Hospital Discharge Research Articles

Amiodarone Administration during Cardiopulmonary Resuscitation Is Not Associated with Changes in Short-Term Mortality or Neurological Outcomes in Cardiac Arrest Patients with Shockable Rhythms.

Background: The search for the best therapeutic approach in cardiopulmonary resuscitations (CPR) remains open to question. In this study, we evaluated if Amiodarone administration during CPR was associated with short-term mortality or neurological development. Methods: A total of 232 patients with sudden cardiac arrest (CA) with shockable rhythms were included in our analysis. Propensity score matching based on age, gender, type of CA, and CPR duration was used to stratify between patients with and without Amiodarone during CPR. Primary endpoints were short-term mortality (30-day) and neurological outcomes assessed by the cerebral performance category. Secondary endpoints were plasma lactate, phosphate levels at hospital admission, and the peak Neuron-specific enolase. Results: Propensity score matching was successful with a caliper size used for matching of 0.089 and a sample size of n = 82 per group. The 30-day mortality rates were similar between both groups (p = 0.24). There were no significant differences in lactate levels at hospital admission and during the following five days between the groups. Patients receiving Amiodarone showed slightly higher phosphate levels at hospital admission, while the levels decreased to a similar value during the following days. Among CA survivors to hospital discharge, no differences between the proportion of good neurological outcomes were detected between the two groups (p = 0.58), despite slightly higher peak neuron-specific enolase levels in CA patients receiving Amiodarone (p = 0.03). Conclusions: Amiodarone administration is not associated with short-term mortality or neurological outcomes in CA patients with shockable rhythms receiving CPR.

Real-world data of in-hospital administration of alglucosidase alfa in French patients with Pompe disease: results from the National Claims Database.

Pompe disease is caused by a rare biallelic mutation in the GAA gene resulting in acid α-glucosidase deficiency and glycogen accumulation. We analyzed hospital admissions associated with the administration of Myozyme®, utilizing the French hospital discharge database, known in France as the Programme de Médicalisation des Systèmes d'Information (PMSI), which comprehensively captures all hospital activity within the country. In this observational study, we examined hospitalization records from April 4, 2012, to December 31, 2019, within the PMSI database, focusing on admissions where Myozyme® was administered. We particularly investigated the incidence of critical care admissions and adverse events (AEs) related to Myozyme®. From 2012 to 2019, approximately 26,714 hospital stays involving Myozyme® administration were recorded for 239 patients. Most (96.6%) of these were outpatient stays, with only 3.2% in critical care. Furthermore, hospitalizations without critical care needs increased from 96% in 2012 to 99% in 2019. Of the patients receiving at least one infusion, 997 critical care admissions were recorded, with 781 (78.3%) occurring concurrent with or the day after the Myozyme® treatment without directly correlating to adverse effects of enzyme therapy. The analysis of the French hospital discharge database indicated that Myozyme® was associated with a low incidence of AEs and complications in a hospital context, supporting the consideration of its safe use in home-infusion settings.

Early detection of pediatric health risks using maternal and child health data

Machine learning (ML)-driven diagnosis systems are particularly relevant in pediatrics given the well-documented impact of early-life health conditions on later-life outcomes. Yet, early identification of diseases and their subsequent impact on length of hospital stay for this age group has so far remained uncharacterized, likely because access to relevant health data is severely limited. Thanks to a confidential data use agreement with the California Department of Health Care Access and Information, we introduce Ped-BERT: a state-of-the-art deep learning model that accurately predicts the likelihood of 100+ conditions and the length of stay in a pediatric patient’s next medical visit. We link mother-specific pre- and postnatal period health information to pediatric patient hospital discharge and emergency room visits. Our data set comprises 513.9K mother–baby pairs and contains medical diagnosis codes, length of stay, as well as temporal and spatial pediatric patient characteristics, such as age and residency zip code at the time of visit. Following the popular bidirectional encoder representations from the transformers (BERT) approach, we pre-train Ped-BERT via the masked language modeling objective to learn embedding features for the diagnosis codes contained in our data. We then continue to fine-tune our model to accurately predict primary diagnosis outcomes and length of stay for a pediatric patient’s next visit, given the history of previous visits and, optionally, the mother’s pre- and postnatal health information. We find that Ped-BERT generally outperforms contemporary and state-of-the-art classifiers when trained with minimum features. We also find that incorporating mother health attributes leads to significant improvements in model performance overall and across all patient subgroups in our data. Our most successful Ped-BERT model configuration achieves an area under the receiver operator curve (ROC AUC) of 0.927 and an average precision score (APS) of 0.408 for the diagnosis prediction task, and a ROC AUC of 0.855 and APS of 0.815 for the length of hospital stay task. Further, we examine Ped-BERT’s fairness by determining whether prediction errors are evenly distributed across various subgroups of mother–baby demographics and health characteristics, or if certain subgroups exhibit a higher susceptibility to prediction errors.

