Longer Hospital Stays Research Articles

Surgical approach to splenic flexure adenocarcinoma of the colon: Less is more?

IntroductionDue to the watershed vasculature and lymphatic drainage of splenic flexure (SF) neoplasms, and their exclusion from large clinical trials, optimal management remains debated. This study evaluated extent of resection and surgical approach for SF adenocarcinoma and their respective outcomes. MethodsAdults with stage I-III splenic flexure adenocarcinoma were identified in the National Cancer Database (2004–2020) and categorized by surgical management. ResultsOf 7412 patients, 4264 (58%) underwent extended colectomy (EC). The cohorts were overall similar, though more patients with stage I disease were managed with segmental colectomy (SC) (24% vs. 20%, p < 0.01). Those undergoing EC had longer hospital stays (LOS) and greater odds of readmission. Use of robotic-assisted surgery was higher in SC (9% vs. 7%, p < 0.01) and increased from 1% in 2010 to 24% in 2020. This approach was independently associated with a shorter LOS than open surgery. Despite a higher number of lymph nodes examined (median 18 vs. 16), EC and SC had similar nodal (both 37%, p = 0.95) and margin involvement (both 4%, p = 0.39). Five-year survival after EC and SC was similar (75% vs. 76%, p = 0.6). Patients undergoing robotic surgery had significantly lower odds of positive surgical margins and experienced an improved prognosis. ConclusionsEC and SC were performed at similar rates for SF adenocarcinoma, while the use of robotic surgery increased over time. Neither extent of resection nor surgical approach significantly impacted oncologic outcomes. These data indicate that surgical decision-making should be balanced between tumor- and patient-specific considerations, morbidity of extended colectomy, and surgeon preference. SynopsisIn a national cohort of splenic flexure cancers, segmental and extended colectomy were associated with comparable rates of negative margins, nodal involvement, and survival. Robotic assist increased over time without impacting oncologic outcomes. Surgical procedure and approach should thus be tailored to clinical condition and surgeon preference.

Risks of Increased Operative Time and Longer Hospital Stays Based on Age in Total Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Total joint arthroplasty is increasingly being performed in younger individuals across the United States. While age-specific outcomes have been evaluated in total hip and knee replacements, the data are not as clear for total ankle arthroplasty (TAA). The purpose of this study was to analyze TAA outcomes and complications by age to improve shared decision-making when considering ankle replacements. Methods: A total of 1,619 primary and revision TAAs from 2012-2020 were collected and included from the National Surgical Quality Improvement Program. Patients were stratified by age into groups less than 55, between 55-70, and greater than 70 years of age. Demographics, medical comorbidities, ASA class, operative time, 30-day complications, and comorbid conditions were compared by univariable analysis. Multivariable analysis was used to analyze readmission rates, reoperation rates, operative time, and hospital length of stay. Results: By univariable analysis, patients greater than 70 have significantly more comorbidities when compared to patients younger than 55. Younger patients have a significantly longer hospital stay, with an average of 1.64 days for those younger than 55 compared to patients 55-70 (1.50 days) and patients older than 70 (1.38 days, p&lt; 0.001). Younger patients also have a significantly longer operative time and a higher risk of still being in the hospital after 30 days (p &lt; 0.001, p=0.034). By multivariable analysis, patients 55-70 have a statistically lower risk of readmission compared to the other two cohorts (p = 0.043). Conclusion: As the incidence of total ankle arthroplasty increases across all ages, it is important to understand specific risks for each age group. Patients younger than 55 experience higher operative times and longer lengths of stay. Patients between 55-70 have a significantly lower risk of reoperation but longer hospital stays. Patients older than 70 tend to have lower reoperation rates, lower readmission rates, and shorter operative times.

