Cause Of Readmission Research Articles

Readmissions After Traumatic Brain Injury in the Nationwide Readmissions Database

IntroductionReadmissions after a traumatic brain injury (TBI) can have severe impacts on long-term health outcomes as well as rehabilitation. The aim of this descriptive study was to analyze the Nationwide Readmissions Database to determine possible risk factors associated with readmission for patients who previously sustained a TBI. MethodsThis retrospective study used data from the Nationwide Readmissions Database to explore gender, age, injury severity score, comorbidities, index admission hospital size, discharge disposition of the patient, and cause for readmission for adults admitted with a TBI. Multivariable logistic regression was used to assess likelihood of readmission. ResultsThere was a readmission rate of 28.7% (n = 31,757) among the study population. The primary cause of readmission was either subsequent injury or sequelae of the original injury (n = 8825; 29%) followed by circulatory (n = 5894; 19%) and nervous system issues (n = 2904; 9%). There was a significantly higher risk of being readmitted in males (Female odds ratio: 0.87; confidence interval [0.851-0.922), older patients (65-79: 32.3%; > 80: 37.1%), patients with three or more comorbidities (≥ 3: 32.9%), or in patients discharged to a skilled nursing facility/intermediate care facility/rehab (SNF/ICF/Rehab odds ratio: 1.55; confidence interval [0.234-0.262]). ConclusionsThis study demonstrates a large proportion of patients are readmitted after sustaining a TBI. A significant number of patients are readmitted for subsequent injuries, circulatory issues, nervous system problems, and infections. Although readmissions cannot be completely avoided, defining at-risk populations is the first step of understanding how to reduce readmissions.

The Use of Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia Is Increasing and Has Low Complication Rates

PurposeTo analyze annual use of hip arthroscopy (HA) and Bernese periacetabular osteotomy (PAO) for the treatment of hip dysplasia (HD), as well as post-operative outcomes, including ipsilateral reoperations. MethodsNinth and Tenth Revision codes of the International Classification of Diseases were used to query the PearlDiver™ Mariner database from January 2010 through January 2022 to identify patients aged 10-59 years who had a presenting diagnosis of HD and subsequently underwent: 1) HA; 2) PAO; or 3) combined HA and PAO (HA-PAO, defined as PAO on the same day or within 28 days following HA). We analyzed annual rates for each treatment, as well as rates of post-operative emergency visits, readmissions and five-year ipsilateral secondary operations (determined via Kaplan-Meier analysis). ResultsThere were 32,068 patients who underwent surgical treatment of HD. For HA, PAO, and HA-PAO, there were 29,700, 2,083, and 285 patients, respectively. All operations had the highest percent-increase from 2015 to 2016. HA and HA-PAO peaked in 2021, while PAO peaked in 2019. For HA, PAO, and HA-PAO, the majority of cases were performed in female patients and patients aged 30-49 years, 10-19 years, and 10-29 years, respectively. The five-year incidence of ipsilateral secondary operations, which include revision HA, PAO, or conversion to total hip arthroplasty, was 9.2% (95% CI: 8.6%- 9.8%) in the HA group and 6.5% (95% CI: 4.1%- 8.8%) in the PAO group. Combining HA with PAO resulted in so few secondary operations that Kaplan-Meier analysis was infeasible. The PAO cohort had the highest 30-day emergency visit and 90-day readmission rates, with infection as the most common cause for readmission. ConclusionHA is more frequently performed than PAO for hip dysplasia. HA-PAO is rising at the greatest rate, demonstrating fewer complications and reoperations.

Clostridioides difficile infection promotes gastrointestinal dysfunction in human and mice post-acute phase of the disease

