Outcomes In Hospitalized Patients Research Articles

Relationship between admission random blood glucose, fasting blood glucose, with severity of coronary lesion and hospital outcomes in patients admitted with ST elevation myocardial infarction

Background: This research addressed the relationships between admission random blood glucose (RBG), fasting blood glucose (FBG), and severity of coronary artery disease (CAD) “assessed by Gensini score “and in hospital outcomes in patient admitted with ST elevated Myocardial Infarction (STEMI). Methods: The research was conducted on 100 cases who were recruited from Cardiology department in Tanta University presented with STEMI and underwent coronary angiography either primary PCI or Pharmaco-invasive, the cases were categorized firstly, according to RBG into two groups: Group 1: Non hyperglycemia group (200 mg/dl). Then after 8hours from admission FBG was tested "regarding FBG Patient is fasting but to be well hydrated" and accordingly the cases were further sub-divided into two groups: Group I: Non-FBG elevated (126 mg/dl). Results: It was shown that there was a significant difference between the hyperglycemic and FBG elevated groups in terms of severity of CAD and In-hospital mortality where both the hyperglycemic and the FBG elevated cases had more extensive CAD and higher Gensini score. Also, the occurrence of major adverse cardiovascular events was higher in these two groups in comparison to their non-hyperglycemic, non FBG elevated counterparts. There was statistically significant positive correlation between Gensini score and RBS and fasting blood glucose level (p

Risk factors independently associated with the maintenance of severe restriction of oral intake and alternative feeding method indication at hospital outcome in patients after acute ischemic stroke

Background and aimsFrom a clinical point of view, post-stroke patients present difficulties in swallowing management. The purpose of this research was to identify risk factors that were independently related to the maintenance of a severe restriction of oral intake in patients affected by acute ischemic stroke. MethodsThe authors conducted a prospective observational cohort study of patients with dysphagia post-acute ischemic stroke who were admitted to an Emergency Room (ER). Demographic and clinical data were collected at ER admission. Swallowing data was based on The Functional Oral Intake Scale (FOIS) and was collected at two distinct moments: initial swallowing assessment and at the patient outcome. Patients were divided into two groups according to their FOIS level assigned on the last swallowing assessment (at hospital outcome): G1 with severe restriction of oral intake and indication of feeding tube – patients with FOIS levels 1 to 4; G2 without restriction of food consistencies in oral intake – patients with FOIS levels 5 to 7. ResultsOne hundred and six patients were included in our study. Results of the multivariate logistic regression model for the prediction of maintenance of a severe restriction of oral intake at hospital outcome in patients post-acute ischemic stroke indicated that increasing age (p = 0.006), and dysarthria (p = 0.003) were associated with higher chances of presenting severe restriction of oral intake at hospital outcome. ConclusionsPatients with acute ischemic stroke in an Emergency Room may experience non-resolved severe dysphagia, indicating the need to prepare for the care/rehabilitation of these patients.

Impact of sex and comorbid diabetes on hospitalization outcomes in acute pancreatitis: A large United States population-based study.

Data on the association between comorbid diabetes mellitus (DM) and acute pancreatitis (AP) remains limited. Utilizing a large, nationwide database, we aimed to examine the impact of comorbid diabetes mellitus on patients admitted for acute pancreatitis. This was a retrospective case-control study of adult patients with AP utilizing the National Inpatient Sample from 2015-2018, using ICD-10 codes. Hospitalization outcomes of patients admitted for AP with comorbid DM were compared to those without comorbid DM at the time of admission. The primary outcome was a mortality difference between the cohorts. Multivariable-adjusted cox proportional hazards model analysis was performed. Data was analyzed as both sex aggregated, and sex segregated. 940,789 adult patients with AP were included, of which 256,330 (27.3%) had comorbid DM. Comorbid DM was associated with a 31% increased risk of inpatient mortality (aOR: 1.31; p = 0.004), a 53% increased risk of developing sepsis (aOR: 1.53; p = 0.002), increased hospital length of stay (LOS) (4.5 days vs. 3.7 days; p < 0.001), and hospital costs ($9934 vs. $8486; p < 0.001). Whites admitted for AP with comorbid DM were at a 49% increased risk of mortality as compared to Hispanics (aOR: 1.49; p < 0.0001). Different comorbidities had sex-specific risks; men admitted for AP with comorbid DM were at a 28% increased risk of mortality (aOR: 1.28; p < 0.0001) as compared to women. Men with comorbid DM plus obesity or hypertension were also at increased risk of mortality as compared to women, whereas women with comorbid DM plus renal failure were at greater risk of mortality as compared to men. Comorbid DM appears to be a risk factor for adverse hospitalization outcomes in patients admitted for AP with male sex and race as additional risk factors. Future prospective studies are warranted to confirm these findings to better risk stratify this patient population.

