1
|
Bech CB, Svendsen JA, Knudsen AW, Munk T, Beck AM. The association between malnutrition and dehydration in older adults admitted to a geriatric unit: An observational study. Clin Nutr ESPEN 2023; 57:598-605. [PMID: 37739711 DOI: 10.1016/j.clnesp.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIM There is an overlap between the risk factors causing low intake of water and low intake of nutrients, respectively. This study aims to explore the agreement between the assessment of malnutrition and the outcome of low-intake dehydration in a population of older hospitalized patients. METHODS Patients ≥65 years old and hospitalized at the geriatric hospital ward were screened for eligibility within 96 h of admission. Dehydration was assessed with the calculated serum osmolarity ≥295 mmol/L (1.86 × (Na+ + K+) + 1.15 × glucose + urea + 14), and (risk of) malnutrition was assessed with NRS-2002 ≥ 3 points, MNA-SF ≤ 7 points, MNA-LF < 17, MUST ≥ 2 points, and GLIM after screening with NRS-2002 and MNA-LF. Follow-up data regarding exercise rehabilitation, readmissions, and mortality was collected 30 days after discharge. Statistics used were the Chi-squared test, Fishers-exact test, and Wilcoxon signed rank test. RESULTS A total of 114 patients (57% females) were included. Median age 85.5 (IQR 80; 89.25) years. A total of 49 (43%) were dehydrated. Fewer females were dehydrated (F: 42.9% vs. M: 67.7%, p = 0.013). The patients with osmolarity ≥295 mmol/L had a higher median weight (68.3 (IQR 58.5; 78.4) vs. 62 (IQR 51.8; 72.1), p = 0.021) and mid-up-arm circumference (27 (IQR 26; 30) vs. 25.5 (IQR 22.9; 28.3), p = 0.004). No significant difference was found in the prevalence of malnutrition between those with or without dehydration (NRS-2002; 70% vs. 81%, p = 0.174; MNA-SF: 23.1 vs. 23.2%, p = 1.0; MNA-LF: 37.1 vs. 30.2%, p = 0.644; MUST: 24.5 vs. 33.8%, p = 0.308; GLIM after screening with NRS-2002: 84.4 vs. 74.5%, p = 0.405, GLIM after screening with MNA-LF: 74.1 vs. 75.6%, p = 0.438). Kappa values varied around 0 and reflected low agreement. There were no differences in the follow-up data, between those who were normohydrated and those who were dehydrated. CONCLUSION We found low agreement between the assessment of malnutrition and low-intake dehydration in a population of older hospitalized patients. All geriatric patients should therefore be assessed for both conditions.
Collapse
Affiliation(s)
- Camilla Balle Bech
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | | | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | - Tina Munk
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark.
| |
Collapse
|
2
|
Alahakoon C, Thanigaimani S, Seng L, Fernando M, Lazzarini P, Golledge J. Editor's Choice - A Systematic Review and Meta-Analysis of the Incidence and Risk Factors for Re-admission to Hospital in People with Diabetes Related Foot Disease. Eur J Vasc Endovasc Surg 2023; 66:195-202. [PMID: 37182607 DOI: 10.1016/j.ejvs.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The aim of this study was to systematically review the incidence and risk factors for 30 day re-admission to hospital following an index admission to treat diabetes related foot disease (DFD). DATA SOURCES A literature search was conducted using Medline/PubMed, Scopus, Cochrane Library, and CINAHL databases. METHODS The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies that reported the rate of total or DFD related 30 day re-admissions were included. Meta-analysis was performed using a random effects model to calculate the pooled mean (95% confidence interval [CI]) of the proportion of patients re-admitted to hospital within 30 days. Meta-regression was performed to determine the association between risk factors and 30 day re-admission. RESULTS Sixteen retrospective studies with a total of 124 683 participants were included. The mean total 30 day re-admission rate was 22.0% (95% CI 17.0 - 27.0%) while the mean DFD related 30 day re-admission rate was 10.0% (95% CI 7.0 - 15.0%). Meta-regression found that greater prevalence of peripheral neuropathy (p = .045) was associated with a higher rate of any 30 day re-admission, and male sex (p = .023) and private health insurance (p = .048) were associated with lower rates of any 30 day re-admission. Coronary artery disease (p= .025) was associated with a higher rate of DFD related re-admission. All studies had low or moderate risk of bias. CONCLUSION This systematic review suggested that about one fifth of patients with DFD are re-admitted to hospital within 30 days, of which about half are to treat DFD. Risk factors for re-admission included female gender, peripheral neuropathy, lack of private health insurance, and coronary artery disease.
Collapse
Affiliation(s)
- Chanika Alahakoon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Shivshankar Thanigaimani
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Malindu Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, New South Wales, Australia
| | - Peter Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.
| |
Collapse
|
3
|
McPeake J, Blayney M, Stewart N, Kaye C, Chan Seem R, Hall R, Martin C, Paton M, Wise A, Puxty K, Lone N. COVID-19 infection and maternal morbidity in critical care units in Scotland: a national cohort study. Int J Obstet Anesth 2023; 53:103613. [PMID: 36564271 PMCID: PMC9715259 DOI: 10.1016/j.ijoa.2022.103613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Previous research has shown that, in comparison with non-pregnant women of reproductive age, pregnant women with COVID-19 are more likely to be admitted to critical care, receive invasive ventilation, and die. At present there are limited data in relation to outcomes and healthcare utilisation following hospital discharge of pregnant and recently pregnant women admitted to critical care. METHODS A national cohort study of pregnant and recently pregnant women who were admitted to critical care in Scotland with confirmed or suspected COVID-19. We examined hospital outcomes as well as hospital re-admission rates. RESULTS Between March 2020 and March 2022, 75 pregnant or recently pregnant women with laboratory-confirmed COVID-19 were admitted to 24 Intensive Care Units across Scotland. Almost two thirds (n=49, 65%) were from the most deprived socio-economic areas. Complete 90-day acute hospital re-admission data were available for 74 (99%) patients. Nine (12%) women required an emergency non-obstetric hospital re-admission within 90 days. Less than 5% of the cohort had received any form of vaccination. CONCLUSIONS This national cohort study has demonstrated that pregnant or recently pregnant women admitted to critical care with COVID-19 were more likely to reside in areas of socio-economic deprivation, and fewer than 5% of the cohort had received any form of vaccination. More targeted public health campaigning across the socio-economic gradient is urgently required.
