Length Of Admission Research Articles

Development and Validation of Machine Learning Models to Predict Readmission After Colorectal Surgery

BackgroundReadmission after colorectal surgery is common and often implies complications for patients and costs for hospitals. Previous works have created predictive models using logistic regression for this outcome but have shown limited accuracy. Machine learning has shown promise in improving predictions by identifying non-linear patterns in data. We sought to create a more accurate predictive model for readmission after colorectal surgery using machine learning. MethodsPatients who underwent colorectal surgery were identified in the National Quality Improvement Program (NSQIP) database including years 2012–2019 and split into training, validation, and test sets. The primary outcome was readmission within 30 days of surgery. Three types of machine learning models were created, including random forest (RF), gradient boosting (XGB), and neural network (NN). A logistic regression (LR) model was also created for comparison. Model performance was evaluated using area under the receiver operating characteristic curve (AUROC). ResultsThe dataset included 213,827 patients after application of exclusion criteria. A total of 23,083 (10.8%) of patients experienced readmission. NN obtained an AUROC of 0.751 (95% CI 0.743–0.759), compared with 0.684 (95% CI 0.676–0.693) for LR. RF and XGB performed similarly with AUROCs of 0.749 (95% CI 0.741–0.757) and 0.745 (95% CI 0.737–0.753) respectively. Ileus, index admission length of stay, organ-space surgical site infection present at time of surgery, and ostomy placement were identified as the most contributory variables. ConclusionsMachine learning approaches outperformed traditional statistical methods in the prediction of readmission after colorectal surgery. After external validation, this improved prediction model could be used to target interventions to reduce readmission rate.

P11.47.B A description of inpatient admissions of adult glioblastoma patients in England 2103 - 2018 from the GlioCova project

Abstract Background The Gliocova dataset uses linked English national cancer data on all 51,775 adult primary brain tumour patients diagnosed between 2013-2018. Here we present early analysis of inpatient admissions of adult glioblastoma (GBM) patients. Material and Methods We identified all adults patients diagnosed with a GBM and extracted all the inpatient admissions for 1 night or more after the date of diagnosis. We focused on number and length of admissions, variation in those numbers, and place of discharge. Results Between 2013 and 2018, 15,294 patients were diagnosed with a glioblastoma in England (60% male) with a median age of 66, of whom, 12,441 (61% male) were admitted overnight with a total of 49,384 admissions post-diagnosis. Half of these patients were less than 64 at the time of their admission. The mean number of post-diagnosis admissions was 4, with a mean length of stay of 9.5 days. However, for half of the admissions, patients stayed 5 days or less in hospital (IQR = 10). Most of the procedures done were treatment-related, such as surgery for which patients stayed an average of 6.3 days (median = 4; IQR = 5). Patients who were admitted for non-treatment reasons stayed on average almost 10 days (median = 5; IQR = 11). Fewer than 3,000 admissions resulted in a patient death (5.5% of all admissions), whereas over 23,000 admissions for 10,426 patients ended with patients being discharged at home. About 2,000 patients were discharged to another hospital, hospice or a nursing home. Conclusion Most of the patients diagnosed with a glioblastoma will be admitted at some point after their diagnosis. Although the average length of stay is not that long, there is a considerable tail of longer-staying patients, for whom improved services and support might enable quicker discharge. To our knowledge, this is the first time inpatient admissions in adult brain patients are being looked at.GlioCova is supported by the Imperial/NIHR BRC, and the members of the GlioCova EAG. This work uses data provided by patients and collected by the NHS as part of their care and support.More information on the Gliocova project can be found on https://blogs.imperial.ac.uk/gliocova.

Pediatric hospital admissions, case severity, and length of hospital stay during the first 18 months of the COVID-19 pandemic in a tertiary children’s hospital in Switzerland

BackgroundSARS-CoV-2 directly contributes to the burden of respiratory disease in children, but indirect effects of protective measures also need to be considered to assess the overall impact of the pandemic on children's health.MethodsWe retrospectively compared pre-pandemic and pandemic data of main admission diagnoses, sorted by ICD-10 diagnosis groups, in a tertiary children's hospital in Switzerland from 2017 until August 2021. Hospital admission rates, severity, and length of stay (LOS) of the individual ICD-10 groups during the pandemic were compared with three previous years accounting for seasonal differences.ResultsAmong 20,168 hospital admissions (n = 13′950 in pre-pandemic years; n = 3′120 in 2020 and n = 3′098 in 2021), there were significant decreases in numbers of admissions for respiratory diseases during the early pandemic with a rebound in summer 2021. During the pandemic, admissions for non-respiratory infections, neoplasms, and skin diseases decreased but increased for trauma. Particularly, a drop in admissions for different respiratory infections [e.g. respiratory syncytial virus (RSV) and bronchiolitis] was pronounced after introduction of strict measures, but admissions increased again after restrictions were loosened. While disease severity was lower for respiratory and neurologic diseases and bronchiolitis throughout the pandemic, gastrointestinal disease admissions had longer LOS and in the first pandemic year greater severity. For RSV and pneumonia, disease severity and LOS were higher in the first pandemic year and lower in the second pandemic year.ConclusionThe pandemic and associated protective measures had a significant effect on respiratory and non-respiratory admissions, particularly with decreases in hospital admissions for respiratory infections followed by a rebound after loosening of measures.