A comparative study to determine the impact of double lockdown on hospital visits, admissions, and patient outcomes in a tertiary care hospital

Background: Unlike COVID 19 lockdown, very little is known about the impact of non-COVID 19 lockdown and two lockdowns (post abrogation of article 370 and post COVID 19) in series on health-care delivery system. Aims and Objectives: The aim of the study was to look for the impact of two lockdowns, separately and in combination, on health-care delivery system. Materials and Methods: Data of patients visiting the pediatric outpatient department, pattern of hospital admissions and patient outcomes 1 month and 6 months before and after two lockdowns were recorded and compared within a lockdown and with each other. Results: Fall in Outpatient visits and its persistence even after 6 months was more pronounced for post COVID 19 Lockdown or lockdown 2 (–73%VS–43% and +195VS–61%). There was a statistically significant difference between admissions rates 1 month before and after lockdown 1 (post article 370 abrogation) as well as 1 month before and after lockdown 2 (P= 0.001; P&lt; 0.0001). For the same time period, admission rates were significantly different for respiratory and gastrointestinal illnesses during the two lockdowns (&lt;0.0001). Also, there was a significant difference between admissions rates 6 month before and after lockdown 1 and 6 months before and after lockdown 2 (P&lt; 0.00001; P&lt;=0.02). There was a significant difference between hospital admission rates 1 month after lockdown 1 and lockdown 2 (&lt;0.0001). There was also significant difference between clinical spectrum of admitted patients 1 month and 6 months after the two lockdowns (&lt;0.03–&lt;0.0001). Conclusion: Both Lockdowns had a significant negative impact on healthcare delivery system. However, post COVID-19 lockdown had a much stronger impact.

Characterizing the burden of biliary tract cancers across 28 hospitals in Ontario, Canada

Background: Despite the increasing incidence of biliary tract cancers (BTCs) in North America, there are no studies that measure the burden of BTCs on hospital admissions, patient outcomes, and healthcare resource utilization. In this study, we report the clinical outcomes and resource utilization for all patients admitted under in-hospital medical services in relation to BTC diagnosis across 28 hospitals in Ontario, Canada.

The association between hospital high-volume anesthesiology care and patient outcomes for complex gastrointestinal cancer surgery: A population-based study

Background: Individual anesthesiology volume has been associated with individual patient outcomes for complex gastrointestinal cancer surgery. However, whether hospital-level anesthesiology care, where changes can be made, influences the outcomes of patients cared at this hospital is unknown. We examined the association of between hospital rates of high-volume anesthesiology care and of postoperative major morbidity.

Acute Pain Management Pearls: A Focused Review for the Hospital Clinician

Acute pain management is a challenging area encountered by inpatient clinicians every day. While patient care is increasingly complex and costly in this realm, the availability of applicable specialists is waning. This narrative review seeks to support diverse hospital-based healthcare providers in refining and updating their acute pain management knowledge base through clinical pearls and point-of-care resources. Practical guidance is provided for the design and adjustment of inpatient multimodal analgesic regimens, including conventional and burgeoning non-opioid and opioid therapies. The importance of customized care plans for patients with preexisting opioid tolerance, chronic pain, or opioid use disorder is emphasized, and current recommendations for inpatient management of associated chronic therapies are discussed. References to best available guidelines and literature are offered for further exploration. Improved clinician attention and more developed skill sets related to acute pain management could significantly benefit hospitalized patient outcomes and healthcare resource utilization.

