Hospital Length Of Hospital Stay Research Articles

Microsurgical Management of Pineal Region Tumors

BackgroundPineal tumours are rare and the pineal region is a challenging surgical location for neurosurgeons. The present study aimed to investigate the effects of microsurgical management in patients with pineal region tumours and explore probable factors associated with preoperative hydrocephalus, postoperative hydrocephalus remission, and prolonged length of hospital stay (LoS). MethodsA retrospective study of patients with pineal region tumours, who underwent microsurgical management at the First Affiliated Hospital of Soochow University(Jiangsu, China) between 1 January 2010 and 31 October, 2022, was conducted. ResultsData from 36 patients were included in this study. The top five common symptoms included headache (58%), dizziness (44%), double vision (22%), vomiting (19%), and nausea (14%). Patients with a lower Karnofsky Performance Score (KPS), younger age, and larger maximum tumour diameters were more vulnerable to preoperative hydrocephalus. Preoperative hydrocephalus also led to a prolonged postoperative LoS (P=0.021). Patients with a lower KPS score (P=0.020) or larger maximum tumour diameters (P=0.045) were more likely to achieve postoperative remission of hydrocephalus. Most postoperative complications led to increased hospital LoS. ConclusionMicrosurgical resection of pineal tumours yielded favourable long-term outcomes. Patients with a lower KPS score, younger age, and larger maximum tumour diameters were more vulnerable to preoperative hydrocephalus and prolonged LoS. Patients with a lower KPS score or larger tumour diameter were likely to achieve significant remission of hydrocephalus after tumour resection.

Serum Albumin as a Marker of Metabolic Response to Injury and its Role with Calorie Intake Regarding Length of Stay, Readmission Rates and Hospital Survival

Background: Studies have shown a relationship between albumin level & hospital mortality, but none have looked at low serum albumin, calorie intake and survival. Aim: To evaluate the relationship between serum albumin level, calorie intake, length of hospital stay (LOS), readmission rates and hospital mortality in a large population of disadvantaged and underinsured patients at a County of Los Angeles Medical Center. Design: Prospective observational study using data collected over a 6-year period of hospital survival, LOS and readmission rate in 11,441 patients. Calorie intake in those 400 patients with serum albumin <1.5 g/dL was collected. Our hypothesis was to test if the relationship of admission serum albumin to mortality was linear or exponential. In addition, in those with a serum albumin <1.5 g/dL, we evaluated calorie intake and hospital survival. Methods: A total of 11,441 patients were included in the dataset. ANOVA and regression analysis were performed. Calorie intake was extracted from dietary and intravenous intake data of each of the 400 patients with an albumin <1.5 g/dL. Results: Serum albumin was obtained within the first 7 days of admission in all patients. Mortality increased in patients with admission serum albumin <3.5 g/dL (8.8% vs 2.3%, p<0.05). Serum albumin was exponentially related to mortality (mortality = 32 / albumin2; p <0.01). The group of patients with albumin <1.5 g/dL had the greatest mortality rate (18%), approximately seven times that of patients with normal serum albumin levels. These patients also had an average LOS of 14.7 days (p<0.05), twice that of patients with normal albumin values. 30-day admission rates for this group were three times greater (6.3% vs. 1.9%, p<0.05). Calorie intake was associated with a dose response curve with regards to hospital mortality. Conclusion: A single measurement of serum albumin identifies patients who are at high risk for prolonged hospital stay, readmission and mortality. Calorie intake may modify mortality risk, but prospective studies are needed.

Cultured Skin in the Modern Era and the Impact of Infrastructure Volatility on Learning Curves: A 33-Year Institutional Review.