736 Burn Injuries During the Pandemic: Older Patients, Delays to Admission, and Longer Hospital Stays

Abstract Introduction The COVID-19 pandemic’s impact on school closures, workforce/employment status, and the enactment of stay-at-home orders may have resulted in changes in the incidence, mechanisms, and time to presentation for treatment of burn injuries. Given the need for prompt treatment of burn injuries to prevent worsening of the injury, infection, and/or critical illness, potential delays in burn treatment during the pandemic may have resulted in poorer patient outcomes. We hypothesize that burn patients demonstrated delays to presentation, changes in burn injury mechanisms, and increased mortality intra-pandemic compared to pre-pandemic. Methods We conducted a retrospective review of records from the burn registry of a tertiary urban burn center. Persons aged 0 to 99 presenting with a burn between March 2019 and March 2021 were included for evaluation (n=1524). Demographics, time to presentation, and admission type were compared for persons presenting pre-pandemic (March 11, 2019-March 10, 2020) to intra-pandemic cases (March 11, 2020-March 10, 2021). TBSA, length of stay, mechanism of injury, and final disposition were compared for inpatients presenting pre- to intra-pandemic. Chi-squared and Student’s t-test analyses were conducted for comparisons between the pre- and intra-pandemic groups; statistical significance was set at p&amp;lt; 0.05. Results Pre-pandemic, 777 persons presented to the burn center with 239 (30.8%) admitted; intra-pandemic, 747 persons presented with 260 (34.8%) admitted. Presenting patient mean age pre-pandemic was significantly lower than intra-pandemic (41 vs. 44 years, p=0.001), as well as mean time to admission (1.41 vs 2.46 days, p=0.04). There was no statistically significant difference in patient gender, race, ethnicity, or admission type pre- vs. intra-pandemic. For inpatient admissions (n=499), there was a significant increase in length of stay pre- vs. intra-pandemic (8.31 vs. 11.26 days, p=0.042); no significant changes in TBSA, mechanisms of burn injury, or disposition were found. Conclusions Our results indicate that patients who presented intra-pandemic were significantly older and had greater injury-to-presentation times than those who presented pre-pandemic. The pandemic did not seem to have a significant effect on burn TBSA, mechanisms of injury, or disposition. These results may have important implications for the role of telehealth in burn care and public health programs for burn prevention and treatment during times of stress on the healthcare system. Applicability of Research to Practice Analysis of pre- and intra-pandemic burn injuries enables explorations of how pandemics impact both the ability of patients to seek treatment and the impact of delays in seeking treatment. Such analysis lends itself well to exploring the vital role of public health advocacy, use of telehealth, and burn prevention campaigns during crises.

Incidence of adverse drug events in patients hospitalized in the medical wards of a teaching referral hospital in Ethiopia: a prospective observational study

BackgroundAdverse drug events (ADEs) are an important public health problem with considerable clinical and economic costs. However there are limited studies of ADE incidence in adult inpatients in low-income countries, particularly in Ethiopia. Hence, this study aimed to assess the incidence of adverse drug events and associated factors in patients hospitalized in the medical wards of Wolaita Sodo University teaching referral hospital (WSUTRH).MethodsA prospective observational study was conducted involving 240 patients admitted to the medical wards of WSUTRH. A checklist was used for data collection, while standard tools were employed for assessing the probability and characterization of ADEs. A multifaceted approach involving daily chart review, patient interview, attendance at ward rounds and/or meetings, and staff reports were employed to collect the data. To identify factors independently associated with ADEs, logistic regression analysis was conducted using Stata version 15.ResultsPatients were followed from ward admission to discharge, accounting for 2200 patient-days of hospital stay. Overall, 976 medications were ordered during the hospital stay. Sixty-four ADEs were identified with an incidence of approximately 27 per 100 admissions and 29 per 1000 patient days. Of the total ADEs, 59% were preventable. Regarding the severity, 2% of the ADEs were severe, while 54% were moderate. The risk of ADEs increased with longer hospital stay (LOHS) (p = 0.021), in patients with blood and immune disease diagnosis (p = 0.001), use of cardiovascular medicines (p = 0.028), and an increase in the number of medications prescribed (p = 0.021).ConclusionsIn this study, ADEs were identified in about one-quarter of the participants. Longer hospital stays, blood and immune diseases, cardiovascular medicines use, and multiple medication use had increased the likelihood of ADE occurrences. The majority of the ADEs were preventable, indicating the existence of a window of opportunity to ensure patient safety.

