Extended Length Research Articles

Predictors for length of stay after surgical aortic valve replacement.

Aortic valve replacement improves and prolongs lives of patients with aortic valve disease, but requires significant healthcare resources, which are mainly determined by the length of associated hospital stays. Therefore, this study aims to identify risk factors for extended length of stay after surgical aortic valve replacement. Between 2018 and 2023, 458 consecutive patients underwent isolated surgical aortic valve replacement at our center and were included in our analysis. To identify independent predictors for hospital and intensive care unit stay, multivariable linear regression analysis using backward elimination process was performed. Upon multivariable linear regression, endocarditis [regression coefficient (β) 2.98; 95% confidence interval (CI) 1.51, 4.45; p<0.001)] and prior aortic valve surgery (β 1.72; 95% CI 0.18, 3.26; p=0.029) were associated with prolonged hospital stay. Prior aortic valve surgery was associated with prolonged intensive care unit stay (β 0.99; 95% CI 0.39, 1.59; p=0.001) as well as chronic obstructive pulmonary disease (β 1.61; 95% CI 0.66, 2.55; p=0.001), smaller prosthetic valve sizes (β -0.18; 95% CI -0.30, -0.06; p=0.003), preoperative atrial fibrillation (β 1.06; 95% CI 0.32, 1.79; p=0.005), and reduced left ventricular ejection fraction (β -0.03; 95% CI -0.05, -0.01; p=0.006). Pending further validation, structured programs aiming to accelerate intensive care unit and hospital discharge after surgical aortic valve replacement should focus on patients with prior cardiac surgery, atrial fibrillation, and chronic obstructive pulmonary disease. Surgeons should aim to implant large-diameter valves. Furthermore, the identified predictors should be used to discuss surgical versus transcatheter procedures in the interdisciplinary heart team.

QLTI-08. PREDICTING POOR HIGH-VALUE CARE OUTCOMES FOLLOWING SURGICAL RESECTION OF MULTIFOCAL GLIOBLASTOMA

Abstract Presenting with dismal prognoses, treatment of multifocal GBM (mGBM) requires extensive medical infrastructure. Individualized assessment for patients at risk of extended length of stay (LOS) and nonroutine discharge disposition, described as high-value healthcare outcomes, has not previously been described. To develop predictive models for extended LOS and nonroutine discharge disposition for mGBM patients. All mGBM patients undergoing surgical resection at our institution (January 1, 2009-December 31, 2020) were included. Predictive models for nonroutine discharge disposition (discharge to a non-home environment) and extended LOS [upper quartile of the LOS for all patients included in the present study’s cohorts (&amp;gt;6 days)] were developed using multivariate logistic regression models. Optimism-corrected C-statistics for each model were calculated using 1000 bootstrapped samples in order to correct for potential bias associated with the limited population size. The Hosmer-Lemeshow test was used to evaluate model goodness of fit and calibration. A total of 137 mGBM patients were included in the present study. Most patients were male (40.1%), white (83.2%), not Hispanic/Latino (97.8%), not married (55.5%) and underwent elective surgery (85.4%). The average age among our patient cohort was 55.41 ± 13.17, the average KPS score was 77.23 ± 14.54 and the average mFI-5 was 0.613 ± 0.760. On bivariate analysis, older age (p=0.015) and decreasing Karnofsky Performance Status (KPS) score (p&amp;lt;0.001) were significantly associated with nonroutine discharge disposition while emergency admission (p=0.010) and increasing frailty (mFI-5) score (p=0.003) were significantly associated with extended LOS. On multivariate analysis, increasing age (p=0.031) and decreasing KPS (p&amp;lt;0.001) predicted nonroutine discharge while emergent admission (p=0.023) and greater mFI-5 (p=0.044) predicted extended LOS. Our models for nonroutine discharge and extended LOS had optimism-correct c-statistics of 0.7507 and 0.7309 respectively and displayed adequate calibration. Following external validation, our models may have utility as a risk stratification tool for this multifocal GBM patient populations.

