Length Of Stay Days Research Articles

Clinical profiles and functional outcomes in elderly stroke survivors undergoing neurorehabilitation: a retrospective cohort study

BackgroundThis retrospective study characterizes clinical profiles and evolution of elderly stroke patients undergoing neurorehabilitation. Additionally, it identifies predictors of functional outcomes and hospital length of stay (LOS). For this purpose, patients aged ≥ 60 years admitted for neurorehabilitation within 6 months post-stroke, were recruited between January 2015 and August 2022. Rehabilitation profiles were identified using two-step clustering analysis, including the Modified Rankin Score (mRS), the National Institutes of Health Stroke Scale (NIHSS) and the motor and cognitive Functional Independence Measure (m-FIM and c-FIM) upon admission. FIM-effectiveness was calculated as (FIM-discharge−FIM-admission)/(maximum FIM−FIM-admission). Linear regression analyses were conducted to identify predictors of functional outcomes and LOS (days).ResultsThe study enrolled 104 patients (68 male; mean age = 69.45 ± 6.5 years). Three clusters were identified: “Moderate” [NIHSS = 7.70 ± 3.21, motor-FIM = 59.42 ± 12.24, cognitive-FIM = 26.96 ± 4.69, mRS = 4 (4–4), aphasia = 41.7%, severe dysphagia = 4.2%, LOS = 45 (33.25–59) days]; “Moderate-severe” [NIHS = 10.40 ± 3.23, motor-FIM = 28.00 ± 7.74, cognitive-FIM = 25.92 ± 6.55, mRS = 4 (4–5), aphasia = 13%, severe dysphagia = 6.4%, LOS = 61 (45–92) days]; and “Severe” group [NIHS = 18.76 ± 4.19, motor-FIM = 16.12 ± 6.69, cognitive-FIM = 10.58 ± 4.14, mRS = 5 (5–5), aphasia = 60.6%, severe dysphagia = 42.4%, LOS = 71 (60.5–97.5) days]. The motor and cognitive FIM effectiveness significantly improved in the “Moderate” (m-FIM-effectiveness = 33.70 [12.16–53.54]; c-FIM-effectiveness = 33.3 [0–50.0]) and “Moderate-severe” cluster (m-FIM-effectiveness = 31.15 [10.34–46.55]; c-FIM-effectiveness = 33.3[0–63.16]) compared to the “Severe” cluster (m-FIM-effectiveness = 5.77 [0–18.77]; c-FIM-effectiveness = 4.65 [0–22.30]) (p = 0.001 and p = 0.025), whereas aphasia and dysphagia improved in all groups (p > 0.1). Severe stroke (NIHSS) (β = 0.33, p < 0.001), greater functional dependence (mRS) (β = 0.24, p = 0.013), presenting dysphagia (β = 0.30, p = 0.002), neuropathic pain (β = 0.22, p = 0.02), depression (β = 0.29, p = 0.003) or in-hospital infections (β = 0.23, p = 0.02) predicted higher LOS.ConclusionsPatient clustering proves valuable in identifying distinct stroke rehabilitation profiles. Low FIM on admission, severe dysphagia, in-hospital infections, and psychotropic medication use, predicted poor functional outcomes and longer hospitalization.

Evaluation of High-dose versus Standard-dose of Dexamethasone on Mortality among the Mechanically Ventilated COVID-19 Patients.

Anti-inflammatory agents like dexamethasone (DEX) are a mainstay of treatment for COVID-19. Despite randomized trials demonstrating that a 6 mg daily dose of DEX improved patient outcomes in hospitalized COVID-19 patients receiving oxygen, clinicians often prescribe higher doses of corticosteroids without evidence to support this practice. The purpose of this study was to compare outcomes of ventilated COVID-19 patients who received standard dose (SD) versus high dose (HD) DEX. This was a multi-site, retrospective, observational study on ventilated COVID-19- positive patients who received DEX for at least three days between June 1, 2020, and January 31, 2022. The primary outcome of this study was the association between mortality and SD (<6 mg daily) versus HD (>10 mg daily) DEX in ventilated COVID-19 patients. Secondary outcomes included average blood glucose (BG), number of BG readings above 200, incidence of bacterial nosocomial infection, ventilator-free days, length of stay (LOS), and ICU LOS. Of the 212 included patients, 53 (25%) received SD DEX, and 159 (75%) received HD DEX. There was no significant effect of DEX dose on mortality, number of BG readings >200, incidence of nosocomial infections, LOS, or ventilator-free days (p >0.05). After controlling for confounding factors, no difference in mortality persisted (OR 1.34 95% CI 0.62- 2.90). Average daily BG and ICU LOS were significantly greater in the HD group compared to the SD group (p = 0.003, p = 0.019, respectively). There was no association between HD DEX and mortality among ventilated COVID- 19 patients compared to SD DEX. Moreover, HD DEX is associated with detrimental effects such as prolonged ICU LOS and higher average daily BG. This study supports the use of SD DEX in ventilated COVID-19 patients.

