Length Of Stay Research Articles

Effect of a daily scrum at the gastrointestinal oncology ward on length of stay: A tertiary center experience.

e13540 Background: The disease course of oncology patients often results in repeated hospitalization and prolonged length of stay (LOS). Next to disease and treatment complexity a causal role is attributed to psychological, social, nutritional and physical factors. Multidisciplinarity between (para)medical actors can limit LOS and reduce days with limited medical value. However this multitude of actors can also hold a reverse effect as it requires coordination between all parties. ‘Scrum’ is a methodology, originating in IT development, to approach complex issues on an operational level. It allows for quick adaptation to evolving situations requiring teamwork, quite similar to the care planned and provided for vulnerable patients with complicated pathology. The goal is to assess whether a daily scrum can impact LOS and the rate of readmissions. Methods: Starting October 2022, a daily scrum was implemented at the GI Oncology ward (capacity: 26 beds) of a tertiary center. Every day a window of 10 to 15 minutes was strictly reserved for a scrum, led by one of the two supervising medical doctors (MDs), together with the rotating residents in training and the head nurse. This daily debriefing of every single patient focused on the exact medical criteria for discharge, next to an upfront concrete plan for paramedical discharge criteria. A linear model was used to test whether the scrum succeeded at reducing LOS, while correcting for case mix (parameters: 3M All Patient Refined Diagnosis Related Groups (APR DRG), age, weight, adjustment for COVID period). All hospitalizations from October 2022 until December 2023 were included in the analysis. Results: 664 GI oncology patients were hospitalized between October 2022 and December 2023. The mean LOS was 6.07 days. After correcting for case mix, LOS was significantly reduced in the period in which a daily scrum was performed compared to four years of data prior to the scrum (-10.4%, p = 0.003). The expected LOS reduction based on the four years of data prior to the scrum was 4.0% ( p < 0.001). Case mix corrected hospital-wide unplanned readmissions within 30 days from discharge did not increase despite this lower LOS. After a change in supervising MDs in August 2023, LOS did not significantly alter (+1.0%, p = 0.837) suggesting durability of the observed effect. Conclusions: A daily scrum at the GI oncology ward significantly shortens LOS. Scrum is a useful tool to optimize the use of bed capacity by reducing days in which the patient is in hospital with no or limited value, and to prevent undesirable bedspacing (‘alternative patients’) at risk for suboptimal care and potential harm.

Artificial intelligence (XGBoost) in predicting outcomes among CAR-T therapy patients: The impact of malnutrition and comorbidities using the National Inpatient Sample (2020-2022).

2536 Background: Chimeric Antigen Receptor T-cell (CAR-T) therapy has revolutionized hematologic malignancy treatment but remains costly, with limited access and complications like prolonged hospitalization, sepsis, and mortality. Malnutrition, common in cancer patients, worsens these outcomes. Despite AI’s growing role in oncology, its use in risk stratification for malnourished CAR-T recipients is underexplored. This study leverages the National Inpatient Sample (NIS) 2020-2022 to develop AI-driven models predicting length of stay (LOS), mortality, and sepsis, incorporating the Charlson Comorbidity Index and other factors. Methods: Using the NIS database, adult CAR-T therapy patients were identified with ICD-10 codes. Key variables included demographics (age, gender, race/ethnicity, income), clinical factors (Charlson Comorbidity Index, sepsis, admission type), and hospital characteristics (size, teaching status). AI models (XGBoost, Random Forest, Neural networks) were trained on the 2020 dataset and validated on 2020-2022 data. Hyperparameter tuning via grid search was performed to optimize model performance. LOS was modeled as a continuous outcome, while mortality and sepsis were classified as binary outcomes. Data preprocessing included handling missing values, one-hot encoding of categorical variables, and standardizing continuous variables. SHapley Additive exPlanations (SHAP) were used to interpret feature importance. Results: The study analyzed 1,912 CAR-T hospitalizations over three years, with 11.5% identified as malnourished. AI models demonstrated strong predictive performance, with XGBoost (RMSE: 3.5 days, R² = 0.82) for LOS, Random Forest (AUC: 0.91) for mortality, and Neural Networks (AUC: 0.87) for sepsis. Malnutrition significantly worsened outcomes, increasing LOS by 14.2 days (p < 0.001) and mortality risk by 3.2-fold (p < 0.001). Patients with Charlson Comorbidity Index scores ≥3 had 9.8-day longer LOS and 2.9-fold higher mortality risk (p < 0.001). Racial disparities were evident, with Black patients at 25% higher risk of prolonged LOS and Hispanic patients at increased risk of sepsis (p < 0.05). Malnourished patients in non-teaching hospitals with high comorbidity burdens had the worst outcomes, emphasizing the need for targeted interventions in high-risk populations. Conclusions: AI-driven models incorporating malnutrition and Charlson Comorbidity Index accurately predict LOS, mortality, and sepsis in CAR-T patients. Early identification and management of malnutrition and comorbidities, particularly in racially diverse populations, are critical to improving outcomes. Future research should focus on prospective validation and AI integration into clinical workflows to mitigate disparities.