Comorbidity Patterns in Chronic Obstructive Pulmonary Disease and Their Associations with Service Utilization

Background The prevalence of combinations of comorbidities and their associations with inpatient service utilization and readmission among patients with chronic obstructive pulmonary disease (COPD) have not been extensively examined. To address this gap in knowledge, an observational prospective study was conducted using retrospective data. Aims To identify patterns of comorbidities linked to length of hospital stay, daily expenses, and one-year readmission. Methods The 30 most common comorbidities were identified in patients with secondary diagnoses using the association rule mining (ARM) method. Regression models were used to examine the relationships between combinations of comorbidities and service utilization, with adjustments for covariates. Results The five most prevalent comorbidities were pulmonary heart disease (40.99%), ischemic heart disease (38.97%), heart failure (36.77%), hypertension (34.11%), and respiratory disorders (19.12%). Most combinations of comorbidities identified by ARM showed significant associations with an extended length of stay (>13 days), increased daily expenses (>930 CNY), and reduced readmission rates. Among these combinations, glycoprotein metabolism disorder had the strongest association with prolonged length of stay (adjusted odds ratio [aOR]): 1.89, 95% confidence interval [CI]: 1.82–1.95). Conversely, the combination of other brain diseases and respiratory failure was linked to higher daily expenses (aOR: 11.34, 95% CI: 10.58–12.15), and the presence of pulmonary heart disease was associated with elevated one-year readmission rates (aOR: 1.41, 95% CI: 1.37–1.46). Conclusion Common combinations of comorbidities among inpatients with COPD were identified from an extensive collection of discharge medical records. Furthermore, the associations between comorbidities, inpatient service usage, and readmission rates were determined.

Postoperative Complications in Patients With Metabolic Syndrome Following Unicompartmental Knee Arthroplasty.

Metabolic syndrome is associated with increased risk of postoperative complications following various orthopedic surgeries. This study looked to identify specific postoperative complications in these patients following unicompartmental knee arthroplasty (UKA). Adult patients undergoing primary UKA were queried in the National Surgical Quality Improvement Program database from 2006-2019. Metabolic syndrome was defined by the simultaneous presence of hypertension, diabetes, and body mass index >30 kg/m2. Two patient groups were categorized in this study: patients with metabolic syndrome and patients without metabolic syndrome. Baseline characteristics and postoperative outcomes were compared between the two cohorts with the use of bivariate and multivariate analyses. In total, 10,557 patients underwent UKA. Of these, 9,511 patients (90.1%) did not have metabolic syndrome whereas 1,046 (9.9%) had metabolic syndrome. Following adjustment for potential confounding variables on multivariate analysis, metabolic syndrome patients had an increased risk of an extended length of stay greater than four days (OR 1.66; p=0.016) compared to patients without metabolic syndrome. Metabolic syndrome was associated with an increased risk of extended length of stay greater than four days following UKA. Physicians should be prepared for this complication as well as others when discussing treatment with metabolic syndrome patients.

Associations Between Patients' Primary Language and Outcomes and Patient Engagement Process Metrics for Total Joint Arthroplasty.

Previous research has indicated language-based disparities in outcomes after total hip and knee arthroplasty. In this study, we examined the relationship between primary spoken language and outcomes and patient engagement process metrics in a multihospital academic health system. This retrospective cohort study included patients who underwent elective primary total hip or knee arthroplasty in 2018 to 2022. Primary language was categorized as English, Spanish, and Other. Associations were examined between language and perioperative outcomes (same-day discharge, extended hospital length of stay, nonhome discharge, 30-day hospital returns, 90-day readmissions, and 90-day combined complications), and engagement-related metrics (preoperative joint class attendance and patient-reported outcome measure [PROM] completion). We report adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Among 8,220 patients (7.9% Spanish and 5.1% Other non-English), we found no notable associations between language and same-day discharge, nonhome discharge, 30-day hospital returns, 90-day readmissions, or 90-day complications. Other (versus English) language was significantly associated with decreased odds of extended length of stay (OR 0.49, 95% CI, 0.32 to 0.76, P = 0.001). In patient engagement, Other (versus English) language was associated with significantly decreased odds of preoperative class attendance (OR 0.72, 95% CI, 0.54 to 0.95, P = 0.02). Spanish (versus English) primary language was significantly associated with decreased odds of preoperative and 1-year PROM completion (OR 0.34 to 0.75, P ≤ 0.001), and Other (versus English) primary language was significantly associated with decreased odds of preoperative PROM completion (OR 0.59, 95% CI, 0.47 to 0.73, P < 0.001). Our findings highlight language-based disparities in patient engagement metrics but comparable outcomes. Differences in findings compared with past literature may be related to institution-specific language-related support systems. There is a need for additional resources to support patients' active participation in their care, regardless of their primary spoken language.

