Longer Average Length Of Stay Research Articles

Late-week Multilevel Anterior Cervical Discectomy and Fusion Associated With Increased Length of Stay.

Retrospective analysis of clinical data from a single institution. To assess the day of surgery during the week as a possible predictor of length of stay (LOS) following anterior cervical discectomy and fusion (ACDF). Surgeries later in the week may result in longer LOS and higher costs for joint arthroplasty, yet this is unclear following spine surgery. Procedures performed later in the week may lead to weekend admissions when there are limited services that may contribute to an extended LOS. We attempt to identify associations between day of surgery and LOS, readmission, and complications following single- and multilevel ACDF. Patients at a single institution undergoing ACDF by 7 primary surgeons in both orthopedic and neurosurgery spine departments between 2015 and 2019 were retrospectively reviewed. Patients were stratified by surgery day at either the beginning (Monday/Tuesday) or end (Thursday/Friday) of the week and by single- or multilevel ACDF. Surgery for trauma, infections, adjacent level disease, or revision were excluded. Patient demographics, Charlson Comorbidity Index (CCI), LOS, postoperative complications, and readmission rates were assessed. Six hundred fifty-two patients underwent ACDF. For single-level ACDF, 222 were reviewed, with 112 having surgery at the beginning and 110 at the end of the week. For multilevel ACDF, 431 were reviewed, with 192 having surgery at the beginning and 239 at the end of the week. No differences in pre- or postoperative variables were determined for single-level ACDF. Despite no differences in pre-operative variables, CCI, operative duration, or number of levels, late-week multilevel ACDF had longer average LOS (2.8±3.0 days) compared to early-week surgery (2.0±2.0 days) ( P =0.018). Late-week multilevel ACDF was associated with an increased LOS, as it may prove beneficial to surgical planning. This conflicts with previous reports that day of week was not associated with LOS following ACDF. III.

769 Racial, Ethnic, and Socioeconomic Disparities in Burn Care Access

Abstract Introduction While racial, ethnic, and socioeconomic disparities in burn care have been identified, there is a paucity of research into specific means by which these disparities manifest. Here, we consider time to initial burn surgery consult. Methods Through a retrospective review of electronic health records, we reviewed all patients evaluated by the burn surgery service at a single regional burn center from Jun 2020 to Apr 2022. We excluded patients without data for time of onset of burn injury. We analyzed differences in time to burn consult, rate of surgical management, and average length of stay (LOS), stratifying by patient race (Caucasian, Black, Asian, Native American, Other), ethnicity (Latino, non-Latino, Other), and insurance payor (Medicaid, Private, Medicare, Other, None). Time to burn consult was defined as time from onset of burn injury to time of burn consult. Results 365 patients met the inclusion criteria. Average age was 33.3 years; 65.8% were male. Average (standard deviation) time to burn consult was 17h7m (1d23h21m). No significant differences in time to burn consult existed when the study group was stratified by race, ethnicity, or insurance payor. Rate of surgical management (Chi-squared p=0.05) and LOS (ANOVA p< 0.0001) differed by insurance payor, but not race or ethnicity. Medicare patients had higher rates of surgical intervention and longer average LOS; patients with no insurance had lower rates of surgical intervention and shorter average LOS. Conclusions Our results indicate that time to burn consult is unlikely to contribute meaningfully to racial, ethnic, and socioeconomic disparities in burn care. Further studies are needed to better understand other aspects of care that may contribute to these disparities. Applicability of Research to Practice Time to burn consult is unlikely to contribute to disparities in burn care. Burn care providers should be mindful of other ways that disparities may manifest.