The Association of Comorbidities With Total Knee Arthroplasty Healthcare Utilization

The Association of Comorbidities With Total Knee Arthroplasty Healthcare Utilization

Impact of graft-versus-host disease on mortality, length of stay, and hospitalization costs in bone marrow transplant patients: A retrospective analysis using the 2021 NIS database.

e18554 Background: Graft-versus-host disease (GVHD) is a significant complication of bone marrow transplantation (BMT), influencing patient outcomes, length of stay (LOS), and hospitalization costs. This study evaluates the prevalence of GVHD in hospitalized BMT patients and its impact on outcomes using the 2021 National Inpatient Sample (NIS) database. Methods: We conducted a retrospective analysis of the NIS 2021 dataset. Patients who underwent BMT and patient’s who developed GVHD were identified using the appropriate ICD-10 codes. Survey-weighted descriptive statistics were used to analyze patient demographics, mortality rates, LOS, and total hospitalization charges (TOTCHG). Multivariable logistic and linear regression models evaluated GVHD’s impact on outcomes, adjusting for age, sex, race, income quartiles, Charlson comorbidity index (CCI), hospital region, teaching status, and bed size. The top principal diagnoses were ranked by weighted counts. Results: A total of 20,165 weighted BMT hospitalizations were analyzed, of which 10.9% (95% CI: 9.8%-12.1%) were associated with GVHD. GVHD patients had a significantly higher mortality rate compared to non-GVHD patients (6.4% vs. 4.5%, p=0.04), longer LOS (10.7 vs. 7.2 days, p<0.001) and GVHD patients had significantly higher mean hospitalization charges ($235,485 vs. $113,706). Adjusted regression showed GVHD was associated with a 50% higher odds of mortality (aOR: 1.50, 95% CI: 1.03-2.31, p=0.031), 3.3 additional hospitalization days (95% CI: 1.70-4.87, p<0.001), and $112,376 higher total charges (95% CI: $54,212-$170,539, p<0.001). Significant adjusted predictors of mortality included age (OR = 1.01, p = 0.009) and Charlson Comorbidity Index (OR = 1.47, p < 0.001). Length of stay was significantly influenced by CCI (0.51 days, p = 0.022), and teaching hospital status (1.76 days, p < 0.001). Hospital charges were significantly higher with CCI ($13,646.94, p = 0.023), and at teaching hospitals ($45,054.57, p < 0.001). The most common primary diagnoses among BMT patients with GVHD included septicemia (650 cases), pneumonia (202 cases), acute kidney failure (320 patients) and COVID-19 (130 cases). Conclusions: GVHD significantly exacerbates the clinical and economic burden of BMT, leading to increased mortality, LOS, and healthcare costs. Age, Charlson Comorbidity Index, and teaching hospital status were also significant predictors of mortality, length of stay, and hospital charges. The most common primary diagnoses among GVHD patients included septicemia, pneumonia, acute kidney failure, and COVID-19, underscoring the complexity and resource-intensive care required for this population. These findings emphasize the need to focus on early detection strategies and innovative treatment modalities to mitigate the impact of GVHD in BMT patients.

Undernutrition in adult hospitalized patients and its impact on the length of stay, a 10-year repeated cross-sectional study analyzing 65,226 stays.

Undernutrition in adult hospitalized patients and its impact on the length of stay, a 10-year repeated cross-sectional study analyzing 65,226 stays.

Analysis of readmission rates, length of stay and mortality among bone marrow transplant and CAR-T patients in a rural state.

e19021 Background: Bone marrow transplantation (BMT) and chimeric antigen receptor T-cell (CAR-T) therapy has become an integral treatment modality for several hematological malignancies and disorders. However, its research in rural states where healthcare disparity is common remains understudied. Methods: This retrospective cohort study analyzed patient data between 2015-2022 at a single academic institution that serves as the only BMT/CAR-T facility in a rural state. Patients were divided into black and white races given very low sample size for other races. Socioeconomic factors, demographics, comorbidities, and insurance status were analyzed. Univariable and multivariable regression models were used to assess the association between race, readmissions, length of stay (LOS), and mortality in these patients. P-value <0.05 was considered significant. Results: Altogether 1,496 patients were included in the study. Of these, 297 identified as black, 1,127 as white, and 72 as other races. A total of 1,157 of these patients had undergone auto-BMT, 87 allo-transplantation, and 52 auto-CAR-T. LOS differed significantly based on the type of BMT and primary insurance (p < 0.001). These effects were observed even when controlling for other demographic variables and when nonparametric, tree-based multivariable models are used. Patients undergoing allo-transplantation had a much longer LOS than auto-BMT and auto-CAR-T patients. On the same note, patients who had private insurance had a much lower LOS than the other groups. In terms of mortality, when adjusting for variables such as age, results indicated that there was a significant difference in 90-day mortality based upon primary insurance (p = 0.024), with Medicare patients having worse outcomes. Additionally, type of therapy received was also significantly associated with 90-day mortality when adjusting for other covariates (p < 0.001). Re-admission rates differed significantly depending on type of treatment received (30-day: p = 0.007, 90-day, p < 0.001). Gender was also found to be statistically significant for 90-day readmission rate (p = 0.010), with females having higher readmission numbers than males. Overall, allo-transplantation patients had higher 30 & 90-day readmission numbers than the other transplant groups. Conclusions: This study highlights disparities that exist especially in rural states where resources are limited for patient care. Type of transplantation, and primary insurance play crucial roles in the length of stay, readmission and mortality of patients undergoing BMT or CAR-T treatment. Addressing the disparities may require improved access to focused interventions.