ObjectivesIn the US, Clostridioides difficile (C. difficile) infection (CDI) is the 8th leading cause of hospital readmission and 7th for mortality among all gastrointestinal (GI) disorders. Here, we investigated GI dysfunction post-CDI in humans and mice post-acute infection. Materials and methodsFrom March 2020 to July 2021, we reviewed the clinical records of 67 patients referred to the UVA Complicated C. difficile clinic for fecal microbiota transplantation (FMT) eligibility. C57BL/6 mice were infected with C. difficile and clinical scores were determined daily. Stool samples from mice were collected to measure the shedding of C. difficile and myeloperoxidase (MPO) levels. On day 21 post-infection, Evans's blue and FITC-70kDa methods were performed to evaluate GI motility in mice. ResultsOf the 67 patients evaluated at the C. difficile clinic, 40 patients (59.7%) were confirmed to have CDI, and 22 patients (32.8%) with post-CDI IBS (diarrhea-type, constipation-type, and mixed-type). In infected mice, levels of MPO in stools and clinical score were higher on day 3. On day 21, mice recovered from body weight loss induced by CDI, and fecal MPO was undetectable. The total GI transit time (TGITT) and FITC-70kDa levels on the proximal colon were increased in infected mice (p = 0.002), suggesting a constipation phenotype post-acute phase of CDI. A positive correlation intestinal inflammation on day 3 and TGITT on day 21 was observed. ConclusionIn conclusion, post-infection intestinal dysfunction occurs in humans and mice post-CDI. Importantly, we have validated in the mouse model that CDI causes abnormal GI transit in the recovery phase of the disease, indicating the potential utility of the model in exploring the underlying mechanisms of post-infectious IBS in humans.

Postpartum Remote Blood Pressure Monitoring Using a Mobile App in Women with a Hypertensive Disorder of Pregnancy.

Hypertensive disorders of pregnancy affect approximately 15% of pregnancies in the United States and are a leading cause of postpartum readmissions. Morbidity due to hypertension may be higher in the first several weeks postpartum. The ability to monitor blood pressure and intervene in the postpartum period is critical to reducing morbidity and mortality. At WellSpan Health, hypertensive disorders were increasing and a leading cause of severe maternal morbidity and readmission. A remote blood pressure monitoring app called BabyScripts™ myBloodPressure was implemented in September 2020. Prior to discharge postpartum, all patients with a diagnosis of a hypertensive disorder of pregnancy were given an automatic blood pressure cuff and instructions on how to monitor and track their blood pressure daily in the app. A total of 1,260 patients were enrolled in the BabyScripts™ myBloodPressure module between September 2020 and July 2022 across five maternity hospitals. Of those enrolled 74% ( n = 938) entered seven or more blood pressures, and of those who entered at least one blood pressure 9% ( n = 107) entered at least one critical range blood pressure ( ≥ 150 mmHg systolic and or ≥ 100 mmHg diastolic). Most women enrolled in the app were highly engaged and entered seven or more readings. Patients with critical blood pressures were identified; thus, the program has the potential to identify those at risk of severe complications. Barriers should be removed, and remote patient monitoring considered as a solution to improve postpartum assessment in patients with hypertensive disorders of pregnancy.

O97: Long term outcomes after negative appendicectomy: does morbidity justify mandatory pre-operative confirmation of appendicitis prior to surgery?

Abstract Introduction Negative appendicectomy is sometimes described as a quality indicator of an acute surgical service. Previous studies have suggested that negative appendicectomy carries an unacceptably high risk of morbidity and advocate pre-operative imaging to confirm a diagnosis in all cases, despite the resource implications this policy carries. This study quantified long term morbidity after negative appendicectomy. Methods This retrospective cohort study identified all patients who underwent appendicectomy for suspected appendicitis from June 2010 to August 2015 at a single centre. Patients with a histologically normal appendix were identified and their notes were interrogated to record outcomes; median follow-up was 10.6 (range, 8 – 13) years. Complications after surgery were classified using the Clavien-Dindo system. Results 1914 patients had an appendicectomy. 181 patients (9.5%) had a negative appendicectomy. There were 40 re-admissions after surgery; half (20 patients) were within 30 days. The most common causes of re-admission were ongoing symptoms with no identifiable cause (15 patients, 37.5%) or post-operative pain (9 patients (22.5%). Overall post-operative complication rate was 11 patients (6.1%). Of these, 6 patients had Grade 1 or 2 complications, 5 patients (3%) had Grade 3 complications (return to theatre for infection, bleeding or hernia) and none had Grade 4 or 5 complications. There was no mortality. Conclusions There is low short- and long-term morbidity after negative appendicectomy which suggests that routine pre-operative imaging to confirm a diagnosis of appendicitis before surgery is unwarranted. The concerns around complications after negative appendicectomy appear unjustified and should not be a quality indicator.

Distinct patterns of postoperative fever in paediatric neurosurgery patients.