Collapse
Affiliation(s)
- J. McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, UK,Corresponding author at: Glasgow Royal Infirmary, 84 Castle St., Glasgow, G4 OSF, UK
| | - M.C. Blayney
- Usher Institute, University of Edinburgh, UK,Public Health Scotland, UK
| | | | | | | | | | | | | | | | - K. Puxty
- NHS Greater Glasgow and Clyde, UK,University of Glasgow, School of Medicine, Dentistry and Nursing, Scotland, UK
| | - N.I. Lone
- Usher Institute, University of Edinburgh, UK,NHS Lothian, Scotland, UK
| | | |
Collapse
|
4
|
Ziga M, Burla L, Imhof A, Gürtler T, Weber M. Inguinal hernia treatment in Switzerland: inpatient vs. outpatient setting - HerStAmb Study (prospective observational two-centre comparative study). Langenbecks Arch Surg 2023; 408:14. [PMID: 36622458 DOI: 10.1007/s00423-023-02766-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/27/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Since 01/2018, AVOS (ambulant vor stationär = outpatient to inpatient) regulation has been progressively implemented in hernia surgery in Switzerland. The aim of this prospective, observational, two-centre comparative study was to compare the outcome of outpatient and inpatient post-operative care in terms of AVOS by examining the re-admission rate, complication rate and quality of life in patients with primary unilateral inguinal hernia repair. METHODS The study ran between 01/2019 and 04/2020 and included 237 patients with a primary unilateral inguinal hernia. Treatment setting was decided according to AVOS guidelines. Primary endpoint was re-admission rate within 6 weeks postoperatively. Secondary endpoints were the complication rate and patient outcome (quality of life) at 6 weeks follow-up postoperatively, as measured by the Short Form 36 Health Survey Questionnaire (SF-36). RESULTS Complications occurred in 11 (14%) inpatient patients, but none required re-admitting for revision until follow-up at 6 weeks after discharge. In the outpatient group, there were 27 (17%) complications reported, while 6 (4%) of these patients crossed over to the inpatient group immediately after surgery. None of the other complications required re-admission until follow-up at 6 weeks. No significant relationship between treatment setting and number of complications/re-admission rate (p=0.458, p=0.061) was observed. The mean outcome (SF-36) between the treatment groups was not significantly different (p=0.16-0.856). CONCLUSION In terms of AVOS selection criteria in Switzerland, primary unilateral inguinal hernia can be safely treated in both treatment settings. Re-admission rates, complications and quality of life do not significantly differ. Day surgery in terms of AVOS might be as effective and efficient, both from the patient's perspective and that of the institution. TRIAL REGISTRATION NUMBER NCT05234242.
Collapse
Affiliation(s)
- Michal Ziga
- Department of Surgery, Cantonal Hospital Schaffhausen, Geisbergstrasse 81, CH-8208, Schaffhausen, Switzerland.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
| | - Laurin Burla
- Department of Visceral-, Thoracic- and Vascular Surgery, Triemli City Hospital, Birmensdorferstrasse 497, CH-8063, Zurich, Switzerland
| | - Adrienne Imhof
- Department of Surgery, Cantonal Hospital Schaffhausen, Geisbergstrasse 81, CH-8208, Schaffhausen, Switzerland
| | - Thomas Gürtler
- Department of Visceral-, Thoracic- and Vascular Surgery, Triemli City Hospital, Birmensdorferstrasse 497, CH-8063, Zurich, Switzerland
| | - Markus Weber
- Department of Visceral-, Thoracic- and Vascular Surgery, Triemli City Hospital, Birmensdorferstrasse 497, CH-8063, Zurich, Switzerland
| |
Collapse
|
5
|
Pornrattanakavee P, Srichan T, Seetalarom K, Saichaemchan S, Oer-areemitr N, Prasongsook N. Impact of interprofessional collaborative practice in palliative care on outcomes for advanced cancer inpatients in a resource-limited setting. BMC Palliat Care 2022; 21:229. [PMID: 36581913 PMCID: PMC9798714 DOI: 10.1186/s12904-022-01121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/16/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Palliative care for patients with advanced cancer improves suffering symptoms, and quality of life (QoL). However, routine implementation of palliative care by specialty palliative care consultation is still an unmet need among in-patients with advanced cancer. Our study aim is to evaluate the effectiveness of a team-based approach on QoLs and readmission rate when compared to routine practice by among medical oncologists. METHODS This study was a prospective, Quasi-Experimental design. In-patients with advanced cancer were non-randomly assigned to receive palliative care service by team-based approach or medical oncologists only. The primary endpoint was QoL. The secondary endpoint was the readmission rate at 7 and 30 days of hospital discharge. RESULTS One hundred twenty-two in-patients were enrolled. In-patients who were assessed by a team-based approach had significantly improved change scores of subjective well-being (SWB) when compared to another group (∆ SWB: -1 [-19 - 11] vs 0 [-9 - 15], p-value = 0.043). Furthermore, patients who were assessed under a team-based approach had significantly decreased in terms of readmission rate at 7 days of hospital discharge (4.92% in the team-based approach group vs. 19.67% in the medical oncologist group, p-value = 0.013). CONCLUSIONS Interdisciplinary collaboration is the key to success in establishing goals of care, which are supporting the best possible QoL and relieving suffering symptoms for those in-patients with advanced cancer. Furthermore, the readmission rate at 7 days of hospital discharge was significantly reduced by a team-based approach. Therefore, comprehensive palliative care assessment by interprofessional collaborative practice is required. TRIAL REGISTRATION Thai Clinical Trials Registry (TCTR): number 20200312001. Date of first registration on 09/03/2020.
Collapse
Affiliation(s)
- Pitchayapa Pornrattanakavee
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Tassaya Srichan
- grid.414965.b0000 0004 0576 1212Division of Nursing, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Kasan Seetalarom
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Siriwimon Saichaemchan
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Nittha Oer-areemitr
- grid.414965.b0000 0004 0576 1212Division of Pulmonary and Critical Care Medicine, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Naiyarat Prasongsook
- grid.414965.b0000 0004 0576 1212Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| |
Collapse
|
6
|
Howard M, Staples JN, Nelamangala S, Kling C, Duska LR. Evaluating the risk of post-operative abscess formation following use of hemostatic agents at time of hysterectomy. Gynecol Oncol Rep 2022; 44:101085. [PMID: 36277030 PMCID: PMC9583097 DOI: 10.1016/j.gore.2022.101085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Use of hemostatic agent at time of hysterectomy is not associated with post-operative abscess formation in this small study. Hemostatic agent use is associated with increased post-operative emergency room visits and readmissions. Overuse of hemostatic agents at time of hysterectomy may contribute to post-operative adverse events.