Early Fluid Is Less Fluid: Comparing Early Versus Late ICU Resuscitation in Severely Injured Trauma Patients.

The temporal trends of crystalloid resuscitation in severely injured trauma patients after ICU admission are not well characterized. We hypothesized early crystalloid resuscitation was associated with less volume and better outcomes than delaying crystalloid. Retrospective, observational. High-volume level 1 academic trauma center. Adult trauma patients admitted to the ICU with emergency department serum lactate greater than or equal to 4 mmol/dL, elevated lactate (≥ 2 mmol/L) at ICU admission, and normal lactate by 48 hours. None. For the 333 subjects, we analyzed patient and injury characteristics and the first 48 hours of ICU course. Receipt of greater than or equal to 500 mL/hr of crystalloid in the first 6 hours of ICU admission was used to distinguish early vs. late resuscitation. Outcomes included ICU length of stay (LOS), ventilator days, and acute kidney injury (AKI). Unadjusted and multivariable regression methods were used to compare early resuscitation vs. late resuscitation. Compared with the early resuscitation group, the late resuscitation group received more volume by 48 hours (5.5 vs. 4.1 L; p ≤ 0.001), had longer ICU LOS (9 vs. 5 d; p ≤ 0.001), more ventilator days (5 vs. 2 d; p ≤ 0.001), and higher occurrence rate of AKI (38% vs. 11%; p ≤ 0.001). On multivariable regression, late resuscitation remained associated with longer ICU LOS and ventilator days and higher odds of AKI. Delaying resuscitation is associated with both higher volumes of crystalloid by 48 hours and worse outcomes compared with early resuscitation. Judicious crystalloid given early in ICU admission could improve outcomes in the severely injured.

Uptake of Same-Day Discharge for Patients Undergoing Robot-Assisted Radical Prostatectomy in the Michigan Urological Surgery Improvement Collaborative.

Postoperative length of stay (LOS) after robot-assisted radical prostatectomy (RARP) is a potentially modifiable aspect of prostate cancer care. Our objective was to evaluate the use of same-day discharge (SDD) RARP and compare pre- and perioperative characteristics of these men with those who underwent hospitalization postoperatively. Perioperative outcomes for patients undergoing RARP were evaluated from the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry. Men were classified by hospital LOS: SDD, 1 day, and 2 days. Practice and surgeon-level variation of SDD and the change in SDD use over time were assessed. The primary outcome was 30-day readmission after RARP. We identified 10,249 men undergoing RARP in MUSIC from 2018 to 2022. Most patients had 1-day LOS (79.6%), with 2.8% undergoing SDD. The proportion of patients undergoing RARPs with SDD rose from 0.6% in 2018 to 1.2% in 2019 and 4.4% for 2020 to 2022. At least one SDD was performed in 12 of 28 MUSIC practices (42.9%) and by 52 of 138 urologists (37.7%). In multivariable analysis, odds of 30-day readmission were not significantly different between patients .undergoing SDD and LOS 1 day (OR: 1.72, 95% CI: 0.92-3.22, P = .090). Limitations include retrospective, registry-based observational study with nonuniform utilization of SDD. Although more patients have undergone SDD after RARP beginning in 2018, rates across Michigan have remained < 5% annually. Importantly, patients undergoing SDD RARP did not experience significantly more readmissions compared to hospitalized patients. SDD appears safe and feasible for select patients who are motivated by this approach.

Increased disease severity during COVID-19 related hospitalization in black non-hispanic, hispanic and medicaid-insured young children.

The COVID-19 pandemic has disproportionately affected marginalized groups in the United States. Although most children have mild or asymptomatic COVID-19, some experience severe disease and long-term complications. However, few studies have examined health disparities in severe COVID-19 outcomes among US children. To examine disparities in the clinical outcomes of infants and children aged <5 years hospitalized with COVID-19 by race/ethnicity and payer status. Children aged <5 years hospitalized with an admission diagnosis of COVID-19 (April 2021-February 2023) were selected from the PINC AI™ Healthcare Database. Hospital outcomes included length of stay (LOS), intensive care unit (ICU) admission, oxygen supplementation, invasive mechanical ventilation (IMV), and prolonged duration of each outcome. Multivariable logistic regression models compared hospitalization outcomes by race/ethnicity and payer status. Among 10,190 children (mean age: 0.9 years, 56.5% male, 66.7% Medicaid-insured), race/ethnicity was distributed as follows: White non-Hispanic (35.1%), Hispanic (any or Unknown race; 28.3%), Black non-Hispanic (15.2%), Other race/ethnicity (8.9%) and Unknown (12.5%). Payer status varied by race/ethnicity. White non-Hispanic children had the highest proportion with commercial insurance (42.9%) while other racial/ethnic groups ranged between 13.8% to 26.1%. Black non-Hispanic children had the highest proportion with Medicaid (82.3%) followed by Hispanic children (76.9%). Black non-Hispanic children had higher odds of prolonged outcomes: LOS (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI]:1.05-1.38), ICU days (aOR = 1.44, 95% CI: 1.07-1.93), and IMV days (aOR = 1.80, 95% CI: 1.09-2.97) compared to White non-Hispanic children. Similar patterns were observed for Hispanic and children of Other race/ethnicity. Medicaid-insured and children with other insurance had higher odds of prolonged LOS and oxygen days than commercially insured patients. There were disparities in clinical outcomes of COVID-19 by race/ethnicity and insurance type, particularly for prolonged-duration outcomes. Further research is required to fully comprehend the causes and consequences of these disparities and develop strategies to reduce them while ensuring equitable healthcare delivery.

