Difference In Readmission Rates Research Articles

P0771 Early Infliximab Rescue therapy is associated with reduced length of stay in patients with acute severe ulcerative colitis

Abstract Background Acute severe ulcerative colitis (ASUC) represents a medical emergency necessitating admission and prompt commencement of intravenous steroids. Up to 40% of patients may require rescue therapy with infliximab, traditionally administered on day 3 of admission based on the Modified Oxford Criteria. This study aimed to evaluate the impact of early (≤ 72 hours) versus standard (> 72 hours) infliximab administration on clinical outcomes. Methods A single centre retrospective cohort study was conducted for patients admitted with ASUC as defined by the Truelove and Witt’s criteria who received infliximab therapy between January 2016 and October 2024. Patients were divided into 2 groups: early infliximab therapy (≤ 72 hours of admission) and standard infliximab therapy (>72hrs of admission). Patient demographics and disease characteristics were accessed from the electronic medical records (EMR). Outcomes assessed included length of stay, 12-month readmission and colectomy rates. Results 84 patients (53% male, 37% female) were included in this study. Of these 31/84, (37%) received early infliximab therapy (median 52 [IQR 45-56] hours) and 53/84 (63%) had standard (median 105 [IQR 94-149] hours) infliximab therapy. Disease characteristics are shown in table 1. Mean albumin on admission was higher in the early infliximab group (36g/L vs 32.5g/L, p= 0.01). No other significant differences were noted. The median length of stay was shorter in patients who received early vs standard infliximab therapy at 6 vs 7 days (p= 0.048). No significant difference was seen in requirement for colectomy between the early and standard groups at index admission (3.2% vs 3.8%, (p = 1.0) or at 12-months follow up (6.6% vs 6.9%, (p = 1.0). Similarly, there was no significant difference in readmission rates at 6-months (33.3% vs 26%, p= 0.67) and at 12-months (40% vs 28.8% p= 0.63) for both ulcerative colitis-related and non-ulcerative colitis causes across the two groups. There was no difference in rate of infective complications in the first 30 days (6.4% vs 7.5%, p = 0.85). A propensity matched cohort of 30 patients (matched 1:1 for age, HR, albumin on admission, Hb on admission, and dose of first infliximab dose) further confirmed shorter length of stay in the early vs standard group at a median of 6 vs 7 days (p= 0.039). Conclusion In patients admitted with ASUC, early infliximab therapy as defined by administration ≤ 72 hours from presentation was associated with shorter hospitalisation, with no difference in rates of colectomy, re-admission or infective complications. An early treatment strategy may reduce the burden of this condition upon health care utilisation.

Treatment Analysis of Very Early and Early Onset Psychosis in the Youth Inpatient Setting.

The United States Food and Drug Administration approved 6 atypical antipsychotics for pediatric treatment of schizophrenia. However, little has been published on the effectiveness of these medications in the acute treatment setting of adolescents with psychosis. Since the clinical uncertainty and poor prognosis proceeding the early onset of schizophrenia has a significant impact on a child's development, there is a critical need for evidence-based data on this population. The aim of our study was to investigate the effect of various antipsychotics on young patients admitted to the inpatient ward presenting with acute psychosis. A retrospective analysis was performed to review the medical records of the patients with specified schizophrenia disorders who were admitted to the inpatient psychiatric unit for treatment with antipsychotics. We analyzed the efficiency of treatment by measuring 30-day readmissions (yes/no), number of readmissions in 30 days, and the length of stay in the inpatient ward. Negative binomial regression and binary logistic regression were used to count the discrete occurrences of an outcome and predict the likelihood of that outcome. We analyzed the medical records of 1117 patients who were assigned to groups based on whether they were treated with aripiprazole (31.9%), risperidone (26.0%), quetiapine (16.2%), and olanzapine (26.0%). Pairwise comparisons revealed receiving risperidone increased the log count of days by an incidence response ratio of 1.15 (1/0.87) compared to receiving aripiprazole (P < .05, 95% CI [0.76, 0.98]). Similarly, quetiapine increased the count of hospital days by a factor of 1.22 (1/0.82) (P < .01, 95% CI [0.70, 0.94]), as well as olanzapine by a factor of 1.23 (1/0.82) compared to receiving aripiprazole (P < .001, 95% CI [0.72, 0.93]). The number of admissions in 30 days was not significantly associated with medication groups (χ2 = 3.93, P = .270) when controlling for other variables. The medication group was also not significantly associated with the likelihood of readmission (χ2 = 5.594, P = .133) when controlling for other variables. Aripiprazole was significantly associated with shortening the log count of days (χ2 = 21.82, P < .0001) when compared to olanzapine and quetiapine. There was no statistical evidence to conclude a difference in readmission rates when comparing medication groups. To our knowledge, these results provide the largest cohort describing the efficacy of different antipsychotics for acute stabilization of psychosis in the inpatient setting.

