Increase In Likelihood Of Mortality Research Articles

Death, Debility, and Destitution Following Hip Fracture

We examined the effects of hip fracture on mortality, entry into long-term institutional care, and new evidence of poverty. We estimate of the proportion of hip fracture patients who require not just short-term rehabilitation but who become dependent on long-term institutional care, and the risk of becoming newly dependent on Medicaid or eligible for low-income subsidies following hip fracture. We used data from 2005 through 2010 for a random 5% sample of Medicare beneficiaries (N = 3.1 million) to conduct a retrospective matched cohort study. We used high-dimensional propensity score matching to compare outcomes for patients who experienced a hip fracture with subjects who did not, but had similar propensity for suffering a hip fracture. We then compared the 1-year risk of death, debility, and destitution between groups. We matched 43,210 hip fracture patients to comparators without a hip fracture. Hip fractures were associated with more than a twofold increase in likelihood of mortality (incidence proportion ratio [IPR] of 2.27, 95% CI, 2.20-2.34), a fourfold increase in likelihood of requiring long-term nursing facility care (IPR, 3.96; 95% CI, 3.77-4.16), and a twofold increase in the probability of entering into low-income status (IPR, 2.14; 95% CI 1.99-2.31) within 1 year following hip fracture compared with subjects without a hip fracture. Hip fracture in elderly patients resulted in increased death, debility, and destitution. Initiatives that lead to improved treatment of osteoporosis could result in a decrease in incidence of fractures, subsequent death, debility, and destitution for older adults.

Impact of Workload on Service Time and Patient Safety: An Econometric Analysis of Hospital Operations

Much of prior work in the area of service operations management has assumed service rates to be exogenous to the level of load on the system. Using operational data from patient transport services and cardiothoracic surgery—two vastly different health-care delivery services—we show that the processing speed of service workers is influenced by the system load. We find that workers accelerate the service rate as load increases. In particular, a 10% increase in load reduces length of stay by two days for cardiothoracic surgery patients, whereas a 20% increase in the load for patient transporters reduces the transport time by 30 seconds. Moreover, we show that such acceleration may not be sustainable. Long periods of increased load (overwork) have the effect of decreasing the service rate. In cardiothoracic surgery, an increase in overwork by 1% increases length of stay by six hours. Consistent with prior studies in the medical literature, we also find that overwork is associated with a reduction in quality of care in cardiothoracic surgery—an increase in overwork by 10% is associated with an increase in likelihood of mortality by 2%. We also find that load is associated with an early discharge of patients, which is in turn correlated with a small increase in mortality rate.

Substernal Thyroidectomy is Associated with Increased Morbidity and Mortality as Compared with Conventional Cervical Thyroidectomy

Although recent single-institution series have reported low morbidity and zero mortality after substernal thyroidectomy, a direct comparison of outcomes between substernal thyroidectomy and conventional cervical thyroidectomy has not been performed. We hypothesized that substernal thyroidectomy would be associated with higher morbidity and mortality as compared with cervical thyroidectomy. Data were extracted from the New York State Statewide Planning and Research Cooperative System database for the years 1998 to 2004. The primary predictor variable was substernal as compared with cervical thyroidectomy. Outcomes variables included postoperative complications, length of stay, and mortality. Multiple logistic regression was used to access the independent effects of substernal thyroidectomy on postoperative outcome. A total of 33,930 patients underwent thyroidectomy, 1,153 (3.4%) of whom underwent substernal thyroidectomy. Compared with patients who underwent cervical thyroidectomy (n=32,777), patients who underwent substernal thyroidectomy were older (p<0.0001), more likely to have a comorbid condition (p<0.0001), more likely to be men (p<0.0001), more likely to lack private insurance (p<0.0001), more likely to undergo total thyroidectomy (p<0.0001), less likely to undergo thyroidectomy for malignancy (p<0.0001), and less likely to undergo thyroidectomy at a high-volume center (p=0.001). After controlling for these covariates, patients who underwent substernal thyroidectomy were considerably more likely to experience recurrent laryngeal nerve injury (p=0.0002), postoperative bleeding (p=0.004), deep venous thrombosis (p=0.0002), and respiratory failure (p<0.0001), and were more likely to receive a red blood cell transfusion (p<0.0001). Patients who underwent substernal thyroidectomy also had a considerably increased length of stay (p<0.0001), and more than an eightfold increase in likelihood of mortality (p<0.0001). Substernal thyroidectomy, as compared with cervical thyroidectomy, is associated with a markedly increased likelihood of both postoperative complications and mortality.