Hypothyroidism Is Associated With Longer Hospital Stay Following Implantation Of Left Ventricular Assist Device.

Background:There has been a steady and consistent rise in the use of left ventricular assist devices in the management of patients with advanced heart failure. Hypothyroidism also remains one of the most common endocrine conditions with a significant impact on the development and overall outcomes of heart failure. The authors analyzed the National Inpatient Sample to evaluate the effect of hypothyroidism on the in-hospital outcomes of patients with end-stage heart failure following the placement of left ventricular assist device.Methods:The national inpatient sample was queried to identify all adult patients who had LVAD placement from 2004 to 2014. They were subsequently divided into those with hypothyroidism and those without hypothyroidism. The primary outcome was in-hospital mortality. Other outcomes were acute kidney injury, length, and cost of hospitalization. Logistic regression models were created to determine the outcomes of interest.Results:Of 2643 patients in the study, 5.4% had hypothyroidism, and 94.6% did not. The hypothyroid patients were significantly older compared to the non-hypothyroid patients (mean age 58.6 years vs 49.95 years, P-value <.0001). Both groups had similar gender composition. In-hospital mortality was similar across both groups. However, there was a higher incidence of acute kidney injury (AKI) in the hypothyroid group (adjusted odds ratio [aOR 1.83, P-value <.001]). Hypothyroid patients had longer hospital stays (adjusted mean difference [aMD] 5.19, P-value .0001). Hospital charges were also higher in the hypothyroid group.Conclusion:This study found that LVAD is associated with longer hospital stay in hypothyroid patients with heart failure.

Incidence, Outcomes and Risk Factors of Heparin-Induced Thrombocytopenia After Total Joint Arthroplasty: A National Inpatient Sample Database Study

Backgrounds: Heparin-induced thrombocytopenia (HIT) is a severe immune-mediated complication of heparin exposure, leading to negative consequences after total hip (THA) and knee arthroplasty (TKA). Materials and Methods: A retrospective study was conducted using the National Inpatient Sample (NIS) database from 2005 to 2014. The incidence and outcomes of HIT after THA or TKA were documented. Logistic regression analysis was performed to identify the postoperative HIT risk factors. Results: A total of 59 3045 patients who underwent THA and 1228 707 patients who underwent TKA were identified. The cumulative incidences were 0.02% and 0.01%, respectively. The HIT group presented significantly higher Charlson Comorbidity Index and Elixhauser Comorbidity Index scores, longer hospital stays (LOS), and higher medical costs. HIT led to a significantly higher mortality rate after THA (2.17% vs 0.16%, P = .0091). In THA, the HIT risk factors were racial minority, AIDS, pulmonary circulation disorders (PCD), psychoses, and hypertension. In TKA, the HIT risk factors were racial minority, PCD, and weight loss. Conclusion: The incidence of HIT after THA and TKA is relatively low; however, HIT significantly increases inpatient mortality, LOS, and medical cost.

Frailty in Older Odontoid Fracture Patients Is an Independent Risk Factor for Increased Complication Rates and Longer Hospital Stays

Zeeshan, Muhammad MD; Rhee, Peter M. MD, FACS; Anderson, Patrice MD, FACS; Jehan, Faisal MD; Khan, Muhammad N. MD; Bowers, Christian MD Author Information

Risk Factors for Complications, Longer Hospital Stay, and Readmission After Total Ankle Arthroplasty.

Studies have shown conflicting results regarding associations of preoperative comorbidities with outcomes after total ankle arthroplasty (TAA). Our aim was to analyze preoperative risk factors for complications, longer hospital stay, and readmission within 30 days after TAA. We conducted a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database. We included 294 patients who underwent TAA from 2009 through 2012. We used multivariate logistic regression to identify risk factors for complications, longer hospital stay, and hospital readmission. Surgical site infection was the most common complication. Diabetes was associated with greater odds of complications as was current smoker status. Notably, obesity was not associated with greater odds of complications. Age, chronic obstructive pulmonary disease, and diabetes mellitus were associated with longer hospital stays. Surgical site infection was the most common reason for hospital readmission. TAA has a low complication rate, with surgical site infection being the most common complication and the most common reason for hospital readmission. Patients with diabetes have greater odds of poor outcomes and prolonged hospital stays after TAA than patients without diabetes. Obesity was not associated with poor outcomes after TAA. Level III.

