Hospital Readmission Research Articles

WP1.10 - Are we Appropriately Consenting Patients for the Risks of Post Operative Urinary Retention following Groin Hernia Surgery?

Abstract Aims Consent is a fundamental process within surgery. General Medical Council (GMC) guidance advises that any recognised risks of harm resulting from a procedure should be discussed. Post-operative urinary retention (POUR) is a frequently encountered risk following groin hernia surgery, yet it can be missed when consenting. We aimed to review how frequently POUR occurs following groin hernia surgery in our hospital, along with how frequently it was consented for. Methods Retrospective data was collected on all patients undergoing planned groin hernia surgery in a single centre over a 6-month period between March and August 2023 . Data was collected on demographics, post-operative complications including POUR, and any other complications requiring hospital re-admission within 30 days. Consent forms were reviewed to identify whether POUR was documented as a risk. Results 128 groin hernia surgeries were carried out over the 6-month period. 13 patients (10.2%) experienced POUR, which was the most common complication in this group of patients. 7 of these patients did not have POUR documented as a risk factor on their consent. With only 46% overall having POUR documented as a risk factor on their consent. Conclusion Despite POUR being a common complication following groin hernia surgery, patients are often not being informed of this as part of the consent process. As over half of those patients who did experience POUR were not warned about this potential complication. Considering its frequency and potential impact on patients, improvements in consenting for POUR should be made.

SP4.14 - Mild acute biliary pancreatitis: still a surgical disease. A post-hoc analysis of the MANCTRA-1 international study

Abstract Aims The current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) reducing the risk of early recurrence. The MANCTRA-1 project disclosed a discrepancy in translating this evidence into clinical practice, estimating a 35 to 70% probability of narrowing this gap within 2025. This study assesses the safety of suboptimal ELC implementation in MABP, looking for risk factors for recurrent acute biliary pancreatitis (ABP) in patients awaiting interval cholecystectomy after an uneventful episode of MABP. Methods We conducted a post hoc analysis of the MANCTRA-1 registry. Clinicaltrials.gov ID NCT04747990. We included MABP patients who did not undergo ELC during the index hospitalization, excluding those who experienced disease-related complications. The primary outcome was the 30-day hospital readmission rate due to ABP recurrence. We performed univariable and multivariable logistic regression to identify risk factors for 30-day ABP recurrence. Results Between January 2019 and December 2020, a total of 2,253 MABP patients from 150 centres were included. The 30-day readmission rate due to ABP recurrence was 6%. The multivariable logistic regression showed that admission to a medical ward (internal medicine or gastroenterology) odds ratio (OR) 1.62 (95%[CI] 1.1;2.37), p=0.01 was an independent risk factor for 30-day ABP recurrence. Conclusion Our real-world analysis provides valuable insights to manage MABP, particularly in centres where ELC strategies cannot be fully implemented due to organizational and clinical constraints. Despite the admitting ward, it underscores the importance of timely access to surgical care in reducing the risk of early recurrence, disclosing the need to implement surgical consultation pathways in ABP care bundles.

COPD 2024: Applying the Canadian Thoracic Society (CTS) 2023 Chronic Obstructive Pulmonary Disease (COPD) Guideline for Preventing Exacerbations, Improving Health Status, and Preventing Mortality

Chronic Obstructive Pulmonary Disease (COPD) is a common, chronic respiratory condition that is associated with the risk of morbidity and mortality. Approximately 2 million Canadians live with COPD, and as many as 1 million suffer while remaining undiagnosed and untreated. COPD exacerbations represent the most expensive cause of hospitalization with the highest likelihood of hospital readmission. Exacerbations are the primary driver of mortality in patients with COPD. These exacerbations are the second leading cause of hospitalization in Canada with an average length of stay of 7 days. In fact, 1 in 5 patients with COPD will die within 1 year of their first hospitalization due to an exacerbation. For those 65 or older in Ontario, the overall 365-day mortality stands at nearly 28% following their first hospitalization due to an exacerbation. The best indicator of the risk of future exacerbations is a history of exacerbations. The time has come to end the stepwise pharmacologic escalation that has defined the treatment paradigm in COPD. The call to action is to shift from the slow promotion of inhaled pharmacotherapy based on exacerbations to a direct escalation to inhaled pharmacotherapy with demonstrated evidence to prevent the exacerbations.

