Longer Length Of Stay Research Articles

779 Utilization of Palliative Care in Patients Succumbing to Primary Burn Injury

Abstract Introduction Burn injury is associated with significant morbidity and mortality. Access to palliative care (PC) is variable, and many patients who die after burns do not receive specialized PC consultation. We conducted a retrospective nation-wide study of patients admitted with a primary diagnosis of burn injury who died prior to hospital discharge to identify factors associated with receiving palliative care. Methods Data from the HCUP National Inpatient Sample (2016-2019) were queried to identify inpatient deaths among adults ≥18 admitted with a primary ICD-10 burn diagnosis. Differences in demographic and clinical characteristics were assessed between patients who did and did not receive PC using chi-square tests and multivariable Poisson regression on data weighted to represent the national population. Baux scores were calculated by adding age and percentage of body burnt based upon ICD-10 code categorizations; a revised Baux score was calculated for inhalation injury. Results Of 98,845 patients admitted to inpatient care from 2016 to 2019 with a primary burn diagnosis, 3250 (3.3%) died prior to discharge. 1390 (42.8%) of patients who died had a PC encounter. Patients who did not receive PC were younger (mean 58.7 vs. 63.9, p=0.0002), had lower Baux scores (mean 104.6 vs. 112.4, p=0.002) and a longer length of stay (LOS) (mean 19.3 vs. 13.3, p=0.008). Controlling for age, sex, Baux score and LOS, White patients had a 35% greater likelihood of receiving PC than Black patients (incidence rate ratio, IRR 1.35, 0.95 CI (1.02,1.79)). All else held constant, patients aged 70-79 had the greatest likelihood (68%, IRR 1.68, 0.95 CI (1.31,2.15)) of receiving PC versus patients < 60 years old. Urban teaching hospitals had the highest percentage of burn patients (92.7% vs. 5.2% non-teaching vs. 2.1% rural) and the highest rate of providing PC (43% vs. 30% non-teaching vs. 20% rural, p=0.446) to patients that died. Insurance type (Medicare, Medicaid, Private, and other) did not correlate with receiving PC (p=0.054). The number of diagnoses, procedures and gender did not differ between deceased patients who did and did not receive PC. Conclusions More than half of burn patients who died prior to discharge did not receive a palliative care consultation. Unsurprisingly, older patients were more likely to receive PC. Patients who did not receive PC were more likely to have been younger, Black, have had lower Baux scores or to have been treated in non-urban non-teaching hospitals. The high Baux score of the younger patients (104.6) is associated with significant risk of death; this population might benefit from PC consultation. The discrepancy between White and Black patients in the delivery of PC services is striking. Further study is necessary to identify not only those burn patients most likely to benefit from PC but also the barriers to receiving palliative care in burn injury. Applicability of Research to Practice Demonstrates the inconsistency of palliative care use in the burn population

747 Burn Mortality Prediction Model and Communication Tool for Healthcare Providers

Abstract Introduction Communication is a key competency – the effective exchange of information is essential to a physician’s role. Currently, our centre does not have a communication tool to help guide point of care discussions between healthcare providers and during family meetings. Prognostic relationship of the BAUX score and ABSI index should be determined. An objective communication tool that shows predicted mortality, length of stay (LOS), and number of operations, specifically in our hospital using BAUX index and ABSI score will allow patients and healthcare providers to better understand prognosis, course in hospital, and develop appropriate expectations for outcomes in our centre. Methods In this cross-sectional study, all burn patients admitted to our Centre from 2012 to June 2022 were retrospectively recruited. Our burn registry was used to extract complete data of patient information including age, gender, %TBSA, burn depth, presence of inhalational injury, need for ventilator support, intensive care unit (ICU) admission days, hospital LOS, BAUX score, rBAUX score, and ABSI index. Patients were divided into three cohorts: all patients without an inhalation injury, a subgroup of smokers with and without an inhalation injury, and all patients with an inhalation injury. For each cohort, a mean LOS in hospital and/or ICU, number of burn operations, and mortality rate per incremental BAUX score and ABSI index was computed. Results A total of 839 patients were included, 725 without and 114 (13.6%) with an inhalation injury. A subgroup of patients (n=286) smokers with and without inhalational injury were separately analyzed. With severity of burn and presence of inhalational injury, both BAUX score and ABSI index show an incremental increase in LOS in hospital, number of operations, and increased mortality. Smokers with rBAUX ≥110 had the longest LOS in hospital, 78.4 hospital days and 35 ICU days. Interestingly, all patients with ABSI 6-7 had the longest LOS/%TBSA and those patients who additionally had an inhalational injury had the highest LOS/%TBSA (5.1 days/%TBSA). Increase in BAUX and ABSI did not correlate with increase in LOS/%TBSA. For BAUX ≥ 90 and ABSI ≥ 8, number of operations and mortality exponentially increased. Conclusions Patients with BAUX ≥ 90 and ABSI ≥ 8 should be counselled on a complex course in hospital. Higher BAUX and ABSI correlate with increased mean LOS and number of operations but not LOS/%TBSA. Using our Centre’s burn registry, we can predict course in hospital and provide this to patients, family, and healthcare providers before tertiary centre transfer and admission. Applicability of Research to Practice An objective communication model showing the burn centre’s mean LOS, LOS/%TBSA, number of operations, and risk of mortality, can help guide physician-patient and physician-healthcare provider communication. This tool will provide realistic burn recovery expectations at admission, family meetings, and when discussing consent.

