Increased Hospital Length Of Stay Research Articles

Impact of Comorbidities as Predictors on Hospital Length of Stay (LOS) and Mortality in Hip Fracture (HF) Patients in a Rural Community

Purpose: Studies on HF at a rural health system area are rare. The research question is “Which demographic, preoperative variables would be independent predictors of outcomes on mortality and hospital LOS?”
 Methods: The design is a community-based cross-sectional study with risk factor analyses. We ascertained HF cases from hospital trauma center registry and Epic software. We employed both descriptive and analytic approaches including multivariable regression analyses of predictors on outcomes.
 Results: Of 201 HF patients, 85.6% occurred in 65 and above years (seniors). Among seniors, females consisted of 64.0% with mean age ± SD: 83.72 ± 7.56 years; extracapsular HF, 55.2%; specified falls, 51.7%; obesity, 15.2%; complication, 3.5%; surgery interventions, 80.8%; mortality within 1, 9.3%; 3, 11.6%; 6, 15.1%; and 12 months, 22.1% after hospital admission. Holding all other variables constant, no surgical intervention increased mortality risk within 1-month (OR=28.87, 95% CI: 4.43; 188.16), 3-months (OR=33.47; 95% CI: 5.24; 213.88), 6-months (OR=21.78; 95% CI: 3.67; 129.48), and 12-months (OR=4.17; 95% CI: 1.33;13.04) compared to surgical intervention; obesity increased 1-month mortality risk (OR=6.00; 95% CI: 1.06; 34.09) compared to no obesity; and patients transferred from community hospital compared to those who were not had an increased 1-month (OR= 8.54; 95% CI: 1.25; 58.13), 3-month (OR=15.31; 95% CI: 2.21; 106.16), 6-month (OR=21.19; 95% CI: 3.34; 134.43), and 12-month (OR=5.14; 95% CI: 1.85; 14.28) mortality risk. Hospital LOS was 3.06 days higher in obese patients than non-obese patients and 2.11 days higher in surgery greater than 48 hours when compared to surgery within 48 hours, holding all other variables constant.
 Conclusions and Potential Impact: We believe that surgical intervention decreases, and obesity increases HF mortality. Obesity and delayed surgical intervention increase hospital LOS. The results of this study have the potential benefit for improving community health of rural, elderly populations in northeast Indiana.

Cerebrovascular Events and Hospital Discharge Outcomes Associated With Drug Use: A Retrospective Case-Matched Study.

Introduction Individuals using cocaine, methamphetamines, cannabis, and other mood-altering drugs (MADs) have been reported to have greater stroke risk when compared to individuals who do not use these drugs. Yet, the impactthat MAD use has on stroke outcomes has not been adequately explored, with existing research not agreeing on the extent to which the use of these drugs influences stroke outcomes. This study aimed to determine the impact that the use of common MADs has on stroke outcome factors such as length of stay (LOS), discharge modified Rankin Scale (mRS), and discharge disposition. Methods A retrospective case-matched study was conducted with two adult cohorts treated for cerebrovascular accidents: those who use MADs and those who do not use MADs prior to their stroke. Subjects identified for the users of MADs cohort were matched at a 1:1 ratio to those who do not use MADs (control cohort) by age, sex, and stroke type (e.g., hemorrhagic or ischemic).Logistic regression was used to calculate odds ratios forfunctional outcomes for stroke patients with and without prior MAD use. Results Activeusers of MADs had an increased overall risk of poor stroke outcome, i.e., increased length of stay, discharge disposition other than to home or to rehabilitation, discharge modified Rankin scale (mRS) 3-6after controlling for stroke severity from initial National Institutes of Health Stroke Scale (NIHSS) (X2{9}=21.68, p<0.01, Cox adjusted R2=0.31). This finding was driven predominately by increased hospital LOS (p=0.006) among the MAD cohort, whereas discharge mRS 3-6 (p=0.24) and discharge disposition to care facility (p=0.27) and expired (p=0.26) did not vary significantly between groups. Conclusion Our study suggests that patients who had actively used MADs prior to their stroke may be at risk of poorer stroke outcomes, namely an increased LOS. Future research should be conducted to further elucidate which factors, such as individualdrugs, amount of drug, acute or recreational use versus chronic or long-term use, and route of administration, for instance, specifically contribute to a longer LOS so that they may be targeted for mitigation.

Streptococcus pneumoniae associated hemolytic uremic syndrome in children.