Evaluating associations between patient-to-nurse ratios and mortality, process of care events and vital sign documentation on paediatric wards: a secondary analysis of data from the EPOCH cluster-randomised trial

ObjectiveTo describe the associations between patient-to-nurse staffing ratios and rates of mortality, process of care events and vital sign documentation.DesignSecondary analysis of data from the evaluating processes of care and...

Association Between Social Determinants of Health and Cancer Treatment Delay in an Urban Population.

Delays in oncologic time to treatment initiation (TTI) independently and adversely affect disease-specific mortality. Social Determinants of Health (SDoH) are increasingly recognized as significant contributors to patients' disease management and health outcomes. Our academic center has validated a 10-item SDoH screener, and we elucidated which specific needs may be predictive of delayed TTI. This is a retrospective cohort study at an urban academic center of patients with a SDoH screening and diagnosis of breast, colorectal, endocrine/neuroendocrine, GI, genitourinary, gynecologic, head and neck, hematologic, hepatobiliary, lung, or pancreatic cancer from 2018 to 2022. Variables of interest included household income, tumor stage, and emergency department (ED) or inpatient admission 30 days before diagnosis. Factors associated with delayed TTI ≥45 days were assessed using multivariable logistic regression. Among 2,328 patients (mean [standard deviation] age, 64.0 (12.8) years; 66.6% female), having >1 unmet social need was associated with delayed TTI (odds ratio [OR], 1.68; 95% CI, 1.54 to 1.82). The disparities most associated with delay were legal help, transportation, housing stability, and needing to provide care for others. Those with ED (OR, 0.49; 95% CI, 0.44 to 0.54) or inpatient (OR, 0.54; 95% CI, 0.50 to 0.58) admission 30 days before diagnosis were less likely to experience delay. Delays in oncologic TTI ≥45 days are independently associated with unmet social needs. ED or inpatient admissions before diagnosis increase care coordination, leading to improved TTI. Although limitations included the retrospective nature of the study and self-reporting bias, these findings more precisely identify targets for intervention that may more effectively decrease delay. Patients with SDoH barriers are at higher risk of treatment delay and could especially benefit from legal, transportation, caregiver, and housing assistance.

App-based telerehabilitation program for older adults on waiting list for physiotherapy after hospital discharge: a feasibility pragmatic randomized trial

BackgroundInactivity while waiting for outpatient physiotherapy worsens the physical deconditioning of older adults after hospital discharge. Exercise programs can minimize the progression of deconditioning. In developing countries, telerehabilitation for older adults on the waiting list is still in the early stages. This study aimed to evaluate the feasibility of the study procedures of a telerehabilitation program for older adults waiting for outpatient physiotherapy after hospital discharge.MethodsThis pragmatic randomized controlled trial recruited older adults (≥ 60 years) with several clinical diagnoses on the waiting list for outpatient physiotherapy in the Brazilian public health system after hospital discharge. The telerehabilitation group (n = 17) received a personalized program of multicomponent remote exercises using a smartphone app. The control group (n = 17) followed the usual waiting list. We assessed recruitment and dropout rates, safety, adherence, and satisfaction. The preliminary effects were verified on clinical outcomes.ResultsWe recruited 5.6 older adults monthly; dropouts were 12%. No serious adverse events were associated with the telerehabilitation program. The weekly adherence was 2.85 (1.43) days, and in 63.3% of the weeks the participants were enrolled, they performed the exercise program at least twice a week. Participants rated the telerehabilitation program as 9.71 (0.21), and the safety of remote exercises without professional supervision as 8.6 (2.2) on a 0–10 scale.ConclusionsThe telerehabilitation program using a smartphone app was safe and presented high participants’ satisfaction and adequate adherence, recruitment, and dropout rates. Therefore, the definitive study can be conducted with few modifications.Trial registrationBrazilian Registry of Clinical Trials (ReBEC), RBR-9243v7. Registered on 24 August 2020. https://ensaiosclinicos.gov.br/rg/RBR-9243v7.

