Patient Length Of Stay Research Articles

1459. Association of Antibiotic Prophylaxis Duration and Length of Stay in Patients Undergoing Coronary Artery Bypass Graft Procedure

Abstract Background Antibiotic prophylaxis in surgery is a standard measure to reduce the risk of microbial contamination following an incision. For most surgeries, a single dose of antibiotics is generally required. However, in patients undergoing coronary artery bypass graft (CABG) procedure, antibiotics have been administered for ≥ 24 hours as data on the optimal duration is not sufficient. We aimed to correlate the duration of antibiotic prophylaxis in patients undergoing CABG with length of hospital stay (LOS). Methods We conducted a retrospective cohort study comparing LOS of patients undergoing CABG who received antibiotic prophylaxis for ≥ 24 hours (extended course group) and those who received it for < 24 hours (short course group). Inclusion criteria were adults who had undergone CABG between 01/09/2015 –01/03/2019 in a cardiology and cardiothoracic surgery hospital. Exclusion criteria were immunocompromised patients, in-hospital mortality and patients with a pre-existing infection. The primary outcome was LOS and we also explored other variables that may predict LOS. Effects were adjusted for confounders using a multivariate linear regression model. Results A total of 855 patients were identified. After exclusion, 840 were included in the analysis of which 425 (50.6%) received antibiotics for ≥ 24 hours and 415 (49.4%) received them for < 24 hours. The median LOS was 12.2 [IQR 11.0] days in the extended course group and 8.4 [IQR 8.8] days in the short course group, with a difference of 3.8 days (95% CI: 1.8-5.7), p-value < 0.001. However, after adjusting for potential confounders the difference was no longer significant, 1.7 days (95% CI: -0.23-3.7), p-value 0.083. Independent predictors of length of stay were, male gender, presence of chronic kidney disease, American Society of Anesthesiologists class, priority of the surgery and history of infection in the last 90 days. Conclusion There is no statistically significant difference in LOS between short and extended antibiotic prophylaxis course in patients undergoing CABG procedure. Future work should explore the cost-effectiveness of short versus extended course antibiotic prophylaxis. Disclosures All Authors: No reported disclosures

Virtual cardiac hospital in the home following cardiac surgery delivers superior patient outcomes, reduces costs, and increases bed availability

Abstract Introduction Increasing patient complexity and unprecedented bed access constraints are important challenges in contemporary delivery of post-operative cardiac surgical care. Bed constraints lead to inefficient ICU discharge, excessive hospital Length Of Stay (LOS), and ineffective transitional care which results in suboptimal patient experience and hospital readmissions. The Cardiac Hospital in the Home (cHITH) model was designed to provide an early supported discharge in a virtual ward environment by an expert team of advanced practice cardiac nurses, pharmacists and cardiologists. The model utilizes wearable technology to monitor cardiac rhythm, oxygen saturation and vital signs in conjunction with daily virtual ward rounds using a standard tele health platform. Care is focused on coaching around mobilization and medical therapy, detection and management of complications and liaison with community pharmacies and providers of sub acute care. Escalation pathways for clinical deterioration were designed to support patient safety. Results Between March and October 2022, 123 of 197 patients were referred to cHITH of whom 103 (84%) were recruited. Where appropriate, results were compared with those from the same calendar period in 2021 and dichotomized to detect early trends in care. The cHITH group had a mean age of 62 ± 4 years with 82% males, 62% underwent isolated CABG surgery and there were no mortalities. Compared with historical results, inpatient LOS was reduced 1.6 days with 35% of care delivered in the virtual cardiac hospital. Readmission at 30 days was reduced by 42% (p<0.05)* and patient satisfaction was >90% (net promoter score). Important trends included an increase in cHITH LOS and a reduction in Total LOS. Projections Modelling of total hospital costs and bed-day savings was performed using real data from the medical centre. Assuming that 75% of patients would be managed in the cHITH for 3.5 days, the projected cost of cHITH care was $24.2M comparing favorably with $27.8M for usual care. When readmitted days are subtracted from total virtual care days the cHITH model of care is projected to save 975 inpatient bed days. Conclusions This virtual model of care has demonstrated safety, efficiency and high levels of patient satisfaction. Ongoing analysis is required to understand the broader applications of this model and to further evaluate quality, safety and efficiency metrics.Table 1.Results

