Hospital Length Of Stay Research Articles

Alcohol withdrawal syndrome presentations to emergency departments in the United States from 2015 to 2023.

Alcohol withdrawal syndrome (AWS) is a common condition prompting emergency department (ED) presentation. However, there are limited recent, large-scale, robust data available on the incidence, admission, and medical treatment of AWS in the ED. This was a retrospective cohort study of ED presentations for AWS from January 1, 2016, to December 31, 2023, using Epic Cosmos. All ED visits with ICD-10 codes corresponding to AWS were included. Outcomes included percentage of total ED visits, percentage admitted, length of stay (LOS), and medications administered. Binary logistic regression models were used to measure the relationship between time and dependent variables and reported as odds ratios (ORs) with 95% confidence intervals (CIs). Out of 242,804,798 ED encounters, 670,430 (0.28%) visits were due to AWS with a rise over time (OR 1.074, 95% CI 1.072-1.075). Of these, 386,618 (57.7%) were admitted (46.2% inpatient floor, 11.5% ICU). Median (IQR) hospital LOS was 3 (2-5) days and median (IQR) ICU LOS was 2 (1-4) days. Among all ED patients, benzodiazepine use declined over time (84.9% to 77.1%; OR 0.917, 95% CI 0.914-0.920), while phenobarbital (4.0% to 21.2%; OR 1.255, 95% CI 1.250-1.259) and gabapentin (11.0% to 16.3%; OR 1.054, 95% CI 1.050-1.057) use increased. Oral and intravenous (IV) benzodiazepines were common (63.1% and 66.6%, respectively). Among IV benzodiazepines, lorazepam was most common (59.9%). Among those discharged from the ED, 29.0% were prescribed benzodiazepines (chlordiazepoxide 21.1%, lorazepam 5.5%, diazepam 1.9%). Anticraving medications, such as gabapentin (1.5%), naltrexone (0.4%), and acamprosate (<0.1%) were uncommon, but rising over time. AWS represents a common reason for ED presentation, with most patients being admitted. We identified a rising incidence with a shift in management to include agents such as phenobarbital and gabapentin. These findings provide important evidence on current trends in AWS to inform health policy and knowledge translation efforts as well as emphasizing the need for ongoing research and evaluation of clinical practices to optimize outcomes for patients with AWS.

Consensus outcomes between health professionals and parents for oral corticosteroids in treating preschool wheeze: a multi-national survey and nominal group technique study

ObjectiveTo obtain priority consensus for outcome measures of oral corticosteroid treatment of preschool wheeze that represent stakeholder groups.Design(1) A systematic review to identify a set of outcome measures; (2) an...

Length of Hospital Stay and Its Predictions Among Patients With Exacerbations of Chronic Respiratory Diseases.

Chronic respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD) may deteriorate into acute exacerbations requiring hospitalization. Assessing the predictors of prolonged hospital stays could help identify potential interventions to reduce the burden on patients and healthcare systems. This study aimed to identify the risk factors attributed to prolonged hospital stays among patients admitted with acute exacerbations of chronic respiratory disorders in Jordan. A retrospective cohort study was conducted by reviewing the demographic and clinical characteristics of hospitalized patients with asthma and COPD exacerbations between January 2017 and July 2021. The recorded variables were checked for their independence. Simple and stepwise multivariate linear regressions were then performed to identify variables associated significantly with a longer hospital length of stay (LOS). A total of 896 cases were evaluated. The mean ± SD stay was 5.66 ± 3.40 days, whereas the median (IQR) was 5.00 (4.00) days. Variables associated significantly with prolonged LOS in the multivariate analysis were female gender (β = 0.089, p = 0.011), pulmonary hypertension (β = 0.093, p = 0.004), allergic rhinitis (β = 0.086, p = 0.007), ICU admission (β = 0.096, p = 0.003), requirement for mechanical ventilation (β = 0.102, p = 0.002), higher total number of medications (β = 0.281, p < 0.001) and the number of exacerbation-related medications (β = 0.200, p < 0.001). However, smoking (β = -0.091, p = 0.008) was significantly associated with a shorter LOS. Gender, pulmonary hypertension, allergic rhinitis, ICU admission, mechanical ventilation, the number of medications and smoking were significantly related to LOS. These findings emphasize the importance of patients' demographics and their clinical status in determining LOS, hence providing protective interventions to shorten it.