Using PARO, a robotic seal, to support people living with dementia: ‘what works’ in inpatient dementia care settings?

Abstract Introduction: The robotic seal PARO has received increased attention as a new technology to support people living with dementia in terms of emotional and physiological outcomes. However, little research has been conducted to improve understanding of how and why PARO may work within inpatient dementia care. We investigate for whom PARO works best in this setting, and why PARO may work. Methods: Informed by principles from realist methodology, qualitative interviews were conducted with healthcare professionals, participants with dementia and their relatives to explore experiences related to the delivery and receipt of an intervention using PARO in an inpatient dementia ward in the United Kingdom (UK). Observations of PARO intervention sessions were conducted to gain further insight into provision and implementation of sessions using PARO in ‘real time’. Data were analysed using thematic analysis, and using the process of configuration mapping, we constructed a visualisation of our findings framed within the Intervention-Context-Actor-Mechanisms-Outcomes (ICAMO) model. Results: The visualisation of our findings framed within the ICAMO model suggests that PARO may result in positive outcomes within inpatient dementia care due to a range of potential mechanisms, including enhancement of social interactions, developing a sense of attachment, evoking emotive memories, physical interaction, and perceiving the robotic animal as a live being. For these mechanisms to be activated, the sessions should be structured but participant-led, and be delivered as needed in a one-to-one setting by a skilled facilitator. Conclusion: Using PARO in an inpatient dementia care context appeared promising and well-received in this small observational study. This study explicitly considers the context and mechanisms of using PARO within inpatient dementia care settings, presenting findings in a structured visualisation framed within the ICAMO model and offering a theoretical basis for future intervention research.

627 Epidemiology, Admissions Outcomes, and Mortality for Geriatric Trochanteric Fractures. A Major Trauma Centre Study

Abstract Aim Femur trochanteric fractures are very debilitating injuries yet are under investigated in orthopaedic literature. We study the epidemiology, hospital admission factors, and mortality for elderly patients with trochanteric fractures. Method All patients over 65 years old at a level-1 trauma-centre with a trochanteric hip fracture from January-2015 to June-2021 were included. Fractures were subdivided with AO/OTA subclassifications into intertrochanteric (31-A1,A2,A3) and subtrochanteric (32-A1,A2) sub-types. Patient demographics, preadmission mobility, time-to-surgery, length-of-surgery, surgical fixation used, inpatient rehabilitation/mobilisation, and post-operative mortality at 1,3,6 and 12 months, were collected. Patients were followed up for minimum of 2-years. Statistical significance was p<0.05. Results A total of 1101 patients were included. The AO/OTA classification was: 31-A1(123), 31-A2(491), 31-A3(105), 32-A1(221), 32-A2(161). Average age was 84.9, with 72.8% patients being female. Average admission-to-surgery, surgery-time, and surgery-to-discharge-time was 21.6hours, 1.2hours, and 15.5days respectively. Overall mortality was 7.2%(1-month), 15.4%(3-months), 20.4%(6-months) and 27.1%(12-months). There were no statistically significant associations of type of fracture, operative method, or surgery-within-36hours, with mortality at any scale. Post-operative mobilisation within 24-hours, with or without physiotherapist aid, was associated with lower mortality on all investigated time scales, compared to no mobilisation (p<0.05). Conclusions Our study presents a large and detailed cohort of patients with trochanteric fractures classified with AO/OTA, the first in the UK, and investigated the associations with inpatient admission and mortality outcomes. Our detailed analysis and high-resolution data will allow for cross region and country comparisons and inform guideline and quality improvement efforts.