Outcomes Among Hospitalized Patients with Amyloidosis and Atrial Fibrillation: A Nationwide Analysis

Background Amyloidosis can affect virtually any organ system; deposition in the heart usually occurs in primary (AL) and mutated transthyretin (ATTR) subtypes. Clinical presentation ranges from heart failure and infiltrative cardiomyopathy to life threatening ventricular arrythmias. Atrial fibrillation has often been described in literature to manifest in patients with amyloidosis, although its clinical significance needs further exploration. Methods We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified hospitalized patients with amyloidosis and atrial fibrillation using appropriate ICD-10 CM codes. We stratified patients based on whether they had atrial fibrillation during the hospitalization or not. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of <0.05 was considered statistically significant. The aim of this study is to investigate the outcomes among hospitalized patients with amyloidosis and atrial fibrillation looking primarily at the in-hospital mortality, risk for cardiogenic shock, and hospital length of stay (LOS). Results We identified a total of 84604 hospitalized patients with amyloidosis, of which 31.73% (26845/84604) had comorbid atrial fibrillation. The overall in-hospital mortality among those with amyloidosis was 6.42% (5432/84604). Among those who had atrial fibrillation, the overall in-hospital mortality rate was significantly higher at 7.17% (389/5432) (p=0.011). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, atrial fibrillation among hospitalized patients with amyloidosis did not significantly increase the risk for in-hospital mortality (adjusted OR 1.12, 95% confidence interval [CI], 0.96-1.31; p=0.150) or prolong hospital LOS (p=0.199). However, concomitant atrial fibrillation among hospitalized patients with amyloidosis increased the risk for cardiogenic shock (aOR 1.65, 95% confidence interval [CI], 1.31-2.06; p=<0.001) Conclusion Atrial fibrillation continues to be a significant comorbidity in patients with amyloidosis. Our study found a statistically significant increase in the risk for cardiogenic shock, but not for in-patient mortality and hospital LOS. Early identification and prompt management with medical therapy or cardioversion is necessary to prevent disastrous complications. Further prospective cohort studies will help to better assess both short- and long-term outcomes in this patient population.

Sex-based differences in left ventricular assist device clinical outcomes.

Heart failure (HF) continues to be a significant public health issue, posing a heightened risk of morbidity and mortality for both genders. Despite the widespread use of left ventricular assist device (LVAD), the influence of gender differences on clinical outcomes following implantation remains unclear. We investigated the impact of gender differences on readmission rates and other outcomes following LVAD implantation in patients admitted with advanced HF. We conducted a retrospective study of patients who underwent LVAD implantation for advanced HF between 2014 and 2020, using the Nationwide Readmissions Database. Our study cohort was divided into male and female patients. The primary outcome was 30-day readmission (30-dr), while secondary outcomes were inpatient mortality, length of stay (LOS), procedural complication rates, and periadmission rates. Multivariate linear, Cox, and logistic regression analyses were performed. During the study period, 11,492 patients with advanced HF who had LVAD placement were identified. Of these, 22% (n = 2532) were females and 78% (n = 8960) were males. The mean age was 53.9 ± 10.8 years for females and 56.3 ± 10.5 years for males (adjusted Wald test, p < 0.01). Readmissions were higher in females (21% vs. 17%, p = 0.02) when compared to males. Cox regression analysis showed higher readmission events (hazard ratio: 1.24, 95% confidence interval: 1.01-1.52, p = 0.03) in females when compared to males. Inpatient mortality, LOS, and most procedural complication rates were not statistically significantly different between the two groups (p > 0.05, all). Women experienced higher readmission rates and were more likely to be readmitted multiple times after LVAD implantation when compared to their male counterparts. However, there were no significant sex-based differences in inpatient mortality, LOS, and nearly all procedural complication rates. These findings suggest that female patients may require closer monitoring and targeted interventions to reduce readmission rates.

Predictive Factors for Length of Stay in Patients Undergoing Total Hip Arthroplasty: A Cross-Sectional Study.