Assessing Clinical Improvement of Infants Hospitalized for Respiratory Syncytial Virus-Related Critical Illness.

Pediatric respiratory syncytial virus (RSV)-related acute lower respiratory tract infection (LRTI) commonly requires hospitalization. The Clinical Progression Scale Pediatrics (CPS-Ped) measures level of respiratory support and degree of hypoxia across a range of disease severity, but it has not been applied in infants hospitalized with severe RSV-LRTI. We analyzed data from a prospective surveillance registry of infants hospitalized for RSV-related complications across 39 U.S. PICUs from October through December 2022. We assigned CPS-Ped (0=discharged home at respiratory baseline to 8=death) at admission, days 2-7,10, and 14. We identified predictors of clinical improvement (CPS-Ped≤2 or 3-point decrease) by day 7 using multivariable log-binomial regression models and estimated the sample size (80% power) to detect 15% between-group clinical improvement with CPS-Ped versus hospital length of stay (LOS). Of 585 hospitalized infants, 138 (23.6%) received invasive mechanical ventilation (IMV). Of the 49 (8.4%) infants whose CPS-Ped score worsened by 2 points after admission, one died. Failure to clinically improve by day 7 occurred in 205 (35%) infants and was associated with age <3 months, prematurity, underlying respiratory condition, and IMV in the first 24 hours in the multivariable analysis. The estimated sample size per arm required for detecting a 15% clinical improvement in a potential study was 584 using CPS-Ped clinical improvement versus 2,031 for hospital LOS. CPS-Ped can be used to capture a range of disease severity and track clinical improvement in infants who develop RSV-related critical illness and could be useful for evaluating therapeutic interventions for RSV.

The Role of the Discharge Planning Team on the Length of Hospital Stay and Readmission in Patients with Neurological Conditions: A Single-Center Retrospective Study

Background: Emerging evidence highlights the critical role of discharge planning teams in enhancing patient care. However, there is lack of data regarding how the implementation of a discharge planning system influences the length of stay (LOS) in hospital and readmission rates among patients with neurological diseases. We conducted a retrospective analysis to examine the effects of discharge planning application on the LOS and readmission rates for patients admitted under the neurology service in Saudi Arabia. Methods: This is a retrospective study conducted at King Abdulaziz Medical City—Western region of Saudi Arabia. We included all patients admitted and discharged under the neurology service between January 2018 and December 2019. The included patients who were divided into the 2018 group (not exposed to discharge planner) and the 2019 group (exposed to discharge planner). The primary endpoints were the LOS and readmission rates. Results: The study included 856 patients (436 allocated to the 2019 group and 420 allocated to the 2018 group). There was no difference between the two groups in the LOS after adjusting confounding factors (β = −0.58, 95% CI [−2.79, 1.61], p = 0.60). However, the 2019 group were more likely to be discharged within three days compared to the 2018 group (41% vs. 26%, p &lt; 0.005). Our analysis showed that patients in the 2019 group were less likely to be readmitted compared to the 2018 group (adjusted odds ratio = 0.70, 95% CI [0.49–0.99], p = 0.0442). Conclusions: Implementation of a discharge planning team was associated with higher early discharge rates and lower hospital readmissions, suggesting potential benefits for healthcare resource utilization in neurological services.

Negative Healthcare Impacts of Management of Presumed Early-Onset Sepsis in Moderate to Late Preterm Infants on Feeding, Jaundice, and Hospital Length of Stay