Adopting combination machine learning models could reduce hospital length of stay for oncology patients.

11084 Background: Integra Connect previously created in-patient (IP) admission prediction model based on OCM data. One of the challenges for practices in a value-based care (VBC) program is to provide continuous care-coordination during and after an IP admission. Our objective is to show how adopting combination machine learning (ML) models can predict IP length of stay (LOS). Potential benefits include an overall reduction in LOS which could minimize the risk of hospital acquired conditions. Methods: ML models were trained on 5 major cancer types (Lung Cancer, Multiple Myeloma, Lymphoma, Small Intestine / Colorectal Cancer, High-risk Breast Cancer') from 7 OCM practices of PP4-PP9 data, excluding surgery IP admission. The top 5 cancer types accounted for ~50% of total in-patient admissions and ~50% of total LOS in days. The IP admissions were divided into 4 major cohorts in terms of LOS in days (1-3: class 1, 4-8: class 2, 9-15: class 3, and more than 15: class 4). To reduce the overall LOS, we adopted two ML models: 1) To classify LOS, a multi-classification model (Model1, an eXtreme Gradient Boosted Trees Classifier) and 2) To predict the LOS for classes 1-3, a regression-based model (Model2, an eXtreme Gradient Boosted Trees Regressor with Early Stopping). Class 4 cohort had a wide range (16- 90+ days) for LOS and therefore was excluded from Model2. The other three cohorts belonged to Q1, IQR, and Q4, respectively. Model1 was trained on 4,280 randomly selected sample IP admissions to balance each class and Model2 was trained on 19,636 IP admissions, both with 102 features. Results: The models were tested on PP10-PP11 claims excluding 0 days LOS. Model1 predicted 296 (3,945) IP admissions in class 4 of which 88 were true positives. Assuming at least a 10% reduction in associated total LOS translated to lower LOS of 1-3% for 5 (7) practices. The remaining 3,649 IP admissions were used to predict LOS by Model2. The difference between actual LOS and Predicted LOS was found as 18%-24%. To address model prediction errors, we defined the target LOS to be predicted LOS with an upper bound of at least 10%. This led to reductions of 6% -16% across practices. Finally, combining the results of both ML models we determined that the potential to lower LOS was at least 6% and at most 19%. Conclusions: Our ML models identified opportunities to reduce LOS across multiple OCM cancer practices for 5 major cancer types. We also identified a cohort of patients with critical condition (class 4) that is vital for practice transformation initiatives. These identified reduction in LOS for oncology patients provides cost reduction and quality improvement opportunities in VBC programs. In the future, more opportunities to lower LOS will be explored with a re-admission prediction model.

Institutional experience with a limb salvage quality improvement initiative to reduce length of stay and readmissions

BackgroundThis article aims to outline the process and present preliminary outcomes of a local quality improvement initiative focusing on length of stay (LOS) and 30-day unplanned readmissions in patients undergoing treatment for peripheral arterial disease. MethodsInitiating with internal data acquisition, our clinical informaticists, adept in Epic data mining, were tasked with monthly query of the database for all patients with peripheral arterial disease managed since May 2021. An automated report of crucial variables, eliminating the need for individual chart review, was thus generated. Studying trends in LOS and readmissions, we set target goals of 7 days for LOS and 11% for 30-day unplanned readmission, referencing the top-decile institutions in the Vizient ranking. To enhance our quality improvement initiative, we formed a comprehensive limb salvage committee, comprising a vascular surgeon, hospitalist, podiatrists, nurses, a case management team, and a clinical researcher. This multidisciplinary team met regularly to review monthly reports, identify trends, and propose improvements. After 6 months of observation, the limb salvage committee finalized a set of recommendations, which were then communicated to the vascular surgery faculty for feedback and subsequent implementation. Monthly outcomes were continuously monitored by the limb salvage committee to assess progress and pinpoint areas necessitating further improvement. ResultsBetween May 2021 and March 2023, 985 consecutive procedures were performed. The average postoperative LOS was 7 ± 10 days, with 35% not meeting the goal. Patients not meeting the LOS goal often had a history of coronary artery disease or congestive heart failure and were admitted initially for nonvascular reasons. The readmission rate was 15%. Recommendations from the limb salvage committee included deferring nonurgent revascularization to outpatient care with prehabilitation for at-risk patients, and early follow-up by a nurse practitioner for wound check and pain management. These recommendations were implemented at the end of March 2023. After implementing these recommendations, 272 cases recorded between April and July 2023 saw a decrease in patients not meeting the target LOS to 27%, and unplanned readmissions decreased to 11%. ConclusionsOur limb salvage quality improvement project has proved efficient in monitoring quality metrics and targeting specific areas in need of improvement. Continuous monitoring is necessary to ensure compliance, track outcomes, and identify areas in need of further improvement. Future studies will assess further the effectiveness of this process in improving patient care.