1292P A review of in-hospital end-of-life care (EOLC) for oncology patients during the COVID-19 pandemic

Globally, 40 to 60% of all patient deaths occur in an acute hospital setting. Patients with cancer make up a significant proportion of those who die in hospitals. Clinicians involved in their care should be competent at recognising dying and documenting the quality of EOLC delivered to patients and families. Continued evaluation and audit of the care of the dying patient is essential for quality improvement at an organisational level. The management of patients who died in Cork University Hospital under the Oncology Service’s care between 1 January 2021 and 31 December 2021 was analysed. Paper and electronic records were reviewed, and patient care was assessed using the Oxford Quality Indicators (QIs) for EOLC. Ethical approval was granted by the Cork University Hospital Quality and Patient Safety Department. 66 patients were identified (M:F 29:37). The median age at time of death was 64 years [30-82]. The average length of admission resulting in death was 12.4 days [0-44]. 6% of patients died in the emergency department and 12% of patients died in the intensive care unit. The risk of dying was documented in 95.5% of cases and was communicated to 65.2% of patients and 82.8% of patients’ families. There was a do not attempt cardiopulmonary resuscitation (DNACPR) order in place for 89.4% of patients. Unnecessary investigations and interventions were stopped for 71.2% of patients. Symptom assessment was documented in 81.8% of cases. What was important to the patient was documented as explored in 24.2% of cases. 10.6% of patients were offered a chaplain or faith advisor. The inpatient palliative care team were involved in 77.2% of cases. Using the Oxford QIs for EOLC, the average quality score was 3.5, on a scale of 1-5: 1 (very poor): 0%, 2 (poor): 21.2%, 3 (satisfactory): 33.3%, 4 (good): 19.7%, 5 (excellent): 25.8%. The average EOLC quality score was 3.5. Oncology patients at our centre received, on average, satisfactory-to-good quality EOLC. Shortcomings identified have led to the development of a care of the dying Pro-forma to improve EOLC delivery and a survey of bereaved relatives to identify gaps in care. Holistic care of the dying is a fundamental part of the cancer care spectrum and needs to be prioritised in the acute hospital setting.

Prolonged lipopolysaccharide-induced illness elevates glucagon-like peptide-1 and suppresses peptide YY: A human-randomized cross-over trial.

Severe systemic inflammation is associated with nausea, loss of appetite, and delayed gastric emptying, which increases hospitalization admission length and mortality rate. There is a lack of human controlled studies exploring gastric emptying rates and underlying mechanisms during inflammatory conditions. We aimed to investigate if systemic inflammation in young men delays gastro‐intestinal transit times, lowers motility, and affects gastrointestinal hormone secretion. This substudy of a randomized crossover trial investigated eight healthy young men on two separate occasions; (I) following an overnight fast (healthy conditions/HC) and (II) fasting and bedrest combined with two lipopolysaccharide (LPS) injections of 1 ng kg−1 following an overnight fast and 0.5 ng kg−1 following another 24 h (systemic inflammation/SI). A standardized protein beverage and a SmartPill capsule (a wireless gastrointestinal monitoring system) were swallowed during each occasion. Whole gut transit time was comparable between HC and SI. SI decreased gastric mean pressure peak amplitude (p = 0.04) and increased pH rise across the pylorus and small bowel pH (p = 0.02) compared with HC. Glucagon‐like peptide‐1 was elevated during SI compared with HC (p = 0.04). Peptide YY was lower during SI compared with HC (p = 0.007). Prolonged LPS exposure combined with fasting and bedrest elevated glucagon‐like peptide 1 concentrations, which may play a role for the nausea and loss of appetite typically associated with SI.

Clinical and Socioeconomic Burden of Respiratory Syncytial Virus in Iceland.