A Retrospective Study on the Factors Affecting Patients Length of Stay at the Burn Center RSUD Dr. Soetomo Surabaya During 2017-2019

Background: Length of stay (LOS) is one of contributor in hospital costs, and attention has been paid to reducing LOS without compromising the quality of care for patients. Hospitals with a burn center have a longer average LOS than hospitals without a burn center, which can result in higher hospitalization costs. This study aims to identify the epidemological and clinical factors that affect LOS in burn patients. Methods: We conducted a retrospective cross-sectional study in design included all patients admitted to the Burn Center Soetomo General Hospital Surabaya between January 2017 - December 2019 who arrived within 48 hours after injury and survived till discharge. Patients who arrived after 48 hours following the injury, death during treatment and discharge against medical advice are excluded. Epidemiological and clinical data, such as age, gender, pre-existing co-morbidities, total body surface area (TBSA) burn wound, depth of burn, inhalation trauma, burn etiology, hospital acquired pneumonia (HAP), sepsis, anemia and hypoalbuminemia collected and subjected to statistical analysis. Results: Of all 249 patients admitted, 136 patients are eligible in the inclusion criteria. Median LOS in the total population was 17 days. The population most often treated for more than 28 days is a patient with a burn area of 30.5-40%, experiencing HAP and hypoalbuminemia. LOS significantly increased with TBSA, inhalation trauma, comorbidities, HAP, sepsis, anemia and hypoalbuminemia. Conclusion: There are several factors associated with the increased LOS observed in burn patients. This study confirmed and identified new factors that were significantly associated with LOS and were not previously discussed in the literature which allows better prediction of LOS and management of patients with burn injuries.

Prevalence and patterns of hospital use for people with frequent alcohol-related hospital admissions, compared to non-alcohol and non-frequent admissions: a cohort study using routine administrative hospital data.

This study compared prevalence and hospital use among individuals frequently admitted to hospital in England with wholly attributable alcohol-related diagnoses (WAAD), known as alcohol-related frequent attenders (ARFAs), with those of non-alcohol frequent attenders (NAFAs), non-frequent alcohol attenders (ARNFAs) and non-alcohol non-frequent attenders (NANFAs). Cross-sectional and longitudinal analyses of 5years of England's Hospital Episode Statistics (HES). Hospital inpatients in England, UK, 2011-16. Two cohorts (2011/12=489 580/7 654 944 patients and 2015/16=490 384/7 660 108 patients) were selected from all adult patients aged ≥18years, treated in English hospitals between 1 April 2011 and 31 March 2016. Patients were categorized as having alcohol-related admissions if diagnoses included a WAAD (ICD-10 classification, WHO, 2016) and frequent admissions if they had more than three hospital admissions during a single HES year. Prevalence of ARFA, number of admissions (spells), occupied bed-days (OBDs), average length of stay (ALOS) and total admission costs over 5years were compared among ARFAs, ARNFAs, NAFAs and NANFAs. On average, 0.7% of people admitted to hospital per annum in England 2011-15 were ARFAs and more than a quarter of all frequent attenders (for all causes) to hospitals had a wholly attributable alcohol diagnosis on admission. ARFAs had longer ALOS than the other patient groups [5.55days versus ARNFA 4.7, NAFA 3.39 and NANFA 2.57days, F=1088.37 (3, 488 570, P<0.001)] in the 2015/16 index year; but fewer spells than NAFAs [5.38 ARFAs versus 5.98 NAFAs, F=20 536.25 (3, 490 380) P<0.001]. The ARFA cohort reduced in size (from 51 934 ARFAs to 20 548) in the course of 5years. ARFAs had the highest average total cost of admissions per person over 5years at £38 189. People with repeated admissions for alcohol-related problems in England appear to be a high-cost, high-need, complex group of patients that makes up more than a quarter of the country's alcohol admissions.

Trends and effect of atrial fibrillation on inpatient outcomes after transcatheter aortic valve replacement.