Background/Objectives: Early-onset sepsis in neonates is a potentially catastrophic condition that demands prompt management. However, laboratory diagnosis via cerebral spinal fluid and blood tests is often inconclusive, so diagnosis on the basis of clinical symptoms and risk factors is frequently required, and the majority of neonates treated with antibiotics for presumed early-onset sepsis (PEOS) do not have culture-proven sepsis. The management of such PEOS is mainly achieved via antibiotic therapy, which itself has adverse effects, creating a dilemma for clinicians in optimising healthcare. This study aimed to assess the impact of PEOS management on the common neonatal concerns of feeding tolerance, hyperbilirubinaemia, weight gain, and length of stay (LoS) in moderate to late preterm infants. Methods: A single-site, matched-cohort, retrospective study was performed on infants born between 32+3 and 36+6 weeks (2016 to 2019) admitted to the Neonatal Unit. PEOS infants on antibiotics (PEOS) were strictly matched by gestational age (±1 day) and birthweight (±5%) against a non-PEOS reference group (NPEOS). The key outcomes included the following: enteral feeding commencement and achievement; feeding intolerance (FI); phototherapy commencement and duration; antibiotic therapy duration; maximum bilirubin (MaxBili); LoS; and net postbirth weight gain. Results: There were no cases of culture-proven early-onset sepsis. PEOS (n = 185): NPEOS (n = 185) via multivariable analysis showed delayed enteral feed commencement (adjusted Odds Ratio [aOR]: 2.75; 95% confidence interval [CI]: 2.32, 3.27); there was no difference in FI, delayed onset of peak jaundice (aOR: 1.24; 95%CI: 1.12, 1.37), increased duration of phototherapy (aOR: 1.24; 95%CI: 1.10, 1.41), and increased LoS (aOR: 1.31; 95%CI; 1.02, 1.67). A univariate analysis also showed the following results (PEOS: NPEOS): no significant difference in MaxBili and delayed full enteral feed achievement (p = 0.010). Univariant or multivariable analysis showed no difference in irradiance levels. However, for NPEOS infants undergoing 0 or 1 phototherapy light treatment, there was an increased irradiance for PEOS (&lt;0.001, 0.037, respectively). Conclusions: In moderate to late preterm infants, while PEOS diagnosis and management resolve the negative health impacts of potential sepsis, they are associated with negative healthcare outcomes on feeding, jaundice, and hospital length of stay.

Comparison of the efficacy and safety of Landiolol and Esmolol in critically ill patients: a propensity score-matched study

BackgroundExcessive tachycardia is associated with impaired hemodynamics and worse outcome in critically ill patients. Previous studies suggested beneficial effect of β-blockers administration in ICU patients, including those with septic shock. However, comparisons in ICU settings are lacking. Our study aims to compare Landiolol and Esmolol regarding heart rate control and hemodynamic variables in general ICU patients.MethodsThis retrospective, observational study was conducted in a 56-bed ICU at a university hospital. A propensity score matching (PSM) was employed to balance baseline differences. Generalized estimating equations (GEE) were used to compare heart rate between two drugs. The primary outcome was heart rate control, while secondary outcomes included hemodynamic response, hospital length of stay (HLOS) and ICU length of stay (ICULOS).ResultsFrom June 2016 to December 2022, 438 patients were included after PSM, (292 in the Esmolol group and 146 the in Landiolol group). Baseline heart rate was similar between groups (Landiolol:120.0 [110.2, 131.0] bpm vs. Esmolol:120.0 [111.0, 129.0] bpm, p = 0.925). During 72 h. of β-blocker infusion, Landiolol reduced heart rate by 4.7 (1.3, 8.1) bpm, more than Esmolol (p = 0.007), while preserving a comparable proportion of patients able to stabilize vasopressor doses within the first 24 h. (82.9 vs. 80.8%, respectively, p = 0.596). Norepinephrine doses and lactate levels were similar between groups over 72 h., while the Landiolol group exhibited notably higher minimal ScvO2 levels (72% [63%, 78%] vs 68% [55%, 73%], respectively, p = 0.006) and a lower maximal PCO2 gap compared to the Esmolol group (7.0 [6.0, 9.0] vs. 8.0 [6.0, 10.0] mmHg, respectively, p = 0.040). Patients in the Landiolol group were observed to experience shorter HLOS than patients in the Esmolol group (26.5 [13.0, 42.0] vs 30.0 [17.0, 47.2] days, respectively, p = 0.044) and ICULOS (4.9 [2.8, 10.0] vs.6.7 [3.4, 13.1] days, respectively, p = 0.011).ConclusionLandiolol provides superior heart rate control in critically ill patients with tachycardia compared to Esmolol, without increasing vasopressor requirements during the first 24 h. Findings from ScvO2 levels and PCO2 gap suggest that Landiolol may exert less impact on cardiac output than Esmolol. Further studies, incorporating comprehensive hemodynamic monitoring, are warranted to clarify the clinical implications of heart rate control with β-blockers in ICU patients with tachycardia.