Objective At an academic institution in rural Virginia, we noticed a trend of increased re-admissions for postoperative pelvic abscesses. The primary study objective was to determine if intraoperative use of hemostatic agents (HA) was associated with postoperative abscess formation in patients undergoing hysterectomy. Methods Retrospective chart review identified women who underwent hysterectomy by a Gynecologic Oncologist for any indication at a single institution from January 1, 2019 through December 31, 2019. Patient and surgical characteristics were abstracted and comparisons were made among those who received any HA and those that did not. The relationship between intraoperative HA use and postoperative pelvic abscess formation was determined using multivariate logistic regression. Secondary outcomes evaluated included the presence of other major post-operative adverse events. Results 428 hysterectomies were identified with a postoperative pelvic abscess rate of 3.7 %. Abscesses were identified in 4 (2.2 %) of cases without vs 12 (4.9 %) of cases with HA use with a logistic regression model demonstrating no significant difference in the groups (OR = 2.10, p = 0.22). Data showed an increase in presentation to the Emergency Department (ED) (OR = 3.43, p = 0.002 adjusted) and higher odds of readmission within 30 days of surgery (OR = 3.19, p = 0.03) with HA use. Conclusions No association was found between HA use and abscess formation; however, data showed HA use was associated with increased odds of presentation to the ED and readmission to the hospital within 30 days of surgery. Given the potential negative impact on patient outcomes, use of these products at time of hysterectomy should be made with careful consideration.
Collapse
Affiliation(s)
- Megan Howard
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| | - Jeanine N. Staples
- Sibley Center for Gynecologic Oncology and Advanced Pelvic Surgery, Sibley Memorial Hospital, Johns Hopkins Medicine, Washington, DC, USA
- Corresponding author at: Sibley Center for Gynecologic Oncology and Advanced Pelvic Surgery, Sibley Memorial Hospital, 5255 Loughboro Rd, NW, Building D, 4th Floor, Washington, DC 20016, USA.
| | - Samhita Nelamangala
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Connell Kling
- Department of Obstetrics and Gynecology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Linda R. Duska
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
7
|
Lee CC, Hsu CC, Lin MH, Chen KH, Wu IW. Hospitalization in patients with dialysis in Taiwan: A nationwide population-based observational study. J Formos Med Assoc 2022; 121 Suppl 1:S39-S46. [PMID: 34998659 DOI: 10.1016/j.jfma.2021.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The hospitalization rate is higher in patients with end-stage kidney disease (ESKD) than in the general population. However, the national estimates in Taiwan remain unclear. Therefore, we investigated the hospitalization rates of ESKD patients in a disease-specific manner from 2010 to 2018 in Taiwan. METHODS This population-based study was conducted using data from the National Health Insurance Research Database. We analyzed the hospitalization rates of patients with ESKD, defined as continuous dialysis for at least three successive months. The first diagnosis at discharge for each hospitalization was defined as the main diagnosis of hospitalization. The hospitalization rate in a certain year was calculated as the number of hospitalizations divided by the number of patients undergoing chronic dialysis in the respective year. RESULTS Hospitalization occurred in half of all prevalent ESKD patients, with an increasing trend over time. The hospitalization rate increased from 964.1 per 1000 person-years in 2010 to 1037.9 per 1000 person-years in 2018. ESKD patients who were male, aged over 75 years, and receiving hemodialysis had higher hospitalization rates. Infection-related hospitalization was the main cause of hospitalization, followed by cardiovascular disease. The 30-day re-admission rate was 19%, and the in-hospital mortality rate was 9%. CONCLUSION Hospitalization rates continued to increase from 2010 to 2018. The high hospitalization rates for infection-related diseases and hemodialysis patients call for further strategies to be developed that reduce the hospitalization burden.
Collapse
Affiliation(s)
- Chin-Chan Lee
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Ming-Huang Lin
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Kuan-Hsing Chen
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - I-Wen Wu
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
8
|
Heo J, Yoon NH, Shin S, Yu SY, Lee M. Effects of the Mental Health and Welfare Law revision on schizophrenia patients in Korea: an interrupted time series analysis. Int J Ment Health Syst 2021; 15:76. [PMID: 34649587 PMCID: PMC8515641 DOI: 10.1186/s13033-021-00499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background High rates of involuntary hospitalization and long lengths of stay have been problematic in Korea. To address these problems, the Mental Health and Welfare Law was revised in 2016, mainly to protect patient rights by managing involuntary admissions. The aim of this study was to evaluate the impact of the revised Mental Health and Welfare Law on deinstitutionalization by using routinely collected data from hospital admissions and continuity of mental health service use after hospital discharge as proxy measures of deinstitutionalization. Methods We used monthly-aggregated claims-based data with a principal or secondary diagnosis of schizophrenia from 2012 to 2019, collected by the National Health Insurance Service. Outcome variables included rates of first admission; discharges; re-admissions within 7, 30, and 90 days; outpatient visits after discharge within 7 and 30 days; and continuity of visits, at least once a month for 6 months after discharge. Using interrupted time series analysis, we estimated the change in levels and trends of the rates after revision, controlling for baseline level and trend. Results There was no significant change in first admission and discharge rates after the revision. Immediately after the revision, however, the rates of re-admission within 7 and 30 days dropped significantly, by 2.24% and 1.99%, respectively. The slopes of the re-admission rate decreased significantly, by 0.10% and 0.14%, respectively. The slopes of the re-admission rate within 90 days decreased (0.001%). The rates of outpatient visits within 7 and 30 days increased by 1.98% and 2.72%, respectively. The rate of continuous care showed an immediate 4.0% increase. Conclusions The revision had slight but significant effects on deinstitutionalization, especially decreasing short-term re-admission and increasing immediate outpatient service utilization.
Collapse
Affiliation(s)
- Jongho Heo
- National Assembly Futures Institute, National Assembly Member's Hall, 1, Uisadang-daero, Yeongdeungpo-gu, Seoul, 07233, Republic of Korea
| | - Nan-He Yoon
- Division of Social Welfare and Health Administration, Wonkwang University, 460 Iksandae-ro, Iksan, 54538, Republic of Korea
| | - Soyoun Shin
- Seoul National University College of Nursing Seoul, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Soo-Young Yu
- Department of Nursing Science, Jeonju University, 303, Cheonjam-ro, Wansan-gu, Jeonju, Jeollabuk-do, 55069, Republic of Korea
| | - Manwoo Lee
- National Assembly Research Service, 1, Uisadang-daero, Yeongdeungpo-gu, Seoul, 07233, Republic of Korea.
| |
Collapse
|
9
|
McHayle A, Pertsch NJ, Toms SA, Weil RJ. Operative duration and early outcomes in patients having a supratentorial craniotomy for brain tumor: A propensity matched analysis. J Clin Neurosci 2021; 92:207-214. [PMID: 34509254 DOI: 10.1016/j.jocn.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022]
Abstract
It is unclear how variations in operative duration affect outcomes after craniotomy for supratentorial brain tumor. We characterized three populations of patients with typical, shorter, and longer durations of craniotomy for supratentorial brain tumor using prospectively collected clinical data from 16,335 patients in the 2012-2018 ACS National Surgical Quality Improvement Program (NSQIP) database. We compared baseline characteristics including demographics, comorbidities, tumor type, and operative features. We used propensity score matching to attain covariate balance and logistic regression to assess odds of unfavorable outcomes. Patients with the shortest operation durations tended to be older, with fewer males, higher ASA class, more metastatic brain tumors, more medical comorbidities, and less use of intraoperative microscope or ultrasound. Patients with the longest operative durations tended to be younger, with more males, fewer non-white minorities, more obesity, lower ASA classes, more intrinsic brain tumors, fewer medical comorbidities, fewer emergency operations, and increased use of intraoperative microscope. For patients with the shortest operations, after matching, we observed significantly decreased odds of prolonged length-of-stay (LOS), major complication, any complication, reoperation, and discharge to a facility; however, there was a significantly increased risk of 30-day mortality. For patients with the longest operations, after matching, we observed significantly increased odds of prolonged LOS; minor, major, and any complication; discharge to facility; and 30-day reoperation. After matching to balance baseline characteristics, operative duration has implications for outcomes following craniotomy for supratentorial brain tumor.
