Higher Length Of Stay Research Articles

Socioeconomic Disparities in the Clinical Outcomes of Pediatric Traumatic Brain Injury: A Nationwide Analysis of the Past Decade

Socioeconomic status has historically influenced traumatic brain injury (TBI) outcomes, yet pediatric TBI disparities remain understudied. We aimed to analyze the National Inpatient Sample (NIS) database for socioeconomic disparities in the outcomes of pediatric TBI patients. The NIS from 2011 to 2020 was retrospectively analyzed for pediatric TBI patients. Socioeconomic variables included age, sex, race, household income, geographic location, and primary expected payer. Outcomes included length of stay (LOS), in-hospital mortality, mortality risk, and illness severity. A total 45,109 pediatric TBI patients (63.9% male) were identified. Mean age was 7.76 years, mean LOS was 4.57 days, and overall mortality rate was 3.2%. African-American or Native American patients had significantly longer LOS (1.6 and 3.4 days, respectively; p<0.01) than White patients. African-American patients had an odds ratio of mortality of 1.57 compared to White patients. Female patients had significantly higher mortality risk and LOS (0.5 days) than male patients (p<0.001). Patients in the bottom 50% of income and those in rural counties had higher odds of mortality (2.20 and 1.27, respectively) compared to higher-income and urban patients. Regional mortality rate differences were significant (p<0.001), with the East South Central region having the highest rate. Medicaid and self-pay patients had higher LOS (p<0.001) and odds ratios of mortality (1.19 and 2.36, respectively) compared to private insurance patients. This study highlights significant differences based on race, sex, income, insurance type, and geographic location in pediatric TBI outcomes. Future research should focus on identifying factors contributing to inequalities and developing strategies to mitigate them.

Pediatric Burn Care for Burn Injury: Outcomes by Timing of Referral Using a U.S. Single-Center Retrospective Cohort, 2005-2019.

Burn centers offer specialized care to pediatric patients with burn injuries. However, data about outcome in relation to timing of transfer are limited. We examined these timings and outcomes among burn-injured pediatric patients. Single-center, retrospective cohort study of U.S. national and international practice. Shriners ESO Trauma Burn Registry, 2005-2019. Patients 0-17 years old admitted to a pediatric burn center with 10-80% total body surface area (TBSA) burn between 2005 and 2019. None. The cohort of 761 patients was subcategorized according to timing of referral: early presentation (EP) (0-7 d), delayed presentation (DP) (8-60 d), and very delayed presentation (VDP) (> 60 d). Primary outcomes included hospital length of stay (LOS), ICU LOS, percent TBSA (%TBSA)/LOS ratio, mortality, and disposition. Dichotomous outcomes were analyzed using logistic regression and continuous outcomes were compared using median regression, both utilizing multivariable analysis adjusting for a priori confounders and presented as adjusted coefficients (ACs) with 95% CI. Delayed referral (DP and VDP) was associated with higher %TBSA burn and with fewer referrals from high-income countries. Compared with EP, VDP was associated with higher LOS/%TBSA (AC, 0.2 [0.01-0.4]). On univariate analysis, in comparison with EP, DP and VDP were associated with higher ICU (DP 16 [6-29]; VDP 8 [0-18]) and hospital LOS (DP 34 [21-55]; VDP 32 [18-58]). Overall, ten of 761 patients died (1.3%), and we found no association between timing of referral and mortality. Also, in 751 survivors, 635 patients (84.6%) were discharged home without home health, and we found no association with timing of referral on multivariable analysis. In this report, we have reviewed our single-center, international burn-injured pediatric cohort, operating in the United States (2005-2019). We find that referral with VDP as opposed to EP was associated with increased LOS/%TBSA.

Proximal Humerus Fractures In The Older Adult: A Retrospective Review Of Proximal Humerus Fractures In The Emergency Department