Utility of Risk Analysis Index for Assessing Morbidity in Patients Undergoing Posterior Spinal Fusion for Adult Spinal Deformity

This study investigates the predictive values of the Risk Analysis Index (RAI), the modified 5-item Frailty Index (mFI-5), and advanced age for predicting 30-day extended length of stay (LOS), 30-day complications and readmissions in patients undergoing posterior spinal fusion (PSF) for adult spinal deformity (ASD). A retrospective cohort study was performed using the 2012-2021 ACS NSQIP database. Adults undergoing posterior spinal fusion for ASD were identified using CPT and ICD codes. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of RAI, mFI-5, and greater patient age for extended LOS, 30-day complications and readmissions. In this cohort of 3,814 patients, RAI identified 90.7% as Robust, 6.0% as Normal, and 3.3% as Frail/Very Frail, while mFI-5 classified 47.1% as Robust, 37.5% as Normal, and 15.3% as Frail/Very Frail. Multivariate analysis revealed both RAI and mFI-5 as significant predictors of extended LOS for Normal (RAI: p<0.001; mFI-5: p=0.012) and Frail/Very Frail patients (RAI: p<0.001; mFI-5: p=0.002). Additionally, RAI was a significant predictor of 30-day complication risk for Normal patients (p=0.005). Furthermore, mFI-5 was a significant predictor of 30-day readmission among Frail/Very Frail patients (p=0.002). This study highlights the utility of RAI and mFI-5 in predicting extended LOS patients undergoing PSF for ASD. RAI was found to be superior to mFI-5 for predicting 30-day readmissions, while mF-5 was greater for 30-day complications. These findings highlight the importance of incorporating frailty assessments into preoperative surgical planning.

Assessing a revised-risk analysis index for morbidity and mortality after spine surgery for metastatic spinal tumors.

Risk Analysis Index (RAI) has been increasingly used to assess surgical frailty in various procedures, but its effectiveness in predicting mortality or in-patient hospital outcomes for spine surgery in metastatic disease remains unclear. The aim of this study was to compare the predictive values of the revised RAI (RAI-rev), the modified frailty index-5 (mFI-5), and advanced age for extended length of stay, 30-day readmission, complications, and mortality among patients undergoing spine surgery for metastatic spinal tumors. A retrospective cohort study was performed using the 2012-2022 ACS NSQIP database to identify adult patients who underwent spinal surgery for metastatic spinal pathologies. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of RAI-rev, mFI-5, and greater patient age with extended length of stay (LOS), 30-day complications, hospital readmission, and mortality. A total of 1,796 patients were identified, of which 1,116 (62.1%) were male and 1,008 (70.7%) were non-Hispanic White. RAI-rev identified 1,291 (71.9%) frail and 208 (11.6%) very frail patients, while mFI-5 identified 272 (15.1%) frail and 49 (2.7%) very frail patients. In the ROC analysis for extended LOS, both RAI-rev and mFI-5 showed modest predictive capabilities with area under the curve (AUC) values of 0.5477 and 0.5329, respectively, and no significant difference in their predictive abilities (p = 0.446). When compared to age, RAI-rev demonstrated superior prediction (p = 0.015). With respect to predicting 30-day readmission, no significant difference was observed between RAI-rev and mFI-5 (AUC 0.5394 l respectively, p = 0.354). However, RAI-rev outperformed age (p = 0.001). When assessing the risk of 30-day complications, RAI-rev significantly outperformed mFI-5 (AUC: 0.6016 and 0.5542 respectively, p = 0.022) but not age. Notably, RAI-rev demonstrated superior ability for predicting 30-day mortality compared to mFI-5 and age (AUC: 0.6541, 0.5652, and 0.5515 respectively, p < 0.001). Multivariate analysis revealed RAI-rev as a significant predictor of extended LOS [aOR: 1.96, 95% CI: 1.13-3.38, p = 0.016] and 30-day mortality [aOR: 5.27, 95% CI: 1.73-16.06, p = 0.003] for very frail patients. Similarly, the RAI-rev significantly predicted 30-day complications for frail [aOR: 2.63, 95% CI: 1.21-5.72, p = 0.015] and very frail [aOR: 3.69, 95% CI: 1.60-8.51, p = 0.002] patients. However, the RAI did not significantly predict 30-day readmission [Very Frail aOR: 1.52, 95% CI: 0.75-3.07, p = 0.245; Frail aOR: 1.46, 95% CI: 0.79-2.68, p = 0.225]. Our study demonstrates the utility of RAI-rev in predicting morbidity and mortality in patients undergoing spine surgery for metastatic spinal pathologies. Particularly, the superiority that RAI-rev has in predicting 30-day mortality may have significant implications in multidisciplinary decision making.