Degenerative spinal conditions requiring emergency surgery: an evolving crisis in a publicly funded health care system.

Surgery for degenerative spine pathologies is typically performed on a scheduled basis; however, worsening symptoms may warrant emergency surgery. An increasing number of patients requiring emergency surgery has been observed (22.6% in 2006 to 34.8% in 2019). We sought to compare the outcomes of patients who received scheduled surgery and those who required emergency surgery. All patients treated between Jan. 1, 2006, and Dec. 31, 2019, were included. Retrospective comparisons were made between patients who were scheduled (elective) for surgery and those requiring emergency surgery, patients who were scheduled for surgery and those who decompensated while on the surgical waitlist and patients who presented as de novo emergencies and those who decompensated while on the surgical waitlist. Among the 6217 patients with degenerative pathologies, 4654 (74.9%) patients were scheduled (elective) for surgery and 1563 (25.1%) were patients requiring emergency surgery. Compared with patients who were scheduled, patients requiring emergency surgery had a longer length of stay (LOS) in hospital (5.1 d, interquartile range [IQR] 2.7-11.2 v. 3.6 d, IQR 1.3-6.4, p < 0.001) and lower rate of home discharge (78.6% v. 94.2%, p < 0.001). Patients requiring emergency surgery were 1.34 times more likely to have any adverse events (95% confidence interval [CI] 1.06-1.68, p = 0.01). When compared with patients who were scheduled for surgery, those who decompensated while on the surgical waitlist had longer LOS (7.0 d, IQR 3.3-15.0 v. 3.6 d, IQR 1.3-6.4, p < 0.001), less home discharge (77.6% v. 94.2%, p < 0.001) and were 2.5 times more likely to have any adverse events (95% CI 1.5-4.1, p < 0.001). Patients who decompensated had a 2.1 times higher risk of having any adverse events than patients who presented as de novo emergencies (95% CI 1.2-3.6, p < 0.001). We observed worse perioperative outcomes for patients requiring emergency surgery for degenerative spinal conditions than for patients who were scheduled for surgery. Patients who decompensated while on the surgical waitlist had the worst outcomes.

An 11-year retrospective study on the epidemiology of paediatric burns in the north of Iran.

Burn injuries in children are distressing physical and emotional events with long-term disability. However, there is little research on the epidemiology of paediatric burns. This information is essential for the development of prevention intervention and acute management. This study aimed to describe epidemiologic characteristics and clinical outcomes of paediatric burns in a burn center in the north of Iran. A retrospective, single-center study was conducted of children (<18 years) admitted to the burns center between 2011 and 2021. The data were analysed by SPSS 24.0 software. The chi-squared test and Fisher's exact test were used to assess categorical variables, and Student's t-tests or One-Way ANOVA was used to evaluate continuous variables. 2951 paediatric burns with mean age 5.30 ± 5.27 years, were admitted during the 11 years, with 1777 boys (60.2%) and 1174 girls (39.8%). By age groups, the majority of children (59.7%) were between 0 and 4 years old, followed by 5 to 8 years (15.7%), 13 to 18 years (14.6%), and 9 to 12 years (10.0%), respectively. The most cause of injury was Hot liquids & vapours (1604, 54.4%). The mean age for burns with fire & flames, hot liquids & vapours, contact, chemical, and electrical was 4.46 ± 4.84, 5.70 ± 5.39, 5.44 ± 5.42, 3.93 ± 3.86, and 3.53 ± 4.06 years, respectively. The total body surface area (TBSA) burned was 14.96 ± 11.94. The longest length of stay (LOS) related to fire and flame was 5.63 ± 7.57 days. The mortality rate was 1.56%. There were significant differences among aetiology groups for the cost per % TBSA (F = 15.784, P < 0.001), which correlated with the burn depth, TBSA, aetiology, LOS, and age. The Ministry of Health should establish strategies for burn prevention and incorporate data surveillance for burn injuries. Community education on kitchen and cooking safety could positively impact the prevalence and outcomes of paediatric burns.

The gut-brain connection: Inflammatory bowel disease increases risk of acute ischemic stroke.

