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Gong X, Jin S, Zhou Y, Lai L, Wang W. Impact of delirium on acute stroke outcomes: A systematic review and meta-analysis. Neurol Sci 2024; 45:1897-1911. [PMID: 38182844 DOI: 10.1007/s10072-023-07287-6] [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: 07/28/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
Delirium is a common complication in acute stroke patients. A 2011 meta-analysis showed an increased risk of in-hospital mortality and mortality within 12 months post-stroke, longer hospitalization durations, and increased likelihood of being discharged to a nursing home for patients experiencing post-stroke delirium. There is a need for an updated meta-analysis with several new studies having been since published. The PubMed and Scopus databases were screened for relevant studies. Inclusion criteria were as follows: retrospective or prospective studies reporting on the effects of delirium accompanying acute stroke on mortality, functional outcomes, length of hospital stay and need for re-admission. Strength of association was presented as pooled adjusted relative risk (RR) for categorical outcomes and weighted mean difference (WMD) for continuous outcomes. Statistical analysis was done using STATA version 16.0. The meta-analysis included 22 eligible articles. Eighteen of the 22 studies were prospective follow ups. Included studies were of good quality. Post-stroke delirium was associated with increased risk of in-hospital mortality, as well as mortality within 12 months post-stroke. Patients with delirium experienced increased hospital stay durations, were at greater risk for hospital readmission, and showed elevated risk for poor functional outcome. Compared to those who did not have delirium, stroke patients with delirium were 42% less likely to be discharged to home. Acute stroke patients with delirium are at an increased risk for poor short- and long-term outcomes. More research is needed to identify the best set of interventions to manage such patients and improve outcomes.
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Affiliation(s)
- Xiao Gong
- Department of Geriatry, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, No. 208, Huancheng East Road, Hangzhou, 310006, Zhejiang Province, China.
| | - Shu Jin
- Department of Geriatry, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, No. 208, Huancheng East Road, Hangzhou, 310006, Zhejiang Province, China
| | - Yong Zhou
- Department of Geriatry, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, No. 208, Huancheng East Road, Hangzhou, 310006, Zhejiang Province, China
| | - Lihua Lai
- Department of Geriatry, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, No. 208, Huancheng East Road, Hangzhou, 310006, Zhejiang Province, China
| | - Wanyi Wang
- Department of Geriatry, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, No. 208, Huancheng East Road, Hangzhou, 310006, Zhejiang Province, China
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Mathew D, Kosuru B, Agarwal S, Shrestha U, Sherif A. Impact of sleep apnoea on 30 day hospital readmission rate and cost in heart failure with reduced ejection fraction. ESC Heart Fail 2023. [PMID: 37295960 PMCID: PMC10375077 DOI: 10.1002/ehf2.14430] [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: 02/20/2023] [Revised: 05/08/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
AIMS In this study, we estimated the 30 day all-cause and heart failure-specific readmission rates, predictors, mortality, and hospitalization costs in patients with obstructive sleep apnoea admitted with acute decompensated heart failure with reduced ejection fraction. METHODS AND RESULTS This is a retrospective cohort study using the Agency of Healthcare Research and Quality's National Readmission Database for the year 2019. The primary outcome was the 30 day all-cause hospital readmission rate. The secondary outcomes were (i) in-hospital mortality rate for index admissions; (ii) 30 day mortality rate for index hospitalizations; (iii) the five most common principal diagnosis for readmission; (iv) readmission in-hospital mortality rate; (v) length of hospital stay; (vi) independent risk factors for readmission; and (vii) hospitalization costs. We identified 6908 hospitalizations that met our study definition. The mean patient age was 62.8 years, and women comprised only 27.6% of patients. The 30 day all-cause readmission rate was 23.4%. 48.9% of readmissions were due to decompensated heart failure. The in-hospital mortality rate during readmissions was significantly higher than that of the index admission (5.6% vs. 2.4%; P < 0.05). The mean length of stay for patients during index admissions was 6.5 days (6.06-7.02), while during readmissions, it was 8.5 days (7.4-9.6; P < 0.05). The mean total hospitalization charges at index admissions were $78 438 (68 053-88 824), while during readmissions, they were higher at $124 282 (90 906-157 659; P < 0.05). The mean total cost of hospitalization during index admissions was $20 535 (18 311-22 758), while at readmissions, it was higher at $29 954 (24 041-35 867; P < 0.05). The total hospital charges for all 30 day readmissions were $195 million, and total hospital costs was $46.9 million. The variables found to be associated with increased rate of readmissions were patients with Medicaid insurance, higher Charlson co-morbidity Index, and longer length of stay. The variables associated with lower rate of readmissions were prior percutaneous coronary intervention and patients with private insurance. CONCLUSIONS In patients with obstructive sleep apnoea admitted with heart failure with reduced ejection fraction, we found a substantial all-cause readmission rate of 23.4% with heart failure readmission constituting about 48.9% of readmissions. Readmissions were associated with higher mortality and resource use.
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Affiliation(s)
- Don Mathew
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Bhanu Kosuru
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Siddharth Agarwal
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Utsav Shrestha
- Department of Pulmonary and Critical Care Medicine, West Virginia University, Morgantown, WV, USA
| | - Akil Sherif
- Department of Cardiology, St Vincent Hospital, Worcester, MA, USA
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Frankel L, Maurente D, Ardeljan AD, Divesh M, Rashid AM, Takabe K, Rashid OM. Improving Gastrointestinal Cancer Care by Enhanced Recovery Protocol Implementation. World J Oncol 2023; 14:135-144. [PMID: 37188038 PMCID: PMC10181426 DOI: 10.14740/wjon1534] [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: 10/06/2022] [Accepted: 02/24/2023] [Indexed: 05/17/2023] Open
Abstract
Background Enhanced recovery protocols (ERPs) have become the standard of care for patients undergoing elective small bowel surgeries but have not yet been adequately studied in community hospitals. In this study, a multidisciplinary ERP was developed and implemented at a community hospital to include minimal anesthesia, early ambulation and enteral alimentation, and multimodal analgesia. The aim of this study was to determine the effects of the ERP on postoperative length of stay (LOS), readmission (RA) rates following bowel surgery, and postoperative outcomes. Methods The study design was a retrospective review of patients undergoing major bowel resection at Holy Cross Hospital (HCH) from January 1, 2017 to December 31, 2017. Patient charts for diagnostic-related group (DRG) 329, 330, and 331 were retrospectively reviewed at HCH in 2017 to compare outcomes in ERP versus non-ERP cases. The Medicare claims database (CMS) was also retrospectively reviewed to compare HCH data to the national average LOS and RA for the same DRG codes. Mean values for LOS and RA were statistically compared to determine significant differences between ERP versus non-ERP patients at HCH and national CMS data versus HCH patients. Results LOS was analyzed for each DRG at HCH. At HCH, for DRG 329, the mean LOS for non-ERP was 13.0833 days (n = 12) versus 3.375 days (n = 8) (P ≤ 0.001) for ERP. For DRG 330, the mean LOS for non-ERP was 10.861 days (n = 36) versus 4.583 days (n = 24) (P ≤ 0.001) for ERP. For DRG 331, the mean LOS for non-ERP was 7.272 days (n = 11) versus 3.348 days (n = 23) (P = 0.004) for ERP. LOS was also compared to national CMS data. The LOS at HCH for DRG 329 improved from the 10th to 90th percentile (n = 238,907); DRG 330 improved from the 10th to the 72nd percentile (n = 285,423); DRG 331 improved from 10th to 54th percentile (n = 126,941) (P < 0.001). The RA at HCH in ERP and non-ERP cases was 3% at 30 and 90 days. CMS RA for DRG 329 was 25.1% at 90 days and 9.9% at 30 days; DRG 330 RA was 18.3% at 90 days and 6.6% at 30 days; DRG 331 RA was 11% at 90 days and 3.9% at 30 days. Conclusion Implementation of ERP following bowel surgery at HCH significantly improved outcomes, in comparison to non-ERP cases, national CMS data, and Humana data. Further research on ERP for other fields and its impact on outcomes in other community settings is recommended.