FP7.7 - Evaluation of small bowel obstruction management: A local audit in comparison to NASBO guidelines

Abstract Aims The National Audit of Small Bowel Obstruction (NASBO) report provides recommendations for optimising the management of small bowel obstruction (SBO). We aimed to audit our management and compare our outcomes with the NASBO report. Methods Retrospective case reviews were conducted for 115 patients admitted with SBO from July-December 2022, evaluating adherence to NASBO guidelines and assessing outcomes. Results The average age was 76 (21-94) years old; 53% male and 47% female. Adhesions (41.7%), hernias (30.4%), malignancy (13%) and inflammatory bowel disease (6.1%) were predominant causes. Treatment included conservative management in 67% of cases, surgery in 27% (of which, 6.1% had a trial of conservative management initially) and palliative care in 6.1%. A summary of the management and outcomes below.Table 1:Summary of managementCT scan on admissionAverage time to CTSurgery performedAverage time to surgeryNutritional screening assessmentLocal audit98.3%9 hours27%2.4 days100%NASBO80%2.2 days48%1 day90%Table 2:Summary of outcomesUnable to eat normally for ≥5 daysAverage length of stay30-day mortality30-day readmissionLocal audit12%7 days14%18%NASBO49%10.7 days8%13% Conclusion We are performing CT scans in a timely manner and screening for malnutrition. Despite a shorter length of stay compared to NASBO, our audit has identified opportunities to improve hospital readmission, suggesting that we may be discharging patients prematurely. We have introduced a SBO checklist to ensure NASBO recommendations are adhered to and to improve our 30-day outcomes.

Health Care Resource Utilization Following Acute Myocardial Infarction: Findings from the RECORD-MI Registry

The contemporary health care resource utilization after an acute myocardial infarction (MI) is not well-known. All patients admitted because of MI between January 2015 and December 2021 across 28 hospitals in the Baylor Scott & White Health system were studied. Patient characteristics and outcomes, including all-cause and cardiovascular (CV) rehospitalizations, emergency department (ED) visits, and outpatient visits were evaluated. Of 6,804 patients admitted because of MI, 6,556 were discharged alive. The median age was 69 years, 60% were men, and 77% had non-ST-elevation MI; 17% (1,090) had multivessel disease. The number of patients with first all-cause readmissions within 30 days, 3 months, and 12 months of discharge were 844 (13%), 1,372 (21%), and 2,306 (35%), respectively, with a higher readmission rate in patients with non-ST-elevation MI, previous heart failure (HF), new-onset HF, and left ventricular ejection fraction ≤40%. ED visits at 12 months for any cause were 2,401 (37%), of which 1,321 (55%) were for any CV cause, with a higher incidence in patients with previous HF. Of the 6,556 patients, 4,102 (63%) had at least 1 primary care visit in the past year, 5,009 (76%) had CV specialty visits, and 3,860 (59%) had non-CV visits, with a similar distribution across subgroups. Patients hospitalized with an MI had a high risk of subsequent hospital readmissions and ED and outpatient visits, especially those with a previous HF diagnosis and those discharged with an MI and HF diagnosis.

Impact of Social Risk Screening on Discharge Care Processes and Postdischarge Outcomes: A Pragmatic Mixed-Methods Clinical Trial During the COVID-19 Pandemic.

Social risk screening during inpatient care is required in new CMS regulations, yet its impact on inpatient care and patient outcomes is unknown. To evaluate whether implementing a social risk screening protocol improves discharge processes, patient-reported outcomes, and 30-day service use. Pragmatic mixed-methods clinical trial. Overall, 4130 patient discharges (2383 preimplementation and 1747 postimplementation) from general medicine and surgical services at a 528-bed academic medical center in the Intermountain United States and 15 attending physicians. Documented family interaction, late discharge, patient-reported readiness for hospital discharge and postdischarge coping difficulties, readmission and emergency department visits within 30 days postdischarge, and coded interviews with inpatient physicians. A multivariable segmented regression model indicated a 19% decrease per month in odds of family interaction following intervention implementation (OR=0.81, 95% CI=0.76-0.86, P<0.001), and an additional model found a 32% decrease in odds of being discharged after 2 pm (OR=0.68, 95% CI=0.53-0.87, P=0.003). There were no postimplementation changes in patient-reported discharge readiness, postdischarge coping difficulties, or 30-day hospital readmissions, or ED visits. Physicians expressed concerns about the appropriateness, acceptability, and feasibility of the structured social risk assessment. Conducted in the immediate post-COVID timeframe, reduction in family interaction, earlier discharge, and provider concerns with structured social risk assessments likely contributed to the lack of intervention impact on patient outcomes. To be effective, social risk screening will require patient/family and care team codesign its structure and processes, and allocation of resources to assist in addressing identified social risk needs.

