Lower Readmission Rates Research Articles

Mapping the landscape of Hospital at home (HaH) care: a validated taxonomy for HaH care model classification

BackgroundHospital at home (HaH) care models have gained significant attention due to their potential to reduce healthcare costs, improve patient satisfaction, and lower readmission rates. However, the lack of a standardized classification system has hindered systematic evaluation and comparison of these models. Taxonomies serve as classification systems that simplify complexity and enhance understanding within a specific domain.ObjectiveThis paper introduces a comprehensive taxonomy of HaH care models, aiming to categorize and compare the various ways HaH services are delivered as an alternative to traditional hospital care.MethodsWe developed a taxonomy of characteristics for HaH care models based on scientific literature and by applying a taxonomy development framework. To validate the taxonomy, and to analyze the current landscape of HaH models we matched the taxonomy to HaH care models described in literature. Finally, to identify types of HaH care implementations, we applied the k-means clustering method to care models represented using the taxonomy.ResultsOur taxonomy consists of 12 unique dimensions structured into 5 perspectives following the progression from triaging, through care delivery, operational processes, and metrics for success: Persons and roles (2 dimensions), Target population (1 dimension), Service delivery and care model (6 dimensions), outcomes and quality metrics (2 dimensions), and training and education (1 dimension). Cluster analysis of 34 HaH care models revealed three distinct types: One cluster (50%, 17/34) focuses on patient eligibility and home environment suitability, a care model to be chosen for clinically complex patients. A second cluster (29.4%, 10/34) aggregates technology-enabled models using telemedicine and remote monitoring that are adaptable across settings. This type could be chosen for generalizable care. The third cluster (20.6%, 7/34) includes complex interventions involving informal caregivers and advanced medical devices, requiring caregiver training, supportive policies, and user-friendly technology to reduce caregiver burden and improve safety.ConclusionsThe clusters identified highlight practical considerations for adapting HaH care approaches to patient and contextual needs. These findings can guide policymakers in developing guidelines and assist practitioners in tailoring HaH care models to specific patient populations. The challenges encountered in collecting information on different characteristics of the taxonomy underscore the urgent need for more comprehensive and standardized reporting in scientific papers on HaH interventions.

Operating on the Oldest-Old: Vaginal Prolapse Surgery Outcomes in Women Over 90.

Women aged 90 years and older ("oldest-old") represent a small but growing population who may experience bothersome pelvic organ prolapse and opt for surgical repair. This study aimed to compare perioperative adverse events (AEs) within 8 weeks of prolapse surgery between women ≥90 years and younger patients. We performed a secondary analysis of a dual-center retrospective cohort study of women ≥61 years old undergoing major prolapse surgery from January 2016 to May 2023. We identified all women ≥90 years and matched them to women <90 years in a 1:4 fashion based on Charlson Comorbidity Index score and surgery type. Matching was performed without replacement. The primary outcome was a composite AE outcome, defined as all intraoperative and postoperative complications within 8 weeks of surgery. There were 24 oldest-old undergoing prolapse surgery who were matched to 96 women with mean ± standard deviation age of 77.2 ± 5.7 years. Women ≥90 years were more likely to have a lower body mass index (P < 0.01), greater preoperative prolapse stage (P = 0.049), and were less likely to have general anesthesia (P < 0.01). Patients did not differ in medical comorbidities, frailty status, concomitant hysterectomy or incontinence procedure, or length of postoperative stay. The oldest-old did not experience any intraoperative complications and had low rates of readmission (8.3%) and discharge to skilled nursing facilities (4.2%). Age ≥90 was not associated with composite AEs on multivariable analysis (adjusted odds ratio 1.60, 95% confidence interval [0.39-6.55]). Age ≥90 years does not appear to increase the risk of perioperative AEs in women with similar comorbidities.

Palliative Care Consults in the Southeast: Lower Readmissions Despite Increased Length of Stay.

Background: Inpatient palliative care (PC) consultations are increasingly used to address operational challenges. We aimed to understand how PC consultations in a southeastern program, affected by pandemic-related care delays, impacted common clinical performance metrics. Methods: This is a retrospective analysis of a tertiary system's adult patients who received PC consultations from December 2021 to August 2022. A Medicare Severity Diagnosis Related Groups (MS-DRG) code was identified for each PC encounter, and a comparison cohort was created from non-PC encounters. Outcomes: There were 1906 patients who received a PC consultation and 7730 patients in the matched cohort. Patients receiving a PC consultation were older (mean age 68.55 years) compared with the matched cohort (mean age 62.75 years). Despite a significantly longer length of stay (LOS) (12.46 days vs. 6.99 days, p < 0.001), the PC group experienced a lower readmission rate (adjusted odds ratio 0.54, 95% confidence interval 0.44-0.65, p < 0.001). Conclusions: Our cohort study using MS-DRG matching indicates that despite increased LOS, PC consultations were associated with significantly lower readmission rates. This suggests their potential to improve resource utilization, especially in regions affected by pandemic-deferred care.

Identifying specific subgroups of older patients at risk of repeated hospital readmissions and death after discharge in a prospective multicentre cohort in France

ObjectiveTo identify specific subgroups of older patients at risk of repeated hospital readmissions and death.DesignProspective, multicentre, DAMAGE (Patient Outcomes After Hospitalization in Acute Geriatric Unit) cohort of adults aged 75...