The Use of Medicines with Anti-cholinergic Properties and Their Health Impacts among Hospitalised Malaysian Geriatric Patients.

BackgroundStudies have shown that the use of medicines with anti-cholinergic (Ach) properties can increase elderly patients’ risk of experiencing falls, confusion, and longer hospital stays (LOS). These adverse effects are preventable with appropriate intervention. Little is known about the use of medicines with Ach properties and their impact on Malaysian elderly patients. This study aimed to investigate the use of medicines with Ach properties and their impact on fall risk, confusion, and longer LOS among hospitalised elderly patients.MethodsThis study utilised a cross-sectional design and was conducted at a single centre where convenience sampling was employed to collect data from elderly patients (> 60 years) admitted to geriatric and medical wards at Hospital Tuanku Ja’afar during a 2-month period (July 2017–August 2017). Patients were excluded from this study if their hospital admission was planned for an elective procedure or if neurocognitive and hepatic impairment were diagnosed prior to the hospital admission. Medicines with Ach properties were identified and classified according to the anti-cholinergic drug scale (ADS). Univariate and multiple logistic regression statistical analyses were performed to assess its impacts on falls, confusion, and LOS.ResultsA total of 145 elderly patients with a mean age of 71.59 years old (SD = 8.02) were included in the study. Fifty-two percent of the participants were female, and the average hospital stay was 6 days (SD = 2.09). Medicines with Ach properties were administered in 62% (n = 90) of the cases. The most commonly prescribed medicine with Ach properties was furosemide (n = 59), followed by ranitidine (n = 44), warfarin (n = 23), and methylprednisolone (n = 22). Compared to patients who did not receive medicines with Ach properties, patients who received them had a significantly higher risk of falls [odds ratios (OR) = 2.61; 95%CI: 1.18, 5.78; P = 0.018], confusion (OR = 3.60; 95%CI: 1.55, 8.36; P = 0.003), and LOS (OR = 4.83; 95%CI: 2.13, 10.94; P < 0.001). Multiple comorbidities also showed a significantly increased risk of falls (OR = 3.03; 95%CI: 1.29, 7.07; P = 0.010).ConclusionMedicines with Ach properties had a significant impact on elderly patients’ health. Strategies for rationally prescribing medicines with Ach properties to Malaysian elderly patients need to be improved and be recognised as an important public health priority.

Malnutrition Identified by Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Is Associated With More 30-Day Readmissions, Greater Hospital Mortality, and Longer Hospital Stays: A Retrospective Analysis of Nutrition Assessment Data in a Major Medical Center.

Few studies have compared malnutrition identified by the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) consensus criteria with clinical outcomes. Our goal was to compare 30-day readmissions (primary outcome), hospital mortality, length of stay (LOS) in survivors, and time to discharge alive (TDA) in all patients assessed as malnourished or not malnourished using these criteria in fiscal year 2015. We hypothesized more frequent admissions, greater mortality, longer LOS, and less likely shorter TDA in the malnourished patients. Demographic variables, clinical outcomes, and malnutrition diagnosis for all initial patient admissions were obtained retrospectively from the electronic medical record. Logistic regression was used to compare categorical and Cox proportional hazards for TDA in unadjusted and adjusted (age, sex, race, medical/surgical admission, Charlson Comorbidity Index) models. Of the 3907 patients referred for nutrition assessment, 66.88% met criteria for moderate or severe malnutrition. Malnourished patients were older (61 vs 58 years, P < .0001), and survivors had longer LOS (15 vs 12 days, P = .0067) and were more likely to be readmitted within 30 days (40% vs 23%, P < .0001). In adjusted models, 30-day readmissions (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.82-2.48) and hospital mortality (OR 1.47, 95% CI 1.0-1.99) were increased, and the likelihood of earlier TDA was reduced (hazard ratio [HR] 0.55, 95% CI 0.44-0.77) in those who had >2-day stay. The AND/ASPEN criteria identified malnourished patients in a high-risk population who had more adverse clinical outcomes. Further studies are needed to determine whether optimal provision of nutrition support can improve these outcomes.

