30-day Hospital Admission Rates Research Articles

Managing Bacterial Infections in the Era of COVID-19

Managing Bacterial Infections in the Era of COVID-19

Comparisons of 30-Day Admission and 30-Day Total Healthcare Costs Between Patients Who Were Treated With Oritavancin or Vancomycin for a Skin Infection in the Outpatient Setting.

ObjectiveHospital admission is a key cost driver among patients with skin and soft tissue infections (SSTI). Data suggest that many SSTI patients are hospitalized unnecessarily and can be managed effectively and safely in an outpatient setting at a substantially lower cost. Oritavancin (ORI) is a single-dose treatment that has the potential to shift care from the inpatient to the outpatient setting. This study sought to compare the 30-day hospital admission rates and mean healthcare costs among SSTI patients who received outpatient ORI or vancomycin (VAN).MethodOver a 1-year period, outpatient prescription claims for VAN and ORI among patients with SSTIs and no hospitalization in past 3 days were for VAN and ORI were analyzed using a retrospective cohort analysis of the Truven Health MarketScan Databases.ResultsDuring the study period, 120 and 6695 patients who received ORI and VAN, respectively, met inclusion criteria. Groups were well matched at baseline. After covariate adjustment, patients who received ORI had a significantly lower 30- day admission rate versus patients who received VAN (6.1% vs 16.2%, respectively; P = .003). Mean healthcare costs 30-day post index were comparable between ORI and VAN patients ($12 695 vs $12 717, respectively; P = 1.0).ConclusionsResults suggest that ORI provides a single-dose alternative to multidose VAN for treatment of SSTI in the outpatient setting and may result in lower 30-day hospital admission rates.

41 - 30-day hospital admission rate following transrectal prostate biopsy: Comparison of 12-core and 18–core biopsy schemes

41 - 30-day hospital admission rate following transrectal prostate biopsy: Comparison of 12-core and 18–core biopsy schemes

Abstract 13197: Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Outpatient Setting

Background: Hypertensive urgency is a commonly encountered outpatient problem. Prevalence and short term outcomes of this condition are unknown. JNC VII recommends aggressive BP control over several days. However, a small percentage of patients are sent to the emergency department. It is unknown whether hospital management of these patients is better than outpatient BP management. Methods: Retrospective cohort study of all patients presenting to an office in a large health care system from 2008-2013 with SBP ≥180mmHg or DBP ≥ 110mmHg. We excluded pregnant women and patients referred to the hospital for symptoms or treatment of other conditions. Patients were divided into 2 groups: those sent home and those referred to hospital. We recorded baseline demographic and clinical data. Propensity matched outcomes recorded included MACE (acute coronary syndrome, stroke/TIA) uncontrolled hypertension (≥140/90 mmHg) and hospital admissions. Results: Of 2,199,019 office visits, 58,583 (5%) had hypertensive urgency. Mean age was 63±15 yrs, 58% were females, 76% Caucasian, mean BMI was 31±8 kg/m2 and mean SBP and DBP were 182±16 and 96±16 mmHg. Only 426 (0.7%) patients were referred to the ED/hospital. On propensity matched analysis between the patients referred to the hospital and sent home, there was no significant difference in MACE events at 7 days (0% vs. 0.13%, p=1), 30 days (0.25% vs. 0%, p=1) or 6 months (0.5% vs. 0.13%, p=0.26). Compared to patients sent home, patients referred to the hospital had less uncontrolled hypertension at 1 month (81% vs. 88%, p=0.001) but not at 6 months (65% vs 69%, p=0.16). They also had higher 7- and 30-day hospital admission rates (8.5% vs. 4.9%, p=0.01; 11.8% vs 7.6%, p=0.02). Conclusion: Hypertensive urgency occurs commonly, but the rate of MACE in asymptomatic patients is very low. ED visits increased hospitalizations, but did not improve outcomes. Most patients with hypertensive urgencies still had uncontrolled hypertension at 6 months.