Burden of metabolic syndrome in patients with acute myocardial infarction and its impact on hospital outcomes

Background: Sparse data are available from India regarding the impact of metabolic syndrome (MetS) on hospital outcomes in patients presenting with acute myocardial infarction (AMI). Therefore, the present study was conducted to evaluate the burden of MetS in patients with AMI and its impact on the hospital outcomes. Methods: This single-centre, observational, cross-sectional study was conducted in the medicine and cardiology intensive care units of a tertiary care hospital in Mumbai, Maharashtra, in patients presenting with AMI. Results: Among the 210 patients (mean age: 56.5 ± 5.2 years; 67.1% males) with AMI studied, 101 (48.1%) fulfilled the criteria for MetS. No significant difference was seen in the age (P = 0.70) and gender (P = 0.55) in patients with and without MetS. Anterior wall was the most common site of infarction; heart failure was the most common complication in both the groups. Case fatality was significantly higher in patients with MetS (P = 0.003). Heart failure was the most common complication in all non-survivors. The duration of hospital stay was significantly longer (P < 0.0001) in patients with MetS. Conclusions: We observed that MetS was evident in almost half (48.1%) of the patients presenting with AMI. The presence of MetS significantly increased the risk of complications, fatality and duration of hospital stay in patients with AMI.

Global monkeypox case hospitalisation rates: A rapid systematic review and meta-analysis.

Estimates of the case hospitalization rate and case fatality rate when hospital care is available for monkeypox (MPX) infections have not been well defined. This rapid systematic review and meta-analysis aimed to estimate the case hospitalisation rate and case fatality rate where hospital care is available. We systematically searched PubMed, Embase, the Lancet Preprints, and MedRxiv for studies published between Jan 1, 1950 and Aug 2, 2022. We included documents which contained both the number of cases and associated hospitalisations of MPX infections. From eligible studies we extracted the country, the year of the study, the study design type, the clade of MPX, the participant characteristics, transmission type, any treatments used, number of cases (including suspected, probable, or laboratory confirmed diagnosis), number of hospitalizations, hospitalized patient outcomes, and case definition. Case hospitalization rate (CHR) was defined as the proportion of cases that were admitted to hospital care while case fatality rate (CFR) was defined as the proportion of cases that died. CHR and CFR were analysed in a fully Bayesian meta-analytic framework using random effects models, including sub-group analysis with heterogeneity assessed using I2. Of the 259 unique documents identified, 19 studies were eligible for inclusion. Included studies represented 7553 reported cases among which there were 555 hospitalizations. Of the 7540 cases for which outcomes were available, there were 15 recorded deaths. The median age of cases was 35 years (interquartile range 28-38, n=2010) and primarily male (7339/7489, 98%) in studies where age or sex were available. Combined CHR was estimated to be 14.1% (95% credible interval, 7.5-25.0, I2 97.4%), with a high degree of heterogeneity. Further analysis by outbreak period indicates CHRs of 49.8% (28.2-74.0, I2 81.4%), 21.7% (7.2-52.1, I2 57.7%), and 5.8% (3.2-9.4, I2 92.4%) during the pre-2017, 2017-2021, and 2022 outbreaks, respectively, again with high levels of heterogeneity. CFR was estimated to be 0.03% (0.0-0.44, I2 99.9%), with evidence of large heterogeneity between the studies. There is limited data for MPX hospitalization rates in countries where MPX has been traditionally non-endemic until the current outbreak. Due to substantial heterogeneity, caution is needed when interpreting these findings. Health care organizations should be cognizant of the potential increase in healthcare utilization. Rapid identification of infection and use of appropriate therapies such as antivirals play a role reducing the CHR and associated CFR. None.