Respiratory syncytial virus (RSV), a very common pathogen, causes variable disease severity. In addition to considerable clinical burden on children, their families and healthcare facilities, RSV infections in children also carry significant direct and indirect socioeconomic burden. We analyzed data from 5 consecutive RSV seasons (2015-2020) and used virologically confirmed RSV infections and age <5 years as case definition. Clinical information was retrieved from electronic patient records. Costs were estimated by assuming an annual 30% attack rate and a combination of direct medical costs and calculations of societal costs of lost productivity. A total of 716 children younger than 5 years of age had confirmed RSV infection of which 254 needed hospitalizations, most of whom were previously healthy. The median length of admission was 3.6 days and 13 patients needed intensive care. The hospital admission incidence rate was 2.5/1000 children/year, but 9.1 for children younger than 1 years of age. The total annual cost of RSV was estimated at €4.3 million, of which 10% was direct healthcare costs. The clinical and socioeconomic disease burden of RSV in Iceland is substantial despite slightly lower hospital admission rates than other high-income countries. The prevention of RSV in young children, either through maternal or infant vaccination, has the potential to decrease both clinical and financial impact of the annual epidemics.

Impact of Cannabis Use, Substance Use Disorders, and Psychiatric Diagnoses on COVID-19 Outcomes: A Retrospective Cohort Study.

Objective: While psychiatric disorders have been recognized as a risk factor for COVID-19 outcomes, the impact of substance use disorders (SUD) on COVID-19 outcomes has not, to date, been examined in a systematic manner. We examined the association between SUD (cannabis, cocaine, alcohol, opioid, and benzodiazepine) as well as psychiatric diagnoses (schizophrenia, mood disorders, anxiety disorders) and COVID-19 outcomes in a large, retrospective cohort study. Methods: COVID-19–positive patients admitted to a large health care system in the US between January and December 2020 were included in this study. SUD and psychiatric diagnoses were identified from urine toxicology reports and ICD-10 diagnosis codes in the electronic medical record, respectively. Multivariable logistic regression was performed controlling for potential confounders such as age, race, sex, smoking status, and medical comorbidities. COVID-19–relevant outcomes included mortality, need for intensive care unit (ICU) admission, need for ventilatory support, length of hospitalization, and number of hospitalizations. Results: Among COVID-19 patients (N = 6,291), those with SUD were more likely to require ICU admission (adjusted odds ratio = 1.46, P = .003) and ventilatory support (AOR = 1.49, P = .01). The association between SUD and ICU admission was driven by alcohol use disorder (AUD), whereas that between SUD and ventilatory support was driven by both AUD and opioid use disorder (OUD). Patients with SUD were more likely to have a longer mean maximum length of hospitalization (11.32 vs 8.62 days, P < .0001) and a greater mean number of hospital admissions in 2020 (2.96 vs 2.33, P < .0001). These associations were significant for cannabis use disorder, AUD, OUD, and benzodiazepine use disorder. The association with greater number of admissions was also significant for cocaine use disorder. Patients with psychiatric diagnoses were also more likely to have a greater maximum length of hospitalization (11.93 vs 8.39 days, P < .0001) and hospital admissions (2.72 vs 2.31, P < .0001). These associations were significant for schizophrenia, mood disorders, and anxiety disorders. Conclusions: COVID-19 patients with SUD had greater likelihood of requiring critical interventions, such as ICU admission and ventilatory support. SUD and psychiatric diagnoses were also associated with a longer duration of hospitalization and greater number of hospital admissions. These findings identify COVID-19 patients with SUD and psychiatric comorbidities as a high-risk group.

Measurement of Procalcitonin as an Indicator of Severity in Patients With Chronic Obstructive Pulmonary Disease Admitted With Respiratory Illness.

IntroductionExacerbations of chronic obstructive pulmonary disease (COPD) are a frequent reason for hospital admission and a major cause of morbidity and mortality. A useful biomarker or indicator of disease severity at the time of presentation could help guide treatment and identify those with poor prognosis who need early aggressive intervention. We hypothesized that patients who present to the hospital with COPD exacerbations who are found to have elevated procalcitonin (PCT) levels will have worse outcomes such as longer admissions, increased intensive care unit (ICU) utilization, and more frequent readmissions than those with normal levels, regardless of presence or absence of infiltrate on initial chest X-ray (CXR).MethodsWe conducted a retrospective chart review of patients admitted to our facility with a respiratory complaint and a diagnosis of COPD to examine the relation between PCT and disease severity. A total of 156 unique encounters were reviewed, with 87 included in the final data set. Data was collected on baseline medical conditions as well as clinical status at the time of presentation. Primary endpoints included the need for overnight ICU admission, hospital length of stay greater than seven days, and repeat visit within 30 days of discharge. Secondary endpoints included the need for intubation at the time of admission, in-hospital mortality or discharge to hospice, and ICU length of stay.ResultsPatients with elevated PCT levels (>0.25ng/mL) had a significantly increased likelihood of a need for ICU admission (odds ratio 3.18) and hospital length of stay greater than seven days (odds ratio 3.38). There was no statistically significant difference in the Emergency Department readmission rate or any of the secondary outcomes.ConclusionsOur data suggests that PCT may be a useful early biomarker for patients with COPD presenting with an acute respiratory illness.