Finding a perfect epidermal transplant remains a holy grail of burn surgery. The epidermis is a site of stem cells that allows for epithelial regeneration. The use of cultured epithelial autografts (CEA) for the treatment of major burns was first reported in 1981. CEA requires specialized skills; thus, reports from different burn centers have shown mixed results. Comparing our modern data with past data shows how this field has advanced while maintaining institutional control. We performed a retrospective analysis of all patients admitted between January 1, 1988 and December 31, 2021 for massive burns that were managed with CEA. Patients were divided into pre-defined groups: G1 (early-era) = 1988-1999, G2 (pre-modern-era) = 2000-2010, and G3 (modern-era) = 2011-2021. We compared demographics, %TBSA, presence of inhalation-injury, length of hospital stay (LOS), complications, and mortality. We treated 52 patients with CEA during the study period. In the modern-era, we found 11 patients; in the pre-modern-era, 10; and in the early-era, 31. Injury characteristics, including %TBSA and the presence of inhalation-injury, were not significantly different between the groups. We observed lower mortality rates in G1 and G3 (G1:20% vs. G2:42% vs. G3:27%, P < 0.05), although the predicted mortality was not significantly different between the groups (G1:50% vs. G2:47% vs. G3:49%, NS). Patients in G1 also had a shorter hospital LOS, in days, (G1:90 vs. G2:127 vs. G3:205, P < 0.05). Finally, the surface-area grafted per patient was the highest in G2 (G1:2,000cm2 vs. G2:4,187cm2 vs. G3:4,090cm2, P < 0.01). CEA has not gained popularity despite proven positive outcomes. Our retrospective analysis showed that CEA should be considered as a treatment option for patients with large burns, given proper training and infrastructure.

Advanced chronic kidney disease increases complications in anterior cervical discectomies with fusions: An analysis of 75,508 patients

BackgroundAlthough anterior cervical discectomy and fusion (ACDF) procedures for cervical spine disease have been increasing amid a growing population of patients with kidney dysfunction, there is a scarcity of literature focusing on kidney dysfunction as a risk-factor for post-operative ACDF complications. The purpose is to evaluate the differential impact of kidney dysfunction on perioperative outcomes including surgical and medical complications, extended length of hospital stay (LOS), and death within 30 days following ACDF. Patient SampleThis was a retrospective cohort study of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program database to identify patients who had undergone an elective ACDF procedure between 2011-2021 using Current Procedural Terminology code 22551. Patients were categorized into five cohorts based on eGFR according to the “Kidney Disease: Improving Global Outcomes” Classification: values of: ≥ 90(reference cohort), 60-89 (G2), 30-59 (G3), 15-29 (G4), and <15 (G5). One-way ANOVA for continuous variables and chi-square tests for categorical variables were used to identify differences in perioperative variables between the five groups. Multivariable logistic regression analysis assessed the effect of kidney dysfunction on post-operative surgical outcomes. Significance was defined as p <0.05. Results75,508 ACDF patients were included, of who 57,480 were G1, 15,186 were G2, 2,192 were G3, 312 were G4, and 338 were G5. G4 and G5 independently increased the risk of medical complications (OR: 1.893, 95% CI [1.296-2.705]; OR: 2.241, 95% CI [1.222-3.964]) and blood transfusion. Only G5 independently increased the risk for extended LOS (OR: 2.410, 95% CI [1.281-4.371], p= 0.005). ConclusionHigh grade CKD is an independent risk factor for medical complications, extended hospital LOS, and blood transfusions following ACDF, underscoring the importance of risk stratification to optimize perioperative management and reduce the burden of complications and healthcare costs. Conversely, low grade CKD does not increase the risk of complications in ACDF.

Related factors associated with the prognosis of children undergoing liver transplantation under the enhanced recovery after surgery nursing concept.

This study aimed to investigate factors associated with the clinical outcomes of patients who underwent pediatric liver transplantation (LT) and received enhanced recovery after surgery (ERAS) nursing. A cohort of 104 pediatric patients was studied at our hospital. Data on 8 indicators and 2 clinical outcomes, including length of hospital stay (LOS) and 30-day readmission rates, were collected. Linear and logistic regression analyses were employed to examine the associations of the 8 indicators with hospital-LOS and readmission risks, respectively. The predictive value of these indicators for the outcomes was determined using the receiver operating characteristic (ROC) curve, decision curve analysis, and importance ranking through the XGBoost method. A comprehensive model was developed to evaluate its predictive accuracy. Regression analyses identified donor age, donor gender, and intensive care unit (ICU)-LOS of recipients as significant predictors of hospital LOS (all P < .05), whereas no indicators were significantly associated with readmission risk. Further, ROC analysis revealed that 3 indicators provided superior prediction for 28-day hospital LOS compared to the median LOS of 18 days. ICU-LOS demonstrated the highest clinical net benefit for predicting 28-day hospital-LOS. Multivariable regression analysis confirmed the independent predictive value of donor age and ICU-LOS for the hospital-LOS (all β > 0, all P < .05). Although the comprehensive model incorporating donor age and ICU-LOS showed stable predictive capability for hospital-LOS, its performance did not significantly exceed that of the individual indicators. In pediatric LT, hospital LOS warrants greater emphasis over readmission rates. Donor age and ICU-LOS emerged as independent risk factors associated with prolonged hospital LOS.