Abstract Background This study aimed to describe the epidemiology and outcomes of older adults diagnosed with proximal humeral fractures (PHFs) in an Irish adult emergency department (ED). Methods A retrospective chart review was conducted on all patients (&amp;gt;65) who had a diagnosis of a PHF, in 2022 within an ED of a large suburban academic teaching hospital in Dublin. Assessment by the Frailty at the Front Door (FFD) team (older adults &amp;gt;75) for those with a PHF was also analysed. Results A total of 53 older adults (&amp;gt;65) were identified within the study period with a PHF while 43 patients (&amp;lt;65) were identified. In the &amp;gt;65 group, seventy-nine percent (N=42) were female. The mean age was 75.6 years of age (Range 65-95). Only 21% (N=11) had operative management. Two-thirds of PHFs in the &amp;gt;65 group required admission to hospital (N=24) (P&amp;lt;0.001). The mean length of stay (LOS) was 12.9 days compared to only 4.5 days in those under the age of 65 (P= 0.14). There were 26 older adults (&amp;gt;75) diagnosed with a PHF. The FFD team assessed 49% (N=11) of older adults (&amp;gt;75) with a PHF. Only 31% (N=8) presented to ED within FFD team operational hours. The average Clinical Frailty Sale was 5 (N=11). The FFD team completed 22 inpatient MDT referrals, four HSCP community referrals, one Public Health Nurse Referral and one application for increase in home care package. Conclusion PHFs tended to occur in older female patients. The majority of PHFs in older adults do not have operative treatment and were associated with higher LOS. FFD teams can play a pivotal role in the assessment and treatment of older adults with a PHF. This may represent opportunities to develop integrated care pathways to maximize an individuals’ independence, to support people at home with PHFs.

Impact of time from discharge to readmission on outcomes: an observational study from the US National Readmission Database

BackgroundThe Hospital Readmission Reduction Programme (HRRP) was created to decrease the number of hospital readmissions for acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia (PNA),...

The impact of cannabis use disorder on urologic oncologic surgery morbidity, length of stay, and inpatient cost: analysis of the National Inpatient Sample from 2003 to 2014.

This study examined the impact of cannabis use disorder (CUD) on inpatient morbidity, length of stay (LOS), and inpatient cost (IC) of patients undergoing urologic oncologic surgery. The National Inpatient Sample (NIS) from 2003 to 2014 was analyzed for patients undergoing prostatectomy, nephrectomy, or cystectomy (n = 1,612,743). CUD was identified using ICD-9 codes. Complex-survey procedures were used to compare patients with and without CUD. Inpatient major complications, high LOS (4th quartile), and high IC (4th quartile) were examined as endpoints. Univariable and multivariable analysis (MVA) were performed to compare groups. The incidence of CUD increased from 51 per 100,000 admissions in 2003 to 383 per 100,000 in 2014 (p < 0.001). Overall, 3,503 admissions had CUD. Patients with CUD were more frequently younger (50 vs. 61), male (86% vs. 78.4%), Black (21.7% vs. 9.2%), and had 1st quartile income (36.1% vs. 20.6%); all p < 0.001. CUD had no impact on any complication rates (all p > 0.05). However, CUD patients had higher LOS (3 vs. 2days; p < 0.001) and IC ($15,609 vs. $12,415; p < 0.001). On MVA, CUD was not an independent predictor of major complications (p = 0.6). Conversely, CUD was associated with high LOS (odds ratio (OR) 1.31; 95% CI 1.08-1.59) and high IC (OR 1.33; 95% CI 1.12-1.59), both p < 0.01. The incidence of CUD at the time of urologic oncologic surgery is increasing. Future research should look into the cause of our observed phenomena and how to decrease LOS and IC in CUD patients.

Outcomes of Acute Kidney Injury among Hospitalized Patients with Infective Endocarditis: A National Inpatient Sample Analysis.

Background/Objectives: Patients with infective endocarditis (IE) are more susceptible to acute kidney injury (AKI). The presence of AKI increases in-hospital complications in these patients. Methods: The 2016-2020 National Inpatient Sample (NIS) database consisting of adult admissions with IE and AKI was utilized. The primary outcome was all-cause inpatient mortality. Secondary outcomes included fluid and electrolyte disorders, stroke, septic arterial embolism, septic shock, cardiogenic shock, valve surgery, vasopressor support, mechanical ventilation, length of stay (LOS), and total hospital charges. Results: Out of a total of 63,725 adult admissions with IE, 16,295 (25.5%) admissions had AKI. Patients with AKI were more likely to be males (63% vs. 57.6%, p < 0.001) and older (55.8 vs. 50.4, p < 0.001). A higher proportion of these patients were admitted to large hospitals (60.6 vs. 55.3%, p < 0.001) and urban teaching hospitals (81.9 vs. 75%, p < 0.001). Patients with AKI had higher LOS (17 ± 16.1 vs. 11.32 ± 11.7, p < 0.001) and hospital charges (USD 239,046.8 ± 303,977.3 vs. USD 124,857.6 ± 192,883.5, p < 0.001). Multivariable analysis showed higher odds of all-cause inpatient mortality (aOR: 2.22, 95% CI: 1.81-2.73, p < 0.001). They also had higher risk for fluid and electrolyte disorder (aOR: 2.31, 95% CI: 2.10-2.53, p < 0.001), septic arterial embolism (aOR: 1.61, 95% CI: 1.42-1.84, p < 0.001), septic shock (aOR: 3.78, 95% CI: 2.97-4.82, p < 0.001), cardiogenic shock (OR: 3.37, 95% CI: 2.65-4.28, p < 0.001), valve surgery (aOR: 1.52, 95% CI: 1.35-1.71, p < 0.001), vasopressor requirement (aOR: 1.99, 95% CI: 1.52-2.60, p < 0.001), and mechanical ventilation (aOR: 2.75, 95% CI: 2.33-3.24, p < 0.001). The association with stroke was elevated but not statistically significant. Conclusions: This large retrospective analysis demonstrated that patients with AKI and infective endocarditis had increased mortality, adverse hospital outcomes, increased LOS, and hospital costs.