Morbidity and trends in length of hospitalisation of very and extremely preterm infants born between 2008 and 2021 in the Netherlands: a cohort study

ObjectivesThis study investigated changes in the length of stay (LoS) at a level III/IV neonatal intensive care unit (NICU) and level II neonatology departments until discharge home for very preterm...

Same-Day Discharge Does Not Increase Resource Utilization Within One Year of Total Joint Arthroplasty

BackgroundWhile the safety of rapid recovery total joint arthroplasty is well established, less is known about its impact on postoperative care utilization patterns. We wished to examine whether same-day discharge—and its associated presumed reduction in hospital-based postoperative care and education—translates to the need for more postoperative support during the 1-year recovery period. MethodsA retrospective review of 1,237 total hip arthroplasty (THA) and 1,710 total knee arthroplasty (TKA) patients who had 0- or 1-day length of stay (LOS) from January 2020 to October 2023 was conducted. The primary outcome was the number of follow-up visits with total joint arthroplasty providers at our institution during the 1-year postoperative period. Secondary outcomes included 30-day emergency department returns, readmissions, 1-year physical therapy utilization, and improvement in Patient-Reported Outcomes Measurement Information System Physical Function scores at 6 to 12 months postoperatively. Bivariate and multivariable analyses were performed to compare outcomes between 0-day and 1-day LOS THA and TKA patients. ResultsIn both the THA and TKA populations, 0-day LOS patients were younger, had a lower average body mass index, were more likely to be White, men, and had an American Society of Anesthesiologists score < 3 than 1-day LOS patients. After controlling for differences between groups, no significant differences in the number of one-year follow-up visits, physical therapy visits, emergency department returns, or readmissions were seen between 0 and 1-day THA or TKA patients. In TKA patients, 1-day LOS was associated with lower improvements in Patient-Reported Outcomes Measurement Information System Physical Function scores. ConclusionsAfter risk adjustment, same-day discharge of THA and TKA patients did not result in increased resource utilization during the one-year postoperative period. In the setting of a coordinated joint arthroplasty program with nurse navigator support, same-day discharge can be safely performed without increasing the need for postoperative care in appropriately selected patients undergoing both THA and TKA.

Intraoperative 3D Fluoroscopy During Open Reduction for DDH: An Effective Alternative to Postoperative CT/MRI.

Computed tomography CT or magnetic resonance imaging (MRI) has been the most used imaging modality to assess hip reduction in developmental dysplasia of the hip (DDH) after open reduction (OR). In 2015, intraoperative 3D fluoroscopy (3D) was introduced at our center as an alternative to CT/MRI. 3D offers the advantage that if hip reduction is insufficient, it can be addressed at the time of surgery. The purpose of this study was to assess the efficacy of 3D in comparison to CT/MRI. This was a single-centre, retrospective comparative study of two consecutive cohorts: those with OR and 3D between 2015 and 2017 and those with OR and CT/MRI between 2012 and 2014. Time to imaging, re-imaging, length of stay (LOS), re-operation, and redislocation or subluxation after cast removal were evaluated. Forty-two patients (46 hips) had 3D, and 30 patients (32 hips) had CT/MRI. Significant differences were found between groups in time to imaging, cast changes, and LOS. All 3D was intraoperative (46 hips), and only 69% (22 hips) of CT/MRI was on the day of surgery ( P <0.01). In the 3D group, 1 hip (2%) had a cast change under the same anesthetic, and 4 hips (13%) from CT/MRI had cast changes in subsequent surgery ( P =0.03). The mean LOS in days for 3D was 1.72 and 2.20 for CT/MRI ( P =0.03). There were no statistically significant differences between groups in further imaging and subluxations or re-dislocations at cast removal. Two hips (4%) in the 3D group had MRI, but with no further intervention ( P =0.51), and at cast removal, there were 3 subluxations in each group ( P =0.69) and 1 redislocation in the 3D group ( P =1.00). Intraoperative 3D improved time to imaging, allowed for cast changes at surgery and had a shorter LOS. Moreover, there were no significant differences found in adverse outcomes between those who underwent 3D versus CT/MRI. 3D should thus be considered an effective alternative to CT/MRI for assessing hip reduction during OR for DDH. Diagnostic Study, level II.

Rebound Inverts the Staphylococcus aureus Bacteremia Prevention Effect of Antibiotic Based Decontamination Interventions in ICU Cohorts with Prolonged Length of Stay.

