Increased Length Of Hospital Research Articles

328 Medicaid Fee-for-Service Is an Independent Predictor of Increased Hospital Length of Stay After Traumatic Brain Injury

INTRODUCTION: Hospital length of stay (HLOS) is a metric of injury severity, resource utilization, and healthcare access. Recent evidence has shown associations between Medicaid and increased HLOS after traumatic brain injury (TBI). Whether managed care organization (Medicaid-MCO) or fee-for-service (Medicaid-FFS) models affect HLOS is unknown. METHODS: The Department of Health Care Access and Information Patient Discharge Database years 2017-2019 were queried for TBI patients aged =18-years (y) using ICD-10 codes (S06.0-S06.9/A). Inclusion criteria were Medicaid-MCO/Medicaid-FFS or PI not designated as death/hospice within 5-days of hospitalization. Demographic, socioeconomic status (SES), care-related, charges, and HLOS variables were compared. Subgroup analyses were performed in severe TBI (intracranial pressure monitor/craniotomy = Yes). Multivariable negative binomial regressions assessed the relationship between insurance and HLOS, adjusting for demographic, SES, injury severity, diagnosis-related group, and major complication/comorbidity. Incidence rate ratios (IRR) were reported. RESULTS: Overall (N = 39,834), 33.2% were Medicaid-MCO, Medicaid-FFS = 24.2%, and PI = 42.6%. Significant differences (p < 0.001) were observed for age (MCO = median 45y, FFS = 37y, PI = 44y), sex (male: MCO = 70.8%, FFS = 80.1%, PI = 68.8%), race (Hispanic: MCO = 35.0%, FFS = 51.6%, PI = 24.6%), lowest-quintile SES (MCO = 33.1%, FFS = 31.9%, PI = 9.0%), discharge to home (MCO = 72.1%, FFS = 76.8%, PI = 68.5%), and charges (MCO = median $100,297, FFS = $120,062, PI = $91,863). HLOS was longest in FFS (median = 4-days [IQR: 2-11], MCO = 4-days [2-9], PI = 3-days [1-7]). These differences were conserved in severe TBI (N = 1,650; MCO = 32.8%, FFS = 31.8%, PI = 35.3%) at greater magnitudes (home discharge: MCO = 15.5%, FFS = 25.6%, PI = 8.2%; charges: MCO = $629,625, FFS = $724,225, PI = $607,082; HLOS: MCO = 22-days [IQR: 13-34], FFS = 26-days [14-44], PI = 17-days [10-27]). On multivariable regression, Medicaid-FFS and MCO had significantly longer HLOS compared with PI in all TBI (IRR = 1.44 [95% CI: 1.41-1.48], IRR = 1.17 [1.15-1.20], respectively) and severe TBI (IRR = 1.52 (1.40-1.65), IRR = 1.25 [1.15-1.36], respectively). CONCLUSIONS: Medicaid-FFS had the highest likelihood of increased HLOS. Medicaid-MCO appeared to be a distinct risk stratum with shorter HLOS and lower hospital charges than Medicaid-FFS. Reasons may include different efficacies in care delivery and reimbursement, and require further investigation.

Diabetes Insipidus after Endoscopic Endonasal Pituitary Macroadenoma Resection: Correlation of Patient and Surgery-Related Risk Factors.

Purpose This article aims to identify patient- and surgery-related factors that could predict the development of postoperative central diabetes insipidus (DI). Methods This is a retrospective case-control study conducted at a single-institution tertiary referral center. Patients undergoing endoscopic endonasal skull base surgery for pituitary adenoma between November 2018 and April 2023 were recruited. The main outcome measures collected include age, gender, comorbidities, tumor type, postoperative DI, intraoperative and postoperative cerebrospinal fluid (CSF) leak, flow of CSF leak, number of layers required for repair, the use of nasal packing, and hospital length of stay. Results A total of 20 patients developed DI postoperatively. Patients' demographic and comorbidity profile did not correlate with DI development. The encounter of an intraoperative CSF leak was correlated with postop DI (chi-square (1) = 18.35, p < 0.001) with a relative risk (RR) of 2.7 (confidence interval [CI] = 1.37-5.28). The use of nasal packs was also correlated with postop DI (chi-square (1) = 10.17, p = 0.001) with a RR of 1.8 (CI = 1.15-2.87). Defects requiring a two or more layers for reconstruction also correlated with postop DI compared to single layer repairs (chi-square (1) = 12.15, p < 0.001) irrelevant of the materials used. Development of DI postop correlated with an increased hospital length of stay ( t (64) = -3.35, p = 0.001). Conclusion The physician should be careful when evaluating patients with pituitary adenomas in the postoperative period, particularly those with intraoperative CSF leak, nasal packing, and those who underwent multilayer reconstruction of the surgical defect.