Factors associated with emergency readmissions after acute stroke: A retrospective audit of two hospitals.

Emergency hospital readmissions within 30 days of discharge from hospital are considered a marker for the quality of hospital care, patient experience, the discharge process and integration with community services. This paper describes the frequency and variations in cause of emergency readmissions at 30 and 90 days following discharge after acute stroke from two stroke units. Retrospective data collection of Hospital Episodes Statistics (HES) and Sentinel Stroke National Audit Programme (SSNAP) of consecutive acute stroke hospital discharges over 24 months from 2017 to 2019 from two specialist stroke units in England. HES data were used to calculate the Charlson comorbidity index (CCI). Covariates were analysed for their association with readmission rate, including: age; gender; CCI; length of stay for first stroke admission; living alone; discharge to a care home; discharge receiving stroke specialist early supported discharge (ESD) rehabilitationand stroke severity as determined by National Institute for Health Stroke Scaleon stroke admission. From 2017 to 2019 there were 1999 live discharges with a primary diagnosis of stroke. Both hospitals had a trend of increasing readmission rates with increasing stroke severity and comorbidity. Longer length of stroke admission, especially for patients with increasing stroke severity, and patients receiving ESD rehabilitation after discharge reduced 90-day readmissions. This association was stronger at 90 days than at 30 days. Different readmission event rates were found at 30 and 90 days and when events were compared between the two hospitals. Understanding differences in readmission event rates between hospitals at 30 and 90 days can support local planning of patient needs in the first weeks after stroke discharge and to investigate ways for hospital to reduce the impact of readmission. It is recommended that stroke services use both 30 and 90-day readmissions to inform service evaluation and improvement.

Association between mental disorders and COVID-19 outcomes among inpatients in France: A retrospective nationwide population-based study

BackgroundMental disorders are at-risk of severe COVID-19 outcomes. There is limited and heterogeneous national data in hospital settings evaluating the risks associated with any pre-existing mental disorder, and susceptible subgroups. Our study aimed to investigate the association between pre-existing psychiatric disorders and outcomes of adults hospitalised for COVID-19. MethodWe used data obtained from the French national hospital database linked to the state-level psychiatric registry. The primary outcome was 30-days in-hospital mortality. Secondary outcomes were to compare the length of hospital stay, Intensive Care Unit (ICU) admission and ICU length. Propensity score matching analysis was used to control for COVID-19 confounding factors between patients with or without mental disorder and stratified by psychiatric subgroups. ResultsAmong 97 302 adults hospitalised for COVID-19 from March to September 2020, 10 083 (10.3%) had a pre-existing mental disorder, mainly dementia (3581 [35.5%]), mood disorders (1298 [12.9%]), anxiety disorders (995 [9.9%]), psychoactive substance use disorders (960 [9.5%]), and psychotic disorders (866 [8.6%]). In propensity-matched analysis, 30-days in-hospital mortality was increased among those with at least one pre-existing mental disorder (hazard ratio (HR) 1.15, 95% CI 1.08–1.23), psychotic disorder (1.90, 1.24–2.90), and psychoactive substance disorders (1.53, 1.10–2.14). The odds of ICU admission were consistently decreased for patients with any pre-existing mental disorder (OR 0.83, 95% CI 0.76–0.92) and for those with dementia (0.64, 0.53–0.76). ConclusionPre-existing mental disorders were independently associated with in-hospital mortality. These findings underscore the important need for adequate care and targeted interventions for at-risk individuals with severe mental illness.

687 How Effective Is the ‘HOT Laparoscopic Cholecystectomy Pathway’ in Reducing Time to Surgery?

Abstract Aim To evaluate whether the introduced ‘HOT laparoscopic cholecystectomy (LC) pathway’ has been effective in reducing outpatient (OP) time to surgery. Method All patients (March-October 2021) who had a LC at either Darent Valley Hospital or Queen Mary's Sidcup were identified via an extensive database search. Patient demographics, clinical diagnosis, number of presentations, in-patient (IP) vs OP LC and days to surgery were recorded. The results were descriptively analysed and compared to findings of the audit in 2020. Results During the study, 216 LCs were recorded, of which 31% took place as an IP and 69% occurred as an OP. Amongst the CEPOD list, 80% had a LC within 8 days of admission, in accordance with NICE guidance. 139 OP LC requests were noted, 75% included “HOT LC” in the ‘to come in” (TCI) request, with an average time to OP LC of 35 days, compared to 54 days for requests which did not include “HOT LC” in the request. This was significantly quicker than the wait time of 84 days in 2019, prior to the implementation of the pathway. Conclusions Introduction of the ‘HOT LC pathway’ in conjunction with greater operative capacity across 2 hospitals has resulted in earlier management of gallbladder disease and subsequently reduced length of hospital admission. Furthermore, inclusion of “HOT LC” in the TCI request significantly reduces delay in OP LC. In light of these findings, the use of the pathway should be encouraged with emphasis on the inclusion of “HOT LC” in the TCI request.