Matched pair analysis of wide versus narrow focus during shockwave lithotripsy for urolithiasis

PurposeTo compare stone clearance and complications between a ‘wide’ (9 × 50 mm) and ‘narrow’ shockwave focus (6 × 28 mm) when undertaking shockwave lithotripsy (SWL) in patients with renal or ureteric stones.MethodsData from patients undergoing SWL using the dual focus Storz Modulith SLX-F2 lithotripter at a single centre were prospectively collected between February 2018 and September 2020. Patients were matched by stone size, location, and number of treatments. Stone clearance, re-presentation within 31 days, symptoms, complications, and need for post SWL-interventions were compared using McNemar’s test.ResultsPatients receiving wide focus SWL (WF-SWL, n = 152) were matched with patients receiving narrow focus SWL (NF-SWL, n = 152). Median stone size was 6 mm; energy delivered to WF-SWL and NF-SWL groups was comparable. Complete stone clearance was achieved in 55% of WF-SWL patients (n = 84) and 41% (n = 63) of NF-SWL patients (p = 0.04). Treatment was considered successful in 74% (n = 113) of WF-SWL cases and 66% (n = 100) of NF-SWL (p = 0.20). No difference in rates of readmission, post-procedural pain, haematuria, urinary tract infections, analgesia or antibiotic requirements were identified.ConclusionThis service evaluation demonstrates no differences in rates of overall treatment success nor complications on comparing WF-SWL and NF-SWL.

Can Endovascular Repair of Unruptured Intracranial Aneurysms Be Safely Performed in an Outpatient Setting? Lessons Learned from Spine Outcome Control Groups.

The performance of select neurosurgical procedures is being transitioned to an outpatient setting rather than an inpatient setting to increase healthcare cost-effectiveness. Despite numerous technological advancements in the treatment of unruptured intracranial aneurysms (UIAs), the procedures are solely performed in an inpatient setting. We aimed to compare the rate of short-term outcomes associated with inpatient endovascular treatment of UIAs with those for established outpatient neurosurgical procedures, including anterior cervical discectomy and fusions (ACDFs) and lumbar discectomies. We performed a retrospective analysis on the data of healthy (Charlson Comorbidity Index ≤4) adult patients undergoing elective neurosurgical procedures including endovascular repair of UIAs, ACDF, and discectomy between January 1, 2012, and August 31, 2019, at a single tertiary facility. Clinical complications and outcomes data were collected and analyzed. The primary outcome variable was the 30-day readmission rate with subgroup analyses of readmission <48 hours and 48 hours to 30 days. A total of 586 patients and a total of 606 procedures were identified, comprising 205 endovascular UIA treatments, 201 ACDFs, and 200 discectomies. Fourteen UIA procedures were excluded from analysis (n = 191) on the basis of anatomic high-risk features. For the primary outcome, there was no statistically significant difference in 30-day readmission rates among the comparison groups (P = .36). For the subgroup analyses, there were no differences in readmission rates for <48 hours (P = .06) and 48 hours to 30 days (P = .71). In addition, there was no significant difference in intraprocedural complication rates among the groups (P = .19). Inpatient elective endovascular treatment of UIAs had similarly low rates of intraprocedural complications and short-term readmissions compared with the established outpatient spine procedures. We hope that our findings may serve as the foundation for future, prospective studies assessing the safety and utility of performing endovascular procedures for UIAs in an outpatient setting.

Implementation of the Robocare nursing model for patients undergoing da Vinci robot-assisted radical gastrectomy for gastric cancer.