Predictors of Neurological Disability at Hospital Discharge for Acyclovir-treated Pediatric Herpes Simplex Virus Encephalitis.

Herpes simplex virus encephalitis (HSE) is a rare but serious neurological infection that causes neurological dysfunction. Research is lacking on the clinical predictors of neurological outcomes and the optimal duration of therapy for pediatric HSE patients. In this study of pediatric HSE patients, we identified factors predicting neurological disability at hospital discharge and examined associations of acyclovir therapy duration with neurological outcomes. This was a retrospective cohort study on 37 children diagnosed with HSE confirmed by polymerase chain reaction at age 1 month to 16 years from 2015 to 2021 in Ho Chi Minh City's Children's Hospital No. 2, Vietnam. For the acyclovir duration analysis, we examined 22 children with negative polymerase chain reaction on day 14 of treatment. Poisson regression was used to obtain the risk ratio and 95% confidence interval. The study population consisted of 73% males, with a median age of 14 months (interquartile range: 9-35). Coma at acyclovir treatment, hypotension and the need for mechanical ventilation ≥48 hours significantly predicted neurological disability in the bivariate analysis. There were no significant associations between acyclovir duration (14 vs. 21 days) and neurological outcomes, adjusting for age at diagnosis and pediatric Glasgow Coma Scale score at acyclovir initiation. We identified significant predictors of neurological disability unaffected by postacyclovir treatment factors. Among patients with negative HSE polymerase chain reaction on day 14, 14 days of acyclovir treatment may be as effective as 21 days. Additional studies on the effects of acyclovir duration are needed.

Developmental Outcomes of Traumatic Brain Injury in Infants and Children: A Prospective Study

Abstract Background Traumatic brain injury (TBI) in children is a significant health burden worldwide. Children aged 0 to 4 years have the highest incidence of TBI among the non-elderly. These children suffer from long term neurological deficits that compromise their quality of life and daily living activities. Objective To determine the developmental outcomes of infants and children with TBI. Subjects and Methods A prospective descriptive study on infants and children with TBI was conducted. Developmental outcomes by Age and Stage Questionnaire 3rd edition (ASQ-3) was assessed twice; once at hospital discharge and another time 3 months later. Further, Bayley scales of infants and toddlers’ development III was assessed only once in the second visit. Results at discharge and follow up were compared and correlated. Results Eighty -five patients were included in the study with 63.5% were males and the median age was 24(12-34) months, range (1- 42 months). There were statistically significant difference between ASQ-3 at discharge and follow up which was higher at follow up than at discharge indicating better developmental outcomes(P < 0.001 for all aspects). Comparison between ASQ-3 (problem solving) and Bayley Scale (cognitive) at follow up shows that there was no statistically significant difference between them with kappa agreement and 95% CI of 0.527 (0.218–0.837). Also, comparison between ASQ-3 (motor) at follow-up and Bayley Scale (motor)at follow up shows that there was no statistically significant difference between them with kappa agreement and 95% CI of 0.285 (0.001 - 0.569). Also, comparison between ASQ-3 (communication) and Bayley Scale (language) at follow up shows that there was no statistically significant difference between them with kappa agreement and 95% CI 0.501 (0.235 - 0.766). this means that both tests were comparable Conclusions ASQ-3 can be used as a screening tool for infants and children after TBI before referral to Bayley scale. Developmental milestones improved at follow up in most infants and children after TBI.