Association between preoperative serum albumin levels and length of stay in elderly patients with hip fractures: A nonlinear relationship.

Previous studies have provided relatively limited evidence in examining the impact of preoperative serum albumin levels on the length of hospital stay (LOS) in patients with hip fractures. This study aimed to elucidate the association between preoperative serum albumin levels and LOS in elderly patients with hip fractures. This retrospective cohort study included 1444 elderly patients undergoing surgical treatment for hip fractures at the Second People's Hospital of Shenzhen from January 2012 to December 2021. The main exposure variable was serum albumin level, and the outcome variable was LOS. A generalized additive model was used to identify the nonlinear relationship between serum albumin levels and LOS, and saturation effects were calculated using a two-piecewise linear regression model. Subgroup analysis was conducted using stratified logistic regression. The median LOS was 10 (8-15) days among all included patients. After adjusting for potential confounding factors (age, sex, comorbidities, hypertension, coronary heart disease, stroke, diabetes, duration of surgery, surgical method, intraoperative blood loss, red cell distribution width, estimated glomerular filtration rate, blood urea nitrogen, postoperative pneumonia, and transfer to ICU), a nonlinear relationship was found between serum albumin levels and LOS, with a turning point at 3.06. On the left side of the turning point, the effect size was not statistically significant (β = 1.84, 95% CI -1.00 to 4.68, P = .2042), while on the right side of the turning point, for every 1 g/dL increase in albumin, LOS decreased by 1.05 days (β = -1.05, 95% CI -1.90 to -0.20, P = .0162). A nonlinear relationship was observed between preoperative serum albumin levels and LOS in elderly patients with hip fractures. When albumin levels were >3.06 g/dL, they were negatively correlated with LOS. This has important implications for clinicians in the development of nutritional improvement strategies.

Acute pulmonary embolism with and without hemodynamic instability (2003-2022): A Swiss nationwide epidemiological study.

Data on the epidemiological burden of acute pulmonary embolism (PE) in Switzerland is unavailable. Knowledge gaps remain on trends in PE-related comorbidities, PE severity, and length of in-hospital stay (LOS) at a nationwide level. We used nationwide, patient-level data including all patients aged 15 years or older hospitalized for PE in Switzerland from 2003 to 2022, amounting to N=180,600. Additionally, we analyzed the Swiss Death Registry for the same period. We estimated the disease-specific age-standardized incidence rates, mortality rates, in-hospital case fatality rates, proportional mortality rates, and LOS. Analyses were stratified by sex and the presence of features of high-risk PE. During the study period, the PE-related incidence rate increased from 0.87 (95%CI: 0.82;0.92) per 1,000 population in 2003 to 1.19 (95%CI: 1.15;1.24) in 2022. In contrast, a decreasing trend was found for mortality rates (18.7 [95%CI: 16.8;20.6] per 100,000 population in 2003, 13 [95%CI: 11.7;14.2] in 2022), in-hospital case fatality rate (9.8 [95%CI: 9.1;10.5] deaths per 100 hospitalized PE patients in 2003, 7.9 [95%CI: 7.4;8.5] in 2019, subsequent increase during COVID-19 pandemic), and LOS (11 [Q1-Q3: 7-18] days in 2003, 8 [Q1-Q3: 4-16] in 2022). No major sex-differences in trends were present. Except for LOS reduction, patients with high-risk features presented with similar trends. The incidence of acute PE in Switzerland increased over the last 20 years. Despite increasing trends in the median age at PE diagnosis, in-hospital case fatality and mortality rate decreased, particularly among patients with high-risk features, and the LOS progressively declined.

Association between Congenital Zika Syndrome and hospitalizations during early childhood: a nationwide cohort study.