Predictive Analytics in Medicare: Reducing Hospital Readmissions through AI-Driven Insights

Predictive Analytics in Medicare: Reducing Hospital Readmissions through AI-Driven Insights

Hospital Readmissions Among Infants With Neonatal Opioid Withdrawal Syndrome

Although cases of neonatal opioid withdrawal syndrome (NOWS) increased 5-fold in recent years, no study has examined national hospital readmission rates for these infants. To examine hospital readmissions for infants with and without NOWS. This retrospective cohort study analyzed serial cross-sectional samples of US hospital discharge records from the Nationwide Readmissions Database for calendar years 2016 to 2020. Infants with NOWS were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The data analysis was performed between January 5, 2023, and May 6, 2024. Neonatal opioid withdrawal syndrome. Survey-weighted logistic regression was used to examine 90-day all-cause and cause-specific hospital readmissions. Multivariable models adjusted for sex, low birth weight, gestational age, multiple gestation, type of insurance, and year of birth. Of the 13 855 246 newborns identified in this weighted analysis, 89 018 (0.6%) were diagnosed with NOWS, of whom 53.8% were male and 81.1% born full-term (>36 weeks gestation). The 90-day all-cause readmission rate was 4.2% for infants with NOWS compared with 3.0% for those without NOWS (P < .001). After risk adjustment, the odds of all-cause readmission were higher among infants with NOWS (adjusted odds ratio [AOR], 1.18; 95% CI, 1.08-1.29). Infants with NOWS had significantly higher odds of readmissions for seizures (AOR, 1.58; 95% CI, 1.01-2.46), failure to thrive (AOR, 1.99; 95% CI, 1.36-2.93), traumatic brain injury (AOR, 2.95; 95% CI, 1.76-4.93), and skull fractures (AOR 3.72; 95% CI, 2.33-5.93). Infants with NOWS had higher odds of receiving a diagnosis of confirmed maltreatment (AOR, 4.26; 95% CI, 2.19-8.27), including for neglect (AOR, 14.18; 95% CI, 5.55-36.22) and physical abuse (AOR, 2.42; 95% CI, 0.93-6.29); however, the latter finding was not statistically significant. In this nationally representative cohort study, infants with NOWS were at increased risk of readmission for any cause as well as for trauma and confirmed maltreatment. These findings may in part reflect the dual stressors that mothers with opioid use disorder face in caring for a newborn with NOWS in the context of a substance use disorder and underscore the need for family-based, in-home services that focus concurrently on substance use treatment and parenting support.

Antibiotic prophylaxis for the prevention of surgical site infections following colorectal surgery: protocol for network meta-analysis of randomized trials

BackgroundSurgical site infections continue to be a significant challenge following colorectal surgery. These can result in extended hospital stays, hospital readmissions, increased treatment costs, and negative effects on patients’ quality of life. Antibiotic prophylaxis plays a crucial role in preventing infection during surgery, specifically in preventing surgical site infections after colorectal surgery in adult patients. However, the optimal antibiotic regimen is still unclear based on current evidence. Considering the limitations of existing reviews, our goal is to conduct a comprehensive systematic review and network meta-analysis of randomized controlled trials to evaluate the comparative benefits and harms of available antibiotic prophylaxis regimens for preventing surgical site infections following colorectal surgery in adult patients.MethodsWe will search the Medline, EMBASE, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials databases to identify relevant randomized controlled trials. We will include trials that (1) enrolled adults who underwent colorectal surgeries and (2) randomized them to any systemic administration of antibiotic (single or combined) prophylaxis before surgery compared to an alternative systemic antibiotic (single or combined antibiotic), placebo, control, or no prophylactic treatment. Pairs of reviewers will independently assess the risk of bias among eligible trials using a modified Cochrane risk of bias instrument for randomized trials. Our outcomes of interest include the rate of surgical site infection within 30 days of surgery, hospital length of stay, 30-day mortality, and treatment-related adverse effects. We will perform a contrast-based network meta-analysis using a frequentist random-effects model assuming a common heterogeneity parameter. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be utilized to assess the certainty of evidence for treatment effects.DiscussionBy synthesizing evidence from available RCTs, this study will provide valuable insight for clinicians, patients, and health policymakers on the most effective antibiotics for preventing surgical site infection.Systematic review registrationPROSPERO CRD42023434544.