This study aimed to assess the safety and feasibility of the Robocare nursing model in patients undergoing da Vinci robot-assisted radical gastrectomy for gastric cancer. A total of 68 patients who underwent da Vinci robot-assisted radical gastrectomy for gastric cancer in our department from January 2022 to June 2022 were enrolled in this study and were assigned to a control group (n = 34) and an intervention group (n = 34). The control group received standard perioperative nursing care, while the intervention group received the Robocare model along with standard care. We compared the differences in postoperative hospital stay length, the incidence of postoperative complications, readmission rates within one month after discharge, and satisfaction with nursing care between the two groups. Compared to the control group, patients in the intervention group exhibited a significantly shorter postoperative hospital stay (mean 8.94days vs. 9.76days, P < 0.05) without an increase in the incidence of postoperative complications (26.5% vs. 29.4%, P > 0.05). In addition, there was no significant difference in readmission rates within 1month after discharge between the two groups (14.7% vs. 5.9%, P > 0.05). Patient satisfaction was significantly higher in the intervention group compared to the control group (96.34% vs. 91.96%, P < 0.05). The implementation of the Robocare nursing model for patients undergoing da Vinci robot-assisted radical gastrectomy for gastric cancer may reduce the length of postoperative hospital stays without increasing the incidence of postoperative complications, while also enhancing patient satisfaction with nursing care.

Unplanned 180-day Readmissions and Healthcare Utilization After Immediate Breast Reconstruction for Breast Cancer.

To assess the burden of post-discharge healthcare utilization given by readmissions beyond 30-days following immediate breast reconstruction (IBR) nationwide. Women with breast cancer who underwent mastectomy and concurrent IBR (autologous and implant-based) were identified within the 2010-2019 Nationwide Readmission Database. Cox proportional hazards and generalized linear regression controlling for patient- and hospital-level confounders were used to determine factors associated with 180-day unplanned readmissions and incremental hospital costs, respectively. Within 180 days 10.7% of 100,942 women were readmitted following IBR.. Readmissions tended to be publicly insured (30.8% vs. 21.7%, P<0.001), and multimorbid (Elixhauser comorbidity index >2 31.6% vs. 19.6%, P<0.001) compared to non-readmitted patients. There were no differences in readmission rates amongst types of IBR (tissue expander 11.2%, implant 10.7%, autologous 10.8%; P>0.69). Of all readmissions, 40% occurred within 30 days and 21.7% in a different hospital, and 40% required a major procedure in the operating room. Infection was the leading cause of readmissions (29.8%). In risk-adjusted analyses, patients with carcinoma in situ, publicly insured, low socioeconomic status, and higher comorbidity burden were associated with increased readmissions (all P<0.05). Readmissions resulted in additional $8,971.78 (95% CI: $8,537.72-9,405.84, P<0.001) in hospital costs which accounted for 15% of the total cost of immediate breast reconstruction nationwide. The majority of inpatient healthcare utilization given by readmissions following mastectomy and IBR occurs beyond the 30-day benchmark. There is evidence of fragmentation of care as a quarter of readmissions occur in a different hospital and over one-third require major procedures. Mitigating postoperative infectious complications could result in the highest reduction of readmissions.

Abstract 387: Readmissions and retreatment among stent‐assisted endovascular coiling patients with unruptured intracranial aneurysm using ENTERPRISE®2 Stent versus LVIS™Stent

Introduction Stent‐assisted endovascular coiling is a safe and effective method for treating wide‐necked unruptured intracranial aneurysm (UIA), which allows for increase in volumetric filling, prevents coil prolapse, and promotes aneurysm thrombosis. The objective of this study was to examine differences in 180‐day inpatient readmissions and retreatment among UIA patients treated with the laser cut nitinol ENTERPRISE® 2 stent versus the braided nitinol LVIS™ stent during endovascular stent assisted coiling procedure. Methods Using a U.S. nationwide hospital database, PINC AI Healthcare Database (PHD), UIA patients aged ≥18 years undergoing endovascular coiling procedures were identified and classified into ENTERPRISE® 2 and LVIS™ cohorts based on the stent used. Study outcomes, including 180‐day all‐cause and UIA‐related inpatient readmissions, and UIA‐related retreatment, were compared between the two groups. Inverse probability of treatment weighting of propensity score approach was used to balance covariates (i.e. patient demographic, comorbidity, and hospital characteristics) between the two cohorts. A weighted generalized estimating equation (GEE) model was used to assess outcomes among the weighted ENTERPRISE® 2 and LVIS™ cohorts. Results Based on study inclusion and exclusion criteria, 249 patients were identified, with 130 in the ENTERPRISE® 2 cohort and 119 in the LVIS™ cohort. Baseline patient characteristics were well balanced after weighting. Patients undergoing endovascular stent assisted coiling procedures using ENTERPRISE® 2 had significantly lower rates of 180‐day all‐cause inpatient readmissions compared to those treated with LVIS™ (9.1% vs 24.3%, p =0.016; odds ratio [OR]: 0.31, 95% confidence interval [CI]: 0.12‐0.82, p =0.018). Bivariate analysis revealed a significantly lower rate of 180‐day UIA‐specific inpatient readmission among the ENTERPRISE® 2 cohort versus the LVIS™ cohort (2.6% vs 12.4%, p =0.036); however, this difference was not significant in GEE analysis (OR: 0.19, 95% CI: 0.03‐1.04, p =0.056). No significant difference was observed for 180‐day UIA‐related retreatment among the study cohorts (ENTERPRISE® 2 vs LVIS™: 2.6% vs 11.6%, p =0.056; OR: 0.20, 95% CI: 0.03‐1.20, p =0.079). Conclusions: Patients who were treated with the laser cut ENTERPRISE®2 stent during endovascular coiling were observed to have significantly lower risk of all‐cause and UIA‐related inpatient readmissions compared to those treated with the braided LVIS™ stent. The laser cut form of the ENTERPRISE®2 stent may allow for high strut tension and compression strength making it less likely to be prone to deformation as compared to a braided stent like the LVIS™, which may be associated with the observed differences in readmission rates among the two stents.