Atrial fibrillation (AF) is common in patients undergoing transcatheter aortic valve replacement (TAVR) but there is conflicting evidence on whether AF impacts outcomes after TAVR. Hospitalizations of adults ≥50 years old who had undergone elective TAVR from 2012 to 2015 were included. Poisson regression was used to assess changes in in-hospital complications, average length of stay (LOS) after TAVR, and discharge disposition over time. Multivariable logistic, linear, and generalized logistic regression models, adjusting for patient and hospital characteristics, were used to estimate the effect of AF on inpatient outcomes. A total of 7,266 TAVR hospitalizations were included; AF was present in 44% of patients. Between 2012 and 2015, there was a significant decrease in the incidence of acute kidney injury, blood transfusion, average LOS, and inpatient mortality both for AF and non-AF patients. However, the incidences of vascular complications and major bleeding decreased only among non-AF patients. After adjustment, AF was associated with increased incidences of TIA/stroke (OR 1.36, 95% CI: 1.01, 1.85), acute kidney injury (OR 1.54, 95% CI: 1.33, 1.78), blood transfusion (OR 1.14, 95% CI: 1.00, 1.30), transfer to a skilled nursing facility (OR 1.38, 95% CI: 1.23, 1.55), and longer average LOS (CIE 1.30, 95% CI: 1.06, 1.54). AF was not associated with inpatient mortality (OR 1.09, 95% CI: 0.81, 1.48). AF is prevalent among patients undergoing TAVR, and is associated with higher incidences of inpatient complications, discharge to a skilled nursing facility, and longer average LOS. While the incidence of many complications has declined in the past few years, continued efforts to further reduce complications in patients with AF is urgently required for expansion of TAVR to broader populations.

Obesity as a Risk Factor Among Hospitalized Patients with Infective Endocarditis.

ObjectiveObesity contributes to diagnostic and management challenges for many hospitalized patients. The impact of obesity on in-hospital outcomes in patients with infective endocarditis has not been studied and was the focus of this investigation.MethodWe used the 2013 and 2014 Nationwide Inpatient Sample to identify adults ≥18 years of age with a principle diagnosis of endocarditis. We divided the sample into 2 groups based on presence of absence of obesity. Multivariate linear and logistic regression analysis was used to compare in-hospital mortality, valvular replacement, length of stay (LOS), and hospitalization charges.ResultsA total of 24 494 adults 18 years and older were hospitalized with infective endocarditis, of which 2625 were classified as obese. Patients with obesity were older (mean age, 57.8 ± 0.3 vs 54.3 ± 0.6 years; P < .01), more likely to be female (50.1% vs 36.1%; P < .01), and had more comorbidities (Charlson comorbidity score ≥ 3, 50.6% vs 28.8%; P < .01). Multivariate regression analysis found no differences between the 2 groups for mortality or repairs or replacements for any valve. On evaluation of resource utilization, patients with obesity had longer average LOS (13.9 days; confidence interval [CI], 12.7–15.1 vs 12.4 days; CI, 12.0–12.8; P = .016) and higher total hospital charges (US $160 789.90; CI, $140.922.40–$180 657.50 vs US $130 627.20; CI, $123 916.70–$137 337.70; P <.01). After adjustment for LOS for total hospital charges, there was no observed difference $11436.26 (CI, -$6649.07–$29521.6; P = .22).Conclusions. Obesity does not significantly impact in-hospital mortality or surgical valvular interventions among patients hospitalized with infective endocarditis, but obesity is associated with increased utilization of hospital resources.

Demographics, Treatment Outcomes and Resource Utilization Among Patients Hospitalized with Adult Onset Hemophagocytic Lymphohistiocytosis (HLH): A Nationwide Analysis

