Length Of Admission Research Articles

Outcomes Among Malnourished Patients With Crohn's Disease Undergoing Elective Ileocecectomy: A Nationwide Analysis.

Crohn's patients' nutritional status can be suboptimal given disease pathophysiology; the effect of a malnourished state prior to elective surgery on post-operative outcomes remains to be more clearly elucidated. This study aims to characterize the effect of malnutrition on post-operative outcomes and readmission patterns for Crohn's patients undergoing elective ileocecectomy using a nationally representative cohort. The colectomy-targeted National Surgical Quality Improvement Program Database (2016-2020) was used to identify patients with Crohn's disease without systemic complications who underwent elective ileocecectomy; emergency surgeries were excluded. Malnourished status was defined as pre-operative hypoalbuminemia <3.5g/dL, weight loss >10% in 6months, or body mass index <18.5kg/m2 prior to surgery. Of 1464 patients (56% female) who met inclusion criteria, 1137 (78%) were well-nourished and 327 (22%) were malnourished. Post-operatively, malnourished patients had more organ space surgical site infections (SSI) (9% vs 4% nourished groups, P < .001) and more bleeding events requiring transfusion (9% vs 3% nourished, P < .001). 30-day unplanned readmission was higher in the malnourished group (14% vs 9% nourished, P = .032). Index admission length of stay was significantly longer in the malnourished group (4days [3-7days] vs the nourished cohort: 4days [3-5days], P < .001). Poor nutritional status is associated with organ space infections and bleeding as well as longer hospitalizations and more readmissions in Crohn's patients undergoing elective ileocecectomy. A detailed nutritional risk profile and nutritional optimization is important prior to elective surgery.

Factors associated with longer hospital admission in elderly patients with major neurocognitive disorder.

Major neurocognitive disorder presents many challenges to patients, families and healthcare systems, especially when a patient requires admission to a psychiatric hospital. To identify characteristics of older patients with major neurocognitive disorder at risk of prolonged admission in a psychiatric hospital. A tertiary psychiatric hospital in Gauteng province, South Africa. The authors conducted a retrospective review of the hospital database and clinical files. Clinical and demographic data were collected from the files of 50 inpatients, 60 years and older, who were diagnosed with major neurocognitive disorder and admitted between 2015 and 2019. Anonymised data from patient records were captured on an electronic spreadsheet and analysed using T-tests and analysis of variance (ANOVA) to investigate the relationship between patient characteristics and length of hospital admission. The mean duration of admission was 18.29 months. Involuntary admission status (β = 0.239, p = 0.049), level of assistance required (moderate level of assistance [β = 0.378, p = 0.005]; high level of assistance [β = 0.336, p = 0.015]), availability of social support (β = -0.319, p = 0.016) and the presence of behavioural or psychological problems (β = 0.437, p = 0.002) were significantly correlated with longer admission. Using a stepwise regression model, the only significant variable associated with a shorter length of stay was the presence of social support (β = -0.512, p = 0.009). Age, type of major neurocognitive disorder and number of comorbidities were not correlated with the duration of admission (p > 0.005). Social support plays an important role in the management of patients with major neurocognitive disorder. The findings in this study highlight healthcare shortages and a need for adequate placement facilities in South Africa for patients who have no other form of support.

Clinical Significance of Pneumocephalus in Pediatric Mild Traumatic Brain Injury.