Total hip arthroplasty (THA) is an effective surgery for patients with end-stage hip joint degenerative arthritis. This study aimed to determine peri-operative factors that impact the length of stay (LOS) and design a formula to predict LOS in patients undergoing THA. This cross-sectional study was performed from September 2019 to January 2020. For this study, all patients who underwent THA over a period of 12 years since 2005 were included in the study. Data about the LOS and several variables including demographic variables, surgery-related variables, transfusion, intensive care unit (ICU) admission, past drug history, comorbidities, and laboratory data, were gathered. Qualitative variables are presented as numbers (%), and quantitative variables are presented as mean Mann± standard deviation. Mann Whitney test , Kruskal-Wallis test, and Spearman's rank correlation test were also used. A total of 524 patients were included in the study; 12 were excluded .261 (51%) were female and 251(49%) male. The mean age was 56.13±17.04 years. In the univariate analysis, the day of admission, surgery indication, transfusion, diabetes mellitus, oral anti-diabetic drugs, American Society of Anesthesiology (ASA) score, preoperative hemoglobin (Hb) level, and type of prosthesis showed significant relation with LOS. Significant variables entered to zero truncated negative binomial regression. Among them, the day of admission, ASA score, preoperative Hb level, and type of prosthesis showed significant relation with LOS (P < 0.05) and were used for model design. Preoperative Hb level, ASA score, day of admission, and prosthesis type have an impact on LOS and can predict LOS in patients who are candidates for THA.

Comparison of the cost analysis in total hip arthroplasty of anterior versus posterior approaches: A propensity score-matched cohort study in a single center

PurposeThe advantage of total hip arthroplasty (THA) in an anterior approach compared with a posterior approach in terms of early postoperative pain and function and lowering dislocation risks is controversial. This study aimed to identify whether THA using the anterior approach lowers costs compared with the posterior approach. MethodsWe identified 294 patients who underwent primary THA and compared the cost of total inpatient stay, inpatient length of stay (LOS), cost of operating room, and the rates of discharged patients, complications, and reoperation between the anterior and posterior approaches using propensity score matching analysis. ResultsOne-to-one matching resulted in 135 pairs of patients who underwent THA using both approaches. The cost of total inpatient stay was significantly lower in the anterior approach (anterior vs. posterior [1,322,800 vs. 1,445,219 yen]; p ​= ​0.04). Furthermore, in the anterior approach, the inpatient LOS was shorter (anterior vs. posterior [19.9 vs. 25.0 days]; p ​< ​0.001). However, there was no significant difference in the cost of the operating room and the rates of patients discharged home, total complications (anterior vs. posterior [5.2 vs. 11.1 ​%]; p ​= ​0.08), or revisions between the two approaches. ConclusionsUsing propensity score matching, the current study demonstrated that THA in the anterior approach shortened inpatient LOS and rendered an 8 ​% reduction in the total inpatient cost compared with the posterior approach.

Performance of artificial intelligence-based algorithms to predict prolonged length of stay after head and neck cancer surgery

BackgroundMedical resource management can be improved by assessing the likelihood of prolonged length of stay (LOS) for head and neck cancer surgery patients. The objective of this study was to develop predictive models that could be used to determine whether a patient's LOS after cancer surgery falls within the normal range of the cohort. MethodsWe conducted a retrospective analysis of a dataset consisting of 300 consecutive patients who underwent head and neck cancer surgery between 2017 and 2022 at a single university medical center. Prolonged LOS was defined as LOS exceeding the 75th percentile of the cohort. Feature importance analysis was performed to evaluate the most important predictors for prolonged LOS. We then constructed 7 machine learning and deep learning algorithms for the prediction modeling of prolonged LOS. ResultsThe algorithms reached accuracy values of 75.40 (radial basis function neural network) to 97.92 (Random Trees) for the training set and 64.90 (multilayer perceptron neural network) to 84.14 (Random Trees) for the testing set. The leading parameters predicting prolonged LOS were operation time, ischemia time, the graft used, the ASA score, the intensive care stay, and the pathological stages. The results revealed that patients who had a higher number of harvested lymph nodes (LN) had a lower probability of recurrence but also a greater LOS. However, patients with prolonged LOS were also at greater risk of recurrence, particularly when fewer (LN) were extracted. Further, LOS was more strongly correlated with the overall number of extracted lymph nodes than with the number of positive lymph nodes or the ratio of positive to overall extracted lymph nodes, indicating that particularly unnecessary lymph node extraction might be associated with prolonged LOS. ConclusionsThe results emphasize the need for a closer follow-up of patients who experience prolonged LOS. Prospective trials are warranted to validate the present results.