▪Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease in which impaired natural killer and cytotoxic T-cell function results in excessive immune activation. It is predominantly seen in children; most of the available data comes from the pediatric population so it cannot be generalized to adult HLH. Treatment of HLH usually involves either treating the underlying cause in the secondary form (i.e. malignancy with chemotherapy, rheumatologic with immune suppression) or chemotherapy and stem cell transplantation for primary, familial etiology, multiple courses of intensive chemotherapy, with stem cell transplantation for relapse and familial disease. Recently, increasing adult HLH cases have been reported. The goal of this study is to describe the association between patient factors, geography, hospital resource utilization, and mortality among adult HLH patients.Methods: We performed a retrospective cohort analysis of the National Inpatient Sample 2012, 2013 and 2014 Databases (HCUP-NIS). Patients were included in the study if they had a principal diagnosis of HLH and were older than 18 years. We used descriptive statistics to characterize the cohort in terms of personal demographic factors (age, race, sex, insurance type, community-level income level), hospital characteristics (size, region, teaching status, and urban or rural location), and admission timing (weekend or weekday). We performed univariate and multivariate regression to analyze the association of the following factors with length of stay and mortality: age, sex, Charlson index, hospital region (Northeast NE, Midwest MW, South, West), income, insurance, hospital size, weekend versus weekday, hospital location (rural versus urban), teaching status. All analyses applied the HCUP-NIS weights.Results: The cohort comprised 760 patients, the majority of whom were male (57.9%), aged 21-30 years (26.3%), white (56.3%), and treated in large (78.9%) and/or teaching (92.1%) hospitals, third quartile for median household income (30.4%), covered by private insurance (43.4%), and treated in the southern US (32.2%). Per hospitalization, the average total hospital charges were $210,526 (95% CI $176,251 to $244,801) and the average length of stay (ALOS) was 18 days (95% CI 16 to 20). On multivariate analysis, ALOS was significantly longer with patients at teaching hospitals (AMD 5.10 95% CI 0.57 to 9.64, p=0.03) or with self-pay status (AMD 29.05 95% CI 21.62 to 36.48, p <0.01). Coverage with private insurance was associated with reduced ALOS (AMD -5.04 95% CI -10.19 to 0.11, p=0.05). Hospital charges was lower with age (AMD -4434 95% CI -7786 to -1082, p=<0.01); however Charlson index increased hospital charges (AMD 33876 95% CI 6043 to 61708, p=0.02). For mortality, age (OR 1.03, 95% CI 1.01-1.05, p=0.002), Charlson index (OR 1.29, 95% CI 1.05-1.57, p=0.013), and Medicaid coverage (OR 0.19, 95% CI 0.049 to 0.698, p=0.013) were statistically significant on univariate analysis, however only age (OR 1.02 95% CI 1.00 to 1.04, p=0.045) was statistically significant on multivariate analysis.Discussion: HLH in adults remains a rare disease which requires prolonged hospitalization and high resource utilization. Receiving care in teaching hospitals increases the length of stay most likely reason is that sicker and more complex patients often end up at teaching hospitals. Private insurance coverage reduced ALOS and self pay increased it. We hypothesize that the shorter ALOS with private insurance is due to increased scrutiny by the insurance provider, while the longer ALOS with self pay is related to difficulties ensuring outpatient follow up. In addition, we hypothesize that the decrease in hospital charges with increasing age may be because of early mortality among these patients. However, further studies are required to investigate the above noted associations. DisclosuresBussel:Rigel: Consultancy, Research Funding; Amgen Inc.: Consultancy, Research Funding; Protalex: Consultancy; Momenta: Consultancy; Novartis: Consultancy, Research Funding; Uptodate: Honoraria; Prophylix: Consultancy, Research Funding. Marks:UPMC: Employment; Heron: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Equity Ownership; Lilly: Membership on an entity's Board of Directors or advisory committees; Odonate: Membership on an entity's Board of Directors or advisory committees.

Patterns of Utilization and Outcome of Hematopoietic Stem Cell Transplantation Among Various Cancers: A Nationwide Analysis