Mild traumatic brain injury (mTBI) comprises most (70%-90%) of all pediatric head trauma cases seeking emergency care. Although most mTBI cases have normal initial head computed tomography scan, a considerable portion of the cases have intracranial imaging abnormalities on computed tomography scan. Whereas other intracranial pathological findings have been extensively studied, little is known about the clinical significance of pneumocephalus in pediatric mTBI. We retrospectively identified pediatric mTBI patients with pneumocephalus using the institutional database of a large regional trauma referral center. Outcome measures were defined as clinically important TBI (ciTBI), hospitalization, intensive care unit (ICU) admission, and neurosurgical intervention. Comparisons were made between pneumocephalus and control (isolated linear fracture) groups as well as between isolated (only linear fracture and pneumocephalus) and nonisolated pneumocephalus (pneumocephalus and TBI) groups. Among 3524 pediatric mTBI cases, 43 cases had pneumocephalus (1.2%). Twenty-one cases (48.8%) had isolated pneumocephalus. The pneumocephalus group had higher rates of ciTBI, hospital admission, ICU admission, and neurosurgery when compared with the isolated linear fracture (control) group. The isolated pneumocephalus group had fewer ciTBI (21.1% vs 70%, P = 0.002), fewer hospitalization (23.8% vs 81.8%, P < 0.001), but similar ICU admission rates (4.8% vs 22.7%, P = 0.089) and length of hospital stay (4.0 ± 2.7 vs 3.6 ± 2.4 days, P = 0.798) in comparison to the nonisolated pneumocephalus group. None of the patients in the isolated group had neurosurgery whereas 2 patients in the nonisolated pneumocephalus group underwent surgery. Multivariable analysis revealed pneumocephalus as an independent predictor of ciTBI and hospital admission, but not ICU admission or neurosurgical intervention. Pneumocephalus is associated with increased rates of hospitalization and ciTBI, but not ICU admission, unfavorable outcome, or neurosurgical intervention in pediatric mTBI. Although usually spontaneously resolving pathology, it may occasionally be linked with complications such as cerebrospinal fluid leakage, meningitis, and tension pneumocephalus. Therefore, careful evaluation, close observation, and early detection of complications may prevent adverse outcomes.

Comparison of Hospitalization for Nonaffective Psychotic Disorders Among Refugee, Migrant, and Native-Born Adults in Sweden and Denmark

Determining whether migrants with nonaffective psychotic disorders (NAPDs) experience poorer outcomes after illness onset is essential to ensure adequate health care provision to these disadvantaged populations. To compare cumulative hospital days for NAPDs during the first 5 years of illness among refugee, nonrefugee, and second-generation migrants and their Swedish and Danish peers. This was a prospective cohort study of individuals treated for incident NAPDs in inpatient or outpatient settings between January 1, 2006, and December 31, 2013, and followed up for 5 years. This population-based study used Swedish and Danish national registries. Included participants were individuals in Sweden and Denmark, aged 18 to 35 years, treated for incident NAPDs. Data analyses were conducted from November 2022 to August 2023. Population group (determined according to residency in either country, not both countries), categorized as refugee (migrants whose residence in Sweden or Denmark was registered as refugee status or family reunification with a refugee), nonrefugee (all other individuals born outside Sweden and Denmark), second generation (individuals born in Sweden or Denmark with at least 1 parent born abroad), or native born (individuals born in Sweden or Denmark with both parents born in these countries). Total hospital days for NAPDs during the first 5 years of illness, analyzed using a hurdle model. Among those ever admitted, total number of admissions and mean admission length were examined. In total, 7733 individuals in Sweden (mean [SD] age, 26.0 [5.1] years; 4919 male [63.6%]) and 8747 in Denmark (mean [SD] age 24.8 [5.0] years; 5324 male [60.9%]) were followed up for 5 years or until death or emigration. After adjusting for a range of sociodemographic and clinical factors, the odds of experiencing any hospital days for NAPD were significantly higher among migrant groups compared with their native-born peers (Sweden: second generation, odds ratio [OR], 1.17; 95% CI, 1.03-1.33; P = .01; nonrefugee migrant, OR, 1.45; 95% CI, 1.21-1.73; P < .001; refugee, OR, 1.25; 95% CI, 1.06-1.47; P = .009; Denmark: second generation, OR, 1.21; 95% CI, 1.05-1.40; P = .01; nonrefugee migrant, OR, 1.33; 95% CI, 1.14-1.55; P < .001). These odds were highest among nonrefugee (Sweden: OR, 2.53; 95% CI, 1.59-4.03; P < .001; Denmark: OR, 2.61; 95% CI, 1.70-4.01; P < .001) and refugee (Sweden: OR, 1.96; 95% CI, 1.43-2.69; P < .001; Denmark: OR, 2.14; 95% CI, 1.42-3.21; P < .001) migrants from Africa and those who had arrived within 3 to 5 years (Sweden: nonrefugee migrants, OR, 1.93; 95% CI, 1.26-2.95; P = .002; refugees, OR, 2.38; 95% CI, 1.46-3.88; P < .001; Denmark: nonrefugee migrants, OR, 1.66; 95% CI, 0.96-2.85; P = .07; refugees, OR, 3.40; 95% CI, 1.13-10.17; P = .03). Among those ever hospitalized, refugees in both countries (Sweden, incidence rate ratio [IRR], 1.30; 95% CI, 1.12-1.51; P < .001; Denmark, IRR, 1.47; 95% CI, 1.24-1.75; P < .001) and second-generation migrants in Denmark (IRR, 1.22; 95% CI, 1.07-1.39; P = .003) experienced more days hospitalized for NAPDs than native-born individuals. In this prospective cohort study of individuals with NAPDs, results suggest that refugee, nonrefugee, and second-generation migrants experience more days hospitalized for these disorders than their native-born peers. Patterns were consistent across 2 countries with different models of psychosis care and immigration and integration policies.