Background Congenital Zika Syndrome (CZS) has been linked to a wide spectrum of abnormalities. However, differences in hospitalization patterns between children with and without CZS have not yet been investigated. Methods We compared rates of hospital admissions for all and specific diseases, proportions of admission causes, and total length of hospital stay (LOS) between children with CZS and those without the syndrome. Adjusted incidence rate ratios (aIRR) and aLOS were estimated using negative binomial regression. Results Compared to those without CZS, the aIRR for all-cause hospitalizations in the CZS group ranged from 3.77 (95%CI: 3.47-4.06) in the neonatal period to 7.76 (95%CI:6.91-8.61) at ages 2-4 years. Similar trends were observed for specific causes of admissions. Most admissions in the CZS group related to congenital malformations, neurological, respiratory and infectious diseases. aLOS ranged from 16.0 days[95%CI:13.2-19.5] to 19.9 days among CZS patients and 6.0 days[95%CI:5.9-6.2] to 9.3 days[95%CI:9.3-9.4] for patients without the syndrome. Conclusions Children born with CZS face significantly higher rates of hospitalization and longer stays compared to those without the syndrome during early childhood.

The Relationship between Types of Wound Care and Length of Hospital Stay in Patients with Fournier’s Gangrene Treated in a Tertiary Hospital

The Relationship between Types of Wound Care and Length of Hospital Stay in Patients with Fournier’s Gangrene Treated in a Tertiary Hospital

Association of the Glasgow Coma Scale with the Length of Hospital Stay in Patients with Thyroid Storm.

Objective The Glasgow Coma Scale (GCS) is widely used to assess the levels of consciousness. This study examined whether or not the initial GCS score could be a marker of the length of hospital stay (LOS) in patients with thyroid storm. Methods We retrospectively analyzed 29 patients with thyroid storm in our hospital between January 2010 and December 2023. Thyroid storm was diagnosed based on the latest diagnostic criteria in Japan. Since 30 days is the upper limit of LOS in the Diagnosis Procedure Combination [DPC]-based reimbursement system, the study population was divided into patients with permissible LOS (<30 days) and those with undesirable LOS (≥30 days). As a supplementary analysis, we examined the correlation of the GCS score and other clinical parameters with LOS using a Spearman's rank correlation analysis. Results The GCS score was significantly higher (14.1±2.7 vs. 9.9±4.9 points; p <0.001), and the Sequential Organ Failure Assessment (SOFA) score significantly lower (1.68±2.16 vs. 7.50±7.91 points; p =0.009) in patients with permissible LOS than in those with undesirable LOS, while other clinical parameters were not significantly different between the groups. The area under the receiver operating characteristic curve of the GCS for the permissible vs. undesirable LOS was 0.866. The baseline parameters that were significantly correlated with LOS were the GCS (ρ =-0.665; p <0.001) and SOFA score (ρ =0.670; p <0.001). The subsequent rank partial correlation analysis showed that GCS was still inversely correlated with LOS, independent of SOFA score (ρ =-0.390; p =0.040). Conclusions GCS, which can be evaluated more easily and quickly than the SOFA score, is a useful marker of LOS in patients with thyroid storm.

The role of hyperaccuracy CT three-dimensional reconstruction technology in partial nephrectomy for completely endophytic renal cell carcinoma: A retrospective propensity-matched cohort study.

To compare the clinicopathological, perioperative, functional, and oncological outcomes of completely endophytic renal cell carcinoma (RCC) patients who underwent partial nephrectomy (PN) with or without preoperative hyperaccuracy CT three-dimensional (HACT3D) reconstruction. A retrospective cohort study was conducted on 154 completely endophytic RCC patients treated with PN at our medical center from January 2018 to December 2023. Patients were divided into two groups based on whether they received preoperative HACT3D reconstruction. To control for selection bias, we implemented 1:1 propensity score matching based on baseline characteristics. In the original cohort, 47 patients in the HACT3D group had higher RENAL scores (P=0.014) and PADUA scores (P=0.012). After matching, each group contained 47 RCC patients with no significant baseline differences (P>0.05). In the matched cohort, patients in the HACT3D group had significantly shorter warm ischemia time (WIT) (22.3 vs. 26.7min, p<0.001), shorter total length of hospital stay (LOS) (10.0 vs. 11.6 days, p=0.012), shorter postoperative LOS (5.8 vs. 7.3 days, p=0.003), and higher trifecta achievement rate (83.0% vs. 36.2%, p<0.001). Among functional variables, patients in the HACT3D group exhibited a smaller increase in postoperative serum creatinine (SCR) (7.5 vs. 16.5μmol/L, p=0.012), and a smaller decrease in postoperative estimated Glomerular Filtration Rate (eGFR) (-6.9 vs. -14.1mL/min/1.73m2, p=0.011). No significant differences were found in pathological outcomes and prognosis between the two groups (p>0.05). For completely endophytic RCC patients, HACT3D reconstruction can assist clinicians in performing precise parameter measurements, designing personalized surgical approaches, and providing intraoperative image guidance.

