Patient Length Of Stay Research Articles

Atrial Fibrillation Is Associated with Worse Outcomes in Patients Hospitalized with Neutropenic Fever: A Nationwide Analysis

Background: Neutropenic fever is a serious complication associated with significant morbidity and mortality in patients receiving chemotherapeutic regimens.Infection is a known adverse prognostic factor among patients with Atrial fibrillation.We sought to determine the impact of Atrial Fibrillation(AF) on hospitalizations for Neutropenic Fever (NF). Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with NF as a principal diagnosis with and without AF as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. The secondary results were Acute kidney injury (AKI), Cardiac arrest (CA), Septic shock (CS), Total hospital charge (THC), and length of stay (LOS). Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders. Results: About 111,770 patients were admitted for NF; 8.7% (9,704) had underlying AF. Cohorts with AF vs No AF had a mean age of 70.9 years [CI 70.4 - 71.4] vs 57.4 years [CI 57.1 - 57.7]; male (60.1% vs 46.8%), female (39.3% vs 53.2%); white (86.1% vs 73.2%), black (5.0% vs 9.3%), and Hispanic (4.1% vs 1.0%). Compared to patients without AF, patients admitted with coexisting AF had an increased risk of inpatient mortality (4.0% vs 1.0%, AOR 2.42, 95% CI 1.78 - 3.27, P<0.0001), AKI (16.8% vs 9.8%, P=0.009), CA (0.8% vs 0.2% P=0.004), SS (12.8% vs 4.9% P<0.0001), THC (IRR 1.19, 95% CI 1.10 - 1.29, P<0.0001), and LOS (IRR 1.14, 95% CI 1.09 - 1.19, P<0.0001). Conclusion: Patients admitted primarily for NF with co-existing atrial fibrillation had a statistically significant increase in mortality, AKI, CA, SS, THC and LOS. The cohorts in the Atrial fibrillation group were associated with higher economic burden and cost utilization. Additional studies are required to elaborate on the delicate management of this patient population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 10724: Use of Right Heart Catheterization and Length of Stay in Patients With Acute Right Heart Failure: A National Inpatient Database Analysis

Background: Right Heart Catheterization (RHC) is an important tool in the assessment of hemodynamic status in patients with right heart failure (RHF), however is underutilized. Objective: To evaluate the use of RHC in RHF with the primary outcome as mortality and secondary outcome as length of stay (LOS) using the National Inpatient Sample (NIS). Methods: Using 2018 NIS database, we queried for adults over 18 years with the diagnosis of acute RHF and RHC as a procedure using the ICD-10 code via STATA program. Multivariate logistic regression method was used to adjust for age, gender, race, Charlson comorbidity index, cardiogenic shock, septic shock, respiratory failure, acute coronary syndrome, heart failure, atrial fibrillation/flutter, acute kidney injury, chronic kidney disease, end-stage renal disease. Using a 95% confidence interval (CI), a p-value less than 0.05 was considered statistically significant. Results: A total of 49010 admissions was recorded for acute RHF of which 4795 underwent RHC. 360 patients (7.5%) died in the RHC group versus 4615 (10.4%) in the non-RHC group.16.9% of patients in the RHC group had cardiogenic shock versus 7.3% in the non-RHF group. On univariate analysis, patients undergoing RHC had decreased odds of mortality compared to patients without RHC [Odds ratio (OR) = 0.69, p=0.003] and patients undergoing RHC had increased LOS compared to patients without RHC [OR= 3.15, p=0.012]. The mean LOS for the RHF group was 13.3 days versus 7.5 days in the non-RHF group. On multivariate analysis, those undergoing RHC had decreased odds of mortality compared to those without RHC [OR= 0.47, p=0.000] and LOS was longer for those undergoing RHC [OR= 3.15, p=0.008]. All the outcomes were statistically significant. Conclusion: Right heart catheterization, when used in acute right failure, showed decreased odds of mortality when compared to patients receiving non-invasive medical management only however, no difference in length of stay was observed.