Sleep disruption in adolescent inpatients: prevalence, associations with clinical outcomes, and clinician perspectives.

Sleep problems are common for adolescents with psychiatric disorders, and sleep treatment may aid mental health recovery. Inpatient admissions are likely a particularly challenging time for sleep. Despite this little is known about the nature of sleep problems, and how sleep treatments could be optimised for this setting. This mixed-methods study set out to better understand sleep disturbances in adolescent inpatients. Study 1 examined the prevalence of Sleep Condition Indicator-assessed insomnia at admission and associations with psychiatric symptoms and admission length in 100 inpatients (aged 11-17 years) on one unit in Oxford. Data were gathered from admission routine measures and medical records. Associations were analysed using linear regressions. Half of the inpatients (n = 50) screened positive for insomnia at admission. Moderate-large significant associations were observed between more severe insomnia and more severe depression (β = -0.56), anxiety (β = -0.51), self-harm (β = -0.49), psychotic experiences (β = -0.32), and conduct problems (β = -0.30), but not admission length. Study 2 gained 12 clinicians' perspectives on sleep problems on the unit via a focus group and semi-structured interviews, analysed using thematic analysis. Ward staff observed insomnia and excessive daytime sleepiness in adolescent inpatients and a reciprocal relationship with mental health symptoms. Ward processes were barriers (e.g., night-time observations) and facilitators (e.g., regular routines) of sleep. Cognitive behavioural therapy for insomnia was not routinely offered but viewed as potentially helpful. Insomnia may be a common problem for adolescent inpatients, associated with greater psychopathology, but not admission length. The possible benefits of psychological sleep interventions for adolescents admitted to psychiatric units now require testing.

218.1: A model to estimate the impact of hospital length of admission on the residual risk of blood-borne virus infection in deceased organ donors.

218.1: A model to estimate the impact of hospital length of admission on the residual risk of blood-borne virus infection in deceased organ donors.

Opioid stewardship and perioperative management of pediatric tympanoplasty.

To provide insight into the intraoperative management, admission course, pain management, and graft success of microscope- and endoscope-assisted tympanoplasty. Retrospective Chart Review. This study included children 18 years and younger who underwent ambulatory tympanoplasty at a tertiary pediatric hospital between January 2018 and December 2020. Medical records were reviewed and information about intraoperative factors, surgical approach, laterality, complications, and post-operative perforation closure success rates was collected. Multivariate analysis was performed to compare and contrast the two surgical approaches. The review included 321 pediatric patients who underwent a tympanoplasty. Endoscopic tympanoplasty accounted for 17.4%, while microscopic tympanoplasty accounted for 82.6%. In both approaches, the rate of intraoperative complications, postoperative complications, audiological improvements, and perforation closure success rates were statistically similar. However, patients who underwent endoscopic tympanoplasty were 3.96 times less likely to require opioids in the post-anesthesia care unit (PACU) and had a shorter post-operative admission length. This pattern emerged regardless of the type of graft used. Obtaining an autograft was not associated with a higher opioid requirement in the PACU. While both approaches are viable, our findings demonstrate the reduced need for opioids with similar success rates following an endoscopic tympanoplasty. Ultimately, the trade-off for the minimally invasive endoscopic approach appears to be a less painful experience for the child while promoting clinically appropriate opioid stewardship in the perioperative setting.