Low Household Income Increases Hospital Length of Stay and Decreases Home Discharge Rates in Lumbar Fusion.

Retrospective Matched Cohort Study. Low median household income (MHI) has been correlated with worsened surgical outcomes, but few studies have rigorously controlled for demographic and medical factors at the patient level. This study isolates the relationship between MHI and surgical outcomes in a lumbar fusion cohort using coarsened exact matching. Patients undergoing single-level, posterior lumbar fusion at a single institution were consecutively enrolled and retrospectively analyzed (n = 4263). Zip code was cross-referenced to census data to derive MHI. Univariate regression correlated MHI to outcomes. Patients with low MHI were matched to those with high MHI based on demographic and medical factors. Outcomes evaluated included complications, length of stay, discharge disposition, 30- and 90day readmissions, emergency department (ED) visits, reoperations, and mortality. By univariate analysis, MHI was significantly associated with 30- and 90day readmission, ED visits, reoperation, and non-home discharge, but not mortality. After exact matching (n = 270), low-income patients had higher odds of non-home discharge (OR = 2.5, P = .016) and higher length of stay (mean 100.2 vs 92.6, P = .02). There were no differences in surgical complications, ED visits, readmissions, or reoperations between matched groups. Low MHI was significantly associated with adverse short-term outcomes from lumbar fusion. A matched analysis controlling for confounding variables uncovered longer lengths of stay and higher rates of discharge to post-acute care (vs home) in lower MHI patients. Socioeconomic disparities affect health beyond access to care, worsen surgical outcomes, and impose costs on healthcare systems. Targeted interventions must be implemented to mitigate these disparities.

Do Patients With Insulin-Dependent and Non-Insulin-Dependent Diabetes Have Different Risks for Complications After Total Ankle Arthroplasty?

Patients with diabetes undergoing total ankle arthroplasty tend to be at greater risk for complications than those without diabetes. However, the effect of diabetes severity and how it impacts the risk for perioperative complications is less clear. The purpose of this study was to compare (1) complications, (2) length of hospital stay, and (3) readmissions within 30 days for total ankle arthroplasty (TAA) patients without diabetes, patients with non-insulin-dependent diabetes, and patients with insulin-dependent diabetes. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, a total of 1803 patients undergoing TAA between 2007 and 2019 were collected. The relationship between diabetes status (no diabetes [n = 1,589], insulin-dependent [n = 169], and non-insulin-dependent [n = 45]) and outcomes were compared. Multivariate linear regression models were used to adjust for confounding variables such as age, sex, race, body mass index, smoking, steroid use, hypertension, chronic obstructive pulmonary disease, anesthesia type, dyspnea, and outpatient status. Statistical significance was set at P <.05. Insulin-dependent diabetes was an independent risk factor for increased odds of infection within 30 days (odds ratio 6.47, 95% CI 0.79-33.66; P = .043). Hospital length of stay was also increased in patients with non-insulin-dependent diabetes (β = 0.21, 95% CI 0.02-0.40; P = .031) and insulin-dependent diabetes (β = 0.40, 95% CI 0.04-0.76; P = .028). However, neither diabetic state demonstrated a statistically significant increase in readmissions or wound complications within 30 days. Patients with insulin-dependent diabetes included in this cohort were at increased risk of having an infection within 30 days after TAA. Additionally, patients with diabetes status had an increased hospital length of stay. These results can inform patients on their potential outcomes after total ankle arthroplasty based on their diabetes status.