Chronic inflammation of the gastrointestinal tract is a hallmark of inflammatory bowel disease (IBD). This increased inflammation is thought to induce a hypercoagulable state that increases the risk for stroke. However, few studies have examined the association between IBD and acute ischemic stroke (AIS). Thus, this study aims to investigate the incidence, treatments, complications, and outcomes of AIS in patients with IBD. ICD-9-CM and ICD-10-CM codes were used to query the National Inpatient Sample for AIS and IBD diagnosis. Baseline demographics, clinical characteristics, complications, treatments, and outcomes were assessed through descriptive statistics, multivariate regression, and propensity score matching (PSM) analysis. Acute stroke severity was assessed using the National Institute of Heath's Stroke Severity Score (SSS) as a template. 1,609,817 patients were diagnosed with AIS between 2010 through 2019. 7468 (0.46%) had concomitant diagnoses of IBD. AIS patients with IBS were younger, more likely to be white and female, but less likely to be obese. Although IBD patients had comparable stroke severities (p = 0.64) to their non-IBS counterparts, they received stroke intervention at statistically different rates than their non-IBD counterparts. Additionally, IBD patients had higher rates of in-hospital complications (p < 0.01) and longer lengths of stay (LOS) (p < 0.01). IBD patients develop AIS at a younger age with similar rates of stroke severity to their non-IBD counterparts, but receive higher rates of tissue plasminogen activator administration and decreased rates of mechanical thrombectomy. Our research shows that patients with IBD are at risk for AIS at an earlier age and are more likely to have complications. This underlies a connection between IBD and a hypercoagulable state that could predispose patients to AIS.

COVID-Induced Alterations in Surgical Care and Outcomes in Perforated Diverticulitis.

COVID-19 caused healthcare systems to significantly alter processes of care. Literature on the pandemic's effect on healthcare processes and resulting surgical outcomes is lacking. This study aims to determine outcomes of open colectomy in patients with perforated diverticulitis during the pandemic. Using CDC data, the highest and lowest COVID mortality rates were calculated and used to establish 9-month COVID-heavy (CH) and COVID-light (CL) timeframes, respectively. Nine-months of 2019 were assigned as pre-COVID (PC) control. Florida AHCA database was utilized for patient-level data. Primary outcomes were length of stay (LOS), morbidity, and in-hospital mortality. Stepwise regression with 10-fold cross-validation determined factors most impacting outcomes. A parallel analysis excluding COVID-positive patients was performed to differentiate COVID-infection from processes of care. There were 3862 patients in total. COVID-positive patients had longer LOS, more intensive care unit admissions, and higher morbidity and mortality. After excluding 105 COVID-positive patients, individual outcomes were not different per timeframe. Regression showed timeframe did not affect primary outcomes. Outcomes following colectomy for perforated diverticulitis were worse for COVID-positive patients. Despite increased stress on the healthcare system during the pandemic, major outcomes were unchanged for COVID-negative patients. Our results indicate that despite COVID-associated changes in processes of care, acute care surgery can still be performed in COVID-negative patients without increased mortality and minimal change in morbidity.

Abstract 283: Outcomes Among Heart Failure Patients Hospitalized For Aortic Dissection: Insight From The National Inpatient Sample

Background: Aortic dissection is a significant cause of morbidity and mortality among hospitalized patients. Previous studies suggested that heart failure (HF) is a significant complication of aortic dissection which oftentimes lead to poor outcomes due to delays in diagnosis and overall increase disease burden. However, there is paucity of data regarding the outcomes of hospitalized aortic dissection patients with comorbid HF. Methods: We utilized the National Inpatient Sample (NIS) Database of the years 2018-2020 in conducting a retrospective cohort study. All analyses were done through StataBE 17.0. Our outcomes of interests were risk for in-hospital mortality, acute kidney injury (AKI) and hospital length of stay (LOS) among hospitalized aortic dissection patients with comorbid HF. Results: A total of 149,026 hospitalized aortic dissection patients were identified in our study, of which 10.27% (n= 15,305/149,026) had HF. Among those, 6390 met our inclusion criteria. The overall in-hospital mortality among aortic dissection patients was 4.14% (n=6,170/149,026). Among those with concomitant HF, the mortality rate was significantly higher at 6.37%(n=407/6390) (p=0.00). After adjusting for possible patient and hospital level confounders, concomitant HF among aortic dissection patients was deemed to be an independent predictor of overall in-hospital mortality (aOR 2.21; 95% CI, 1.46-3.36; p=0.00) and it was found that systolic (aOR 2.47; 95% CI, 1.42-4.29; p=0.00) and diastolic HF (aOR 2.11; 95% CI, 1.08-4.13; p=0.03) were associated with higher in-hospital mortality compared to those with combined HF (aOR 1.48; 95% CI, 0.44-4.95; p=0.52). Further, concomitant HF increased the risk for the development of in-hospital AKI (aOR 3.16; 95% CI, 2.35-4.24; p=0.00) and longer LOS (aOR 4.16; 95% CI, 2.92-5.40; p=0.00), regardless of HF subtype. Conclusion: Our analysis showed that comorbid HF increased the risk for in-hospital mortality, risk for AKI and longer hospital LOS. On subgroup analysis, systolic and diastolic HF were associated with increased risk for in-hospital mortality and all three HF subtypes increased the risk for AKI and were associated with a longer hospital LOS.

The Combined Effect of Delirium and Falls on Length of Stay and Discharge.