The impact of nutritional status on revision total shoulder arthroplasty: perioperative outcomes and complications

BackgroundAs the prevalence of primary total shoulder arthoplasty (TSA) increases in the United States so does the number of revision TSA. Those undergoing primary TSA with lower nutritional status have been shown to have worse outcomes; however, little knowledge exists regarding the effects of malnutrition on outcomes following revision TSA. The purpose of this study is to determine the clinical outcomes and complication rates following revision TSA, as well as the prevalence of diabetes mellitus (DM) in malnourished patients undergoing revision TSA. MethodsThe American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2013 to 2020 and found 783 cases of revision TSA. Albumin was used as a surrogate marker for nutritional status. Patients were stratified into unmatched cohorts of normal (albumin ≥ 3.5 g/dL, n = 700) and low (albumin < 3.5 g/dL, n = 83) nutritional status, as well as by diagnosis of DM. Comparative differences in demographics, comorbidities, length of stay (LOS), readmission, reoperation, and 30-day postoperative complications related to their nutritional status and presence of DM were analyzed using chi-squared tests, independent sample t tests, and multivariate analysis on SPSS. ResultsPatients within the low albumin cohort were more likely to be female (P = .008), increased mean age (P = .018), on dialysis (P = .002), had undergone an emergency procedure (P < .001), classified with a dependent functional status (P < .001), and had a higher American Society of Anesthesiologists classification (P < .001). There was a higher percentage of patients with a DM diagnosis and hypoalbuminemia compared to nondiabetic patients (36.2% vs. 19.4%, P < .001). Compared to the normal albumin cohort, the low albumin cohort was found to have significantly longer LOS (P = .025), increased bleeding/transfusion complications (8.4% vs. 3.3%, P = .021), and increased reoperation rate (8.4% vs. 0.71%, P = .034). No significant difference in readmission was found (P = .226). ConclusionEleven percentage of patients undergoing revision TSA were malnourished and had higher LOS and reoperation rates. Patients with DM had a significantly higher incidence of being malnourished than those without DM. Malnourishment represents a potential modifiable risk factor for patients undergoing revision TSA, and surgeons should screen patients preoperatively, especially those patients with DM.

Long-term outcomes of PGA-TMC absorbable synthetic scaffold in both clean and contaminated ventral hernia repairs.

Biosynthetic meshes afford the cost advantages of being made from fully synthetic material, but are also biodegradable, making them a versatile option that can be used in both clean and contaminated cases. The aim of this study is to evaluate the safety profile and long-term outcomes of using GORE BIO-A (BIO-A) as an adjunct to abdominal wall reconstruction in all wound classes. A retrospective review identified patients undergoing abdominal hernia repair using BIO-A from October 2008 to June 2018. The primary outcome was hernia recurrence rate. Only patients with at least 6-month follow-up were included when looking at recurrence rates. Secondary outcomes included 30-day morbidity categorized according to CDC Surgical Site Infection Criteria, return to operating/procedure room (RTOR), 30-day readmission, length of stay (LOS), and mortality. A total of 207 patients were identified, CDC Wound Classification breakdown was 127 (61.4%), 41 (19.8%), 14 (6.8%), and 25 (12.1%) for wound classes I, II, III, and IV, respectively. Median follow-up was 55.4months (range 0.2-162.4). Overall recurrence rate was 17.4%. Contaminated cases experienced higher recurrence rates (28.8% versus 10.4%, p = 0.002) at a mean follow up of 46.9 and 60.8months for contaminated and clean patients, respectively. Recurrent patients had higher BMI (32.4 versus 28.4kg/m2, p = 0.0011), larger hernias (162.2 versus 106.7 cm2, p = 0.10), higher LOS (11.1 versus 5.6days, p = 0.0051), and higher RTOR rates (16.7% versus 5.6%, p = 0.053). 51 (24.5%) patients experienced some morbidity, including 19 (9.2%) surgical site occurences, 7 (3.4%) superficial surgical site infections, 16 (7.7%) deep surgical site infections, and 1 (0.5%) organ space infection. This study affirms the use of biosynthetic mesh as a cost-effective alternative in all wound classifications, yielding good outcomes, limited long-term complications, and low recurrence. rates.