Collapse
Affiliation(s)
- Allison McHayle
- The Warren Alpert School of Medicine, Brown University, Providence, RI, United States.
| | - Nathan J Pertsch
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States
| | - Steven A Toms
- The Warren Alpert School of Medicine, Brown University, Providence, RI, United States; Department of Neurosurgery, Rhode Island Hospital, Providence, RI, United States
| | - Robert J Weil
- Department of Neurosurgery, Southcoast Brain & Spine, North Dartmouth, MA, United States
| |
Collapse
|
10
|
Rydwik E, Lindqvist R, Willers C, Carlsson L, Nilsson GH, Lager A, Dreilich M, Lindh Mazya A, Karlsson T, Alinaghizadeh H, Boström AM. Health status and health care utilization after discharge from geriatric in-hospital stay - description of a register-based study. BMC Health Serv Res 2021; 21:760. [PMID: 34332571 PMCID: PMC8325853 DOI: 10.1186/s12913-021-06751-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study is the first part of a register-based research program with the overall aim to increase the knowledge of the health status among geriatric patients and to identify risk factors for readmission in this population. The aim of this study was two-fold: 1) to evaluate the validity of the study cohorts in terms of health care utilization in relation to regional cohorts; 2) to describe the study cohorts in terms of health status and health care utilization after discharge. Methods The project consist of two cohorts with data from patient records of geriatric in-hospital stays, health care utilization data from Stockholm Regional Healthcare Data Warehouse 6 months after discharge, socioeconomic data from Statistics Sweden. The 2012 cohort include 6710 patients and the 2016 cohort, 8091 patients; 64% are women, mean age is 84 (SD 8). Results Mean days to first visit in primary care was 12 (23) and 10 (19) in the 2012 and 2016 cohort, respectively. Readmissions to hospital was 38% in 2012 and 39% in 2016. The validity of the study cohorts was evaluated by comparing them with regional cohorts. The study cohorts were comparable in most cases but there were some significant differences between the study cohorts and the regional cohorts, especially regarding amount and type of primary care. Conclusion The study cohorts seem valid in terms of health care utilization compared to the regional cohorts regarding hospital care, but less so regarding primary care. This will be considered in the analyses and when interpreting data in future studies based on these study cohorts. Future studies will explore factors associated with health status and re-admissions in a population with multi-morbidity and disability.
Collapse
Affiliation(s)
- E Rydwik
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden. .,Stockholm Region Council, FOU nu, Research and Development Center for the Elderly, Järfälla, Sweden. .,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Solna, Sweden.
| | - R Lindqvist
- Department of Learning, Informatics, Management, and Ethics (LIME), Division of Innovative Care Research, Karolinska Institutet, Solna, Sweden
| | - C Willers
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Stockholm Region Council, FOU nu, Research and Development Center for the Elderly, Järfälla, Sweden
| | - L Carlsson
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary care, Karolinska Institutet, Huddinge, Sweden
| | - G H Nilsson
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary care, Karolinska Institutet, Huddinge, Sweden.,Stockholm Region Council, Academic Primary Care Center, Stockholm, Sweden
| | - A Lager
- Stockholm Region Council, Center for Epidemiology and Society, Stockholm, Sweden
| | - M Dreilich
- Advanced Home Care, Familjeläkarna, Stockholm, Sweden
| | - A Lindh Mazya
- Department of Neurobiology, Care Sciences and Society, Division of Departmental Geriatrics, Karolinska Institutet, Huddinge, Sweden.,Geriatric Department, Danderyd Hospital, Danderyd, Sweden
| | - T Karlsson
- Stockholm Region Council, Academic Primary Care Center, Stockholm, Sweden
| | - H Alinaghizadeh
- Stockholm Region Council, Academic Primary Care Center, Stockholm, Sweden
| | - A-M Boström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.,Inflammation and Aging Theme, Karolinska University Hospital, Huddinge, Sweden.,Stockholms Sjukhem, R&D unit, Stockholm, Sweden
| |
Collapse
|
11
|
Darveau SC, Pertsch NJ, Toms SA, Weil RJ. Short term outcomes associated with patients requiring blood transfusion following elective laminectomy and fusion for lumbar stenosis: A propensity-matched analysis. J Clin Neurosci 2021; 90:184-190. [PMID: 34275547 DOI: 10.1016/j.jocn.2021.05.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/25/2021] [Accepted: 05/27/2021] [Indexed: 12/01/2022]
Abstract
Perioperative blood transfusion has been associated with poor outcomes but the impacts of transfusion after fusion for lumbar stenosis have not been well-described. We assessed this effect in a large cohort of patients from 2012 to 2018 in the National Surgical Quality Improvement Program (NSQIP). We evaluated baseline characteristics including demographics, comorbidities, hematocrit, and operative characteristics. We generated propensity scores using baseline characteristics and patients were matched to approximate randomization. We assessed odds of 30-day outcomes including prolonged length-of-stay (LOS), complications, discharge to facility, readmission, reoperation, and death using logistic regression. We identified 16,329 eligible patients who underwent lumbar fusion for stenosis; 1,926 (11.8%) received a transfusion. Before matching, there were multiple differences in baseline covariates including age, gender, BMI, ASA class, medical comorbidities, hematocrit, coagulation indices, platelets, operative time, fusion technique, number of levels fused, and osteotomy. However, after matching, no significant differences remained. In the matched cohorts, transfusion was associated with increased prolonged LOS (OR 1.66, 95% CI 1.45-1.91, p < 0.001), minor complication (OR 1.60, 95% CI 1.20-2.12, p = 0.001), major complication (OR 1.51, 95% CI 1.16-1.98, p = 0.003), any complication (OR 1.54, 95% CI 1.24-1.92, p < 0.001), discharge to facility (OR 1.70, 95% CI 1.48-1.95, p < 0.001), 30-day readmission (OR 1.56, 95% CI 1.23-1.99, p < 0.001), and 30-day reoperation (OR 1.85, 95% CI 1.35-2.53, p < 0.001). Although transfusion is performed based on perceived clinical need, this study contributes to growing evidence that it is important to balance the risks of perioperative blood transfusion with its benefits.