Delirium or a fall are associated with many negative outcomes including increased length of stay (LOS) and discharge to a facility; however, this relationship is incompletely understood. A cross-sectional study of all hospitalizations in a large, tertiary care hospital evaluated the effect of delirium and a fall on the outcomes of LOS and risk of being discharged to a facility. The study included 29,655 hospital admissions. A total of 3,707 (12.5%) patients screened positive for delirium and 286 (0.96%) had a reported fall. After adjustment for covariates, relative to patients without delirium or a fall, patients with delirium only had a 1.64-fold longer LOS; patients with fall only had a 1.96-fold longer LOS; and patients who had delirium and fall had a 2.84-fold longer LOS. The adjusted odds of discharge to a facility, relative to those without delirium or a fall, was 8.98 times higher in those with delirium and a fall. Delirium and falls influence LOS and likelihood of being discharged to a facility. The joint impact of falls and delirium on LOS and facility discharge was more than additive. Hospitals should consider the integrated management of delirium and falls.

Factors Associated With Hip Fracture Length of Stay Among Older Adults in a Community Hospital Setting

Hip fractures in geriatric populations constitute a heavy burden on the healthcare system. The study goal was to identify patient, hospital, and surgical factors associated with hospital length of stay (LOS) for geriatric patients with hip fractures requiring surgical intervention in a community hospital setting. This was a cross-sectional retrospective chart review of geriatric hip fractures that underwent surgical fixation at a community hospital between 2017 and 2019. The scope of the surgeries was limited to cephalomedullary device fixation or hemiarthroplasty hip fracture surgeries. Sliding hip screw or total hip arthroplasty procedures and patients who died during the index hospitalization were excluded. Median tests were conducted to examine differences between the groups. Unadjusted and adjusted truncated negative binomial regression models were used to examine the factors associated with LOS. Bivariate analyses revealed results that the factors associated with a longer LOS were preoperative anemia (P = 0.029), blood transfusion (P = 0.022), and the number of days between admission and surgery (P = 0.001). The adjusted regression model results suggested that older patients, patients who underwent surgery more than one day after admission, current smokers, malnourished patients, patients with sepsis, and patients with a history of a thromboembolic event had statistically significant (P < 0.05) longer LOS. However, patients who live in institutions (nursing homes or assisted living) had a shorter LOS than those who live at home alone or with family (P < 0.05). Older adult patients who underwent surgery with a cephalomedullary device or hip hemiarthroplasty for a hip fracture and had preoperative anemia, postoperative blood transfusions, and increased days between admission and surgery had a longer LOS. Additional factors positively associated with a longer LOS included current smokers, malnourishment, admission with sepsis, and patients with a history of a thromboembolic event. Of interest, institutionalized patients had a shorter LOS than those living at home alone or with family.

A-14 | Outcomes Among Patients With Systolic Heart Failure Hospitalized for ST-Elevation Myocardial Infarction (STEMI) Undergoing Coronary Artery Bypass Grafting (CABG): A Nationwide Population-Based Study

Previous studies suggested that coronary artery bypass grafting (CABG) among ST-elevation myocardial infarction (STEMI) patients with systolic heart failure (HF) resulted in low mortality rates. However, there is paucity of data regarding the impact of systolic HF among STEMI patients undergoing CABG (STEMI-CABG) in terms of in-hospital outcomes and use of mechanical circulatory support (MCS). We queried the National Inpatient Sample (NIS) to identify patients with STEMI who underwent CABG using appropriate ICD-10 codes between 2018-2020. We aim to investigate the impact of systolic HF among STEMI-CABG patients based on in-hospital mortality, length of stay (LOS), risk for cardiogenic shock (CS) and MCS utilization. A multivariable logistic regression analysis was used to calculate adjusted odds ratios (ORs) for the outcomes of interest. A total of 486,075 patients hospitalized for STEMI were identified, of which 4.94% (24,015/486,075) underwent CABG. Among STEMI-CABG patients, 23.15% (5,560/24,015) had systolic HF. The overall in-hospital mortality rate among hospitalized STEMI-CABG patients was 6.48% (1555/24,015). Among those with systolic HF, the in-hospital mortality rate was significantly higher at 8.18% (454/5560, p=0.01). After adjusting for possible confounders, concomitant systolic HF among hospitalized STEMI-CABG patients was not an independent predictor of overall in-hospital mortality (aOR 0.69; 95% CI, 0.40-1.21; p=0.20) and MCS utilization including percutaneous left ventricular assist device (aOR 1.51; 95% CI, 0.87-2.62; p=0.15), extracorporeal membrane oxygenation (aOR 1.12; 95% CI, 0.48-2.64; p=0.79), and intraaortic balloon pump (aOR 1.33; 95% CI, 0.98-1.76; p=0.06). However, systolic HF among hospitalized STEMI-CABG patients was found to be an independent predictor for the development of CS (aOR 1.68; 95% CI, 1.26-2.23; p=0.00) and longer LOS (aOR 1.86; 95% CI, 1.54-3.18; p=0.01). Our analysis showed that systolic HF among STEMI-CABG patients was not an independent predictor of increased in-hospital mortality and MCS utilization. However, it increased the risk for CS and longer LOS.