Introduction: Hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT) is performed to treat hematologic malignancies such as acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), multiple myeloma (MM), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML), myelodysplastic syndrome (MDS), lymphomas (HL and NHL) and hemophagocytic lymphohistiocytosis (HLH). Inpatient data on the characteristics of patients receiving BMT, the distribution of BMT among the above mentioned hematological cancers and their outcomes is lacking. This study analyzes patient and hospital characteristics of patients undergoing BMT, in addition the study describes resource utilization and outcomes of BMT among various hematological cancers.Methods: We performed a retrospective cohort analysis of the National Inpatient Sample 2014 Database (HCUP-NIS). Patients were included in the study if they had a procedure diagnosis of BMT and a medical diagnosis of acute or chronic leukemia (ALL, AML, CLL, CML), lymphoma (HL and NHL), MM, MDS or HLH. HSCT or BMT includes both Allogeneic and Autologous Stem Cell Transplant however we did not differentiate one from the other since BMT in MM is almost universally auto stem cell transplantation. We performed descriptive statistics to characterize the cohort in terms of personal demographic factors (age, race, sex, insurance type, community level income level), indication for HSCT, hospital characteristics (size, region, teaching status, and urban or rural location), and timing of admission (weekend or weekday). We performed univariate analyses using these variables to determine the associations with LOS and mortality. All analyses apply the HCUP-NIS weights.Results: The cohort comprised of 18,275 patients who underwent HSCT. Most patients were male (59.1%), white (70.4%), aged 51-70 years (53.9%), and covered by private insurance (57.0%). Nearly a third (31.3%) lived in communities with the highest quartile of household incomes. The most common diagnosis associated with HSCT was MM (27.6%), followed by AML (15.6%). Most HSCT was performed at large hospitals (74.5%); only 0.1% were performed in rural and 1.1% at non-teaching hospitals. Average length of stay (ALOS) was 25.54 days (95% CI 24.19 to 26.89) and the mean total charges (per hospitalization) were $346,555 (95% CI $310,465 to $382,645) and net charge was $6.33 billion. Several factors were associated with lower ALOS: age (AMD -0.31, 95% CI -0.37 to -0.24), Charlson index (AMD -0.85, 95% CI -1.60 to -0.12), private insurance coverage (AMD -3.65, 95% CI -5.25 to -2.067) and self pay status (AMD -13.56, 95%CI -17.13 to -10.00). Urban (AMD 6.74, 95% CI 1.01 to 12.48), and teaching hospitals (AMD 8.31 95% CI 2.88 to 13.72) had longer ALOS. Only Hispanic race (OR 0.23 95% CI 0.068 to 0.77) and Charlson index (OR 1.2 95% CI 1.04 to 1.39) were associated with mortality. Multivariate analysis did not show any significant associations of mortality with age, race, geographic region, hospital size, median household income, type of insurance, timing of admission, or teaching or location status of hospitals.Discussion: MM accounted for the most significant portion of HSCT in 2014, although its incidence is lower than that for leukemia and lymphoma. This may partly be because autologous stem cell transplantation (ASCT) after high dose chemotherapy is the mainstay of MM treatment. In contrast to other hematological malignancies, some MM patients may also undergo tandem transplantation. Most HSCT recipients were covered under private insurance, and a significant proportion of them came from communities with the highest quartile of median household incomes. This suggests that socioeconomic status influences access to HSCT therapy, likely related to out of pocket costs. In addition, social determinants of health including health literacy, access to health care may play a role. Surprisingly, ALOS decreased with increasing age and Charlson comorbidity index. Reasons are unclear but may be related to increased or earlier mortality. Additional studies could help to elucidate this relationship. DisclosuresBussel:Rigel: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Momenta: Consultancy; Uptodate: Honoraria; Protalex: Consultancy; Amgen Inc.: Consultancy, Research Funding; Prophylix: Consultancy, Research Funding. Marks:Odonate: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Equity Ownership; Lilly: Membership on an entity's Board of Directors or advisory committees; Heron: Membership on an entity's Board of Directors or advisory committees; UPMC: Employment.

Abstract 246: Length of Stay and Its Association With Get With the Guidelines-stroke Award Recognition

Background and Objectives: The average length of stay (ALOS) provides important information regarding care efficiency and the financing of hospitals. A shorter ALOS helps to reduce hospital costs, increase capacity optimization, and improve hospital efficiency. A longer ALOS can be associated with reduced readmission rates and mortality rates. The objective of this study was to analyze the ALOS for stroke patients based on etiology subtype and Get With The Guidelines (GWTG)-Stroke award recognition. Methods: A retrospective review of the ALOS for hemorrhagic and ischemic stroke patients was conducted for the states of Illinois, Iowa, and Michigan from 99 hospitals using GWTG-Stroke from July 2014 through December 2015. Stroke subsets, GWTG award status, and ALOS were examined. Results: The national ALOS is 5.22 days for ischemic stroke, 12.75 days for subarachnoid hemorrhage (SAH), and 8.5 days for intracerebral hemorrhage (ICH). The ALOS for ischemic stroke was 4.36 days for non-award winning hospitals and 4.52 days for award winning hospitals. The ALOS for SAH was 7.51 days for non-award winning hospitals and 10.77 days for award winning hospitals. The ALOS for ICH was 18.63 days for non-award winning hospitals and 6.80 days for award winning hospitals. Further broken down, hospitals with a higher award (gold vs silver), had longer ALOS for both SAH and ICH (11.11 vs 8.72 and 7.07 vs 5.84 respectively), while there was no significant difference in ALOS for ischemic stroke. Conclusions: This study demonstrated that GWTG-Stroke award winning hospitals have a shorter ALOS for ICH and a higher ALOS for SAH than non-award winning hospitals. Those hospitals that have attained gold award status more closely align with national ALOS. Thus, hospitals that are more adherent to guideline recommended care via a quality improvement program may be more efficient when providing care, which impacts hospitals costs.