Previous small-scale, single-center investigations of Streptococcus pneumoniae associated hemolytic uremic syndrome (SpHUS) have shown increased disease severity among SpHUS relative to non-SpHUS patients. Our study compares the impact of S. pneumoniae on patient outcomes between SpHUS cases and non-SpHUS controls using the national, multicenter retrospective Pediatric Health Information Systems (PHIS) Database. Children <18 years of age with a diagnosis of HUS were included. Univariate analyses and multivariable linear and logistic regressions were utilized to assess the impact of S. pneumoniae on mortality, length of stay (LOS), intensive care unit admission (ICU), and mechanical ventilation use. Models were adjusted for demographic and clinical characteristics, including cardiac, neurologic, pulmonary, gastrointestinal, immunologic and renal clinical complications. Of 3,952 index HUS hospitalizations, 231 (5.8%) were due to SpHUS. SpHUS patients had worse outcomes, including longer hospital stays, increased rate of ICU admission, and increased use of mechanical ventilation (p < 0.001 for all). There was a strong positive relationship between clinical complications and adverse outcomes. After adjusting for covariates, SpHUS was associated with an increase in hospital LOS by 3.47 days (p = 0.009) and overall ICU-LOS by 4.21 days (p < 0.001). SpHUS was also associated with increased likelihood of mechanical ventilation (OR: 3.08; p < 0.001), with no increase in ICU admission (p = 0.070) and in-hospital mortality (p = 0.3874). Our study highlights that SpHUS patients are at increased risk of multiple adverse outcomes likely due to the summative impact of pneumococcal infection and HUS as well as more frequent clinical complications.

Abstract 18561: Trends Among Patients Undergoing Transvenous Lead Extraction: A Single Center Experience

Background: In recent years there has been an increase in cardiac device-related infections and the need for transvenous lead extraction (TLE). Limited data exist on secular trends in baseline characteristics and outcome measures among patients undergoing this high-risk procedure. Objective: To examine secular trends in baseline characteristics and outcomes for patients undergoing lead extraction procedure at our institution. Methods: We conducted a retrospective chart review of patients undergoing TLE from 2010 to 2021, at a tertiary academic institution. Patients were divided into three epochs (2010-2013, 2014-2017 and 2018-2021). Baseline characteristics in hospital length of stay (LOS) and survival were compared between groups. Results: A total of 794 patients, with a mean age of 64±16 years, were analyzed. 481 (60%) patients had infection as the indication for TLE. On average, 2 ± 1 leads were extracted per patient. The longest lead dwell time was 6.5 ± 4.8 years. Significant progressive increase in baseline comorbidity over time is noted (Table 1). A concomitant increase in infection indication versus lead management was also noted. There was a significant increase in the median hospital LOS across epochs; 3.88 IQR (1.26-10.06) for epoch 1 vs 7.34 IQR (2.25-13.35) for epoch 2, vs 9.06 IQR (5.78-14.05) for epoch 3 (P &lt; 0.0001). While there was no difference in long term survival curves (log rank p =0.4), between group analysis showed higher risk for 30 day [RR 2.24(1.08-4.66) p=0.0306] and 1 year mortality [RR 1.44 (1.004-2.05) p=0.0478] between epoch 3 vs epoch 1. Conclusion: Across epochs, the number of TLE procedures performed decreased while patient morbidity increased with a notable increase in infection indication for the procedure. This corresponded to a progressive increase in hospital LOS and an emergent signal toward increased near-term mortality.

Neighborhood Income Is Associated with Health Care Use in Pediatric Short Bowel Syndrome

ObjectiveTo evaluate associations between neighborhood income and burden of hospitalizations for children with short bowel syndrome. Study designWe used the Pediatric Health Information System (PHIS) database to evaluate associations between neighborhood income and hospital readmissions, readmissions for central-line associated bloodstream infections (CLABSI), and hospital length of stay (LOS) for patients <18 years with SBS hospitalized between 1/1/2006 and 10/1/2015. We analyzed readmissions with recurrent event analysis and analyzed LOS with linear mixed effects modeling. We used a conceptual model to guide our multivariable analyses, adjusting for race, ethnicity, and insurance status. ResultsWe included 4,289 children with 16,347 hospitalizations from 43 institutions. Fifty-seven percent of the children were male, 21% were Black, 19% were Hispanic, and 67% had public insurance. In univariable analysis, children from low-income neighborhoods had a 38% increased risk for all-cause hospitalizations (rate ratio [RR] 1.38, 95% CI 1.10, 1.72, p=0.01), an 83% increased risk for CLABSI hospitalizations (RR 1.83, 95% CI 1.37, 2.44, p<0.001), and increased hospital LOS (β 0.15, 95% CI 0.01, 0.29, p=0.04). In multivariable analysis, the association between low-income neighborhoods and elevated risk for CLABSI hospitalizations persisted (RR 1.70, 95% CI 1.23, 2.35, p<0.01, respectively). ConclusionChildren with SBS from low-income neighborhoods are at increased risk for hospitalizations due to CLABSI. Examination of specific household- and neighborhood-level factors contributing to this disparity may inform equity-based interventions.

High flow nasal cannula use is associated with increased hospital length of stay for pediatric asthma.