1021 Accuracy of Clinical Coding in General Surgery and Its Financial Impact

Abstract Aim To analyse the clinical coding performed at a tertiary centre after patient discharge and compare it with the clinical summary to identify any inconsistency and its financial implications. Method Fifty patient episodes were selected randomly between June 2023 and August 2023 under the general surgery department. Clinical notes, discharge summaries and existing clinical codes were scrutinized by liaison with the clinical coding department. Financial losses were noted, and the summary was later presented at the local clinical governance meeting. Results A total of £38,760 was lost in 50 patients. Loss incurred was primarily due to incomplete information in the discharge summary, related to the patient’s comorbidities, incomplete diagnosis, and procedure/investigations. These results were discussed in a clinical governance meeting and a poster was made to disseminate the conclusion and improve the quality of the discharge summary. Conclusions A total of £38,760 of funding was lost due to discrepancies in the clinical coding. An intervention in the form of a poster and teaching session was conducted for junior doctors and a repeat cycle is planned in the due course of time to improve the quality and minimise the loss of funding.

Chinese self-report version of biological rhythms interview for assessment in neuropsychiatry (C-BRIAN-SR) - psychometric properties and prospective follow-up in patients with non-seasonal depression

ABSTRACT This study examined the psychometric properties and longitudinal changes of the self-reporting Traditional Chinese version of Biological Rhythms Interview for Assessment in Neuropsychiatry (C-BRIAN-SR) among healthy controls (HC) and patients with major depressive episode (MDE). Eighty patients with a current MDE and 80 HC were recruited. Assessments were repeated after two weeks in HC, and upon the discharge of MDE patients to examine the prospective changes upon remission of depression. The C-BRIAN-SR score was significantly higher in the MDE than HC group. The concurrent validity was supported by a positive correlation between scores of C-BRIAN-SR, Insomnia Severity Index and the Hospital Anxiety Depression Scale. C-BRIAN-SR negatively correlated MEQ in the MDE group (r = .30, p = 0.009), suggesting higher rhythm disturbances were associated with a tendency toward eveningness. A moderate test-retest reliability was found (r = .61, p < 0.001). A cut-off of 38.5 distinguished MDE subjects from HC with 82.9% of sensitivity and 81.0% of specificity. C-BRIAN-SR score normalized in remitted MDE patients but remained higher in the non-remitted. The C-BRIAN-SR is a valid and reliable scale for measuring the biological rhythms and may assist in the screening of patients with MDE.

Evidence-based physiotherapy interventions: evaluation of current practice in a palliative care service

Maintaining independence and quality of life are significant issues for patients with a life-limiting illness and physiotherapists play an essential role in the palliative care multidisciplinary team in maintaining, restoring, and improving physical function and quality of life (QOL). This study aims to describe current physiotherapy interventions utilized in a palliative care service and compare it to the evidence base of physiotherapy interventions in palliative care. An audit was conducted of all inpatient and community palliative care patients referred for physiotherapy review and intervention, over a 4-week period. A literature search was conducted and the level of evidence for individual physiotherapy interventions was assessed. The audit identified 35 patients referred to the Physiotherapist for the assessment and management of mobility, falls risk management and prevention, lymphoedema management and assessment of functional decline. The most frequently performed physiotherapy assessments and interventions were for mobility and transfer (94.3%), falls prevention and management (74.3%), reconditioning and strengthening (57.1%), and exercise prescription (48.6%). Physiotherapy in the palliative care setting is becoming more accepted to help benefit the function and QOL of patients with advanced progressive diseases. This audit highlights the importance of these interventions in assisting patients to manage their symptoms and function at home.

Medical costs and incremental medical costs of asthma among workers in the United States.