Assessing the Impact of Comorbid Hypercalcemia on Inpatient Outcomes of Patients With Diffuse Large B-cell Lymphoma During Admission for Chemotherapy.

Introduction Diffuse large B-cell lymphoma (DLBCL) may be complicated by hypercalcemia at various stages of treatment. The impact of hypercalcemia on chemotherapy admission outcomes in DLBCL is not well described. Methods In a retrospective analysis, using the National Inpatient Sample database (2018 - 2020), patients with DLBCL admitted for chemotherapy were dichotomized based on the presence of hypercalcemia. Our primary outcome was all-cause mortality. Secondary outcomes included length of stay (LOS), total charge, rate of acute kidney injury (AKI), tumor lysis syndrome (TLS), hyperkalemia, metabolic acidosis, acute encephalopathy, septic shock, Clostridiodes difficile infection, acute respiratory failure, and venous thromboembolic events (VTE). Results We identified 78,955 patients, among whom 1,375 (1.74%) had hypercalcemia. Hypercalcemia was associated with higher odds of all-cause mortality (aOR:3.05, p-value:0.020), TLS (aOR:8.81, p-value<0.001), acute metabolic encephalopathy (aOR:4.89, p-value<0.001), AKI (aOR:5.29, p-value<0.001), hyperkalemia (aOR:2.84, p-value:0.002), metabolic acidosis (aOR:3.94, p-value<0.001) and respiratory failure (aOR:2.29, p-value:0.007) and increased LOS by 1 day andtotal charge by 12, 501 USD. Conclusions In patients with DLBCL admitted for inpatient chemotherapy, those with hypercalcemia compared to a cohort without had higher odds of; all-cause mortality, TLS, AKI, acute encephalopathy, acute metabolic acidosis, hyperkalemia, and acute respiratory failure as well as higher LOS and total charge.

Which Demographic and Clinical Characteristics Can Better Predict the Length of Hospital Stay among Traumatic Patients? A Retrospective Single-Center, Registry-Based Study.

Lengthy hospitalization may lead to an increased hospital-acquired patient complication, including infections, as well as increased costs for both healthcare systems and patients. A few studies evaluated the impact of various clinical and demographic variables on patients' length of stay (LOS). Hence, in this study, we aimed to investigate the impact of various variables on traumatic patients' LOS. This is a retrospective single-center, registry-based study of traumatic patients admitted to Taleqani, a major trauma center in Kermanshah, Iran. A Minimal Dataset (MDS) was developed to retrieve traumatic data on demographic and clinical aspects. We used univariable and multiple quantile regression models to evaluate the association between independent variables, including ISS, GCS, and SBP, with LOS. LOS is practically defined as the time interval between hospital admission and discharge. The LOS durations have been presented as median (Q1 to Q3) hours. A p-value of <0.05 was considered statistically significant. A total of 2708 cases were included in this study, with 1989 (73.4%) of them being male. The median LOS was 87.00 (48.00 to 144.00) hours. When adjusted for systolic blood pressure (SBP), Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and cause of injury, the two characteristics of spine/back and multiple trauma were significantly associated with the higher LOS, with 43 (20.5 to 65.48) and 24 (10.39 to 37.60) hours more than extremities (P < 0.001 and P = 0.005). Besides, the patients admitted due to road traffic injuries (RTI) were discharged 16 and 41 hours later than falling and cutting/stabbing (P = 0.008 and < 0.001, respectively). Moreover, the patients with ISS≥16 and 9≤ISS≤15 had a median of 51 (21 to 80) and 34 (22 to 45) LOS hours more, compared to 1≤ISS≤8, respectively (P < 0.001). The trauma cases experiencing SBP ≤ 90 mmhg on admission had a median of 41 (20 to 62) hours more hospitalization period than those with SBP> 90 mmhg (P < 0.001). At last, the patients with GCS of 9 to 12 and GCS of 3 to 8 were hospitalized for 39 and 266 hours more than GCS of 13 to 15 (P < 0.001). Determining independent determinants of prolonged LOS may lead to better identifying at-risk patients on admission. Trauma care providers should consider the following risk factors for increased LOS: higher ISS, Lower GCS, and SBP, multiple trauma or spine injury, and trauma resulting from falling or cutting/stabbing. As a result, the impact of extended LOS might be reduced by intervening in the related influencing factors.