High flow nasal cannula (HFNC) is a respiratory device increasingly used to treat asthma. Recent mechanistic studies have shown that nebulized medications may have reduced delivery with HFNC, which may impair asthma treatment. This study evaluated the association between HFNC use for pediatric asthma and hospital length of stay (LOS). This was a retrospective matched cohort study. Cases included patients aged 2-18 years hospitalized between January 2010 and December 2021 with asthma and received HFNC treatment. Controls were selected using logistic regression propensity score matching based on demographics, vital signs, medications, imaging, and social and environmental determinants of health. The primary outcome was hospital LOS. A total of 23,659 encounters met eligibility criteria, and of these 1766 cases included HFNC treatment with a suitable matched control. Cases were well-matched in demographics, social and environmental determinants of health, and clinical characteristics including use of adjunctive asthma therapies. The median hospital LOS for study cases was significantly higher at 87 h (interquartile range [IQR]: 61-145) compared to 66 h (IQR: 43-105) in the matched controls (p < 0.01). There was no significant difference in the rate of intubation and mechanical ventilation (8.9% vs. 7.6%, p = .18); however, the use of NIV was significantly higher in the cases than the control group (21.3% vs. 6.7%, p < .01). In this study of children hospitalized for asthma, HFNC use was associated with increased hospital LOS compared to matched controls. Further research using more granular data and additional relevant variables is needed to validate these findings.

Predictive Risk Factors for Childbirth-Associated Breast Infections in the United States: A 10-Year Perspective.

Infectious mastitis is a common condition that affects up to 33% of lactating women. Several risk factors have been suggested to be strongly associated with breast abscess, nipple infection, and non-purulent mastitis associated with childbirth. In this retrospective cohort study, we gathered data from the National Inpatient Sample (NIS) between 2005 and 2014 and utilized data stratification and backward linear regression to analyze the predictive factors associated with patients hospitalized with breast infection after childbirth, with special consideration of risk factors affecting hospital length of stay (LOS). In the ten-year period, 4614 women were hospitalized with a primary diagnosis of breast abscess, nipple infection, or non-purulent mastitis associated with childbirth. Mean (SD) age was 26.75 (6) years. The highest frequency distribution of cases was observed in patients aged 22-30 years (49.82%). Mean (SD) LOS was 2.83 (1.95) days. Mean (SD) LOS in patients with procedure was 3.53 (2.47) days, which was significantly longer than that in those with no procedure (2.39 (1.36) days, p < 0.001). Primary diagnosis of breast abscess and occurrence of a hospital procedure were most significantly associated with prolonged LOS. Factors such as age, socioeconomic position, severity of functional loss, as well as comorbidities were also contributing risk factors to the development of breast infection and increased hospital LOS. Further studies should examine these findings, as they relate to breastfeeding practices and concentrate on establishing best practices for risk reduction and prevention of childbirth-associated breast and nipple infections and hospitalizations.

Complicated Cellulitis is an Independent Predictor for Increased Length of Stay in the Neonatal Intensive Care Unit

To assess cellulitis in the neonatal intensive care unit (NICU) setting and identify risk factors for its disease severity and whether cellulitis influences length of stay (LOS). In this retrospective study, patients with cellulitis were identified using the electronic health record while admitted to the NICU at Massachusetts General for Children from January 2007 to December 2020. Demographic and clinical data were extracted from patient records. Two multivariable logistic regression models were constructed to assess for independent predictors for increased LOS (≥30days) and complicated cellulitis in the hospital. Eighty-four patients met the study criteria; 46.4% were older than 14days at the time of diagnosis of cellulitis, 61.9% were non-White, and 83.3% were born prematurely; 48.8% had complicated cellulitis as defined by overlying hardware (41.7%), sepsis (7.1%), requirement for broadened antibiotic coverage (7.1%), bacteremia (4.8%), and/or abscess (3.6%). The mean hospital LOS was 58.5±36.1days SD, with 72.6% having a LOS greater than 30days. Independent predictors of increased LOS were extreme prematurity (<28weeks' gestation) (OR: 14.7, P=.03), non-White race (OR: 5.7, P=.03), and complicated cellulitis (OR: 6.4, P=.03). No significant predictors of complicated cellulitis were identified. This study identifies complicated cellulitis in the NICU as an independent predictor of increased hospital LOS in neonates. Implementation of strategies to mitigate the development of cellulitis may decrease LOS among this high-risk population.

Assessing inpatient outcomes for patients with small cell lung cancer presenting with superior vena cava thrombosis.