Postoperative fever is a common problem following neurosurgery but data on the causes among paediatric patients is sparse. In this report, we determined the incidence, causes, and outcomes of postoperative fever in paediatric neurosurgical patients (< 18years), and contrasted the findings with an adult cohort published recently from our unit. We recruited 61 patients who underwent 73 surgeries for non-traumatic neurosurgical indications over 12months. A standard protocol was followed for the evaluation and management of postoperative fever. We prospectively collected data pertaining to operative details, daily maximal temperature, clinical features, and use of surgical drains, urinary catheters, and other adjuncts. Elevated body temperature of > 99.9 °F or 37.7°C for > 48h or associated with clinical deterioration or localising features was considered as "fever"; elevated temperature not meeting these criteria was classified as transient elevation in temperature (TET). Twenty-six patients (35.6%) had postoperative fever, more frequent than in adult patients. TET occurred in 12 patients (16.4%). The most common causes of fever were aseptic meningitis (34.6%), followed by urinary tract infections (15.4%), pyogenic meningitis, COVID-19, and wound infections. Postoperative fever was associated with significantly longer duration of hospital admission and was the commonest cause of readmission. In contrast to adults, early temperature elevations in paediatric patients may portend infectious and serious non-infectious causes of fever, including delayed presentation with aseptic meningitis, a novel association among paediatric patients. Investigation guided by clinical assessment and conservative antibiotic policy in keeping with the institutional microbiological profile provides the most appropriate strategy in managing paediatric postoperative fever.

Re-Admissions of 'Unknown' Traumatic Brain Injury Patients - Inadequacy of Rehabilitative Services in a Developing Country.

In neurosurgical practice, continuous care after discharge and the ability to detect subtle indicators of clinical deterioration are mandatory to prevent the progression of a disease. The care of 'unknown' patients discharged to rehabilitation homes may not have this privilege, especially in resource-poor countries such as India. We have attempted to study the causes and outcomes of re-admissions of 'unknown' patients with previous traumatic brain injury (TBI) to estimate the quality of nursing care in our rehabilitation centers. The electronic hospital records of all consecutive 'unknown' TBI patients with unplanned re-admissions at our institute from January 2014 to December 2018 were retrospectively reviewed and analyzed for the factors determining the risk and outcomes of re-admission. Out of 245 patients sent to rehabilitation homes at discharge, 47 patients (19.18%) were re-admitted. A total of 33 patients (70%) were re-admitted between 1 month and 1 year. Out of these, 38 patients (80.9%) were re-admitted because of preventable causes. Fifteen patients (31.9%) died during the hospital stay. The rest of the 32 (68%) patients were discharged after the management of the concerned condition with an average hospital stay of 9 ± 11.1 days. The average Glasgow coma scale (GCS) at re-admission of the patients who died was 6 (range 3-11). Two patients were brought in the brain dead status, whereas 20 patients (42.6%) had a GCS of 5 or below at the time of re-admission. The risk of mortality among patients with non-preventable causes was 88.9% (8/9) compared to preventable causes 18.4% (7/38). However, preventable causes for re-admission are much more common, resulting in nearly a similar overall contribution to mortality. There is a high rate of mortality and morbidity in 'unknown' patients with TBI because of poor post-discharge care in developing countries. Because preventable causes are the major contributor to re-admissions, the re-admission rate is a good indicator of a lack of adequate rehabilitative services. The need for improving the post-discharge management of 'unknown' patients with TBI in resource-poor countries cannot be over-emphasized.

Improving Compliance with Preoperative Nasal Povidone-Iodine to Prevent Surgical Site Infection in Vascular and Neurosurgery Services in a Community Teaching Hospital.

Surgical site infections (SSI) remain a cause of morbidity, prolonged hospitalization, surgical readmission, and death. Nasal colonization with methicillin-resistant Staphylococcal aureus is a frequent cause of device-related SSI and nasal mupirocin has been used for prevention. More recently, povidone-iodine nasal swabs have become an alternative. It is cheaper, ensures compliance and there are no concerns regarding antimicrobial resistance. However, its adoption was suboptimal in a community hospital system in southwestern Ohio, especially in neurosurgery and vascular surgery. Quality improvement techniques, including solicitation of stakeholder input, surgeons and perioperative nurses' education, and the use of reminders to order and administer the povidone-iodine nasal swabs improved physician ordering and nurse administration compliance, leading to fewer infections. The interventions continued after the project was completed, sustaining decreases in neurosurgery and vascular surgery, and fewer SSI through the first years of the pandemic. Despite the complexity of these surgeries, simple interventions were effective in addressing the problem.

Vulnerability to functional decline is associated with noncardiovascular cause of 90-day readmission in hospitalized patients with heart failure.