Abstract 11699: In Hospital Outcomes of Acute Coronary Artery Dissection and Obesity

Introduction: Coronary artery dissection is an emergency condition due to a tear in the coronary arterial wall, and it’s an uncommon cause of acute coronary syndrome. The Effect of Obesity on the outcome of acute coronary artery dissection is poorly documented. Hence, our study sought to estimate the impact of Obesity on clinical outcomes of hospitalizations of patients with acute Coronary artery dissection using the national database. Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with acute Coronary artery dissection as a principal diagnosis with and without Obesity as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. The secondary results were Acute kidney injury (AKI), Cardiogenic shock (CS), Cardiac arrest (CA), Total hospital charge (THC), and length of stay (LOS). Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders. Results: About 2440 patients were admitted for acute Coronary artery dissection; 17.4% (425) had underlying obesity. Cohorts with obesity vs No obesity had a mean age of 52.9 years [CI 50.4 - 55.5] vs 55.9 years [CI 54.5 - 57.4]; male (20% vs 25.8%), female (80% vs 74.2%); white (71.3% vs 73.3%), black (21.3% vs 12.0%), and Hispanic (6.3% vs 7.8%). Compared to patients without obesity, patients admitted with coexisting obesity had similar inpatient mortality (7.1% vs 3.2%, AOR 3.22, 95% CI 0.74 - 13.88, P=0.118), AKI (15.3% vs 9.9%, P 0.357), CS (9.4% vs 11.2% P=0.098), CA (5.9% vs 5.0% P=0.530), THC (IRR 0.94, 95% CI 0.64 - 1.37, P=0.738), and LOS (IRR 0.79, 95% CI 0.59 - 1.05, P=0.107). Conclusions: Patients admitted primarily for acute Coronary artery dissection with co-existing Obesity had similar inpatient mortality, AKI, CS, CA, THC, and LOS compared to patients without Obesity.

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

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

Abstract 13455: Clinical Outcomes of Intravascular Ultrasound During Percutaneous Coronary Intervention- United States Nation-Wide Analysis 2014 Through 2019

Introduction: Intravascular Ultrasound (IVUS) is a catheter-based real-time imaging procedure that assists in both diagnosis and treatment during Percutaneous Coronary Intervention (PCI). Over the years, IVUS-guided PCI have become more popular. In this study, we aimed to analyze the trends of use of IVUS-guided PCI, adjusted in-hospital mortality, hospital length of stay (LOS) and inpatient cost over the years. Methods: Data were extracted from the National Inpatient Sample (NIS) 2014 through 2019 Database. The NIS was searched for PCI with and without IVUS in adult patients (age ≥ 18) using ICD 9 and 10 codes. Outcomes of interest were utilization rates of IVUS during PCI, trend of adjusted in-hospital mortality, adjusted mean LOS and adjusted mean cost. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. Results: Of 2,871,865 PCIs in 2014 through 2019, 201,075 (7.0%) were coupled with IVUS. The use of IVUS during PCI steadily increased from 6.2% in 2014 to 9.3% in 2019 (trend p&lt;0.001). The adjusted in-hospital mortality and inpatient LOS for PCI with IVUS showed statistically insignificant trend of higher mortality (1.3% in 2014 vs. 1.6% in 2019, trend p=0.053) and shorter LOS (3.2 days in 2014 vs. 3.0 days in 2019, trend p=0.148). The mean adjusted cost steadily increased over the years for patients undergoing PCI with IVUS (24236$ in 2014 vs. 28700$ in 2019, trend p=0.012). Conclusions: There is a steady rise in use of IVUS during PCI. There is a steady hike in hospital costs for PCI with IVUS hospitalizations however in-hospital mortality and LOS remain the same.