8589 Background: Superior Vena Cava Syndrome (SVCS) is a condition characterized by obstruction of the SVC that can commonly be caused by thrombus formation in the SVC. Small cell lung cancer (SCLC) frequently results in obstruction of the SVC. When severe enough, SVCS can present as a life-threatening oncological emergency. In this study we aim to explore baseline characteristics of SVC thrombosis (SVCT) in patients with SCLC, the prevalence of US hospitalizations, and disparities with regards to race and socioeconomic status. Methods: National Inpatient Sample was utilized to obtain pertinent data. Total hospitalizations with coexistent comorbidities of SCLC were extracted from the 2016 to 2019 database. Adult patients with a secondary diagnosis of SVC thrombosis were determined by using ICD-10 codes. We studied the racial and socioeconomic differences as well as length of stay (LOS), total hospital charges (THC), and all-cause mortality outcomes in cancer patients with and without SVC thrombosis. Statistical analysis was performed on STATA, with logistic regression analyses and chi-square tests. Results: A total of 480,750 patients were hospitalized for SCLC. 720 of these patients had SVC thrombosis (0.15% of SCLC patients). The mean age of those with thrombi was significantly lower compared to those without thrombi (64 vs. 69, p &lt; 0.001). The SCLC with SVCT cohort had statistically higher proportion of black patients than the other cohort. Charlson index was significantly higher in SCLC with SVCT cohort (5.8 vs. 5, p &lt; 0.001). Average income between the two cohort groups were similar. Medicaid and private insurance utilization were more common in SCLC with SVCT admissions compared to without SVCT. Patients presenting with SVC thrombosis had an increased hospital LOS (10 vs. 6 days, p &lt; 0.001) and cost compared to other cohorts ($117,320 vs. $80,806, p &lt; 0.005). All-cause mortality in patients with SCLC was 7.7% and the presence of SVC thrombosis significantly increased the odds of inpatient mortality (18.0%). Non-White races were associated with higher odds of mortality in SCLC admissions. In addition, patients with SVC thrombus also had greater odds of having a concomitant pulmonary embolism during hospitalization. Conclusions: In this study we found that race, insurance type, and comorbidities impacted the likelihood of developing thrombosis in the superior vena cava in patients with SCLC. Though the incidence is rare, SVC thrombosis indicates a poor prognostic factor for patients with SCLC. Further studies to evaluate these disparities in race and socioeconomic factors are warranted. The development of thrombosis and subsequent SVC syndrome is a potentially life-threatening condition; addressing potential reversible risk factors could improve mortality in a large subgroup of hospitalizations related to SCLC.

Health-economic modelling of cost savings due to the use of rezafungin based on a German cost-of-illness study of candidiasis.

Candida species are responsible for fungal diseases and the development of nosocomial bloodstream infections. Treatment is resource-intensive and economically challenging for healthcare systems. Cost analyses of drugs against candidiasis, such as rezafungin, are thus of great interest to healthcare payers. We conducted a cost-of-illness study of patients with Candida infections based on real-word data of the Department I of Internal Medicine, University Hospital Cologne (Germany) between 2016 and 2021. Health-economic parameters were analysed to describe the economic impact of Candida infections. Potential cost savings due to the administration of rezafungin were modelled for patients with invasive candidiasis or candidaemia based on a 5 day reduction of ICU length of stay (LOS) shown by the STRIVE study. We found 724 cases (652 patients) with Candida infections, of which 61% received ICU treatment (n = 442) and 29% were mechanically ventilated (n = 207). Twenty-six percent died during hospitalization (n = 185). Median LOS was 25 and 15 days, on normal wards and ICU, respectively. Median total treatment costs per case accounted for €22 820. Based on the ICU LOS reduction, the retrospective model showed a median cost-saving potential of €7175 per hospital case with invasive candidiasis or candidaemia. Accumulated cost savings for 37 patients of €283 335 were found. Treatment of candidiasis is cost intensive due to increased hospital LOS. The ICU LOS reduction rezafungin showed in STRIVE would lead to sustainable cost savings.

PC17. Implementation of an Enhanced Recovery after Surgery Protocol for Cleft Palate Repair

PURPOSE: Enhanced recovery after surgery (ERAS) protocols have been implemented across surgical disciplines, including cleft surgery, to decrease hospital stays and improve outcomes. The authors aim to describe the implementation of an ERAS protocol for cleft palate repair at a tertiary care hospital. METHOD: Patients undergoing cleft palate repair at the authors’ institution over a 10-year period were collected (n=242). Cleft demographics and operative details were collected. Primary outcome measures were hospital length of stay (LOS) and narcotic usage. Secondary outcome measures were fistula development and need for speech surgery. Chi-square tests and independent t-tests determined significance. RESULTS: Infiltration with bupivacaine was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased hospital LOS (p < 0.01). Utilization of the Furlow palatoplasty was associated with decreased hospital LOS (p < 0.01). Patients using the ERAS protocol experienced shorter LOS (p < 0.01). Fistula development was associated with increased 24-hour morphine equivalent usage (p < 0.01). Need for speech surgery was associated with increased 24-hour morphine equivalent usage (p < 0.01) and increased hospital LOS (p < 0.05). CONCLUSION: This study reiterates the benefit of an ERAS protocol for patients undergoing cleft palate repair. The protocol resulted in decreased LOS and narcotic use. The finding regarding fistula formation and need for speech surgery requiring increased narcotics may indicate that the initial postoperative period is vital to adequate wound healing and subsequent outcomes. This study has implications for ways to maximize hospital reimbursement, as well as potentially improve outcomes.