Could rebound explain the paradoxical lack of prevention effect against Staphylococcus aureus blood stream infections (BSIs) with antibiotic-based decontamination intervention (BDI) methods among studies of ICU patients within the literature? Two meta-regression models were applied, each versus the group mean length of stay (LOS). Firstly, the prevention effects against S. aureus BSI [and S. aureus VAP] among 136 studies of antibiotic-BDI versus other interventions were analyzed. Secondly, the S. aureus BSI [and S. aureus VAP] incidence in 268 control and intervention cohorts from studies of antibiotic-BDI versus that among 165 observational cohorts as a benchmark was modelled. In model one, the meta-regression line versus group mean LOS crossed the null, with the antibiotic-BDI prevention effect against S. aureus BSI at mean LOS day 7 (OR 0.45; 0.30 to 0.68) inverted at mean LOS day 20 (OR 1.7; 1.1 to 2.6). In model two, the meta-regression line versus group mean LOS crossed the benchmark line, and the predicted S. aureus BSI incidence for antibiotic-BDI groups was 0.47; 0.09-0.84 percentage points below versus 3.0; 0.12-5.9 above the benchmark in studies with 7 versus 20 days mean LOS, respectively. Rebound within the intervention groups attenuated and inverted the prevention effect of antibiotic-BDI against S. aureus VAP and BSI, respectively. This explains the paradoxical findings.

Association between weight-for-length percentile and ICU length of stay in patients with a single ventricleundergoing bidirectional Glenn repair: A retrospective cohort study.

Poor weight gain has been identified as an independent risk factor for increased surgical morbidity and mortality for patients with single-ventricle physiology undergoing staged surgical palliation. Conversely, excessive weight gain has also emerged as an independent risk factor predicting increased morbidity and mortality in a single-center study. Given this novel single-center concept, we investigated the impact of excessive weight on patients with single-ventricle physiology undergoing bidirectional Glenn palliation in a multicenter study model. Patients from the Pediatric Heart Network Single Ventricle Reconstruction Trial (n = 387) were analyzed in a retrospective cohort study examining the independent effect of weight percentile on intensive care unit (ICU) length of stay (LOS) and ventilator days. Locally estimated scatterplot smoothing (LOESS) regression was used to plot weight-for-length (WFL) percentiles by ICU LOS and ventilator days. Unadjusted and adjusted ordinal regression was used to model ICU LOS and ventilator days. Scatterplots and LOESS regression curves demonstrated increasing ICU LOS and ventilator days for increasing WFL percentiles. Unadjusted ordinal regression analysis of ICU LOS demonstrated a trend of increasing ICU LOS for increasing WFL percentiles that was not statistically significant (P = 0.11). A similar trend was demonstrated in adjusted ordinal regression that was not statistically significant (P = 0.48). Unadjusted and adjusted ordinal regression analysis of ventilator days did not reach statistical significance (P = 0.07). Excessive weight gain has a clinically relevant but not statistically significant association with increased ICU LOS and ventilator days for those patients in the >90th WFL percentile for age.

Liposomal Bupivacaine Suspension Can Reduce the Length of Stay of Patients Undergoing Open Reduction and Internal Fixation of Mandibular Fracture

Poorly controlled postoperative pain results in prolonged length of stay (LOS). The use of liposome bupivacaine injectable suspension (LB) for postoperative pain control is a relatively recent practice. The purpose of this study was to investigate the following. In patients undergoing open reduction and internal fixation of mandibular fracture(s), does the use of LB reduce LOS compared with regular bupivacaine? We implemented a retrospective cohort study of consecutive patients with mandibular fracture(s) presented to Grady Memorial Hospital in Atlanta, GA, from January 2021 to January 2022. Adult patients diagnosed with 1 or more isolated mandibular fracture(s) and treated by open reduction and internal fixation were included. We excluded patients with non-isolated mandibular fracture(s), isolated condyle, infected, previously treated fractures, and documented allergy to amide local anesthetics and/or its preservatives. Primary predictor variable was the use of local anesthetic. Primary outcome variable was LOS, defined as the number of days from surgical procedure until discharge. Secondary outcome variables were number of opioid prescription refill(s) and postoperative pain at discharge, determined with visual analogue score. Demographics, American Society of Anesthesiologists classification, smoking, alcohol exposure, illicit drug use, etiology, location, laterality, number of fracture(s), surgical approach, and method of maxillomandibular fixation. Univariate and bivariate analyses were calculated. Statistical significance was P<.05. Sixty-two subjects met the inclusion criteria (31 subjects in each group). The mean ages in LB/regular bupivacaine and regular bupivacaine alone groups were 33.3 (±12) and 35.1 (±15.6), respectively (P=.94), the mean LOS in days was 0.23 (±0.44) in LB/regular bupivacaine and 1.48 (±1.77) in regular bupivacaine alone (P=<.001), and the mean VAS pain scores for LB/regular bupivacaine and regular bupivacaine alone groups were 0.53 (±1.07) and 1.87 (±2.66), respectively (P=.02). Mean number of opioid prescription refill(s) was 0 in LB/regular bupivacaine and 1 in regular bupivacaine alone group, respectively (P=.01). The study findings suggest that the use of LB/regular bupivacaine for mandibular fracture(s) results in decrease in LOS and number of opioid refills compared to regular bupivacaine alone.