High inpatient-opioid consumption predicts extended length of hospital stay in patients undergoing spinal fusion for adolescent idiopathic scoliosis.

Opioids are common medications used following spine surgery. However, few studies have assessed the impact of increased inpatient-opioid consumption on outcomes following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The aim of this study was to determine the impact of increased inpatient-opioid consumption on hospital length of stay (LOS) following PSF for AIS. A retrospective cohort study was performed using the Premier Healthcare Database (2016-2017). Adolescent patients (11-17years old) who underwent PSF for AIS, identified using ICD-10-CM coding, were stratified by inpatient MME (morphine milligram equivalent) consumption into Low (< 25th percentile for the cohort), Medium (25-75th percentile), and High (> 75th percentile) cohorts. Demographics, comorbidities, intraoperative procedures, perioperative adverse events (AEs), length of hospital stay (LOS), non-routine discharge rates, cost of admission, and 30-day readmission rates were assessed. A logistic multivariate regression analysis was performed to determine the association between inpatient MME consumption and extended LOS. Of the 1042 study patients, 260 (24.9%) had Low-MME consumption, 523 (50.2%) had Medium-MME consumption, and 259 (24.9%) had High-MME consumption. A greater proportion of patients in the High cohort identified as non-Hispanic white (Low: 46.5% vs Medium: 61.4% vs High: 65.3%, p < 0.001), while the proportion of patients reporting any comorbidity did not vary across the cohorts (p = 0.940). The number of post-operative AEs experienced also did not vary across the cohorts (p = 0.629). A greater proportion of patients in the High cohort had an extended LOS (Low: 6.5% vs Medium: 8.6% vs High: 19.7%, p < 0.001), while a greater proportion of patients in the Low cohort had an increased cost of admission (Low: 33.1% vs Medium: 20.3% vs High: 26.6%, p < 0.001). The High cohort had increased 30-day readmission rates relative to the Low and Medium cohorts (Low: 0.8% vs Medium: 0.2% vs High: 1.5%, p = 0.049). Non-routine discharge rates did not vary among the cohorts (p = 0.441). On multivariate analysis, High-MME consumption was significantly associated with extended LOS, while Medium-MME consumption was not [Medium: aOR: 1.48, CI (0.83, 2.74), p = 0.193; High: aOR: 4.43, CI (2.47, 8.31), p < 0.001]. Our study showed that high post-operative-MME consumption was significantly associated with extended LOS in patients undergoing PSF for AIS. In light of these findings, changes to existing protocols that decrease the reliance on opioids for post-operative analgesia are merited to improve patient outcomes and reduce health-care expenditures.

Photoperiod and temperature interactions drive the latitudinal distribution of Laminaria hyperborea (Laminariales, Phaeophyceae) under climate change.

Due to global rises in temperature, recent studies predict marine species shifting toward higher latitudes. We investigated the impact of interacting abiotic drivers on the distribution potential of the temperate kelp Laminaria hyperborea. The ecosystem engineering species is widespread along European coasts but has not yet been observed in the High Arctic, although it can survive several months of low temperatures and darkness. To investigate its ability to extend northward in future, we conducted a long-term multifactorial experiment with sporophytes from Porsangerfjorden, Norway-close to the species' documented northernmost distribution margin. The samples were exposed to three different photoperiods (PolarDay, LongDay, and PolarNight) at 0°C, 5°C, and 10°C for 3 months. Optimum quantum yield of photosynthesis (Fv/Fm), dry weight, pigments, phlorotannins, and storage carbohydrates were monitored. Both physiological and biochemical parameters revealed that L. hyperborea was strongly influenced by the different photoperiods and their interaction with temperature, while temperature alone exerted only minor effects. The Fv/Fm data were integrated into a species distribution model to project a possible northward expansion of L. hyperborea. The combination of extended day lengths and low temperatures appeared to be the limiting reason for northward spread of L. hyperborea until recently. However, with water temperatures reaching 10°C in summer, this kelp will be able to thrive also in the High Arctic. Moreover, no evidence of stress to Arctic winter warming was observed. Consequently, L. hyperborea has a high potential for spreading northward with further warming which may significantly affect the structure and function of Arctic ecosystems.