Epidemiologic risk factors for patients admitted with chronic pancreatitis and pancreatic ductal adenocarcinoma in the United States

Epidemiological studies of chronic pancreatitis (CP) and its association with pancreatic ductal adenocarcinoma (PDAC) are limited. Understanding demographic and ethno-racial factors may help identify patients at the highest risk for CP and PDAC. To evaluate the ethno-racial risk factors for CP and its association with PDAC. The secondary aim was to evaluate hospitalization outcomes in patients admitted with CP and PDAC. This retrospective cohort study used the 2016 and 2017 National Inpatient Sample databases. Patients included in the study had ICD-10 codes for CP and PDAC. The ethnic, socioeconomic, and racial backgrounds of patients with CP and PDAC were analyzed. Hospital admissions for CP was 29 per 100000, and 2890 (0.78%) had PDAC. Blacks [adjusted odds ratio (aOR) 1.13], men (aOR 1.35), age 40 to 59 (aOR 2.60), and being overweight (aOR 1.34) were significantly associated with CP (all with P < 0.01). In patients with CP, Whites (aOR 1.23), higher income, older age (aOR 1.05), and being overweight (aOR 2.40) were all significantly associated with PDAC (all with P < 0.01). Men (aOR 1.81) and Asians (aOR 15.19) had significantly increased mortality (P < 0.05). Hispanics had significantly increased hospital length of stay (aOR 5.24) (P < 0.05). Based on this large, nationwide analysis, black men between 40-59 years old and overweight are at significantly increased risk for admission with CP. White men older than 40 years old and overweight with higher income were found to have significant associations with CP and PDAC. This discrepancy may reflect underlying differences in healthcare access and utilization among different socioeconomic and ethno-racial groups.

The Effect of Nurse Staffing on Patient Outcomes in Acute Care Hospitals in Korea

Nurse staffing is an important factor influencing patient health outcomes. This study aimed to analyze the effects of nurse staffing on patient health outcomes, such as length of stay, mortality within 30 days of hospitalization, and readmission within 7 days of discharge, in acute care hospitals in Korea. Data from the first quarter of 2018 were collected using public and inpatient sample data from the Health Insurance Review and Assessment Service. The data of 46,196 patients admitted to 536 general wards of acute care hospitals were analyzed. A multilevel logistic analysis was performed for the patients' mortality and early readmission, and a multilevel zero-truncated negative binomial analysis was performed for the length of stay. The average length of stay in acute care hospitals was 6.54 ± 6.03 days, the mortality rate was 1.1%, and the early readmission rate was 7.1%. As the nurse staffing level increased, the length of stay and number of early readmissions were likely to decrease. It can be concluded that interventions to improve nurse staffing are required; for example, a policy that compels medical institutions to comply with Korea's medical law standards should be implemented. Additionally, continuous research and interventions are needed to establish an appropriate nurse staffing level according to patient severity.

Examination of Impact of After-Hours Admissions on Hospital Resource Use, Patient Outcomes, and Costs.