Long-term aspirin use in patients hospitalized with ischemic colitis.

Ischemic colitis is a form of mesenteric ischemia that often presents in patients with vascular disease. Long-term aspirin use has been shown to improve the outcomes in patients with cardiovascular or cerebrovascular disease. However, the relationship between aspirin use and ischemic colitis is unclear. Patients with a diagnosis of ischemic colitis were identified using the 2020 Nationwide Inpatient Sample. Patients were stratified by long-term aspirin use at the time of hospitalization. Data were collected regarding mortality, bowel perforation, peritonitis, shock, blood transfusion, length of stay in days (LOS), hospital charges, age, sex, race, primary insurance, median income, hospital region, hospital size, and comorbidities. The relationship between aspirin use and outcomes was analyzed using multivariate regression analysis. A total of 67,685 patients were included. Aspirin users had a mean age of 72.8 years compared to 66.8 years for non-aspirin users. Long-term aspirin use was associated with a lower risk of in-hospital mortality (P<0.001), bowel perforation (P<0.001), peritonitis (P=0.01), shock (P<0.001), and blood transfusion (P<0.001). The mean LOS was 6.1 days in the aspirin group compared to 9.4 days in the non-aspirin group. Ischemic colitis patients taking aspirin had a mean hospitalization charge of $87,123 compared to $161,610 for those not using aspirin. Our study examined the impact of aspirin use in ischemic colitis patients. Among patients hospitalized with ischemic colitis, we found that long-term aspirin use was associated with a lower risk of in-hospital mortality and adverse events.

Comparison of nine machine learning regression models in predicting hospital length of stay for patients admitted to a general medicine department

BackgroundThe General Medicine (GM) department has the highest patient volume and heterogeneity among other hospital specialties. Closely examining hospitalization data is crucial because patients come with various conditions or traits. Length of stay (LoS) in hospitals is often used as an efficiency indicator. It is influenced by various factors, including the patient's medical background, demographics, and type of diseases/signs/symptoms at the triage. LoS is a variable that can vary widely, making it difficult to estimate it promptly and accurately, but doing so is highly beneficial. Moreover, efficiently grouping and managing patients based on their expected LoS remains a significant challenge for healthcare organizations. ObjectivesThis study aimed to compare the predictive ability of nine Machine Learning (ML) regression models in estimating the actual number of LoS days using demographics and clinical information recorded at admission as independent variables. MethodsWe analyzed data collected on patients hospitalized at the GM department of the Sant'Orsola-Malpighi University Hospital in Bologna, Italy, who were admitted through the Emergency Department. The data were collected from January 1, 2022, to October 26, 2022. Nine ML regression models were used to predict LoS by analyzing historical data and patient information. The models' performance was assessed through root mean squared prediction error (RMSPE) and mean absolute prediction error (MAPE). Moreover, we used K-means clustering to group patients' medical and organizational criticalities (such as diseases, signs, symptoms, and administrative problems) into four clusters. Feature Importance plots and SHAP (SHapley Additive exPlanations) values were employed to identify the more essential features and enhance the interpretability of the results. ResultsWe analyzed the LoS of 3757 eligible patients, which showed an average of 13 days and a standard deviation of 11.8 days. We randomly divided patients into a training cohort of 2630 (70 %) and a test cohort of 1127 (30 %). The predictive performance of the different models was between 11.00 and 16.16 days for RMSPE and between 7.52 and 10.78 days for MAPE. The eXtreme Gradient Boosting Regression (XGBR) model had the lowest prediction error, both in terms of RMSPE (11.00 days) and MAE (7.52 days). Sex, arrival via own vehicle/walk-in, ambulance arrival, light blue risk category, age 70 or older, and orange risk category are some of the top features. ConclusionThe ML models evaluated in this study reported good predictive performance, with the XGBR model exhibiting the lowest prediction error. This model holds the potential to aid physicians in administering appropriate clinical interventions for patients in the GM department. This model can also help healthcare services predict the resources necessary to better manage hospitalization.

Impact on Inpatient Length of Stay in Adults with Deep Partial-Thickness Burns: Comparing the Bioengineered Allogeneic Cellularized Construct Expanded-Access Trial with National Burn Repository Data.