Extended length of stay in an Australian private psychiatric hospital: an observational study of patient, clinical, and treatment characteristics

BackgroundPatient extended length of stay has been scarcely studied in Australian inpatient psychiatric units (IPUs). Previous research has focused on public IPUs, however, private IPUs also care for a large proportion of people with mental illness.ObjectivesThis study aimed to identify patient, clinical, and treatment characteristics associated with ELOS within a private IPU and compare these characteristics with those of public IPUs. It is hypothesised that patients with ELOS will have complex characteristics such as high unemployment status, multiple psychiatric diagnoses and physical health comorbidities.MethodThis cross-sectional study examined characteristics of ELOS in a private Australian IPU between 1st July 2018 and 30th July 2019. A retrospective patient file audit collected characteristics of ELOS patients.ResultsOf the 54 ELOS patients (M = 42.52 years [18.62]) admitted, the average LOS was 55.04 days (SD = 4.4 days). Most patients were female (77.8%), single (44.4%) and their income status was unemployed (25.9%), employed (24.1%) and pensioner (22.2%). The most prevalent psychiatric diagnoses were major depressive disorder (29.6%), eating disorder (24.1%), alcohol or substance use disorder (7.4%), and complex post-traumatic stress disorder (7.4%) respectively.ConclusionThis study highlights patient, clinical, and treatment characteristics prevalent among private inpatients with ELOS. Future research should examine whether these are distinct from admissions that are not prolonged, with the aim to identify and reduce ELOS, and improve patient recovery, hospital flow and capacity.

Rejuvenating liquid crystal elastomers for self-growth

To date, only one polymer can self-grow to an extended length beyond its original size at room temperature without external stimuli or energy input. This breakthrough paves the way for significant advancements in untethered autonomous soft robotics, eliminating the need for the energy input or external stimuli required by all existing soft robotics systems. However, only freshly prepared samples in an initial state can self-grow, while non-fresh ones cannot. The necessity of synthesizing from monomers for each use imposes significant limitations on practical applications. Here, we propose a strategy to rejuvenate non-fresh samples to their initial state for on-demand self-growth through the synergistic effects of solvents and dynamic covalent bonds during swelling. The solvent used for swelling physically transforms the non-fresh LCEs from the liquid crystal phase to the isotropic phase. Simultaneously, the introduction of the transesterification catalyst through swelling facilitates topological rearrangements through exchange reactions of dynamic covalent bonds. The rejuvenation process can also erase growth history, be repeated several times, and be regulated by selective swelling. This strategy provides a post-modulation method for the rejuvenation and reuse of self-growing LCEs, promising to offer high-performance materials for cutting-edge soft growing robotics.

Adaptation of indoor ornamental plants to various lighting levels in growth chambers simulating workplace environments

Despite the growing interest in indoor greenery and its positive effects on occupants’ well-being, there is limited knowledge on the optimal light levels for indoor plants that ensure energy efficiency and sustainable growth. This study explored the survival of ornamental plants under low-light conditions typical of indoor workplaces without daylight and investigated the impact of increased light intensity or extended day length on their growth. Three species of foliage plants (Epipremnum aureum, Pachira aquatica, and Rhaphidophora tetrasperma) were cultivated in growth chambers with three different lighting schemes. The results showed that plants sustained growth with 6.8 μmol m−2 s−1 white LED light for 9 h/day, suggesting that extra lighting might not be necessary for shade-tolerant species in offices. In this environment, plants maintained efficient photosynthesis under low illumination by increasing their specific leaf area. Elevating the light to 20.1 μmol m−2 s−1 and extending the day length to 18 h/day enhanced the plants’ relative growth rate. Climbing plants allocated more biomass to stems, resulting in a lower leaf weight ratio and noticeably altering their appearance. This study demonstrates that customized lighting strategies effectively support indoor greening goals, like adjusting intensity for energy savings or adding light for greening large spaces.