Risk of Adverse Outcomes When Plastic Surgery Procedures Are Combined

The ability to study population-level outcomes of outpatient cosmetic procedures has been limited by a lack of longitudinal data. This study aimed to describe the rates of adverse events in patients who underwent an isolated cosmetic surgery procedure compared with those who had a combination of two procedures. Retrospective longitudinal analysis was performed of the 2005 to 2010 California Office of Statewide Health Planning and Development Ambulatory Surgery Database. Patients were included if they had undergone an abdominoplasty or any other procedure that was identified as frequently performed concurrently with abdominoplasty. Patients' subsequent in-patient admissions and emergency department visits were identified. Outcomes analyzed were the 30-day and 1-year venous thromboembolism rates, 30-day hospital admission rate, 30-day emergency department visit rate, and 30-day mortality rate. A total of 477,741 patients were analyzed, of whom 16,893 had undergone two concurrent procedures. The 12-month venous thromboembolism rate was 0.57 percent for patients undergoing abdominoplasty, 0.20 percent for liposuction, 0.12 percent for breast procedures, 0.32 percent for hernia repair, 0.28 percent for face procedures, and 0.28 percent for thigh lift/brachioplasty. Greater than additive 30-day and 1-year venous thromboembolism rates were observed among patients who underwent an abdominoplasty and liposuction (0.68 percent and 0.81 percent, respectively) and those who underwent an abdominoplasty and hernia repair (0.93 percent). Some combinations of elective outpatient procedures conferred an additive, and sometimes more than additive, venous thromboembolism risk. This is an important consideration when informing patients of potential postoperative complications and for venous thromboembolism prophylaxis.

PD2-01 INFECTION-RELATED HOSPITALIZATIONS AFTER PROSTATE BIOPSY IN A STATE-WIDE QUALITY IMPROVEMENT COLLABORATIVE

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 2014PD2-01 INFECTION-RELATED HOSPITALIZATIONS AFTER PROSTATE BIOPSY IN A STATE-WIDE QUALITY IMPROVEMENT COLLABORATIVE Paul R. Womble, MD Maxwell W. Dixon, BS Susan M. Linsell, MHSA Zaojun Ye, MS James E. Montie, MD Brian R. Lane, MD, PhD David C. Miller, andMD, MPH Fank N. BurksMD Paul R. WomblePaul R. Womble More articles by this author , Maxwell W. DixonMaxwell W. Dixon More articles by this author , Susan M. LinsellSusan M. Linsell More articles by this author , Zaojun YeZaojun Ye More articles by this author , James E. MontieJames E. Montie More articles by this author , Brian R. LaneBrian R. Lane More articles by this author , David C. MillerDavid C. Miller More articles by this author , and Fank N. BurksFank N. Burks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.133AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While transrectal prostate biopsy is the cornerstone of prostate cancer diagnosis, serious post-biopsy infectious complications are reported to be increasing. A better understanding of the true prevalence and microbiology of these events is needed to guide quality improvement in this area and ultimately better early detection practices. METHODS Using data from the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry, we identified all men who underwent transrectal prostate biopsy at 21 practices in Michigan from March 2012 through June 2013. Trained data abstractors recorded pertinent data, including prophylactic antibiotics and all biopsy-related hospitalizations within 30 days of the procedures. For a subset of patients, claims data and follow-up telephone calls were utilized for validation. All men admitted for an infectious complication were identified and their culture data obtained. We then compared the frequency of infection-related hospitalization rates across practices and according to antibiotic prophylaxis in concordance with AUA best practice recommendations. RESULTS The overall 30-day hospital admission rate following prostate biopsy was 0.97%, ranging from 0% to 4.2% across 21 MUSIC practices (Figure). Ninety-five percent of admissions were for infectious complications; the majority of cultures identified fluoroquinolone-resistant organisms. AUA concordant antibiotics were administered in 96.3% of biopsies. Patients receiving noncompliant antibiotic regimens were significantly more likely to be hospitalized for infectious complications (3.8% vs. 0.89%, p = 0.0026). CONCLUSIONS Infection-related hospitalizations occur in approximately 1% of men undergoing prostate biopsy in Michigan. Our findings suggest that many of these events could be avoided by implementing new protocols (e.g., culture-specific or augmented antibiotic prophylaxis) that both adhere with AUA best practice recommendations and address fluoroquinolone resistance. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e15 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Paul R. Womble More articles by this author Maxwell W. Dixon More articles by this author Susan M. Linsell More articles by this author Zaojun Ye More articles by this author James E. Montie More articles by this author Brian R. Lane More articles by this author David C. Miller More articles by this author Fank N. Burks More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Infection Related Hospitalizations after Prostate Biopsy in a Statewide Quality Improvement Collaborative