Inpatient Length of Stay in Femur Fracture Patients in Emergency Hospital, Mansoura University

Inpatient Length of Stay in Femur Fracture Patients in Emergency Hospital, Mansoura University

Breast-Enhanced Recovery After Surgery Protocol Decreased Opioid Usage, Anti-Emetic Requirement and Hospital Length of Stay in Patients Undergoing Total Mastectomy Without Reconstruction

Breast-Enhanced Recovery After Surgery Protocol Decreased Opioid Usage, Anti-Emetic Requirement and Hospital Length of Stay in Patients Undergoing Total Mastectomy Without Reconstruction

Influence of Body Mass Index on the Evaluation and Management of Pediatric Abdominal Pain in the Emergency Department.

Introduction: Childhood obesity is a serious concern in the United States, with over one third of the pediatric population classified as obese. Abdominal pain is one of the most common chief complaints among pediatric emergency department (ED) visits. We hypothesized that overweight and obese children being evaluated in the ED for abdominal pain would have higher resource utilization than their normal and underweight peers. Methods: This was a retrospective review of pediatric patients <18years who presented with abdominal pain to the ED of a tertiary care center from January 1, 2014-September 3, 2020. Patients were excluded if they did not have both a height and weight recorded. We categorized patients as underweight (body mass index [BMI] <5th percentile); normal weight (BMI 5th to <85th percentile), overweight (BMI 85th to <95th percentile); or obese (BMI ≥95th percentile). Descriptive statistics were used to examine the study population. We used chi-square tests to examine the differences in patient characteristics between normal/underweight patients and overweight/obese patients. The Kruskal-Wallis test was completed for examining differences in the medians. We used multivariable logistic regression to examine visit characteristics associated with overweight/obese patients, including ED interventions, testing, and length of stay (LOS). Results: Of the 184 subjects included in the analysis, nine (4.9%) were underweight, 108 (58.7%) were normal weight, 21 (11.4%) were overweight, and 46 (25.0%) were obese. Patients with a BMI of ≥85th percentile were older (median 15 vs 13years, P = 0.01). They were otherwise similar in demographics. There was no significant difference between normal/underweight and overweight/obese subjects in disposition (37% vs 43% discharge, P = 0.38), 72-hour return (7% vs 6%, P = 0.82), ED LOS (median 4.42 vs 3.95 hours, P = 0.195), or inpatient LOS (median 42.0 vs 34.2 hours, P = 0.06). There were no statistically significant differences in total number of ED tests or interventions received by overweight/obese patients compared to normal/underweight patients, and each subject received a median of six tests (interquartile range [IQR] 4-7) and two interventions (IQR 1-3). Conclusion: Among pediatric patients presenting to the ED with abdominal pain, we found that patient characteristics and ED resource utilization (including testing, intervention, disposition, and LOS) did not differ significantly across BMI categories.

Psychiatric comorbidity and trauma: impact on inpatient outcomes and implications for future management.

This study aimed to quantify the impact of pre-existing psychiatric illness on inpatient outcomes after major trauma and to assess acuity of psychiatric presentation as a predictor of outcomes. A retrospective single-center cohort study identified adult trauma patients with an Injury Severity Score (ISS) ≥ 16 between January 2018 and December 2019. Bivariate analysis assessed patient characteristics, injury characteristics, and injury outcomes between patients with and without psychiatric comorbidity. A sub-group analysis explored further effects of psychiatric history and need for inpatient psychiatric consultation on outcomes. Of 640 patients meeting inclusion criteria, 99 patients (15.4%) had at least one psychiatric comorbidity. Patients with psychiatric comorbidity sustained distinct mechanisms of injury and higher in-hospital morbidity (44% vs. 26%, OR 1.97, 95% CI 1.17-3.3, p = 0.01), including pulmonary morbidity (31% vs. 21%, p < 0.01), neurologic morbidity (18% vs 7%, p < 0.01), and deep wound infection (8% vs. 2%, p < 0.01) than the control cohort. Psychiatric patients also had significantly greater median intensive care unit (ICU), length of stay (LOS) (1day vs. 0days, p = 0.04), median inpatient ward LOS (10days vs. 7days, p = 0.02), and median overall hospital LOS (16days vs. 11days, p < 0.01). In sub-group analysis, patients with a history of psychiatric illness alone had comparable outcomes to the control group. Psychiatric comorbidity negatively impacts inpatient morbidity and inpatient LOS. This effect is most pronounced among acute psychiatric episodes with or without a history of mental illness.