Frailty is Superior to Age at Predicting Extended Length of Stay and Immediate Postoperative Complications Following Total Wrist Arthrodesis

Abstract Hypothesis The modified five-factor frailty index (mFI-5) is a better predictor than age alone of increased risk of extended length of stay (LOS) and postoperative complications in patients undergoing total wrist arthrodesis (TWA). Methods The National Inpatient Sample database was queried for patients undergoing elective TWA. Patients were identified using the International Classification of Diseases, 10th Revision procedure codes, excluding nonelective cases, hardware removal, and patients with cerebral palsy or seizure disorders. Frailty was assessed by identifying the variables used in the mFI-5 and patients were categorized as nonfrail (mFI-5 = 0), prefrail (mFI-5 = 1), and frail (mFI-5 ≥ 2). Outcomes assessed included LOS and immediate postoperative complications such as nausea and vomiting requiring admission, acute kidney injury, postoperative hypotension, postoperative hypothyroidism, and urinary tract infection. Logistic regression was used to analyze the association between frailty status and both extended LOS and immediate postoperative complications. Results Between 2015 and 2019, 685 patients underwent TWA, with 49.6% not frail, 33.5% prefrail, and 16.7% frail. Prefrail and frail patients were at increased risk of undergoing extended LOS (OR 2.182, p = 0.001; OR 2.312, p = 0.002, respectively). Age over 65 (OR 1.995, p &lt; 0.001) and female sex (OR 1.605, p = 0.029) were also independent risk factors. Frail patients were found to have an increased likelihood of acquiring any postoperative complication (OR 3.865, p &lt; 0.001), while elderly age was not a significant risk factor (OR 1.361, p = 0.298). Using receiver operating characteristic (ROC) curve analysis, the mFI-5 demonstrated superior discriminatory ability compared with age for extended LOS (Area under the curve (AUC) 0.729 vs. 0.542) and postoperative complications (AUC 0.712 vs. 0.673). Conclusion Our study demonstrates that both elderly age and frailty are independent predictors of extended hospitalization following TWA, while frailty but not age, is a significant predictor of immediate postoperative complications. To our knowledge, our study is the first to report an association between frailty status and immediate postoperative complications following TWA. Incorporating a preoperative frailty screening can allow for more open and informed preoperative discussion about surgical risk for elective procedures such as TWA, as well as allow for enhanced postoperative planning.

Design and Evaluation of Natural Face Pack

The majority of cosmetic products on market are synthetic in nature and have a variety of negative side effects when used is an extended length of time. Use of herbal cosmetics is one remedy for this issue. Herbal cosmetics are thought to be generally safe with little adverse effects. Some of main skin problems are acne, redness, wrinkles, dark circles, pimples, dry skin, dead skin. By utilising herbal cosmetics such as face packs, scrubs, creams, etc., all these issues can be reduced. The objective of this work is to Formulation and Evaluation of herbal face pack by using natural ingredients for by using natural substances, radiant skin. Four differ-rent formulations with varying conc. of ingredients like multani-mitti, turmeric, aloe vera, sandal wood, orange peel, neem , nutmeg and rose petals powder are evaluated for their organoleptic properties, stability, physico-chemical parameters, irritancy test and microbial load.

Comparison of Two Previously Validated Risk Assessment and Prediction Tool Models in Extended Length of Stay Patients Following total Hip Arthroplasty

IntroductionPrevious studies have attempted to validate the risk assessment and prediction tool (RAPT) in primary total hip arthroplasty (THA) patients. The purpose of this study was to: (1) identify patients who had an extended length of stay (LOS) following THA; and (2) compare the accuracy of 2 previously validated RAPT models. MethodsWe retrospectively reviewed all primary THA patients from 2014 to 2021 who had a completed RAPT score. Youden’s J computational analysis was used to determine the LOS where facility discharge was statistically more likely. Based on the cut-offs proposed by Oldmeadow and Dibra, patients were separated into high- (O: 1 to 5 versus D: 1 to 3), medium- (O: 6 to 9 versus D: 4 to 7), and low- (O: 10 to 12 versus D: 8 to 12) risk groups. ResultsWe determined that an LOS of greater than 2 days resulted in a higher chance of facility discharge. In these patients (n = 717), the overall predictive accuracy (PA) of the RAPT was 79.8%. The Dibra model had a higher PA in the high-risk group (D: 68.2 versus O: 61.2% facility discharge). The Oldmeadow model had a higher PA in the medium-risk (O: 78.7 versus D: 61.4% home discharge) and low-risk (O: 97.0 versus D. 92.5% home discharge) groups. ConclusionsAs institutions continue to optimize LOS, the RAPT may need to be defined in the context of a patient’s hospital stay. In patients requiring an LOS of greater than 2 days, the originally established RAPT cut-offs may be more accurate in predicting discharge disposition. Level of EvidenceIII Retrospective Cohort Study.