Utility of computed tomography reconstructed thoracolumbar spinal imaging in blunt trauma.

Fractures of the thoracolumbar (TL) spine are common and may cause neurologic damage, pain, and reduced quality of life. Computed tomography (CT) TL reconstructions from CT chest, abdomen, and pelvis (CAP) are used to identify TL fractures; however, their benefit over CAP imaging is unclear. We hypothesized that reformatted TL images do not identify additional clinically significant injuries or change outcomes. Retrospective data were collected 2016 to 2021 from trauma patients at a level 1 trauma center. All patients 18 years or older with TL fractures on CT CAP with/without CT TL reformats were included. Clinically significant TL fractures were defined as requiring operative fixation, brace, or spinal rehabilitation. A binary classification model was created to assess the diagnostic utility of CTCAP compared with CTTL in predicting clinically significant fractures in patients who underwent CT CAP/TL. There were 828 patients with TL fractures, 634 had both CT CAP/CT TL (CAPTL) and 194 CTCAP only (CAP). There were 134 clinically significant TL fractures (16%) (14 [7.2%] CT CAP vs. 120 [18.9%] CT CAPTL, p < 0.001). There were no differences among unstable fractures, fractures on magnetic resonance imaging (MRI) only, mortality, or neurologic deficits on discharge between CAPTL and CAP ( p > 0.05). Among clinically significant fractures, CAPTL was not associated with increased MRI utilization, surgery, spinal brace, or spinal cord rehabilitation ( p > 0.05). Among clinically insignificant fractures, CAPTL was associated with increased MRIs, length of stay (LOS), and intensive care unit LOS ( p < 0.05). CAPTL was also an independent predictor of increased MRIs (odds ratio, 5.79; 95% confidence interval, 2.29-14.65; p < 0.01) and spine consultation (odds ratio, 2.39; 95% confidence interval, 1.64-3.67; p < 0.01). More CT CAP/TL were performed in those with clinically significant fractures; however, CTCAP was equivalent to CTTL for detection of fractures ( p > 0.05). CTCAP alone is sufficient to identify clinically significant TL fractures. While the addition of TL reformatted imaging minimizes missed injuries, it is associated with increased hospital LOS and MRI resource utilization. Therefore, careful consideration is needed for appropriate CT TL patient selection. Therapeutic/Care Management; Level IV.

Is Severe Traumatic Brain Injury no Longer a Contra-Indication for Surgical Stabilization of Rib Fractures in Patients with Multiple Rib Fractures? A Propensity-Matched Analysis.

Traumatic brain injury (TBI) is often considered a contraindication to surgical stabilization of rib fractures (SSRF). In this study, we hypothesized that compared to non-operative management, SSRF is associated with improved outcomes in TBI patients. Using the ACS-TQIP 2016-2019, we performed a retrospective analysis of patients with concurrent TBI and multiple rib fractures. Following propensity score matching, we compared patients who underwent SSRF with those who were managed nonoperatively. Our primary outcome was mortality. Secondary outcomes included ventilator-associated pneumonia (VAP), hospital and intensive care unit (ICU) length of stay (LOS), ventilator days, tracheostomy rate, and hospital discharge disposition. In a subgroup analysis, we stratified patients into mild and moderate TBI (GCS >8) and severe TBI (GCS ≤ 8). Out of 36,088 patients included in this study, 879 (2.4%) underwent SSRF. After propensity-score matching, compared with non-operative management, SSRF was associated with decreased mortality (5.4% vs. 14.5%,p < .001), increased hospital LOS (15 days vs. 9 days,p < .001), increased ICU LOS (12 days vs. 8 days,p < .001) and increased ventilator days (7 days vs. 4 days,p < .001). In the subgroup analyses, in mild and moderate TBI SSRF was associated with decreased in-hospital mortality (5.0% vs. 9.9%,p = .006), increased hospital LOS (13 days vs. 9 days,p < .001), ICU LOS (10 days vs. 7 days,p < .001), and ventilator days (5 days vs. 2 days, p < .001). In patients with severe TBI, SSRF was associated with decreased mortality (6.2% vs. 18%,p < .001), increased hospital LOS (20 days vs. 14 days,p = .001), and increased ICU LOS (16 days vs. 13 days,p = .004). In patients with TBI and multiple rib fractures, SSRF is associated with a significant decrease in in-hospital mortality and with longer hospital and ICU lengths of stay. These findings suggest that SSRF should be considered in patients with TBI and multiple rib fractures. Level IV, Therapeutic.