Correlates of Length of Stay and Boarding in Florida Emergency Departments for Patients With Psychiatric Diagnoses.

Length of stay (LOS) and boarding in the emergency department (ED) for psychiatric patients have been the subject of concern, given the problems with crowding and excessive wait times in EDs. This investigation examined correlates of LOS and boarding in Florida EDs for patients presenting with psychiatric complaints from 2010 to 2013. Utilizing the Florida ED discharge database, the authors examined the association of LOS and boarding with hospital and encounter factors for adult patients presenting with a primary psychiatric diagnosis (N=597,541). The mean LOS was 7.77 hours. Anxiety disorders were the most frequent psychiatric complaint and were associated with the lowest mean LOS compared with other diagnoses (p<.05). Patient encounters resulting in a presentation of intentional self-harm and suicidality or schizophrenia were associated with significantly longer stays compared with other psychiatric diagnoses. Commercial insurance was associated with the shortest average LOS. African Americans, Hispanics, and patients age 45 and older were associated with a longer average LOS. Smaller hospital size, for-profit ownership, and rural designation were associated with a shorter average LOS. Teaching status was not associated with LOS. Furthermore, 73% of encounters resulting in transfers qualified as episodes of boarding (a stay of more than six or more hours in the ED). Extended LOS was endemic for psychiatric patients in Florida EDs.

The Financial Burden and Health Care Utilization Related to Intentional Versus Unintentional Foreign Body Ingestion in a University Hospital: A Pilot Study

Introduction: Foreign body ingestion is a common problem faced by gastroenterologists. Previous literature has focused on accidental foreign body ingestion, primarily in the form of esophageal food impactions. Recently, the cost associated with intentional foreign body ingestion has been recognized as a significant problem. There are no studies assessing the financial impact of intentional foreign body ingestion compared to accidental ingestion. This study assesses the total hospital-related costs of intentional foreign body ingestion compared with unintentional ingestion. Methods: Retrospective review comparing the demographics, hospital length of stay (LOS), and overall cost for episodes of intentional ingestion of foreign bodies (IFB) compared to unintentional foreign body ingestions and esophageal food impactions (UFI) at the University of Arizona Medical Center. Hospital billing data from 2006-2012 generated from relevant ICD-9 codes was utilized to identify potential cases of foreign body ingestion. Due to initial availability of the data, we analyzed cases from 2010-2011 and identified appropriate cases from a detailed review of hospital charts and electronic medical records. Total cost based on emergency room, procedural, and inpatient costs were calculated. Total hospital length of stay, concurrent medical or psychiatric issues, endoscopic findings, and documented reason for ingestion were also assessed. Results: From Jan 2010-Dec 2011, 20 cases, consisting of 13 patients met criteria for IFB, and 29 cases consisting of 27 patients, met criteria for UFI. Two patients had 3 intentional foreign body ingestions, and 4 patients had two episodes of IFB. Two patients had a second episode of UFI. 75% of the IFB cases (9 patients) were reported suicidal attempts and 10 of the 13 patients with intentional foreign body ingestions had a psychiatric disorder. 70.6% of IFB cases required hospitalization compared to 11.1% UFI cases. Average LOS was 2.5 days for IFB compared to 0.78 days for UFI. The average total cost of medical care for IFB was $208,668.95 compared to $11349.94 for UFI (p=0.03350) (see table 1). Conclusion: In this study, the cost associated with IFB were significantly higher than for UFI. Patients with IFB also had higher rates of hospitalization, longer average LOS, more repeat episodes, and were more likely to have psychiatric disorders compared to UFI. To decrease the costs associated with IFB, additional resources for prevention including psychiatric care may be beneficial.Table 1

Use of the SONET score to evaluate Urgent Care Center overcrowding: a prospective pilot study

ObjectivesTo derive a tool to determine Urgent Care Center (UCC) crowding and investigate the association between different levels of UCC overcrowding and negative patient care outcomes.DesignProspective pilot study.SettingSingle centre study...