Less Is (Sometimes) More: Laparoscopic Peritoneal Lavage and Drainage for Diverticulitis.

Introduction: Laparoscopic lavage and drainage (LLD) emerged as an alternative to Hartmann's procedure (HP) for patients with diverticulitis and uncontained perforation. Although initially popular as a less invasive approach, its use in modern practice is in question. This summary will review the available literature to show techniques, outcomes, and indications. Methods: The literature was reviewed for relevant case studies, randomized trials, prospective series, retrospective analyses, and meta-analyses to define peritoneal lavage and determine the clinical outcomes of peritoneal lavage. Results: LLD can be considered on an individual basis for Hinchey III diverticulitis (purulent peritonitis), but there are several contraindications. The extent of adhesionolysis (limited versus extensive) as well as the management of sites of perforation found during surgery are debated. Most surgeons continue lavage with warm saline until water runs clear and place drains in the operation. Three randomized controlled trials (RCTs), the LADIES, SCANDIV, and DILALA trials compared LLD with either resection and anastomosis or Hartmann's procedure. One other RCT (the LapLAND trial) is still with results pending. The LADIES trial studied LLD versus primary anastomosis and resection in Hinchey III diverticulitis and was terminated early secondary to higher 30-day morbidity in the LLD arm; however, 3-year data showed no significant difference in morbidity and mortality. The SCANDIV trial compared LLD with resection in acute diverticulitis (Hinchey I-III) and saw no difference in 90-day morbidity or mortality; however, it noted higher rates of reoperation in the LLD group. The DILALA trial compared Hinchey III diverticulitis patients undergoing LLD with open HP and found that the LLD group had a lower rate of reoperation at 2 years, but no difference in rates of readmission or mortality. Conclusions: Debate still remains over the technique of LLD and specific indications, as well as outcomes compared with resection and primary anastomosis or HP.

National trends and costs of same day discharge in patients undergoing elective minimally invasive colectomy

BackgroundEnhanced Recovery Pathways (ERPs) have enabled safe same day discharge (SDD) of select patients after elective minimally invasive colectomy. We aimed to analyse the financial impact of SDD in these cases. MethodsWe queried the Nationwide Readmission Database (2016–2019) and included patients with a hospital length of stay ≤2 days after minimally invasive elective colectomy. Propensity score matched pairs of patients discharged on the day of the operation and those discharged on post operative day 1 or 2 were compared. Our primary outcome was the combined cost of hospitalization and readmission. ResultsSDD patients had lower comorbidity (33 ​% vs 21 ​%) and illness severity (79 ​% vs 63 ​%), more Medicare insurance (44 ​% vs 38 ​%), and more benign neoplasms (52 ​% vs 17 ​%). Most SDD patients underwent right colectomy (89 ​%). Across 647 matched pairs, total cost was significantly lower in SDD patients ($8000 vs. $12,900; p ​< ​0.001) due to cheaper index hospitalizations. No difference in readmission rates or costs emerged. ConclusionSDD reduced costs of index hospitalization and may be cost-effective in a select cohort of healthier patients.

Association between hospital type and length of stay and readmissions for young adults with complex chronic diseases.