Asthma, a chronic respiratory disease, is associated with high economic burden. This study estimates per-worker medical and incremental medical costs associated with treated asthma by socioeconomic and demographic characteristics, industries, medical events, and sources of payments for workers aged ≥18 years. We analyzed Medical Expenditure Panel Survey data from 2018 to 2020 to assess medical costs for treated asthma among workers using the International Classification of Diseases, Tenth Revision, Clinical Modification code for asthma (J45). We used two-part regression models to estimate medical and incremental medical costs controlling for covariates. All results are adjusted for inflation and presented in 2022 US dollar values. An estimated annual average of 8.2 million workers out of 176 million had at least one medical event associated with treated asthma. The annualized estimated per-worker incremental medical costs for those with treated asthma was $457 and was highest among: those in the age group of 35-44 years ($534), in the western region ($768), of Hispanic ethnicity ($693), employed in the utility and transportation industries ($898), males ($650), and for inpatient admissions ($754). The total annualized medical costs of treated asthma was $21 billion and total of incremental medical costs was $3.8 billion. Findings of higher incremental medical costs for treated asthma among workers in certain socioeconomic, demographic, and industry groups highlight the economic benefit of prevention and early intervention to reduce morbidity of asthma in working adults. Our results suggest that the per-person incremental medical costs of treated asthma among workers are lower than that for all US adults.

1152 Soft Tissue Infections of the Hand – Reducing Inpatient Cost and Duration of Stay in a London Plastic Surgery Department

Abstract Introduction Soft tissue infections of the upper limb referred to plastic surgery units often require hospital admission for intravenous antibiotics, irrespective of surgical intervention. Aim We explored approaches to reducing the cost and duration of inpatient admission for antibiotic treatment for soft tissue infections. Method We sampled data over a two-month period in 2023 to explore the number, type, and severity of soft tissue infections of the upper limb seen in London Plastic Surgery department. Results 35 patients with soft tissue infections of the upper limb were included. We found no correlation between age; white cell counts or c-reactive protein levels on day of presentation with duration of inpatient stay. Our studies showed that 78% of patients were discharged within 72 hours of admission or procedure, with a greater number of inpatient bed-days for patients receiving intravenous antibiotics without surgery, compared to patients receiving antibiotics and discharge within 3 days of receiving surgical intervention (36 days vs 25 days). 84% of patients were not located within post-codes accessible to existing outpatient antibiotic therapy (OPAT) services. By extending outpatient antibiotic cover for these patients, we projected a total 568 bed-day saving through 202 bed days annual avoidable inpatient bed-stay savings (3+ days, non-OPAT post-codes) and 366 bed days for additional annual avoidable short inpatient bed-stay savings (≤3 days admission, all post-codes), with projected annual cost savings of £319,558. Conclusions Our study projects a possible reduction in inpatient cost and duration of stay through extended OPAT cover in patients requiring intravenous antibiotics for soft-tissue infections of the upper limb.

P-729 Contribution of medical-administrative databases to health monitoring: example of ovarian hyperstimulation syndrome (OHSS)

Abstract Study question Can we monitor post-oocyte retrieval ovarian hyperstimulation syndrome (OHSS) in the French national health data system to complement the French ART vigilance system? Summary answer Medico-administrative databases offer a more comprehensive view of post-oocyte retrieval complications and can be used to detect abnormal increases in frequency and outlier ART centers. What is known already Assisted reproductive technology (ART), widely used in Europe, accounts for about 3% of births in France. The various studies of ART complications are reassuring, showing relatively low overall complication rates. Nonetheless, the European Union has established a vigilance system to monitor these complications. However, this system is not an exhaustive source of information and does not provide a complete overview of post-ART complications. Study design, size, duration The study population was identified from the comprehensive French National Hospital discharge database and included 53,490 women under 46 years old who underwent 65,924 oocyte retrievals in 2022. Women were classified into three population subgroups according to the indication of oocyte retrieval: infertility (IF), fertility preservation (FP), and oocyte donation (OD). Participants/materials, setting, methods Hospital stays for OHSS within two months post-retrieval were analyzed and characterized according to various characteristics (age, comorbidities, indication of oocyte retrieval, type of hospital stay, length of hospital stay...). Multivariate analysis was performed to determine the relation between the occurrence of OHSS and women’s characteristics, and results are expressed as odds ratios (ORs) and 95% CI. A funnel plot was used to compare the OHSS rate per center with the national average. Main results and the role of chance Hospitalized OHSS accounted for 1.1% of retrievals in 2022 (n = 718). The mean age of the women was 31.6 years (SD 4.5). Women with Polycystic Ovary Syndrome (PCOS) accounted for about 4% of the women with OHSS. More than half of OHSS hospital stays lasted less than two days (54%). Of these stays, 2% of women were in intensive care. Multivariate analysis showed a significantly higher OHSS risk in women under 30 and those with PCOS. Other risk factors are currently introduced into the model, such as a history of OHSS or pregnancy. Funnel plot analysis showed that one ART center has an OHSS rate significantly higher than the national average. In the centers that stand out from all the others, the objective is to return to these centers to understand the possible reasons for this observed rate and to implement corrective measures. Limitations, reasons for caution Despite all its advantages, the French national health data system presents some limitations, such as the risk of inappropriate coding. Moreover, the unavailability of personal or clinical information prevented us from considering certain risk factors. Wider implications of the findings Despite the limits of using medico-administrative databases, this approach provides a better representation of post-ART complications and is a promising way to complement the ART vigilance reporting system. This concept will also be generalized to other complications with regular feedback to professionals. Trial registration number not applicable