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Affiliation(s)
- Lexi Frankel
- Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Diego Maurente
- Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Amalia D. Ardeljan
- Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Manjani Divesh
- Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Ali M. Rashid
- Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, the State University of New York, Buffalo, NY, USA
| | - Omar M. Rashid
- Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
- Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
- University of Miami, Leonard Miami School of Medicine, Miami, FL, USA
- Massachusetts General Hospital, Boston, MA, USA
- Broward Health, Fort Lauderdale, FL, USA
- TopLine MD Alliance, Fort Lauderdale, FL, USA
- Memorial Health, Pembroke Pines, FL, USA
- Delray Medical Center, Delray, FL, USA
- Corresponding Author: Omar M. Rashid, Complex General Surgical Oncology, General & Robotic Surgery, TopLine MD Alliance, Fort Lauderdale, FL 33308, USA.
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Ruan H, Zhang H, Wang J, Zhao H, Han W, Li J. Readmission rate for acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis. Respir Med 2023; 206:107090. [PMID: 36528962 DOI: 10.1016/j.rmed.2022.107090] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/13/2022] [Revised: 12/04/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The readmission rate following hospitalization for chronic obstructive pulmonary disease (COPD) exacerbations is extremely high and has become a common and challenging clinical problem. This study aimed to systematically summarize COPD readmission rates for acute exacerbations and their underlying risk factors. METHODS A comprehensive search was performed using PubMed, Embase, Cochrane Library, and Web of Science, published from database inception to April 2, 2022. Methodological quality was evaluated using the Newcastle-Ottawa Scale (NOS). We used a random-effects model or a fixed-effects model to estimate the pooled COPD readmission rate for acute exacerbations and underlying risk factors. RESULTS A total of 46 studies were included, of which 24, 7, 17, 7, and 20 summarized the COPD readmission rates for acute exacerbations within 30, 60, 90, 180, and 365 days, respectively. The pooled 30-, 60-, 90-, 180-, and 365-day readmission rates were 11%, 17%, 17%, 30%, and 37%, respectively. The study design type, age stage, WHO region, and length of stay (LOS) were initially considered to be sources of heterogeneity. We also identified potential risk factors for COPD readmission, including male sex, number of hospitalizations in the previous year, LOS, and comorbidities such as heart failure, tumor or cancer, and diabetes, whereas obesity was a protective factor. CONCLUSIONS Patients with COPD had a high readmission rate for acute exacerbations, and potential risk factors were identified. Therefore, we should propose clinical interventions and adjust or targeted the control of avoidable risk factors to prevent and reduce the negative impact of COPD readmission. SYSTEMATIC REVIEW REGISTRATION PROSPERO, identifier CRD42022333581.
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Affiliation(s)
- Huanrong Ruan
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of PR China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China; Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China
| | - Hailong Zhang
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of PR China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China; Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China; Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450003, PR China.
| | - Jiajia Wang
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of PR China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China; Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China; Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450003, PR China
| | - Hulei Zhao
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of PR China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China; Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China; Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450003, PR China
| | - Weihong Han
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of PR China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China; Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China
| | - Jiansheng Li
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of PR China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China; Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, PR China; Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450003, PR China
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Hu YY, Jiang X, Mao FY, Zhang J, Liu L, Gu J, Wu Q, Li C. Effect of positive event recording based on positive psychology on healthy behaviors and readmission rate of patients after PCI: a study protocol for a prospective, randomized controlled trial. Trials 2022; 23:1013. [PMID: 36514114 PMCID: PMC9746175 DOI: 10.1186/s13063-022-06964-9] [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: 12/16/2020] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Unhealthy behaviors of coronary heart disease (CHD) patients are closely related to the occurrence of major heart events, which increases the readmission rate and brings a heavy economic burden to families and society. Therefore, it is necessary for health care workers to take active preventive and therapeutic measures to keep or establish healthy behaviors of patients. Positive psychological intervention has been proved to be effective, but it has not been reported in the field of CHD in China. The purpose of this study is to explore the effects of positive event recording based on positive psychology on the healthy behaviors, readmission rate, and anxiety of patients with CHD, in order to provide new ideas for the development of secondary prevention strategies for CHD. METHODS This is a prospective, single-center, randomized controlled trial (RCT). The subjects will be enrolled from the Department of Cardiology, the First Affiliated Hospital of Soochow University. There are 80 cases in total; according to the random number table, the subjects are randomly divided into the intervention group (n = 40) and the control group (n = 40). The patients in the intervention group will receive the intervention of recording positive events once a week for 3 months, while the patients in the control group receive conventional nursing. The primary outcomes will include healthy behaviors, readmission rate, and anxiety, and the secondary outcomes will include psychological capital, subjective well-being, and corresponding clinical laboratory indicators. The protocol was approved by the Medical Ethics Committee of Soochow University (approval no. SUDA20200604H01) and is performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. All participants provide written informed consent. DISCUSSION This study will verify whether positive event recording based on positive psychology can make patients maintain healthy behaviors, reduce readmission rate, and improve anxiety after PCI. Then, this study will provide new ideas and references for the development of secondary prevention strategies for patients with CHD. TRIAL REGISTRATION Chinese Clinical Trials Registry 2000034538. Registered on 10 July 2020.
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Affiliation(s)
- Yao-Yao Hu
- grid.429222.d0000 0004 1798 0228Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Jiang
- grid.89957.3a0000 0000 9255 8984Nursing Department, the Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Fang-Ying Mao
- grid.263761.70000 0001 0198 0694School of Nursing, Soochow University, Suzhou, China
| | - Jing Zhang
- grid.263761.70000 0001 0198 0694School of Nursing, Soochow University, Suzhou, China
| | - Lin Liu
- grid.429222.d0000 0004 1798 0228Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie Gu
- grid.429222.d0000 0004 1798 0228Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qing Wu
- grid.429222.d0000 0004 1798 0228Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun Li
- grid.429222.d0000 0004 1798 0228Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China
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Zhang Y, Zhao X, Zhao B, Xu L, Chen X, Ruan A. Nursing factors associated with length of stay and readmission rate of the elderly residents from nursing home based on LTCfocus database. Public Health 2022; 213:19-27. [PMID: 36332413 DOI: 10.1016/j.puhe.2022.09.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Nursing factors have been found to be associated with a reduction in readmission rates. Nevertheless, few attentions have been given to the effect of nursing factors on nursing home (NH) residents. This study was to assess the impact of nursing factors on the hospital readmissions and length of stay (LOS) of the elderly residents from the NH. STUDY DESIGN This was a cross-sectional study. METHODS Data were extracted from the NH of the LTCFocus.org data set between 2011 and 2018. The study included residents aged ≥55 years who were admitted to NH in the United States, following a hospitalization event. The nursing factors included facility-level data elements and medical care personnel. An unsupervised machine learning algorithm (K-means) was used to cluster NH according to readmission rate and LOS. Multivariate logistic regression analysis was performed. RESULTS This study consisted of 107,000 NH-year observations. The median readmission rate was 17%, with a median LOS was 28.00 days. Three clusters were identified: cluster 1 was a high readmission rate with high LOS, cluster 2 was a low readmission rate with low LOS, and cluster 3 was a high readmission rate with low LOS. Multifacility and admission/bed were associated with a reduction in readmission rate and LOS in both cluster 1 vs cluster 2 and cluster 3 vs cluster 2. The special care unit and registered nurses' ratio were associated with decreased readmission rate and LOS in cluster 1 vs cluster 2. Total beds and Alzheimer unit decreased the readmission rate and LOS, whereas certified nursing assistant increased the readmission rate and LOS in cluster 3 vs cluster 2. NH for profit was associated with elevated readmission rate and LOS in cluster 1 vs cluster 2 and decreased readmission rate and LOS in cluster 3 vs cluster 2. Based on the subgroup analysis, the certified nursing assistant decreased readmission rate and LOS in cluster 1 vs cluster 2 and increased readmission rate and LOS in cluster 3 vs cluster 2 (all P < 0.005). CONCLUSION This study indicates the importance of the improvement of nurse number and level and the inputs of facility characteristics in NH.