Hematocrit and lactate trends help predict outcomes in trauma independent of CT and other clinical parameters.

Hematocrit and lactate have an established role in trauma as indicators of bleeding and cell death, respectively. The wide availability of CT imaging and clinical data poses the question of how these can be used in combination to predict outcomes. To assess the utility of hematocrit or lactate trends in predicting intensive care unit (ICU) admission and hospital length of stay (LOS) in patients with torso trauma combined with clinical parameters and injury findings on CT. This was a single-center retrospective study of adults with torso trauma in one year. Trends were defined as a unit change per hour. CT findings and clinical parameters were explanatory variables. Outcomes were ICU admission and hospital LOS. Multivariate logistic and negative binomial regression models were used to calculate the odds ratio (OR) and incident rate ratio (IRR). Among 840 patients, 561 (72% males, age 39 ± 18) were included, and 168 patients (30%) were admitted to the ICU. Decreasing hematocrit trend [OR 2.54 (1.41-4.58), p = 0.002] and increasing lactate trend [OR 3.85 (1.35-11.01), p = 0.012] were associated with increased odds of ICU admission. LOS median was 2 (IQR: 1-5) days. Decreasing hematocrit trend [IRR 1.37 (1.13-1.66), p = 0.002] and increasing lactate trend [2.02 (1.43-2.85), p < 0.001] were associated with longer hospital LOS. Hematocrit and lactate trends may be helpful in predicting ICU admission and LOS in torso trauma independent of organ injuries on CT, age, or admission clinical parameters.

Predictors of recovery in a medium secure service: Influence of the Welsh Government's Mental Health (2010) Measure

BackgroundResearch to date has failed to examine the effectiveness of MSUs in facilitating recovery, or the influence that mental health policy may have on this process. Examining predictors of short-term clinical outcomes during inpatient admission and the effects of policy changes may inform future policy, treatment planning and may improve service user outcomes. AimsTo examine whether service user admission characteristics and length of stay predicted recovery status at discharge from medium secure care and whether a recovery-focused change in policy (introduction of the Mental Health (Wales) Measure (2010)) impacted either on recovery or the relationship between service user characteristics and recovery. MethodsThe study adopted a retrospective analysis of quantitative data obtained from healthcare records from a Welsh MSU between 2007 and 2017 (n = 198). The DUNDUM-4 scale assessed recovery whilst DUNDRUM-2 assessed security need at admission. Service user admission characteristics included HCR-20 subscale scores, previous security-level transitions, adverse childhood experiences, substance misuse histories. ResultsShorter inpatient stays and higher scores on the dynamic HCR-20 clinical subscale were associated with poorer recovery outcomes. The relationship between admission characteristics and recovery endured despite changes in policy. Implementation of recovery focused legislation was associated with improved recovery. ConclusionsThe findings suggest that treatment should focus on dynamic risk factors to improve service user outcomes and highlights the need for long-term medium-secure provision for some. Further research is needed to evaluate the success of MSUs and the validity of the DUNDRUM-4 across UK secure services.

Assessment of Healthcare Associated Infections in a Medical Intensive Care Unit

Objective: This study was undertaken to assess the current status of healthcare associated infections (HAIs) in our institution during a 2-year period in relation to causative agents and their distribution, use and duration of invasive mechanical ventilation, and infection rate and incidence in comparison with national data.&#x0D; Methods: Patients admitted to Medical ICUs of Meram State Hospital between 1st Jan 2019 and 31st Dec 2020 wereincluded. During a 2-year period a total of 47 patients were diagnosed with HAIs based on Centers for Disease Control and Prevention (CDC) and National Nosocomial Infection Surveillance Network (NNISN) criteria.&#x0D; Results: During 6041 follow-up days for 922 patients admitted to ICU, a total of 47 HAIs cases were detected. The most common types of HAIs included healthcare-associated pneumonia in 21 patients (45.6%) and other infections of the respiratory system in 12 patients (26.1%). The most common causative agent was Acinetobacter baumannii, which was found in 27 patients (50.9%).&#x0D; Conclusion: HAIs is an unavoidable condition in ICUs owing to a number of factors such as frequent use of invasive devices, prolonged length of admission, and increased number of complications. One of the major health targets in healthcare facilities is to control an manage HAIs. Avoidance from unnecessary catheterizations, timely removal of invasive catheters, increased adherence to infection control measures, prevention of inappropriate antibiotic use, compliance with isolation procedures, and initiation of appropriate antibiotherapy based on documentation of causative organisms will significantly reduce HAIs incidence.