Nighttime and weekends in hospital and intensive care unit (ICU) contexts are thought to present a greater risk for adverse events than daytime admissions. Although some studies exist comparing admission time with patient outcomes, the results are contradictory. No studies currently exist comparing costs with the time of admission. We investigated the differences in-hospital mortality, ICU length of stay, ICU mortality, and cost between daytime and nighttime admissions. All adult patients (≥18 years of age) admitted to a large academic medical-surgical ICU between 2011 and 2015 were included. Admission cohorts were defined as daytime (8:00-16:59) or nighttime (17:00-07:59). Student's t-tests and chi-squared tests were used to test for associations between days spent in the ICU, days on mechanical ventilation, comorbidities, diagnoses, and cohort membership. Regression analysis was used to test for associations between patient and hospitalization characteristics and in-hospital mortality and total ICU costs. The majority of admissions occurred during nighttime hours (69.5%) with no difference in the overall Elixhauser comorbidity score between groups (p=0.22). Overall ICU length of stay was 7.96 days for daytime admissions compared to 7.07 days (p=0.001) for patients admitted during nighttime hours. Overall mortality was significantly higher in daytime admissions (22.5% vs 20.6, p=0.012); however, ICU mortality was not different. The average MODS was 2.9 with those admitted during the daytime having a significantly higher MODS (3.0, p=0.046). Total ICU cost was significantly higher for daytime admissions (p=0.003). Adjusted ICU mortality was similar in both groups despite an increased rate of adverse events for nighttime admissions. Daytime admissions were associated with increased cost. There was no difference in all hospital total cost or all hospital direct cost between groups. These findings are likely due to the higher severity of illness in daytime admissions. Daytime admissions were associated with a higher severity of illness, mortality rate, and ICU cost. To further account for the effect of staffing differences during off-hours, it may be beneficial to compare weekday and weeknight admission times with associated mortality rates.

Risks and Outcomes of Hospitalization in Patients with Chronic Lymphocytic Leukemia Admitted with Immune Thrombocytopenia: An Analysis of the National Inpatient Sample Database (2005-2019)

Risks and Outcomes of Hospitalization in Patients with Chronic Lymphocytic Leukemia Admitted with Immune Thrombocytopenia: An Analysis of the National Inpatient Sample Database (2005-2019)

The Impact of Chronic Kidney Disease on Hospitalization Outcomes in Patients Admitted with Acute Myeloid Leukemia: A Nationwide Analysis Using the National Inpatient Sample Database (2015-2019)

Background: Patients with baseline chronic kidney disease (CKD) are more susceptible to acute kidney injury during treatment for acute myeloid leukemia (AML). In addition, some CKD patients may not be a candidate for intensive therapeutic regimens due to their comorbidities. These factors increase the risk of complications during hospitalization for this subset of AML patients. Methods: The data for this study was obtained from the publicly available National Inpatient Sample Database (NIS). We used the International Classification of Diseases, 10th Revision (ICD-10) codes to collect data on hospitalizations for AML for patients >18 years of age. The data was further classified into hospitalizations with or without CKD (all stages included). The Mann-Whitney U and Chi-square tests were performed to compare continuous and categorical variables respectively for the unadjusted data. Propensity Score Matching (PSM) was done to account for multiple potentially confounding demographic variables and co-morbid conditions such as age, gender, sex, chronic obstructive pulmonary disease (COPD), pulmonary hypertension, diabetes, hypothyroidism, obesity, coronary artery disease (CAD), history of myocardial infarction, smoking, liver disease, peripheral vascular disease (PVD), alcohol abuse, and drug abuse. A total of 4330 AML cases with CKD were matched with 4330 cases of AML without CKD (control group). A multivariate logistic regression model was then performed taking into consideration the hospital characteristics, median household income of the patients, and the previously mentioned comorbidities to generate the adjusted odds ratio for outcomes of interest between the two groups. Results: The data for 53,068 hospitalizations for AML was collected between 2015-2019. Among these, 6997 cases had concurrent CKD. Patients with CKD were significantly older than their counterparts (72 vs 63 years, p<0.001), were more likely to be male (65.8% vs 53.4%, p<0.001), and black (13.9% vs 9.6%, p<0.001). They also had significantly more comorbid conditions like CAD, COPD, history of myocardial infarction, hypertension, diabetes, hypothyroidism, liver disease, and PVD. After PSM, multivariate logistic regression revealed CKD patients with AML had significantly higher odds of need for hemodialysis (OR: 4.26, 95% CI: 2.94-6.17, p<0.001), and mechanical ventilation (OR: 1.34, 95% CI: 1.13-1.58, p<0.001). AML patients with CKD also had higher odds of tumor lysis syndrome (OR: 2.00, 95% CI: 1.62-2.47; p<0.001), cardiogenic shock (OR: 3.55, 95% CI: 1.69-7.44, p<0.001), septic shock (OR: 1.38, 95% CI: 1.14-1.66, p<0.001), and all-cause mortality (OR: 1.29, 95% CI: 1.12-1.48, p<0.001). Interestingly, AML patients with CKD had lower odds of receiving a blood transfusion (OR: 0.87, 95% CI: 0.79-0.95; p=0.003), or platelet transfusion (OR: 0.79, 95% CI: 0.71-0.88; p<0.001) likely because of the lower chance of receiving intensive induction therapy as they had higher odds of receiving palliative care treatment instead (OR: 1.25, 95% CI: 1.12-1.48, p<0.001) (Figure 1). Conclusion: This large retrospective study suggests CKD as an independent risk factor for adverse hospitalization outcomes regardless of treatment modality in AML patients. CKD should therefore be accounted for when making therapy decisions for this subset of patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Socioeconomic predictors of cost and length of stay for erythroderma: a cross-sectional analysis of the national inpatient sample.