Reducing 30-Day Readmissions in Patients With Alcohol Use Disorder

The 30-day hospital readmission rate for alcohol use disorder (AUD) at a Veteran’s Affairs hospital is 2% higher than the national benchmark. This quality improvement project aimed to implement a holistic approach to care of veterans with AUD through optimization of the Clinical Institute Withdrawal Assessment for Alcohol Scale-Revised protocol and development of a revised and evidence-based alcohol withdrawal syndrome order set. After implementation, there was a statistically significant decrease in 30-day readmissions and an increase in prescription of adjuvant therapies such as gabapentin and hydroxyzine. This quality improvement project improved the processes of care related to treatment of veterans with AUD admitted with alcohol withdrawal syndrome.

Swiss COVID-19 hospital surveillance: an in-depth analysis of the factors associated with hospital readmission dynamics in community-acquired COVID-19 cases.

The COVID-19 pandemic has placed unprecedented pressure on hospitals worldwide. In such a context of tension in healthcare systems, efficiently allocating hospital resources is a crucial aspect of crisis management. The aim of this study was to describe the clinical characteristics of readmitted patients and to determine risk factors for hospital readmission using data from the Swiss COVID-19 Hospital-Based Surveillance system (CH-SUR). We investigated hospital readmissions within 60 days after discharge of patients from the CH-SUR surveillance system with a first hospitalisation between 1 December 2020 and 1 December 2021. Only community-acquired cases were considered. We compared the baseline characteristics of readmitted and non-readmitted patients. We performed univariable and multivariable logistic regression analyses to investigate the risk factors for hospital readmission. Of the 8039 eligible patients, 239 (3.0%, 95% confidence interval [CI] 2.6-3.3%) were readmitted to hospital within 60 days of discharge, with no significant variations observed over the study period; 80% of all readmissions occurred within 10 days of discharge of the index hospital stay. Based on our multivariable logistic regression models, factors increasing the odds of hospital readmission were age ≥65 years (odds ratio [OR] 1.63, 95% CI 1.24-2.15), male sex (OR 1.47, 95% CI 1.12-1.93), being discharged to home after first hospitalisation (OR 1.77, 95% CI 1.19-2.62), having oncological pathology (OR 1.82, 95% CI 1.27-2.61) and being immunosuppressed (OR 2.34, 95% CI 1.67-3.29). Age, sex, cardiovascular diseases, oncological pathologies and immunosuppression were the main risk factors identified for hospital readmission.

Predictive Validity of the Academy of Nutrition and Dietetics/American Society for Parental Nutrition Indicators to Diagnose Malnutrition and the Screening Tool for Risk on Nutritional Status and Growth among Hospitalized Children Relative to Medical Outcomes

ObjectiveTo evaluate predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators to diagnose pediatric malnutrition (AAIMp) and the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) in regard to pediatric patient outcomes in US hospitals. Study designA prospective cohort study (Clinical Trial Registry: NCT03928548) was completed from August 2019 through January 2023 with 27 pediatric hospitals or units from 18 US states and Washington DC. ResultsThree hundred and forty-five children were enrolled in the cohort (n=188 in the AAIMp validation subgroup). There were no significant differences in the incidence of emergency department (ED) visits and hospital readmissions, hospital length of stay (LOS), or healthcare resource utilization for children diagnosed with mild, moderate, or severe malnutrition using the AAIMp tool compared with children with no malnutrition diagnosis. The STRONGkids tool significantly predicted more ED visits and hospital readmissions for children at moderate and high malnutrition risk (moderate risk - incidence rate ratio [IRR] 1.65, 95% confidence interval [CI]: 1.09, 2.49, p = 0.018; high risk - IRR 1.64, 95% CI: 1.05, 2.56, p = 0.028) and longer LOS (43.8% longer LOS, 95% CI: 5.2%, 96.6%, p = 0.023) for children at high risk compared with children at low risk after adjusting for patient characteristics. ConclusionsMalnutrition risk based on the STRONGkids tool predicted poor medical outcomes in hospitalized US children; the same relationship was not observed for a malnutrition diagnosis based on the AAIMp tool.