57. Staged vs same-day circumferential thoracolumbar spine surgery

<h3>BACKGROUND CONTEXT</h3> Complexity and potential risk to the patient in the perioperative period have led to circumferential spine fusion surgery often being performed in a staged fashion, whether in the same admission or split admission. There is no established protocol or clear evidence that this is beneficial to the patient. Previous studies of this topic have tended to favor same-day surgery to staged surgery with decreased blood loss, length of stay and cost. Multiple factors can potentially contribute to morbidity for these patients, including multiple insults activating inflammatory response and repeated exposures to anesthetics. <h3>PURPOSE</h3> To determine if there is a difference in complication profile between staged vs same-day circumferential, multi-approach thoracolumbar spine surgery. <h3>STUDY DESIGN/SETTING</h3> A retrospective single-center cohort assessment for adult patients undergoing multiple approach thoracolumbar fusion surgery from January 2012 to December 2021 in an academic center. <h3>PATIENT SAMPLE</h3> All patients who underwent anterior or lateral approaches for the purpose of disc preparation and fusion and subsequently had a posterior approach for screws were included. The same-day group had both parts performed under the same anesthetic vs the staged group who had separate anesthetics on separate days in a planned fashion <h3>OUTCOME MEASURES</h3> Primary outcome: complication rate at 90 days. Secondary outcomes: complication profile - readmission, reoperation, DVT/PE, Ileus, delayed extubation, infection. Surgical characteristics - length of stay, operative time, estimated blood loss, transfusion rates. Demographic characteristics -ages, sex, BMI, diabetes, smoking habits. <h3>METHODS</h3> A retrospective single-center cohort assessment for adult patients undergoing multiple approach thoracolumbar fusion surgery from January 2012 to December 2021. Patients who underwent anterior or lateral approaches for the purpose of disc preparation and fusion and subsequently had a posterior approach for screws were included. The same-day group had both parts performed under the same anesthetic vs the staged group who had separate anesthetics on separate days in a planned fashion. Statistical comparison of demographic data (ages, sex, BMI, diabetes, smoking habits), complication rates (readmission, reoperation, DVT/PE, Ileus, delayed extubation, infection) and surgical characteristics (operative time, length of stay, estimated blood loss, transfusion rates) was made between the two groups. <h3>RESULTS</h3> A total of 1039 patients (918 same-day vs 121 staged) underwent circumferential thoracolumbar spine surgery from 2012 to 2021. The groups differed slightly in demographics with the staged group being slightly older (56.7 yrs same-day vs 59.6 yrs staged, p < 0.05) and had a higher incidence of smoking (6.6% same-day vs 22.3% staged, p < 0.001). The average time between stages was 2.5 days (SD 2.15). The total operative time was significantly longer in the staged group (354 min same-day vs 523 min staged, p < 0.001). The overall complication rate was not significantly different between the two groups (22.0% same-day vs 29.8% staged, p=0.748). Analysis of specific complications demonstrated an increase in DVT/PE (1.4% same-day vs 11.6% staged, p < 0.001) and postoperative ileus (4.2% same-day vs 15.7% staged, p < 0.001) in the staged group. The length of hospital admission was longer in the staged group (4.6 days same-day vs 7.7 days staged, p < 0.0001). <h3>CONCLUSIONS</h3> Staging circumferential surgery did not demonstrate statistical increase in complications at 90 days. However, review of specific postoperative complications including DVT/PE and postoperative ileus demonstrated significant increase in the staged group compared to the same-day group. The staged patients had a significantly longer hospital stay and their total surgery time was significantly longer. These would ultimately contribute heavily to hospital costs. There were potential limitations in the comparison of the groups with the staged patients being older and more likely to smoke. The study group recommends considering if staging the surgery is required as it can lead to increase in DVT/PE and postoperative ileus with prolonged stay in hospital. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Delivery timing for the opioid–exposed infant

