Identify Baseline Patient Characteristics Research Articles

Predictors of Discharge to an Inpatient Extended Care Facility After Total Hip or Knee Arthroplasty

Increased emphasis has been placed on hospital length of stay and discharge planning after total joint arthroplasty (TJA). The purpose of this study was to identify baseline patient characteristics that are predictive of discharge to an inpatient extended care facility (ECF) after TJA. Clinical, demographic, and resource utilization data were analyzed for 7818 consecutive patients who underwent primary or revision TJA at 1 of 3 high-volume TJA centers. A stepwise linear regression model was used to identify predictors of discharge to an ECF. Overall, 29% of patients were discharged to an ECF after TJA. Older age, higher American Society of Anesthesiologists class, Medicare insurance, and female sex were all associated with a higher likelihood of discharge to an ECF. Significant differences in practice patterns were found across hospitals with respect to discharge disposition after TJA. Further study is necessary to determine the appropriate criteria for discharge to an ECF after TJA.

A model to predict chemotherapy-related severe or febrile neutropenia in cycle one among breast cancer and lymphoma patients

8068 Background: Chemotherapy used to treat cancer may produce severe (absolute neutrophil count ≤250/mm3) or febrile neutropenia (SFN), which often results in fever, infection, and hospitalization. This can lead to dose delays or reductions in subsequent chemotherapy cycles and/or early termination of therapy. Recent studies suggest most patients who experience SFN do so early in the course of chemotherapy, in particular during the first cycle. Several recent risk models for neutropenia have identified baseline patient characteristics that predict the occurrence of neutropenia. The ability to identify patients at risk for developing neutropenia early in their therapy might help guide appropriate hematopoietic growth factor use. We evaluated possible risk factors associated with cycle 1 SFN among a sample of patients with NHL or breast cancer. Methods: A historical case series of 1,617 patients (704 NHL and 913 early-stage breast cancer) who received initial chemotherapy at 16 community and academic oncology practices between 1991 and 1999 were selected for study. SFN was defined as absolute neutrophil count ≤250/mm3 or febrile neutropenia. Results: A total of 461 patients (29%) experienced at least one SFN episode; 268 (58%) of these patients (167 [59%] with NHL and 101 [56%] with breast cancer) had SFN in cycle 1. Risk factors associated with cycle 1 SFN included age ≥65 years (Odds ratio [OR] 2.08; 95% CI: 1.48–2.92), baseline hemoglobin <12.0 g/dL (OR 1.90; 95% CI: 1.41–2.58), presence of heart, renal, or liver disease (OR 2.12; 95% CI: 1.03–4.36), NHL (OR 1.64; 95% CI: 1.16–2.32), planned full chemotherapy dose intensity (OR 2.74; 95% CI: 1.55–4.84), and no growth factor in the first 5 days of cycle 1 (OR 1.82; 95% CI 1.07–3.08). Conclusions: Data routinely available to the clinician can help identify patients at risk for SFN in cycle 1. In our model assessing chemotherapy-related SFN in breast cancer and lymphoma, patients ≥65 were twice as likely to have SFN in Cycle 1. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen, Inc. Amgen, Inc.; Schering-Plough Amgen, Inc. Amgen, Inc.

Characteristics associated with delirium persistence among newly admitted post-acute facility patients.

Delirium is costly, common, and may persist for weeks or months. Therefore, the adverse impact of delirium on loss of independence may occur in the post-acute setting rather than in the hospital. The purpose of this study is to describe the rate of delirium persistence and identify baseline patient characteristics that are associated with delirium persistence at 1 month among newly admitted post-acute facility patients who were admitted with delirium. Patients were recruited from 4 Boston area skilled nursing facilities specializing in post-acute care (PAC). Assessment instruments included the Confusion Assessment Method Diagnostic Algorithm, the modified Delirium Symptom Interview, the Memorial Delirium Assessment Scale (MDAS), and the Blessed Dementia Rating Scale (BDRS). Multiple logistic regression analyses were used to identify patient characteristics associated with delirium persistence (at 1 month). Nearly 51% of the 85 delirious patients enrolled in this study had delirium at their 1-month follow-up assessment. Four patient factors associated with delirium persistence were identified: older age (> or =85 years), severe delirium at PAC admission (MDAS score >15), prehospital cognitive impairment based on proxy report [BDRS], and the presence of all 8 modified Delirium Symptom Interview symptoms at PAC admission. Our model has very good predictive power (area under the receiver operating characteristic = 0.85). Delirium is persistent in the post-acute setting. If verified in further research, the risk factors found in this study could be used to identify patients who are likely to have delirium after 1 month, and may prove useful in developing and targeting interventions of care.

Risk of major hemorrhage for outpatients treated with warfarin.

To determine the incidence of major hemorrhage among outpatients started on warfarin therapy after the recommendation in 1986 for reduced-intensity anticoagulation therapy was made, and to identify baseline patient characteristics that predict those patients who will have a major hemorrhage. Retrospective cohort study. A university-affiliated Veterans Affairs Medical Center. Five hundred seventy-nine patients who were discharged from the hospital after being started on warfarin therapy. The primary outcome variable was major hemorrhage. In our cohort of 579 patients, there were 40 first-time major hemorrhages with only one fatal bleed. The cumulative incidence was 7% at 1 year. The average monthly incidence of major hemorrhage was 0.82% during the first 3 months of treatment and decreased to 0.36% thereafter. Three independent predictors of major hemorrhage were identified: a history of alcohol abuse, chronic renal insufficiency, and a previous gastrointestinal bleed. Age, comorbidities, medications known to influence prothrombin levels, and baseline laboratory values were not associated with major hemorrhage. The incidence of major hemorrhage in this population of outpatients treated with warfarin was lower than previous estimates of major hemorrhage measured before the recommendation for reduced-intensity anticoagulation therapy was made, but still higher than estimates reported from clinical trials. Alcohol abuse, chronic renal insufficiency, and a previous gastrointestinal bleed were associated with increased risk of major hemorrhage.