351 Snapshot of Transient Ischaemic Attack inpatient management at a model three Irish hospital

Abstract Background Transient Ischaemic Attack (TIA) is a common presentation to hospitals and portends a high risk for eventual stroke. The EXPRESS study suggested the benefit of urgent outpatient assessment of TIA, which was associated with a 80% risk reduction of early recurrent stroke when compared to usual care. The HSE model of care for stroke endorses that rapid access TIA clinics could reduce costs of hospital admissions. Average length of admission for TIA is 6.7 days in Ireland. This study aimed to examine TIA admission lengths and identify possible targets for improvement in a model three Irish hospital. Methods All patients with a HIPE coded diagnosis of ‘Transient Ischaemic Attack’ from 17/12/21 to 20/8/22 were included. All coded diagnoses of ‘Transient Ischaemic Attack’ had a normal MRI brain DWI—abnormal MRI DWI imaging is coded as stroke. Therefore the true number of TIAs was not captured. Hospital electronic databases were used to identify baseline demographics, date of inpatient investigation request and date of inpatient investigation completion. Results 64 cases were identified. The median age was 79 years (interquartile range 67 to 86 years). 45% were female. 52% were admitted under a stroke/geriatric team. Median length of admission was 4 days (IQR 3 to 7 days). CT was requested on median day 0. MRI, carotid doppler US and echocardiogram were requested on a median day 1. 94% underwent CT brain imaging on median day 1. 34 (53%) underwent MRI brain DWI, on median day 3. 13 (20%) underwent carotid doppler US, on median day 3. 20 (31%) underwent echocardiogram, on median day 4. Conclusion Length of hospital stay has improved compared to prior studies. Limited access to investigations may prolong hospital stay. Streamlining services with development of urgent outpatient TIA clinics, could improve outcomes, save clinician time, free up hospital beds and save hospital funding.

Association of Socioeconomic Factors and Severity of Bronchiolitis Hospitalizations.

It is unclear if socioeconomic status (SES) factors influence severity of illness of patients hospitalized with bronchiolitis. This study was conducted to identify SES factors including the Center for Disease Control and Prevention's Social Vulnerability Composite Index (SVI), estimated income, proportion of minority, proportion of living below poverty, insurance status, and number of household members associated with length of stay (LOS) and intensive care unit admission. Infants hospitalized at a tertiary care urban center for bronchiolitis were identified using International Classification of Diseases codes. Federal information processing system codes were identified from home address and paired with SVI and 2018 census tract. Other measures of SES were obtained from the Federal Financial Institutions Examination Council. Number of household members, insurance, age, sex, and history of prematurity were recorded from patient chart. Length of stay was modeled with mixed effects negative binomial regression and pediatric intensive care unit (PICU) admission with mixed effects logistic regression with random intercept at the census tract and adjustment for clinical factors. A total of 417 infants had median age of 144 days (interquartile range (IQR): 61, 357) and 136 (33%) were born premature. Median LOS was 62 hours (24, 136) with 97 (23%) patients admitted to the PICU. Median household members were 4 (4, 5). For each increase in household member, there was 7% increase in LOS (incidence rate ratio 1.07, 95% confidence interval: 1-1.14, P = .038). Social Vulnerability Composite Index, subcategories, insurance status, estimated income, percent of minority, and percent of poverty did not show any associations with length of hospitalization or PICU admission. Increasing number of household members may be associated with increased bronchiolitis hospital LOS. We find no associations with other SES measures.