While transrectal prostate biopsy is the cornerstone of prostate cancer diagnosis, serious post-biopsy infectious complications are reported to be increasing. A better understanding of the true prevalence and microbiology of these events is needed to guide quality improvement in this area and ultimately better early detection practices. Using data from the MUSIC registry we identified all men who underwent transrectal prostate biopsy at 21 practices in Michigan from March 2012 to June 2013. Trained data abstractors recorded pertinent data including prophylactic antibiotics and all biopsy related hospitalizations. Claims data and followup telephone calls were used for validation. All men admitted to the hospital for an infectious complication were identified and their culture data were obtained. We then compared the frequency of infection related hospitalization rates across practices and according to antibiotic prophylaxis in concordance with AUA best practice recommendations. The overall 30-day hospital admission rate after prostate biopsy was 0.97%, ranging from 0% to 4.2% across 21 MUSIC practices. Of these hospital admissions 95% were for infectious complications and the majority of cultures identified fluoroquinolone resistant organisms. AUA concordant antibiotics were administered in 96.3% of biopsies. Patients on noncompliant antibiotic regimens were significantly more likely to be hospitalized for infectious complications (3.8% vs 0.89%, p=0.0026). Infection related hospitalizations occur in approximately 1% of men undergoing prostate biopsy in Michigan. Our findings suggest that many of these events could be avoided by implementing new protocols (eg culture specific or augmented antibiotic prophylaxis) that adhere to AUA best practice recommendations and address fluoroquinolone resistance.

Increasing Hospital Admission Rates for Urological Complications After Transrectal Ultrasound Guided Prostate Biopsy

Transrectal ultrasound guided prostate biopsy is widely used to confirm the diagnosis of prostate cancer. The technique has been associated with significant morbidity in a small proportion of patients. We conducted a population based study of 75,190 men who underwent a transrectal ultrasound guided biopsy in Ontario, Canada, between 1996 and 2005. We used hospital and cancer registry administrative databases to estimate the rates of hospital admission and mortality due to urological complications associated with the procedure. Of the 75,190 men who underwent transrectal ultrasound biopsy 33,508 (44.6%) were diagnosed with prostate cancer and 41,682 (55.4%) did not have prostate cancer. The hospital admission rate for urological complications within 30 days of the procedure for men without cancer was 1.9% (781/41,482). The 30-day hospital admission rate increased from 1.0% in 1996 to 4.1% in 2005 (p for trend <0.0001). The majority of hospital admissions (72%) were for infection related reasons. The probability of being admitted to hospital within 30 days of having the procedure increased 4-fold between 1996 and 2005 (OR 3.7, 95% CI 2.0-7.0, p <0.0001). The overall 30-day mortality rate was 0.09% but did not change during the study period. The hospital admission rates for complications following transrectal ultrasound guided prostate biopsy have increased dramatically during the last 10 years primarily due to an increasing rate of infection related complications.

Population-based linkage of health records to detect urological complications and hospitalisation following transrectal ultrasound-guided biopsies in men suspected of prostate cancer