Hospital readmission is common among patients with heart failure. Vulnerability to decline in physical function may increase the risk of noncardiovascular readmission for these patients, but the association between vulnerability and the cause of unplanned readmission is poorly understood, inhibiting the development of effective interventions. We examined the association of vulnerability with the cause of readmission (cardiovascular vs. noncardiovascular) among hospitalized patients with acute decompensated heart failure. This prospective longitudinal study is part of the Vanderbilt Inpatient Cohort Study. The primary outcome was the cause of unplanned readmission (cardiovascular vs. noncardiovascular). The primary independent variable was vulnerability, measured using the Vulnerable Elders Survey (VES-13). Among 804 hospitalized patients with acute decompensated heart failure, 315 (39.2%) experienced an unplanned readmission within 90 days of discharge. In a multinomial logistic model with no readmission as the reference category, higher vulnerability was associated with readmission for noncardiovascular causes (relative risk ratio [RRR] = 1.36, 95% confidence interval [CI]: 1.06-1.75) in the first 90 days after discharge. The VES-13 score was not associated with readmission for cardiovascular causes (RRR = 0.94, 95% CI: 0.75-1.17). Vulnerability to functional decline predicted noncardiovascular readmission risk among hospitalized patients with heart failure. The VES-13 is a brief, validated, and freely available tool that should be considered in planning care transitions. Additional work is needed to examine the efficacy of interventions to monitor and mitigate noncardiovascular concerns among vulnerable patients with heart failure being discharged from the hospital.

Stroke Subtype and Risk of Subsequent Hospitalization: The Atherosclerosis Risk in Communities Study

Risk of readmission after stroke differs by stroke (sub)type and etiology, with higher risks reported for hemorrhagic stroke and cardioembolic stroke. We examined the risk and cause of first readmission by stroke subtype over the years post incident stroke. Atherosclerosis Risk in Communities (ARIC) study participants (n = 1,412) with first-ever stroke were followed up for all-cause readmission after incident stroke. Risk of first readmission was examined by stroke subtypes (cardioembolic, thrombotic/lacunar, and hemorrhagic [intracerebral and subarachnoid]) using Cox and Fine-Gray proportional hazards models, adjusting for sociodemographic and cardiometabolic risk factors. Among 1,412 participants (mean [SD] age 72.4 [9.3] years, 52.1% women, 35.3% Black), 1,143 hospitalizations occurred over 41,849 person-months. Overall, 81% of participants were hospitalized over a maximum of 26.6 years of follow-up (83% of participants with thrombotic/lacunar stroke, 77% of participants with cardioembolic stroke, and 78% of participants with hemorrhagic stroke). Primary cardiovascular and cerebrovascular diagnoses were reported for half of readmissions. Over the entire follow-up period, compared with cardioembolic stroke, readmission risk was lower for thrombotic/lacunar stroke (hazard ratio [HR] 0.82, 95% CI 0.71-0.95) and hemorrhagic stroke (HR 0.74, 95% CI 0.58-0.93) in adjusted Cox proportional hazards models. By contrast, there was no statistically significant difference among subtypes when adjusting for atrial fibrillation and competing risk of death. Compared with cardioembolic stroke, thrombotic/lacunar stroke was associated with lower readmission risk within 1 month (HR 0.66, 95% CI 0.46-0.93) and during 1 month-1 year (HR 0.78, 95% CI 0.62-0.97), and hemorrhagic stroke was associated with lower risk during 1 month-1 year (HR 0.60, 95% CI 0.41-0.87). There was no significant difference between subtypes in readmission risk during later periods. Over 26 years of follow-up, 81% of stroke participants experienced a readmission. Cardiovascular and cerebrovascular diagnoses at readmission were most common across stroke subtypes. Though cardioembolic stroke has previously been reported to confer higher risk of readmission, in this study, the readmission risk was not statistically significantly different between stroke subtypes or over different periods when accounting for the competing risk of death.

Trends and benefits of early hip arthroplasty for femoral neck fracture in China: a national cohort study.