Surgical Conditions Account for the Majority of Admissions to Three Primary Referral Hospitals in Rural Mozambique

The World Health Organization has identified the primary referral hospital as its priority site for improving surgical care in low- and middle-income countries. Little is known about the relative burden surgical patients place on health care facilities at this level. This research estimates the fraction of admissions due to surgical conditions at three hospitals in rural Mozambique. Prospective data were collected on all inpatients at three primary referral hospitals in Mozambique during a 12-day period. We compared the number of surgical patients and their length of stay (LOS) to the patients admitted to the medicine, pediatric, and maternity wards. These findings were validated using retrospective data collected from one hospital from January to May 2012. Patients with surgical conditions (i.e., patients admitted to the surgical or maternity ward) accounted for 57.5 % of admissions and 48.0 % of patient-days. The majority of patients were admitted to the maternity ward (32.3 %). The other admissions were evenly distributed to the pediatric (22.5 %), medical (20.0 %), and surgical (25.2 %) wards. Compared to patients from the three other wards, surgical patients had longer average LOS (8.7 vs. 1.9-7.7 days) and a higher number of total patient-days (891 vs. 252-703 days). The most prevalent procedures were cesarean section (33.3 %) and laceration repair/wound care (11.8 %). Surgical conditions are the most common reason for admissions at three primary referral hospitals in rural Mozambique. These data suggest that surgical care is a major component of health care delivered at primary referral hospitals in Mozambique and likely other sub-Saharan African countries.

Neutrophil-Lymphocyte Ratio as a Predictor of Adverse outcomes of Acute Pancreatitis

Background: Most acute pancreatitis risk scoring systems use total white blood cell counts (WBC) as one of the riskfactors. Thevalue of the neutrophil-lymphocyte ratio (NLR) to predict the severity of acute pancreatitis has not been previously evaluated. Methods. This observational study included 283 patients admitted to a tertiarycenter between 2004 and 2007. The patients were arranged into tertiles according to NLR and WBC values. The primary outcomes were intensive care unit (ICU) admission and length of stay (LOS) in the hospital. Results:According to NLR tertiles, patients in the 3rd tertile (NLR ≥7.6) had significantly more ICU admissions (17 vs. 2.2%, p < 0.0001) and longer average LOS (6.2 vs. 4.2 days, p < 0.002) compared with those in the 1st tertile (NLR <3.6). According to WBC tertiles, patients in the 3rd tertile had more ICU admissions (12.6vs.6.2%, p=0.12) and a longer average LOS (5.8vs. 4.4 days, p = 0.059) compared to patients in the 1st WBC tertile, but thisdid not reach statistical significance. In the multivariate model including NLR, WBC and other predictors, only NLR tertiles (p < 0.0262) and modified early warning scores (p<0.0025) were significant predictors of ICU admission. Likewise, in the multivariate model of LOS, only NLR and glucose level were significant predictors of longer LOS (p<0.0161 and p < 0.0053, respectively). Conclusion: NLR is superior to total WBC in predicting adverse outcomes of acute pancreatitis. According to our data, we suggest using the NLR cutoff value of >4.7 as a simple indicator of severity in patients presenting with acute pancreatitis.