Erythroderma is an uncommon but serious dermatologic disorder that often requires hospitalization for diagnosis and treatment. However, little is known about predictors influencing cost and patient outcomes. The present study sought to characterize the sociodemographic factors that predict patient outcomes and hospital cost. Data were obtained from the 2016-2018 National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality for patients of any age with a primary or secondary diagnosis of exfoliative dermatitis. Regression analyses were performed to find predictors for hospital costs and patient outcomes, represented by the length of stay (LOS). Univariate analysis of LOS revealed urban teaching hospitals were associated with prolonged LOS (p = 0.023). Univariate analysis of hospital cost yielded the following factors associated with increased hospital cost: Black and Asian patients (p = .045), urban teaching hospitals (p = .035), and northeast or south geographic location (p = .004). Multivariable regression analysis revealed prolonged LOS was associated with female sex (p = .043) and large bed capacity (p = .044) while shorter LOS was associated with increased age (p = .025); lower hospital costs were associated with private-owned hospitals - (p = .025). In patients diagnosed with erythroderma, there appear to be racial, economic, and geographic disparities for patients that lead to greater hospital costs and longer LOS.

Acute gastrointestinal failure is associated with worse hemodynamic and perfusion parameters over 48 h after admission in patients with septic shock: Retrospective cohort study.

This study aimed to investigate the relationship between acute gastrointestinal injury (AGI) and hemodynamic and perfusion parameters in the first week of intensive care unit (ICU) admission and evaluate the association of AGI with ICU and hospital outcomes in patients with septic shock undergoing mechanical ventilation. This retrospective cohort study applied the criteria proposed by the European Society of Intensive Medicine to classify the participants into risk/dysfunction group (AGI grade I and II) and failure group (AGI grade III and IV). Hemodynamic and perfusion parameters data previously collected in the first 48 h after ICU admission (admission, 12, 24, 48 h) were analyzed. A total of 163 were included and classified into AGI grades I (n = 79), II (n = 64), III (n = 20), and IV (none). Groups consisted of AGI risk/dysfunction (n = 143, 87.8%) and AGI failure (n = 20, 12.2%) patients. Patients with AGI failure had higher heart rate and mottling score (MS) at admission, lower mean arterial pressure, and an oliguria incidence at 12 h compared with those without AGI failure. Skin MS and abdominal primary site of infection were risk factors for AGI failure. AGI failure tended to be a risk factor for ICU mortality (risk ratio [95% CI]: 1.37 [0.99-1.89]; P = 0.053). AGI was frequently observed in patients with septic shock in the first week of ICU admission. Higher heart rate and MS and lower mean arterial pressure and incidence of oliguria were identified in patients with AGI failure compared with those without. AGI failure was associated with ICU mortality.