What is Associated with the Greatest Effect on Lengths of Stay after Total Knee Arthroplasty: The Hospital, the Surgeon, or the Patient

Introduction: Patient-, hospital-, and surgeon-related factors are each associated with the variable nature of length of stay (LOS) after total knee arthroplasty (TKA). However, there is a paucity of literature regarding these intertwined relationships. This study aimed to determine if the hospital, the surgeon, or the patient has the greatest association with LOS after TKA. Materials and Methods: A total of 11,402 patients were identified from a multicenter prospectively collected institutional database between January 01, 2017, and April 01, 2019. Surgeons and hospitals were subdivided into three groups: (1) low volume (&lt;10 and &lt;100 cases, respectively), (2) intermediate volume (10–150 and 100–400 cases, respectively), and (3) high volume (&gt;150 and &gt;400 cases, respectively). Patient demographics, comorbidities, hospital academic status, and LOS were identified. Univariate and multivariate analyses were performed to compare hospital-, surgeon-, and patient-related factors. Results: Neither hospital (P = 0.173) volume nor surgeon (P = 0.413) volume were significantly associated with LOS in multivariate analyses while controlling for patient-, surgeon-, and hospital-related factors. Patient medical factors including diabetes (P &lt; 0.001), congestive heart failure (P &lt; 0.001), peripheral vascular disease (P &lt; 0.001), chronic kidney disease (P &lt; 0.001), chronic obstructive pulmonary disease (P &lt; 0.001), and anemia (P &lt; 0.033), as well as academic teaching hospitals (P &lt; 0.001) were associated with a significant increase in hospital LOS. Conclusion: Patient’s chronic medical conditions and hospital status as an academic teaching hospital were found to be the most important associated risk factors on post-operative hospital LOS after TKA. This study directs the focus onto pre-operative optimization and patient selection and helps demonstrate where to best allocate resources to successfully decrease LOS. Keywords: Lengths of stay, Total knee arthroplasty, Pre-operative optimization, Complications, High volume surgeon.

Does Morbid Obesity (BMI ≥40 kg/m2) Impact Operative Time, Blood Loss, Length of Stay, or Complications Following Anatomic Total Shoulder Arthroplasty?

There have been conflicting reports regarding the effects of obesity on both surgical time and blood loss following anatomic shoulder arthroplasty. Varying categories of obesity has made comparison amongst existing studies difficult. A retrospective review of consecutive anatomic shoulder arthroplasty cases (aTSA) was undertaken. Demographic data, including age, gender, body mass index (BMI), age-adjusted Charleson Comorbidity Index (ACCI), operative time, hospital length of stay (LOS), and both POD#1 and discharge visual analogue score (VAS) was collected. Intra-operative total blood volume loss (ITBVL) and need for transfusion was calculated. BMI was categorized as non-obese (<30 kg/m2), obese (30-40 kg/m2) and morbidly obese (≥40 kg/m2). Unadjusted associations of BMI with operative time, ITBVL and LOS were examined using Spearman correlation coefficients. Regression analysis was used to identify factors associated with hospital LOS. There were 130 aTSA cases performed, including 45 short stem and 85 stemless implants, of which 23 (17.7%) were morbidly obese, 60 (46.2%) were obese and 47 (36.1%) were non-obese. Median operative time for the morbidly obese cohort was 119.5 minutes (IQR 93.0, 142.0) versus 116.5 minutes (IQR 99.5, 134.5) for the obese cohort versus 125.0 minutes (IQR, 99.0, 146.0) for the non-obese cohort. (P=0.61) The median ITBVL for the morbidly obese cohort was 235.8 ml (IQR 144.3, 329.7) versus 220.1 ml (IQR 147.7, 262.7) for the obese cohort versus 216.3 ml (IQR 139.7, 315.5) for the non-obese cohort. (P=0.72). BMI ≥40kg/m2 (IRR 1.32, P=0.038), age (IRR 1.01, P=0.026), and female gender (IRR 1.54, P<0.001) were predictive of increased LOS. There was no difference with regards to in-hospital medical complications (P=0.13), surgical complications (P=1.0), need for re-operation (P=0.66) and 30-day return to the ER (P=0.06). Morbid obesity was not associated with increased surgical time, ITBVL and perioperative medical or surgical complications following aTSA, though it was predictive of increased hospital LOS.

Frailty in middle cranial fossa approach for encephalocele or cerebrospinal fluid leak repair.