The prevalence of opioid use disorder and medication-assisted treatment in pregnancy is increasing. Compared with term infants, preterm infants have a lower incidence of neonatal opioid withdrawal syndrome. It is unknown whether early term delivery compared with full or late-term delivery decreases the risk of neonatal opioid withdrawal syndrome. This study aimed to compare the neonatal outcomes among opioid-exposed infants born in the early, full, and late-term periods. This was a retrospective cohort study of opioid-exposed pregnancies delivering at a single center from 2010 to 2017 at ≥37 weeks gestation. Participants with multiple gestations or fetal anomalies were excluded. Maternal opioid exposurewas defined as prescription (including medication-assisted treatment) or nonprescription opioid use or a positive urine drug screen in pregnancy for opiates. The primary outcome was a neonatal composite of respiratory distress syndrome, neonatal sepsis, neonatal seizures, hypoxic ischemic encephalopathy, jaundice requiring treatment, 5-minute Apgar <5, neonatal intensive care unit admission, neonatal opioid withdrawal syndrome, or neonatal death. The secondary outcomes included individual components of the primary outcome, birthweight, need for and length of neonatal opioid withdrawal syndrome treatment, length of hospital admission, and maximum Finnegan scores. Early (37-<39), full (39-<41), and late (41-<42 weeks) term groups were defined by the American College of Obstetricians and Gynecologists. Of 399 infants, 136 (34.1%), 229 (57.4%), and 34 (8.5%) were born in the early, full, and late-term periods, respectively. Two hundred and seventy patients (67.7%) received medication-assisted treatment for opioid use disorder, and the baseline characteristics were similar in all the groups except for history of intranasal heroin use, positive urine toxicology screen for heroin or any opiates, and delivery indication (P<.05). The primary composite outcome occurred in 313 (78.4%) neonates, and 296 (74.2%) neonates had neonatal opioid withdrawal syndrome. More than half (219 [54.9%]) of opioid-exposed neonates were admitted to the neonatal intensive care unit, and 160 (40.1%) required pharmacologic neonatal opioid withdrawal syndrome treatment for a mean duration of almost 3 weeks (19.0±16.1 days). There were no significant differences in the primary composite outcome, incidence of neonatal opioid withdrawal syndrome, or other secondary outcomes (except birthweight) between neonates born in the early, full, or late-term periods. Although neonatal morbidity was frequent among opioid-exposed neonates, the incidence and severity of neonatal opioid withdrawal syndrome or other neonatal outcomes were not different between neonates delivered in the early, full, and late-term periods, suggesting that opioid-exposed infants may not benefit from early term delivery.

Trends and outcomes of children, adolescents, and adults hospitalized with inherited metabolic disorders: A population-based cohort study.

Inherited metabolic disorders (IMDs) comprise a heterogeneous class of genetic disorders characterized by impaired biochemical functions in metabolism. However, incidences and outcomes of patients hospitalized with IMDs are largely unknown. We conducted a population-based cohort study using nationwide in-hospital claims data in Switzerland from 2012 to 2020. We assessed incidence rates of hospitalizations and hospital-associated outcomes, stratified in five age groups (0-9, 10-19, 20-39, 40-59, and 60-90 years) and three types of IMDs (peptide, amine and amino acid metabolism disorders [AD], carbohydrate metabolism disorders [CD], fatty acid, and ketone body metabolism disorders [FD]). A total of 7293 hospitalizations with IMD were identified, of which 3638 had AD, 3153 CD, and 502 FD. Incidence rates for hospitalizations per 100 000 person-years were highest under the age of 10 years across all types of IMDs (8.69 for AD, 5.73 for CD, 3.71 for FD) and decreased thereafter. In patients with AD and CD, hospitalization rates increased again in adults aged 60-90 years (7.28 for AD, 7.25 for CD), while they remained low in patients with FD (0.31). Compared to inpatients without IMD, adult IMD patients had a higher burden of hospital-associated adverse outcomes including an increased risk of in-hospital mortality, intensive care unit admission, mechanical ventilation, and longer length of hospital or intensive care unit stay. Incremental risk of 30-day, 1-year, and 2-year hospital readmission was highest among children and adolescents with IMD.

TH6.13 Post-Operative Pain Management Following Emergency Laparotomy

Abstract Aims Post-operative pain is a common yet challenging presentation. Although an expected part of the acute recovery phase, uncontrolled pain is associated with poorer patient experience, delayed functional recovery and increased morbidity. Up to 40% of patients report severe pain that negatively impacts on their post-operative recovery. We aimed to determine whether post-operative complications and length of hospital admission were associated with choice of analgesic agents. Methods We conducted a retrospective observational study of 42 patients who underwent a laparotomy between March – May 2021. Data was extracted from patients electronic medical records and summarised in Microsoft Excel. Statistical analysis was performed using the Chi-Squared and Mann-Whitney U tests. Results 22 patients (52.4%) experienced post-operative complications whilst 20 (47.6%) did not. In those without post-operative complications, a greater proportion received Patient Controlled Analgesia (PCA) compared to those with post-operative complications (17, 85% vs 11, 50%, p = 0.02). We also observed a trend towards greater use of Oxycodone (11, 55% vs 6, 27%) and Meptazinol (11, 55% vs 7, 32%) in those without post-operative complications (p= 0.07 and p = 0.13 respectively). The length of hospital admission was significantly shorter for patients who received PCA (median = 11 days) compared to those who did not (median = 15 days) (U = 111.5, p = 0.04). Conclusions This study emphasises the importance of effective post-operative analgesia in reducing post-operative complications and improving speed of recovery. We suggest that the use of PCA should be encouraged for post-operative analgesia following emergency laparotomies.