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

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

Abstract 16146: A Scoping Review of Adverse Outcomes Associated With Cardiac Resynchronization Therapy Device Implantation: Implications for Informed Consent

Background/Objectives: Cardiac Resynchronization Therapy (CRT) is a treatment option for many adults with heart failure with reduced ejection fraction (HFrEF). While the benefits of CRT are well-established, the downstream implications of adverse events are not well-characterized. We sought to better understand the ramifications of CRT-related adverse events on length of hospital stay (LOS) and mortality—information relevant for patients and clinicians to make informed decisions about pursuing CRT. Design: Scoping Review Methods: We conducted an initial PubMed search using terms including “Congestive Heart Failure” or “Heart Failure” and "Cardiac resynchronization" or "Cardiac re-synchronization" or "Biventricular pacing.” We reviewed resulting articles that were written in English, studied CRT devices, and outlined adverse events related to CRT device placement. We separately searched PubMed for additional articles outlining individual adverse events identified using search terms “event name,” “mortality,” and “hospital stay.” We read articles and summarized data regarding the impact of reported adverse events on hospital LOS and mortality. Results: Our search identified 18 full length articles with relevant data. The most common adverse events included device implant failure/non-response, lead dislodgment, coronary sinus dissection, and pocket hematoma. The LOS and mortality rates of each event are shown in Table 1. Of note, LOS for implantation in the ambulatory setting is up to 1 day; LOS for uncomplicated implantation during hospitalization is 4.6 days. Implantation during hospitalization with complication is mean 13.6 days. Conclusion: While absolute risks for adverse events associated with CRT implantation are low, several have important implications on hospital LOS and mortality. These findings warrant inclusion in discussion regarding the risks of CRT when clinicians and patients engage in informed decision making related to CRT.

Pediatric Blunt Splenic Trauma: Disparities in Management and Outcomes

IntroductionWhile nonoperative management has become widely accepted, whether nonoperative management of blunt splenic trauma is standardized across pediatric trauma centers and different racial groups warrants further investigation. Using the National Trauma Database, the purpose of this study was to quantify the differences in the management of pediatric splenic trauma across different pediatric trauma centers, with respect to injury severity, race, ethnicity, and insurance. MethodsPatients under 20 y of age with blunt splenic trauma reported to the 2018 and 2019 National Trauma Data Bank were identified. Primary outcomes were splenectomy, embolization, transfusion, mortality, injury severity score (ISS), and length of hospital stay (LOS) and length of intensive care unit stay. Continuous data and categorical data were analyzed using ANOVA and Chi-squared test, respectively. Nearest 1:1 neighbor matching was performed between minority patients and White patients. P < 0.05 for all comparative analyses was considered statistically significant. ResultsOf the total cohort (n = 1919), 70.3% identified as White, while 21.6% identified as Black or Hispanic. The mortality rate was 0.3%. Among different race categories, the frequency of spleen embolization (P = 0.99), splenectomy (P = 0.99), blood transfusion (P = 1), and mortality (P = 1), were not significantly different. After controlling for ISS and age with propensity score matching, the mean hospital LOS remained significantly higher in minority patients, with a mean of 5.44 d compared to 4.72 d (P = 0.05). Mean length of intensive care unit stay was not significantly different after propensity matching, with a mean of 1.79 d and 1.56 spent in the ICU for minority and White patients respectively (P = 0.17). While propensity score matching preserved statistical significance, the ISS for the minority group remained 1.12 times higher than the ISS of the Caucasian group. There was no statistically significant difference among races with respect to different payment methods and insurance status, although Black and Hispanic patients were proportionally underinsured. ConclusionsWhile minority patients had a relatively higher number of operative interventions and longer hospital and ICU stays, after propensity score matching, mean ISS remained higher in the minority group. Our findings suggest that injury severity is likely to influence the difference in LOS between the two groups. Furthermore, our data highlight how nonoperative management is not standardized across pediatric trauma centers.