Evaluating the role of C-reactive protein and procalcitonin in risk stratification and outcomes of febrile neutropenia in solid malignancies.

e24080 Background: C-reactive protein (CRP) and procalcitonin (PCT) are widely used during inpatient admissions for febrile neutropenia (FN). However, neither of these biomarkers is included in the clinically validated Multinational Association for Supportive Care (MASCC) risk index, which limits their utility in risk stratification and outcome prediction. This study evaluated the role of CRP and PCT in predicting clinical outcomes in patients with FN and solid malignancies, focusing on key outcomes such as length of stay (LOS), antibiotic duration, and mortality. The secondary objective was to assess these biomarkers' correlation with the MASCC risk index and their effect on its predictive accuracy. Methods: We conducted a prospective observational study at Aga Khan University Hospital, Karachi, Pakistan, from June 2023 to September 2024. A total of 100 adult patients with solid malignancies admitted with FN were included. Demographic and clinical data were recorded, and patients were stratified by MASCC risk index. Median CRP and PCT levels were compared using the Mann-Whitney U test. Logistic regression assessed associations between biomarkers and outcomes (mortality, LOS antibiotic duration), reported as odds ratios (OR) with 95% confidence intervals (CI). ROC analysis evaluated biomarker predictive accuracy. Analyses were performed using Stata, with p < 0.05 considered significant. Results: Of the 100 patients, n = 49 were identified as low risk (MASCC ≥21). The mean age was 54 years, with high-risk patients (MASCC < 21) being older (mean 58 years) compared to low-risk patients (mean 50 years). The median PCT levels were 0.8 and CRP levels were 15.5. PCT levels were significantly associated with several clinical outcomes. Patients with elevated PCT levels had a longer LOS (p < 0.05) and required extended durations of antibiotic therapy (p < 0.05), indicating a link between higher biomarker levels and more severe infections. Elevated PCT levels were also significantly associated with increased mortality risk (p < 0.05, OR: 10.91, 95% CI: [1.26, 94.52]), underlining its prognostic value. CRP showed weaker associations and limited prognostic utility. In terms of risk stratification, PCT levels demonstrated a significant association with the MASCC score (p < 0.05) and MASCC risk classification (p < 0.05), suggesting its potential role in enhancing the MASCC scoring system’s predictive accuracy. Conclusions: PCT has significant predictive value for LOS, antibiotic duration, and mortality, while also showing a strong association with MASCC risk index. These findings highlight the potential role of incorporating PCT into FN risk stratification and management protocols. Larger prospective studies should explore the integration of PCT with the MASCC risk index, enabling improved identification of high-risk patients prone to FN-related complications.

Impact of palliative care on mortality, length of stay, and hospital charges in common cancers.

12087 Background: Palliative care is a vital component of advanced cancer management, offering symptom relief, improved quality of life, and comprehensive care for patients with complex health needs. While its clinical benefits are well-documented, its impact on hospital outcomes—such as in-hospital mortality, length of stay (LOS), and total hospitalization charges (TOTCHG)—remains underexplored across major cancers. Using the 2021 National Inpatient Sample (NIS), this study evaluates the influence of palliative care utilization on these outcomes among hospitalized patients with breast, lung, colon, bladder, and prostate cancers. Methods: This retrospective analysis examined 966,753 weighted hospitalizations, representing breast (163,594), lung (383,215), colon (168,750), bladder (86,555), and prostate (182,280) cancers. Palliative care utilization was the primary exposure. Outcomes assessed included in-hospital mortality, LOS, and TOTCHG. Survey-weighted logistic and linear regression models were used to adjust for patient demographics (age, sex, race, income quartile), comorbidities (Charlson Comorbidity Index, CCI), and hospital characteristics (location, teaching status, region, bed size). Results: The overall mortality rate was 6.6%, highest in lung (9.3%) and lowest in prostate (4.7%) and colon cancers (4.8%). Palliative care patients had higher mortality (28.5%; p < 0.001). Adjusted analyses showed increased mortality with higher CCI (OR = 0.71, p < 0.001) and urban hospitals (OR = 1.40, p < 0.001), while female patients had reduced risk (OR = 0.86, p < 0.001).LOS averaged 5.98 days, longer for palliative care patients (7.68 days; p < 0.001). TOTCHG averaged $83,430, higher for palliative care ($90,488; p < 0.001). Black patients incurred higher charges (+$10,475, p = 0.001), and urban hospitals had lower costs (-$35,094, p < 0.001).Palliative care was concentrated in urban (93.7%) and teaching hospitals (80%), with significant underrepresentation of Black and Hispanic patients in the utilisation of palliative care. (19.2% and 8.8%). Conclusions: Palliative care in hospitalized cancer patients addresses the needs of patients with advanced disease and significant comorbidities. However, the study highlights stark disparities in healthcare access, resource utilization, and demographic representation based on race, socioeconomic status, and hospital characteristics. Palliative care outcomes cancer comparison table. Cancer Type Total Hospitalizations Mortality Rate (%) MeanLOS Mean Hospital Charges Palliative Care Mortality Rate (%) Palliative Care LOS Palliative CareCharges Breast 163594 6.6 7.34 85727 26.4 7.34 85727 Lung 383215 9.3 6.19 82776 30.55 7.53 89760 Colon 168750 4.8 6.62 96148 24.99 8.09 95202 Bladder 86555 4.7 8.33 92731 25.9 8.33 92731 Prostate 182280 4.7 5.41 79410 27.12 7.81 91883