Characteristics and Outcomes of Black and White Patients Hospitalized With Nonalcoholic Steatohepatitis: A Nationwide Analysis.

Nonalcoholic steatohepatitis (NASH) is an increasingly common etiology for liver-related hospitalizations in the United States. The aim of this study was to examine the differences of disease characteristics and outcomes between hospitalized Black and White patients with NASH. We used the National Inpatient Sample (NIS) to identify all adult hospitalizations with NASH (ICD-10 code: K75.81) from 2016 to 2018. We compared demographic and clinical characteristics between Black and White patients. Multivariable models were computed to compare all-cause mortality, length of stay (LOS), and total hospital costs between the groups. There were 43,409 hospitalizations with NASH (41,143 White, 2266 Black). Black patients were less likely to have cirrhosis (33.6%) compared with Whites (56.4%), P <0.0001. Black patients were less likely to have esophageal variceal bleeding (1.2% vs. 3.5%), ascites (17.1% vs. 28.8%), and acute liver failure (16.2% vs. 28.9%) compared with Whites (all P <0.0001). These findings were consistent among patients with cirrhosis. Mortality was higher among Blacks compared with Whites (3.9% vs. 3.7%, adjusted odds ratio=1.34; 95% confidence interval: 1.05-1.71, P =0.018). Compared with Whites, Blacks had a longer LOS (6.3 vs. 5.6, P <0.001), and higher hospital costs ($18,602 vs. $17,467; P =0.03). In this large population of inpatients with NASH, Black patients were less likely to have cirrhosis and liver disease-related complications, but had overall worse hospital mortality, longer LOS, and higher hospital costs. Further research is warranted to elaborate on factors that generate the health inequities in NASH outcomes between Black and White patients.

PO-04-156 INSIGHTS REGARDING OUTCOMES FOR COVID-19 HOSPITALIZATIONS WITH ADULT CONGENITAL HEART DISEASE (ACHD)

As of December 2022, SARS-CoV-2 coronavirus resulted in over 6 million deaths worldwide.[1] It was realized early into the pandemic, that COVID-19 significantly impacts the Cardiovascular system. [2] Patients with pre-existing cardiovascular comorbidities were particularly at higher risk of adverse outcomes during their hospitalizations. [3] Similarly, it can be safe to assume patients with adult congenital heart disease (ACHD) should considered a high-risk population for the development of severe COVID infection with increased rates of significant cardiovascular complications. Based on this reasoning and the paucity of data available on this topic using a large database, we sought to investigate the outcomes of patients with ACHD who were admitted to the hospital with COVID-19. The National Inpatient Sample database for 2020 was queried to identify adult hospitalizations with a primary diagnosis of COVID-19 and a secondary diagnosis of ACHD using International Classification of Diseases – 10 Clinical Modification (ICD-10-CM) codes. The primary outcome studied was inpatient mortality, while secondary outcomes included inpatient complications, mean length of stay (LOS), and total hospital charge (THC). Multivariate logistic and linear regression analyses were used to adjust for possible confounders and analyze the variables. Out of 1,050,045 COVID-19 hospitalizations registered, 2,425 (0.23%) had ACHD as a secondary diagnosis. Encounters with ACHD who were hospitalized with COVID-19 had significantly higher adjusted odds of inpatient mortality (Adjusted Odds Ratio [aOR]: 1.4, [95% CI: 1.05-1.88], p=0.022), Longer LOS (Mean 2.4 days, [95% CI: 1.35-3.40], p <0.001), and higher Total Hospital Charges (Mean $53,000, [95% CI: 20811-85190], p <0.001). A Forrest plot (Figure 1) demonstrates a graphical representation of the multivariate analysis of the significant in-hospital complications when adjusted for patient demographics, comorbidities, and hospital characteristics. Among COVID-19 hospitalizations, those with a history of congenital heart diseases had significantly worse outcomes in terms of in-hospital mortality, sepsis; the need for endotracheal intubation, mechanical ventilation, and vasopressors; developing acute kidney injury and pulmonary embolism, in addition to the longer length of stay, and higher total hospital charges.

Characteristics of Patients With Lennox-Gastaut Syndrome and Predictors for a Longer Stay Following Hospitalization (P3-1.011)