Collapse
Affiliation(s)
- Spencer C Darveau
- The Warren Alpert School of Medicine, Brown University, Providence, RI, United States.
| | - Nathan J Pertsch
- The Warren Alpert School of Medicine, Brown University, Providence, RI, United States
| | - Steven A Toms
- The Warren Alpert School of Medicine, Brown University, Providence, RI, United States; Department of Neurosurgery, Rhode Island Hospital, Providence, RI, United States
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, United States
| |
Collapse
|
12
|
Fahmy M, Sylvester KW, Migliore M, Eguale T, Fanikos J, Connors JM, Goldhaber SZ. Extended duration venous thromboembolism prophylaxis with betrixaban for patients re-admitted with venous thromboembolism. J Thromb Thrombolysis 2021; 52:22-9. [PMID: 33835335 DOI: 10.1007/s11239-021-02376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 10/21/2022]
Abstract
Patients hospitalized for an acute medical illness remain at risk of developing venous thromboembolism (VTE) post-discharge. Betrixaban, an oral direct Factor Xa inhibitor, is approved for extended VTE thromboprophylaxis in acutely ill medical patients. The primary objective of this study was to evaluate patients re-admitted with VTE within 30 days of discharge to determine if they would have been eligible for extended duration VTE prophylaxis during the index admission. We used three different sets of eligibility criteria: the APEX study criteria, the Bevyxxa® (betrixaban) package insert, and Mass General Brigham HealthCare System's Center for Drug Policy Guidelines. A secondary aim was to describe the reasons for ineligibility. Within 30 days of the index hospital admission, 226 patients were re-admitted with new VTE between January 2017 and December 2018. Of these, 134 (59%) were excluded based on pre-defined exclusion criteria. Of the remaining 92, 22 patients (23.9%) were eligible based on the APEX study criteria, 26 patients (28.2%) based on Mass General Brigham HealthCare System's Center for Drug Policy Guidelines, and 92 patients (100%) based on the Bevyxxa® package insert. There were 22 patients (23.9%) who were eligible for VTE prophylaxis with betrixaban based on all three criteria. Appropriate betrixaban use may have prevented some of the VTE events and re-admissions that occurred within 30 days of initial hospital discharge.
Collapse
|
13
|
Abstract
INTRODUCTION Grade III hemorrhoidal disease may require surgical treatment. Several minimally invasive techniques can be offered to the patient, particularly ligation of the hemorrhoidal arteries/mucopexy or even stapled hemorrhoidopexy. A technique of radiofrequency thermocoagulation of hemorrhoids has recently been introduced. The aim of our study was to assess the efficacy and early morbidity of this procedure. METHODS Data from successive patients undergoing radiofrequency thermocoagulation for grade II to IV hemorrhoidal disease between December 2017 and December 2019 were retrospectively collated. RESULTS Seventy-four patients, with a mean age of 53 years, underwent operation during the study period. The major indication was grade III hemorrhoidal disease in 95% of patients. More than 80% of patients underwent operation as an outpatient. Eighteen (24.3%) patients developed a postoperative complication within 30 days, of whom two (2.7%) required revisional surgery for rectal bleeding and severe anal pain, respectively. Seven (9.5%) patients were re-admitted to hospital and 18 (24.3%) had an unscheduled early return visit within 30 postoperative days. At three months following surgery, the anatomical and functional result was satisfactory in more than 93% of patients. CONCLUSION Radiofrequency hemorrhoidal thermocoagulation is an effective technique in the treatment of grade III hemorrhoidal disease. Despite a non-negligible rate of minor postoperative complications requiring an early consultation or re-hospitalisation, severe complications occurred in less than 3% of operated patients.
Collapse
Affiliation(s)
- F Drissi
- Digestive surgery department, Vendée departmental hospital, Les Oudairies, 85000 La-Roche-sur-Yon, France.
| | - M-H Jean
- Digestive surgery department, Vendée departmental hospital, Les Oudairies, 85000 La-Roche-sur-Yon, France
| | - E Abet
- Digestive surgery department, Vendée departmental hospital, Les Oudairies, 85000 La-Roche-sur-Yon, France
| |
Collapse
|
14
|
Ambler GK, Kotta PA, Zielinski L, Kalyanasundaram A, Brooks DE, Ali A, Chowdhury MM, Coughlin PA. The Effect of Frailty on Long Term Outcomes in Vascular Surgical Patients. Eur J Vasc Endovasc Surg 2020; 60:264-272. [PMID: 32417030 DOI: 10.1016/j.ejvs.2020.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/13/2020] [Accepted: 04/08/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Frailty is a multidimensional vulnerability due to age associated decline. The impact of frailty on long term outcomes was assessed in a cohort of vascular surgical patients. METHODS Patients aged over 65 years with a length of stay greater than two days admitted to a tertiary vascular unit over a single calendar year were included. Demographics, mode of admission, and diagnosis were recorded alongside a variety of frailty specific characteristics. Using the previously developed Addenbrookes Vascular Frailty Score (AVFS - 6 point score: anaemia on admission, lack of independent mobility, polypharmacy, Waterlow score > 13, depression, and emergency admission) the effect of frailty on five year mortality and re-admission rates was assessed using multivariable regression techniques. The AVFS was further refined to assess longer term outcomes. RESULTS In total, 410 patients (median age 77 years) were included and followed up until death or five years from the index admission. One hundred and thirty-four were treated for aortic aneurysm, 75 and 96 for acute and chronic limb ischaemia respectively, 52 for carotid disease, and 53 for other pathologies. The in hospital mortality rate was 3.6%. The one, three, and five year survival rates were 83%, 70% and 59%; and the one, three, and five year re-admission free survival rates were 47%, 29%, and 22% respectively. Independent predictors of five year mortality were age, lack of independent mobility, high Charlson score, polypharmacy, evidence of malnutrition, and emergency admission (p < .010 for all). Patients with AVFS 0 or 1 had restricted mean survival times which were one year longer than those with AVFS 2 or 3 (p < .001), who in turn had restricted mean survival times over one year longer than those with AVFS of 4 or more (p < .001). CONCLUSION Frailty factors are strong predictors of long term outcomes in vascular surgery. Further prospective studies are warranted to investigate its utility in clinical decision making.
