effect of co-variates. ICU mortality, hospital mortality, 6 months mortality, and outcome at 6 months were used as dependent variables. Results Overall, 886 patients were analysed with a mean age of 45.5 years. High-level falls were most prevalent in the blue-collar group (19%), most low-level falls occurred in the retired group. Traffic accidents were most common in students. The injuries were most severe in the blue-collar group and students. Highest mortalities and unfavourable outcomes were in the retired, students and white-collar workers had the best outcomes. Compared to retired patients, all groups had higher odds of favourable outcome at 6 months after adjusting for co-variates—OR from 2.2 (95% CI 1.1–4.6) for entrepreneurs to 3.6 (95% CI 1.8–7.2) for the blue-collar group. Conclusion Our paper provides clues pertaining specifically to variations in patterns and outcomes of TBI according to occupational status which can inform prevention and planning of services and can serve to plan priorities for further research.
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Heathcote K, Wullschleger M, Gardiner B, Morgan G, Barbagello H, Sun J. The Importance of Place of Residence on Hospitalized Outcomes for Severely Injured Trauma Patients: A Trauma Registry Analysis. J Rural Health 2019; 36:381-393. [PMID: 31840316 DOI: 10.1111/jrh.12407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Socioecological factors are understudied in relation to trauma patients' outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality. METHODS A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to individual patient variables. Step-wise multivariable negative binomial regression and proportional hazards regression analyses were undertaken, adjusting for injury and patient factors. Outcomes were ALSD and inpatient mortality. FINDINGS We analyzed 1,025 patients. Statistically significant increased hazard of inpatient mortality was found for older age (HR 3.53, 95% CI: 1.77-7.11), injury severity (HR 5.27, 95% CI: 2.78-10.02), remoteness of injury location (HR 1.75, 95% CI: 1.06-2.09), and mechanisms related to intentional self-harm or assault (HR 2.72, 95% CI: 1.48-5.03,). Excess mortality risk was apparent for rural patients sustaining less severe injuries (HR 4.20, 95% CI: 1.35-13.10). Increased risk for longer ALSD was evident for older age (RR 1.35, 95% CI: 1.07-1.71), head injury (RR 1.39, 95% CI: 1.19-1.62), extremity injuries (RR 1.82, 95% CI: 1.55-2.14), and higher injury severity scores (ISS) (RR 1.51, 95%: CI: 1.29-1.76). CONCLUSIONS Severely injured rural trauma patients are more likely to be socioeconomically disadvantaged and sustain injuries predisposing them to worse hospital outcomes. Further research is needed to understand more about care pathways and factors influencing the severity, mechanism and clinical consequences of rural-based traumatic injuries.
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Affiliation(s)
| | - Martin Wullschleger
- Division of Specialty and Procedural Services, Gold Coast University Hospital and School of Medicine, Griffith University, Parkland, Gold Coast, Queensland, Australia
| | - Ben Gardiner
- Division of Specialty and Procedural Services, Gold Coast University Hospital and School of Medicine, Griffith University, Parkland, Gold Coast, Queensland, Australia
| | - Geoffrey Morgan
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Holly Barbagello
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Jing Sun
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Luben R, Hayat S, Khawaja A, Wareham N, Pharoah PP, Khaw KT. Residential area deprivation and risk of subsequent hospital admission in a British population: the EPIC-Norfolk cohort. BMJ Open 2019; 9:e031251. [PMID: 31848162 PMCID: PMC6937051 DOI: 10.1136/bmjopen-2019-031251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate whether residential area deprivation index predicts subsequent admissions to hospital and time spent in hospital independently of individual social class and lifestyle factors. DESIGN Prospective population-based study. SETTING The European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) study. PARTICIPANTS 11 214 men and 13 763 women in the general population, aged 40-79 years at recruitment (1993-1997), alive in 1999. MAIN OUTCOME MEASURE Total admissions to hospital and time spent in hospital during a 19-year time period (1999-2018). RESULTS Compared to those with residential Townsend Area Deprivation Index lower than the average for England and Wales, those with a higher than average deprivation index had a higher likelihood of spending >20 days in hospital multivariable adjusted OR 1.18 (95% CI 1.07 to 1.29) and having 7 or more admissions OR 1.11 (95% CI 1.02 to 1.22) after adjustment for age, sex, smoking status, education, social class and body mass index. Occupational social class and educational attainment modified the association between area deprivation and hospitalisation; those with manual social class and lower education level were at greater risk of hospitalisation when living in an area with higher deprivation index (p-interaction=0.025 and 0.020, respectively), while the risk for non-manual and more highly educated participants did not vary greatly by area of residence. CONCLUSION Residential area deprivation predicts future hospitalisations, time spent in hospital and number of admissions, independently of individual social class and education level and other behavioural factors. There are significant interactions such that residential area deprivation has greater impact in those with low education level or manual social class. Conversely, higher education level and social class mitigated the association of area deprivation with hospital usage.