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Affiliation(s)
- Yunping Zhang
- School of Nursing and Midwifery, Jiangsu College of Nursing, Huaian 223005, PR China.
| | - Xueping Zhao
- School of Nursing, Soochow University, Suzhou 215031, PR China
| | - Beibei Zhao
- School of Nursing and Midwifery, Jiangsu College of Nursing, Huaian 223005, PR China
| | - Lu Xu
- School of Nursing and Midwifery, Jiangsu College of Nursing, Huaian 223005, PR China
| | - Xiaofang Chen
- Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, 215021, PR China
| | - Aichao Ruan
- Department of Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223001, PR China
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Stauss R, Savov P, Tuecking LR, Windhagen H, Ettinger M. Robotic-assisted TKA reduces surgery duration, length of stay and 90-day complication rate of complex TKA to the level of noncomplex TKA. Arch Orthop Trauma Surg 2022. [PMID: 36241901 DOI: 10.1007/s00402-022-04618-8] [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] [Received: 11/17/2021] [Accepted: 09/06/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Complex primary total knee arthroplasties (TKA) are reported to be associated with excessive episode of care (EOC) costs as compared to noncomplex procedures. The impact of robotic assistance (rTKA) on economic outcome parameters in greater case complexity has not been described yet. The purpose of this study was to investigate economic outcome parameters in the 90-days postoperative EOC in robotic-assisted complex versus noncomplex procedures. MATERIALS AND METHODS This study is a retrospective, single-center review of 341 primary rTKAs performed between 2017 and 2020. Patient collective was stratified into complex (n = 218) and noncomplex TKA (n = 123) based on the presence of the following criteria: Obese BMI, coronal malalignment, flexion contracture > 10°, posttraumatic status, previous correction osteotomy, presence of hardware requiring removal during surgery, severe rheumatoid arthritis. Group comparison included surgery duration, length of stay (LOS), surgical site complications, readmissions, and revision procedures in the 90-days EOC following rTKA. RESULTS The mean surgery duration was marginally longer in complex rTKA, but showed no significant difference (75.26 vs. 72.24 min, p = 0.258), neither did the mean LOS, which was 8 days in both groups (p = 0.605). No differences between complex and noncomplex procedures were observed regarding 90-days complication rates (7.34 vs. 4.07%, p = 0.227), readmission rates (3.67 vs. 3.25%, p = 0.841), and revision rates (2.29 vs. 0.81%, p = 0.318). CONCLUSIONS Robotic-assisted primary TKA reduces the surgical time, inpatient length of stay as well as 90-days complication and readmission rates of complex TKA to the level of noncomplex TKA. Greater case complexity does not seem to have a negative impact on economic outcome parameters when surgery is performed with robotic assistance.
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Geißler K, Rippe W, Boeger D, Buentzel J, Hoffmann K, Kaftan H, Mueller A, Radtke G, Guntinas-Lichius O. 30-day readmission rate in pediatric otorhinolaryngology inpatients: a retrospective population-based cohort study. J Otolaryngol Head Neck Surg 2021; 50:55. [PMID: 34544499 PMCID: PMC8454104 DOI: 10.1186/s40463-021-00536-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/28/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Analysis of frequency and reasons for planned and unplanned 30-day readmission in hospitalized pediatric otorhinolaryngology patients using German Diagnosis Related Group (G-DRG) system data. METHODS A retrospective population-based cohort study in Thuringia, Germany, was performed for the year 2015 with 2440 cases under 18 years (55.6% male) out of a total number of 15.271 inpatient cases. The majority of pediatric patients were from 2 to 5 years old (54.5%). The most frequent diagnoses were hyperplasia of adenoids or/and tonsils (26.6%). 36 cases (1.5%) experienced readmission within 30-days. RESULTS 30-day readmission was planned in 9 cases (25% of all readmission) and was unplanned in 27 cases (75%). The median interval between index and readmission treatment was 8 days. Postoperative bleeding after adenoidectomy, tonsillotomy/tonsillectomy or tracheostomy (33.4%) and infectious complications after surgery like acute otitis media, abscess formation or fever (36.2%) were the most frequent reasons for 30-day readmission. Compared to adults treated in 2015 in Thuringia, the readmission rate was higher in adult patients (8.9%) than in this pediatric cohort. In contrast to children, readmissions in adults were mainly planned (65.1%) with a different spectrum of underlying diseases and reasons for readmission. CONCLUSION The 30-day readmission rate seemed to be lower for pediatric otolaryngology patients compared to adult patients. Unplanned readmissions dominated in pediatric patients, whereas planned readmissions dominated in adults.
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Affiliation(s)
- Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Wido Rippe
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Daniel Boeger
- Department of Otorhinolaryngology, SRH Zentralklinikum, Suhl, Germany
| | - Jens Buentzel
- Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen, Germany
| | - Kerstin Hoffmann
- Department of Otorhinolaryngology, Sophien- Und Hufeland-Klinikum, Weimar, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, HELIOS-Klinikum, Erfurt, Germany
| | - Andreas Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum, Gera, Germany
| | - Gerald Radtke
- Department of Otorhinolaryngology, Ilm-Kreis-Kliniken, Arnstadt, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Palve JS, Luukkaala TH, Kääriäinen MT. Autologous reconstructions are associated with greater overall medium-term care costs than implant-based reconstructions in the Finnish healthcare system: A retrospective interim case-control cohort study. J Plast Reconstr Aesthet Surg 2021; 75:85-93. [PMID: 34627717 DOI: 10.1016/j.bjps.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/27/2020] [Revised: 06/04/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies have mainly reported the short-term costs of different reconstruction techniques. Revision operations may increase costs in longer follow-up. Authors report medium-term data on different reconstruction methods. We hypothesised that the reconstruction method would affect not only the duration of reconstruction process but also total costs. METHODS The reconstruction database was reviewed from 2008 to 2019. Women with autologous (deep inferior epigastric perforator, transverse musculocutaneous gracilis and latissimus dorsi [LD] without implant) and implant-based (implant and LD with implant) reconstructions were included. Variables evaluated included age, body mass index, smoking, comorbidities, radiotherapy, complications and readmissions. Risk factors for multiple revision surgeries were analysed. Time to definitive reconstruction and related costs were also calculated. RESULTS In total, 591 patients with autologous reconstructions and 202 with implant-based reconstructions were included. The median follow-up time was 73 months. Definitive reconstruction was obtained in 443 days in implant-based reconstructions and in 403 days in autologous reconstructions (P = 0.050). Independent risk factors for multiple surgeries were younger age (P < 0.001) and comorbidity (P = 0.008). No statistically significant difference was observed in the rate of overall surgical procedures (P = 0.098), but implant-based reconstructions were more commonly associated with two or more planned operations (P = 0.008). Autologous reconstructions were associated with greater total cost ($22 052 vs. $18 329, P < 0.001). CONCLUSIONS This review of reconstructions over a 12-year study period revealed that autologous reconstructions are associated with greater overall costs, but there is no statistically significant difference in reconstruction time or rate of surgical procedures. However, a full cost assessment between reconstructive techniques requires a much longer follow-up period.