The modified 5-item frailty index (mFI-5) is a concise, comorbidity-based risk stratification tool that can predict adverse outcomes after surgery. The goal of this study was to understand the frailty of patients undergoing surgery for temporal encephalocele or cerebrospinal fluid (CSF) leak and the utility of mFI-5 for predicting increased post-operative outcomes. A retrospective review of adults with temporal encephalocele or CSF leak who underwent middle cranial fossa (MCF) approach craniotomies with or without mastoidectomy from January 2015 through August 2021 at a tertiary care academic medical center was performed. Patients who underwent additional surgeries or extended surgical approaches were excluded. The mFI-5 was calculated for all patients. Demographic and clinical data were obtained from the medical record. Thirty-six patients underwent 40 MCF approach craniotomies for temporal encephalocele or CSF leak, including three revision cases and one patient with sequential bilateral operations. Mean age was 54.1 ± 10.8 years, and 66.7% were female. In the univariable regression analysis, mFI-5 score, age, and procedure time use were significantly associated with increased hospital length of stay (LOS) but not increased intensive care unit (ICU) LOS. Anesthesia time and lumbar drain were significantly associated with increased hospital LOS and ICU LOS, and they remained significantly associated with increased hospital LOS in the multivariable model. Frailty is associated with increased hospital LOS stay among patients undergoing MCF approach for CSF leak or encephalocele. Reducing anesthesia time and avoiding lumbar drain use are potentially modifiable risk factors that can reduce the LOS and associated costs. 4.

Abstract 9997: Atrial Fibrillation and Supraventricular Tachycardia Are Predictors of Inpatient Mortality in Mechanically Ventilated Patients in the United States

Objective: Arrhythmias are a significant clinical challenge and can complicate hospital course for mechanically ventilated patients. We aimed to determine the burden of arrhythmias and their effect on inpatient outcomes in mechanically ventilated patients in the US. Methods: The national inpatient sample was retrospectively studied (2015-2019) to identify all mechanically ventilated patients aged &gt;17. We further identified the following arrhythmias within each admission: atrial fibrillation (AF), non-sustained ventricular tachycardia (NSVT), supra-ventricular tachycardia (SVT), atrioventricular block (AVB) and ventricular fibrillation (VF). Primary outcomes were inpatient mortality rate, hospital length of stay (LOS) and total cost for each type of arrythmia. Demographic (age, sex, race) and clinical information (history of hypertension, stroke, myocardial infarction, obesity) was recorded. Data was studied in STATA 15 and multivariate logistic regression was used to estimate adjusted odds ratios (AOR) reported with p-value (significance=&lt;0.05). Results: Our analysis included 1,745,867 weighted discharges of mechanically ventilated patients. Mean age was 65 years (56% male, 69% Caucasian). Most frequent arrythmia was AF (63% of all patients) and least common was AVB (11%). AF, VF, and SVT were associated with an increase in mortality (AOR: 3.52, 2.78, 1.45 respectively, p &lt; 0.001). NSVT, AF, and SVT were associated with an increase in hospital LOS of 4.5, 3.2, and 2.8 days respectively (AOR 3.31, 2.94, 1.75 respectively, p&lt;0.001). The adjusted inpatient cost was highest in patients with NSVT ($21,567, p&lt;0.05). AVB and NSVT were not associated with an increase in mortality (p&lt;0.05). On gender and race stratification, African American males had the highest mortality rate secondary to AF and VF (AOR: 3.54 and 4.21 respectively, p&lt;0.001). Conclusion: We demonstrate that atrial fibrillation, ventricular fibrillation, and SVT are independently associated with increased mortality in mechanically ventilated patients. We also show that NSVT is associated with increase in hospital LOS in these patients. African American mechanically ventilated males had the highest mortality rates secondary to atrial and ventricular fibrillation.

Abstract 9993: Effect of Major Depressive Disorder on Inpatient Outcomes of Hypertensive Emergency: Analysis From National Inpatient Sample

Objective: Our aim was to determine if co-diagnosis of major depressive disorder (MDD) influenced inpatient outcomes of hypertensive emergency (HTNE) admissions. Methods: We analyzed the national inpatient sample (2012-2019) for HTNE admissions of ages &gt;18 years. The primary outcomes were hospital length of stay (LOS), costs (adjusted for inflation), adverse hospital events (need for mechanical circulatory support and intubation) and in-hospital mortality. Secondary outcomes included predictors of mortality in HTNE patients with MDD. Demographic (age, sex, race) and clinical (history of hypertension, hyperlipidemia, stroke, chronic kidney disease, myocardial infarction, obesity, smoking) factors were adjusted for. Data was analyzed in STATA 16.0, and adjusted odds ratios (AOR) were calculated using linear and logistic regression method. Results: Our study included 149,366 weighted discharges for HTNE. Prevalence of MDD was 9.6% (n=14,339). Average age of the patients were 48 years. 65% were Caucasians, 57% were females and average LOS was 5.5 days. Patients with MDD had longer LOS (6.4 vs 5.1 p&lt;0.001). The adjusted hospital cost was $25,923 higher in patients with MDD (p&lt;0.001), and they also had higher odds of inpatient mortality (AOR 1.76, [1.53 -1.83], P &lt; 0.001). The odds for requiring mechanical circulatory support were higher in patients with MDD (AOR 1.44, P &lt; 0.001). African American men had the highest inpatient costs and LOS. Several conditions increased mortality in HTNE patients with MDD including obesity, cerebrovascular disease (CVD) and end-stage renal disease (ESRD). (Figure 1) Conclusion: Major depressive disorder has an important and unexplored association with hypertension. Our study demonstrates that patients admitted with hypertensive emergency have increased hospital LOS, cost, adverse hospital events and mortality when they have concomitant depression.