Collapse
Affiliation(s)
- Graeme K Ambler
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Prasanti A Kotta
- University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Lukasz Zielinski
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David E Brooks
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Amjad Ali
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mohammed M Chowdhury
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Patrick A Coughlin
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| |
Collapse
|
15
|
Li DJ, Lin CH, Wu HC. Factors predicting re-hospitalization for inpatients with bipolar mania--A naturalistic cohort. Psychiatry Res 2018; 270:749-754. [PMID: 30551320 DOI: 10.1016/j.psychres.2018.10.073] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/21/2018] [Accepted: 10/27/2018] [Indexed: 01/21/2023]
Abstract
Patients with bipolar mania often require re-hospitalization, which can be a social-economic burden. This study aimed to investigate the factors affecting time to re-hospitalization for inpatients with acute bipolar mania. In this 6-year naturalistic study we reviewed the charts of inpatients with acute bipolar mania. Potential dichotomous factors including sex, family history of affective disorder, suicide history, and discharge against medical advice, involuntary admission, psychotic features, substance use disorder, and remission at discharge were recorded. Continuous variables including age, age at onset of affective episodes, and number of previous hospitalizations were also recorded. We used survival analysis with a univariate Cox proportional hazard regression model, along with forward multivariate model, to identify the potential factors. Of the 165 patients, 23% achieved symptomatic remission at discharge. In the forward Cox model, psychotic features, discharge against medical advice and higher number of previous hospitalizations were significant risk factors for re-admission. Remission at discharge was significantly associated with preventing re-hospitalization. We identified several predictors for re-hospitalization among inpatients with bipolar mania. Further studies are needed in other real-world settings to validate our results.
Collapse
Affiliation(s)
- Dian-Jeng Li
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chi Wu
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
| |
Collapse
|
16
|
Slullitel PA, Estefan M, Ramírez-Serrudo WM, Comba FM, Zanotti G, Piccaluga F, Buttaro MA. Re-admissions treble the risk of late mortality after primary total hip arthroplasty. Int Orthop 2018. [PMID: 29525914 DOI: 10.1007/s00264-018-3876-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Following a total hip arthroplasty (THA), early hospital re-admission rates of 3-11% are considered as 'acceptable' in terms of medical care cost policies. Surprisingly, the impact of re-admissions on mortality has not been priorly portrayed. Therefore, we sought to determine the mortality rate after 90-day re-admissions following a THA in a series of patients from a captive medical care program. PATIENTS AND METHODS We prospectively analysed 90-day readmissions of 815 unilateral, elective THA patients operated upon between 2010 and 2014 whose medical care was the one offered by our institution. We stratified our sample into readmitted and non-readmitted cohorts. Through a Cox proportional hazards model, we compared demographic characteristics, clinical comorbidities, surgical outcomes and laboratory values between both groups in order to determine association with early and late mortality. RESULTS We found 37 (4.53%) re-admissions at a median time of 40.44 days (IQR 17.46-60.69). Factors associated with re-admission were hospital stay (p = 0.00); surgical time (p = 0.01); chronic renal insufficiency (p = 0.03); ASA class 4 (p = 0.00); morbid obesity (p = 0.006); diabetes (p = 0.04) and a high Charlson index (p = 0.00). Overall mortality rate of the series was 3.31% (27/815). Median time to mortality was 455.5 days (IQR 297.58-1170.65). One-third (11/37) of the re-admitted patients died, being sepsis non-related to the THA the most common cause of death. After adjusting for confounders, 90-day re-admissions remained associated with mortality with an adjusted HR of 3.14 (CI95% 1.05-9.36, p = 0.04). CONCLUSIONS Unplanned re-admissions were an independent risk factor for future mortality, increasing three times the risk of mortality.
Collapse
Affiliation(s)
- Pablo A Slullitel
- Hip Surgery Unit, 'Carlos E. Ottolenghi' Institute of Orthopaedics, Italian Hospital of Buenos Aires, 4247 Potosi St, ACK1199, Buenos Aires, Argentina.
| | - Martín Estefan
- Hip Surgery Unit, 'Carlos E. Ottolenghi' Institute of Orthopaedics, Italian Hospital of Buenos Aires, 4247 Potosi St, ACK1199, Buenos Aires, Argentina
| | - Wilber M Ramírez-Serrudo
- Hip Surgery Unit, 'Carlos E. Ottolenghi' Institute of Orthopaedics, Italian Hospital of Buenos Aires, 4247 Potosi St, ACK1199, Buenos Aires, Argentina
| | - Fernando M Comba
- Hip Surgery Unit, 'Carlos E. Ottolenghi' Institute of Orthopaedics, Italian Hospital of Buenos Aires, 4247 Potosi St, ACK1199, Buenos Aires, Argentina
| | - Gerardo Zanotti
- Hip Surgery Unit, 'Carlos E. Ottolenghi' Institute of Orthopaedics, Italian Hospital of Buenos Aires, 4247 Potosi St, ACK1199, Buenos Aires, Argentina
| | - Francisco Piccaluga
- Hip Surgery Unit, 'Carlos E. Ottolenghi' Institute of Orthopaedics, Italian Hospital of Buenos Aires, 4247 Potosi St, ACK1199, Buenos Aires, Argentina
| | - Martín A Buttaro
- Hip Surgery Unit, 'Carlos E. Ottolenghi' Institute of Orthopaedics, Italian Hospital of Buenos Aires, 4247 Potosi St, ACK1199, Buenos Aires, Argentina
| |
Collapse
|
17
|
Stone AV, Jinnah A, Wells BJ, Atkinson H, Miller AN, Futrell WM, Lenoir K, Emory CL. Nutritional markers may identify patients with greater risk of re-admission after geriatric hip fractures. Int Orthop 2017; 42:231-238. [PMID: 28988402 DOI: 10.1007/s00264-017-3663-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/24/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE Osteoporotic hip fractures are increasing in prevalence with the growing elderly population. Morbidity and mortality remain high following osteoporotic hip fractures despite advances in medical and surgical treatments. The associated costs and medical burdens are increased with a re-admission following hip fracture treatment. This study sought to identify demographic and clinical values that may be a predictive model for 30-day re-admission risk following operative management of an isolated hip fracture. METHODS Between January 1, 2013 and April 30, 2015 all patients admitted to a single academic medical centre for treatment of a hip fracture were reviewed. Candidate variables included standard demographics, common laboratory values, and markers of comorbid conditions and nutrition status. A 30-day, all-cause re-admission model was created utilizing multivariate logistic regression. RESULTS A total of 607 patients with hip fractures were identified and met the inclusion criteria; of those patients, 67 were re-admitted within 30 days. Univariate analysis indicates that the re-admission group had more comorbidities (p < 0.001) and lower albumin (p = 0.038) and prealbumin (p < 0.001). The final, reduced model contained 12 variables and incorporated four out of five nutritional makers with an internally, cross-validated C-statistic of 0.811 (95% CI: 0.754, 0.867). CONCLUSION Our results indicate that specific nutritional laboratory markers at the index admission may identify patients that have a greater risk of re-admission after hip fracture. This model identifies potentially modifiable risk factors and may allow orthogeriatricians to better educate patients and better treat post-operative nutritional status and care.