Predictors of patient length of stay post stroke rehabilitation.

There is little research on length of hospital stay (LOS) in patients post stroke in South African rehabilitation facilities. As LOS is an important indicator of cost-of-care, this information may be useful to all stakeholders. To determine the predictors of hospital LOS in patients post stroke rehabilitation. A retrospective file review of 243 patients. Patient functional ability was measured using the Functional Independence Measure (FIM). Predictors of LOS were determined with multiple regression analysis. The median admission and discharge FIM scores were 43 (range: 16-119) and 75 (range: 16-120) points respectively. The median LOS was 43 (range: 3-112) days. Predictors of LOS were premorbid psychiatric conditions, impaired speech, requiring oxygen support, the development of pneumonia and admission FIM motor score, with admission FIM motor score being the strongest individual predictor of LOS (41%). Admission FIM score had an influence on patient outcomes and LOS. Patients with higher admission FIM motor scores may be able to participate in rehabilitation better and thus have shorter LOS. Being able to predict LOS on admission allows facility administrators to manage bed occupancy, human and clinical resources in post stroke rehabilitation.

Establishment and evaluation of a predictive model for length of hospital stay after total knee arthroplasty: A single-center retrospective study in China.

Total knee arthroplasty (TKA) is the ultimate option for end-stage osteoarthritis, and the demand of this procedure are increasing every year. The length of hospital stay (LOS) greatly affects the overall cost of joint arthroplasty. The purpose of this study was to develop and validate a predictive model using perioperative data to estimate the risk of prolonged LOS in patients undergoing TKA. Data for 694 patients after TKA collected retrospectively in our department were analyzed by logistic regression models. Multi-variable logistic regression modeling with forward stepwise elimination was used to determine reduced parameters and establish a prediction model. The discrimination efficacy, calibration efficacy, and clinical utility of the prediction model were evaluated. Eight independent predictors were identified: non-medical insurance payment, Charlson Comorbidity Index (CCI) ≥ 3, body mass index (BMI) > 25.2, surgery on Monday, age > 67.5, postoperative complications, blood transfusion, and operation time > 120.5 min had a higher probability of hospitalization for ≥6 days. The model had good discrimination [area under the curve (AUC), 0.802 95% CI, 0.754-0.850]] and good calibration (p = 0.929). A decision curve analysis proved that the nomogram was clinically effective. This study identified risk factors for prolonged hospital stay in patients after TKA. It is important to recognize all the factors that affect hospital LOS to try to maximize the use of medical resources, optimize hospital LOS and ultimately optimize the care of our patients.

Factors associated with residential fire-related hospitalisations and deaths: A 10-year population-based study

This study aims to identify residential fire risk factors and their health outcomes in terms of hospital admissions from burns and smoke inhalation together with related readmissions, length of hospital stay (LOS), costs of hospitalisation and mortality within 30 days of the fire incidence. Residential fire-related hospitalisations from 2005 to 2014 in New South Wales, Australia were identified using linked data. Univariate and multivariable Poisson regression analyses were performed to determine factors associated with residential fires on hospital admission and loss of life. During the study period, 1862 individuals were hospitalised due to residential fires. In terms of prolonged LOS, high hospitalisation cost or mortality, fire incidents’ that damaged both contents and structures of the property; were ignited by smokers’ materials and/or due to mental or physical impairment of the residents had more adverse outcomes. Individuals aged 65 and over with comorbidities and/or acquired severe injuries from the fire incident were at a higher risk of long-term hospitalisation and death. This study provides information to response agencies in communicating fire safety messages and intervention programs to target vulnerable population. In addition, it also supplies indicators on hospital usage and LOS following residential fires to health administrators.

Factors affecting length of hospital stay in stroke survivors in South Africa: A call for a stroke unit.