Limited studies have examined the benefits of early arthroplasty within 48h from admission to surgery for femoral neck fractures (FNFs). Using the national inpatient database, the authors aimed to investigate the trends in early arthroplasty within 48h for FNFs in China and to assess its effect on in-hospital complications and 30-day readmission patterns. This was a retrospective cohort study. Patients receiving primary total hip arthroplasty (THA) or hemiarthroplasty (HA) for FNFs in the Hospital Quality Monitoring System between 2013 and 2019 were included. After adjusting for potential confounders with propensity score matching, a logistic regression model was performed to compare the differences in in-hospital complications [i.e. in-hospital death, pulmonary embolism, deep vein thrombosis (DVT), wound infection, and blood transfusion], rates and causes of 30-day readmission between early and delayed arthroplasty. During the study period, the rate of early THA increased from 18.0 to 19.9%, and the rate of early HA increased from 14.7 to 18.4% ( P <0.001). After matching, 11731 pairs receiving THA and 13568 pairs receiving HA were included. Compared with delayed THA, early THA was associated with a lower risk of pulmonary embolism [odds ratio (OR) 0.51, 95% CI: 0.30-0.88], DVT (OR 0.59, 95% CI: 0.50-0.70), blood transfusion (OR 0.62, 95% CI: 0.55-0.70), 30-day readmission (OR 0.82, 95% CI: 0.70-0.95), and venous thromboembolism-related readmission (OR 0.50, 95% CI: 0.34-0.74). Similarly, early HA was associated with a lower risk of DVT (OR 0.70, 95% CI: 0.61-0.80) and blood transfusion (OR 0.74, 95% CI: 0.68-0.81) than delayed HA. Despite a slight increase, the rate of early arthroplasty remained at a low level in China. Given that early arthroplasty can significantly improve prognosis, more efforts are needed to optimize the procedure and shorten the time to surgery.

Unplanned 30-day readmission rate after ophthalmological surgery as a quality-of-care indicator.

The 30-day readmission rate provides a standardised quantitative evaluation of some postoperative complications. It is widely used worldwide in many medical and surgical specialities, and the World Health Organization recommends its use for monitoring healthcare system performance. In ophthalmology, its measurement is biased by the frequent and close planned surgery on one eye and then the other, particularly in the case of cataract surgery. This study measures the 30-day unplanned readmission rate in ophthalmology, globally and by surgery subtype, and describes the causes of readmission. All patients readmitted within 30 days of ophthalmic surgery at Nantes University Hospital between January 2017 and December 2020 were identified in the Medical Information System. An ophthalmologist examined each medical record and collected the following data: the reason for readmission, comorbidities, the pathology treated, surgery type, surgery duration, the surgeon's experience, anaesthesia type, severity and readmission morbidity. For the 8522 ophthalmic surgeries performed in the four-year study period, 282 30-day unplanned readmissions were identified. The overall 30-day unplanned readmission rate was 2.07% for elective surgery, with a high variability depending on the surgery type: 0.95% for phacoemulsification, 4.95% for vitreoretinal surgery (3.42% for non-elective vitreoretinal surgery, 5.44% for retinal detachment surgery), 5.66% for deep lamellar keratoplasty and 11.90% for trabeculectomy. The unplanned 30-day readmission rate for ocular trauma surgery (emergency care) was 11.0%. Seven percent of all unplanned 30-day readmissions were not associated with an ophthalmological problem. This study is the first to report 30-day unplanned readmission in ophthalmology, globally and by surgical subtype, for elective and urgent procedures. This indicator can be used longitudinally to detect an increase in risk or transversely to compare the quality of care between different public or private hospitals.

Readmission and reoperation rates after laparoscopic bariatric surgery in an Italian center of excellence.

The aim of this study was to analyze short-term outcomes focusing on readmissions after laparoscopic bariatric metabolic surgery (BMS) in an Italian academic Bariatric Center of Excellence IFSO-European Chapter (EC). This is a retrospective study based on the analysis of a prospectively maintained institutional database. Patients aged between 18 and 65 years who underwent primary BMS and/or revisional BMS (RBMS) between 2012 and 2021 were included. Primary endpoint was to analyze the readmission rate at 30 postoperative days. The secondary endpoint involved assessing the causes of readmission within 30 days of discharge, the rates, and types of reoperations and/or additional procedures related to the first surgery, and the outcomes of readmitted patients. A total of 2297 patients were included in the study. Among them, 2143 underwent primary surgery and 154 patients underwent RBMS. Eighty-two percent of the Enhanced Recovery after Surgery (ERAS) protocol items were applied starting from 2016. Within 30 days after discharge, 48 patients (2.09%) were readmitted. Overall readmission rate following primary and revisional BMS was 2.15%, respectively 1.30%. Ten readmitted patients (20.8%) had complications graded IIIb or more (Clavien-Dindo classification) and needed additional procedures. Mortality rate was 4.17% among readmitted patients. Only 2.09% of patients undergoing laparoscopic bariatric surgery were readmitted. Of these, 20.8% required additional procedures. Standardization of surgical techniques and perioperative protocols in a bariatric center of excellence resulted in a low readmission rate even in RBMS.