The role of medical speciality input in the management of older neurosurgical inpatients

Background With an increasing elderly population, the number of neurosurgical patients aged 65 and over is rising. Ageing is closely related to multimorbidity and frailty, which are both recognised risk factors for postoperative complications and mortality. Comanagement by geriatricians and surgeons has been shown to reduce the length of admission and improve postoperative outcomes in orthopaedics, but evidence for this in neurosurgical patients is limited. Aims To evaluate the demographics of the elderly neurosurgical population, and determine if input by medical teams or completion of frailty scores impacts patient outcomes. Methods A retrospective notes review and review of coding and HES data, including length of stay, number of comorbidities, and mortality rate, was collected for geriatric neurosurgery and spinal surgery patients 65 years and older who were discharged following inpatient admission from April 2019 – March 2020. Full medical notes were retrieved for patients with a length of stay exceeding 14 days, with data on frailty scores and involvement of medical teams collected. Statistical tests were applied to evaluate the difference in outcomes between those reviewed and those not reviewed by medical teams. Results Eighty-one patients had a length of stay over 14 days. 43% of these 81 patients were reviewed by medical teams during their admission. The mean length of stay was significantly shorter in those receiving medical input (22.8 ± 10.6 days vs 32.4 ± 16.0 days, p = 0.003). There was also a significant association between the completion of a frailty score and subsequent input by medical teams. Conclusions The reduction in length of stay observed when patients were reviewed by medical teams supports the role of elderly care physician comanagement in the elderly inpatient neurosurgical population.

National validation of the Centers for Medicare & Medicaid Services strategy for identifying potential surgical-site infections following colon surgery and abdominal hysterectomy.

National validation of claims-based surveillance for surgical-site infections (SSIs) following colon surgery and abdominal hysterectomy. Retrospective cohort study. US hospitals selected for data validation by Centers for Medicare & Medicaid Services (CMS). The study included 550 hospitals performing colon surgery and 458 hospitals performing abdominal hysterectomy in federal fiscal year 2013. We requested 1,200 medical records from hospitals selected for validation as part of the CMS Hospital Inpatient Quality Reporting program. For colon surgery, we sampled 60% with a billing code suggestive of SSI during their index admission and/or readmission within 30 days and 40% who were readmitted without one of these codes. For abdominal hysterectomy, we included all patients with an SSI code during their index admission, all patients readmitted within 30 days, and a sample of those with a prolonged surgical admission (length of stay > 7 days). We calculated sensitivity and positive predictive value for the different groups. We identified 142 colon-surgery SSIs (46 superficial SSIs and 96 deep and organ-space SSIs) and 127 abdominal-hysterectomy SSIs (58 superficial SSIs and 69 deep and organ-space SSIs). Extrapolating to the full CMS data validation cohort, we estimated an SSI rate of 8.3% for colon surgery and 3.0% for abdominal hysterectomy. Our colon-surgery surveillance codes identified 93% of SSIs, with 1 SSI identified for every 2.6 patients reviewed. Our abdominal-hysterectomy surveillance codes identified 73% of SSIs, with 1 SSI identified for every 1.6 patients reviewed. Using claims to target record review for SSI validation performed well in a national sample.

Oxygen saturation targets for children with respiratory distress: a systematic review.

In children with respiratory distress, supplemental oxygen is indicated at peripheral oxygen saturation (SpO2) thresholds of 90-94%. However, these thresholds are poorly studied. We conducted a systematic review to summarise the existing evidence for SpO2 thresholds in children with respiratory distress. Electronic databases and registries were searched for original articles published from 1 January 2010 to 7 January 2022 comparing two or more SpO2 thresholds in children with respiratory distress. Primary outcomes were safety, including mortality, neurocognitive outcomes and readmissions, and effectiveness, including admission rate and length of hospital stay. Methodological appraisal was performed using the Cochrane Risk of Bias 2 (RoB-2) or Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) tools. Results were narratively synthesised. We retrieved 3384 results; seven studies were included. Lower thresholds ranged from 80% to 92% and were compared with higher thresholds ranging from 92% to 94%. Studies were highly heterogeneous in setting, design, population and outcomes. Risk of bias varied from low to high. Lower SpO2 thresholds had equivalent mortality, neurocognitive outcomes and readmissions or re-attendance to healthcare to higher thresholds. Lower SpO2 thresholds showed a significant decrease in admission rates by up to 40% and shortened hospitalisation duration by 10-18 h. The current SpO2 thresholds of 90-94% in children with respiratory distress may be too high, which could lead to unnecessary hospitalisations and prolonged hospitalisation duration. SpO2 thresholds as low as 88% are potentially safe in children with respiratory distress and may reduce hospitalisation rates and length of stay. However, high-quality evidence is needed to support this.