Collapse
Affiliation(s)
- Austin V Stone
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alexander Jinnah
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
| | - Brian J Wells
- Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Family Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Public Health Sciences, Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, NC, USA
| | - Hal Atkinson
- Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna N Miller
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Wendell M Futrell
- Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kristin Lenoir
- Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Cynthia L Emory
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| |
Collapse
|
18
|
Basques BA, Erickson BJ, Leroux T, Griffin JW, Frank RM, Verma NN, Romeo AA. Comparative outcomes of outpatient and inpatient total shoulder arthroplasty: an analysis of the Medicare dataset. Bone Joint J 2017; 99-B:934-938. [PMID: 28663400 DOI: 10.1302/0301-620x.99b7.bjj-2016-0976.r1] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/22/2017] [Indexed: 12/14/2022]
Abstract
AIMS The aim of the present study was to compare the 30- and 90-day re-admission rates and complication rates of outpatient and inpatient total shoulder arthroplasty (TSA). PATIENTS AND METHODS The United States Medicare Standard Analytical Files database was questioned to identify patients who had undergone outpatient or inpatient TSA between 2005 and 2012. Patient characteristics were compared between the two groups using chi-squared analysis. Multivariate logistic regression analysis was used to control for differences in baseline patient characteristics and to compare the two groups in terms of post-operative complications within 90 days and re-admission within 30 days and 90 days. RESULTS A total of 123 347 Medicare subscribers underwent TSA between 2005 and 2012; 3493 (2.8%) had the procedure performed as an outpatient. A significantly greater proportion of patients who underwent TSA as inpatients were women, had a history of smoking, and had a greater incidence of medical comorbidity including diabetes, coronary artery disease, congestive heart failure, and chronic kidney disease (p < 0.05 for all). Re-admission rates were significantly higher for inpatients at both 30 days (0.83% versus 0.60%, p = 0.016, odds ratio 1.8) and 90 days (2.87% versus 2.04%, p < 0.001, odds ratio 1.8). Complications, including thromboembolic events (p < 0.001) and surgical site infection (p = 0.002), were significantly higher in inpatients. CONCLUSION Patients who underwent TSA on an outpatient basis were overall younger and healthier than those who had inpatient surgery, which suggests that patient selection was taking place. After controlling for age, gender, and medical conditions, patients who underwent TSA as outpatients had lower rates of 30- and 90-day re-admission and a lower rate of complications than inpatients. Cite this article: Bone Joint J 2017;99-B:934-8.
Collapse
Affiliation(s)
- B A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA
| | - B J Erickson
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA
| | - T Leroux
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA
| | - J W Griffin
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA
| | - R M Frank
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA
| | - N N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA
| | - A A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA
| |
Collapse
|
19
|
Lodhi MK, Ansari R, Yao Y, Keenan GM, Wilkie D, Khokhar AA. Predicting Hospital Re-admissions from Nursing Care Data of Hospitalized Patients. ACTA ACUST UNITED AC 2017; 2017:181-193. [PMID: 29104962 DOI: 10.1007/978-3-319-62701-4_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Readmission rates in the hospitals are increasingly being used as a benchmark to determine the quality of healthcare delivery to hospitalized patients. Around three-fourths of all hospital re-admissions can be avoided, saving billions of dollars. Many hospitals have now deployed electronic health record (EHR) systems that can be used to study issues that trigger readmission.However, most of the EHRs are high dimensional and sparsely populated, and analyzing such data sets is a Big Data challenge. The effect of some of the well-known dimension reduction techniques is minimized due to presence of non-linear variables. We use association mining as a dimension reduction method and the results are used to develop models, using data from an existing nursing EHR system, for predicting risk of re-admission to the hospitals. These models can help in determining effective treatments for patients to minimize the possibility of re-admission, bringing down the cost and increasing the quality of care provided to the patients. Results from the models show significantly accurate predictions of patient re-admission.
Collapse
|
20
|
Soni A, Kadam S, Pandit A, Patole S. Early Discharge of Preterm Infants- An Indian Perspective. J Clin Diagn Res 2016; 10:SC21-SC23. [PMID: 28208967 DOI: 10.7860/jcdr/2016/21176.9110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Early home discharge of preterm infants is a priority in developing countries due to bed shortage and poor socio-economic status. There is wide variation in home discharge policies for preterm infants. Limited data exists on optimal timing for discharging such infants. In view of the socio-economic and medico-legal importance of the issue, we aimed to study the outcomes of our ex-preterm infants discharged home 'early', to guide our clinical practice. AIM To study the rates of re-admissions/mortality within 4 weeks after discharge in preterm (born <34 weeks) infants. MATERIALS AND METHODS This was an analysis of retrospectively collected data on all ex-preterm infants (gestation <34 weeks at birth) discharged home from our Neonatal Intensive Care Unit (NICU) during the study period. Infants enrolled were stratified based on their gestation age: Group I (n=54): 26-29 weeks, Group II (n=181): 30-34 weeks. Data on demographic characteristics, hospital course and outcomes were analysed for infants meeting inclusion criteria. Re-admission and/or mortality within 4 weeks after discharge were studied. RESULTS The mean±(SD) duration of stay was 42±19 vs. 19±14 days in group I vs. II infants. Five (2.7%) infants were re-admitted within the first four weeks after discharge in group II; none in group I. CONCLUSION Early home discharge for preterm infants born <34 weeks was feasible and safe in our set-up. Large prospective studies are required to confirm these benefits.
Collapse
Affiliation(s)
- Ankit Soni
- Resident, Division of Neonatology, Department of Paediatrics, King Edward Memorial Hospital , Pune, India
| | - Sandeep Kadam
- Senior Consultant, Department of Paediatrics, King Edward Memorial Hospital , Pune, India
| | - Anand Pandit
- Professor, Department of Paediatrics, King Edward Memorial Hospital , Pune, India
| | - Sanjay Patole
- Professor, Centre for Neonatal Research and Education, University of Western Australia , Perth, Western Australia, Australia
| |
Collapse
|
21
|
Meijide H, Mena Á, Rodríguez-Osorio I, Pértega S, Castro-Iglesias Á, Rodríguez-Martínez G, Pedreira J, Poveda E. Trends in hospital admissions, re-admissions, and in-hospital mortality among HIV-infected patients between 1993 and 2013: Impact of hepatitis C co-infection. Enferm Infecc Microbiol Clin 2016; 35:20-26. [PMID: 27609631 DOI: 10.1016/j.eimc.2016.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND New patterns in epidemiological characteristics of people living with HIV infection (PLWH) and the introduction of Highly Active Antiretroviral Therapy (HAART) have changed the profile of hospital admissions in this population. The aim of this study was to evaluate trends in hospital admissions, re-admissions, and mortality rates in HIV patients and to analyze the role of HCV co-infection. METHODS A retrospective cohort study conducted on all hospital admissions of HIV patients between 1993 and 2013. The study time was divided in two periods (1993-2002 and 2003-2013) to be compared by conducting a comparative cross-sectional analysis. RESULTS A total of 22,901 patient-years were included in the analysis, with 6917 hospital admissions, corresponding to 1937 subjects (75% male, mean age 36±11 years, 37% HIV/HCV co-infected patients). The median length of hospital stay was 8 days (5-16), and the 30-day hospital re-admission rate was 20.1%. A significant decrease in hospital admissions related with infectious and psychiatric diseases was observed in the last period (2003-2013), but there was an increase in those related with malignancies, cardiovascular, gastrointestinal, and chronic respiratory diseases. In-hospital mortality remained high (6.8% in the first period vs. 6.3% in the second one), with a progressive increase of non-AIDS-defining illness deaths (37.9% vs. 68.3%, P<.001). The admission rate significantly dropped after 1996 (4.9% yearly), but it was less pronounced in HCV co-infected patients (1.7% yearly). CONCLUSIONS Hospital admissions due to infectious and psychiatric disorders have decreased, with a significant increase in non-AIDS-defining malignancies, cardiovascular, and chronic respiratory diseases. In-hospital mortality is currently still high, but mainly because of non-AIDS-defining illnesses. HCV co-infection increased the hospital stay and re-admissions during the study period.