In-Hospital Receipt of Ivermectin Is Associated With No Benefit in Mortality, Disease Progression, or Length of Stay for Patients With Mild to Moderate COVID-19

Background Use of the antiparasitic agent ivermectin as a potential treatment for early coronavirus disease 2019 (COVID-19) is not recommended, yet inpatient administration continues to be seen. Methods This was a retrospective analysis of more than 100,000 patients admitted to a large health system of community hospitals for COVID-19 to assess the association of ivermectin administration, either early in disease course or at higher severity, with mortality and disease progression (intensive care unit admission or use of mechanical ventilation). Propensity match analysis was used to account for covariates. Results Of the 122,002 patients hospitalized with COVID-19 included in this analysis, 1.1% (1380) received ivermectin while at mild to moderate severity (on room air or nasal cannula), and 0.2% (n = 293) received the drug while severe (noninvasive or mechanical ventilation). Among those who received it with mild to moderate severity, there was no effect on relative risk (RR) of mortality (RR, 1.01; 95% confidence interval [CI], 0.802–1.27), intensive care unit admission (RR, 0.984; 95% CI, 0.865–1.12), or use of mechanical ventilation (RR, 0.976; 95% CI, 0.777–1.23), but an increase in average length of stay (mean days, 8.0 vs 7.5; P &lt; 0.001). Of those who received their first dose of ivermectin with more severe COVID-19, there was an increase in the RR of mortality (RR, 1.63; 95% CI, 1.34–1.99; P &lt; 0.001). Conclusion Among hospitalized patients admitted with mild to moderate COVID-19, in-hospital administration of ivermectin provides no benefit in mortality or disease progression when administered early in the disease course, and may contribute to excess mortality when administered to patients at more severe disease states.

280 Does Delayed Physiotherapy Assessment Postoperatively Affect Mortality or Length of Stay in Patients Following Surgery for a Neck of Femur Fracture?

Abstract Aim National guidance states that patients with a neck of femur fracture (NOFF) should be assessed by a physiotherapist on the first postoperative day. This can pose problems given the finite availability of physiotherapists. This study aims to determine if delayed assessment impacts patients' postoperative mortality or length of stay in the hospital. Method A prospective case series of all NOFFs surgically treated at a major trauma centre between 2013-2022 was performed. Patients ≥65 years of age were included from a unit-based prospective database. Results A total of 3411 patients were included. 3062 were assessed by a physiotherapist on the first postoperative day (POD1), and 349 on day two and beyond (POD2+). Delayed physiotherapy was principally due to the day of operation, where the POD2+ group more likely had surgery on a Friday or Saturday, p&amp;lt;0.001. The two groups were comparable in age, gender, fracture morphology, preoperative ASA and Rockwood frailty scores, and surgical procedure. The average length of stay for POD1 was 16.9 days (SD = 21.1), and 16.0 days (SD = 12.4) for POD2+, p = 0.450. Mortality was lower in the POD2+ group at 30 days after surgery, p = 0.040. There was no difference in mortality at 1 year, p = 0.295, 2 years, p = 0.724, and overall, p = 0.826. Conclusions Delayed physiotherapy assessment does not worsen length of stay in NOFF patients. Lower early mortality in this group indicates a possible benefit in delaying physiotherapy assessment although there was no significant difference in mortality beyond 30 days. However, a seven-day physiotherapy service would still be required for continuity of postoperative care.

Erector Spinae Plane Blocks for Circumferential Lumbar Spinal Fusion: Retrospective Cohort Study.