To investigate the effect of StrataGraft (bioengineered allogeneic cellularized construct [BACC]) treatment on inpatient length of stay (LOS) as an indicator of hospital resource utilization. Data from the single-arm StrataCAT trial for adult patients with deep partial-thickness (DPT) burns who received BACC were compared with data from a matched external control arm comprising patients who received autografting for burn treatment from the National Burn Repository (NBR) during the same time period as StrataCAT. A matching, quasi-experimental approach was used to investigate the cause-and-effect relationship between BACC treatment and LOS (days). Matching factors included sex, age, ethnicity, race, burn causes, %TBSA burned (third-degree), %TBSA burned (second- and third-degrees), inhalation injury, diabetes mellitus, and hypertension. Balance was assessed between the cohorts for each confounder by standardized mean differences (SMD). Outcome was reported as average treatment effect on the treated. The BACC and NBR Autograft cohorts included 47 and 2641 patients, respectively. Following matching, the Autograft cohort had 137 patients and was weighted to 47 patients. Patients in the BACC and final (matched) Autograft cohorts were similar in all demographic and clinical covariate categories after matching (ie, the absolute SMD were < 0.1). Treatment with BACC reduced the inpatient LOS by an average of 4.84 days (P = 0.0127) relative to the comparable (matched) Autograft cohort. An ad hoc analysis revealed that mean [SD] LOS for BACC and the weighted Autograft cohorts were 17.68 [12.75] and 22.51 [19.75] days, respectively, and were 1.39 [0.94] and 1.88 [1.31] days per %TBSA burned, respectively. The significantly reduced inpatient LOS observed with BACC compared to Autograft in adults with DPT burns may translate into reduced burden on the healthcare system, reduced costs for inpatient burn treatment, and clinical benefits for patients.

Effect of methylene blue on outcomes in patients with distributive shock: a meta-analysis of randomised controlled trials

ObjectiveThis meta-analysis aimed to demonstrate the effect of methylene blue (MB) in patients with distributive shock.DesignMeta-analysis.MethodsAccording to the Prospective International Register of Systematic Reviews (Preferred Reporting Items for Systematic Reviews...

Impact of Multiplex Polymerase Chain Reaction Test in Patients With Meningitis or Encephalitis.

The objective of this study was to evaluate the impact of the FilmArray meningitis/encephalitis panel (FAME) on length of stay (LOS) and duration of antimicrobial treatment in children and adults in a Japanese community hospital. This retrospective cohort study was conducted in Japan between January 2016 and December 2022. We included hospitalized patients with cerebrospinal fluid (CSF) samples and those aged <2 months or who had 5 or more white blood cells/μL in the CSF. To compare the days of therapy (DOT) and LOS between the pre-FAME and FAME periods, multivariate Poisson regression analyses were conducted without an offset term. The number of cases undergoing pathogen-specific polymerase chain reaction increased from 3.7% in the pre-FAME period to 57.5% in the FAME period (P < .001). The pathogen identification rate also increased during the FAME period, from 0.4% to 18.7% (P < .001). While the antibacterial DOT was not statistically different between the 2 periods (adjusted rate ratio [aRR], 1.06 [95% confidence interval {CI}, 1.00-1.13]; P = .063]), the antiviral DOT was significantly shorter in the FAME period (aRR, 0.80 [95% CI, .71-.89]; P < .001). This study revealed a significant reduction in antiviral use during the FAME period, whereas LOS and antibacterial use did not decrease. Given the possibility of factors (eg, the COVID-19 pandemic) affecting the epidemiology of meningitis and encephalitis, the indications and impact of the FAME test should be evaluated with continuous monitoring of the epidemiology of meningitis and encephalitis and its clinical impact.

Facility-Related Healthcare Resource Utilization (HCRU) for Patients Treated with Idecabtagene Vicleucel (Ide-Cel, bb2121) in a Real-World (RW) Setting: A Single-Center Experience