Impact of Physiotherapy on Functional Status and Length of Stay of Patients Admitted to Intensive Care Unit

Background: Early mobilization of patients with critical illness reduces the consequences of extended periods of bed rest and improves self-care functions and quality of life. Early mobilization for mechanically ventilated patients in any ICU prevents patients from a spiral of progressive complications, leading to either nursing home placement or persistent critical illness. Early mobilization of ICU patients has been associated with improved muscle strength and functional independence, a shorter duration of delirium, mechanical ventilation, and ICU length of stay. Objective: This study was undertaken to assess the impact of physiotherapy management and early mobilization on Functional Status and Length of Stay in patients admitted to the Intensive Care Unit. Methods: An observational study was conducted at a tertiary care university teaching hospital in Mysore, South India, among patients admitted to medical and surgical intensive care units. The patients were assessed, and the patient’s baseline characteristics were recorded. The study subjects were divided into two groups, the intervention and the control groups. There were 71 patients in the intervention group and 67 patients control group. Subjects in the intervention group underwent physiotherapy management and early mobilization. Subjects in the control group did not undergo physiotherapy management and early mobilization. Physiotherapy intervention was given 2-3 times/day, and the outcome measures were the length of stay in ICU and assessment of physical morbidity using the Chelsea Critical Care Physical Assessment Tool (CPAx). Results: The results showed that subjects in the intervention group were weaned from the ventilator support (3.86±3.4 and 5.59±4.3, p = 0.005) and oxygen support (5.23±0.99 and 7.48±2.0, p = 0.000) much earlier than the subjects in the control group. The length of ICU stay was significantly less in the intervention group than in the control group (7.71±3.70 days and 11.64±4.8 days with a p-value, p = 0.000). respectively Conclusion: This study demonstrated that implementation of physiotherapy intervention and early mobilization in critically ill patients undergoing treatment in intensive care unit resulted in early weaning from ventilator support and supplemental oxygen therapy, with improvement in functional status leading to reduced length of ICU stays compared to the patients who were not given physiotherapy intervention and early mobilization.

A Machine Learning Model to Predict Length of Stay and Mortality among Diabetes and Hypertension Inpatients.

Background and Objectives: Taiwan is among the nations with the highest rates of Type 2 Diabetes Mellitus (T2DM) and Hypertension (HTN). As more cases are reported each year, there is a rise in hospital admissions for people seeking medical attention. This creates a burden on hospitals and affects the overall management and administration of the hospitals. Hence, this study aimed to develop a machine learning (ML) model to predict the Length of Stay (LoS) and mortality among T2DM and HTN inpatients. Materials and Methods: Using Taiwan's National Health Insurance Research Database (NHIRD), this cohort study consisted of 58,618 patients, where 25,868 had T2DM, 32,750 had HTN, and 6419 had both T2DM and HTN. We analyzed the data with different machine learning models for the prediction of LoS and mortality. The evaluation was done by plotting descriptive statistical graphs, feature importance, precision-recall curve, accuracy plots, and AUC. The training and testing data were set at a ratio of 8:2 before applying ML algorithms. Results: XGBoost showed the best performance in predicting LoS (R2 0.633; RMSE 0.386; MAE 0.123), and RF resulted in a slightly lower performance (R2 0.591; RMSE 0.401; MAE 0.027). Logistic Regression (LoR) performed the best in predicting mortality (CV Score 0.9779; Test Score 0.9728; Precision 0.9432; Recall 0.9786; AUC 0.97 and AUPR 0.93), closely followed by Ridge Classifier (CV Score 0.9736; Test Score 0.9692; Precision 0.9312; Recall 0.9463; AUC 0.94 and AUPR 0.89). Conclusions: We developed a robust prediction model for LoS and mortality of T2DM and HTN inpatients. Linear Regression showed the best performance for LoS, and Logistic Regression performed the best in predicting mortality. The results showed that ML algorithms can not only help healthcare professionals in data-driven decision-making but can also facilitate early intervention and resource planning.

Clinical efficacy of Jingyin granules, a Chinese patent medicine, in treating patients infected with coronavirus disease 2019