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Affiliation(s)
- Robert Luben
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Shabina Hayat
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Anthony Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Nicholas Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Paul P Pharoah
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
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Kuo LW, Fu CY, Liao CA, Liao CH, Hsieh CH, Wang SY, Chen SW, Cheng CT. Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database. BMJ Open 2019; 9:e032062. [PMID: 31722950 PMCID: PMC6858192 DOI: 10.1136/bmjopen-2019-032062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES: To assess the impact of lower socioeconomic status on the outcome of major torso trauma patients under the single-payer system by the National Health Insurance (NHI) in Taiwan. DESIGN: A nationwide, retrospective cohort study. SETTING: An observational study from the NHI Research Database (NHIRD), involving all the insurees in the NHI. PARTICIPANTS: Patients with major torso trauma (injury severity score ≥16) from 2003 to 2013 in Taiwan were included. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify trauma patients. A total of 64 721 patients were initially identified in the NHIRD. After applying the exclusion criteria, 20 009 patients were included in our statistical analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was in-hospital mortality, and we analysed patients with different income levels and geographic regions. Multiple logistic regression was used to control for confounding variables. RESULTS: In univariate analysis, geographic disparities and low-income level were both risk factors for in-hospital mortality for patients with major torso trauma (p=0.002 and <0.001, respectively). However, in multivariate analysis, only a low-income level remained an independent risk factor for increased in-hospital mortality (p<0.001). CONCLUSION: Even with the NHI, wealth inequity still led to different outcomes for major torso trauma in Taiwan. Health policies must focus on this vulnerable group to eliminate inequality in trauma care.
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Affiliation(s)
- Ling-Wei Kuo
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Chien-An Liao
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Chi-Tung Cheng
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
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Smith RR, Hill DM, Hickerson WL, Velamuri SR. Analysis of factors impacting length of stay in thermal and inhalation injury. Burns 2019; 45:1593-1599. [PMID: 31130323 DOI: 10.1016/j.burns.2019.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Several studies have analyzed single or combinations of variables for impact on length of stay (LOS) in thermally-injured patients. The objective of this study was to evaluate a multitude of established variables and potentially identify novel variables associated with LOS in a single study. METHODS This two-year, retrospective study included all patients admitted to the burn center between January 2015 and December 2016. Exclusions included death during admission, lack of thermal or inhalation injury, age less than 18 years, readmission(s), and if pregnant or incarcerated. Baseline demographics and pertinent data were collected using electronic medical records. Regression analysis was used to determine the most predictive variables. RESULTS Six hundred twenty-nine patients were admitted during the inclusion period and 354 patients remained for analysis after exclusion. Univariable analysis revealed 32 variables significantly associated with LOS. Using multivariable regression, the best-fit baseline demographic model included: percent total body surface area (TBSA) injured, lower/middle socioeconomic status, clotting disorders, anemia, admission serum creatinine, and percent third degree injured (r2 = 0.557). The best-fit combined model (incorporating baseline demographics and early in-hospital variables) included: acute kidney injury, infection and received vasopressor(s), percent TBSA injured, admission serum ethanol level, maximum C-reactive protein, and maximum total bilirubin (r2 = 0.828). CONCLUSIONS There are multiple factors associated with the increased LOS seen in patients with thermal and inhalation injury. This study confirmed and identified novel factors not previously discussed in the literature that were significantly associated with LOS. Expansion of the data submitted to the National Burn Repository and the Burn Quality Improvement Program may be warranted. This study confirms claims from previous studies on inadequacy of current data submitted for benchmarking and under-reimbursement for the care of such a complex population.