Transrectal ultrasound-guided prostate biopsy is a common urological procedure with known complications. We determined the urological complication and 30-day hospital admission rate in a population-based cohort using unique identifier and deterministic methodology of record linkage. 715 men who underwent a transrectal ultrasound-guided biopsy in Tayside region of Scotland between April 2007 and September 2011 were identified from hospital records using their unique Community Health Index Number. Multiple hospital electronic databases (Central Vision, Insite, Wisdom, and TOPAS) and departmental-based resources (morbidity and mortality records, daily ward electronic records) were linked to estimate urological complications (urinary tract infection, urinary retention, haematuria) and rates of hospital admission. Cross-validation of information was obtained by searching a drug dispensing information network and microbiology database for infective complications. The hospital admission rate was compared for two different prophylactic antibiotic regimens used during the study period. Of the 715 men who underwent transrectal ultrasound biopsy, 386 (53.9 %) were diagnosed with prostate cancer and 329 (46.1 %) were found to have benign histology. The hospital admission rate for urological complications within 30 days of the procedure for men without cancer was 1.95 % (14/715). The 30-day hospital admission rate was not different for different regimens of prophylactic antibiotics. There were 50 (6.99 %; 50/715) urine cultures requested to the microbiology department within 30 days of procedures; out of which 20 (2.79 %; 20/715) were positive. Most of these were generated from general practice requests. Eight blood cultures obtained within the same period were all negative. Eleven patients (1.7 %) presented with urinary retention during the same period and required indwelling catheterisation. None of them had any surgical procedure. Validation of electronic record linkage against telephonic questionnaires by specialist nurse showed a high reliability of the methodology (κ = 0.91). High quality validated record linkage of cohort data in the present study using a unique identifier, protocol-based procedure and antibiotic prophylaxis showed that hospitalisation following TRUS biopsies occurs in less than 2 % of patients. However, a significant number of patients report to primary care, and centrally held records based on coding alone could underestimate the true incidence of complications.

278 POPULATION-BASED LINKAGE OF HEALTH RECORDS TO DETECT UROLOGICAL COMPLICATIONS AND HOSPITALIZATION FOLLOWING TRANSRECTAL ULTRASOUND GUIDED BIOPSIES IN MEN SUSPECTED OF PROSTATE CANCER

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2012278 POPULATION-BASED LINKAGE OF HEALTH RECORDS TO DETECT UROLOGICAL COMPLICATIONS AND HOSPITALIZATION FOLLOWING TRANSRECTAL ULTRASOUND GUIDED BIOPSIES IN MEN SUSPECTED OF PROSTATE CANCER Fahad Yousif, Sarfraz Ahmed, Stephen Lang, and Ghulam Nabi Fahad YousifFahad Yousif Dundee, United Kingdom More articles by this author , Sarfraz AhmedSarfraz Ahmed Dundee, United Kingdom More articles by this author , Stephen LangStephen Lang Dundee, United Kingdom More articles by this author , and Ghulam NabiGhulam Nabi Dundee, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.336AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transrectal ultrasound guided prostate biopsy is a common urological procedure with known complications. We determined the urological complication and 30 day hospital admission rate in a population based cohort used deterministic methodology of record-linkage. METHODS A population based study of cohort of 715 men who underwent a transrectal ultrasound guided biopsy in Tayside region of Scotland between April 2007 and September 2011 were identified from hospital records using unique Community Health Index (CHI) number. Multiple hospital electronic databases (Central vision, Insite, Wisdom, TOPAS) and departmental based resources (morbidity and mortality records,daily ward electronic records) were linked to estimate urological complications (urinary tract infection, urinary retention) and rates of hospital admission. Cross validation of information was obtained by searching Drug dispensing information network and microbiology database for infective complications. The hospital admission rate was compared for two different prophylactic antibiotic regimens used during the study period. RESULTS Of the 715 men who underwent transrectal ultrasound biopsy; 386 (53.9%) were diagnosed with prostate cancer and 329 (46.1%) were found to have benign histology. The hospital admission rate for urological complications within 30 days of the procedure for men without cancer was 1.95% (14/715). The 30-day hospital admission rate was not different for different regimens of prophylactic antibiotics. There were 50 (6.99%; 50/715) urine cultures requested to the microbiology department within 30 days of procedures; out of which 20 (2.79%; 20/715) were positive. Most of these came from general practice requests. Six blood cultures obtained within the same period were all negative. Eleven patients (1.7%) presented with urinary retention during the same period and required indwelling catheterisation. None of them had any surgical procedure. Validation of electronic record-linkage against telephonic questionnaires by specialist nurse showed a high reliability of the methodology (ê=0.91). CONCLUSIONS High quality validated record linkage of cohort data in the present study using an unique identifier, protocol based procedure and antibiotics prophylaxis showed that hospitalisation following TRUS biopsies is less than 2%. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e113 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fahad Yousif Dundee, United Kingdom More articles by this author Sarfraz Ahmed Dundee, United Kingdom More articles by this author Stephen Lang Dundee, United Kingdom More articles by this author Ghulam Nabi Dundee, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