Elevated Renal Pelvic Pressures during Percutaneous Nephrolithotomy Risk Higher Postoperative Pain and Longer Hospital Stay.

Renal pelvic pressure may vary during percutaneous nephrolithotomy. We sought to determine the relationship of postoperative pain to endoscope caliber, renal pelvic pressure and hospital stay. We reviewed the records of 20 percutaneous nephrolithotomies done under ureteroscopic guidance with renal pelvic pressure monitoring. The ureteroscope working channel was connected to a pressure transducer and used to determine renal pelvic pressure at baseline, when irrigating with a 26Fr rigid nephroscope and a 16Fr flexible nephroscope, and during suction. Patient demographics, operative characteristics, Likert pain scores and length of hospital stay were compared as stratified by average renal pelvic pressure. The Mann-Whitney U and Fisher exact tests were used with p<0.05 considered significant. A total of 220 measurements were recorded in 20 patients undergoing single access percutaneous nephrolithotomy. Mean patient age was 55.2 years (range 20 to 77) and mean body mass index was 32.4 kg/m2 (range 18 to 53.3). Rigid nephroscopy resulted in significantly higher average renal pelvic pressure than flexible nephroscopy (30.3 vs 12.9 mm Hg, p = 0.007). Average renal pelvicpressure was 30 mm Hg or greater in 7 patients (35%) undergoing rigid nephroscopy and in none (0%) undergoing flexible nephroscopy (p <0.01). Patients exposed to an average renal pelvic pressure of 30 mm Hg or greater during rigid nephroscopy had significantly higher average pain scores (p = 0.004) and longer hospital stays (p = 0.04) than patients with renal pelvic pressure less than 30 mm Hg. Average renal pelvic pressure 30 mm Hg or greater during rigid nephroscopy was also associated with a longer skin to calyx distance (105.5 vs 79.7 mm, p = 0.03). Knowledge of the factors that influence renal pelvic pressure and methods to control pressure extremes may improve patient outcomes during percutaneous nephrolithotomy.

Resistant Hypertension after Hypertensive Intracerebral Hemorrhage Is Associated with More Medical Interventions and Longer Hospital Stays without Affecting Outcome.

Hypertension (HTN) is the most common cause of spontaneous intracerebral hemorrhage (ICH). The aim of this study is to investigate the role of resistant HTN in patients with ICH. We conducted a retrospective study of all consecutive ICH admissions at our medical center from November 2013 to October 2015. The clinical features of patients with resistant HTN (requiring four or more antihypertensive agents to keep systolic blood pressure <140 mm Hg) were compared with those with responsive HTN (requiring three or fewer agents). Of the 152 patients with hypertensive ICH, 48 (31.6%) had resistant HTN. Resistant HTN was independently associated with higher body mass index and proteinuria. Compared to the responsive group, patients with resistant HTN had higher initial blood pressures and greater requirement for ventilator support, hematoma evacuation, hypertonic saline therapy, and nicardipine infusion. Resistant HTN increases length of stay (LOS) in the intensive care unit (ICU) (4.2 vs 2.1 days; p = 0.007) and in the hospital (11.5 vs 7.0 days; p = 0.003). Multivariate regression analysis showed that the rate of systolic blood pressure >140 mm Hg and duration of nicardipine infusion were independently associated with LOS in the ICU. There was no significant difference in hematoma expansion and functional outcome at hospital discharge between the two groups. Resistant HTN in patients with ICH is associated with more medical interventions and longer LOS without effecting outcome at hospital discharge.

Obesity Is Associated With More Complications and Longer Hospital Stays After Orthopaedic Trauma.