BackgroundJingyin granules (JY), one patented Chinese herbal formula, have been advised for treating coronavirus disease 2019 (COVID-19) in China. As of now, the safety and effectiveness of JY in treating COVID-19 patients were still to be evaluated. PurposeTo investigate the safety and clinical effectiveness of JY in treating mild COVID-19 patients. Study designWe carried out a prospective cohort study, as the highly infectious COVID-19 omicron variant ranged in Shanghai (ClinicalTrial.gov registration number: ChiCTR2200058692). MethodsParticipants infected with COVID-19, who were diagnosed as mild cases, were assigned to receive either JY (JY group) or traditional Chinese medicine placebo (placebo group) orally for 7 days. The primary clinical indicators were the RNA negative conversion rate (NCR) and the incidence of severe cases. The secondary clinical indicators were the negative conversion time (NCT), inpatient length of stay (ILOS), and the disappearance rates of clinical symptoms. ResultsNine hundred participants were recruited in this clinical trial study, and 830 patients met the eligibility criteria. Seven hundred and ninety-one patients, accomplished the following-up assessment, including 423 cases of JY group and 368 cases of placebo group. NCR in JY group at 7-day posttreatment was considerably greater compared with placebo group (89.8% [380/423] vs 82.6% [304/368], P = 0.003). None of the patients with mild COVID-19 developed into severe cases. The median NCT of SARS-CoV-2 and ILOS in JY group were lesser than that in placebo group (4.0 [3.0,6.0]vs 5.0 [4.0,7.0] days, P < 0.001; 6.0 [4.0, 8.0] vs 7.0 [5.0, 9.0] days, P < 0.001). In both groups, the obvious improvement in clinical symptoms was observed, but the difference was not significant. In the subgroup of age ≤ 60 years, JY promoted SARS-CoV-2 RNA negative conversion (HR=1.242; 95% CI: 1.069-1.444, P < 0.001). No patients in both groups were reported as the case of serious adverse event. ConclusionJY maybe the potential medicine for treating mild COVID-19 patients, which had beneficial effects on increasing NCR, and shortening NCT and ILOS.

The Association of Preoperative Depression, and C-Reactive Protein Levels with a Postoperative Length of Stay in Patients Undergoing Coronary Artery Bypass Grafting

This study aimed to explore the role of preoperative and postoperative C-reactive protein (CRP) levels in mediating the association between the preoperative depression symptoms and postoperative length of stay in patients undergoing coronary artery bypass grafting (CABG). Preoperative depression symptoms of 212 elective CABG patients were measured using the Beck Depression Inventory (BDI-II). The patient’s demographic and clinical parameters were collected from medical records prior to surgery. Patients were followed up during their in-hospital stay to measure early (1–3 days post-surgery) and persistent (4–6 days post-surgery) CRP response to CABG surgery. The higher persistent CRP response was significantly (p &lt; 0.001) associated with a longer postoperative hospital stay. The binary logistic regression analysis confirmed the association of persistent CRP change with prolonged hospital stay (OR = 1.017, 95% CI = 1.005–1.029, p = 0.009). However, when the gender subgroups were analyzed separately, that remained significant (OR = 1.016, 95% CI = 1.004–1.028, p = 0.005) only for the male subgroup. There was no significant association between elevated BDI-II depression scores and longer postoperative hospital stay. Additionally, no significant influence of BDI-II scores on preoperative or postoperative CRP levels, or vice versa, was detected. Further work is needed to explore the extent and pathways through which depression might influence the postoperative recovery of CABG patients.

Factors Affecting Length of Stay in Patients Referred to Emergency Department in Bandar Abbas, Iran

Background: The increase in demand for emergency services causes overcrowding in emergency departments. Length of stay in emergency departments also influences overcrowding in emergency departments and is a key factor for monitoring the performance in emergency departments. This study investigated the factors affecting length of stay in patients referred to emergency department in Bandar Abbas, Iran. Methods: This retrospective cross-sectional study was conducted from December 2018 and February 2019 by investigating 234 eligible patients referred to Emergency Department of Shahid Mohammadi. Demographic characteristics were also recorded, which included gender, age, type of disease, triage level, the time for entry to emergency specialist visit, specialist visit to order time, entry to imaging/lab assay, entry to other specialist consultants, and time for entry to final decision. Results: The results did not indicate any significant difference in both genders and all age groups (P&gt;0.05), but entry time to lab/imaging assays was significantly lower in patients under 40 years old (P=0.001). Moreover, specialist visit to order time (P=0.001), entry to lab/imaging assays (P=0.003), and entry to final decision time (P=0.013) were significantly shorter in the patients with cardiac diseases. Furthermore, entry to specialist visit time (P=0.001), entry to lab/imaging assays time (P=0.0212), and entry to final decision time (P=0.004) were significantly lower in the patients with lower levels of triage. Conclusions: Triage levels are contributing factors for lengths of stay in emergency department, and these factors can be used for decreasing emergency department lengths of stay.