Trends and determinants of time spent in the emergency department among Australian hospital presenting self-harm cases

AimsWaiting time (WT) and length of stay (LOS) are important metrics used to assess service delivery in emergency departments (EDs), and have been associated with subsequent re-presentations in EDs. This study investigated socio-demographic and health service determinants of WT and LOS among hospital treated self-harm (SH) cases presenting to EDs in Australian based hospitals. MethodsThis study employed a retrospective cohort study of all SH cases (N=6203) presenting to public hospital EDs in the Western Sydney catchment area from January 2016 to December 2022. Cox proportional hazard models were used to analyse demographic and service factors related to WT and LOS in Australian hospitals along with a description of secular trends in WT and LOS. ResultsLonger WT was evident for patients aged 15-64 than 0-14 years, non-admitted patients and patients arriving at the ED via transport other than ambulance whereas longer LOS was associated with older patients (65+ years). The inflow of non-SH cases to the ED did not have an impact on WT or LOS among SH cases. WT and LOS increased over time, particularly post the onset of the COVID-19 pandemic. The number of current self-harm cases receiving treatment in ED at the time of patient’s arrival also increased WT and LOS. ConclusionsWT and LOS have increased, especially post the onset of the COVID-19 pandemic. These findings necessitate the urgent need for updated strategies to manage ED resources, and suggest initiatives relating to ED diversion where appropriate for patients presenting to hospital following SH.

Frailty index predicts adverse short- and long-term outcomes in older adults with rib fractures.

Older adults with rib fractures pose an increasing clinical and financial burden on healthcare. Identifying and addressing the increased risk of adverse outcomes has been a key objective in geriatric co-management of surgical patients. The Comprehensive Geriatric Assessment-based Frailty Index (FI-CGA) is a useful predictor of complications and mortality in older adults, but its value in rib fracture management remains unclear. This study investigates the association between FI-CGA and short- and long-term outcomes of older adults with rib fractures. Rib fracture patients ≥65 years, with a FI-CGA score available, were retrospectively identified from a single level-I trauma center between 2018 and 2022. FI-CGA scores were categorized as pre-frail (<0.20), mild frailty (0.20-0.29), moderate frailty (0.30-0.39), and severe frailty (≥0.40). Outcome measures included mortality up to two years, length of stay (LOS), complications, and 30-day readmission. 288 patients were included for analysis (57 pre-frail; 66 mildly frail; 61 moderately frail; 104 severely frail). Compared to the pre-frail group, only severely frail patients were at higher risk of 90-day (OR 5.71 [CI 1.29 - 52.67]) and 1-year mortality (OR 6.66 [CI 2.18 - 27.37]), while 2-year mortality was higher in mild (OR 3.77 [CI 1.30 - 12.57]), moderate (OR 4.28 [CI 1.46 - 14.51]) and severe (OR 6.42 [CI 2.43 - 20.11]) frailty groups. Hospital (p=0.183) and ICU LOS (p=0.131) was similar across groups. Severely frail patients were at risk of pneumonia (OR 3.50 [CI 0.95 - 19.48]) and delirium (OR 4.16 [CI 1.33 - 17.40]), while other complications were similar between groups (p=0.679). Adjusted proportional hazard ratios for mortality were significantly higher for moderate frailty (HR 1.99 [CI 1.02 - 3.89]) and severe frailty (HR 2.66 [CI 1.10 - 3.73]). FI-CGA was also a significant predictor if used per 0.01 point (HR 1.03 [CI 1.01 - 1.04)]) and per 0.1 point (HR 1.29 [CI 1.12 - 1.47]). FI-CGA can identify vulnerable rib fracture patients at risk of in-hospital complications, and short- and long-term mortality. Continuous FI-CGA scores provide a granular and individualized risk assessment. In severely frail patients with rib fractures, FI-CGA may assist in aligning treatment with individual patients' needs and goals of care.