Predictors of prolonged hospital length of stay following craniotomy for brain tumor resection: A systematic review and meta-analysis.

e23245 Background: Hospital length of stay (LOS) is a crucial indicator for assessing the quality of care. Identifying predictors of prolonged hospital LOS helps to improve care quality and reduce healthcare costs. In this study, we conducted a systematic review and meta-analysis to identify the preoperative and operative factors influencing the prolonged hospital LOS in patients undergoing craniotomy for tumor resection. Methods: A comprehensive search was conducted in major databases including PubMed, Google Scholar, ScienceDirect, and Cochrane Library.Covariates included for assessing predictors were age, race or ethnicity, tumor histology, operative time, American Society of Anesthesiologists (ASA) class, and admission source. Heterogeneity was measured as I2 and a p-value of < 0.05 was considered statistically significant. Results: Six observational studies including 18023 patients were analyzed. ASA class 3 (OR, 1.39, CI:1.16-1.63, I2 = 70.51%, p < 0.05), ASA class > 3 (OR, 2.21, CI:1.82-2.60, I2 = 0%, p < 0.05) and admission source other than home (OR, 3.19, CI:2.58-3.79, I2 = 52.31%, p < 0.05) were associated with statistically significant prolonged LOS. Although statistically insignificant, asian ethnicity (OR, 0.98, CI: 0.85-1.12) and tumor resection for meningiomas (OR, 0.68, CI: 0.24-1.13) were associated with lesser LOS while African ethnicity (OR, 1.47, CI:0.97-1.97), longer operative time (OR, 1.19, CI:0.04-2.35) and age > 70 (OR, 1.95, CI:0.65-3.26) were associated with prolonged hospital LOS. Conclusions: Our systematic review and meta-analysis analyzed various preoperative and operative predictors of prolonged hospital LOS in patients undergoing craniotomy for tumor resection. These findings could inform targeted interventions to improve care and reduce costs. Further studies are needed to explore additional determinants and validate these results.

Preoperative glycemic control and postoperative clinical outcomes in patients with type 2 diabetes mellitus undergoing bariatric surgery.

Preoperative glycemic control and postoperative clinical outcomes in patients with type 2 diabetes mellitus undergoing bariatric surgery.

Optimizing hospital length of stay and bed allocation using a fuzzy stochastic transportation problem framework with lomax distribution.

Managing hospital Length of Stay (LOS) is essential for improving patient flow and resource utilization. This study introduces the Fuzzy Stochastic Transportation Problem with Lomax Distribution (FSTPWLD) as a framework to address LOS variability. The Lomax distribution effectively represents heavy-tailed data, capturing the uncertainty and skewness typical of patient discharge times. By integrating this distribution into the FSTPWLD model, the study offers a novel method to predict and manage LOS under fluctuating demand and capacity. The model aims to minimize operational costs while maintaining high standards of patient care, using probabilistic constraints and objective functions. Numerical experiments and simulations demonstrate the effectiveness of our approach in improving resource allocation and reducing bottlenecks. The results highlight the potential of using advanced probabilistic models to enhance decision-making processes in healthcare management, providing a foundation for future research and practical applications in hospital administration. The model demonstrated its efficacy with a predicted New Average Length of Stay (New ALOS) achieving a mean absolute error (MAE) of ±5 ., significantly improving accuracy compared to traditional methods. Additionally, the integration of fuzzy and stochastic elements led to a 20 . reduction in bed allocation mismatches, optimizing resource utilization across hospital departments.•Novel Integration of Lomax Distribution in FSTPWLD: Utilizes the Lomax distribution to model heavy-tailed LOS data, capturing inherent uncertainty and variability in hospital discharge times.•Optimized Decision-Making for Healthcare Management: Employs probabilistic constraints and fuzzy stochastic models to balance operational costs and patient care quality, improving resource allocation.•Validated through Simulations and Practical Scenarios: Numerical experiments highlight the model's effectiveness in reducing bottlenecks and enhancing hospital administration efficiency.

Trends and outcomes in Merkel cell carcinoma: A nationwide analysis of sociodemographic characteristics, inpatient utilization, and mortality (2016–2021).