Associations of PM2.5 exposure with emergency department visits and readmissions among preterm infants with bronchopulmonary dysplasia.

To quantify the association of ambient air pollution (particulate matter, PM2.5) exposure with medically attended acute respiratory illness among infants with bronchopulmonary dysplasia (BPD). Single center, retrospective cohort study of preterm infants with BPD in Metropolitan Philadelphia. Multivariable logistic regression quantified associations of annual mean PM2.5 exposure (per μg/m3) at the census block group level with medically attended acute respiratory illness, defined as emergency department (ED) visits or hospital readmissions within a year after first hospital discharge adjusting for age at neonatal intensive care unit (NICU) discharge, year, sex, race, insurance, BPD severity, and census tract deprivation. As a secondary analysis, we examined whether BPD severity modified the associations. Of the 378 infants included in the analysis, 189 were non-Hispanic Black and 235 were publicly insured. Census block PM2.5 level was not significantly associated with medically attended acute respiratory illnesses, ED visits, or hospital readmissions in the full study cohort. We observed significant effect modification by BPD grade; each 1 µg/m3 higher annual PM2.5 exposure was medically attended acute respiratory illness (adjusted odds ratio [aOR] 1.65, 95% CI: 1.06-2.63) among infants with Grade 1 BPD but not among infants with grade 3 BPD (aOR 0.83, 95% CI: 0.47-1.48) (interaction p = .024). Cumulative PM2.5 exposure in the year after NICU discharge was not significantly associated with medically attended acute respiratory illness among infants with BPD. However, infants with Grade 1 BPD had significantly higher odds with higher exposures. If replicated, these findings could inform anticipatory guidance for families of these infants to avoid outdoor activities during high pollution days after NICU discharge.

Actual Cost of Extracorporeal Cardiopulmonary Resuscitation: A Time-Driven Activity-Based Costing Study.

To determine the actual cost and drivers of the cost of an extracorporeal cardiopulmonary resuscitation (E-CPR) care cycle. A time-driven activity-based costing study conducted from a healthcare provider perspective. A quaternary care ICU providing around-the-clock E-CPR service for out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) in Australia. The E-CPR care cycle was defined as the time from initiating E-CPR to hospital discharge or death of the patient. Detailed process maps with discrete steps and probabilistic decision nodes accounting for the complex trajectories of E-CPR patients were developed. Data about clinical and nonclinical resources and timing of activities was collected multiple times for each process . Total direct costs were calculated using the time estimates and unit costs per resource for all clinical and nonclinical resources. The total direct costs were combined with indirect costs to obtain the total cost of E-CPR. From 10 E-CPR care cycles observed during the study period, a minimum of 3 observations were obtained per process. The E-CPR care cycle's mean (95% CI) cost was $75,014 ($66,209-83,222). Initiation of extracorporeal membrane oxygenation (ECMO) and ECMO management constituted 18% of costs. The ICU management (35%) and surgical costs (20%) were the primary cost determinants. IHCA had a higher mean (95% CI) cost than OHCA ($87,940 [75,372-100,570] vs. 62,595 [53,994-71,890], p < 0.01), mainly because of the increased survival and ICU length of stay of patients with IHCA. The mean cost for each E-CPR survivor was $129,503 ($112,422-147,224). Significant costs are associated with E-CPR for refractory cardiac arrest. The cost of E-CPR for IHCA was higher compared with the cost of E-CPR for OHCA. The major determinants of the E-CPR costs were ICU and surgical costs. These data can inform the cost-effectiveness analysis of E-CPR in the future.