<h3>Objective:</h3> To investigate characteristics of Lennox-Gastaut syndrome (LGS) patients and factors that influence the length of stay (LOS). <h3>Background:</h3> LGS is a rare form of severe epileptic encephalopathy, and there is a paucity of data on these patients. <h3>Design/Methods:</h3> The 2019 National Inpatient Sample(NIS) from HCUP, AHRQ, and partners was used first to find cases of LGS with a principal diagnosis. Various patient characteristics were also studied. The mean LOS was explored, and variables that could lead to a longer than mean LOS were also probed via regression models. <h3>Results:</h3> We found 3210 patients with a principal diagnosis of LGS. The mean LOS was 4.17 days. Patients with LGS were predominantly males (54.4%), Whites (51.4%), and dependent on Medicaid (52.5%). Only 1.6% had diabetes, 4.7% had hypertension, 2.8% reported a diagnosis of depression, and 4.0% were obese. 15.9% of cases were admitted on the weekend. The overall mean age of all patients with LGS was 17.12 years. After adjusting for several factors, several variables were observed that could predispose to a longer hospital stay (LOS≥5 days), such as ages ≥60 years (aOR 2.339, p=0.014) and 20–39 years (aOR1.368, p=0.004) (compared to patients of ages 0–19 years), diabetes (aOR 2.012, p=0.026), and hypertension (aOR 2.264, p&lt;0.01), while LGS patients covered by private insurances (aOR 0.614, p=0.007) showed a lower risk relative to Medicare beneficiaries. No statistically significant risks were seen for sex, race, depression, obesity, and admission on the weekend. Finally, patients with a longer LOS were older (mean age of 20.10 years) compared to those with LOS &lt;5 (mean age of 16.09 years). <h3>Conclusions:</h3> Our study provides an up-to-date perspective on various patient characteristics with LGS and factors that can cause a longer hospitalization, including different age groups, diabetes, and hypertension. Further studies addressing these differences can help optimize the care of these patients. <b>Disclosure:</b> Dr. Sombans has nothing to disclose. Dr. Sanikommu has nothing to disclose. Dr. Ramphul has nothing to disclose. Dr. Verma has nothing to disclose. Dr. Ramphul has nothing to disclose. Dr. Kumar has nothing to disclose. Dr. Meena has nothing to disclose. Dr. Kumari has nothing to disclose. Dr. Gonzalez Mejias has nothing to disclose. Dr. Jairam Das Lohana has nothing to disclose. Dr. Arti has nothing to disclose.

Incremental costs of hospital-acquired infections in COVID-19 patients in an adult intensive care unit of a tertiary hospital from a low-resource setting

BackgroundHospital-acquired infections (HAIs) are a global public health problem and put patients at risk of complications, including death. HAIs increase treatment costs, but their financial impact on Serbia’s healthcare system is unknown. Our goal was to assess incremental costs of HAIs in a tertiary care adult intensive care unit (ICU) that managed COVID-19 patients.MethodsA retrospective study from March 6th to December 31st, 2020 included patients with microbiologically confirmed COVID-19 (positive rapid antigen test or real-time polymerase chain reaction) treated in the ICU of the Teaching Hospital for Infectious and Tropical Diseases, University Clinical Centre of Serbia. Demographic and HAI-specific data acquired in our ICU were collected, including total and stratified medical costs (services, materials, laboratory testing, medicines, occupancy costs). Median total and stratified costs were compared in relation to HAI acquisition. Linear regression modelling was used to assess incremental costs of HAIs, adjusted for age, biological sex, prior hospitalisation, Charlson Comorbidity Index (CCI), and Glasgow Coma Scale (GCS) on admission. Outcome variables were length of stay (LOS) in days and mortality.ResultsDuring the study period, 299 patients were treated for COVID-19, of which 214 were included. HAIs were diagnosed in 56 (26.2%) patients. Acinetobacter spp. was the main pathogen in respiratory (38, 45.8%) and bloodstream infections (35, 42.2%), the two main HAI types. Median total costs were significantly greater in patients with HAIs (€1650.4 vs. €4203.2, p < 0.001). Longer LOS (10.0 vs. 18.5 days, p < 0.001) and higher ICU mortality (51.3% vs. 89.3%, p < 0.001) were seen if HAIs were acquired. Patients with ≥ 2 HAIs had the highest median total costs compared to those without HAIs or with a single HAI (€1650.4 vs. €3343.4 vs. €7336.9, p < 0.001). Incremental costs in patients with 1 and ≥ 2 HAIs were €1837.8 (95% CI 1257.8–2417.7, p < 0.001) and €5142.5 (95% CI 4262.3–6022.7, p < 0.001), respectively.ConclusionsThis is the first economic evaluation of HAIs in Serbia, showing significant additional costs to our healthcare system. HAIs prolong LOS and influence ICU mortality rates. Larger economic assessments are needed to enhance infection control practices.

Determinants of clinical outcome and length of stay in acute care forensic psychiatry units