Assessment of Nutritional Status and Correlation of Factors With Body Mass Index of Cancer Patients: A Cross-Sectional Study.

Decreased diet intake and malnourishment have profound implications on cancer patients' quality of life and survival. Malnutrition increases the risk of postoperative complications, increases hospital length stays, reduces patient's tolerance to radiation and chemotherapy treatment, and results in poor response to treatment. In the present study, we intended to assess the nutritional status of cancer patients and find the correlation of body mass index with anthropometric and blood parameters. The study was prospective and cross-sectional, and 104 patients with newly diagnosed solid tumors were included. Patient demographics, symptoms, and anthropometric and blood parameters were collected. The correlation was estimated with Pearson's correlation coefficient. A p-value of less than 0.05 was considered significant. The association between stages of the disease, dental status, type of diet, and BMI was p=0.701, 0.216, and 0.422, respectively, and was not statistically significant. The anthropometric parameters mid upper arm circumference (MUAC cm), mid arm circumference (MAC cm), and triceps skinfold thickness (TSF mm) correlated with body mass index (BMI kg/m2) and had statistically significant p values of 0.0001, 0.0001, and 0.033, respectively. The correlation was assessed between hemoglobin, red cell distribution width, neutrophil-to-lymphocyte ratio, and serum albumin levels with BMI, but except for albumin (p=0.05), no other blood parameter correlated. Nutritional assessment is vital in recognizing patients at risk of treatment-associated complications and poor responders to treatment. In this study, BMI correlated with anthropometric parameters MUAC, MAMC, and TSF. Baseline dietary assessments of patients will help focus on the nutritional build-up of patients before starting treatment.

Inpatient outcomes for lung cancer patients presenting with superior vena cava thrombosis

Background A specific cause of superior vena cava (SVC) syndrome, SVC thrombosis, is a rare but known complication in cancer patients. Early identification and management of SVC thrombosis in lung cancer patients may lead to improved patient outcomes and a reduction in healthcare costs. Methods We studied the racial and socioeconomic differences, length of stay, total hospital charges, and all-cause mortality outcomes in patients with lung cancer with and without SVC thrombosis using data from the National Inpatient Sample. Statistical analysis was performed on STATA. Results A total of 480,750 patients were hospitalized for lung cancer; 720 (0.15%) of these patients had SVC thrombosis. The lung cancer with SVC thrombosis cohort had a statistically higher proportion of Black patients. Patients with lung cancer presenting with SVC thrombosis had an increased hospital length of stay (10 vs 6 days, P < 0.001) and cost ($117,320 vs $80,806, P < 0.005) compared to those without SVC thrombosis. All-cause mortality in patients with lung cancer was 7.7% and the presence of SVC thrombosis significantly increased the odds of inpatient mortality (18.0%). Nonwhite races were associated with higher odds of mortality in lung cancer admissions. Conclusion Race, insurance type, and comorbidities impacted the likelihood of developing SVC thrombosis in patients with lung cancer. SVC thrombosis is a poor prognostic factor for patients with lung cancer. Further studies to evaluate these disparities are warranted.

Ambient fine particulate matter chemical composition associated with in-hospital case fatality, hospital expenses, and length of hospital stay among patients with heart failure in China.