Cerebrospinal Creatine Kinase BB Isoenzyme: A Biomarker for Predicting Outcome After Cardiac Arrest.

Cerebrospinal fluid creatine kinase BB isoenzyme (CSF CK-BB) after cardiac arrest (CA) has been shown to have a high positive predictive value for poor neurological outcome, but it has not been evaluated in the setting of targeted temperature management (TTM) and modern CA care. We aimed to evaluate CSF CK-BB as a prognostic biomarker after CA. We performed a retrospective cohort study of patients with CA admitted between 2010 and 2020 to a three-hospital health system who remained comatose and had CSF CK-BB assayed between 36 and 84h after CA. We examined the proportion of patients at hospital discharge who achieved favorable or intermediate neurological outcome, defined as Cerebral Performance Category score of 1-3, compared with those with poor outcome (Cerebral Performance Category score 4-5) for various CSF CK-BB thresholds. We also evaluated additive value of bilateral absence of somatosensory evoked potentials (SSEPs). Among 214 eligible patients, the mean age was 54.7 ± 4.8years, 72% of patients were male, 33% were nonwhite, 17% had shockable rhythm, 90% were out-of-hospital CA, and 83% received TTM. A total of 19 (9%) awakened. CSF CK-BB ≥ 230 U/L predicted a poor outcome at hospital discharge, with a specificity of 100% (95% confidence interval [CI] 82-100%) and sensitivity of 69% (95% CI 62-76%). When combined with bilaterally absent N20 response on SSEP, specificity remained 100% while sensitivity increased to 80% (95% CI 73-85%). Discordant CK-BB and SSEP findings were seen in 13 (9%) patients. Cerebrospinal fluid creatine kinase BB isoenzyme levels accurately predicted poor neurological outcome among CA survivors treated with TTM. The CSF CK-BB cutoff of 230 U/L optimizes sensitivity to 69% while maintaining a specificity of 100%. CSF CK-BB could be a useful addition to multimodal neurological prognostication after CA.

Predictors of Nonhome Discharge After Cervical Disc Replacement.

Retrospective review of a national database. The aim of this study was to identify the factors that increase the risk of nonhome discharge after CDR. As spine surgeons continue to balance increasing surgical volume, identifying variables associated with patient discharge destination can help expedite postoperative placement and reduce unnecessary length of stay. However, no prior study has identified the variables predictive of nonhome patient discharge after cervical disc replacement (CDR). The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients who underwent primary 1-level or 2-level CDR between 2011 and 2020. Multivariable Poisson regression with robust error variance was employed to identify the predictors for nonhome discharge destination following surgery. A total of 7276 patients were included in this study, of which 94 (1.3%) patients were discharged to a nonhome destination. Multivariable regression revealed older age (OR: 1.076, P<0.001), Hispanic ethnicity (OR: 4.222, P=0.001), BMI (OR: 1.062, P=0.001), ASA class ≥3 (OR: 2.562, P=0.002), length of hospital stay (OR: 1.289, P<0.001), and prolonged operation time (OR: 1.007, P<0.001) as predictors of nonhome discharge after CDR. Outpatient surgery setting was found to be protective against nonhome discharge after CDR (OR: 0.243, P<0.001). Age, Hispanic ethnicity, BMI, ASA class, prolonged hospital stay, and prolonged operation time are independent predictors of nonhome discharge after CDR. Outpatient surgery setting is protective against nonhome discharge. These findings can be utilized to preoperatively risk stratify expected discharge destination, anticipate patient discharge needs postoperatively, and expedite discharge in these patients to reduce health care costs associated with prolonged length of hospital stay. IV.