Abstract 14569: Impact of Psoriasis on Inpatient Outcomes of Patients Admitted for Coronary Artery Bypass Graft: Analysis of the National Inpatient Sample

Introduction: Psoriasis is a systemic chronic inflammatory disorder with a global prevalence of 2-3%. Characterized by its skin manifestations and multiple comorbidities, it is notably associated with 50% increased likelihood of coronary artery, cerebrovascular and peripheral artery diseases. This study aims to assess the impact of psoriasis on inpatient outcomes of patients admitted for coronary artery bypass graft (CABG). Hypothesis: Co-existing psoriasis worsens hospital outcomes in patients admitted for CABG. Methods: We searched the National Inpatient Sample (NIS) 2016-17 database to identify adult hospitalizations with CABG as the principal diagnosis with and without psoriasis as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes were length of hospital stay (LOS) and total hospital charge (THC). Using Stata 17 software, multivariable logistic and linear regression analysis were applied to adjust for confounders. Results: There were over 71 million discharges included in the combined 2016-17 NIS database. Out of 477,389 CABG hospitalizations, 3,765 (0.8%) had psoriasis. The adjusted odds ratio (AOR) for inpatient mortality for CABG with co-existing psoriasis compared to those without psoriasis was 0.67 (95% CI 0.39-1.15, p=0.146). Hospitalizations for CABG with co-existing psoriasis had a decreased adjusted mean LOS by -0.44 days (95% CI {-0.85} - {-0.25}, p=0.037) and incurred a lower THC by -16,178.83 USD (95% CI {-27,541.02} - {4,816.63}, P=0.005) compared to those without psoriasis. Conclusions: In summary our study showed that CABG patients with psoriasis had a lower THC and LOS with no significant difference in mortality compared to CABG patients without psoriasis. It may be attributed to younger age group or immunosuppressive therapy and might warrant investigation into a more lenient CABG criteria for psoriasis patients.

The Association Between Hospital High-volume Anesthesiology Care and Patient Outcomes for Complex Gastrointestinal Cancer Surgery: A Population-based Study.

To examine the association of between hospital rates of high-volume anesthesiology care and of postoperative major morbidity. Individual anesthesiology volume has been associated with individual patient outcomes for complex gastrointestinal cancer surgery. However, whether hospital-level anesthesiology care, where changes can be made, influences the outcomes of patients cared at this hospital is unknown. We conducted a population-based retrospective cohort study of adults undergoing esophagectomy, pancreatectomy, or hepatectomy for cancer from 2007 to 2018. The exposure was hospital-level adjusted rate of high-volume anesthesiology care. The outcome was hospital-level adjusted rate of 90-day major morbidity (Clavien-Dindo grade 3-5). Scatterplots visualized the relationship between each hospital's adjusted rates of high-volume anesthesiology and major morbidity. Analyses at the hospital-year level examined the association with multivariable Poisson regression. For 7893 patients at 17 hospitals, the rates of high-volume anesthesiology varied from 0% to 87.6%, and of major morbidity from 38.2% to 45.4%. The scatter plot revealed a weak inverse relationship between hospital rates of high-volume anesthesiology and of major morbidity (Pearson: -0.23). The adjusted hospital rate of high-volume anesthesiology was independently associated with the adjusted hospital rate of major morbidity (rate ratio: 0.96; 95% CI, 0.95-0.98; P <0.001 for each 10% increase in the high-volume rate). Hospitals that provided high-volume anesthesiology care to a higher proportion of patients were associated with lower rates of 90-day major morbidity. For each additional 10% patients receiving care by a high-volume anesthesiologist at a given hospital, there was an associated reduction of 4% in that hospital's rate of major morbidity.

Inpatient Teleneurology Follow-up Has Comparable Outcomes to In-Person Neurology Follow-up.