Collapse
Affiliation(s)
- Héctor Meijide
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain; Servicio de Medicina Interna, Hospital Quiron, A Coruña, Spain
| | - Álvaro Mena
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain.
| | - Iria Rodríguez-Osorio
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
| | - Sonia Pértega
- Unidad de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
| | - Ángeles Castro-Iglesias
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
| | - Guillermo Rodríguez-Martínez
- Unidad de Admisión y Documentación Clínica, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, A Coruña, Spain
| | - José Pedreira
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
| | - Eva Poveda
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain
| |
Collapse
|
22
|
Buldu I, Tepeler A, Karatag T, Ozyuvali E, Elbir F, Yordam M, Unsal A. Which factors affect the hospital re-admission and re-hospitalization after flexible ureterorenoscopy for kidney stone? World J Urol 2016; 34:1291-5. [PMID: 26694186 DOI: 10.1007/s00345-015-1750-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To investigate patient- and procedure-related factors associated with hospital re-admission (HR) and re-hospitalization following flexible ureteroscopy (f-URS). PATIENTS AND METHODS The records of patients who underwent f-URS for renal stones in two reference centers between 2011 and 2015 were examined retrospectively. Patients who were re-admitted to the hospital or re-hospitalized for any reason within 30 days after hospital discharge related to the f-URS procedure were evaluated. The patient- and procedure-related factors affecting the re-admission and re-hospitalization rates were revealed using backward stepwise multiple binary logistic regression analysis. RESULTS The study included 647 patients with a mean age of 46.1 ± 13.7 years. The mean BMI was 27.3 ± 4.6 kg/m(2), and the median ASA score was 1.85. The mean stone diameter was 14.2 ± 5.3 mm. The mean operation and fluoroscopy times were 50.2 ± 16.9 min and 43.1 ± 37.6 s, respectively. The mean hospitalization time was 1.42 ± 0.84 days, and the complication rate was 12.8 % (83/647). Overall, 523 (80.3 %) patients became stone-free, while residual fragments <4 mm were detected in 73 (11.3 %) patients. The procedure failed in 7.9 % of the cases. While 82 (12.7 %) patients were re-admitted, 31 (4.8 %) patients were re-hospitalized for further treatment. Stone-free status was an independent predictor of HR, while the stone-free status, hospitalization time, and postoperative complications all predicted re-hospitalization. CONCLUSIONS We found that inability to achieve stone-free status predicted HR and re-hospitalization, while postoperative complication and prolonged hospitalization also predicted re-hospitalization.
Collapse
|
23
|
Zhao LP, Kofidis T, Chan SP, Ong TH, Yeo TC, Tan HC, Lee CH. Sleep apnoea and unscheduled re-admission in patients undergoing coronary artery bypass surgery. Atherosclerosis 2015; 242:128-34. [PMID: 26188535 DOI: 10.1016/j.atherosclerosis.2015.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 07/01/2015] [Accepted: 07/02/2015] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Although it has been recognised as a cardiovascular risk factor, data on sleep apnoea screening before coronary artery bypass grafting (CABG) are scarce. This study sought to determine the prevalence, predictors and effects of sleep apnoea on re-admission in patients undergoing CABG. METHOD We prospectively recruited 152 patients to undergo an overnight sleep study before CABG. Sleep apnoea was defined as an apnoea-hypopnoea index of ≥15 events per hour. Data on unscheduled re-admission due to cardiovascular events were collected. RESULTS Among the 138 patients who completed the sleep study, sleep apnoea was diagnosed in 69 (50%). The patients who had sleep apnoea had a lower left ventricular ejection fraction (p = 0.029), a larger left atrial diameter (p = 0.014) and a larger left ventricular end-systolic dimension (p = 0.019) than those who did not. Angiographic SYNTAX and Gensini scores were similar in patients with and without sleep apnoea. The generalised structural equation model revealed that hypertension, a high body mass index and chronic renal failure were independent predictors of sleep apnoea (p < 0.05). After an average follow-up of 6 ± 3 months, 12 patients with sleep apnoea (17.3%) and three patients without sleep apnoea (4.3%) were involved in unscheduled re-admission. Patients with sleep apnoea were almost five times more likely to have an unscheduled re-admission due to cardiovascular events (adjusted odds ratio: 4.63, 95% CI: 1.24-17.31, p = 0.023) than those without sleep apnoea. CONCLUSIONS Sleep apnoea was prevalent and predictive of unscheduled re-admissions in patients scheduled for CABG.
Collapse
|
24
|
van Tuijn CF, Prins M, Luitse JS, Geerlings SE. Prognostic factors for important clinical outcomes in patients with a severe infection. Int J Emerg Med 2010; 3:293-8. [PMID: 21373295 DOI: 10.1007/s12245-010-0220-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 07/05/2010] [Indexed: 11/25/2022] Open
Abstract
Background Patients who are admitted with a suspicion of a severe infection usually enter the hospital through the emergency department (ED). The recognition of prognostic factors in an early stage affects further treatment and might improve clinical outcomes. Aims We examined possible prognostic factors for four important outcomes: intensive care unit (ICU) admission, positive blood cultures, mortality and re-admission. Methods All adult patients arriving at the ED with a suspected infection for whom admittance and intravenous (iv) antibiotics were indicated were included between March and December 2006. Possible prognostic variables were obtained from medical history, physical examination and laboratory results during the ED presentation. Data were analysed using logistic regression analysis. Results A total of 295 ED patients were evaluated, of whom 27 were referred to the ICU, 62 had a positive blood culture, 16 died and 48 were re-admitted. In multivariate analysis, patients with a respiration rate of >25/min were at higher risk for ICU admission. Patients with a positive blood culture had a higher heart rate and a higher percentage of segmented neutrophils. Patients who died during admission were more likely to be older, confused and had lower blood pressure. Patients who were re-admitted within 30 days were more likely to be male, younger and less likely to have a positive blood culture. Conclusions Routine clinical and biochemical information can be used to predict ICU admission, the presence of bacteraemia, mortality and re-admission (within 30 days) and should be taken into consideration for treatment decisions.
Collapse
|