Differential burdens: A study of gastric cancer hospitalization and outcomes across race and ethnicities.

256 Background: Despite advances in H. pylori screening and eradication, gastric cancer remains a significant public health issue as the 4th most common cancer globally. Racial and ethnic disparities in disease presentation, surgical intervention, and healthcare burden in United States are not well understood. Methods: We retrospectively analyzed National Inpatient Sample data (2016-2020) for gastric cancer hospitalizations in patients ≥18 years. Primary outcome was in-hospital mortality. Secondary outcomes included disparities in gastrectomy, length of stay (LOS), and total hospital charges. Results: In our study, we analyzed 207,690 hospitalizations related to gastric cancer from 2016- 2019. Over this period, we observed a decrease in gastric cancer-related hospitalizations, from 42,865 to 39,855. However, among Hispanics, there was a significant increase in hospitalizations from 6,309 to 6,930 cases (annual percentage change [APC] of 1.89%, P&lt;0.01). Notably, there was a significant higher in in-hospital mortality odds for African-American (AA) (aOR 1.15, 95CI: 1.03-1.29), Asian (aOR 1.23, 95CI: 1.06-1.42), and all other races (aOR 1.35, 95CI: 1.13-1.60). Surgical interventions differed among racial groups, with AA having lower odds of undergoing total gastrectomy (aOR 0.71, 95CI: 0.60-0.86), and Asians having higher odds of receiving partial gastrectomy (aOR 1.59, 95CI: 1.41-1.78). LOS also differs between ethnicities, AA had the highest LOS 7.9±0.1d days, followed by Native American/Other (NA) at 7.5±0.2 days. The financial impact of also differs, with Asians incurring the highest mean total charges at 101,436.8±3,253.5, followed by NA at 93,102.7±3,954.7. The total hospital charge burden of gastric cancer increased from 3,682.8 million to 3,880.0 million (APC 1.04%). The white population experienced the highest increase in this burden, from 1,879.2 million to 1,990.0 million (APC of 1.10%). Conclusions: Despite an overall decrease in gastric cancer hospitalizations, our study reveals notable disparities across racial and ethnic groups. Hospitalizations increased among Hispanics, and AA, Asians, and NA faced higher mortality odds. AA experienced the longest lengths of stay, while Asians bore the highest mean total charges. These findings highlight the need for targeted interventions to mitigate these disparities.[Table: see text]

Sleep-disordered Breathing and Inpatient Outcomes in Nonsurgical Patients: Analysis of the Nationwide Inpatient Cohort.

Rationale: Sleep-disordered breathing (SDB) is associated with increased complications and length of stay (LOS) after surgery. SDB-related adverse consequences for nonsurgical admissions are not well defined. Objectives: Evaluate associations between SDB and subtypes and LOS, cost, and mortality in nonsurgical patients. Methods: This retrospective cohort analysis used adult nonsurgical admissions from the 2017 National Inpatient Sample of the Healthcare Costs and Utilization Project. SDB associations with LOS (primary outcome), costs, and mortality were evaluated via logistic regression. Covariates included age, sex, Elixhauser Comorbidity Index, socioeconomic status, hospital type, and insurance type. Results: The cohort included 6,046,544 hospitalizations. Compared with those without SDB, patients with SDB were older (63.6 ± 13.5 vs. 57.4 ± 20.7 yr), higher proportion male (55.8% vs. 40.9%), and more likely to be White (75.7% vs. 66.5%). SDB was associated with increased odds of increased LOS and hospitalization costs (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.16-1.17 and OR, 1.67; 95% CI, 1.66-1.67 in adjusted analyses, respectively) but lower mortality (OR, 0.79; 95% CI, 0.77-0.81). The results for obstructive sleep apnea (OSA) echoed those for SDB. Obesity hypoventilation syndrome had substantially increased LOS (OR, 3.05; 95% CI, 2.98-3.13), mortality (1.76; 95% CI, 1.66-1.86), and costs (OR, 2.67; 95% CI, 2.60-2.73) even after adjustment. Conclusions: Obesity hypoventilation syndrome is associated with higher LOS, mortality, and costs during hospitalization, whereas OSA, despite higher LOS and costs, is associated with decreased mortality. Investigation is warranted on whether paradoxically higher costs but lower mortality in OSA may be indicative of less vigilance in hospitalized patients with undiagnosed SDB.