Abstract WMP59: Prognosis After Cerebral Venous Thrombosis: Long-Term Readmission Patterns in a Canadian Population-Based Cohort

Background: Information on long-term care utilization patterns following the acute care period of cerebral venous thrombosis (CVT) is limited. We examined readmission reasons and patterns after discharge from index CVT hospitalization. Methods: A population-based cohort of patients diagnosed with CVT (2000-2017) was constructed using linked administrative data. Descriptive statistics were calculated for baseline demographics and readmission causes. Readmission proportions were calculated for first readmission every year during the 10 years after diagnosis. Survival analysis was used to examine associations between patient factors and readmission events. Results: The cohort included 508 patients, 56% female and mean age 49.6 years (SD 19). Median time-to-first readmission is 1.8 years (95% CI 1.4-2.4), with 39% of patients readmitted in 1 year (95% CI 35-43) and 69% in 5 years (95% CI 64-73). Cancer-related CVT was associated with a higher rate of readmission (p&lt;0.0001) and traumatic CVT was associated with a lower rate (p=0.005). In patients younger than age 50 (mean: 36.1 years, SD 9), headache and epilepsy were among the top five reasons for readmission. For patients older than 50 years (mean: 67.6 years, SD 11), cerebral infarction was among the top five reasons. Readmission rate stabilized over time. Conclusion: Cancer-related CVT was associated with significantly higher readmissions and traumatic CVT had significantly lower readmissions. The most common neurologic reasons for readmission differed by age group, but included headaches, seizures, and stroke. Readmission rates were highest in the first two years following discharge but stabilized over time.

Predictors and Significance of Readmission after Esophagogastric Surgery: A Nationwide Analysis.

The aim of this study is to identify risk factors for readmission after elective esophagogastric cancer surgery and characterize the impact of readmission on long-term survival. The study will also identify whether the location of readmission to either the hospital that performed the primary surgery (index hospital) or another institution (nonindex hospital) has an impact on postoperative mortality. Over the past decade, the center-volume relationship has driven the centralization of major cancer surgery, which has led to improvements in perioperative mortality. However, the impact of readmission, especially to nonindex centers, on long-term mortality remains unclear. This was a national population-based cohort study using Hospital Episode Statistics of adult patients undergoing esophagectomy and gastrectomy in England between January 2008 and December 2019. This study included 27,592 patients, of which overall readmission rates were 25.1% (index 15.3% and nonindex 9.8%). The primary cause of readmission to an index hospital was surgical in 45.2% and 23.7% in nonindex readmissions. Patients with no readmissions had significantly longer survival than those with readmissions (median: 4.5 vs 3.8 years; P < 0.001). Patients readmitted to their index hospital had significantly improved survival as compared to nonindex readmissions (median: 3.3 vs 4.7 years; P < 0.001). Minimally invasive surgery and surgery performed in high-volume centers had improved 90-day mortality (odds ratio, 0.75; P < 0.001; odds ratio, 0.60; P < 0.001). Patients requiring readmission to the hospital after surgery have an increased risk of mortality, which is worsened by readmission to a nonindex institution. Patients requiring readmission to the hospital should be assessed and admitted, if required, to their index institution.

Cord blood albumin level as a predictor of neonatal physiological jaundice in healthy term neonate