Length of Stay in Patients Undergoing Tracheoplasty: A NSQIP Study.

Prolonged length of stay (LOS) has been associated with increased morbidity and resource utilization in various surgical procedures. We aim to determine factors associated with increased hospital stay in patient undergoing tracheoplasty. The 2012-2018 National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing tracheoplasty. Patient LOS was the primary clinical outcome. A LOS >75th percentile was considered as prolonged and was utilized for bivariate analysis of demographic, comorbidity, and operative characteristics. LOS was utilized as a continuous variable for multivariate linear regression analysis. A total of 252 patients were queried. The majority of patients were female (67.5%), white (82.4%), and over the age of 65 (77.0%). Patients had a median LOS of 7 days with the 75th percentile cutoff being defined at 10 days. On bivariate analysis of associated comorbidities, patients with prolonged LOS were more commonly obese (72.4% vs. 53.1%, p=0.009), diabetic (37.9% vs. 16.5%, p < 0.001), dyspneic (58.6% vs. 40.7%, p=0.016), and had chronic steroid use (25.9% vs. 12.9%, p=0.018). Multivariable logistic regression analysis demonstrated significant associations between prolonged LOS and both chronic obstructive pulmonary disorder (COPD) (OR: 3.43, p=0.020) and chronic steroid use (OR: 3.81, p=0.018). This study elucidates factors associated with prolonged LOS in patients undergoing tracheoplasty. Patients with COPD and chronic steroid use were significantly associated with prolonged LOS. 4 Laryngoscope, 133:1938-1942, 2023.

324 Effect of High-sensitivity Troponin on Emergency Department Length of Stay for Patients Evaluated for Acute Coronary Syndrome

324 Effect of High-sensitivity Troponin on Emergency Department Length of Stay for Patients Evaluated for Acute Coronary Syndrome

S681 Increased Mortality and Length of Stay in Patients With Gastrointestinal Bleeding With Cardiovascular Disease Compared to Patients Without Cardiovascular Disease

S681 Increased Mortality and Length of Stay in Patients With Gastrointestinal Bleeding With Cardiovascular Disease Compared to Patients Without Cardiovascular Disease

3.48 Length of Stay for Patients With ASD in the Emergency Department

Youth with ASD often face difficulties when seeking mental health care. Outpatient providers and inpatient psychiatric units willing and able to treat patients with ASD can be difficult to find. Prior studies have shown that patients with ASD are at risk for prolonged hospital admissions in comparison to patients without ASD. The purpose of this study was to compare length of stay (LOS) in the emergency department (ED) for children with ASD presenting with behavioral health concerns to their typically developing peers.

S1238 Trends of Alcohol Withdrawal Delirium in the Last Decade: Analysis of the Nationwide Inpatient Sample

Introduction: Alcohol use disorder and high-risk drinking have been increasing in the US recently. Approximately half of patients with alcohol use disorder experience alcohol withdrawal when they reduce or stop drinking. This study aimed to describe the epidemiologic trends of alcohol withdrawal delirium (AWD) over the last decade. Methods: This was a retrospective longitudinal trends study involving hospitalizations with AWD in the US from 2010 to 2019. We sourced data from the Nationwide Inpatient Sample database. The study involved two cohorts of hospitalizations: all hospitalizations complicated by AWD and hospitalizations with AWD as the principal diagnosis for admission. We calculated the crude admission rate and the incidence of AWD per million adult hospitalizations during each calendar year. We used multivariable regression trend analysis to obtain trends in mortality, length of stay (LOS), and total hospital charges (THC) adjusted for age categories, sex, and race. Results: The incidence of AWD per million hospitalizations increased from 2671.8 in 2010 to 3405.6 in 2019, with an annual percentage change (APC) of 3.1% (p < 0.001). AWD admission rate per million hospitalizations increased from 1030.3 in 2010 to 1556.0 in 2019, with an average APC of 5.0% (p < 0.001). There were statistically significant trends of increasing inpatient mortality (p trend = 0.044), LOS (p trend = 0.006), and THC (p trend < 0.001). Multivariate analysis showed that younger age, female gender, and Black race were associated with lower inpatient mortality and THC. Younger age and female gender were also associated with shorter LOS. Black race was associated with longer LOS. Conclusion: High-risk drinking and alcohol use disorder have been increasing in the US. The likelihood of alcohol withdrawal increases with increasing alcohol consumption. The observed trends likely reflect the changes in alcohol consumption observed in the last two decades. The inferior outcomes observed in elderly could be contributed to higher prevalence of comorbidities, higher sensitivity to benzodiazepines, and polypharmacy. Better outcomes in females could be attributed to the more conservative drinking patterns, gender-selective adaptations at the molecular level induced by alcohol, and hormonal factors. Better outcomes in Blacks are likely due to lower rates of binge drinking and genetic factors.