Delayed Discharge From the Intensive Care Unit Is Associated With Longer Hospital Lengths of Stay

The study authors sought to determine if delayed discharge from the intensive care unit (ICU) secondary to a lack of floor beds led to longer postoperative hospital length of stay (LOS) or more hospital readmissions. A retrospective study comparing patients with delayed discharge from the ICU to patients without delayed discharge. At a cardiovascular ICU in a tertiary care university hospital. A total of 5,777 patients that were ready for discharge from the ICU after recovering from cardiac surgery. None. The authors used linear regression to measure postoperative hospital LOS and logistic regression to measure hospital readmission in patients whose transfer out of the ICU was delayed at least overnight to patients who were transferred out the same day. There were 3,903 patients transferred to the stepdown unit on the same day as the transfer order and 1,874 patients were transferred on a subsequent day. The postoperative LOS was shorter in the no delay group (9 ± 9 v 11 ± 10 days, standardized difference = 0.162), whereas the stepdown unit stay was similar (6 ± 6 v 5 ± 6 days, standardized difference = 0.076). The readmission rates were 15% in the no delay group versus 14% in the delayed discharge group (standardized difference = 0.032). After adjustment, the authors found by linear regression that delayed discharge was associated with an increase (0.72 [95% CI 0.43-1.01] days, p < 0.001) in postoperative LOS but was not associated with readmission. The study authors found that patients who had their discharge from the ICU delayed had an increased hospital LOS but a similar rate of hospital readmission.

Potentially Inappropriate Medication Administration Is Associated With Adverse Postoperative Outcomes in Older Surgical Patients: A Retrospective Cohort Study.

The American Geriatrics Society (AGS) Beers Criteria is an explicit list of potentially inappropriate medications (PIMs) best avoided in adults ≥65 years of age. Cognitively impaired and frail surgical patients often experience poor outcomes after surgery, but the impacts of PIMs on these patients are unclear. Our objective was to assess whether perioperative PIM administration was associated with poor outcomes in geriatric surgical patients. We then evaluated the association between PIM administration and postoperative outcomes in subgroups of patients who were frail or cognitively impaired. We performed a retrospective cohort study of patients ≥65 years of age who underwent elective inpatient surgery at a large academic medical center from February 2018 to January 2020. Edmonton Frail Scale and Mini-Cog screening tools were administered to all patients at their preoperative clinic visit. A Mini-Cog score of 0 to 2 was considered cognitive impairment, and frailty was defined by an Edmonton Frail Scale score of ≥8. Patients were divided into 2 groups depending on whether they received at least 1 PIM (PIM+), based on the 2019 AGS Beers Criteria, in the perioperative period or none (PIM-). We assessed the association of preoperative frailty, cognitive impairment, and perioperative PIM administration with the length of hospital stay and discharge disposition using multiple regression analyses adjusted for age, sex, ASA physical status, and intensive care unit (ICU) admission. Of the 1627 included patients (mean age, 73.7 years), 69.3% (n = 1128) received at least 1 PIM. A total of 12.7% of patients were frail, and 11.1% of patients were cognitively impaired; 64% of the frail patients and 58% of the cognitively impaired patients received at least 1 PIM. Perioperative PIM administration was associated with longer hospital stay after surgery (PIM-, 3.56 ± 5.2 vs PIM+, 4.93 ± 5.66 days; P < .001; 95% confidence interval [CI], 0.360-0.546). Frail patients who received PIMs had an average length of stay (LOS) that was nearly 2 days longer than frail patients who did not receive PIMs (PIM-, 4.48 ± 5.04 vs PIM+, 6.33 ± 5.89 days; P = .02). Multiple regression analysis revealed no significant association between PIM administration and proportion of patients discharged to a care facility (PIM+, 26.3% vs PIM-, 28.7%; P = .87; 95% CI, -0.046 to 0.054). Perioperative PIM administration was common in older surgical patients, including cognitively impaired and frail patients. PIM administration was associated with an increased hospital LOS, particularly in frail patients. There was no association found between PIM administration and discharge disposition.