Factors Affecting Implant Length in Primary Inflatable Penile Prosthesis Placement

ObjectivesTo evaluate predictors of implant length for men undergoing primary IPP placement. MethodsA multicenter, retrospective cohort study was performed for men undergoing primary IPP placement at 16 high-volume surgical centers. Patient demographics, comorbidities, operative approach, and implanted cylinder and rear tip extender length were recorded. Associations between potential preoperative and intraoperative predictors of total device length were tested using non-parametric correlation and Kruskal-Wallis tests, followed by multiple regression. ResultsOf 3,951 men undergoing primary IPP placement from July 2016 – July 2021, the median implant length was 20 cm (IQR: 19 – 22). Shorter implant length was associated with increasing age in years (β = -0.01, p=0.009), Asian ethnicity (β = -2.34, p=0.008), history of radical prostatectomy (β = -0.35, p=0.001), and use of an infrapubic surgical approach (β = -1.02, p<0.001). Black or African American ethnicity was associated with the implantation of longer devices (β = 0.35, p<0.001). No significant associations were recorded with BMI, history of intracavernosal injections, diabetes mellitus, tobacco use, radiation therapy, Peyronie’s disease, priapism, or cavernosal dilation technique. ConclusionsThe length of an implanted penile prosthesis was found to be associated with preoperative and intraoperative factors including history of radical prostatectomy and operative approach. The knowledge of these associations may assist in the preoperative counseling of patients receiving IPP and help create accurate postoperative expectations.

Retention mechanism in combined hydrodynamic and slalom chromatography for analyzing large nucleic acid biopolymers relevant to cell and gene therapies

Slalom chromatography (SC) was discovered in 1988 for analyzing double-stranded (ds) DNA. However, its progress was impeded by practical issues such as low-purity particles, sample loss, and lack of a clear retention mechanism. With the rise of cell and gene therapies and the availability today of bio-inert ultra-high-pressure liquid chromatography (UHPLC) columns and systems, SC has regained interest. In SC, the elution order is opposite to that observed in hydrodynamic chromatography (HDC): larger DNA molecules are more retained than small ones. Yet, the underlying SC retention mechanism remains elusive.We provide the physicochemical background necessary to explain, at a microscopic scale, the full transition from a HDC to a SC retention mechanism. This includes the persistence length of the DNA macromolecule (representing DNA stiffness), their relaxation time (τR) from the non-equilibrium contour length to the equilibrium entropic configuration, and the relationship between the mobile phase shear rate (〈γ̇〉) in packed columns and the DNA extended length. We propose a relevant retention model to account for the simultaneous impact of hydrodynamic chromatography (HDC) and SC on the retention factors of a series of large and linear dsDNAs (ranging from 2 to 48 kbp). SC data were acquired using bio-inert MaxPeakTM Columns packed with 1.7μm BEHTM 45 Å, 1.8μm BEH 125 Å, 2.4μm BEH 125 Å, 5.3μm BEH 125 Å, and 11.3μm BEH 125 Å Particles, an ACQUITYTM UPLCTM I-class PLUS System, and either 1 × PBS (pH 7.4) or 100 mM phosphate buffer (pH 8) as the mobile phase. SC is a non-equilibrium retention mode that is dominant when the Weissenberg number (Wi=〈γ̇〉τR) is much larger than 10 and the average extended length of DNA exceeds the particle diameter. HDC, on the other hand, is an equilibrium retention mode that dominates when Wi<1 (DNA chains remaining in their non-extended configuration). Maximum dsDNA resolution is observed in a mixed HDC-SC retention mode when the extended length of the DNA is approximately half the particle diameter. This work facilitates the development of methods for characterizing various plasmid DNA mixtures, containing linear, supercoiled, and relaxed circular dsDNAs which all have different degree of molecular stiffness.