Mortality and Length of Stay Implications of Deterioration-Associated Transfer to the Intensive Care Unit over Different Time Frames

Background: Quality improvement initiatives in the acute care setting often target reduction of mortality and length of stay (LOS). Unplanned care escalations are associated with increased mortality risk and prolonged LOS, but may be precipitated by different factors, including appropriate triage, bed availability, and post-admission deterioration. Objectives: This work evaluates different transfer timeframes to quantify the impact of deterioration-associated unplanned transfers to intensive care (ICU) on mortality and LOS, informing evidence-based interventions to improve patient care. Design: This retrospective analysis examined 519 181 adult inpatients discharged from 15 hospitals in the United States. A propensity matched cohort analysis compared mortality and overall hospital LOS for patients admitted to routine and intermediate care units who did and did not have an unplanned ICU transfer within 12, 12-48, or ⩾48 hours from admission. Methods: Population cohorts were matched on age, sex, admitting unit type, admission type, and admission acuity. Multivariable regression analysis was used to estimate the impact of unplanned transfer on mortality and LOS. Sensitivity sub-analyses compared direct ICU admissions to unplanned ICU transfers using the same transfer timeframes and endpoints. Results: Patients with unplanned transfers in each of three timeframes had statistically higher mortality rates and longer LOS than matched cohorts without unplanned transfer. Differences between cohorts was greatest in patients transferring ⩾48 hours post-admission for both mortality (25.1% vs 1.9%, P &lt; .0001) and LOS ( x¯ = 14.7 vs 5.3, P &lt; .0001). Multivariate analysis showed unplanned ICU transfer significantly increased odds of mortality and prolonged LOS, with later transfers having the most profound influence (19-fold increase in mortality and 2-fold increase in LOS). Sensitivity analyses found a statistically significant increase in mortality and LOS associated with unplanned ICU transfer across all three timeframes. Conclusion: The association of later transfers with elevated mortality and LOS underscores the importance of timely intervention on patient deterioration.

Association of Grit and Resilience With Short-Term Post-Transplant Outcomes in Lung Allograft Recipients.

The importance of mental toughness on lung transplant outcomes is unknown. We performed a pilot study to assess whether pretransplant grit and resilience are associated with short-term posttransplant outcomes. We enrolled 31 lung transplant candidates, of whom 7 (26%) had greater mental toughness, defined as the upper tertile for both grit and resilience within our cohort. There were no differences in baseline characteristics between patients with higher and lower mental toughness. Greater mental toughness was associated with a shorter hospital length of stay (LOS) [12 days (interquartile range, IQR 10-12) vs. 17 days (IQR 14-24), p = 0.02] and reduced posttraumatic stress severity [median 0 (IQR 0-2) vs. 6.5 (IQR 4-9), p < 0.01]. On multivariable analyses adjusting for age and Duke Activity Status Index, greater mental toughness was associated with a shorter hospital LOS [beta = -11.96 (95% CI 0.05-23.86), p < 0.05] and reduced PTSD [beta = -10.7 (95% CI -21.6-0.04), p = 0.053]. Lung transplant candidates with greater mental toughness may have improved short-term outcomes.

Hyperglycemia Risk Evaluation of Hydrocortisone Intermittent Boluses Vs Continuous Infusion in Diabetic Patients with Septic Shock: A Prospective Cohort Study

Background &amp; Objectives: Septic shock is a serious condition associated with a high mortality rate because of the multiorgan dysfunction caused by dysregulated host immune responses to infection. Giving low dose steroids in septic shock patients has been shown to hasten the reversal of shock and current Surviving Sepsis Guidelines (SSG) also suggest using low dose steroids for the same. Also, the use of steroids causes hyperglycaemia particularly in diabetic patients. The current SSG does not specify the method of administration. The primary objective of our study was to compare continuous infusion vs intermittent boluses of hydrocortisone to obtain a better glycaemic control. Methods: A prospective cohort study was conducted in diabetic patients with septic shock admitted in Multi Disciplinary Intensive Care Unit (MDICU) of PRS hospital from July 2022 to February2023. Hydrocortisone was given as continuous infusion in 55 subjects and the remaining 55 received intermittent boluses of hydrocortisone and average blood glucose values were measured in both the groups. Results: Among 110 patients, 55 patients each received continuous infusion and intermittent boluses of hydrocortisone respectively. The mean blood glucose values in continuous infusion group were 161.1 ± 22.7 and 172.5 ± 21.0 (mg/ dl) in intermittent boluses group which was statistically significant with a p value of 0.007. There was no statistically significant difference among the groups in 28-day mortality, ICU length of stay (LOS), hospital LOS, or other secondary safety outcomes. Conclusions: This study infers that giving hydrocortisone as continuous infusions in septic shock patients leads to better glycaemic control when compared to intermittent boluses of hydrocortisone, without any difference in 28-day mortality.