Abstract 18548: Racial Disparities in the In-Hospital Outcomes of Patients Undergoing Percutaneous Peripheral Endovascular Procedures

Introduction: Endovascular revascularization is becoming the mainstay management of peripheral vascular disease (PVD). Our study seeks to find out the impact of racial disparity on the outcome of this procedure. Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS is the largest all-payer inpatient healthcare database in the United States. The NIS was searched for hospitalization of adult patients with PVD who had endovascular revascularization, using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Following Propensity score matching, we assessed for a primary outcome of inpatient mortality. The secondary results were acute kidney injury (AKI), amputation, cardiac arrest, cardiogenic shock, total hospital charge (THC), and length of stay (LOS). Results: About 395,510 patients with PVD had endovascular revascularization; 322,015 patients who had the procedure were either White (n=254,840, 79.1%) or Black (n=67,175, 20.9%). White patients had a mean age of 69.2±0.1 years compared to 64.9±0.1 years in Black patients (males: 61.1% versus 53.4%; females: 38.9% versus 46.6%). Compared to White patients, Blacks had significantly lower in-hospital mortality (2.2% versus 2.6%; p=0.005) and cardiogenic shock (0.9% vs 1.2%; p=0.004); however, they had significantly higher AKI (21.6% vs 19.0% p-value 0.015), amputations (7.6% vs 4.4% p-value &lt;0.001), and LOS (10.1 vs 7.5; p-value &lt;0.001) compared to Whites. Conclusions: This study showed that compared to Whites, Black patients were more predisposed to amputations, AKI, and higher LOS despite having a lower mortality rate after endovascular revascularization.

Psychiatric Consults Associated With Longer Length of Stay in Trauma Patients—A Retrospective Study

IntroductionMental illness is a risk factor for intentional and unintentional injury and is associated with readmission. The impact of psychiatric consults on length of stay (LOS) of trauma patients is still undergoing study. MethodsTrauma registry at Ascension St. Mary's of Saginaw, a community level 2 trauma center, was queried. Further chart review was performed to demographically characterize the control and intervention groups. Univariate and multivariate regression was performed to identify the association between psychiatric consultation and LOS while considering demographic variables and Injury Severity Score. ResultsA total of 661 patients were identified with trauma and a documented mental health disorder. 612 did not receive a psychiatric consultation and 49 did. The group without a psychiatric consultation had a mean and median LOS of 6 d and 4 d, respectively, compared to 12 d and 10 d for those with a psychiatric consult (P < 0.0001). Mean ISS scores comparable across all groups. Delirium was associated with the highest LOS with a mean of 17.25 d and a median of 14.5 d. All 11 patients transferred to a psychiatric facility at discharge received a consult for self-harm. ConclusionsPsychiatric consultations were associated with lengthened stay of trauma patients independent of initial injury severity and documented mental health disorders, and more transfers to inpatient psych facilities. This represents an important prognostic factor for a patient's course of care and suggests that trauma physicians should be well-versed at identifying mental health issues which may require early intervention, as well as managing delirium.

895 A Retrospective Analysis of National Emergency Laparotomy Audit (NELA) Data at a Tertiary Hospital

Abstract Aim To audit emergency laparotomy outcomes in a tertiary hospital and identify areas for improvement. Method Retrospective analysis of 148 cases from Year 8 (12/2020-11/2021) of NELA patient data. Categorical and continuous data were analysed through chi-squared and t-tests, using R (version:4.2.2). Results Our NELA patient length-of-stay (LOS) was 2.2x the national mean (33.59 vs.15.1 days). 14 statistical outliers in LOS were identified which compounded the discrepancy between our median (15 days) and mean (33.59 days). Patients with stomas formed had a significantly higher mean LOS compared to those without (42 vs 26 days). Frail patients did not have a higher LOS, and much higher mean rates of review by geriatricians was noted (87% vs. 24% nationally). A greater percentage of our patients had high pre-operative mortality risk scores compared to nationally (51.5% vs. 43.5%). A higher percentage of our patients had ischaemia (20.8% vs. 8.9%) and haemorrhage (5.6% vs. 2.6%) as indications for surgery. However, our 30-day mortality rate was lower on average (5.5% vs. 9.7%). Conclusions Our hospital's high rates of complicated cases and low mortality rates suggest a high-quality of patient care. Length of stay has been identified as an area for improvement, and we propose implementation of special discussion of long-staying patients in weekly ward round meetings as a potential intervention. While there may be various factors contributing to our higher mean LOS, we postulate that our status as a major stoma centre and tertiary referral centre for complicated cases as likely the primary cause.