Background: Neonatal jaundice is a very common condition worldwide, occurring in up to 60% of term and 80% of pre-term newborns in the 1st week of life and the most common cause for readmission. The present study was conducted to evaluate the predictive value of umbilical cord blood albumin level for subsequent development of neonatal jaundice in healthy term neonates. The present study is conducted to find usefulness of cord blood albumin in predicting the subsequent development of significant neonatal jaundice. Methods and Methods: This is a hospital-based prospective study conducted in 100 healthy term neonates. Cord blood albumin level estimation was done at birth. Total serum bilirubin estimation was done for all babies with clinically suspected jaundice at 72–96 h of age. The neonates were divided into three Groups A, B, and C based on the cord albumin levels of &lt;2.8 g/dL, 2.8–3.3 g/dL, and &gt;3.3 g/dL, respectively. The main outcome of the study was inferred in terms of serum bilirubin ≥17 mg/dL, newborn required phototherapy, and exchange transfusion. Results: Groups A, B, and C had 21, 35, and 44 newborns, respectively. In Group A, 18 (85.7%) neonates had total bilirubin of &gt;17 mg/dL, of which 16 (76.19%) required phototherapy and 2 (9.52%) needed exchange transfusion. 23 (65.7%) neonates in Group B developed jaundice, of which 12 (34.2%) needed phototherapy and none of them required exchange transfusion. In Group C, 15 (34.09%) developed jaundice of which 1 (2.2%) required phototherapy and none of them required exchange transfusion (p&lt;0.001). Conclusion: Cord blood albumin level ≤2.8 g/dL is a significant risk factor for developing neonatal hyperbilirubinemia that requires early intervention, while cord blood albumin &gt;3.3 g/dL is probably safe for early discharge. Hence, this can help to identify the at-risk neonates. Hence, routine determination of cord blood albumin level can be advocated to keep a track on at-risk neonates.

IDENTIFYING FACTORS THAT WORSEN IN-HOSPITAL OUTCOMES IN PATIENTS WITH VENTRICULAR TACHYCARDIA (VT) AND INFLAMMATORY BOWEL DISEASE (IBD)

Abstract BACKGROUND IBD is a proinflammatory state that can have numerous complications involving all systems of the body. There is a known association with cardiovascular disease. However, there are limited studies that have examined the impact of cardiac arrhythmias such as VT on patients with IBD (Crohn’s Disease and Ulcerative Colitis). The aim of this study was to evaluate the economic burden and various hospital outcomes associated with patients with IBD with and without VT. METHODS Patients aged 18 years with IBD and VT versus IBD alone were identified from the US Nationwide Inpatient Sample (NIS), from the years 2010-2019. ICD 9 and 10 codes were utilized and multivariate regression analysis utilizing propensity matching (Kernel method) was used to estimate the odds ratios of in-hospital mortality, the average length of hospital stay (LOS), and hospital charges (TOTHC), after adjusting for age, gender, race, primary insurance payer status, hospital type and size (number of beds), hospital region, hospital teaching status, and other demographic characteristics. Weighted analysis utilizing Stata 17 MP was performed. RESULTS For patients with Crohn’s disease and depression, mean age at readmission was 51.6 years and there was a high readmission rate and mortality at 30 days (readmission rate 5.2%, p&amp;lt;0.01 and mortality rate 2.8%, p&amp;lt;0.01) which increased significantly at 90 days (readmission rate 8.4%, p&amp;lt;0.01). Hospital LOS and TOCHG remained relatively the same compared to the index admission for both 30 day and 90 day readmissions (Table 1). A very similar trend was seen for UC and depression as well: mean age at readmission was 51.4 years and there was a high readmission rate and mortality at 30 days (readmission rate 5.0%, p&amp;lt;0.01 and mortality rate 2.6%, p&amp;lt;0.01) which increased significantly at 90 days (readmission rate 8.4%, p&amp;lt;0.01 and mortality rate 2.9%, p&amp;lt;0.01). The top 10 causes of readmission at 30 days and 90 days for both UC and Crohn’s are summarized in Table 1. CONCLUSION Our study revealed that patients with IBD and VT had increased mortality, LOS, and TOTHC were increased compared to patients with IBD only. Further studies are required to further evaluate this patient population.

Preeclampsia in Ghana: A study on the prevalence and risk factors of postpartum readmission in the Ashanti Region

AbstractBackgroundDespite significant improvements in its management, preeclampsia continues to be one of the frequent causes of postpartum readmission. Increased awareness of the risk factors for postpartum readmission is required to reduce its incidence and related complications. This study determined the prevalence and associated risk factors for postpartum readmission among women with preexisting preeclampsia in a Ghanaian population.MethodsThis hospital‐based retrospective study was conducted at the obstetrics and gynaecology units of Komfo Anokye Teaching Hospital in Ghana. We reviewed the medical records including sociodemographic and obstetric characteristics of preeclampsia patients. Statistical analyses were performed using Statistical Package for Social Sciences Version 26.0 and GraphPad Prism version 8.0. p‐Value &lt;0.05 was considered statistically significant.ResultsA total of 208 preeclampsia patients were considered in this study. The rate of postpartum readmission for a hypertensive disorder among women with preeclampsia was 46%. After adjusting for multiple confounders in the multivariate logistic model, having a family history of hypertension [aOR = 3.512, 95% CI (1.669–7.394), p = 0.0028] was associated with increased odds for postpartum readmission. However, being nulliparous [aOR = 0.321, 95% CI (0.116–0.887), p = 0.0028] was independently associated with a reduced odd for postpartum readmission.ConclusionThe rates of postpartum readmission are significantly high among preeclampsia women. Our findings highlight the importance of continued efforts to improve the health outcomes of both mother and newborn, including heightened monitoring of at‐risk patients in the Ghanaian population.