The Effects of Systemic Tranexamic Acid Administration on Drainage Volume, Length of Hospital Stay, and Postoperative Complications in Reduction Mammaplasty.

Background: Reduction mammaplasty is a common, elective, and safe operation, usually executed in healthy patients. Nonetheless, postoperative complications like bleeding and seroma formation can occur and significantly complicate the postoperative course. Tranexamic acid (TXA), a commonly used antifibrinolytic drug, offers a novel approach to reduce these complications. This study aims to evaluate its effect on the rate of postoperative bleeding, drainage volume, length of hospital stay, and other postoperative complications in patients undergoing reduction mammaplasty. Method: A retrospective study on all patients undergoing reduction mammaplasty at the Department of Plastic, Reconstructive, and Aesthetic Surgery EOC between 2015 and 2022 was conducted. Patients were divided into the TXA group receiving systemic TXA for 48 h and the control group not receiving any TXA. All data were analyzed using nonparametric formulas. Results: A total of 209 breasts were included in the study, with 138 cases in the control group and 71 in the TXA group. Three cases requiring revision surgery due to bleeding were observed in the control group, whereas none were observed in the TXA group. Total drainage volume was significantly reduced in the TXA group compared to the control group (TXA: 41.6 mL vs. control: 53.8 mL; p = 0.012), resulting in a significant reduction in length of hospital stay (TXA: 1.6 days vs. control: 2.2 days; p = 0.0001). Conclusions: TXA is a well-tolerated drug that significantly reduces postoperative bleeding and drainage volume, resulting in earlier drain removal and reduced length of hospital stay. TXA should, therefore, be widely used in plastic surgery, especially as trends in healthcare systems necessitate more outpatient procedures and quicker postoperative recovery.

Respiratory Severity Score (RSS): A Predictive Tool for Successful Extubation in Preterm Neonates

Introduction: The coexistence of immature lungs, poor respiratory drive, overly compliant chest wall, and surfactant deficiency in preterm neonates, leads to dependency on mechanical ventilation during the first days of life. Respiratory Severity Score (RSS) is a readily available, simple and non-invasive extubation failure prediction tool. Objective This study aims to evaluate the utility of pre-extubation RSS as a tool for predicting successful extubation among preterms. Methods and Analysis: This was a retrospective study with a duration of two years started after obtaining clearance from the Institutional Ethics Committee. All preterm neonates ventilated in NICU were included in the study. The hospital unit number was noted and the respective patient records were procured from the hospital records department. Demographic data were recorded from the files. Pre-extubation RSS was calculated. Other findings related to clinical review such as duration of invasive and non-invasive ventilation, surfactant requirement, intraventricular hemorrhage (IVH), early and late-onset sepsis, length of hospital stay (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) mortality data etc. were also recorded. The age, time of extubation and weight of those babies who underwent planned extubation were also recorded. Results: The RSS and RSS/kg were significantly higher among the neonates who failed extubation ( P &lt; .001). The Area under curve (AUC) for RSS and RSS/kg was 0.921 and 0.85, respectively. There was a significantly higher proportion of morbidities such as late-onset sepsis ( P = .046), grade ≥3 IVH ( P = .004) and ROP ( P = .043) observed among the neonates with extubation failure. The prevalence of in-hospital mortality was observed only among neonates with extubation failure which was statistically significant ( P &lt; .001). Conclusion: This study shows that pre-extubation RSS is an excellent tool for predicting successful extubation and is more accurate than RSS/kg. RSS could be a useful tool for clinicians to assess readiness of extubation. However, more prospective, multicentric studies are necessary to validate the generalizability of RSS.