Impact of sequential capacity building on emergency department organisational flow during COVID-19 pandemic: a quasi-experimental study in a low-resource, tertiary care centre

IntroductionA quasi-experimental study was conducted to estimate the impact of sequential emergency department (ED) capacity building interventions on key performance indicators such as patients’ length of stay (LOS) and wait...

Racial and income characteristics and the burden of illness among metastatic prostate cancer patients.

e17064 Background: The incidence of metastatic prostate cancer has increased dramatically between 2010 and 2017 in the United States. Since the racial and ethnic mix of the population of the United States (U.S.) have changed between the years 2010 and 2020–it is extremely important to understand its effects on prostate cancer outcomes. Therefore, we investigated the burden of illness across racial groups and income levels among patients diagnosed with metastatic prostate cancer. Methods: This study utilized the U.S. 2017 National Inpatient Sample database to identify hospitalizations with a primary diagnosis of prostate cancers. We evaluated associations between race and income levels, and the burden of illness (total charges and length of stay (LOS)) adjusting for patient and clinical factors with multivariable generalized linear models. Results: A total of 63,880 metastatic prostate cancer patients were included in the study, and the median [IQR] age was 74 [66, 82]. There were 65.6% Whites, 20.6% Blacks, 7.7% Hispanics, and 6.1% Asians and Others. Blacks had a higher prevalence in the age group 45-55 (34.2%), when compared to 55-64 (29.8%), or &gt; 65 (17.6%) age group. There were only 10% Blacks and 4.9% Hispanics living in high-income neighborhoods, whereas this was 75.5% for Whites. In the adjusted analysis, compared to the Whites, Hispanics (1.43; 95%CI-1.29- 1.57), and Asians and Others (1.39; 95%CI- 1.25- 1.56) had a higher total charge; and compared to Whites, Blacks had a higher LOS (1.28; 95%CI-1.15-1.44). Compared to high-income neighborhoods, those living in the 26th to 50th percentile had a lower total charge (0.86; 95%CI- 0.78-0.94). Compared to the &gt; 65 years age group, the 44-55 age group had a lower total charge (0.73; 95%CI-0.61-0.89). Compared to patients with Medicare, those with Private Insurance (0.87; 95%CI- 0.80-0.94) and Self-pay and Others (0.73; 95C%CI-0.62–0.86) had a lower total charge. And when compared to non-elective admissions, elective admissions had a higher total charge (1.44; 95%CI-1.29- 1.59). Conclusions: Hispanics and Asians and Others had a higher burden of illness, and Blacks had a higher LOS. Patients who reside in lower income neighborhoods had lower total charges. Understanding prostate cancer outcomes by race and income is crucial to designing strategies to improve access to care.

Trends in diabetes mellitus among hospital hospitalizations in Switzerland

Abstract Funding Acknowledgements Type of funding sources: None. Background In Switzerland, the prevalence of diabetes mellitus (DM) has increased in the general population, but little is known regarding DM-related hospitalizations and their impact on mortality and health costs. Objective To assess 1) the evolution of hospitalizations for DM as first diagnosis and as comorbidity; 2) the association of DM with ICU admission, length of stay (LOS), in-hospital mortality and costs. Methods Swiss hospital discharge data for period 2012-2020. Type 1 (T1DM), type 2 (T2DM) and other types (OTDM) of DM were considered. Costs were estimated using Swiss diagnosis related groups. Results Between 2012 and 2020, the number of hospitalizations (% total) increased from 4204 (0.27) to 4980 (0.45) for T2DM, 539 (0.05) to 854 (0.08) for T1DM and 221 (0.02) to 381 (0.03) or OTDM. Hospitalizations with DM as comorbidity increased from 89,752 (8.6) to 128,700 (11.7) for T2DM, 2934 (0.29) to 3536 (0.32) or T1DM and 5774 (0.58) to 9143 (0.83) for OTDM. Compared to non-DM hospitalizations, hospitalizations for T1DM had a higher likelihood of ICU admission: odds ratio and 95% CI: 3.49 (3.30-3.71), while T2DM had higher LOS: 6.0±1.0 vs. 5.1±1.0 days, and all DM types had a lower odd of in-hospital mortality. Patients with any type of DM as comorbidity had a longer LOS than patients without. Total cost of DM rose from CHF 42 million in 2012 to almost 100 million in 2019 and decreased afterwards. Conclusion DM represents an increasing health and economic burden in Switzerland.