The objective of this study was to characterize relationships between obesity and initial hospital stay, including complications, in patients with multiple system trauma and surgically treated fractures. Prospective, observational. Level 1 trauma center. Three hundred seventy-six patients with an Injury Severity Score greater than 16 and mechanically unstable high-energy fractures of the femur, pelvic ring, acetabulum, or spine requiring stabilization. Data for obese (body mass index ≥ 30) versus nonobese patients included presence of pneumonia, deep vein thrombosis, pulmonary embolism, infection, organ failure, and mortality. Days in ICU and hospital, days on ventilator, transfusions, and surgical details were documented. Complications occurred more often in obese patients (38.0% vs. 28.4%, P = 0.03), with more acute renal failure (5.70% vs. 1.38%, P = 0.02) and infection (11.4% vs. 5.50%, P = 0.04). Days in ICU and mechanical ventilation times were longer for obese patients (7.06 vs. 5.25 days, P = 0.05 and 4.92 vs. 2.90 days, P = 0.007, respectively). Mean total hospital stay was also longer for obese patients (12.3 vs. 9.79 days, P = 0.009). No significant differences in rates of mortality, multiple organ failure, or pulmonary complications were noted. Medically stable obese patients were almost twice as likely to experience delayed fracture fixation due to preference of the surgeon and were more likely to experience delay overall (26.0% vs. 16.1%; P = 0.02). Mean time from injury to fixation was 34.9 hours in obese patients versus 23.7 hours in nonobese patients (P = 0.03). Obesity was noted among 42% of our trauma patients. In obese patients, complications occurred more often and hospital and ICU stays were significantly longer. These increases are likely to be associated with greater hospital costs. Surgeon decision to delay procedures in medically stable obese patients may have contributed to these findings; definitive fixation was more likely to be delayed in obese patients. Further study to optimize the care of patients with increased body mass index may help to improve outcomes and minimize additional treatment expenses.

Penicillin Allergy Is Associated with Longer Hospital Stays and Increased Antibiotic Use

Penicillin allergy is reported by roughly 10% of the U.S. population, but in a recent study in which patients who reported penicillin allergy were skin tested and given oral challenges, fewer than 10% were truly allergic (NEJM JW Gen Med Jul 11, 2013). This overreporting leads clinicians to prescribe other antibiotics, which may be more expensive, less efficacious, and more likely …

Abstract WMP93: Uninsured Patients have Longer Hospital Stays and are Less Likely to Receive Rehab than Insured Patients

Background: In 2010 the estimated direct and indirect cost of stroke was $53.9 billion. The long-term burden to society is thought to be much more costly. Whether or not this sum can be reduced has been a subject of great debate. Recently, healthcare reform has been a priority for policy makers with health insurance as a prevailing issue. We examined the healthcare records of patients in the US who presented with stroke symptoms in a 10-year period from 2001-2011, and compared them to patients in the state of Arizona as well as our University Hospital in the same time period. We then looked for differences in the cost of stroke with regard to variations in insurance status. Methods: The records of 978,813 patients with stroke symptoms in the US from January 2001 through December 2011 were compared with 18,875 Arizona (AZ) patients. This data was evaluated and compared with data obtained from the records of 1,123 patients admitted to the University Medical Center (UMC), and separated by insurance status, discharge location and length of stay (LOS) for different stroke subtypes. The information was gathered from the get with the guidelines stroke database and only included hospitals that reported their information. Results: The mean LOS for stroke patients in the US, AZ and UMC were: 5.25 days, 4.69 and 4.75 days, respectively. When separated by insurance status, the mean LOS for patients at UMC with Medicare was 4.27 days (n=470), for Medicaid it was 6.17 days (n=150) and 5.13 days (n=464) for private insurance. Compared with insured patients, uninsured patients had a LOS of 8.18 days (n=39; p=.001). Uninsured patients were discharged home without rehab 24.4% of the time compared with only 8.8% of insured patients (p=.001), even though 93.5% of uninsured patients were considered for rehab. Conclusion: Uninsured patients had a LOS that was 3.3 days longer than insured patients and had an estimated 72% higher cost of hospitalization. Uninsured patients were almost 3 times less likely than insured patients to be discharged with rehab, and consequently were less likely to achieve long-term functional independence. Ultimately, the price of stroke in the uninsured is paid for by taxpayers, since these patients will require social services granted by the government for disability.

RSV, Rhinovirus Coinfection Linked to Longer Hospital Stays

RSV, Rhinovirus Coinfection Linked to Longer Hospital Stays