Circumferential lumbar spine fusions are extensive procedures that involve accessing the lumbar spine from multiple approaches. These surgeries often make postoperative pain control challenging, and efforts have been made to find alternative methods of analgesia that do not rely solely on opioids. The use of erector spinae plane (ESP) blocks has been found to be effective in controlling pain while decreasing narcotic requirements in patients undergoing thoracolumbar spine surgery. The purpose of this study is to evaluate the efficacy of ESP blocks for postoperative pain control and its effect on opioid consumption in patients undergoing circumferential lumbar spinal fusion. A retrospective review was performed on patients undergoing 1- or 2-level elective anterior lumbar interbody fusion with open posterior decompression and posterolateral fusion. An analysis was performed to determine the effect of ESP blocks on hospital length of stay (LOS), pain scores using the visual analog scale, and opioid consumption using morphine milligram equivalents. 144 patients were included in the cohort analysis, of whom 36 patients received a preoperative ESP block and 108 did not. Demographic data, comorbidities, and number of levels fused were equally distributed between groups. Patients who received an ESP block had shorter LOS (3.0 vs 4.0 days, P = 0.005) and lower cumulative morphine milligram equivalent in the first 48 hours after surgery (123.7 vs 141.2, P = 0.05). Visual analog scale scores did not significantly differ between patients group except for on postoperative day 4 and at 12-month follow-up. The use of ESP blocks for patients undergoing 1- or 2-level circumferential fusion via an anterior lumbar interbody fusion with concomitant posterior open procedures was associated with decreased postoperative inpatient opioid requirements and LOS. This cohort study supports the growing body of evidence that ESP blocks are a useful adjunct for multimodal pain control. 3 CLINICAL RELEVANCE: The data and results of this study provide clinical evidence supporting the use of ESP blocks in patients undergoing circumferential lumbar spine fusion procedures.

The Use of Methylphenidate During Inpatient Rehabilitation After Pediatric Traumatic Brain Injury: Population Characteristics and Prescribing Patterns.

To understand how methylphenidate (MPH) is used in youth with traumatic brain injury (TBI) during inpatient pediatric rehabilitation. Inpatient pediatric rehabilitation. In total, 234 children with TBI; 62 of whom received MPH and 172 who did not. Patients were on average 11.6 years of age (range, 2 months to 21 years); 88 of 234 were female; the most common mechanism of injury was motor vehicle collision (49%); median (IQR) acute hospital length of stay (LOS) and inpatient rehabilitation LOS were 16 (10-29) and 23 (14-39), respectively; 51 of 234 were in a disorder of consciousness cognitive state at time of inpatient rehabilitation admission. Multicenter, retrospective medical record review. Patient demographic data, time to inpatient pediatric rehabilitation admission (TTA), cognitive state, MPH dosing (mg/kg/day). Patients who received MPH were older (P = .011); TTA was significantly longer in patients who received MPH than those who did not (P =.002). The lowest recorded dose range by weight was 0.05 to 0.89 mg/kg/d, representing an 18-fold difference; the weight-based range for the maximum dose was 0.11 to 0.97 mg/kg/d, a 9-fold difference. Patients in lower cognitive states at admission (P = .001) and at discharge (P = .030) were more likely to receive MPH. Five patients had side effects known to be associated with MPH; no serious adverse events were reported. This multicenter study indicates that there is variable use of MPH during acute inpatient rehabilitation for children with TBI. Children who receive MPH tend to be older with lower cognitive states. Dosing practices are likely consistent with underdosing. Clinical indications for MPH use during inpatient pediatric rehabilitation should be better defined. The use of MPH, as well as its combination with other medications and treatments, during inpatient rehabilitation needs to be further explored.

The Impact of Rocuronium and Sugammadex on Length of Stay in Patients Undergoing Open Spine Surgery: A Propensity Score-Matched Analysis.

Enhanced Recovery After Surgery (ERAS), an all-encompassing perioperative care approach, has been demonstrated to enhance surgical results, mitigate postoperative issues, and decrease the length of hospital stay (LOS) in diverse surgical specialties. In this retrospective study, our objective was to examine the influence of muscle relaxant selection on LOS and perioperative results in adult patients undergoing open spine surgery. Specifically, we compared 201 patients who received cisatracurium and neostigmine with 201 patients who received rocuronium and sugammadex, after 1:1 propensity score matching. The utilization of the rocuronium and sugammadex combination in anesthesia for open spinal surgery did not lead to a reduction in the LOS but was associated with a decreased incidence of postoperative chest radiographic abnormalities, including infiltration, consolidation, atelectasis, or pneumonia (p = 0.027). In our secondary analysis, multivariate analysis revealed multiple determinants influencing the prolonged LOS (>7 days) during open spine surgery. Bispectral index-guided anesthesia emerged as a protective factor, while variables such as excessive intraoperative blood loss and fluid administration as well as postoperative chest radiographic abnormalities independently contributed to prolonged LOS.