Criminological and sociodemographic variables, such as previous criminal convictions, increased risk of violence, early onset of mental disorder, antisocial personality, psychosis and low social support, have all been related to longer length of stay (LoS) and poorer outcome in long stay forensic services. The factors impacting on LoS and clinical response in acute care specialized units are poorly documented. To address this issue, we examined the psychiatric records of all cases admitted between January 1st and December 31th 2020 in the sole acute ward for detained persons located in the central prison of the Geneva County, Switzerland. Information on judicial status included pre-trial versus sentence execution, previous incarcerations, and age of the first incarceration. Sociodemographic data included age, gender, marital status, and education attainment. Previous inpatient stays prior to incarceration were recorded. All of the ICD-10 clinical diagnoses were made by two independent, board-certified psychiatrists blind to the scope of the study. The standardized assessment was based on the HoNOS (Health of Nation Outcome Scales) at admission and discharge, HONOS-secure at admission, HCR-20 (Historical Clinical Risk 20) version 2, PCL-R (Psychopathy Checklist Revised), and SAPROF (Structured Assessment of Protective Factors). Stepwise forward multiple linear regression models predicting the LoS and delta HONOS respectively were built with the above mentioned parameters. The selected variables were then used in univariate and multivariable regression models. Higher HCR-scores (mainly on clinical items), and longer LoS were related to higher delta HONOS scores. In contrast, cases in pre-trial detention showed a worst clinical outcome. In multivariable models, all three variables remained independent predictors of the clinical outcome and explained 30.7% of its variance. Only education and diagnosis of borderline personality were related to the LoS and explained 12.6% of its variance in multivariable models. Our results suggest that the use of acute wards specialized in forensic psychiatry are mainly useful for patients with prior inpatient care experience, and higher violence risk during sentence execution. In contrast, they seem to be less performant for persons in pre-trial detention that could benefit from less restrictive clinical settings.

Risk factors for massive transfusion in obstetrical hemorrhage and consideration of a whole blood program.

Postpartum hemorrhage (PPH) is one of the leading causes of obstetric complications. The goal of this study was to identify risk factors for obstetric (OB) massive transfusion (MT) and determine the feasibility of developing a low-titer group O RhD-positive whole blood (LTO + WB) protocol for OB hemorrhage. A retrospective study of OB patients who received transfusion within 24 h. MT patients were those who received >3 U of pRBC within 1 h or > 10 U in 24 h. Patient demographics, OB history, comorbidities, blood type, antibody status, and known risk factors for PPH and maternal-fetal outcomes were compared. Logistic regression was used for univariate and multivariate analyses. Of the 610 transfused OB patients, 12.0% (n = 73) required MT. Groups were well matched for body mass index (BMI), maternal comorbidities, and history of spontaneous vaginal deliveries. The incidence of the previous cesarean section was higher in the MT group. Exactly 93.9% of patients were RhD-positive and 3.77% of all patients possessed an antibody on pretransfusion testing. Patients with MT had a longer length of stay (LOS), higher rate of intensive care unit (ICU) admission, fetal death, and hysterectomy. Multivariate analysis found age >35, PPH, placenta percreta, accreta, and increta to be significant (p < .05) risk factors for MT. Patients over 35 years and those with abnormal placentation are at increased risk of requiring MT. With a time to delivery of 2 days, potential MT patients can be identified early, and with a 94% rate of RhD-positive+, they are eligible to receive low-titer O whole blood (LTOWB) providing hemostatic resuscitation with reduced donor exposure.

Fibrinogen is an independent preoperative predictor of hospital length of stay among patients undergoing coronary artery bypass grafting

ObjectiveThis study aims to examine the impact of preoperative fibrinogen concentration on the short-term outcomes and hospital length of stay (LOS) of patients undergoing Coronary Artery Bypass Grafting (CABG).MethodsBetween January 2010 and June 2022, a retrospective analysis comprised 633 patients who sequentially received isolated, primary CABG. These patients were categorized into normal fibrinogen group (fibrinogen < 3.5 g/L) and high fibrinogen group (fibrinogen ≥ 3.5 g/L) according to preoperative fibrinogen concentration. The primary outcome was LOS. To correct for confounding and investigate the effect of preoperative fibrinogen concentration on the short-term outcomes and LOS, we employed propensity score matching (PSM). The correlation between fibriongen concentration and LOS in subgroups was examined using subgroup analysis.ResultsWe categorized 344 and 289 patients in the “normal fibrinogen group” and “high fibrinogen group”, respectively. After PSM, compared to the normal fibrinogen group, the high fibrinogen group had a longer LOS [12.00 (9.00–15.00) vs. 13.00 (10.00–16.00), P = 0.028] and higher incidence of postoperative renal impairment [49 (22.1%) vs. 72 (32.4%), P = 0.014]. Cardiopulmonary bypass (CPB) or non-CPB CABG patients showed similar correlations between various fibrinogen concentrations and LOS, according to subgroup analyses.ConclusionsFibrinogen is an independent preoperative predictor of both the LOS and the postoperative renal impairment that occurs after CABG. Patients with high preoperative fibrinogen concentration had a higher incidence of postoperative renal impairment and a longer LOS, emphasizing the significance of preoperative fibrinogen management.