e21592 Background: Merkel cell carcinoma(MCC) is an aggressive, rapidly progressing neuroendocrine malignancy of the skin. We aimed to analyse the burden of MCC in inpatient hospitalizations in the US. Methods: Patients admitted with MCC between 2016 and 2021 were identified from the Nationwide Inpatient Sample (NIS) using ICD-10 codes. The primary objective was to identify Sociodemographic characteristics using descriptive statistics. The secondary objectives were to determine the burden of inpatient hospital utilization, such as length of stay(LOS), Total hospitalization charges (THC), and mortality, using multivariate linear and logistic regression. Univariate linear regression models were used to examine the relationship of the outcomes across the years. Results: A total of 8,569 admissions were recorded, with 71% of the patients being male. The mean age of the population was 74.7 years. Among the cohort, 0.4% had a diagnosis of HIV, 5.3% had a history of solid organ transplantation (SOT), and 7.9% had a Concomitant hematological malignancy (CHM). Patients with HIV and SOT were significantly younger, with a mean age difference of 13.4 and 9.7 years, respectively (p < 0.005). The racial distribution showed that most patients were White (89.6%, OR of MCC 3.1, p < 0.001), belonging to zip codes with higher median incomes (28.6%). Medicare was the predominant payer, covering 79.8% of admissions. Hospital characteristics revealed that 93.5% of admissions took place in urban settings, with hospitals in the South having the highest number of admissions (37.3%), especially in the South Atlantic census division (21.7%). Regarding tumor location, the face was the most common site (24.4%), followed by the upper limb (18.6%) and scalp (16.3%). The odds hospitalization with MCC increased with age at 5.8% per year (OR 1.05, p < 0.001) and was higher among SOT (OR 4.7 p < 0.001) and CHM (OR 2.3, p < 0.001). No significant differences were observed among inpatient metrics based on age, gender, race, Median income, or the location of the MCC. Patients with HIV had shorter LOS (-6 days, p < 0.001), while patients with CHM had longer (+ 2 days, p < 0.05). The in-hospital mortality in patients with MCC was 6.8% , with the odds of mortality being higher with CHM (OR 2.8, p = 0.005). Though the odds of MCC hospitalizations increased from 2016 to 2021 by 7.5% per year(OR 1.07 p < 0.001), the trends in LOS, THC, and mortality did not reach statistical significance. Conclusions: The study shows that MCC hospitalizations have been increasing over the years and primarily involve elderly, White males in urban areas. Patients with SOT or CHM had worse outcomes, including more extended LOS and higher mortality. These findings highlight the need for targeted interventions for high-risk groups and further research to address disparities to improve care.

Economic impact and mortality outcomes of palliative care integration among cancer patients: Analysis of National Inpatient Sample 2018-2022.

12031 Background: While palliative care integration into oncology represents a quality metric, its relationship with mortality outcomes and cost implications remains incompletely characterized. This study evaluates the association between palliative care consultation and healthcare utilization across major cancer types. Methods: We conducted a retrospective analysis using the National Inpatient Sample (2018-2022). Eligible patients included adults with primary diagnoses of lung, breast, prostate, or colon cancer. Palliative care utilization was identified (ICD-10 code Z51.5). Primary endpoints included in-hospital mortality, length of stay (LOS), and total charges. Propensity score matching (1:1 nearest neighbor, caliper 0.2) was used to account for selection bias. Confounding variables included age, race, insurance status, hospital characteristics, and comorbidity burden. Missing data were handled using complete case analysis. Temporal trends were assessed using Cochran-Armitage test. Results: Among 1,104,888 eligible hospitalizations (469,831 lung, 203,857 breast, 204,837 colon, 226,065 prostate), 70,863 in-hospital deaths occurred. Palliative care consultation was associated with reduced LOS (adjusted mean difference: -1.2 days; 95% CI: -1.4 to -1.0; p<0.001) and lower total charges (adjusted mean difference: -$31,947; 95% CI: -$34,521 tor o -$29,373; p<0.001) among deceased patients. Cancer-specific mortality rates with without were: lung (31.26% vs 4.16%, p<0.001), breast (26.72% vs 2.16%, p<0.001), colon (25.60% vs 2.27%, p<0.001), and prostate (27.07% vs 1.98%, p<0.001). Overall palliative care utilization increased from 13.50% to 15.91% (2018-2022; APC: +0.68%; p-trend<0.001). DNR status strongly predicted palliative care utilization (adjusted OR: 4.50; 95% CI: 4.41-4.60; p<0.001). Conclusions: In this large nationwide analysis, palliative care consultation was associated with significant reductions in healthcare utilization and costs among deceased cancer patients. Universal implementation could potentially save 27,744 hospital days and $996.4 million annually, suggesting substantial opportunities for healthcare system optimization. Healthcare utilization outcomes by cancer type and palliative care status. Cancer Type Deaths (N) PC Rate (%) Adjusted Cost Difference* ($) Adjusted LOS Difference* (Days) Lung 41,808 61.45 -32,655 (-35,124, -30,186) -0.94 (-1.12, -0.76) Breast 9,981 60.80 -31,382 (-34,276, -28,488) -0.97 (-1.18, -0.76) Colon 9,667 56.95 -47,079 (-50,612, -43,546) -1.32 (-1.56, -1.08) Prostate 9,407 56.61 -37,099 (-40,388, -33,810) -0.81 (-1.02, -0.60) *Values represent adjusted differences (95% CI) between palliative care and non-palliative care groups. PC = Palliative Care; LOS = Length of Stay.

Outcomes Observed Within Embedded Geriatric Services in Emergency General Surgery: A Systematic Review.