Stroke in Africa is a growing and neglected crisis with the incidence more than doubling in low- to middle-income countries in the last four decades. Despite this growing threat, implementation of stroke models of care in hospitals is lacking. Stroke units as a model of care have been shown to decrease mortality, reduce length of hospital stay (LOS) and improve outcomes in stroke survivors. To determine the profile of stroke survivors and identify factors contributing to LOS at Chris Hani Baragwanath Academic Hospital (CHBAH) in South Africa to support stroke unit implementation. This study involved a retrospective record review of stroke survivors admitted to CHBAH between September 2018 and May 2019. Factors associated with LOS were determined using linear regression models; univariate and multiple regression models were fitted. A total of 567 participants' data were included. Overall, 51.85% of the participants required services from all rehabilitation disciplines. The median LOS was 9 days (interquartile ranges [IQR]: 5-11 days) with each discipline providing an average of six sessions. Participants who were referred to the rehabilitation team 3 days after admission to hospital stayed 6 days longer compared with those participants who were referred earlier (p < 0.001). Delayed referral to the rehabilitation team resulted in increased LOS. This study supports the need for dedicated stroke units to decrease hospital LOS and improve patients' outcomes by ensuring early, well-coordinated rehabilitation intervention and discharge planning. The study highlights the urgency for re-evaluation of stroke care infrastructure within Gauteng to streamline and provide accessible stroke models of care.

Does rapid mobilisation as part of an enhanced recovery pathway improve length of stay, return to function and patient experience post primary total hip replacement? A randomised controlled trial feasibility study

PurposeDay-zero ambulation may enable patients to recover and leave hospital quicker following total hip replacement (THR). The present randomised control feasibility study investigated the efficacy of day-zero ambulation as a physiotherapeutic intervention.MethodsThirty-six non-blinded adults aged 44–85 (Mean 67.1; SD 9.6 years) undergoing primary, uncomplicated THR were block randomized to either a control group (n = 18) with standard post-operative physiotherapy or an intervention group (n = 18) incorporating walking on the same day as the operation. Outcomes were length of hospital stay (LOS), time to reach functional milestones and achieve all physiotherapy discharge criteria, post-operative pain scores, complications and patient experience.ResultsParticipants treated with day-zero ambulation had reduced median hospital LOS of 1 day (p = .096), and median reduced times to reaching functional milestones of 39.7 h quicker to transfer to a chair (p < .001), 24.5 h quicker to walk 10 m (p = .009) and 26.4 h quicker to independently ascend and descend stairs (p = .01). Participants in the intervention group were deemed physiotherapy ready to leave hospital significantly earlier than control group (1.04 days, p = .015).ConclusionsDay-zero ambulation appears safe and may have clinically relevant effects in speeding patient functional recovery and facilitating earlier discharge from hospital.Implications for RehabilitationDay-zero ambulation following total hip replacement (THR) appears safe.Preliminary data suggest that day-zero mobilisation following THR could be efficacious and support the need for a fully powered randomised controlled trial.There may be a clinically relevant effect in speeding patient functional recovery and facilitating an earlier discharge from hospital.

S20 Impact of Anxiety on Patients With IBD: Insights From the National Inpatient Database (NIS)- 2015-2019

Background: Inflammatory Bowel Disease (IBD) can have numerous complications involving all systems of the body. People with inflammatory bowel disease (IBD) are at increased risk of developing mental health disorders, such as anxiety. The aim of our study was to examine the impact of anxiety on the outcomes of patients with IBD. Methods: The Nationwide Inpatient Sample (NIS) database encompasses approximately 7 million inpatient hospitalizations annually in the United States. Data were extracted from the National Inpatient Sample (NIS) Database for the years 2015-2019. Patients aged 18 years and above with diagnoses of IBD and anxiety were identified using ICD codes. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, the average length of hospital stay (LOS), and hospital charges using STATA 17. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: We identified 1,198,839 patients with IBD of which 235,880 patients were matched to those with anxiety. Average age was 52.04 years. There was a significant decrease in inpatient mortality (OR 0.56, CI 0.51-0.62, P < 0.0001) and total cost of hospitalization (-$3,242.13, CI -4,259.55 - -2224.70, P < 0.0001), but hospital length of stay increased (0.27 days, CI 0.20-0.34, P < 0.0001) between patients with IBD with cannabis use when compared to IBD patients without cannabis use. Conclusion(s): The different clinical manifestations and symptoms of IBD may cause several psychological changes in patients. Past studies demonstrated that psychological stress and disorders can trigger flares and relapses in patients with IBD. Our study showed that there was a statistically significant decrease in inpatient mortality and hospital LOS for patients with both IBD and anxiety compared to those with only IBD. Anxiety is known to be 2 to 3 times higher in patients with IBD, but it reduces morbidity and mortality. This may be due to the increased surveillance and treatment to this subgroup of patients. Given the known association between IBD and anxiety, clinicians be vigilant in detecting and treating concomitant anxiety as this could lead to better outcomes in this patient population, as our study revealed. Future randomized control trials are needed to further study the impact of anxiety on IBD.