Automated machine learning (AutoML) can predict 90-day mortality after gastrectomy for cancer

Early postoperative mortality risk prediction is crucial for clinical management of gastric cancer. This study aims to predict 90-day mortality in gastric cancer patients undergoing gastrectomy using automated machine learning (AutoML), optimize models for preoperative prediction, and identify factors influential in prediction. National Cancer Database was used to identify stage I–III gastric cancer patients undergoing gastrectomy between 2004 and 2016. 26 features were used to train predictive models using H2O.ai AutoML. Performance on validation cohort was measured. In 39,108 patients, 90-day mortality rate was 8.8%. The highest performing model was an ensemble (AUC = 0.77); older age, nodal ratio, and length of inpatient stay (LOS) following surgery were most influential for prediction. Removing the latter two parameters decreased model performance (AUC 0.71). For optimizing models for preoperative use, models were developed to first predict node ratio or LOS, and these predicted values were inputted for 90-day mortality prediction (AUC of 0.73–0.74). AutoML performed well in predicting 90-day mortality in a larger cohort of gastric cancer patients that underwent gastrectomy. These models can be implemented preoperatively to inform prognostication and patient selection for surgery. Our study supports broader evaluation and application of AutoML to guide surgical oncologic care.

Predicting Length of Stay in Patients With Acute Myocardial Infarction: Insights From the CADOSA Registry

Predicting Length of Stay in Patients With Acute Myocardial Infarction: Insights From the CADOSA Registry

Predictors of ICU Length of Stay in Patients with COVID-19: A Retrospective Study

Background. The available evidence has made the long-term accompaniment of COVID-19 and its other variants with human life predictable. Different studies have proposed different and, in some cases, contradictory findings as factors determining the duration of hospitalization of patients with COVID-19. The present study aimed to identify the factors related to the duration of ICU length in patients with COVID-19. Methods. The present study retrospectively analyzed the data related to patients aged 1 to 97 years with COVID-19 registered in Isfahan's COVID-19 registration system. The data of those patients with COVID-19 who were alive at the time of discharge (n=453) were analyzed in the present study. Information related to laboratory findings, clinical data, and co-morbidities were collected. T-test, correlation, and analysis of variance tests were used in crude analysis. The linear regression model was used to determine the factors related to the ICU length and their importance. Results. The mean (SD) of intensive care unit days was 0.64 (2.39). Higher than normal values of INR, hemoglobin, and creatinine increased the average length of stay in ICU by 2.45 (p=0.001), 3.82 (p &lt;0.001), and 0.72 (p &lt;0.001) days, respectively. Among underlying co-morbidities, the presence of other respiratory diseases significantly increased the average length of stay in the ICU by 1.5 days (p=0.024). Standardized regression coefficients also showed that higher-than-normal hemoglobin and increased WBC values were the most important variables predicting ICU hospitalization length. Conclusion. The higher-than-normal values of hemoglobin and increased WBC values are the most important predictors of the length of hospitalization in the ICU. The findings of the present study can be helpful in the decision-making of specialists to reduce the duration of hospitalization in the ICU and to help diagnose more critical cases.

Peripheral Nerve Block Delays Mobility and Increases Length of Stay in Patients With Geriatric Hip Fracture.

Peripheral nerve blocks (PNB) has been increasingly used in the care of patients with geriatric hip fracture to reduce perioperative opiate use and the need for general anesthesia. However, the associated motor palsy may impair patients' ability to mobilize effectively after surgery and subsequently may increase latency to key mobility milestones postoperatively, as well as increase inpatient length of stay (LOS). The aim of this study was to investigate time-to-mobility milestones and length of hospital stay between peripheral, epidural, and general anesthesia. A retrospective review identified 1,351 patients aged 65 years or older who underwent surgery for hip fracture between 2012 and 2018 at a single academic health system. Patients were excluded if baseline nonambulatory, restricted weight-bearing postoperatively, or sustained concomitant injuries precluding mobilization, with a final cohort of 1,013 patients. Time-to-event analyses for discharge and mobility milestones were assessed using univariate Kaplan-Meier and multivariate Cox proportional hazard regression analyses. PNB was associated with delayed postoperative time to ambulation ( P < 0.001) and time to out-of-bed ( P = 0.029), along with increased LOS ( P < 0.001). Epidural anesthesia was associated with less delay to first out-of-bed ( P = 0.002), less delay to ambulation ( P = 0.001), and overall reduced length of stay ( P < 0.001). PNB was associated with slower mobilization and longer hospitalization while epidural anesthesia was associated with quicker mobilization and shorter hospital stays. Epidural anesthesia may be a preferable anesthesia choice in patients with geriatric hip fracture when possible. Level III.