Previous studies have observed the adverse effects of ambient fine particulate matter pollution (PM2.5) on heart failure (HF). However, evidence regarding the impacts of specific PM2.5 components remains scarce. We included 58 129 patients hospitalised for HF between 2013 and 2017 in 11 cities of Shanxi, China from inpatient discharge database. We evaluated exposure to PM2.5 and its components ((sulphate (SO42-), nitrate (NO3-), ammonium (NH4+), organic matter (OM) and black carbon (BC)), along with meteorological factors using bilinear interpolation at each patients' residential address. We used multivariable logistic and linear regression models to assess the associations of these components with in-hospital case fatality, hospital expenses, and length of hospital stay. Increase equivalents to the interquartile range (IQR) in OM (odds ratio (OR) = 1.13; 95% confidence interval (CI) = 1.02, 1.26) and BC (OR = 1.14; 95% CI = 1.02, 1.26) were linked to in-hospital case fatality. Per IQR increments in PM2.5, SO42-, NO3-, OM, and BC were associated with cost increases of 420.62 (95% CI = 285.75, 555.49), 221.83 (95% CI = 96.95, 346.71), 214.93 (95% CI = 68.66, 361.21), 300.06 (95% CI = 176.96, 423.16), and 303.09 (95% CI = 180.76, 425.42) CNY. Increases of 1 IQR in PM2.5, SO42-, OM, and BC were associated with increases in length of hospital stay of 0.10 (95% CI = 0.02, 0.19), 0.09 (95% CI = 0.02, 0.17), 0.10 (95% CI = 0.03, 0.17), and 0.16 (95% CI = 0.08, 0.23) days. Our findings suggest that ambient SO42-, OM, and BC might be significant risk factors for HF, emphasising the importance of formulating customised guidelines for the chemical constituents of PM and controlling the emissions of the most dangerous components.

Geriatric Pain Protocol: Impact of Multimodal Pain Care for Elderly Orthopedic Trauma Patients

ABSTRACT Hip fractures are costly, and associated complications are the leading cause of injury-related deaths in persons 65 years or older. Uncontrolled pain leads to increased hospital length of stay (LOS), delayed physical therapy, and long-term functional impairment. The Geriatric Pain Protocol (GPP) is Cedars-Sinai's multimodal pain management solution, addressing the needs of older adult inpatients who have suffered fractures. Study participants included hip fracture patients admitted between February 1, 2019, and March 5, 2021. Inclusion criteria were patients 65 years or older with a hip fracture sustained from a ground-level fall and surgical candidate. Participants were divided into 2 categories: Geriatric Fracture Program (GFP) and non-GFP, with physician participation in the GFP being the differentiating factor. End points included postoperative pain, postoperative opioid utilization, LOS, complications, and 30-day readmission rates. The GPP decreased morphine milligram equivalent (MME) daily totals on days 1 and 2 and improved pain management compared with non-GPP patients. MMEs were lower in the GPP group than in the non-GPP group for both postoperative day 1 (POD1) (P = 0.007) and POD2 (P = 0.043); the Numerical Rating Scale (NRS) pain score on POD1 was lower in the GPP group (vs non-GPP, P = 0.013). There were no group differences in NRS POD2 pain or complications (all Ps &gt; 0.1). The study sample (N = 453) had no significant difference between sex and LOS (all Ps &gt; 0.3). Although not statistically significant, the 30-day readmission rate trended lower in patients treated in accordance with the GPP. Use of the GPP reduced pain levels and MME totals.

A budget impact analysis of a powered hybrid mattress to prevent pressure ulcers in the Austrian inpatient setting: An original research.

Pressure ulcer is a considerable health problem and is associated with an increased hospital length of stay (LOS), nursing effort, costs, and reduced quality of life. The aim of this analysis is to compare the economic, clinical, and nursing benefit after the implementation of the powered hybrid mattress Dyna-Form Mercury Advance SMARTcare® in 2019 with the situation in 2017 (rental systems Arjo BariAir® and Arjo TheraKair Visio®, and purchased foam mattresses Arjo Simuflex®) using a single center. In the framework of a budget impact analysis, a difference-in-difference approach was used to compare pre-implementation longitudinal data (2017) with post-implementation data (2019). The longitudinal data comprise the mattress resource use, patient characteristics, and LOS. The care effort was gathered based on a full survey of all 75 members of the nursing staff using the online tool "LimeSurvey." In this survey, the resource use of the different mattress systems was identified in terms of time (minutes or days). This analysis was performed from the hospital perspective and included direct costs of mattress systems, Austrian diagnostic-related group costs for the hospital stay and nursing staff costs for 2019. Based on 1253 patients "at-risk," the total yearly costs implementing the powered hybrid mattress amounts to 654,248€ compared with 901,469€ when using Arjo products. The budget impact shows a cost advantage of 247,221€. Furthermore, the powered hybrid mattress system leads to fewer nursing-staff time in minutes per year (-1,031,097 min [1,993,204 vs. 3,024,302]); 242€ are saved per patient. Compared with the Arjo products, fewer inpatient cases of pressure ulcers (-44 cases [0 vs. 44]) were documented. Despite the higher total outlay of costs associated with the powered hybrid mattress, the long-term savings potential showed a significant cost advantage per annum for the single center. Therefore, the use of the hybrid mattress leads to considerable economic, clinical, and nursing benefits.