An aging population and advances in surgery have led to increasing need for geriatric management of elderly patients undergoing emergency general surgical care. Integration of a proactive geriatric service for these patients may beneficially impact both traditionally measured hospital and patient-based metrics. Here, we synthesize evidence regarding measurable outcomes of embedded geriatric care within emergency general surgery. A comprehensive search was conducted across Medline, Embase, Cochrane Library, CINAHL, and Scopus databases by two independent reviewers. The included publications reported outcomes of embedded geriatric services in emergency general surgery. Prespecified outcomes assessed in these studies included patient-reported outcomes, length of stay (LOS), mortality rate, complication rate, intensive care admission, readmission rate, and institutionalization. A total 3100 studies were imported, and eight prospective prepost studies were included in the final review. Length of stay, mortality rate, and medical complication rates were the most frequently assessed outcomes, with each recorded in at least 5 of the 8 included studies. 7 of the 8 studies reported reduced LOS, with four of these reporting a statistically significant difference. The results were variable for other hospital outcomes, including mortality, readmission, and complication rates. Only one source reported on patient-related outcomes, utilizing two tools at multiple time points. No significant prepost effects on patient-related outcomes were noted in this study. Published data on integrating geriatric care in emergency general surgery is limited, but decreased LOS is consistently reported. Further research is necessary to confirm wider effects of integrated geriatric care on relevant hospital and patient outcomes.

Timing of radiofrequency identification tag placement: can early placement save time and patient experience?

Radiofrequency identification tag localization (TL) is a method of localizing nonpalpable breast cancers and high-risk lesions that can be performed prior to the day of surgery (DOS). We evaluated if placement of TL prior to DOS would affect patients' length of stay (LOS) and improve surgical on-time starts. A retrospective review of excisional biopsies and lumpectomies with TL was performed. Associations between timing of TL (DOS vs. prior), time in radiology, surgical case delay, LOS on DOS, and total LOS were assessed. 439 patients underwent TL for nonpalpable breast cancer or high-risk lesions between July 2018 and July 2021 at our institutions. 158 TL procedures were performed on the DOS and 281 TL procedures were performed a median of 3days prior to the DOS (range 1-28). All intended targets were removed. The median total LOS (time in radiology and surgery) was 336min and 434min for the early placement group and DOS group, respectively (p < 0.001). The median length of time in radiology was 47min for the early placement group and 54min for the DOS group (p < 0.001). Cases were significantly more likely to be delayed (p = 0.002) and could not be first-start cases if TL was performed on DOS. Vasovagal events during TL and narcotic use in the post-operative setting were rare across both groups. TL prior to DOS was associated with a decrease in total LOS (p < 0.001) and case delay (p = 0.002), as well as an increase in first-start cases. These findings suggest the potential superiority of TL prior to DOS.

Temporal trends and determinants of palliative care utilization among hospitalized patients with acute myeloid leukemia.

e13832 Background: Patients with acute myeloid leukemia (AML) are frequently hospitalized for intensive chemotherapy and treatment-related complications and are at risk for significant physical and psychological burdens. Integrating palliative care enhances symptom management and improves the quality of life for these patients. This study examined temporal trends and predictors of palliative care utilization among hospitalized AML patients. Methods: A retrospective cohort study using the National Inpatient Sample (2016–2020) identified primary AML hospitalizations via ICD-10-CM codes. Patients were categorized by documented palliative care encounters. Trends in palliative care utilization from 2016 to 2020 were examined, and baseline sociodemographic characteristics were summarized. Multivariable logistic regression identified independent predictors of palliative care utilization. Results: Of 33,430 AML hospitalizations, only 14% involved palliative care, with an increase in consultations from 12.5% in 2016 to 16.4% in 2020. The median age of patients receiving palliative care was 66 years (IQR: 53–74), and 54.6% were male. Most patients were non-Hispanic White (73.5%), followed by African American (10.5%) and Hispanic (7.5%). Medicare was the most common payer (39%), followed by private insurance (23.3%) and Medicaid (9.8%). Patients aged ≥75 years were less likely to receive palliative care compared to younger patients (OR = 0.613, 95% CI: 0.563–0.667, p &lt; .001). Males had slightly higher odds of receiving palliative care than females (OR = 1.072, 95% CI: 1.007–1.142, p = .030). Hispanic patients had lower odds of palliative care utilization compared to non-Hispanic Whites (OR = 0.727, 95% CI: 0.590–0.895, p = .003), while Native American patients had higher odds (OR = 2.542, 95% CI: 1.493–4.330, p &lt; .001). Surprisingly, patients with a high comorbidity burden were less likely to receive palliative care than those with fewer comorbidities (OR = 0.476, 95% CI: 0.435–0.521, p &lt; .001). Non-elective admissions were associated with reduced odds of palliative care (OR = 0.251, 95% CI: 0.132–0.475, p &lt; .001). Conversely, hospital stays exceeding five days were linked to increased odds of receiving palliative care (OR = 1.339, 95% CI: 1.244–1.441, p &lt; .001). Regional differences were notable, with higher palliative care utilization in the Northeast compared to the Midwest (OR = 1.264, 95% CI: 1.152–1.388, p &lt; .001). Conclusions: Palliative care remains underutilized among hospitalized AML patients, with notable disparities based on age, race/ethnicity, admission type, comorbidity burden, and geographic region. Efforts should focus on addressing systemic inequities, particularly for vulnerable populations, and enhancing access to palliative care services to ensure equitable and comprehensive care. Factors associated with palliative care utilization among hospitalized patients with acute leukemia. OR (95%CI) P value Age Less than 70 Reference 70 years and older 0.613 (0.563-0.667) &lt;0.001 Sex Females Reference Males 1.072(1.007-1.142) 0.03 Race/Ethnicity Non-Hispanic White Reference African American 0.789(0.622-1.001) 0.051 Hispanic 0.727(0.59-0.895) 0.003 Native Americans 2.554(1.493-4.330) &lt;0.001 Others 0.383 (0.302-0.485) &lt;0.001 Insurance type Medicare Reference Medicaid 0.985(0.833-1.166) 0.864 Private 0.703(0.593-0.834) &lt;0.001 Other 0.748(0.552-1.012) 0.060 Mode of admission Elective Reference Non-elective 0.251(0.132-0.475) &lt;0.001 Hospital region Midwest Reference Northwest 1.264(1.162-1.388) &lt;0.001 South 0.905(0.830-0.987) 0.024 West 0.903(0.814-1.002) 0.056 Length of Stay (LOS) LOS 5 days or less Reference LOS &gt; 5days 1.339(1.244-1.441) &lt;0.001 Charleston co-morbidity index Low (0-4) Reference Medium (5-7) 0.476(0.435-0.521) &lt;0.001 High (&gt;8) 0.785(0.721-0.855) &lt;0.001 OR = odds ratio; CI = confidence intervals; model adjusted for age, gender, race/ethnicity, insurance type, hospital location, Charlson comorbidity index, admission type and length of stay.