There is a paucity of information around whether hospital length of stay and readmission rates differ based upon hospital type for adolescents and young adults (AYA) with complex chronic diseases (CCDs). To measure the association between hospital type and readmission rates and index admission LOS among AYA with CCDs. We performed a retrospective cross-sectional study of 2017 Healthcare Cost and Utilization Project State Inpatient Databases, including patients 12-25 years old with cystic fibrosis (CF), sickle cell disease (SCD), spina bifida (SB), inflammatory bowel disease (IBD), and diabetes mellitus (DM). Index hospitalizations were categorized by hospital type (pediatric hospitals [PHs], adult hospitals with pediatric services [AHPSs], and adult hospitals without pediatric services [AHs]), CCD, and age group. We compared case-mix adjusted 30-day readmission rates and differences in index admission LOS between hospital types. Adult hospitals without pediatric services exhibited higher readmission rates (25.4%) than AHPS (22.9%) and PH (15.1%). Compared to patients with CF admitted to AH, lower readmission rates were associated with longer LOS at both AHPS (relative ratio [RR]: 1.25, 95% confidence interval [CI]: 1.02-1.55) and PH (RR: 1.59, 95% CI: 1.28-1.97). Patients with DM admitted to AHPS (odds ratio [OR]: 0.75, 95% CI: 0.62-0.91) and PH (OR: 0.47, 95% CI: 0.31-0.71) also demonstrated lower readmission rates than those admitted to AH. For AYA with CCD, hospital type is associated with differences in readmission rates and LOS. Lower readmission rates at hospitals with pediatric services compared to adult hospitals without pediatric services suggest hospital type has a significant impact on outcomes.

Outpatient Endocrine Protocol and Testing Coincides with Reduced Length of Postpituitary Surgery Admission

Abstract Objective The study objective was to compare the length of stay (LOS) and the proportion of one-night admissions before and after the implementation of an endocrine monitoring protocol following endoscopic transsphenoidal surgery (ETSS) for pituitary adenoma. Methods Patients who underwent transsphenoidal pituitary adenoma resection between July 1, 2018, and September 9, 2022, were identified, and divided into two cohorts before and after the implementation of the monitoring protocol. The overall LOS and number of nights of admission were recorded. Readmission within 30 days after surgery was also recorded. The number of outpatient laboratory tests performed and the time to the first test were also noted. Results Thirty patients were identified in the preprotocol group and 60 in the postprotocol group. The average admission length in the preprotocol group was significantly longer than the average admission length in the postprotocol group (2.4 vs. 1.7 days, p = 0.004). The percentage of one-night admissions increased from 13 to 57% (p &lt; 0.001). There were no significant differences in readmission rates between the two groups (p = 0.681). The number of laboratory encounters increased from a mean of 1.38 to 2.40 (p = 0.030), while the time to the first test decreased from a mean of 3.43 to 2.36 days (p = 0.049). Conclusion Patients admitted after ETSS for pituitary adenoma had shorter hospital stay and greater proportion of one-night admission with the implementation of an endocrine monitoring protocol. The all-cause readmission rate was not statistically different between the two groups. Through aggressive outpatient laboratory monitoring, one-night admission for ETSS may be feasible.

Outcomes of intravenous immunoglobulin treatment of immunocompromised patients with viral respiratory infections

BackgroundLimited guidelines exist for treating immunocompromised patients hospitalized for acute viral respiratory infection. Little is known about clinical and economic benefits of intravenous immunoglobulin (IVIG) administration in patients with acute viral respiratory infections. ObjectiveTo compare clinical and economic outcomes among immunocompromised patients hospitalized with viral respiratory infections who received IVIG with those who did not. MethodsWe performed a retrospective cohort study on all patients hospitalized for a respiratory viral infection between 2011 and 2016 at 2 large academic centers including data on age, sex, virus species, immunosuppression type, and receipt of IVIG. Outcomes included death, hospital readmission, length of stay (LOS) in the hospital, and LOS in the intensive care unit (ICU). ResultsA total of 270 patient admissions were reviewed, and 35.6% received IVIG. The average age was 40.6 years, 50% were female, and 74% were transplant patients. The most common virus was rhinovirus (50.7%). Use of IVIG was significantly associated with a shorter ICU LOS (β = −0.534, P = .012) and a longer hospital LOS (β = 0.887, P < .01). IVIG administered within 48 hours of hospitalization (n = 229) was associated with a shorter ICU LOS (β = −2.08, P = .001) and a shorter hospital LOS for patients hospitalized at least 2 days (β = −0.461, P = .007). There were no significant differences in readmission rates or death. ConclusionThis double-center, retrospective cohort analysis is one of the first studies to evaluate the effect of IVIG on immunocompromised patients hospitalized with respiratory viral infections. IVIG was associated with a shorter hospital and ICU LOS, especially when administered within 48 hours of admission.