Abstract 13274: The Safety of Early Discharge After Tavi in Northern and Rural Ontario Canada

Introduction: Early hospital (&lt;48hrs) discharge following transcatheter aortic valve implantation (TAVI) is an increasingly adopted practice. However, the safety of such an approach among patients residing in rural areas in Northern Ontario, including remote and medically underserved areas is lacking. Methods: After adapting the Vancouver 3M clinical pathway, all patients who underwent TAVI in Sudbury, Ontario were included in the analysis. The primary endpoint was all-cause mortality within 30 days. Secondary endpoints included procedural complications, post-TAVI length of hospital stay (LOS) and 30-day re-hospitalizations. Results: 165 patients underwent TAVI after adapting the Vancouver 3M clinical pathway. Mean age was 81 years (SD ± 8). Median STS-mortality score was 2.5% (IQR, 1.9-3.5). There was one in-hospital death (0.6%) with no 30 day mortality observed beyond hospital discharge. 11 patients (6.7%) required rehospitalization within 30 days, 3 of them for cardiac complaints. More over, after adoption of the 3M clinical pathway, the need for procedural mechanical ventilation and surgical vascular cut-down declined from 100% and 97% at baseline, to 6% and 2% respectively. Similarly, after adapting the 3M clinical pathway, the number of patients receiving TAVI on a given procedural day increased from two to three patients. Median post TAVI-LOS declined from 5 days (2-6 days) to 1 day (1-3 days). Conclusions: By transitioning to a 3M approach, our study has shown that early discharge after TAVI in Northern Ontario at a single lower-volume TAVI centre is feasible and safe, with favorable outcomes and improved hospital LOS. Furthermore, resource utilization improved with fewer patients requiring mechanical ventilation and surgical cut-down, leading to a downstream increase in the number of patients receiving TAVI on a given procedural day. This experience can potentially improve TAVI equity for underserved and vulnerable populations, reduce TAVI wait times and bridge variations in TAVI funding.

Effects of on-Table Extubation after Pediatric Cardiac Surgery.

Background: Enhanced recovery after surgery (ERAS) protocols are utilizing a multidisciplinary approach, reassessing physiology to improve clinical outcomes, reducing length of hospital stay (LOS) stay, resulting in cost reduction. Since its introduction in colorectal surgery. the concept has been utilized in various fields and benefits have been recognized also in adult cardiac surgery. However, ERAS concepts in pediatric cardiac surgery are not yet widely established. Therefore, the aim of the present study was to assess the effects of on-table extubation (OTE) after pediatric cardiac surgery compared to the standard approach of delayed extubation (DET) during intensive care treatment. Study Design and Methods: We performed a retrospective analysis of all pediatric cardiac surgery cases performed in children below the age of two years using cardiopulmonary bypass at our institution in 2021. Exclusion criteria were emergency and off pump surgeries as well as children already ventilated preoperatively. Results: OTE children were older (267.3 days vs. 126.7 days, p < 0.001), had a higher body weight (7.0 ± 1.6 kg vs. 4.9 ± 1.9 kg, p < 0.001), showed significantly reduced duration of ICU treatment (75.9 ± 56.8 h vs. 217.2 ± 211.4 h, p < 0.001) and LOS (11.1 ± 10.2 days vs. 20.1 ± 23.4 days; p = 0.001) compared to DET group. Furthermore, OTE children had significantly fewer catecholamine dependencies at 12-, 24-, 48-, and 72-h post-surgery, while DET children showed a significantly increased intrafluid shift relative to body weight (109.1 ± 82.0 mL/kg body weight vs. 63.0 ± 63.0 mL/kg body weight, p < 0.001). After propensity score matching considering age, weight, bypass duration, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Mortality (STATS)-Score, and the outcome variables, including duration of ICU treatment, catecholamine dependencies, and hospital LOS, findings significantly favored the OTE group. Conclusion: Our results suggest that on-table extubation after pediatric cardiac surgery is feasible and in our cohort was associated with a favorable postoperative course.