Association of preoperative anaesthesia consultation prior to elective noncardiac surgery with patient and health system outcomes: a population-based study

BackgroundSurgical volumes and use of preoperative anaesthesia consultations are increasing. However, contemporary data estimating the association between preoperative anaesthesia consultation and patient (days alive and at home [DAH30], mortality) and system (costs, length of stay, and readmissions) outcomes are not available. MethodsWe conducted a population-based comparative effectiveness study using linked health administrative data among patients aged ≥40 yr who underwent intermediate-risk to high-risk elective, inpatient, noncardiac surgery in Ontario, Canada (2009–17). Our primary outcome was DAH30. Secondary outcomes included DAH90, 30-day and 1-yr mortality, 30-day health system costs, length of index admission, and 30-day readmissions. Propensity score overlap weights were used to adjust for confounders. Prespecified effect modifier analyses focused on high-risk subgroups. ResultsAmong 364 149 patients, 274 365 (75.3%) received a preoperative anaesthesia consultation. No adjusted association was found (22.5 days vs 22.5 days; adjusted ratio of means 1.00, 95% CI 1.00–1.00) between consultation and DAH30 in the full population. We identified significant effect modification (significantly more DAH30) among patients with ischaemic heart disease, ASA physical status ≥4, frailty index score ≥0.21, and who underwent vascular surgery. Secondary outcomes were associated with preoperative consultation, including greater DAH90, decreased length of stay, lower 30-day and 1-yr mortality, and reduced 30-day costs. ConclusionsPreoperative anaesthesia consultation was not associated with greater DAH30 across the overall study population. However, important potential benefits were observed among high-risk subgroups. Research is needed to identify optimal patient populations and consultation processes.

1070 Epidemiology and Incidence of Pelvic Fractures

Abstract Aim There is a lack of recent UK based literature reporting on the incidence of pelvic fractures, and the demographic associations with fracture locations. Our study reports the incidence and factors associated with pelvic fractures at a major trauma centre over a 7-year period. Method Data from pelvic fractures treated at a Level 1 Trauma Centre was collected from January 2015 to January 2022. Fracture location, patient demographics, and operative status were collected and analysed. Results A total of 3137 patients with pelvic fractures were included, with an incidence of 78.6/100,000 patients per year. The mean age was 63.0, 53% of patients were female and the mean BMI was 25.3. The mean length of hospital admission was 20.5 days. Patients with Pubis fractures had the highest mean age (65.55), whilst those with ilium fractures had the lowest (51.14), both significantly different from the mean (p&amp;lt;0.001). Female patients were more likely to have pubis (60.1%) fractures but less likely to have acetabulum (30.0%) fractures (p&amp;lt;0.01). Patients with acetabular fractures had a higher BMI (p&amp;lt;0.01) and the highest rate of operative fixation (48.5%). Conclusions Our study provides insight into the incidence and epidemiology of pelvic fractures in a UK major trauma centre setting, the first study in over 15 years in this context. This contributes to the literature, and allows inter-country comparisons to be conducted, and guidelines and policies to be more informed.

996 Circumcisions in the Community; a New Initiative

Abstract Introduction The average waiting time for an initial outpatient appointment in urology at UHL is 23 weeks and waiting times for circumcisions are significantly longer. A new initiative in Leicester has enabled a proportion of fit and healthy NHS patients to have their circumcision under LA within the community. Our aim was to audit our practice to determine if this initiative could be trialled across other urological departments in the UK. Method A prospective database has been maintained and 76 patients who underwent a circumcision in the community between November 2021 and August 2022 were identified. 16 patients were excluded since they were not contactable via telephone. Online hospital records and GP records were used in addition to contacting patients via telephone to collect data. Results The mean satisfaction level with the service provided was 8.28. The total post-operative complication rate was 35% with a 25% post operative surgical site infection rate. There were 2 (3.3%) admissions to hospital secondary to penile abscesses and possible skin necrosis of which both required drainage in theatre. The average length of admission for these patients was 2.5 days. 3 (5%) patients were unhappy with cosmesis, and 2 patients have had/are awaiting a redo circumcision. Conclusions Through this new initiative 76 patients have been removed from the NHS waiting lists for circumcision thereby reducing waiting times with very high patient satisfaction. This indicates that this new initiative could be trialled in other departments and could also be used to reduce waiting lists for other minor procedures.