1901 Determinants of hospital readmissions in older people with dementia: A scoping review

Abstract Introduction In the UK, fifty-three percent of hospitalised older people with dementia have multimorbidity, and are at an increased risk of hospital readmission within 30 days from discharge. Between 20-40% of these readmissions are preventable [1]. Current research focused on the biological causes of readmissions. However, older people with dementia have additional psychosocial factors increasing their risk of readmission. The aim of this scoping review was to identify psychosocial determinants within the context of known biological factors. Methods Electronic databases MEDLINE, EMBASE, CINAHL and PsychInfo were searched from inception until July 2022. Quantitative and qualitative studies in English including adults aged 65 years and over with dementia, their care workers and informal carers were considered if they investigated readmission. An inductive approach was adopted to map determinants of hospital readmission. Identified themes were described as narrative categories. Results Seventeen studies including 7,194,878 participants met our inclusion criteria from a total of 4736 articles. Sixteen quantitative studies included observational cohort and randomised controlled trial designs. One American study was qualitative. Ten studies were based in the USA, and one study each from Taiwan, Australia, Canada, Sweden, Japan, Denmark, and The Netherlands. Large hospital and insurance records provided data in over 2 million patients in one American study. Identified psychosocial determinants included inadequate hospital discharge planning, limited interdisciplinary collaboration, and socioeconomic inequalities among ethnic minorities. Biological determinants included reduced mobility and accumulation of comorbidities. Use of antipsychotic medications might explain the interplay between biological and psychosocial determinants. Conclusion Poorly defined roles and responsibilities of health and social care professionals and poor communication during care transitions increase the risk of readmission in older people with dementia. Reference 1. Godard-Sebillotte C, Strumpf E, Sourial N, et al. L. Primary care continuity and potentially avoidable hospitalization in persons with dementia. J Am Geriatr Soc. 2021;69(5):1208-20.

Causes and Predictors of 30-Day Readmission in Patients With Stroke Undergoing Mechanical Thrombectomy: A Large Single-Center Experience.

The 30-day readmission rate has emerged as a metric of quality care and is associated with increased health care expenditure. We aim to identify the rate and causes of 30-day readmission after mechanical thrombectomy and provide the risk factors of readmission to highlight high-risk patients who may require closer care. This is a retrospective study from a prospectively maintained database of 703 patients presenting for mechanical thrombectomy between 2017 and 2023. All patients who presented with a stroke and underwent a mechanical thrombectomy were included in this study. Patients who were deceased on discharge were excluded from this study. Our study comprised 703 patients, mostly female (n = 402, 57.2%) with a mean age of 70.2 years ±15.4. The most common causes of readmission were cerebrovascular events (stroke [n = 21, 36.2%], intracranial hemorrhage [n = 9, 15.5%], and transient ischemic attack [n = 1, 1.7%]).Other causes of readmission included cardiovascular events (cardiac arrest [n = 4, 6.9%] and bradycardia [n = 1, 1.7%]), infection (wound infection postcraniectomy [n = 3, 5.2%], and pneumonia [n = 1, 1.7%]). On multivariate analysis, independent predictors of 30-day readmission were history of smoking (odds ratio [OR]: 2.2, 95% CI: 1.1-4.2) P = .01), distal embolization (OR: 3.2, 95% CI: 1.1-8.7, P = .03), decompressive hemicraniectomy (OR: 9.3, 95% CI: 3.2-27.6, P < .01), and intracranial stent placement (OR: 4.6, 95% CI: 2.4-8.7) P < .01). In our study, the rate of 30-day readmission was 8.3%, and the most common cause of readmission was recurrent strokes. We identified a history of smoking, distal embolization, decompressive hemicraniectomy, and intracranial stenting as independent predictors of 30-day readmission in patients with stroke undergoing mechanical thrombectomy.