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Affiliation(s)
- J S Palve
- Department of Plastic Surgery, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital Finland.
| | - T H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital and Health Sciences, Faculty of Social Sciences, Tampere University Finland
| | - M T Kääriäinen
- Department of Plastic Surgery, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital Finland
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Janati A, Ebrahimoghli R, Sadeghi-Bazargani H, Gholizadeh M, Toofan F, Gharaee H. Impact of the Iranian Health Sector Evolution Plan on Rehospitalization: An Analysis of 158000 Hospitalizations. Iran J Public Health 2021; 50:161-169. [PMID: 34178775 PMCID: PMC8213611 DOI: 10.18502/ijph.v50i1.5083] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: In May 2014, Iran launched the most far-reaching reform for the health sector, so-called Health Sector Evolution Plan (HSEP), since introduction of the primary health care network, with a systematic plan to bring about Universal Health Coverage. We aimed to analyze the time to first all-caused rehospitalization and all-caused 30-day readmission rate in the biggest referral hospital of Northwest of Iran before and after the reform. Methods: We retrospectively analyzed discharge data for all hospitalization occurred in the six-year period of 2011–2017. The primary endpoints were readmission-free survival, and overall 30-day readmission rate. Using multivariate cox proportional hazards regression and logistic regression, we assessed between-period differences for readmission-free survival time and overall 30-day rehospitalization, respectively. Results: Overall, 157969 admissions were included. After adjusting for available confounders including age; sex; ward of admission; length of stay; and admission in first/second half of year, the risk of being readmitted within 30 days after the reform was significantly higher (worse) compared to pre-reform hospitalization (odd ratio 1.22, P<0.001, 95% CI, 1.15–1.30). Adjusting for the same covariates, after-reform period also was slightly significantly associated with decreased (deteriorated) readmission-free time compared with pre-HSEP period (HR 1.06, P=0.005, 95% CI 1.01–1.11). Conclusion: HSEP seems insufficient to improve neither readmission rate, nor readmission-free time. It is advisable some complementary strategies to be incorporated in the HSEP, such as continuity of care promotion, self-care enhancement, effective information flow, and post-discharge follow up programs.
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Affiliation(s)
- Ali Janati
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Ebrahimoghli
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Masoumeh Gholizadeh
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Firooz Toofan
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hojatolah Gharaee
- District Health Center of Hamadan City, Hamadan University of Medical Sciences, Hamadan, Iran
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11
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Williams GA, Liu J, Chapman WC, Hawkins WG, Fields RC, Sanford DE, Doyle MB, Hammill CW, Khan AS, Strasberg SM. Composite Length of Stay, An Outcome Measure of Postoperative and Readmission Length of Stays in Pancreatoduodenectomy. J Gastrointest Surg 2020; 24:2062-2069. [PMID: 31845140 PMCID: PMC7295670 DOI: 10.1007/s11605-019-04475-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/12/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE Postoperative length of stay (PLOS) and readmission rate are pancreatoduodenectomy (PD) outcome measures, which are reported individually but may be interrelated. The purpose of this study was to evaluate how well a composite length of stay measure (CLOS) that included PLOS and readmission length of stay describes outcomes. To do so, we evaluated how well CLOS correlated to postoperative complications absolutely and compared to PLOS. METHODS A total of 668 PDs performed between 2011 and 2018 were evaluated. CLOS was calculated from PLOS and readmission length of stay. Complication severity was judged by the Modified Accordion Grading System (MAGS). Multinomial logistical regression models (MLRM) were used to investigate the relationship between either PLOS or CLOS and complications. Multilevel and pairwise area under curves (AUC) using SAS macro %MultAUC were provided for both models. RESULTS A total of 432 of 668 patients (65%) developed complications. One hundred seventy-seven patients (27%) were readmitted. Mean PLOS was 10.2 days (7.1 SD) and mean CLOS was 12.3 days (10.1 SD). PLOS and CLOS both were correlated linearly to MAGS grade. Spearman correlation coefficient for CLOS vs. MAGS of 0.68 was higher than that of 0.49 for PLOS vs. MAGS. Multilevel AUC from MLRM using PLOS was 0.66, but multilevel AUC from MLRM using CLOS was 0.71. DISCUSSION CLOS provides an accurate estimate of hospital day utilization per patient for PD, reflecting not only the basal hospital recovery time for PD but the added time needed because of readmissions due to complications. It is tightly correlated to number and severity of postoperative complications.
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Affiliation(s)
- Gregory A Williams
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - William C Chapman
- Section of Transplant Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - William G Hawkins
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ryan C Fields
- Section of Surgical Oncology, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Dominic E Sanford
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Majella B Doyle
- Section of Transplant Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Chet W Hammill
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Adeel S Khan
- Section of Transplant Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA.
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Altshuler M, Mueller KB, MacConnell A, Wirth P, Sandhu FA, Voyadzis JM. Reoperation, Readmission, and Discharge Disposition for Patients With Degenerative Lumbar Pathology Treated With Either Open or Minimally Invasive Techniques: A Single-Center Retrospective Review of 1435 Cases. Neurosurgery 2020; 87:1199-1205. [PMID: 32542331 DOI: 10.1093/neuros/nyaa246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/10/2019] [Accepted: 04/11/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Spine surgery has been transformed by the growth of minimally invasive surgery (MIS) procedures. Previous studies agree that MIS has shorter hospitalization and faster recovery time when compared to conventional open surgery. However, the reoperation and readmission rates between the 2 techniques have yet to be well characterized. OBJECTIVE To evaluate the rate of subsequent revision between MIS and open techniques for degenerative lumbar pathology. METHODS A total of 1435 adult patients who underwent lumbar spine surgery between 2013 and 2016 were included in this retrospective analysis. The rates of need for subsequent reoperation, 30- and 90-d readmission, and discharge to rehabilitation were recorded for both MIS and traditional open techniques. Groups were divided into decompression alone and decompression with fusion. RESULTS The rates of subsequent reoperation following MIS and open surgery were 10.4% and 12.2%, respectively (P = .32), which were maintained when subdivided into decompression and decompression with fusion. MIS and open 30-d readmission rates were 7.9% and 7.2% (P = .67), while 90-d readmission rates were 4.3% and 3.6% (P = .57), respectively. Discharge to rehabilitation was significantly lower for patients under 60 yr of age undergoing MIS (1.64% vs 5.63%, P = .04). CONCLUSION The use of minimally invasive techniques for the treatment of lumbar spine pathology does not result in increased reoperation or 30- and 90-d readmission rates when compared to open approaches. Patients under the age of 60 yr undergoing MIS procedures were less likely to be discharged to rehab.
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Affiliation(s)
- Marcelle Altshuler
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Kyle B Mueller
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Ashley MacConnell
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Peter Wirth
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Faheem A Sandhu
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Jean-Marc Voyadzis
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, District of Columbia
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Qin SB, Zhang XY, Fu Y, Nie XY, Liu J, Shi LW, Cui YM. The impact of the clinical pharmacist-led interventions in China: A systematic review and Meta-Analysis. Int J Clin Pharm 2020; 42:366-77. [PMID: 32078109 DOI: 10.1007/s11096-020-00972-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
Abstract
Background The clinical pharmacist has been an important partner in clinical treatment team. In China, there is no systematic review to evaluate the effectiveness of clinical pharmacy services on patients' outcomes such as hospitalization days, readmission rate and mortality. Aim of the review To investigate the impact of clinical pharmacist services on patients' length of hospitalization, readmission and mortality in China. Methods A literature search was performed in PubMed, EMBASE, Cochrane Library, clinicaltrials.gov, and a Chinese database (up to January 2019). Randomized control trials or pre- to post-intervention comparison studies were included to investigate the impact of clinical pharmacist-led interventions on the length of stay, readmission rate and mortality of inpatients. Basic information, intervention and therapeutic area were extracted. Results After screening all articles from the mentioned databases, 14 studies were included for meta- analysis and subgroup analysis. Most studies focused on cardiology and respiratory diseases. Results show that clinical pharmacist services can reduce the length of stay of inpatients (MD: - 3.00, 95% CI - 4.72 to - 1.29, P < 0.01) and the readmission rate (RR 0.44, 95% CI 0.35-0.56, P < 0.01) as well as the mortality of patients during hospitalization (RR 0.57, 95% CI 0.35-0.92, P = 0.02). Conclusions Clinical pharmacist-led interventions could significantly reduce Chinese patients' length of hospitalization and readmission rate. More studies are needed to confirm the relationship between the clinical pharmacist-led interventions and patients' mortality.