Hierarchical organic microspheres from diverse molecular building blocks

Microspherical structures find broad application in chemistry and materials science, including in separations and purifications, energy storage and conversion, organic and biocatalysis, and as artificial and bioactive scaffolds. Despite this utility, the systematic diversification of their morphology and function remains hindered by the limited range of their molecular building blocks. Drawing upon the design principles of reticular synthesis, where diverse organic molecules generate varied porous frameworks, we show herein how analogous microspherical structures can be generated under mild conditions. The assembly of simple organic molecules into microspherical structures with advanced morphologies represents a grand challenge. Beginning with a partially condensed Schiff base which self-assembles into a hierarchical organic microsphere, we systematically synthesized sixteen microspheres from diverse molecular building blocks. We subsequently explicate the mechanism of hierarchical assembly through which these hierarchical organic microspheres are produced, isolating the initial monomer, intermediate substructures, and eventual microspheres. Furthermore, the open cavities present on the surfaces of these constructs provided distinctive adsorptive properties, which we harnessed for the immobilization of enzymes and bacteriophages. Holistically, these hierarchical organic microspheres provide an approach for designing multi-functional superstructures with advanced morphologies derived from simple organic molecules, revealing an extended length scale for reticular synthesis.

Identifying Independent Predictors of Short-Term Postoperative Morbidity in Patients Undergoing Cranioplasty.

The present study intends to identify independent predictors of short-term postoperative complications and health utilization in patients undergoing cranioplasty. Demographic, clinical, and intraoperative characteristics were collected for each patient undergoing cranioplasty in the National Surgery Quality Improvement Program database from 2011 to 2020. The 30-day outcomes analyzed were medical complications, wound complications, return to the operating room, extended hospital stay, and non-home discharge. Bivariate analyses were initially used to identify variables that yielded a P value less than 0.2 which were subsequently analyzed in a multivariate logistic regression to identify independent predictors of the aforementioned outcomes. In total, 2316 patients undergoing cranioplasty were included in the analysis. Increased operative time and totally dependent functional status significantly increased odds of returning to the operating room. Increased age, operative time, cranioplasty size >5cm, and various comorbidities were associated with increased odds of non-home discharge. Bleeding disorders were independently associated with increased odds of wound complications. Increased age, operative time, cranioplasty size >5cm, and several medical history features predisposed to medical complications. Demographic characteristics, including age and race, along with various operative and medical history characteristics were associated with increased odds of extended length of stay. Identification of risk factors can help guide preoperative risk management in cranioplasty.

Association of Pre-Operative Hyponatraemia with Morbidity and Mortality in Patients Undergoing Non-Urgent Degenerative Spine Surgery, a Retrospective Study.

Hyponatraemia increases the morbidity and mortality risks of orthopaedic patients. When undergoing spine surgery, hyponatraemic patients have high risks of pneumonia and of staying in hospital for up to 1 day longer compared with non-hyponatraemic patients. This study aims to assess the occurrence of adverse events among patients with pre-operative hyponatraemia after undergoing lumbar surgery. A retrospective cohort study was conducted. Patients who underwent spinal surgery in 2011 to 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate analysis was conducted to demonstrate the difference in post-operative complication rates between hyponatraemic patients and normonatraemic patients. Post-operative adverse events, need for blood transfusion and length of stay were considered as clinical outcome data. A total of 58,049 patients were included; pre-operatively, 55,012 (94.8%) were normonatraemic and 3037 (5.2%) were hyponatraemic. Multivariate analysis showed that hyponatraemic patients had higher rates of adverse events, blood transfusions and urinary tract infections. Specifically, 632 (20.8%) hyponatraemic patients developed adverse events, compared with 6821 (12.4%) normonatraemic patients; the hyponatraemic patients received transfusions, compared with 6821 (7.4%) normonatraemic patients; and 97 (3.2%) hyponatraemic patients developed urinary tract infections, compared with 715 (1.3%) normonatraemic patients. Finally, an extended length of stay beyond 6 days occurred in 604 (19.9%) hyponatraemic patients, compared with 4676 (8.5%) normonatraemic patients. Our study identified an association between pre-operative hyponatraemia and post-operative adverse events in spinal surgery patients. However, it is unclear whether hyponatraemia caused the higher adverse event rate.