S901 Rural versus Urban Differences in Inflammatory Bowel Disease (IBD) Hospitalizations: An Analysis of the National Inpatient Sample (NIS)

Introduction: Inflammatory bowel disease (IBD) is a significant cause of adult hospitalizations in the United States. There are fundamental differences in demographic distribution, socioeconomic status, access to care, and healthcare infrastructure between rural and urban areas in the US. However, very limited data evaluating these differences is available. The study aims to compare outcomes of IBD patients in these two different settings and explore the causes for any observed differences. Methods: Data obtained from the national inpatient sample (NIS) 2016–2019 database was evaluated for IBD admissions in rural and urban hospitals of the US. The primary outcome assessed was inpatient mortality, while secondary outcomes included odds of developing bowel perforation, septic shock, perianal disease, need for RBC transfusion, total hospital charges (THC), and length of stay (LOS). Results: A total of 348,469 adult IBD hospitalizations occurred during the study period. Out of this number, 24,044 patients were managed in rural settings, while 324,425 patients were managed in urban settings. The mean age of rural IBD patients was 48 years old while it was 44 years old in urban areas. Rural IBD patients had shorter inpatient LOS (3.94 days vs 5.03 days, p< 0.001) and THC ($24,515 vs $48,754, p< 0.001) than urban IBD patients. There was no difference between patient groups regarding inpatient mortality, developing septic shock, bowel perforation, need for RBC transfusion, and odds of developing perianal disease. Conclusion: The current study indicates most IBD care variables assessed between rural/urban settings were not different. However, differences were observed in LOS and THC between rural and urban IBD patients. The high cost of health care in urban settings most likely contributed to observed differences in the THC due to advanced treatments not being readily available in the rural environment. Increased access to subspecialist practices more comforTable with IBD patient care in urban areas also may contribute to a prolonged LOS as they likely deal with more medically complex patients who require advanced diagnostic testing not available at rural institutions. Improved understanding of rural/urban IBD patient severity variations and care access/availability are needed to accurately ascertain the reason behind these differences.

The Relationship Between Blood Transfusions and Mortality and Length of Stay in Patients Followed up with a Diagnosis of COVID-19 in Intensive Care Units

The Relationship Between Blood Transfusions and Mortality and Length of Stay in Patients Followed up with a Diagnosis of COVID-19 in Intensive Care Units

Crohn's Disease with Fistula: 10 Year Trends and Mortality in the United States.