TH3.8 Retrospective study on the use of colonic stents in malignancy; a bridge to surgery or the end of the line?

Abstract Aim Colonic stenting is a management option for obstructed left sided colorectal malignancy in the emergency and elective setting. Stenting can provide a bridge to curative surgery or to adjuvant treatment. The aim of this study was to assess the role of colonic stenting in management of obstructed colorectal cancer. Methods This retrospective cohort study analyses prospectively collected data from two centres within one Health Board in Wales. Patients were recorded in a cancer database, who underwent colonic stenting for left sided colonic malignancy between January 2008 and December 2021. Patient demographics, treatment pathways, length of admission, stoma formation rates and morbidity were recorded. Results In total, 98 patients, with a mean age of 73.5 years (range 37–97) underwent a colonic stent. The majority were elective 55% (n=54). The sigmoid colon was the commonest site of tumour in 33 patients, with metastatic disease in 82% (n=80). The study found 86% (n=84) of patients were successfully stented. The mean length of admission was 13 days. The complication rate was 23% (n=23), most commonly stent obstruction (n=6). Stenting was a bridge to curative surgery for 3 patients, and 47% (n=46) received adjuvant treatment. Five-year survival was 19.3% (n=19). The overall stoma rate was 10.2% (10 patients). Conclusion This study shows colonic stenting is a viable alternative in surgical management for advanced obstructing colorectal malignancy but not as a bridge to surgery. The majority of this cohort returned home following stenting, had a low overall stoma rate and 19% survival at 5 years.

Real-world analysis of tumor lysis syndrome in patients started on venetoclax combination for acute myeloid leukemia.

Venetoclax is utilized with low-dose cytarabine or a hypomethylating agent for the treatment of acute myeloid leukemia. Clinical trials report a risk of tumor lysis syndrome and the package insert recommends a venetoclax dose ramp-up at the initiation. The purpose of this study was to evaluate the risk of tumor lysis syndrome in a large population of patients with acute myeloid leukemia outside of a clinical trial and evaluate the incidence of hospital-acquired complications during inpatient ramp-up. We performed a retrospective study of adult patients with acute myeloid leukemia receiving venetoclax with a hypomethylating agent or low-dose cytarabine. The primary outcome was the incidence of tumor lysis syndrome. Secondary outcomes included risk factors for tumor lysis syndrome, length of admission, and incidence of hospital-acquired complications. One hundred thirteen patients were included. Although all patients were given some form of prophylaxis, the incidence of tumor lysis syndrome was 8.8%. All were laboratory tumor lysis syndrome; one with hyperuricemia, nine with hypocalcemia, and ten with hyperphosphatemia. Six patients received sevelamer. Tumor lysis syndrome was resolved in all cases. No clinical tumor lysis syndrome occurred. Hepatic dysfunction, tumor lysis syndrome high-risk stratification, higher baseline white blood cell count, and lactate dehydrogenase levels were more common in the tumor lysis syndrome group. Hospital-acquired complications reached 13% in those directly admitted for dose ramp-up. Tumor lysis syndrome was uncommon and manifested as minor lab abnormalities. White blood cell count continues to be an indicator of risk for tumor lysis syndrome. Those who present with an elevated white blood cell or are otherwise at high risk for tumor lysis syndrome should be admitted for ramp-up. Otherwise, initiation and monitoring of venetoclax are feasible in the outpatient setting.

EP-682 Management of Superficial Abscesses: Scope for Day Case Surgery

Abstract Background Superficial abscesses form a large part of surgical emergencies in many units and are considered a low priority emergency often leading to delayed definitive treatment. Aims and objectives The aim of this study was to investigate the efficiency of emergency treatment of superficial abscesses and to identify areas for service improvement. A set criterion for ambulatory care was made: Apyrexial on admission, White Cell Count of less than 13.5×10*9/L, CRP less than 100mg/L, no significant co-morbidities and no other medical concerns for admission. Patients who meet this criteria should be sent home to present for planned procedures the next morning. Methodology Retrospective audit of care provided to patients who required drainage of superficial abscess under general anaesthesia over a six-month period. Results 76 patients were included in the study. 39% of the patients had their abscesses drained on the day of presentation with another 50% waited till the next day for procedure while the remaining 11% waited for 2 or more days. The time interval between admission and surgery ranged from 2 hours to 94 hours (mean ± SD 19 ± 16.25. The length of admission ranged from 7 to 167 hours (mean ± 43 hours). Of the 130 overnight beds used by the 76 patients, 53 nights were spent awaiting surgery and 77 following surgery and awaiting discharge. Conclusion Out of 76 patients, 40 patients fulfilled the inclusion criteria of ambulatory abscess pathway and could have been discharged the same day for next day surgery.