Abstract TMP42: Reducing 30-day Stroke Readmissions Using a Multi-Step Quality Improvement Approach

Background: Thirty-day all-cause readmissions occur in about 12% of acute ischemic stroke (AIS) patients, are associated with a 4-fold increase in mortality, and are associated with increased cost utilization. Therefore, reducing 30-day readmissions in AIS patients is of paramount importance. In this study, we aimed to test the effect of a multi-step quality improvement (QI) initiative on readmission rates in hospitalized AIS patients. Methods: We included all patients discharged from a Comprehensive Stroke Center with a diagnosis of AIS or TIA over a 3-year period. The pre-intervention period was 1/1/2020 - 9/30/2021. The approach was instituted on 10/1/2021. After a 3-month washout, the post-intervention period was 1/1/2022 - 6/30/2023. Intervention measures are below.1. An inpatient checklist was instituted to help providers identify and address common problems before AIS/TIA patients were discharged.2. Complex patients discharged home would receive a call shortly after discharge to ensure good understanding of their care and next steps. Such patients were also scheduled to follow up in a rapid access clinic within 2 weeks of discharge.3. Complex patients discharged to a facility required a handoff call to the facility’s accepting provider.4. All readmissions were reviewed in our monthly QI meeting, with efforts to identify preventable causes.We used t-tests to compare mean observed to expected (O:E) length of stay and mortality metrics between the pre- and post-intervention periods. We used Chi Square tests to compare overall readmission rates. Results: Over the study period, 2532 patients were discharged with a principal diagnosis of AIS or TIA, and the all-cause 30-day readmission rate was 8.8% (223/2532). Compared to pre-intervention, the post-intervention period had a lower 30-day readmission rate (7.6% vs. 10.2%, p = 0.023), a non-significantly lower mean O:E mortality rate (0.71 vs. 0.82, p = 0.252), and a non-significantly lower mean O:E hospital length of stay (0.92 vs. 0.88, p = 0.13). Conclusion: At a Comprehensive Stroke Center, a multi-step approach for transitions of care was associated with reduced all-cause readmission rates without increasing hospital length of stay or mortality. Our findings require external validation.

Trauma patient heterotopic ossification diagnosis is associated with increased hospital length of stay

BackgroundTraumatic heterotopic ossification (tHO) refers to the development of extra-skeletal bone in muscle and soft tissues following tissue insult secondary to surgery or trauma. This presents a persistent clinical concern associated with significant patient morbidity and expense to diagnose and treat. Traumatic HO is a substantial barrier to rehabilitation for trauma-injured patients. As such, the development of tHO after burn and other trauma is hypothesised to prolong inpatient length of stay (LOS) and thus increase health care costs. ObjectiveTo investigate the association between an inpatient tHO diagnosis and hospital LOS in trauma patients. MethodsA retrospective audit of trauma patients over a 14-year period was completed using data from four WA hospitals. Burn and neurological trauma patients diagnosed with tHO as an inpatient (tHO+) and control subjects (tHO-), matched (1:3) by age, gender, and injury severity factors, were identified using medical diagnostic codes. Data relating to patient and injury-related determinants of LOS from tHO+ and tHO- subjects were analysed to model the association of tHO on total hospital length of stay. Results188 identified patients were hospitalised due to traumatic injury; 47 patients with tHO following burn injury (n = 17), spinal cord injury (n = 13) and traumatic brain injury (n = 17), and 141 control patients. Those who developed tHO during hospitalisation had a significantly higher median LOS than matched trauma patients who did not develop tHO (142 days vs. 61 days). Multivariate regression analyses identified the following independent predictive factors of a prolonged hospital LOS: tHO diagnosis, mechanical ventilation hours, injury to the hip region and thigh area, other ossification disorder, pressure injury, admission to intensive care unit and deep vein thrombosis. Trauma patients diagnosed with tHO during their hospital admission stayed 1.6 times longer than trauma patients matched for injury severity without a tHO diagnosis (IRR 1.56, 95% CI 1.35–1.79, p<0.001). ConclusionTraumatic heterotopic ossification is an independent explanatory factor for increased hospital LOS in patients following burns, spinal cord, and traumatic brain injury. Early diagnosis may assist in reducing the impact of tHO on acute hospital stay after trauma.