2097 RISING HOSPITAL ADMISSION RATES FOR UROLOGIC COMPLICATIONS AFTER TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY

You have accessJournal of UrologyProstate Cancer: Detection and Screening IV1 Apr 20102097 RISING HOSPITAL ADMISSION RATES FOR UROLOGIC COMPLICATIONS AFTER TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY Robert Nam, Laurence Klotz, Andrew Loblaw, John Trachtenberg, Andrew Simor, Aleksandra Stanimirovic, and Steven Narod Robert NamRobert Nam More articles by this author , Laurence KlotzLaurence Klotz More articles by this author , Andrew LoblawAndrew Loblaw More articles by this author , John TrachtenbergJohn Trachtenberg More articles by this author , Andrew SimorAndrew Simor More articles by this author , Aleksandra StanimirovicAleksandra Stanimirovic More articles by this author , and Steven NarodSteven Narod More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2171AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transrectal ultrasound (TRUS)-guided prostate biopsy is widely used to confirm the diagnosis of prostate cancer. The technique has been associated with significant morbidity in a small proportion of patients. METHODS We conducted a population-based study of 75,190 men who underwent a TRUS-guided biopsy in Ontario, Canada, between 1996 and 2005. We used hospital and cancer registry administrative databases to estimate the rates of hospital admission and mortality due to urologic complications associated with the procedure. RESULTS Of the 75,190 men who underwent a TRUS biopsy, 33,508 (44.6%) were diagnosed with prostate cancer and 41,682 (55.4%) did not have prostate cancer. The hospital admission rate for urologic complications within 30 days of the procedure for men without cancer was 1.9% (781/41,482). The 30-day hospital admission rate rose from 1.0% in 1996 to 4.1% in 2005 (p-value for trend <0.0001). The majority of hospital admissions (72%) were for infection-related reasons. The probability of being admitted to hospital within 30 days of having the procedure rose four-fold between 1996 and 2005 (odds ratio = 3.7; 95% C.I.: 2.0 – 7.0, p<0.0001). The overall 30-day mortality rate was 0.09%, but did not change over the study period. CONCLUSIONS The hospital admission rates for complications following a TRUS-guided prostate biopsy have risen dramatically over the last ten years, primarily due to an increasing rate of infection-related complications. Toronto, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byPearle M (2018) Should We Change Our Prophylactic Antimicrobial Regimen for Prostate Biopsy?Journal of Urology, VOL. 185, NO. 4, (1181-1183), Online publication date: 1-Apr-2011. Volume 183Issue 4SApril 2010Page: e815 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Nam More articles by this author Laurence Klotz More articles by this author Andrew Loblaw More articles by this author John Trachtenberg More articles by this author Andrew Simor More articles by this author Aleksandra Stanimirovic More articles by this author Steven Narod More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Increasing Hospital Admission Rates for Urological Complications After Transrectal Ultrasound Guided Prostate Biopsy

Transrectal ultrasound guided prostate biopsy is widely used to confirm the diagnosis of prostate cancer. The technique has been associated with significant morbidity in a small proportion of patients. We conducted a population based study of 75,190 men who underwent a transrectal ultrasound guided biopsy in Ontario, Canada, between 1996 and 2005. We used hospital and cancer registry administrative databases to estimate the rates of hospital admission and mortality due to urological complications associated with the procedure. Of the 75,190 men who underwent transrectal ultrasound biopsy 33,508 (44.6%) were diagnosed with prostate cancer and 41,682 (55.4%) did not have prostate cancer. The hospital admission rate for urological complications within 30 days of the procedure for men without cancer was 1.9% (781/41,482). The 30-day hospital admission rate increased from 1.0% in 1996 to 4.1% in 2005 (p for trend <0.0001). The majority of hospital admissions (72%) were for infection related reasons. The probability of being admitted to hospital within 30 days of having the procedure increased 4-fold between 1996 and 2005 (OR 3.7, 95% CI 2.0-7.0, p <0.0001). The overall 30-day mortality rate was 0.09% but did not change during the study period. The hospital admission rates for complications following transrectal ultrasound guided prostate biopsy have increased dramatically during the last 10 years primarily due to an increasing rate of infection related complications.