Musculoskeletal injuries sustained at the California, USA: Baja California, Mexico border

BackgroundIndividuals attempting to enter the USA from Mexico at non-authorized points along the border fence often sustain injuries requiring medical intervention. We evaluated characteristics of this patient population and their hospital care to better understand patient treatment needs. Given the high-velocity nature of these injuries, we hypothesized that higher pain scores would be associated with longer lengths of hospital stay.MethodsIn this cross-sectional study, we selected records of all patients from 2013 to 2019 who received care by the Orthopaedic Surgery department following an injury sustained at the California-Baja California border. We evaluated demographics, musculoskeletal injuries, procedures, length of hospital stay (LOS), follow-up, and pain scores via retrospective chart review. We used linear regression, adjusting for age and gender, to evaluate associations between pain scores and hospital LOS.ResultsAmong all 168 patients, there were 248 total injuries comprised of 46% lower extremity, 15% upper extremity, 17% spine, and 4% pelvic injuries. Average age at injury was 33 ± 10, 74% were male, and 85% identified as Hispanic. Of this patient population, 68% underwent operative interventions, 26% sustained open injuries, and 21% required external fixation for initial injury stabilization. Thirteen percent were seen for follow-up after discharge. Spine (n = 42), pilon (n = 36), and calcaneus fractures (n = 25) were the three most common injury types. Average LOS for all patients was 7.8 ± 8.1 days. Pain scores were not significantly associated with LOS ( p = 0.08). However, for every surgical procedure performed, hospital LOS was increased by 5.16 ± 0.47 days (p < 0.001).ConclusionMany injuries incurred by patients crossing the border were severe, requiring multiple surgical interventions and a prolonged LOS. The higher number of procedures was significantly associated with longer LOS in all operatively treated patients. Future studies are needed to determine how we can optimize care for this unique patient population and facilitate post-discharge care.

Radiation Dose Reduction and Surgical Efficiency Improvement in Endoscopic Transforaminal Lumbar Interbody Fusion Assisted by Intraoperative O-arm Navigation: A Retrospective Observational Study.

ObjectiveEndoscopic transforaminal lumbar interbody fusion (Endo-TLIF) has gained increasing popularity among spine surgeons. However, with the use of fluoroscopy, intraoperative radiation exposure remains a major concern. Here, we aim to introduce Endo-TLIF assisted by O-arm-based navigation and compare the results between O-arm navigation and fluoroscopy groups. MethodsSixty-four patients were retrospectively analyzed from May 2019 to September 2020; the nonnavigation group comprised 34 patients, and the navigation group comprised 30 patients. Data on radiation dose, blood loss, postoperative drains, surgery time, complications, and length of hospital stay (LOS) were collected. Clinical outcomes were evaluated from postoperative data such as fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS). Radiation dose and surgery time were selected as primary outcomes; the others were second outcomes. ResultsAll patients were followed up for at least 12 months. No significant differences were detected in intraoperative hemorrhage, postoperative drains, hospital LOS, or complications between the 2 groups. The radiation dose was significantly lower in the navigation group compared with the nonnavigation group. The time of cannula placement and pedicle screw fixation was significantly reduced in the navigation group. No significant differences were detected between the clinical outcomes in the 2 groups (VAS and ODI scores). ConclusionThe present study demonstrates that O-arm-assisted Endo-TLIF is efficient and safe. Compared with fluoroscopy, O-arm navigation could reduce the radiation exposure and surgical time in Endo-TLIF surgery, with similar clinical outcomes. However, the higher doses exposed to patients remains a negative effect of this technology.