The cost of a plastic surgery team assisting with cranioplasty

ObjectivesCranioplasty is a commonly performed neurosurgical procedure that restores cranial anatomy. While plastic surgeons are commonly involved with cranioplasties, the cost of performing a cranioplasty with neurosurgery alone (N) vs. neurosurgery and plastic surgery (N + P) is unknown. MethodsA single-center, multi-surgeon, retrospective cohort study was undertaken on all cranioplasties performed from 2012 to 22. The primary exposure variable of interest was operating team, comparing N vs. N + P. Cost data was inflation-adjusted to January 2022 using Healthcare Producer Price Index as calculated by the US Bureau of Labor Statistics. Results186 patients (105 N vs. 81 N + P) underwent cranioplasties. The N + P group has a significantly longer length-of-stay (LOS) 4.5 ± 1.6days, vs. 6.0 ± 1.3days (p < 0.001), but no significant difference in reoperation, readmission, sepsis, or wound breakdown. N was significantly less expensive than N + P during both the initial cranioplasty cost ($36,739 ± $4592 vs. $41,129 ± $4374, p 0.014) and total cranioplasty costs including reoperations ($38,849 ± $5017 vs. $53,134 ± $6912, p < 0.001). Univariable analysis (threshold p = 0.20) was performed to justify inclusion into a multivariable regression model. Multivariable analysis for initial cranioplasty cost showed that sepsis (p = 0.024) and LOS (p = 0.003) were the dominant cost contributors compared to surgeon type (p = 0.200). However, surgeon type (N vs. N + P) was the only significant factor (p = 0.011) for total cost including revisions. ConclusionsHigher costs to N + P involvement without obvious change in outcomes were found in patients undergoing cranioplasty. Although other factors are more significant for the initial cranioplasty cost (sepsis, LOS), surgeon type proved the independent dominant factor for total cranioplasty costs, including revisions.

198 Endoscope-Assisted Suturectomy for Metopic Synostosis: 15-year Experience at Boston Children’s Hospital

INTRODUCTION: Metopic synostosis is a subtype of craniosynostosis characterized by trigonocephaly. Endoscope-assisted suturectomy has shown its relevance as an alternative option with a lower rate of transfusion, short hospital length of stay (LOS) while maintaining comparable cosmetic outcome when compared with open repair. However, no previous reports have shown the long-term results of this procedure and factors associated with outcome. METHODS: 133 pediatric patients with metopic synostosis treated with endoscope-assisted suturectomy between 2006 and 2021were retrospectively reviewed. Peri- and post-operative variables were extensively collected. LOS and the length of helmet therapy were defined as primary outcome. Logistic regression or median regression analysis was conducted for multivariable analysis to identify factors associated with longer LOS and length of helmet therapy. P&lt;0.05 was defined as statistically significant. RESULTS: Median age was 93-days, median weight was 5.8 kg and median cranial index 0.82. Eighty-two percent of patients were male. Median surgical time was 48 minutes and estimated blood loss was 40 mL. 10 patients (7.5%) received intra- or post-op transfusion. Median pre-op Hb level was 10.1 g/dL with immediate postop level of 7.4 g/dL. Median hospital LOS was 1 day. The median length of helmet therapy was 6 months. Only one patient required minor correctional surgery for recurrence in long-term. In multivariable analysis, larger number of the pain medications administered within 24 hours after the operation (OR 1.79; P&lt;0.001) and lower weight (OR 2.33 per kg lower; P=0.024) were significantly associated with longer LOS. Larger pre-op cranial index (OR 11.8; P=0.022) was significantly associated with longer length of helmet therapy. CONCLUSIONS: Our comprehensive study demonstrates that endoscope-assisted suturectomy is a safe and effective treatment for metopic synostosis and novel predictive factors associated with outcomes.

Assessment of Risk Factors Correlated with Outcomes of Traumatic Lower Extremity Soft Tissue Reconstruction.

The National Trauma Data Bank (2015-2018) was queried for lower extremity reconstructions. Univariable and multivariable analyses determined associations with inpatient outcomes. There were 4675 patients with lower extremity reconstructions: local flaps (77%), free flaps (19.2%), or both (3.8%). Flaps were most commonly local fasciocutaneous (55.1%). Major injuries in reconstructed extremities were fractures (56.2%), vascular injuries (11.8%), and mangled limbs (2.9%). Ipsilateral procedures prereconstruction included vascular interventions (6%), amputations (5.6%), and fasciotomies (4.3%). Postoperative surgical site infection and amputation occurred in 2% and 2.6%, respectively. Among survivors (99%), mean total length of stay (LOS) was 23.2 ± 21.1 days and 46.8% were discharged to rehab. On multivariable analysis, vascular interventions prereconstruction were associated with increased infection [odds ratio (OR) 1.99, 95% confidence interval (CI) 1.05-3.79, P = 0.04], amputation (OR 4.38, 95% CI 2.56-7.47, P < 0.001), prolonged LOS (OR 1.59, 95% CI 1.14-2.22, P = 0.01), and discharge to rehab (OR 1.49, 95% CI 1.07-2.07, P = 0.02). Free flaps were associated with prolonged LOS (OR 2.08, 95% CI 1.74-2.49, P < 0.001). Prereconstruction vascular interventions were associated with higher incidences of adverse outcomes. Free flaps correlated with longer LOS, but otherwise similar outcomes. Investigating reasons for increased complication and healthcare utilization likelihood among these subgroups is warranted.