Unveiling inequities: Racial disparities in MACCE outcomes among esophageal cancer patients.

e16165 Background: Esophageal cancer is a highly lethal malignancy with significant racial and ethnic disparities in clinical outcomes and healthcare utilization. Cardiovascular and cerebrovascular events, including myocardial infarction (MI), arrhythmias, and sudden cardiac arrest, add to the disease burden. This study uses the National Inpatient Sample (NIS) from 2016–2021 to investigate racial disparities in MACCE outcomes, mortality, and healthcare resource utilization among hospitalized esophageal cancer patients. Methods: A retrospective cohort analysis was performed using the NIS database to identify adult esophageal cancer patients. Demographic and clinical characteristics, including race, socioeconomic status, and comorbidities, were compared across racial groups. Primary outcomes included in-hospital mortality, MI, sudden cardiac arrest, stroke, and arrhythmia. Healthcare utilization metrics, including length of stay (LOS) and total charges, were also analyzed. Multivariable logistic regression models adjusted for potential confounders were used to assess racial disparities in these outcomes. Results: Among 229,963 esophageal cancer patients, the racial distribution included White (80.5%), Black (10.0%), Hispanic (6.2%), Asian or Pacific Islander (2.4%), Native American (0.5%), and Other (2.2%). Black (OR 1.148, p = 0.014) and Asian or Pacific Islander (OR 1.228, p = 0.038) patients had significantly higher odds of mortality compared to White patients. Black patients had a lower risk of MI (OR 0.72, p = 0.008) but were significantly more likely to experience sudden cardiac arrest (OR 2.206, p &lt; 0.001). Hispanic (OR 1.398, p = 0.021) and Other racial groups (OR 1.688, p = 0.025) also had increased odds of sudden cardiac arrest. Atrial fibrillation was significantly less common in Black (OR 0.627, p &lt; 0.001), Hispanic (OR 0.52, p &lt; 0.001), and Asian or Pacific Islander (OR 0.476, p &lt; 0.001) patients. Length of stay was significantly longer for Black (8.25 days), Hispanic (7.34 days), and Other (7.71 days) racial groups compared to White patients (6.79 days, p &lt; 0.001). Hospital charges were highest among Hispanic ($107,531) and Asian or Pacific Islander ($109,164.6) patients compared to White patients ($84,753.53, p &lt; 0.001). Conclusions: This study identifies significant racial disparities in esophageal cancer outcomes, with Black and Asian patients experiencing higher mortality and Black patients demonstrating an increased risk of sudden cardiac arrest. Differences in length of stay and hospital charges underscore healthcare inequities. These findings emphasize the need for targeted interventions to reduce cardiovascular risks and improve equitable healthcare access and outcomes for racial and ethnic minority populations with esophageal cancer.

A Systematic Review of Length of Stay Linked to Hospital-Acquired Falls, Pressure Ulcers, Central Line-Associated Bloodstream Infections, and Surgical Site Infections.

A Systematic Review of Length of Stay Linked to Hospital-Acquired Falls, Pressure Ulcers, Central Line-Associated Bloodstream Infections, and Surgical Site Infections.

The paradoxical impact of depression on mortality, length of stay, and hospitalization charges in patients with prostate and bladder cancer: Using the 2021 NIS database.