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14
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Ba F, Siddiqui J. Deep brain stimulation for Parkinson disease - What does the short-term outcome analysis tell us? Parkinsonism Relat Disord 2019; 70:94-95. [PMID: 31831380 DOI: 10.1016/j.parkreldis.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Fang Ba
- Division of Neurology, Department of Medicine, University of Alberta, 7-131 Clinical Sciences Building, 11350 - 83 Avenue, Edmonton, Alberta, T6G 2G3, Canada.
| | - Junaid Siddiqui
- University of Missouri- School of Medicine, University of Missouri Health Care, 531, CS&E Building, 1 Hospital Drive, Columbia, MO, 65212, USA.
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15
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Wang CY, Brown J. Readmissions after Pancreatic Surgery in Patients with Pancreatic Cancer: Does Hospital Variation Exist for Quality Measurement? Visc Med 2019; 36:304-310. [PMID: 33005656 DOI: 10.1159/000502894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/20/2019] [Accepted: 08/22/2019] [Indexed: 01/08/2023] Open
Abstract
Background The appropriateness of using readmission rate after pancreatic surgery among pancreatic cancer patients as a quality metric to evaluate hospital performance has been widely discussed in the literature. Objectives The present study reported readmission rate using Nationwide Readmissions Database (NRD), examined the reasons and risk factors for readmissions, and evaluated the appropriateness of using it as a quality metric. Method We analyzed 3,619 patient discharge records in 2014. The outcome of interest was all-cause 30-day readmission. Reasons for readmission were grouped into clinical associated categories. Hierarchical regression model was used for examining the relationship between risk factors and readmission. Results The 30-day readmission rate was 20.95%. The most common reason for readmission was surgery-related complication. In descriptive analyses, age, certain comorbidities, number of chronic conditions, mortality risk, severity of illness, living at large metropolitan area, resident of the state where patients received initial care, postoperative complication, length of stay, discharge location, and receiving care at the hospitals in large metropolitan area were predictive of readmission. In multivariable analysis, age, depression, peripheral vascular disorder, mortality risk, and discharge location were independently associated with readmission. The intraclass correlation coefficient was 0.41 for hierarchical regression model. Conclusions Readmission after pancreatic surgery remains an important issue. Our study found the majority of variation in readmissions is accounted for by patient factors whereas there was little between hospital variation. This finding does not support the use of readmission rate after pancreatic surgery as a quality metric.
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Affiliation(s)
- Ching-Yu Wang
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Joshua Brown
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
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Rao A, Kim D, Darzi A, Majeed A, Aylin P, Bottle A. Regional variations in trajectories of long-term readmission rates among patients in England with heart failure. BMC Cardiovasc Disord 2019; 19:86. [PMID: 30954063 DOI: 10.1186/s12872-019-1057-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to compare the characteristics and types of heart failure (HF) patients termed "high-impact users", with high long-term readmission rates, in different regions in England. This will allow clinical factors to be identified in areas with potentially poor quality of care. METHODS Patients with a primary diagnosis of heart failure (HF) in the period 2008-2009 were identified using nationally representative primary care data linked to national hospital data and followed up for 5 years. Group-based trajectory models and sequence analysis were applied to their readmissions. RESULTS In each of the 8 NHS England regions, multiple discrete groups were identified. All the regions had high-impact users. The group with an initially high readmission rate followed by a rapid decline in the rate ranged from 2.5 to 11.3% across the regions. The group with constantly high readmission rate compared with other groups ranged from 1.9 to 12.1%. Covariates that were commonly found to have an association with high-impact users among most of the regions were chronic respiratory disease, chronic renal disease, stroke, anaemia, mood disorder, and cardiac arrhythmia. Respiratory tract infection, urinary infection, cardiopulmonary signs and symptoms and exacerbation of heart failure were common causes in the sequences of readmissions among high-impact users in all regions. CONCLUSION There is regional variation in England in readmission and mortality rates and in the proportions of HF patients who are high-impact users.
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Vahidy FS, Meyer EG, Bambhroliya AB, Meeks JR, Begley CE, Wu TC, Tyson JE, Miller CC, Bowry R, Ahmed WO, Gealogo GA, McCullough LD, Warach S, Savitz SI. Rationale and Design of a Statewide Cohort to examine efficient resource utilization for patients with Intracerebral hemorrhage (EnRICH). BMC Neurol 2018; 18:31. [PMID: 29562884 PMCID: PMC5863437 DOI: 10.1186/s12883-018-1036-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 05/26/2017] [Accepted: 03/12/2018] [Indexed: 11/14/2022] Open
Abstract
Background Intracerebral hemorrhage is a devastating disease with no specific treatment modalities. A significant proportion of patients with intracerebral hemorrhage are transferred to large stroke treatment centers, such as Comprehensive Stroke Centers, because of perceived need for higher level of care. However, evidence of improvement in patient-centered outcomes for these patients treated at larger stroke treatment centers as compared to community hospitals is lacking. Methods / design “Efficient Resource Utilization for Patients with Intracerebral Hemorrhage (EnRICH)” is a prospective, multisite, state-wide, cohort study designed to assess the impact of level of care on long-term patient-centered outcomes for patients with primary / non-traumatic intracerebral hemorrhage. The study is funded by the Texas state legislature via the Lone Star Stroke Research Consortium. It is being implemented via major hub hospitals in large metropolitan cities across the state of Texas. Each hub has an extensive network of “spoke” hospitals, which are connected to the hub via traditional clinical and administrative arrangements, or by telemedicine technologies. This infrastructure provides a unique opportunity to track outcomes for intracerebral hemorrhage patients managed across a health system at various levels of care. Eligible patients are enrolled during hospitalization and are followed for functional, quality of life, cognitive, resource utilization, and dependency outcomes at 30 and 90 days post discharge. As a secondary aim, an economic analysis of the incremental cost-effectiveness of treating intracerebral hemorrhage patients at higher levels of care will be conducted. Discussion Findings from EnRICH will provide much needed evidence of the effectiveness and efficiency of regionalized care for intracerebral hemorrhage patients. Such evidence is required to inform policy and streamline clinical decision-making.
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Affiliation(s)
- Farhaan S Vahidy
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA.
| | - Ellie G Meyer
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
| | - Arvind B Bambhroliya
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
| | - Jennifer R Meeks
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
| | - Charles E Begley
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tzu-Ching Wu
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
| | - Jon E Tyson
- Center for Clinical Research and Evidence Based Medicine at McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Charles C Miller
- Center for Clinical Research and Evidence Based Medicine at McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ritvij Bowry
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Wamda O Ahmed
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gretchel A Gealogo
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Louise D McCullough
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
| | - Steven Warach
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Sean I Savitz
- Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, University of Texas - Health, Houston, TX, USA
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Abstract
Health care policy makers have placed increased attention on the cost of health care making outpatient joint arthroplasty an attractive alternative to routine hospital admission. Recent studies have shown outpatient shoulder arthroplasty is a safe and cost-effective alternative to inpatient shoulder arthroplasty. Proper patient selection, patient education, effective pain management strategies, and attention to intraoperative blood loss are keys in the success of outpatient shoulder arthroplasty.