Community emergency departments often transfer patients for lack of neurology coverage, potentially burdening patients and accepting facilities. Telestroke improves access to acute stroke care, but there is a lack of data on inpatient teleneurology and telestroke care. From our prospective telestroke registry, we retrospectively reviewed 3702 consecutive patients who were seen via telestroke between September 2015 and December 2018. Patients who required transfer after initial telestroke evaluation or who were kept at hospitals without consistent neurology coverage were excluded from analysis. We compared baseline demographics, clinical characteristics, and hospital outcomes in patients who were subsequently followed remotely by a teleneurology neurohospitalist and those followed in person by a neurohospitalist. There were 447 (23%) patients followed by a teleneurology neurohospitalist and 1459 (77%) patients followed in person by a neurohospitalist. Both groups presented with similar stroke severity. In multivariate analysis, there were no significant differences in discharge disposition, stroke readmission rates, or 90-day modified Rankin Scale (mRS) scores. Length of stay was shorter with teleneurology follow-up. In the subgroup of patients who received tissue plasminogen activator, patients showed no differences in outcomes and had similar complication rates. Teleneurology follow-up resulted in a 3% transfer rate for higher level of care after admission. There remained no difference in outcomes in a subanalysis without Comprehensive Stroke Centers. A higher proportion of non-Hispanic Black patients and a lower proportion of Hispanic patients in the teleneurology follow-up group were possibly due to spoke location demographics. Teleneurology follow-up resulted in comparable outcomes to in-person neurology follow-up, with few transfers after admission. For select neurology and ischemic stroke patients, teleneurology follow-up provides an alternative to transfer for hospitals lacking neurology coverage.

Hospital Volume and Postoperative Outcomes after Elective Lung Resection in Infants with Congenital Lung Malformations

INTRODUCTION: The relationship between hospital volume and patient outcomes after pediatric lung resection remains unknown. This study evaluated the association between hospital volume and postoperative outcomes in infants undergoing elective lung resection for congenital lung malformations (CLM). METHODS: After IRB approval, infants >30 days of age who underwent elective CLM resection were identified in the Pediatric Health Information System database (2016 to 2020). Those with previous symptomatic disease were excluded. Annual lung resection tertiles were used to classify hospitals into low (1 to 7 cases), medium (8 to 11 cases), or high (>11 cases) volume centers. Primary outcomes were hospital length of stay (LOS) and postoperative complications. Linear or Poisson multivariable regressions were performed. RESULTS: There were 1,420 infants from 48 hospitals. CLMs included congenital pulmonary airway malformations (n = 623, 43.9%) and bronchopulmonary sequestrations (n = 364, 25.6%). The mean annual cases at low-, medium-, and high-volume hospitals were 4.6 ± 1.6, 8.9 ± 1.2, and 36.4 ± 23.6, respectively. The median LOS was 2 days (interquartile range 2 to 3), and there were no differences based on center volume (p = 0.139). Overall postoperative complications were significantly increased at low-volume centers (31.1%) compared with medium-volume (16%) and high-volume (25%) centers (p < 0.001; Table 1). Respiratory complications were significantly increased in low-volume centers (28.8%) compared with medium-volume (14%) and high-volume (23%) centers (p < 0.001). Adjusted odd ratios showed a 51% reduction in overall complications (95% CI 0.37 to 0.65, p < 0.001) at medium/high-volume centers. Table 1. - Patient Outcomes by Center Volume Variable Low (n =89 patients) Medium (n = 534 patients) High (n = 497 patients) p Value Operative approach Thoracoscopic, n (%) 295 (75.8) 403 (75.5) 248 (49.9) <0.001 Open, n (%) 121 (31.1) 83 (15.5) 124 (24.9) <0.001 Respiratory complications, n (%) 112 (28.8) 73 (13.7) 112 (22.5) <0.001 Postoperative ventilation, n (%) 25 (6.4) 32 (6.0) 15 (3.0) 0.034 Length of stay (d), median (IQR) 2.00 (2–4) 2.00 (2–3) 2.00 (2–3) 0.139 Mortality, n (%) 1 (0.3) 1 (0.2) 0 (0) 0.7366 30-day readmission, n (%) 22 (5.7) 16 (3.0) 14 (2.8) 0.062 CONCLUSION: For elective infant lung resections, these data suggest that low-volume hospitals are associated with increased postoperative complications. Further study of CLM outcomes, including the role of surgeon-specific volume, is warranted.