e17148 Background: Depression is a prevalent comorbidity in patients with cancer, potentially influencing treatment outcomes. This study evaluates the association of depression with mortality, length of stay (LOS), and hospitalisation charges (TOTCHG) among patients with prostate cancer and bladder cancer. Methods: We conducted a retrospective analysis of the NIS 2021 database. Hospitalised patients with prostate cancer, bladder cancer and depression were identified using the appropriate ICD-10 codes. Survey-weighted descriptive statistics were utilized to analyze patient demographics, mortality rates, LOS, and TOTCHG. Multivariable logistic and linear regression models evaluated the impact of depression on outcomes, adjusting for age, sex, race, income quartiles, Charlson comorbidity index, hospital region, teaching status, and bed size. Results: In this study, 182,280 hospitalised prostate cancer patients and 40,855 hospitalised bladder cancer patients were analyzed. Among prostate cancer patients, 9.3% (16,785 patients) were depressed, with depressed individuals slightly younger (adjusted coefficient -0.42 years, p=0.036), predominantly White (76.2%, p&lt;0.001), privately insured (76.1%, p&lt;0.001), with higher comorbidity (85.9%, p&lt;0.001), &amp; in the Midwest region (25.9%, p&lt;0.001). Among bladder cancer patients, 11.4% (4,645 patients) were depressed, with depression more common in younger individuals (adjusted coefficient -1.07 years, p=0.004), women (31.4%, p&lt;0.001), White patients (86.9%, p&lt;0.001), those with higher comorbidity (85.8%, p&lt;0.001), Northeast (29.1%, p=0.019) and privately insured (63.2%). Depressed prostate cancer patients had lower mortality rates (3.75% vs. 4.67%, adjusted OR 0.76, p=0.004), shorter hospital stays (5.33 vs 6.13 days, adjusted - 0.72 days, p&lt;0.001), &amp; lower hospitalization charges ($73,977 vs. $85,966, adjusted reduction -$11,699, p&lt;0.001). Depressed bladder cancer patients had lower mortality rates (6.45% vs. 9.53%, adjusted OR 0.63, p=0.001), slightly shorter hospital stays (7.25 vs. 7.66 days, adjusted - 0.42 days, p=0.032), and reduced hospitalization charges ($92,321 vs. $104,156, adjusted reduction -$10,327, p=0.023). Conclusions: This study reveals that depression was more prevalent in younger, White, privately insured patients with higher comorbidities. Interestingly, depressed patients in both cohorts had lower mortality rates, shorter hospital stays, and reduced hospitalisation charges despite their higher comorbidity burdens, suggesting potential differences in healthcare utilisation, disease management, or psychosocial factors. These findings underscore the importance of recognising and addressing depression, as it may not only affect patient quality of life but also play a significant role in shaping clinical and economic outcomes.

Atrial fibrillation epidemiology and impact on clinical outcomes in non-Hodgkin lymphoma patients hospitalized with sepsis: Evidence from nationwide data.

e19048 Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is frequently complicated by sepsis. There is an association between AF and hematologic malignancies. Non-Hodgkin lymphoma (NHL) patients are prone to infections, and AF is common in this patient population. Despite this, limited data exist on the specific impact of AF on NHL patients hospitalized with sepsis. This study aims to explore how AF affects outcomes in this patient population, addressing a critical gap in knowledge. Methods: Patients diagnosed with NHL and hospitalized with sepsis between 2019 and 2021 were identified using ICD-10 codes from the National Inpatient Sample (NIS). Patients were stratified by the presence or absence of AF. Sociodemographic variables, comorbidities, and clinical outcomes were analyzed. The primary outcome was all-cause mortality, while secondary outcomes included complications, treatments, length of stay (LOS), and hospitalization costs. Multivariate regression models were utilized to assess associations, with statistical significance defined as p &lt; 0.05 and adjusted odds ratios (aORs) or adjusted incidence rate ratios (aIRRs) reported with 95% confidence intervals (CI). Results: Among 67,064 NHL patients hospitalized with sepsis, 16,774 (25.01%) had AF. Patients with AF were older (mean age 75.52 years vs. 66.93 years, p &lt; 0.001), predominantly male (63.8% vs. 36.2%, p &lt; 0.001), identified as White (72.49%, p &lt; 0.001), insured by Medicare (81.68%, p &lt; 0.001), located in the southern United States (34.07%, p = 0.0004), and had a Charlson Comorbidity Index (CCI&gt; 2: 86.53% vs. 74.72%, p &lt; 0.001). AF patients had higher odds of all-cause mortality (aOR 1.53, 95% CI 1.37–1.72) and complications, including ventricular tachyarrhythmia (aOR 1.91, 95% CI 1.36–2.67), acute heart failure (aOR 2.11, 95% CI 1.82–2.46), respiratory failure (aOR 1.41, 95% CI 1.30–1.54), septic shock (aOR 1.65, 95% CI 1.49–1.82), metabolic encephalopathy (aOR 1.19, 95% CI 1.07–1.33), disseminated intravascular coagulation (aOR 1.44, 95% CI 1.01–2.05), acute kidney injury (aOR 1.34, 95% CI 1.23–1.47), and acute hepatic failure (aOR 1.41, 95% CI 1.09–1.81). Invasive interventions, such as renal replacement therapy (aOR 1.56, 95% CI 1.26–1.93), mechanical ventilation (aOR 1.46, 95% CI 1.25–1.70), and vasopressors (aOR 1.54, 95% CI 1.23–1.88), were more frequently required. AF was associated with higher costs ($120,230 vs. $115,924, aIRR 1.21, 95% CI 1.14–1.28) and LOS (8.83 vs. 8.33 days, aIRR 1.16, 95% CI 1.11–1.21). No differences were observed in rates of venous thromboembolism, gastrointestinal hemorrhage, acute ischemic stroke or acute hemorrhagic stroke. Conclusions: AF markedly worsens outcomes in NHL patients hospitalized with sepsis, as evidenced by higher mortality, increased complications, and greater healthcare resource utilization. These findings underscore the critical need for tailored management strategies aimed at improving outcomes in this vulnerable patient population.