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Affiliation(s)
- Tyler J Brolin
- Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - Thomas W Throckmorton
- Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
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DiFiori MM, Lamb LC, Calavan LL, Comey CH, Feeney JM. Readmissions in Patients with Anticoagulated Intracranial Hemorrhage: A Retrospective Review. World Neurosurg 2017; 110:e305-e309. [PMID: 29122733 DOI: 10.1016/j.wneu.2017.10.165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/27/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the effect of direct oral anticoagulants (DOACs) compared with warfarin on the 30-day readmission rates in patients with traumatic intracranial hemorrhage (ICH). METHODS We conducted a retrospective review of patients from our hospital's trauma database admitted between June 2011 and October 2015 to our level II trauma center after sustaining a traumatic ICH while receiving anticoagulant therapy. Patients were stratified based on the anticoagulation drug (DOAC or warfarin) prescribed on admission. The readmission rates between the 2 groups were compared using χ2 analysis and multivariate logistic regression. Patients who died during their initial admission were excluded. RESULTS Over the 4-year period, 160 patients were admitted with traumatic ICH. Seventy-nine were receiving warfarin and 57 were receiving a DOAC at admission. Data collected included age, sex, injury severity score, admission Glasgow Coma Score, Abbreviated Injury Scale (head), mechanism of injury, hospital and intensive care unit lengths of stay, discharge destination (eg, home, rehabilitation facility, nursing facility), comorbidities, operative interventions, readmissions, and reasons for the readmissions. The rate of readmission for rebleeding of ICH was significantly lower in the DOAC group compared with the warfarin group (5.3% vs. 17.7%; P = 0.04). Multivariate logistic regression suggests that warfarin use, but not DOAC use, is associated with increased readmission both for all causes and for ICH rebleeding. CONCLUSIONS Warfarin use is associated with higher readmission rates in patients with intracranial bleeding for both all-cause readmissions and for intracranial rebleeding.
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Affiliation(s)
- Monica M DiFiori
- Department of Surgery, Trauma and Critical Care, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Laura C Lamb
- Department of Surgery, Trauma and Critical Care, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA; University of Connecticut School of Medicine Farmington, Connecticut, USA
| | - Lori L Calavan
- Department of Surgery, Trauma and Critical Care, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA; Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Christopher H Comey
- Department of Surgery, Trauma and Critical Care, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA; University of Connecticut School of Medicine Farmington, Connecticut, USA; Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - James M Feeney
- Department of Surgery, Trauma and Critical Care, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA; University of Connecticut School of Medicine Farmington, Connecticut, USA; Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut, USA.
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Abstract
BACKGROUND Global budget (GB) is considered one of the most important payment methods available. Since a new round of healthcare system reforms in 2009, the Chinese government has been paying attention to this prospective payment. However, it is unclear whether GB has influenced cost control and how it works in rural China. METHODS YC county was chosen as the intervention group, with 33,175 inpatients before and 36,883 inpatients after the reform (2012 and 2014, respectively). ZJ county acted as the control group, with 23,668 and 29,555 inpatients, respectively. The inpatients' information was collected from a local insurance agency. The difference-in-difference method (controlling for age, gender, living status, severity of the disease, whether the patient had surgery, the level of medical institutions, and the secular trends of the two groups) was applied to estimate the effects on total spending (TS), reimbursement expense (RE), out-of-pocket payment (OOP), readmission rate, and seven kinds of medical service items. RESULTS At per practice level, the GB was associated with a ¥263.35 (p < .001) and ¥447.46 (p < .001) decrease in growth of TS and RE, respectively, while OOP increased by ¥188.06 (p < .001). At per capital level, the decrease in growth of TS and RE was ¥64.39 (p = .301) and ¥467.45 (p < .001), respectively, whereas the increase of OOP was more significant at ¥408.19 (p < .001). Savings were concentrated in unclassified items (¥197.68, p < .001), drug prescription (¥69.03, p < .001), surgery (¥40.18, p < .001), cure (¥4.95, p = .565), and diagnosis (¥3.61, p = .064). Meanwhile, the readmission rate increased by 11.4% (p < .001). CONCLUSIONS The GB has a prominent impact on curbing the growth of insurance fund expenditures, as well as drug and medical consumable costs. However, the patients' out-of-pocket payment has risen. Doctors decomposed hospitalization to deal with supervision, which was harmful to patients. Any medical insurance payment reform should be undertaken prudently, and its likely outcomes should be weighed comprehensively.
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Affiliation(s)
- Ruibo He
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , PR China
| | - Yudong Miao
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , PR China
| | - Ting Ye
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , PR China
| | - Yan Zhang
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , PR China
| | - Wenxi Tang
- b School of International Pharmaceutical Business , China Pharmaceutical University , Nanjing , PR China
| | - Zhong Li
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , PR China
| | - Liang Zhang
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , PR China
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Abstract
BACKGROUND The aim of this study was to examine the hospital readmissions in a 10 year follow-up of a stroke cohort previously studied for acute and subacute complications and to focus on their frequency, their causes and their timing. METHODS The hospital records of 243 patients, 50% of a cohort of 489 patients acutely and consecutively admitted to our stroke unit in 2002/3, were subjected to review 10 years after the incidental stroke and all acute admissions were examined. The main admitting diagnoses were attributed to one of 18 predefined categories of illness. Additionally, the occurrence of death was registered. RESULTS After 10 years 68.9% of patients had died and 72.4% had been readmitted to the hospital with a mean number of readmissions of 3.4 (+15.1 SD). 20% of the readmissions were due to a vascular cause, 17.3% were caused by infection, 9.3% by falls with (6.1%) and without fracture, 5.7% by a hemorrhagic event. The readmission rate was highest in the first 6 months post stroke with a rate of 116.2 admissions/100 live patient-years. Falls with fractures occurred maximally 3-5 years post stroke. CONCLUSIONS Hospital readmissions over the 10 years following stroke are caused by vascular events, infections, falls and hemorrhagic events, where the first 6 months are a period of particular vulnerability. The magnitude and the spectrum of these long-term complications suggest the need for a more comprehensive approach to post stroke prophylaxis.
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Affiliation(s)
- Gitta Rohweder
- From the Stroke Unit, Department of Internal Medicine, St Olav's Hospital, University Hospital of Trondheim, Harald Hardraades gate 5, 7030, Trondheim, Norway. .,The Institute for Neuromedicine (INM), Faculty of Medicine and Health Sciences, Norwegian University of Science And Technology (NTNU), Trondheim, Norway.
| | - Øyvind Salvesen
- The Unit of Applied Clinical Research, Faculty of Medicine and Health Sciences, Norwegian University of Science And Technology (NTNU), Trondheim, Norway
| | - Hanne Ellekjær
- From the Stroke Unit, Department of Internal Medicine, St Olav's Hospital, University Hospital of Trondheim, Harald Hardraades gate 5, 7030, Trondheim, Norway.,The Institute for Neuromedicine (INM), Faculty of Medicine and Health Sciences, Norwegian University of Science And Technology (NTNU), Trondheim, Norway
| | - Bent Indredavik
- From the Stroke Unit, Department of Internal Medicine, St Olav's Hospital, University Hospital of Trondheim, Harald Hardraades gate 5, 7030, Trondheim, Norway.,The Institute for Neuromedicine (INM), Faculty of Medicine and Health Sciences, Norwegian University of Science And Technology (NTNU), Trondheim, Norway
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Schipmann S, Schwake M, Suero Molina E, Roeder N, Steudel WI, Warneke N, Stummer W. Quality Indicators in Cranial Neurosurgery: Which Are Presently Substantiated? A Systematic Review. World Neurosurg 2017; 104:104-12. [PMID: 28465269 DOI: 10.1016/j.wneu.2017.03.111] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Owing to the rising costs of health care delivery, the quality of delivered care has become a central issue across all medical specialties. Consequently, there is increasing pressure to create standardized frameworks for measuring quality of care. In the field of cranial neurosurgery, health care administrators have begun applying quality measures that are easily available but might be inaccurate in measuring the quality of care. METHODS We performed a systematic literature review on quality indicators (QIs) that are presently used in this field, aiming to elucidate which QIs are scientifically founded and thus potentially justifiable as measures of quality. We found a total of 8 QIs, and methodologically evaluated published studies according to the AIRE (Appraisal of Indicators through Research and Evaluation) criteria. These criteria include length of hospital stay, all-cause readmission rate, and unplanned reoperation rate. RESULTS Our review indicates that these presently used or proposed QIs for neurosurgery lack scientific rigor and are restricted to rudimentary measures, and that further research is necessary. CONCLUSIONS Neurosurgeons need to define their own QIs and actively participate in the validation of these QIs to provide the best possible patient outcomes. More reliable clinical registries, obligatory for all neurosurgical services, should be established as a basis for establishing such indicators, with risk adjustment being an important element of any such indicators.