Bromocriptine treatment and outcomes in peripartum cardiomyopathy: the EORP PPCM registry.

Peripartum cardiomyopathy (PPCM) remains a serious threat to maternal health around the world. While bromocriptine, in addition to standard treatment for heart failure, presents a promising pathophysiology-based disease-specific treatment option in PPCM, the evidence regarding its efficacy remains limited. This study aimed to determine whether bromocriptine treatment is associated with improved maternal outcomes in PPCM. PPCM patients from the EORP PPCM registry with available follow-up were included. The main exposure of this exploratory non-randomized analysis was bromocriptine treatment, and the main outcome was a composite endpoint of maternal outcome (death or hospital readmission within the first 6 months after diagnosis, or persistent severe left ventricular dysfunction [left ventricular ejection fraction <35%] at 6-month follow-up). Inverse probability weighting was used to minimize the effects of confounding by indication. Multiple imputation was used to account for missing data. Among 552 patients with PPCM, 85 were treated with bromocriptine (15%). The primary endpoint was available in 491 patients (89%) and occurred in 18 out of 82 patients treated with bromocriptine in addition to standard of care (22%) and in 136 out of 409 patients treated with standard of care (33%) (p=0.044). In complete case analysis, bromocriptine treatment was associated with reduced adverse maternal outcome (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.10-0.83, p=0.021). This association remained after applying multiple imputation and methods to correct for confounding by indication (inverse probability weighted model on imputed data OR 0.39, 95% CI 0.19-0.81, p=0.011). Thrombo-embolic events were observed in 5.9% of the patients in the bromocriptine group versus 5.6% in the standard of care group (p=0.900). Among women with PPCM, bromocriptine treatment in addition to standard of care was associated with better maternal outcomes after 6 months.

Patient Focus: Rates of Heart Failure Medicines and Hospital Readmission: An explanation of “Prescription Patterns in the Management of Heart Failure and its Association with Readmissions: A Retrospective Analysis”

Patient Focus: Rates of Heart Failure Medicines and Hospital Readmission: An explanation of “Prescription Patterns in the Management of Heart Failure and its Association with Readmissions: A Retrospective Analysis”

Textbook outcome in short bowel syndrome

BackgroundTextbook outcome (TO) is a single composite score representing ideal care for a procedure or medical condition. Short bowel syndrome (SBS) patients are at high risk for complications and death. Our aim was to determine the incidence of and predictive factors for a TO in SBS patients. Methods515 adults with SBS were followed for 12 months after initial hospital discharge for SBS. TO was defined based on eight outcome parameters. Demographic data, intestinal anatomy, and nutritional outcome were compared in patients with and without TO. Results78 (15 ​%) patients had a TO. The frequency of the different components of TO were: PN ​< ​1 year (39 ​%), BMI >18.5 ​kg/m2 (89 ​%), no stoma (59 ​%), no surgical intervention (71 ​%), no hospital readmission (56 ​%), no vascular access infection (62 ​%), absence of end stage liver disease (96 ​%), and survival (97 ​%). Intestinal remnant length and anatomy type were predictive of a TO. ConclusionsA TO is achieved in 15 ​% SBS patients using the selected criteria. This is largely attributable to continued need for PN. Intestinal length and anatomy were independent predictors of TO.