Impact of qSOFA Score on the Outcome of Patients in ICU with Respiratory Tract Infection

Abstract Background The quick Sequential Organ Failure Assessment (qSOFA) score is a bedside prompt that may identify patients with suspected infections who are greater risk for poor outcome in the intensive care unit (ICU). Objectives To assess the impact of qSOFA score on the outcome of patients in ICU with respiratory tract infection. Patients and Methods This Observational prospective study study carried out at ICU department of Ain Shams University Hospitals and Al Mahala Chest Hospital during the period from 1 February 2020 till March 2021 and included 122 patients presented by respiratory infection. Diagnosis of infection based on clinical, laboratory, radiological and/or microbiological evidence in accordance with guidelines for diagnosis of infection. All patients subjected to full history, physical examination, full laboratory tests (including arterial blood gas, complete blood cell with differentiation, international normalized ratio, kidney function tests, liver function tests, random blood sugar, C-reactive protein, erythrocyte sedimentation rate, serum sodium and serum potassium), chest X-ray and/or computerized tomography of chest, sputum cytological analysis and sputum culture. Measurement of qSOFA done in all patients. Results The median of qSOFA score in survivors was 0 while in nonsurvivors 1 at admission and after 48 hours with a significant difference between both groups. In overall patients qSOFA cutoff 1 has sensitivity and specificity 70% &amp; 80.37%, respectively. Conclusion The qSOFA scores were associated with in hospital mortality, hospital admission, ICU admission, and hospital length of stay in patients likely to be admitted both with and without suspected infection, qSOFA is an easy tool that can be used to predict outcomes.

Microbiological Spectrum of Neutropenic Sepsis in Cancer Patients Admitted to a Tertiary Health Care Centre.

To examine the microbiological profile, sensitivity of organisms, treatment and outcomes of in-patients suffering from febrile neutropenia in a tertiary healthcare centre. Data was obtained from the Electronic Medical Health records in Aster Medcity, Cochin, IND. The study population included adult patients undergoing treatment for hematologic malignancies or solid tumors in the hospital between January 2021 and March 2023. Febrile neutropenia episodes were identified based on (1) absolute neutrophil count ≤1500 mm3, (2) at least a single recorded oral temperature of >38.0∘C (100.4∘F) sustained over a one-hour period. Febrile neutropenia consequences included ICU admission, length of ICU admission, and mortality. Total 115 cases of febrile neutropenia were identified in the time period from January 2021 to March 2023. Organisms were isolated from 43% of all the cultures taken. The most common organism isolated was Klebsiella pneumoniae (32.81%), followed by Escherichia coli (29.69%) and Pseudomonas aeruginosa (10.94%). Other organisms that were also isolated were Candida albicans (3.13%), Aeromonas hydrophilia, Acinetobacter baumannii, Burkholderia cepacia, Enterobacter cloacae, Enterococcus faecium, Staphylococcus epidermidis, Staphylococcus hemolyticus, Streptococcus spp, and one case of Ralstonia mannitolytica. Multi-drug resistance (MDR) was seen in 33% of isolates and extensive-drug resistance was seen in 19% of isolates. E. coli showed the highest prevalence of antibiotic resistance with 68% growing MDR isolates and 16% growing XDR isolates. ICU stay was required in 34% of patients with a median duration of stay of three days. A mortality rate of 16.52% was seen, with 17.11% in hematological malignancies and 15.38% in solid tumors. This study showed an increasing prevalence of Gram-negative bacterial infection in patients with febrile neutropenia. It also shows a high prevalence of antibiotic resistance in microbes in febrile neutropenia. Larger multi-hospital studies are required to better understand the microbiological profile of febrile neutropenia and identify the developing antimicrobial resistance trends.