Association of atrial fibrillation and outcomes in patients undergoing bone marrow transplantation.

Haematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for several malignant and non-malignant haematologic conditions. Patients undergoing HSCT are at an increased risk of developing atrial fibrillation (AF). We hypothesized that a diagnosis of AF would be associated with poor outcomes in patients undergoing HSCT. The National Inpatient Sample (2016-19) was queried with ICD-10 codes to identify patients aged >50 years undergoing HSCT. Clinical outcomes were compared between patients with and without AF. A multivariable regression model adjusting for demographics and comorbidities was used to calculate the adjusted odds ratio (aOR) and regression coefficients with corresponding 95% confidence intervals and P-values. A total of 50 570 weighted hospitalizations for HSCT were identified, out of which 5820 (11.5%) had AF. Atrial fibrillation was found to be independently associated with higher inpatient mortality (aOR 2.75; 1.9-3.98; P < 0.001), cardiac arrest (aOR 2.86; 1.55-5.26; P = 0.001), acute kidney injury (aOR 1.89; 1.6-2.23; P < 0.001), acute heart failure exacerbation (aOR 5.01; 3.54-7.1; P < 0.001), cardiogenic shock (aOR 7.73; 3.17-18.8; P < 0.001), and acute respiratory failure (aOR 3.24; 2.56-4.1; P < 0.001) as well as higher mean length of stay (LOS) (+2.67; 1.79-3.55; P < 0.001) and cost of care (+67 529; 36 630-98 427; P < 0.001). Among patients undergoing HSCT, AF was independently associated with poor in-hospital outcomes, higher LOS, and cost of care.

747 Burn Mortality Prediction Model and Communication Tool for Healthcare Providers

Abstract Introduction Communication is a key competency – the effective exchange of information is essential to a physician’s role. Currently, our centre does not have a communication tool to help guide point of care discussions between healthcare providers and during family meetings. Prognostic relationship of the BAUX score and ABSI index should be determined. An objective communication tool that shows predicted mortality, length of stay (LOS), and number of operations, specifically in our hospital using BAUX index and ABSI score will allow patients and healthcare providers to better understand prognosis, course in hospital, and develop appropriate expectations for outcomes in our centre. Methods In this cross-sectional study, all burn patients admitted to our Centre from 2012 to June 2022 were retrospectively recruited. Our burn registry was used to extract complete data of patient information including age, gender, %TBSA, burn depth, presence of inhalational injury, need for ventilator support, intensive care unit (ICU) admission days, hospital LOS, BAUX score, rBAUX score, and ABSI index. Patients were divided into three cohorts: all patients without an inhalation injury, a subgroup of smokers with and without an inhalation injury, and all patients with an inhalation injury. For each cohort, a mean LOS in hospital and/or ICU, number of burn operations, and mortality rate per incremental BAUX score and ABSI index was computed. Results A total of 839 patients were included, 725 without and 114 (13.6%) with an inhalation injury. A subgroup of patients (n=286) smokers with and without inhalational injury were separately analyzed. With severity of burn and presence of inhalational injury, both BAUX score and ABSI index show an incremental increase in LOS in hospital, number of operations, and increased mortality. Smokers with rBAUX ≥110 had the longest LOS in hospital, 78.4 hospital days and 35 ICU days. Interestingly, all patients with ABSI 6-7 had the longest LOS/%TBSA and those patients who additionally had an inhalational injury had the highest LOS/%TBSA (5.1 days/%TBSA). Increase in BAUX and ABSI did not correlate with increase in LOS/%TBSA. For BAUX ≥ 90 and ABSI ≥ 8, number of operations and mortality exponentially increased. Conclusions Patients with BAUX ≥ 90 and ABSI ≥ 8 should be counselled on a complex course in hospital. Higher BAUX and ABSI correlate with increased mean LOS and number of operations but not LOS/%TBSA. Using our Centre’s burn registry, we can predict course in hospital and provide this to patients, family, and healthcare providers before tertiary centre transfer and admission. Applicability of Research to Practice An objective communication model showing the burn centre’s mean LOS, LOS/%TBSA, number of operations, and risk of mortality, can help guide physician-patient and physician-healthcare provider communication. This tool will provide realistic burn recovery expectations at admission, family meetings, and when discussing consent.