Disparities in postdischarge follow-up and risk of readmission between Medicaid and privately insured patients.

Studies have identified higher risk of readmission for patients with Medicaid compared to those with private insurance. Postdischarge follow-up is utilized as an intervention to reduce readmissions in the Medicare population, but it is unclear whether follow-up reduces risk of readmission for patients with Medicaid. To assess whether follow-up within 30 days of discharge reduces risk of readmission and mitigates readmission disparities based upon insurance status. This retrospective cohort study used Cox proportional hazard and competing risk models to estimate associations between sociodemographic and clinical characteristics, follow-up, and readmission. We analyzed data from 4281 patients aged 21-64 years with Medicaid or private insurance who were hospitalized from January 2017 to December 2019 for one of five conditions associated with high risk of readmission. Outpatient follow-up within 30 days of discharge and 30-day all-cause readmission were outcomes. Overall risk of readmission was similar for Medicaid and privately insured patients in this cohort (13.7% and 14.5%, respectively). Patients with Medicaid were 23% points less likely to complete outpatient follow-up within 30 days compared to patients with private insurance (p < .001). However, outpatient follow-up before readmission within 30 days of discharge was not associated with a significant difference in readmission rate (hazard ratio: 1.10, 95% confidence interval: 0.91-1.32) in the overall sample or in analysis stratified by payer. We found similar rates of readmission for Medicaid and privately insured patients despite significant disparities in postdischarge follow-up. Timely follow-up care alone may not be sufficient as an intervention to reduce readmissions.

Social Capital and Surgery Access Among Medicare Beneficiaries.

To compare the rates of unplanned procedures for access-sensitive surgical conditions among beneficiaries living in census tracts of varying social capital levels. Access-sensitive surgical conditions are conditions ideally screened for and treated in an elective setting. However, when left untreated, these conditions may result in unplanned (i.e., urgent or emergent) surgery. It is possible that social capital-the resources available to individuals through their membership in a social network-may impact the likelihood of a planned procedure occurring. Medicare beneficiaries who underwent one of three access-sensitive procedures (abdominal aortic aneurysm repair, colectomy for cancer, and ventral hernia repair) between 2016-2020 were stratified by their census tract level of social capital, the exposure variable. Outcomes included rate of unplanned surgery, readmission, 30-day mortality, and complications which were risk-adjusted with a logistic regression model that accounted for patient age, sex, race, comorbidities, and area deprivation. A total of 975,048 beneficiaries were included (mean [SD] patient age, 76 [7.6] years; 443,190 were male [45.45%]). Compared to patients from census tracts in the highest overall social capital decile, those from census tracts with the least social capital were on average more likely to undergo unplanned surgery (40.67% versus 35.28%, OR=1.26 P<0.001). Additionally, beneficiaries in these communities were also more likely to experience postoperative complications (24.99% versus 22.90%, OR=1.12 P<0.001), but there was no significant difference in rates of readmission or mortality. When evaluating only elective procedures, the differences between the lowest and highest social capital decile groups reduced significantly for complications (12.77% versus 12.11%, OR=1.06 P=0.04), the differences in mortality rates collapsed, and differences in readmission rates remained insignificant. These data suggest that Medicare beneficiaries who live in communities with lower social capital are more likely to undergo unplanned surgery for access-sensitive conditions. Efforts to improve social capital in these communities may be one strategy for reducing the rate of unplanned operations.

Substance Use is Associated with Increased Readmissions, But Not In-hospital Morbidity or “Long-term” survival After Left Ventricular Assist Device Implantation