Scoping Review of Healthcare Disparities in Treatment of Craniosynostosis: Assessing Impacts of Race, Insurance, and Socioeconomic Status

Background: Racial and socioeconomic factors persist as barriers to timely diagnosis and treatment for children with craniosynostosis, contributing to inequitable care. This scoping review aims to better understand how disparities influence differences in services, approach, and outcomes for patients undergoing surgical corrections for craniosynostosis. Methods: We conducted a PRISMA systematic review of all articles published between 2003 and 2023 within PubMed/Medline, Embase, and a Scopus cited review. Variables of interest included sociodemographic factors such as race, socioeconomic status (SES), and insurance status, and measurements of treatment access or outcomes within craniosynostosis surgical repair. Results: The final analysis included 28 studies, of which 21 studies examined race, 13 examined insurance status, and 5 examined household income or other socioeconomic factors. Overall, non-White, minority patients, patients with Medicaid or government-funded insurance, and patients from lower SES were more likely to experience delays in diagnosis and presentation for surgery compared to White and privately-insured patients. Black and Hispanic patients and patients with public insurance were more likely to undergo open cranial vault reconstruction (CVR) at an older age and experience longer total surgery time, increasing perioperative complication risk, compared to patients who underwent endoscopic procedures. Sociodemographic factors including non-White race, lower SES, and being underinsured or uninsured predisposed patients to the more expensive CVR procedure, increased hospital length of stay (LOS), and a higher rate of readmission, accumulating to greater total cost of care. Conclusion: Significant disparities continue to exist in craniosynostosis management. It is still unknown whether these discrepancies in the type of operation lead to significant clinical differences in neurocognitive outcomes, revision operations, or patient/parent satisfaction with appearance. This study highlights gaps in the current body of knowledge to better inform future aeas of investigation to ensure the best outcomes for all children born with craniosynostosis regardless of patient demographic.

The use of Montgomery salivary bypass tubes and pharyngocutaneous fistula following salvage laryngectomy.

Pharyngocutaneous fistula (PCF) is the most common complication to follow total laryngectomy (TL) and is associated with increases in length of hospital stay and with a need for revision surgery or readmission, as well as with delays in return to oral diet. Patients who require salvage TL (STL) or primary (chemo)radiation therapy are at higher risk for developing PCF. Due to the quality-of-life burden of PCF on patients, limiting this occurrence is crucial. We conducted a retrospective cohort study of patients undergoing STL with placement of Montgomery salivary bypass tube (MSBT)™ for at least 2 weeks duration between 2013 and 2017 at a single institution. Our patients all underwent free flap reconstruction. Our primary outcome of interest was development of PCF. Secondary outcomes included demographics, previous treatment, base of tongue (BOT) involvement, extent of defect, concurrent neck dissection (ND), and margin status. Univariate χ 2 analysis was used to evaluate factors associated with PCF. Forty-four patients underwent STL with Montgomery tube placement and free flap reconstruction. Eight developed PCF (18.2%). The average age was 61.6 years; 36 patients were male (81.8%), whereas eight patients were female (18.2%). There was no association between PCF and previous chemoradiation versus radiation (15.8% vs. 33.3%, P < 0.30), BOT involvement versus not (11.1 vs. 22.2%, P < 0.38), circumferential versus partial defect (18.8% vs. 17.9%, P < 0.94), ND versus none (10% vs. 25%, P < 0.20), or margin status. PCF complicated 18.2% of STL cases at our institution and was not associated with differences in primary treatment modality, presence of concomitant ND, extent of pharyngeal defect, BOT involvement, or positive frozen or permanent surgical margin.

Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019.

To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019. This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression. A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend. The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend. From 2011 to 2019, the diabetes mellitus hospitalization rate was 6.77 per 10,000 inhabitants, with a falling trend. Total expenditure was US$420,692.23 and it showed a rising trend. The study warns of the increase in child and adolescent hospitalizations, which indicates the need to invest in preventive actions and early diagnosis. The increase in length of hospital stay and related costs indicates a worrying scenario for the Brazilian National Health System and emphasizes the need to improve access to and quality of care, with a focus on diabetes education, so as to avoid complications and hospitalizations.

Delay in post-endoscopic refeeding in patients with upper GI bleeding leads to increased hospital length of stay

BackgroundPatients with acute upper gastrointestinal bleeding (UGIB) are made NPO prior to endoscopy. It is standard practice in those found to have low risk lesions to immediately resume a usual diet. Here, we evaluated refeeding practices in hospitalized patients with UGIB after endoscopy. MethodsIn this retrospective single-center cross-sectional study, we examined patients over the age of 18 with acute UGIB and low risk or no endoscopic lesion(s). Appropriate refeeding was categorically defined as resuming normal diet ≤ 4 h post-endoscopy. ResultsOf 230 patients (mean age, 62 years; 57% female) with acute UGIB and low-risk lesions or no lesion(s), 96 [41% (95% CI: 35% to 48%)] received their usual diet within 4 h after EGD. For the remaining 134 patients, refeeding was delayed on average from 13 (NPO until regular diet) to 31 (NPO until liquid diet, then regular diet) hours. Baseline clinical features were identical in patients who received their regular diet within 4 h after EGD and those who did not. Hospital length of stay was shorter in patients receiving usual diets promptly (5.3 days vs. 6.4 days, p = 0.03). Patients in an ICU at the time of their endoscopy had a statistically significantly higher probability of not being refed appropriately [OR 2.371, 95% CI 1.191-4.722). ConclusionsInappropriate dietary restrictions are frequent in patients with UGIB caused by low risk lesions. This delay in refeeding leads to increased length of hospital stay - suggesting that appropriate refeeding is an opportunity to improve patient care.

Role of Arterial Lactate and Lactate Clearance in Risk Stratification of Patients with Upper Gastrointestinal Bleeding Presenting to the Emergency Department for use at Primary Health Care Level

Abstract Background: Upper gastrointestinal bleeding is a common presenting complaint in the emergency department (ED) and carries a small but significant mortality rate. In spite of the availability of various scoring systems, risk stratification for in hospital morbidity and mortality remains difficult. There is no single test that can reliably predict active bleeding from the upper gastrointestinal tract for use at primary health level. Aims and Objectives: To study the role of lactate clearance as a predictor of active bleeding and also to determine whether an ED arterial lactate can predict adverse outcomes like increased hospital length of stay, in hospital, 30-day and 60-day mortality. Methods and Material: Prospective single centre observational study at a tertiary hospital in north Kerala that included all stable adult patients who presented with the complaints of hematemesis, melena or both to the ED Arterial lactate was drawn at the bedside, a priori initial arterial lactate cut-off value of 2.2 mmol/L was selected and in patients with lactate value above the cut-off, a second lactate was measured to calculate lactate clearance. Results: Lactate clearance ≤13.39% was found to be associated with a high risk for active bleeding (odds ratio: 23.33; 95% CI = 4.337 to 125.512, P &lt; 0.001). Optimal cut-off points for lactate as well as lactate clearance were derived using receiver operating characteristics curve. Conclusions: Lactate clearance can reliably rule in as well as rule out active bleeding in patients who might seem hemodynamically stable at the initial presentation to the ED.

Cardiac Catheterization and Outcomes for Elderly Patients Hospitalized With Heart Failure.