Average length of stay in hospice for five types of cancer

17038 Background: Factors which influence average length of stay (ALOS) for cancer patients who choose hospice include patient and family preferences, availability of hospice services, demographics, specialty and experience of referring physician, advances in treatment options, and type of cancer. In this paper, we examine trends in ALOS for the top five cancers in patients who utilized a large, national hospice provider between 2000 and 2006. Methods: We examined 61,457 patients with prostate, colorectal, breast, lung, or pancreatic cancer who were admitted to one of 40 hospice programs and died on service between 1/1/2000 and 11/30/2006. The top five cancers accounted for 58% of all cancer deaths in the Vitas programs. The effect of Type of Cancer and Year on ALOS was evaluated using analysis of variance. Pair-wise differences were compared using the Bonferroni correction. Results: Overall ALOS was 40.6 days. ALOS for prostate, colorectal, breast, lung and pancreas was 47.9, 45.6, 45.5, 37.8 and 31.7 days, respectively. Prostate, colorectal and breast ALOS were not significantly different from one other; lung ALOS was significantly less than the top three (p &lt; .001); and pancreas ALOS was significantly lower than all others (p &lt; .001). There was no evidence of yearly trends in ALOS for different cancers during the study period. Conclusions: ALOS for patients with one of the five leading cancers who elected hospice services prior to death has remained remarkably stable over the last seven years. This stability, combined with an overall ALOS of less than six weeks, suggests that much still needs to be done to maximize cancer patient utilization of hospice services. The somewhat longer ALOS for patients with prostate, colorectal and breast cancer may be related to differences in natural history and effectiveness of anti-neoplastic therapies when compared to cancers of the lung and pancreas. No significant financial relationships to disclose.

Relationship of Malnutrition and Length of Stay in the Hospital

LEARNING OUTCOME: To examine the relationship between malnutrition, average length of stay, and hospital costs.Recent studies have suggested that malnutrition may increase average length of stay (ALOS) and thereby increase medical costs. A retrospective chart review of 150 randomly selected cardiac patients was performed to assess this possible relationship and to investigate if early nutrition intervention can eliminate/reduce hospital costs. Subjects were classified into levels of malnutrition by utilizing albumin, total lymphocyte count, percent ideal weight, and percent weight loss. Results indicated a 67% prevalence of malnutrition. Severely malnourished subjects had a five day longer ALOS than adequately nourished subjects, however, across all groups this was not statistically significant, F(2,138)=2.267, (p>.05). In terms of nutrition intervention, subjects who received early nutrition intervention (⩽4 days) had a five day shorter ALOS compared to those who received late nutrition intervention (⩾5 days), however, this was not statistically significant, F(2,138)=12.61, (p>.05). The five day difference in ALOS was substantial in increasing medical costs. A potential patient day savings of 5179,028 for the total sample could have been captured if malnutrition was treated in the hospital stay and nutrition intervention initiated early. Overall, malnutrition still exists in hospitals and costs may be reduced by improving nutrition practices to identify and treat malnutrition early in the stay.

Inpatient health care utilization for patients with HIV and AIDS in the Edinburgh City Hospital.

A retrospective analysis of HIV-positive patients admitted to the City Hospital, Edinburgh by 31st December 1992, 7 years after the inception of the HIV clinic, revealed that 373 patients, 72% of them injection drug users (IDUs), had required 2069 admissions (5.5/admitted patient, 3.3/clinic patient or 0.5/clinic patient/year) and had utilized 21,934 bed days (59 bed days/admitted patient, 35 days/clinic patient or 5 bed days/clinic patient/year). The average length of stay (ALOS) was significantly longer for AIDS than HIV (non-AIDS) admissions (14.0 vs 9.5, P < 0.0001) as it was for admissions with a CD200 diagnosis (a CD4 count below 200 cells per mm3 on two consecutive occasions) compared to those without (12.1 vs 10.0 days, P = 0.004). There was no gender effect on ALOS but there was a significant effect of risk activity; homo/bisexuals had a significantly longer ALOS than drug users (P < 0.0001). Homo/bisexual patients with AIDS or a CD200 diagnosis had longer ALOS than drug users (15.7 vs 13 days and 15.8 vs 10.8). By 1992 each member of the clinic was on average utilizing one admission per year and 11.6 bed days per year. The number of admissions in that year for patients without a CD200 or AIDS diagnosis was however low (0.5 and 0.75 admissions/patient/year) compared to patients with an AIDS or CD200 diagnosis (2.6 and 1.6 admissions/patient/year). The annual number of occupied bed days/living patient was greatest for those with AIDS (60 vs 5 days) or with a CD200 diagnosis (23.5 vs 4.1 days).(ABSTRACT TRUNCATED AT 250 WORDS)