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Affiliation(s)
- Rebecca R Smith
- Department of Clinical Pharmacy, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA.
| | - David M Hill
- Department of Clinical Pharmacy, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Burn Research, Firefighters Regional Burn Center, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN 38103, USA.
| | - William L Hickerson
- Department of Plastic Surgery, Firefighters Regional Burn Center, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Plastic Surgery, College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38103, USA.
| | - Sai R Velamuri
- Department of Plastic Surgery, Firefighters Regional Burn Center, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Plastic Surgery, College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38103, USA.
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Abedzadeh-Kalahroudi M, Razi E, Sehat M. The relationship between socioeconomic status and trauma outcomes. J Public Health (Oxf) 2018; 40:e431-e439. [DOI: 10.1093/pubmed/fdy033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/07/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Ebrahim Razi
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mojtaba Sehat
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Beyond DRG: The effect of socio-economic indicators on inpatient resource allocation in Australia. HEALTH POLICY AND TECHNOLOGY 2018. [DOI: 10.1016/j.hlpt.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wong TH, Nadkarni NV, Nguyen HV, Lim GH, Matchar DB, Seow DCC, King NKK, Ong MEH. One-year and three-year mortality prediction in adult major blunt trauma survivors: a National Retrospective Cohort Analysis. Scand J Trauma Resusc Emerg Med 2018; 26:28. [PMID: 29669572 PMCID: PMC5907285 DOI: 10.1186/s13049-018-0497-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Survivors of trauma are at increased risk of dying after discharge. Studies have found that age, head injury, injury severity, falls and co-morbidities predict long-term mortality. The objective of our study was to build a nomogram predictor of 1-year and 3-year mortality for major blunt trauma adult survivors of the index hospitalization. Methods Using data from the Singapore National Trauma Registry, 2011–2013, we analyzed adults aged 18 and over, admitted after blunt injury, with an injury severity score (ISS) of 12 or more, who survived the index hospitalization, linked to death registry data. The study population was randomly divided 60/40 into separate construction and validation datasets, with the model built in the construction dataset, then tested in the validation dataset. Multivariable logistic regression was used to analyze 1-year and 3-year mortality. Results Of the 3414 blunt trauma survivors, 247 (7.2%) died within 1 year, and 551 (16.1%) died within 3 years of injury. Age (OR 1.06, 95% CI 1.05–1.07, p < 0.001), male gender (OR 1.53, 95% CI 1.12–2.10, p < 0.01), low fall from 0.5 m or less (OR 3.48, 95% CI 2.06–5.87, p < 0.001), Charlson comorbidity index of 2 or more (OR 2.26, 95% CI 1.38–3.70, p < 0.01), diabetes (OR 1.31, 95% CI 1.68–2.52, p = 0.04), cancer (OR 1.76, 95% CI 0.94–3.32, p = 0.08), head and neck AIS 3 or more (OR 1.79, 95% CI 1.13–2.84, p = 0.01), length of hospitalization of 30 days or more (OR 1.99, 95% CI 1.02–3.86, p = 0.04) were predictors of 1-year mortality. This model had a c-statistic of 0.85. Similar factors were found significant for the model predictor of 3-year mortality, which had a c-statistic of 0.83. Both models were validated on the second dataset, with an overall accuracy of 0.94 and 0.84 for 1-year and 3-year mortality respectively. Conclusions Adult survivors of major blunt trauma can be risk-stratified at discharge for long-term support.
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Affiliation(s)
- Ting Hway Wong
- Department of General Surgery, Singapore General Hospital / Duke-National University of Singapore Medical School, Outram Road, Singapore, 169608, Republic of Singapore.
| | | | - Hai V Nguyen
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada
| | - Gek Hsiang Lim
- National Registry of Diseases Office, Health Promotion Board, Singapore, Singapore
| | | | - Dennis Chuen Chai Seow
- Department of Geriatric Medicine, Singapore General Hospital / Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Nicolas K K King
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital / Duke-National University of Singapore Medical School, Singapore, Singapore
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