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Manuel-Vázquez A, Latorre-Fragua R, Ramiro-Pérez C, López-Marcano A, Al-Shwely F, De la Plaza-Llamas R, Ramia JM. Ninety-day readmissions after inpatient cholecystectomy: A 5-year analysis. World J Gastroenterol 2017; 23:2972-2977. [PMID: 28522915 PMCID: PMC5413792 DOI: 10.3748/wjg.v23.i16.2972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/24/2017] [Accepted: 03/31/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To determine the incidence of readmission after cholecystectomy using 90 d as a time limit.
METHODS We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomy-related complications. We excluded ambulatory cholecystectomy, cholecystectomy combined with other procedures, oncologic disease active at the time of cholecystectomy, finding of malignancy in the resection specimen, and scheduled re-admissions for other unrelated pathologies.
RESULTS We analyzed 1423 patients. There were 71 readmissions in the 90 d after discharge, with a readmission rate of 4.99%. Sixty-four point seven nine percent occurred after elective surgery (cholelithiasis or vesicular polyps) and 35.21% after emergency surgery (acute cholecystitis or acute pancreatitis). Surgical non-biliary causes were the most frequent reasons for readmission, representing 46.48%; among them, intra-abdominal abscesses were the most common. In second place were non-surgical reasons, at 29.58%, and finally, surgical biliary reasons, at 23.94%. Regarding time for readmission, almost 50% of patients were readmitted in the first week and most second readmissions occurred during the second month. Redefining the readmissions rate to 90 d resulted in an increase in re-hospitalization, from 3.51% at 30 d to 4.99% at 90 d.
CONCLUSION The use of 30-d cutoff point may underestimate the incidence of complications. The current tendency is to use 90 d as a limit to measure complications associated with any surgical procedure.
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Lu MLR, Davila CD, Shah M, Wheeler DS, Ziccardi MR, Banerji S, Figueredo VM. Marital status and living condition as predictors of mortality and readmissions among African Americans with heart failure. Int J Cardiol 2016; 222:313-318. [PMID: 27500756 DOI: 10.1016/j.ijcard.2016.07.185] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 06/01/2016] [Accepted: 07/28/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Socioeconomic factors, including social support, may partially explain why African Americans (AA) have the highest prevalence of heart failure and with worse outcomes compared to other races. AA are more likely to be hospitalized and readmitted for heart failure and have higher mortality. The purpose of this study is to determine whether the social factors of marital status and living condition affect readmission rates and all-cause mortality following hospitalization for acute decompensated heart failure (ADHF) in AA patients. METHODS Medical records from 611 AA admitted to Einstein Medical Center Philadelphia from January, 2011 to February, 2013 for ADHF were reviewed. Patient demographics including living condition (nursing home residents, living with family or living alone) and marital status (married or non-married -including single, divorced, separated and widowed) were correlated with all-cause mortality and readmission rates. RESULTS In this cohort (53% male, mean age 65±15, mean ejection fraction 32±16%) 25% (n=152) of subjects were unmarried. Unmarried patients had significantly higher 30-day readmission rates (16% vs. 6% p=0.0002) and higher 1-year mortality (17% vs. 11% p=0.047) compared with married patients. Fifty percent (n=303) of subjects were living with family members, while 40% (n=242) and 11% (n=66) were living alone or in a nursing facility, respectively. Patients living with family members had significantly lower 30-day readmission rates when compared with those living alone or in a nursing facility (7% vs 21% vs. 18% p=<0.0001). Furthermore, they had the lowest 1-year mortality (14% vs 32% for nursing facility patients and 17% for those living alone (p=0.0007). After controlling for traditional risk factors (age, gender, body mass index, peak troponin I, left ventricular ejection fraction, B-type natriuretic peptide, hypertension, diabetes mellitus, hyperlipidemia, and coronary artery disease), being married was an indpendent predictor of 1-year mortality (OR 0.50 p=0.019) and living alone for 30-day readmission (OR 2.86 p=<0.001). CONCLUSION The socioeconomic factors of marital status and living condition significantly correlated with mortality and 30-day readmission rate in AA heart failure patients. Specifically, being married and living with family independently predict lower mortality and fewer readmissions. Surprisingly, living in a nursing facility was associated with significantly higher mortality than living alone or with family.
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Affiliation(s)
- Marvin Louis Roy Lu
- Einstein Medical Center, Department of Medicine, Philadelphia, PA, United States
| | - Carlos D Davila
- Einstein Medical Center, Department of Medicine, Philadelphia, PA, United States
| | - Mahek Shah
- Lehigh Valley Heart Specialists, Lehigh Valley Healthcare Network, Allentown, PA, United States
| | - David S Wheeler
- Einstein Medical Center, Department of Medicine, Philadelphia, PA, United States
| | | | - Sourin Banerji
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, United States
| | - Vincent M Figueredo
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, United States; Sidney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, PA, United States.
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Rahman R, Saba S, Bazaz R, Gupta V, Pokrywka M, Shutt K, Bridge C, Yassin MH. Infection and readmission rate of cardiac implantable electronic device insertions: An observational single center study. Am J Infect Control 2016; 44:278-82. [PMID: 26704827 DOI: 10.1016/j.ajic.2015.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Infection is one of the most serious complications following surgical placement of cardiac implantable electronic devices (CIEDs). Infection prevention efforts are necessary in reducing CIED infectious outcomes. These devices, however, are commonly inserted in higher risk patients, which may explain the ongoing risk of surgical site infection (SSI) in this population. The rates of CIED infection and utilization vary widely in the literature. The definitions of infection may also vary between clinical definitions and the National Healthcare Safety Network (NHSN) criteria. METHODS The primary objective of this study was to review patient data to identify risk factors for infection and readmission after CIED placement at an academic medical center. The secondary objectives were to compare the rates of SSI identified by NHSN criteria compared to that obtained by applying clinical infection definitions. RESULTS The overall rate of infection (SSI) was 1.9%, which was identical in both the clinical definition and NHSN reported data. The 30 day readmission rate and the 90 day readmission rate were 12.7% and 25.6% respectively with the most readmissions related to the patients' underlying medical conditions. A lower ejection fraction (EF) was identified as an independent risk factor for readmission, inpatient procedures, smoking and device infection were also significantly associated with readmission after CIED insertion.