Introduction: Ide-cel is a B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T cell therapy associated with deep and durable responses and improved quality of life among triple-class exposed (TCE) patients with relapsed/refractory multiple myeloma (RRMM) (Munshi NC, et al. N Engl J Med 2021;384:705-716; Delforge M, et al. Blood Adv 2022;6:1309-1318). An analysis of 2-year post-infusion facility-related HCRU (fHCRU) associated with ide-cel treatment in the phase 2 KarMMa clinical trial (NCT03361748) found that most facility costs were incurred within the first month following infusion where the median hospital length of stay (LOS) was 19.5 days which included the clinical trial requirement of hospitalization for monitoring and 20% of the patients had intensive care unit (ICU) stays (McGarvey N, et al. Blood 2022;140(suppl 1):10947-10948). In this study, we estimated fHCRU and associated costs for patients with TCE RRMM receiving ide-cel in RW clinical practice. Methods: This was a retrospective chart review of adults (≥ 18 years of age) with TCE RRMM who received an ide-cel infusion in RW clinical practice at H. Lee Moffitt Cancer Center, Tampa, FL, USA from May 25, 2021 to December 27, 2022. Costs were estimated using a two-step micro-costing methodology. Unit costs were sourced from public databases or literature, adjusted to 2022 US dollars and then applied to fHCRU. Patient characteristics and fHCRU were characterized using descriptive statistics, and the distribution of fHCRU was examined by key characteristics using Wilcoxon rank sum or chi-square tests. fHCRU and total facility costs included LOS and ICU stays obtained from the National Inpatient Sample and peer-reviewed literature, inflated to 2022 US dollars (USD); LOS days included readmissions. Unit costs (2022) were applied to post-index hospitalizations at the rate of USD 3001.80 per inpatient day and USD 9351.52 per ICU day. Results: A total of 109 patients were included. Median age was 65 years, 61% were male, 67% were non-Hispanic White, 14% had extramedullary disease, and 28% had high-risk cytogenetics. Patients had a median (range) of 6.0 (4.0-13.0) prior lines of MM therapy; 75% and 30% of patients were triple- and penta-class refractory, respectively. Median (range) follow-up was 9.2 months (0.2-24.4). Any grade cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) occurred in 82% and 17% of patients, respectively. Moderate or worse CRS and ICANS (grade ≥ 2) occurred in 19% and 10% of patients, respectively. A total of 71% of patients received tocilizumab, 34% received steroids, and 2% received anakinra for toxicity management. Only 26% of patients would have been eligible for the KarMMa trial. In the overall cohort, median LOS was 8.0 days (interquartile range [IQR], 7.0-10.0) and total median hospital costs were USD 24,014 (IQR, USD 21,013-30,018). Five (5%) patients had an ICU stay (median 8.0 days; IQR, 8.0-12.0) with total median costs of USD 76,252 (IQR, USD 76,252-114,378). fHCRU was comparable when analyzed by extramedullary disease, high-risk cytogenetics, penta-class refractory status, age at infusion (&amp;lt; 65 vs ≥ 65 years), and KarMMa clinical trial eligibility criteria ( P &amp;gt; 0.05). LOS and total costs were significantly lower among those with grade &amp;lt; 2 versus grade ≥ 2 CRS (both P &amp;lt; 0.05) or ICANS (both P &amp;lt; 0.01). Patients with more severe toxicity (grade ≥ 2) had a longer median LOS (CRS: 9 vs 8 days, P = 0.017; ICANS: 14 vs 8 days, P = 0.0026, respectively), were more likely to have an ICU stay (CRS: 24% vs 0%, P &amp;lt; 0.001; ICANS: 36% vs 1%, P &amp;lt; 0.001, respectively), and had higher median hospital costs (CRS: USD 27,016 vs USD 24,014, P = 0.0069; ICANS: USD 51,031 vs USD 24,014, P = 0.002, respectively) than patients with less severe toxicity (grade &amp;lt; 2) (Figure). Conclusion: This is the first study to characterize fHCRU and associated costs for patients with TCE RRMM who received ide-cel in a RW single-center practice. Median LOS was only 8 days and few patients (5%) had an ICU stay. fHCRU and associated costs were higher among patients who experienced moderate or worse CRS and neurologic toxicity. A limitation of this study is that fHCRU does not consider drug costs, including that of ide-cel. Additional studies with larger sample sizes and detailed cost analyses are needed to further quantify RW HCRU and pre-infusion and post-infusion costs in this patient population.

Eliminating the benzos: A benzodiazepine-sparing approach to preventing and treating alcohol withdrawal syndrome.

Alcohol withdrawal syndrome (AWS) represents significant cost to the hospitalized trauma population from a clinical and financial perspective. Historically, AWS has been managed with benzodiazepines. Despite their efficacy, benzodiazepines carry a heavy adverse effect profile. Recently, benzodiazepine-sparing protocols for the prophylaxis and treatment of AWS have been used in medical patient populations. Most existing benzodiazepine-sparing protocols use phenobarbital, while ours primarily uses gabapentin and clonidine, and no such protocol has been developed and examined for safety and efficacy specifically within a trauma population. In December of 2019, we implemented our benzodiazepine-sparing protocol for trauma patients identified at risk for alcohol withdrawal on admission. Trauma patients at risk for AWS admitted to an academic Level 1 trauma center before (conventional) and after (benzodiazepine-sparing [BS]) protocol implementation were compared. Outcomes examined include morphine milligram equivalent dosing rates and lorazepam equivalent dosing rates as well as the Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar) scores, hospital length of stay, intensive care unit length of stay, and ventilator days. A total of 387 conventional and 134 benzodiazepine sparing patients were compared. Injury Severity Score (13 vs. 16, p = 0.10) and admission alcohol levels (99 vs. 149, p = 0.06) were similar. Patients in the BS pathway had a lower maximum daily CIWA-Ar (2.7 vs. 1.5, p = 0.04). While mean morphine milligram equivalent per day was not different between groups (31.5 vs. 33.6, p = 0.49), mean lorazepam equivalents per day was significantly lower in the BS group (1.1 vs. 0.2, p < 0.01). Length of stay and vent days were not different between the groups. Implementation of a benzodiazepine-sparing pathway that uses primarily clonidine and gabapentin to prevent and treat alcohol withdrawal syndrome in trauma patients is safe, reduces the daily maximum CIWA-Ar, and significantly decreases the need for benzodiazepines. Future studies will focus on outcomes affected by avoiding AWS and benzodiazepines in the trauma population. Therapeutic/Care Management; Level IV.