Implementation of a High-sensitivity Troponin Assay for Adult Patients Who Present to the Emergency Department: The Role of Clinical Decision Support

BackgroundThe objective of this study was to assess the health outcomes for patients who present to the emergency department (ED) with cardiac chest pain after the implementation of an accelerated diagnostic protocol using a high-sensitivity troponin assay (hs-TnI). MethodsThis prospective before-after cohort study used population-based linked health administrative data for adult patients who presented to a Canadian urban ED with chest pain of suspected cardiac origin over a 2-year study period. The primary outcome was ED length of stay (LOS). Secondary outcomes included operational and clinical outcomes within 30 days of the index ED visit. ResultsDuring the study period, 4339 patients were included, with 2031 in the conventional troponin group and 2308 in the hs-TnI group. Overall, the median age was 56 years and 52% were male. The median ED LOS was reduced from 430 minutes to 400 minutes after protocol implementation (median difference, -30.0; 95% confidence interval, -47.8 to -12.3). For discharged patients who underwent serial troponin tests, the LOS was 89 minutes shorter (95% confidence interval, -110.8 to -67.2). The proportion of patients discharged increased from 73% to 78% after implementation (P = 0.0001). At 30 days, there were no differences in hospital readmission or major adverse event outcomes. ConclusionsUsing clinical decision support, the implementation of a new hs-TnI and accelerated diagnostic protocol was associated with shorter ED LOS and fewer hospitalizations for adult patients with chest pain who were assessed in the ED. These results suggest that the protocol is effective and safe in real-world clinical settings.

Neighborhood Socioeconomic Disadvantage is Associated with Increased Healthcare Utilization After Septic and Aseptic Revision Total Hip Arthroplasty

BackgroundA greater Area Deprivation Index (ADI), a tool that gauges socioeconomic disadvantage at the neighborhood level, is associated with worse healthcare outcomes following primary total hip arthroplasty (THA). However, its association with revision THA (rTHA) is unknown. This study aimed to determine the association between ADI and rates of postoperative healthcare resource utilization following rTHA. MethodsA total of 996 patients who underwent rTHA between 2016 and 2022 were enrolled in a prospective study. The primary outcomes assessed were non-home discharge disposition (DD), length of stay (LOS) ≥ 3 days, 90-day emergency department (ED) visits, and 90-day hospital readmissions. The ADI was calculated using the patient’s home address at the time of surgery, with greater ADI indicating greater socioeconomic disadvantage. We evaluated the mediation effect of patient race on ADI and postoperative healthcare utilization using a multivariable logistic regression model. ResultsA higher median ADI was revealed for patients who experienced non -home discharge (P = 0.001), extended LOS (P < 0.001), and ED readmission within 90-days of surgery (P = 0.045). When comparing septic versus aseptic rTHA patients, there were significant differences in healthcare resource utilization but no difference in ADI between the two groups. For aseptic rTHA, ADI significantly mediated the effect of race on both non-home DD and LOS ≥ 3 (41% and 46% mediation, respectively). In septic rTHA, ADI mediated 31.1% of the effect of race on non-home DD, but showed minimal mediation effect on LOS. The mediation effect of ADI on ED admission and hospital readmission was minimal for both groups ConclusionHigher ADI scores are associated with increased healthcare utilization after rTHA, including longer hospital stays and more non-home discharges. The ADI significantly mediates the effect of race on these outcomes, particularly in aseptic rTHA cases, suggesting that neighborhood socioeconomic factors play a crucial role in previously observed racial disparities.

Delayed Gastric Emptying and Other Adverse Outcomes in Patients Undergoing Classic Whipple Versus Pylorus-Sparing Pancreatoduodenectomy.

Background and objective Pancreatoduodenectomy (PD), or the Whipple procedure, has many variants. There is a lack of data in the literature in terms of comparing various types of this procedure. This study aimed to comparethe classic Whipple procedure with the pylorus-sparing Transverso-Longmire technique, focusing on postoperative complications and delayed gastric emptying (DGE). Methodology We conducted a retrospective observational study including 97 adult patients who underwent either the classic Whipple procedure or the pylorus-sparing technique at Hospital Médica Sur from 2016 to 2021. Data on patient demographics, comorbidities, type of surgery, clinical presentation, and postoperative complications were collected. DGE was defined according to the International Study Group of Pancreatic Surgery(ISGPS) criteria. Results Among the 97 patients, 50.5% were men, and the median age of the cohort was 65 years. Almost all patients underwent surgery for malignancy (96.9%). The classic Whipple group had fewer cases of DGE (9.8% vs. 30.6%, p=0.01), shorter hospital stays (7 vs. 11 days, p=0.001), and lower readmission rates (13.1% vs. 33.3%, p=0.017). The pylorus-sparing PD was associated with a lower incidence of bile leak [odds ratio (OR)=0.62, 95% confidence interval (CI): 0.53-0.73]. However, this technique was associated with a higher incidence of DGE (OR=4, 95% CI: 1.34-12.1), overall hospital admission rates (OR=3.3, 95% CI: 1.2-9.2), and admissions that resulted in a surgical event (OR=1.9, 95% CI: 1.21-2.96). DGE was associated with the need for a second surgery (OR=10.5, 95% CI: 2.8-39.5) and hospital readmission (OR=10, 95% CI: 3.1-32.3). Conclusions While the pylorus-sparing technique is associated with reduced bile leaks, it results in a higher incidence of DGE, prolonged hospital stays, and increased readmissions. Clinicians opting for the pylorus-sparing technique should ensure careful patient selection and rigorous postoperative monitoring.