Crohn's disease (CD) results in significant morbidity, mortality, and healthcare burden. This study evaluated the temporal trends of CD hospitalizations with a fistula over the last decade to understand the outcomes of severe CD. National Inpatient Sample database from 2009 to 2019 was used to identify CD hospitalizations with a fistula. The outcomes of interest included temporal trend analysis of length of stay (LOS), mean inpatient cost (MIC), and mortality. There was an increase in the total number of fistulizing CD hospitalizations from 5,386 in 2009 to 12,900 in 2019 (p<0.01). The mean age decreased from 44.9±0.6 to 41.8±0.4 years for the study period (p<0.01). Caucasians were the predominant ethnicity, followed by Africans, Hispanics, and others (p<0.001). The mean LOS for fistulizing CD hospitalizations decreased significantly from 11.57±0.09 days in 2009 to 7.20±0.05 days in 2019 (p<0.001). There was a significant decrease in inpatient mortality from 1.72% in 2009 to 0.73% in 2019 (p<0.01). The MIC did not have a significant trend. There was a decreasing trend toward partial/total colectomies, rectosigmoid, and small bowel surgeries from 2009 to 2019 (p<0.001). There has been a rise in CD hospitalizations with fistulizing disease in the last decade. Despite this, the mortality and inpatient LOS have been decreasing significantly. In addition, the increase in CD hospitalizations with fistulizing disease has had no significant effect on hospital costs.

Effect of Ginseng Extract Supplementation on Procalcitonin Level, Neutrophil, and Length of Stay In Patients With Community Acquired Pneumonia

Background: Pneumonia is an acute inflammation of the lung parenchyma caused by microorganisms (bacteria, viruses, fungi, parasites) and causes of high morbidity and mortality. Ginsenoside in ginseng have anti-inflammatory effects, potentially as adjunctive therapy in community-acquired pneumonia (CAP) patients. As much as 43% of patients at dr. Moewardi Hospital in 2016 were hospitalized have passed away. The aim of this study was to determine the effect of ginseng extract on levels of procalcitonin, neutrophils, and length of stay of community-acquired pneumonia patients. Method: The quasi-experimental clinical trial with the pretest posttest design approach was conducted on 26 community acquired pneumonia patients who were hospitalized in Dr. Moewardi Hospital Surakarta from October until November 2019 using consecutive sampling. The control group (n=13) received standard antibiotics while the treatment group (n=13) received additional ginseng extract 2x100 mg/day for 14 days. Procalcitonin was measured at admission, third and fourteenth day; neutrophils are measured at admission and third day; length of stay is based on the number of days of treatment in hospital. Results: There was a significant difference (P=0.001) towards decreased of serum procalcitonin levels between treatment group (-0.63±0.06) compared to control group (-0.38±0.07). There was a significant difference (P&lt;0.001) towards decreased of neutrophil levels between treatment group (-6.68±1.34) compared to control group (-3.51±0.88). There was a significant difference (P=0.001) towards decreased of length of stay between treatment group (5.69±0.95) compared to control group (7.15±0.99). Conclusion: Ginseng extract containing ginsenoside as its main ingredient, can act as an anti-inflammatory which can be used as adjunctive therapy in community-acquired pneumonia patients who are hospitalized to accelerate clinical improvement and shorten the length of stay.

The Impact of Rapid PCR Testing for Viral Respiratory Infections on Acute Admissions From the Emergency Department and Inpatient Length of Stay.

Diagnosing influenza and respiratory syncytial virus (RSV) with conventional multiplex respiratory viral polymerase chain reaction (PCR) takes 24-72 hours compared with under two hours for recently available rapid PCR tests. We investigated the impact of rapid diagnosis of acute respiratory viral infection on admission odds from the emergency department (ED) and acute inpatient length of stay (LOS), as well as concordance between the rapid and conventional PCR tests used at our institution. Single-center retrospective cohort study of patients presenting to the ED with influenza-like illness. We compared the odds of admission and acute LOS in patients investigated with rapid PCR, those investigated with conventional PCR, and those investigated with both tests. Multivariable logistic regression was used to assess the odds of admission, while linear regression was used to assess LOS. There was no significant change in the odds of admission among patients who received the rapid PCR compared to conventional PCR (odds ratio: 1.01, 95% confidence interval [CI]: 0.50-2.02; p = 0.96). There was also no significant difference in LOS of admitted patients who received rapid PCR testing (regression coefficient: -0.32, 95% CI: -1.75 to 1.12; p = 0.66). The rapid PCR test used at our institution yielded fully concordant results with conventional PCR testing. Rapid PCR testing is as sensitive as conventional PCR testing for the diagnosis of influenza and RSV but is neither associated with a significant impact on admission nor inpatient LOS. Further research is needed to assess the impact of rapid testing on isolation room use.