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Malhotra A, Mandip KC, Shaukat A, Rector T. All-cause hospitalizations for inflammatory bowel diseases: Can the reason for admission provide information on inpatient resource use? A study from a large veteran affairs hospital. Mil Med Res 2016; 3:28. [PMID: 27602233 PMCID: PMC5011983 DOI: 10.1186/s40779-016-0098-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 03/17/2016] [Accepted: 08/30/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Inflammatory bowel diseases (IBDs) are group of chronic inflammatory illnesses with a remitting and relapsing course that may result in appreciable morbidity and high medical costs secondary to repeated hospitalizations. The study's objectives were to identify the reasons for hospitalization among patients with inflammatory bowel diseases, and compare inpatient courses and readmission rates for IBD-related admissions versus non-IBD-related admissions. METHODS A retrospective chart review was performed on all patients with IBD admitted to the Minneapolis VA Medical Center between September 2010 and September 2012. RESULTS A total of 111 patients with IBD were admitted during the 2-year study period. IBD flares/complications accounted for 36.9 % of the index admissions. Atherothrombotic events comprised the second most common cause of admissions (14.4 %) in IBD patients. Patients with an index admission directly related to IBD were significantly younger and had developed IBD more recently. Unsurprisingly, the IBD admission group had significantly more gastrointestinal endoscopies and abdominal surgeries, and was more likely to be started on medication for IBD during the index stay. The median length of stay (LOS) for the index hospitalization for an IBD flare or complication was 4 (2-8) days compared with 2 (1-4) days for the other patients (P = 0.001). A smaller percentage of the group admitted for an IBD flare/complication had a shorter ICU stay compared with the other patients (9.8 % vs. 15.7 %, respectively); however, their ICU LOSs tended to be longer (4.5 vs. 2.0 days, respectively, P = 0.17). Compared to the other admission types, an insignificantly greater percentage of the group whose index admission was related to an IBD flare or complication had at least one readmission within 6 months of discharge (29 % versus 21 %; P = 0.35). The rate of admission was approximately 80 % greater in the group whose index admission was related to an IBD flare or complication compared to the other types of admission (rate ratio 1.8, 95 % confidence interval 0.96 to 3.4), although this difference did not reach statistical significance (P = 0.07). CONCLUSION Identifying the reasons for the patients' index admission, IBD flares versus all other causes, may provide valuable information concerning admission care and the subsequent admission history.
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Affiliation(s)
- Ashish Malhotra
- Division of Gastroenterology, Department of Medicine, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN 55147 USA ; Center of Innovation, Minneapolis VA Medical center, Minneapolis, MN USA ; Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - K C Mandip
- Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN 55147 USA ; Center of Innovation, Minneapolis VA Medical center, Minneapolis, MN USA ; Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - Thomas Rector
- Center of Innovation, Minneapolis VA Medical center, Minneapolis, MN USA ; Department of Medicine, University of Minnesota, Minneapolis, MN USA
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Alezra E, Lasselin J, Forzini T, François T, Viart L, Saint F. [Prognostic factors for severe infection after flexible ureteroscopy: Clinical interest of urine culture the day before surgery?]. Prog Urol 2015; 26:65-71. [PMID: 26482456 DOI: 10.1016/j.purol.2015.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 02/18/2015] [Revised: 08/22/2015] [Accepted: 09/04/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The objectives of this study have been to determine prognostic factors for acute pyelonephritis (AP) after flexible ureteroscopy (FU), to assess the frequency of readmission for AP and to study the usefulness of urinalysis the day before surgery. METHODS Between 2010 and 2013, 266 patients have had at least one ureteroscopy (n=325). All infectious complications and unplanned readmissions within the month after FU were retrospectively evaluated. Several data have been collected: age, sex, BMI, surgical indication (calculis or tumor), number of previous ureteroscopies, number of previous surgeries for calculis, stones number, size and location, bilateral interventions, operating time, preoperative ureteral stenting, postoperative stenting, hospitalization stay, urine culture the day before surgery (j-1) and prescription of antibiotic therapy the week before FU. Correlation between these variables and acute pyelonephritis (AP) the month following the USSR was tested (StatView 4.5, SAS Institute) (P<0.05 significant). RESULTS We observed 24 postoperative APs (7.4%), 17 prior to hospital discharge and 7 requiring rehospitalization. In univariate analysis, the significant prognostic factors of postoperative AP have been: stone size (>14 mm) (P=0.03); operating time (70 minutes) (P<0.005); positive day - 1 urine culture (P<0.001); antibiotics treatment the week before FU (P<0.001). In multivariate analysis, antibiotics prescription during the week before USSR remained significant (P<0.002; RR 5.8 [1.9-15]). CONCLUSION Acute pyelonephritis requiring unplanned admission after ureteroscopy is a rare complication (2.4%). Urinalysis one day before ureteroscopy could allow early antibiotic therapy and may reduce 63% of unplanned hospital admissions for acute pyelonephritis. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- E Alezra
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France.
| | - J Lasselin
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France
| | - T Forzini
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France; HeRVI EA 3801, laboratoire de recherche, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France
| | - T François
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France
| | - L Viart
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France; Laboratoire d'anatomie et d'organogénèse, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France
| | - F Saint
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France; HeRVI EA 3801, laboratoire de recherche, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France; Biobanque de Picardie, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France
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Kuo LE, Wachtel H, Fraker D, Kelz R. Reoperative parathyroidectomy: who is at risk and what is the risk? J Surg Res 2014; 191:256-61. [PMID: 25012272 DOI: 10.1016/j.jss.2014.05.073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Persistent and recurrent hyperparathyroidism necessitate reoperation, which is associated with increased procedure-specific complication rates. The effect of reoperative parathyroidectomy on more generalized outcomes is poorly understood. We sought to determine patient, provider, and perioperative characteristics associated with reoperation, as well as to determine the associated risks. METHODS All patients receiving a parathyroidectomy in the American College of Surgeons National Surgical Quality Improvement Program database (2008-2011) were identified. Patients receiving initial parathyroidectomy were compared with those receiving reoperative parathyroidectomy. Descriptive statistics and univariate analyses were performed. Multivariate logistic regression models were developed for significant outcome measures. RESULTS Of 9114 parathyroidectomies performed, 8738 (95.9%) were initial and 376 (4.1%) were reoperative. The annual rate of reoperation was 3.6%-4.8%. Patients undergoing reoperative parathyroidectomy were more likely to be obese (48.5 versus 40.0%, P = 0.009) and American Society of Anesthesiologist class 3 (40.7 versus 30.3%, P = 0.001) than patients undergoing initial parathyroidectomy. There was no difference in gender, age, or race. Reoperations had a longer median operative time (101 minimum, interquartile range [IQR] [74-146] versus 76 [55-105], P <0.001) and a longer postoperative length of stay (median days until discharge 1, IQR [1-1] versus 1, IQR [0-1], P <0.001). No difference was found in the rates of mortality and common postoperative morbidity as measured in NSQIP. Patients undergoing reoperation were more likely to be readmitted within 30 d (12.7 versus 2.6%, P <0.001). After adjusting for confounders, reoperation continued to be significantly associated with readmission (odds ratio 3.82, confidence interval: 1.63-8.97; P = 0.002). CONCLUSIONS Obesity and an American Society of Anesthesiologist 3 classification are independently associated with reoperation. Readmission within 30 d is associated with reoperation and is a target for patient education and quality improvement after this procedure.
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Kuzniewicz MW, Parker SJ, Schnake-Mahl A, Escobar GJ. Hospital readmissions and emergency department visits in moderate preterm, late preterm, and early term infants. Clin Perinatol 2013; 40:753-75. [PMID: 24182960 DOI: 10.1016/j.clp.2013.07.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The increased vulnerability of late preterm infants is no longer a novel concept in neonatology, with many studies documenting excess morbidity and mortality in these infants during the birth hospitalization. Because outcomes related to gestational age constitute a continuum, it is important to analyze data from the gestational age groups that bookend late preterm infants infants-moderate preterm infants (31-32 weeks) and early term infants (37-38 weeks). This article evaluates hospital readmissions and emergency department visits in the first 30 days after discharge from birth hospitalization in a large cohort of infants greater than or equal to 31 weeks' gestation.
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Affiliation(s)
- Michael W Kuzniewicz
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Avenue (2101 Webster Annex), Oakland, CA 94612, USA; Division of Neonatology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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