Aim: Patients with active substance use are not eligible for heart transplantation and often undergo left ventricular assist device (LVAD) implantation. We define substance use as use of a substance that precludes transplant such as tobacco products, marijuana, illicit drug use, and excessive alcohol use. The purpose of this study is to describe and compare outcomes in patients with active or recent substance use undergoing LVAD implantation to those who do not use substances. Materials and Methods: We performed a single-center retrospective cohort study of all patients undergoing HeartMate3 implantation during the period from 2017 to 2023. The patients were divided into those who have a current or recent history of substance use (SUD) and those who do not. The primary outcome was survival. And the secondary outcome measures included in-hospital outcomes and readmission rate. The Kaplan Meier method was used to calculate overall survival. An unadjusted multivariate cox proportion hazards model was used to assess differences in survival. Adjusted Poisson regression models were used to determine differences in readmission rates. Results: 177 patients were included, with 55 (31%) of patients using substances at the time of implantation (mainly tobacco products and marijuana). Patients using substances were younger (p&lt;0.001) and had a higher body mass index (p=0.012). Survival (HR 1.51, CI (0.84-2.71)) and in-hospital outcomes were not significantly different between groups (stroke, bleeding, renal failure, days in intensive care, length of stay, mortality). When adjusting for age and INTERMACS score, patients with SUD had significantly higher rates of readmissions compared to those without SUD (IRR: 1.23, 95% CI:1.02-1.50, p=0.035). Conclusions: In conclusion, in a large single-center retrospective cohort study, patients who are using substances at the time of LVAD implantation have the same survival and in-hospital complication rates as patients who are not using substances. When adjusting for age and INTERMACS score, patients who use substances have a higher readmission rate than patients who are not using substances.

Comparative analysis of geriatric hip fracture management outcomes in teaching and nonteaching hospitals in Jordan

Hip fractures are common orthopedic injuries that have significant impacts on patients and healthcare systems. Previous studies have shown varying outcomes for hip fracture management in different settings, with diverse postoperative outcomes and complications. While teaching hospital settings have been investigated, no studies have specifically examined hip fracture outcomes in teaching hospitals in Jordan or the broader Middle East region. Therefore, the aim of this study was to investigate this important outcome. A cohort comprising 1268 patients who underwent hip fracture fixation from 2017 to 2020 was analyzed for nine distinct outcomes. These outcomes encompassed time to surgery, ICU admissions, perioperative hemoglobin levels, length of hospital stay, readmission rates, revision procedures, and mortality rates at three time points: in-hospital, at 6-months, and at 1-year post-surgery. The analysis of 1268 patients (616 in teaching hospitals, 652 in non-teaching hospitals) showed shorter mean time to surgery in teaching hospitals (2.2 days vs. 3.6 days, p < 0.01), higher ICU admissions (17% vs. 2.6%, p < 0.01), and more postoperative blood transfusions (40.3% vs. 12.1%, p < 0.01). In-hospital mortality rates were similar between groups (2.4% vs. 2.1%, p = 0.72), as were rates at 6-months (3.1% vs. 3.5%, p = 0.65) and 1-year post-surgery (3.7% vs. 3.7%, p = 0.96). Geriatric hip fracture patients in teaching hospitals have shorter surgery times, more ICU admissions, and higher postoperative blood transfusion rates. However, there are no significant differences in readmission rates, hospital stays, or mortality rates at various intervals.

The Next Target for Readmission Reporting? Exploring Readmission Rates of Patients with CLABSI

Background: Multi-drug resistant organisms (MDROs) are a common cause of healthcare-associated infections, particularly central line-associated bloodstream infections (CLABSIs). Prior research has shown that MDROs cause up to 67% of CLABSIs and have up to a 37% increase in 30 day readmission, which is higher than readmission rates for other conditions reported to the Centers for Medicare and Medicaid Services (CMS). The objective of the study was to determine overall 90-day readmission rates, and if there was a difference in readmission rate within 90 days post discharge for patients who had a MDRO as the causative pathogen of their CLABSI compared to patients who did not have an MDRO. Methods: A retrospective analysis of patient data from a nine-hospital system was performed on patients who had a CLABSI and were discharged alive between January 1st, 2018, and December 31st, 2019. Basic descriptive statistics were performed, and the potential differences in readmission rates were examined using Chi-square analyses. Results: The overall readmission rate for all CLABSIs was 46.9%. The chi-square analysis determined there was not a significant difference in readmission rates in patients who had a MDRO CLABSI compared to patients with a non-MDRO CLABSI (59.1% vs. 44.6%, x2= 1.564 , p= 0.211). Conclusion: There was not a significant difference in readmission rates between patients with an MDRO CLABSI compared to a non-MDRO CLABSI. However, the overall readmission rate for this patient population was much higher than seen in previous literature and other publicly reported readmission rates. Additional research is recommended to explore if the increased CLABSI readmission rates seen are a unique finding to this health system.