Antimicrobial Resistance and Associated Risk Factors of Gram-Negative Bacterial Bloodstream Infections in Tikur Anbessa Specialized Hospital, Addis Ababa.

BackgroundBloodstream infections (BSIs) are significant causes of morbidity and mortality in Ethiopia and worldwide. Alarming is the rapid global spread of antimicrobial resistance (AMR) in bacteria.ObjectiveTo determine the microbial profile, antimicrobial susceptibility pattern, and associated risk factors for bloodstream infections in Tikur Anbessa Specialized Hospital (TASH) Addis Ababa Ethiopia.MethodsA cross-sectional study was conducted between September 2018 and March 2019. Blood collected twice from each septicemia suspected patient were processed following standard bacteriological procedures. AST was performed by using the disk diffusion test according to CLSI 2017 and 2018 guidelines. Data captured in Epidata were cleaned and analyzed by SPSS version 21 software.ResultsThe prevalence of BSI was 28.06% and a higher proportion of pathogene detected were gram-negative bacteria (GNB) (54.5%) and gram-positive bacteria (GPB) (45.43%). The most abundant bacterial species were Klebsiella pneumoniae 17.6%, CoNS 15.2%, and Acinetobacter spp 11.0%. Culture positivity was associated with age below 6 years, neonates AOR p=<0.001, infants AOR p=<0.001, Pre-school P=0.002, ICU admission COR p=<0.001, length of admission >5 days COR P=0.016, temperature greater than 38°C, AOR p=0.013, instrument usage during medical care AOR, p=<0.001, chronic illness AOR p=0.027, and neonatal incubation AOR p=0.013. GNB average drug resistance rate was 57.9% of the commonly used antibiotics and the most efficient and inefficient drugs were amikacin (10.8%) and ampicillin (94.6%). The gram-negative isolates showed a 95.3% rate of multi-drug resistance; and MDR, XDR, and PDR were observed at 55.8%, 32.2%, and 7.3%, of isolates respectively. This finding shows children especially neonates were highly affected by drug resistant BSI.ConclusionPediatric patients and ICU patients are more affected by BSI, and drug-resistant bacteria are a major problem. Therefore, appropriate intervention approaches need to be implemented.

Impact of rapid molecular testing on diagnosis, treatment and management of community-acquired pneumonia in Norway: a pragmatic randomised controlled trial (CAPNOR)

BackgroundCommunity-acquired pneumonia (CAP) causes a large burden of disease. Due to difficulties in obtaining representative respiratory samples and insensitive standard microbiological methods, the microbiological aetiology of CAP is difficult to ascertain. With a few exceptions, standard-of-care diagnostics are too slow to influence initial decisions on antimicrobial therapy. The management of CAP is therefore largely based on empirical treatment guidelines. Empiric antimicrobial therapy is often initiated in the primary care setting, affecting diagnostic tests based on conventional bacterial culture in hospitalized patients. Implementing rapid molecular testing may improve both the proportion of positive tests and the time it takes to obtain test results. Both measures are important for initiation of pathogen-targeted antibiotics, involving rapid de-escalation or escalation of treatment, which may improve antimicrobial stewardship and potentially patient outcome.MethodsPatients presenting to the emergency department of Haukeland University Hospital (HUH) in Bergen, Norway, will be screened for inclusion into a pragmatic randomised controlled trial (RCT). Eligible patients with a suspicion of CAP will be included and randomised to receive either standard-of-care methods (standard microbiological testing) or standard-of-care methods in addition to testing by the rapid and comprehensive real-time multiplex PCR panel, the BioFire® FilmArray® Pneumonia Panel plus (FAP plus) (bioMérieux S.A., Marcy-l’Etoile, France). The results of the FAP plus will be communicated directly to the treating staff within ~2 h of sampling.DiscussionWe will examine if rapid use of FAP plus panel in hospitalized patients with suspected CAP can improve both the time to and the proportion of patients receiving pathogen-directed treatment, thereby shortening the exposure to unnecessary antibiotics and the length of hospital admission, compared to the standard-of-care arm. The pragmatic design together with broad inclusion criteria and a straightforward intervention could make our results generalizable to other similar centres.Trial registrationClinicalTrials.govNCT04660084. Registered on December 9, 2020