Heart failure affects over 6 million people in the United States (US) with limited evidence to support the use of cardiac catheterization. The benefit of its use remains mostly as expert opinion. This study intends to assess the benefits and risks of cardiac catheterization in elderly patients admitted for heart failure. This was a retrospective study using data from the National Inpatient Sample, including admissions 65 years and older hospitalized for heart failure, between 2008 and 2016. The outcomes analyzed were in-hospital mortality, total hospital costs, and length of stay. After controlling for covariates, cardiac catheterization was found to have a protective association with mortality (OR 0.87, 95% CI 0.833-0.912, P < .0001), an increased hospital length of stay by 2.88 days (95% CI: 2.84-2.92 days, P < .0001) and approximately $16 255 increase in cost. Cardiac catheterization was associated with decreased in-hospital mortality, longer length of stay and higher total costs in admissions with heart failure aged 65 years or older.

Financial model for a transitional pain service at a large tertiary academic center in the USA

Approximately 1 in 10 patients undergoing surgery is considered at high risk for poor pain and opioid-related outcomes due to chronic pain or persistent opioid use prior to surgery, leading...

Chinese expert consensus on the prevention and treatment of postoperative delirium of cardiovascular surgery

Postoperative delirium of cardiovascular surgery occurs in up to 26%-52% of patients after cardiovascular surgery and is associated with adverse outcomes, including increased hospital length of stay, higher cost of care, higher rates of readmission. The combination of multiple factors leads to postoperative delirium of cardiovascular surgery, including preoperative (previous psychiatric conditions and cognitive disfunction, cerebrovascular disease, age, cardiac insufficiency, and so on), intraoperative (duration of surgery>5 h, emergency surgery, anesthetic drugs, direct myocardial injury, and so on) and postoperative (pain, sleep disturbance, Deep sedation, duration of mechanical ventilation>72 h) risk factors. On the basis of the latest literature at home and abroad and the clinical experience of many experts, the Cardiac Critical Care Branch of China International Exchange and Promotive Association for Medical and Health sought to develop a consensus document"Chinese expert consensus on the prevention and treatment of postoperative delirium of cardiovascular surgery", in order to standardize the management of postoperative delirium of cardiovascular surgery and improve the prognosis of patients.

Bloodstream Infections in Children Hospitalized for Influenza, the Canadian Immunization Monitoring Program Active.

We aimed to estimate the proportion of children hospitalized for influenza whose illness was complicated by bloodstream infection, describe their clinical course, and identify the factors associated with bloodstream infection. We performed active surveillance for laboratory-confirmed influenza hospitalizations among children ≤16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from the 2010-2011 to 2020-2021 influenza seasons. Factors associated with bloodstream infection were identified using multivariable logistic regression analyses. Among 9179 laboratory-confirmed influenza hospital admissions, bloodstream infection occurred in 87 children (0.9%). Streptococcus pyogenes (22%), Staphylococcus aureus (18%) and Streptococcus pneumoniae (17%) were the most common bloodstream infection pathogens identified. Children with cancer [adjusted odds ratio (aOR): 2.78; 95% confidence interval (CI): 1.23-5.63], a laboratory-confirmed nonbloodstream bacterial infection (aOR: 14.1; 95% CI: 8.04-24.3) or radiographically-confirmed pneumonia (aOR: 1.87; 95% CI: 1.17-2.97) were more likely to experience a bloodstream infection, whereas children with chronic lung disorders were less likely (aOR: 0.41; 95% CI: 0.19-0.80). Disease severity markers such as intensive care unit admission (aOR: 2.11; 95% CI: 1.27-3.46), mechanical ventilation (aOR: 2.84; 95% CI: 1.63-4.80) and longer hospital length of stay (aOR: 1.02; 95% CI: 1.01-1.03) were associated with bloodstream infection. Bloodstream infection also increased the odds of death (aOR: 13.0; 95% CI: 4.84-29.1) after adjustment for age, influenza virus type and the presence of any at-risk chronic condition. Bloodstream infections, although infrequent, are associated with intensive care unit admission, mechanical ventilation, increased hospital length of stay and in-hospital mortality, thus requiring increased levels of care among pediatric influenza hospitalizations.