Implementing Change: Sustaining Enhanced Recovery After Surgery Protocols in Pediatric Surgery Using Iterative Assessments

IntroductionWhile Enhanced Recovery After Surgery (ERAS) protocols are becoming more common in pediatric surgery, there is still little published about protocol compliance and sustainability. MethodsThis is a prospective observational study to evaluate the compliance of an ERAS protocol for pectus repair at a large academic children’s hospital. Our primary outcome was overall protocol compliance at 1-y postimplementation of the ERAS protocol. Our comparison group included all pectus repairs for 2 y before protocol implementation. ResultsOverall protocol compliance at 12 mo was 89%. Of the 16 pectus repairs included in the ERAS protocol group, 94% (n = 15) and 94% (n = 15) received preoperative acetaminophen and gabapentin, respectively, which was significantly greater than the historical control group (P < 0.001). For the intraoperative components analyzed, only the intrathecal morphine was significantly different than historical controls (100% versus 49%, P < 0.001). Postoperatively, the time from operating room to return to normal diet was shorter for the ERAS group (0.53 d versus 1.16 d, P < 0.001). There was no significant difference in readmission rates between the two groups. ConclusionsERAS protocol compliance varies based on phase of care. Solutions to sustain protocols depend on the institution and the patient population. However, the utilization of implementation science fundamentals was invaluable in this study to identify and address areas for improvement in protocol compliance. Other institutions may adapt these strategies to improve protocol compliance at their centers.

Indications for Readmission for Small Bowel Obstruction: A Comparison of Medical vs Surgical Service Admission.

Small bowel obstruction (SBO) impacts the health care system and patient quality of life. Previously, we evaluated differences between medical and surgical admissions in the management of SBO. This study investigates indications for readmission based on original admission to medical (MS) or surgical services (SS). A retrospective chart review was performed for 799 patients aged 18 to 89 admitted between 2012 and 2019 with a diagnosis of SBO. Patient characteristics examined included length of stay (LOS), prior abdominal operations, prior SBO, use of small bowel follow through imaging, operative intervention, mortality, and 30-day readmission. There was no difference in readmission rates in patients originally admitted to MS or SS (13.2% vs 12.7%, P = .86). Patients admitted to SS were more likely to be readmitted for recurrent SBO (39% vs 8.6%, P = .006). Patients admitted to MS were more likely to be readmitted for other reasons (73.9% v. 40.2%, P = .004). In the MS cohort, 30.4% (7 patients) had surgery during their initial admission for SBO, and none of those patients were readmitted for recurrent SBO (rSBO). In the SS cohort, 23% had surgery during their initial admission and 31.6% were readmitted for rSBO (P = .002). Patients admitted to SS were more likely to be readmitted for rSBO and to require surgery. Patients admitted to MS were more likely to be readmitted for other reasons. None of the MS patients who had surgery were readmitted for SBO. 31.6% of SS patients who had surgery were readmitted for SBO.

A component-based analysis of metabolic syndrome's impact on 30-day outcomes after hip fracture: reduced mortality in obese patients.

Hip fractures are a common injury associated with significant morbidity and mortality. In the United States, there has been a rapid increase in the prevalence of metabolic syndrome (MetS), a condition comprised several common comorbidities, including obesity, diabetes mellitus, and hypertension, that may worsen perioperative outcomes. This article assesses the impact of MetS and its components on outcomes after hip fracture surgery. Patients who underwent nonelective operative treatment for traumatic hip fractures were identified in the 2015-2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Baseline characteristics between groups were compared, and significant differences were included as covariates. Multivariate regression was performed to assess the impact of characteristics of interest on postoperative outcomes. Patients with MetS, or a single one of its constitutive components-hypertension, diabetes, and obesity-were compared with metabolically healthy cohorts. In total 95,338 patients were included. Patients with MetS had increased complications (OR 1.509; P < 0.001), but reduced mortality (OR 0.71; P < 0.001). Obesity alone was also associated with increased complications (OR 1.14; P < 0.001) and reduced mortality (OR 0.736; P < 0.001). Both hypertension and diabetes alone increased complications (P < 0.001) but had no impact on mortality. Patients with MetS did, however, have greater odds of adverse discharge (OR 1.516; P < 0.001), extended hospital stays (OR 1.18; P < 0.001), and reoperation (OR 1.297; P = 0.003), but no significant difference in readmission rate. Patients with MetS had increased complications but decreased mortality. Our component-based analysis showed had obesity had a similar effect: increased complications but lower mortality. These results may help surgeons preoperatively counsel patients with hip fracture about their postoperative risks.