Frequency &amp; Predictors of Depression in Patients of Chronic Heart Failure with Reduced Ejection Fraction (HFrEF)

Background: Clinically significant depression is estimated to occur in a significant portion of chronic heart failure (CHF) patients and increases sharply with increase in heart failure severity. However, the frequency and predictors of depression in this group of patients are underreported. This study was designed to assess frequency &amp; predictors of depression in patients of chronic heart failure with reduced ejection fraction (HFrEF). Methods: This cross-sectional analytical study was performed in the department of Cardiology, Dhaka Medical College Hospital, Dhaka, during the period from October’2018 to Septemeber’2019. One hundred and fifty-two CHF patients with reduced ejection fraction (&lt;40%) either admitted in the department of Cardiology or attended Cardiology OPD, Dhaka Medical College Hospital (DMCH), Dhaka who fulfilled the selection criteria were included into the study. A translated and validated Patient Health Questionnaire (PHQ-9) in Bengali was used to assess depression level in CHF patients in this study. Informed written consent was taken from each patient. Approval for the study was taken from Ethical Review Committee (ERC) of Dhaka Medical College before commencement of the study. After compiling data from all participants, statistical analyses were performed using the Statistical Package for Social Science (SPSS), version 22.0 for windows. Results: Mean age of the patients was 58.68±9.40 years, ranging from 36 to 75 years. Male predominance was noted (72% vs 28%). Overall, frequency of depression was 56%. Among the depressed patients (n=85), majority (40%) had minimal depression while 27%, 19% and 14% had mild, moderate and severe depression. respectively. Among the different risk factors, DM and sedentary lifestyle were significantly associated with depression (p&lt;0.05). Age &gt;65 years, sedentary lifestyle, and H/O past MI were independently associated with depression among chronic HErEF patients. Widowed patients, diabetes, hospital readmission in last 2 months before study inclusion and NYHA class III/IV were also significantly associated with depression among patients with chronic HFrEF (p&lt;0.05). Conclusion: More than half of the patients with chronic HFrEF had concurrent depression of varied severity. Proper care of depression along with HF may improve the survival and quality of life of these patients. Bangladesh Heart Journal 2024; 39(2): 74–84

The association between patient self-reported experiences with medication discharge counselling and hospital readmissions: a cross-sectional analysis of a population-based survey

ObjectiveTo investigate the association between patient-reported experiences with new medication discharge counselling and readmission to hospital or emergency department (ED) visits within 30 days of discharge. MethodsA retrospective cross-sectional study of patient-reported experiences from 8715 patients who reported being prescribed a new medication at discharge from a public hospital. Completeness of medication counselling was assessed based on (i) explanation of medication purpose, (ii) explanation of medication side effects, (iii) patient involvement in decision to use medication, (iv) provision of contradictory information. Multilevel models were used to estimate self-reported 30-day readmission or ED visit related to care received using adjusted odds ratios (AORs). ResultsPatients who were explained medication purpose were half as likely to report a readmission (AOR 0.54, 95%CI 0.31-0.93) or ED visit (AOR 0.65, 95%CI 0.48-0.87) within 30 days of discharge. Conversely, those who reported receiving contradictory information were more likely to report a readmission (AOR 1.62, 95%CI 1.16-2.26) and ED visit (AOR 1.82, 95%CI 1.41-2.34). ConclusionPatients who reported receiving comprehensive counselling on new medications were less likely to report being readmitted or visiting an ED within 30 days of discharge.