The Increased Length of Hospital Stay and Mortality Associated With Community-Associated Infections in Australia

BackgroundAn increasing proportion of antibiotic-resistant infections are community acquired. However, the burden of community-associated infections (CAIs) and the resulting impact due to resistance have not been well described.MethodsWe conducted a multisite, retrospective case–cohort study of all acute care hospital admissions across 134 hospitals in Australia. Patients admitted with a positive culture of 1 of 5 organisms of interest, namely Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus faecium, from January 1, 2012, through December 30, 2016, were included. Data linkage was used to link hospital admissions and pathology data. Patients with a bloodstream infection (BSI), urinary tract infection (UTI), or respiratory tract infection (RTI) were included in the analysis. We compared patients with a resistant and drug-sensitive infection and used regression analyses to derive the difference in length of hospital stay (LOS) and mortality estimates associated with resistance.ResultsNo statistically significant impact on hospital LOS for patients with resistant CAIs compared with drug-sensitive CAIs was identified. CAI patients with drug-resistant Enterobacteriaceae (E. coli, K. pneumoniae) BSIs were more likely to die in the hospital than those with drug-sensitive Enterobacteriaceae BSIs (odds ratio [OR], 3.28; 95% CI, 1.40–6.92). CAI patients with drug-resistant P. aeruginosa UTIs were more likely to die in the hospital than those with the drug-sensitive counterpart (OR, 2.43; 95% CI, 1.12–4.85).ConclusionsThe burden of CAI in the hospital is significant, and antibiotic resistance is adding to associated mortality.

Investigation Into the Effect of COVID-19 Infection on Length of Hospital Stay and Mortality in Patients With Rheumatoid Arthritis.

BackgroundSARS-CoV-2 (COVID-19) is a positive-stranded ribonucleic acid (RNA) virus of the coronavirus family, which has resulted in one of the most serious pandemics, with more than 14 million cases confirmed globally. Rheumatoid arthritis (RA) is estimated to be prevalent in 0.5-1% of the U.S. population. So far, there has been little evidence of COVID-19 infection and its propensity to result in increased mortality or length of hospital stay in patients with RA. To contribute to this body of literature, this study will assess the degree to which COVID-19 is associated with increased mortality and length of hospital stay in patients with RA while also taking into account these patients' comorbidities.MethodsOur retrospective study included 14,180 patients (age >18, median 58, range 18-90) who tested positive for COVID-19 or were assumed to have COVID-19 infection from January 1st, 2020, through July 31st, 2020. Patients were grouped based on the diagnosis of RA and COVID-19 infection versus those without RA. Patients who were diagnosed with systemic lupus erythematosus (SLE), chronic obstructive pulmonary disease, and hypertension were excluded. Covariates included age, body mass index (BMI), race, sex, maximum C-reactive protein value, maximum D-dimer value, and comorbid diabetes mellitus. Outcome measures were length of hospital stay (LOS), in-hospital mortality, intensive care unit (ICU) admission, ICU LOS, mechanical ventilation, time on mechanical ventilation, and discharge to hospice. The logistic regression model was used to estimate the probability of in-hospital mortality, ICU admission, placement on mechanical ventilation, discharge to hospice, and in-hospital mortality related to home anti-inflammatory use when comparing patients with RA and COVID-19 infection to COVID-19 infected patients without RA.ResultsOf the total 14,180 patients (males 57.1%, females 42.9%), 159 patients (1.1%), had a diagnosis of RA. There was no significant association between RA and hospital LOS, ICU admission, ICU LOS, LOS on mechanical ventilation, or discharge to hospice among those infected with COVID-19. Yet, RA was associated with higher mortality (OR: 1.65; 95% CI: 1.07-2.53; p=0.02) and placement on mechanical ventilation (OR: 1.82; 95% CI: 1.22-2.71; p<0.01) amidst patients infected with COVID-19.ConclusionThis study suggests that patients with RA and COVID-19 have a significantly increased likelihood of in-hospital mortality and placement on mechanical ventilation. While challenging to realize in a pandemic situation, large studies nationwide are necessary to improve our understanding of COVID-19 infection in patients diagnosed with RA.