The use of community treatment orders in people with substance induced psychosis

The community treatment order (CTO) is a legally mandated approach to community based psychiatric care that has been in existence for over 20 years in the Canadian province of Saskatchewan. Changes to legislation of CTOs implemented in 2015, has resulted in bolstered use of this approach to treat substance induced psychosis (SIP). Treatment plans implemented with the use of CTOs in the present study include pharmacotherapy, in the form of long-acting injectable antipsychotics (LAI-AP). The purpose of this retrospective, observational study was to determine whether there is a benefit for the use of a CTO with LAI-AP to mandate treatment for individuals diagnosed with SIP, and rates of both readmission to hospital, and presentation to emergency departments. We observed that individuals diagnosed with SIP and assigned a CTO that included a LAI-AP demonstrated a significantly lower rate of presentations to emergency departments and a lower rate of readmissions to hospital in the first one year following diagnosis, compared to those diagnosed with SIP and not assigned a CTO. Our results suggest that use of legally mandated treatment in this diagnostic group may ease both fiscal and human resource burdens on the healthcare system. Our finding may also assist when planning treatment pathways and services for people with a diagnosis of SIP.

Health and economic evaluation of herbal medicines for heart failure: A population-based cohort study.

Heart failure (HF) represents an advanced stage of various cardiovascular disorders, with its elevated admission rates and resultant health economic burden posing an ongoing global concern. To evaluate the health and economic benefits of herbal medicine (HM) for patients with HF. Population-based cohort study. A five-year retrospective cohort study was carried out at a nationally recognized hospital in China. The study utilized propensity score matching (PSM) to match patients with HF. Chi-square tests were used to analyze dichotomous variables, and t-tests were employed for continuous variables. Logistic regression was used to examine hospital readmission rates, while multiple linear regression was utilized to evaluate direct medical costs. Statistical significance was set at p < 0.05. After implementing PSM, 1924 HF patients were included in the analysis. The study identified two significant risk factors affecting the readmission rates: age over 65 years (adjusted odds ratio (OR) = 1.25, 95 % confidence interval (CI) [1.02, 1.53]) and smoking (adjusted OR = 1.31, 95 % CI [1.01, 1.70]). Additionally, patients who received adjunctive HM treatment exhibited a significantly lower readmission rate compared to those without HM treatment (adjusted OR = 0.76, 95 % CI [0.64, 0.92]). Furthermore, the use of HM during patient hospitalization did not significantly impact direct medical expenses but instead provided positive health economic benefits (incremental cost-effectiveness ratio (ICER) = 98.52). Factors influencing direct routine medical costs included over 65 years of age (Coef = 60.78, 95 % CI [36.25, 85.31]), and cardiac function classification (New York Heart Association (NYHA) III: Coef = 1979.92, 95 % CI [1401.82, 2558.03]; NYHA IV: Coef = 6052.48, 95 % CI [5166.59, 6938.38]). The integration of HM in patients with HF reduced readmission rates without a notable increase in direct medical costs, and the expense of HM remains an economically range indicating positive health economic outcomes.

At-Home Care Program for Acute Myeloid Leukemia Induction Phase in Patients Treated with Venetoclax-Based Low-Intensity Regimens.

Background: Even though venetoclax in combination with azacitidine (VenAza) is considered a low-intensity regimen, its patients present a high incidence of cytopenia and infections during the first courses, making the initial management a challenging phase. Methods: This difficulty in our center led to the establishment of an At-Home (AH) program for ramp-up and follow-up patients during the VenAza combination induction phase focused on therapy administration, patient and caregiver education, and management of adverse events (AEs). A total of 70 patients with newly diagnosed acute myeloid leukemia (ND-AML) or relapsed/refractory AML (R/R AML) were treated with VenAza from March 2019 to May 2022. We compared outcomes between patients managed with a hospital-based (inpatient) approach and those managed through the AH program. Results: Despite most patients experiencing grade 3-4 cytopenias (96.9%), the incidence of serious infections and other AEs was comparable between both groups, with no significant difference in febrile neutropenia (42.3% vs. 27.8%, p = 0.38). Overall, the AH cohort demonstrated a significantly lower hospital readmission rate after ramp-up (29.5% vs. 84.6%, p = 0.001). Moreover, the inpatient cohort's admission days were longer than in the AH cohort (13 vs. 8, p = 0.28). Conclusions: AH management was feasible and safe, leading to better resource use, enhanced patient comfort, and improved treatment compliance. The potential of AH programs for managing low-intensity chemotherapy regimens can reduce hospital admissions and subsequently improve patient and caregiver well-being.

Incidence and predictors of readmission following hospitalization for thoracic disc herniation.

Symptomatic thoracic disc herniations (TDH) are relatively rare and can be discovered incidentally on neuroimaging. Surgical interventions for TDH represent only 4 % of all surgeries performed for intervertebral disc pathologies, which are most commonly indicated for myelopathy and radiculopathy. Given the absence of publications on rates of readmissions following hospitalization for TDH, we aim to establish baseline metrics for the 90-day all-cause readmission rates and pertinent risk factors. The 2020 Nationwide Readmissions Database was used to screen for patients with a primary diagnosis of TDH and disc degeneration within the first 9 months of the year. Demographic information, admission details, clinical data, comorbidities, and surgical treatment were extracted. Patients were divided into two groups based on readmission status. A sub-analysis was performed by treatment. Overall, 970 patients met our inclusion criteria. Of these, 183 patients (18.9 %) were readmitted within a mean of 34.58 days. The readmission group was significantly older and more likely to have been admitted non-electively. Surgical treatment was associated with a lower readmission rate. Eight comorbidities differed significantly between the groups. Independent risk factors for readmission included non-surgical treatment, Medicare insurance, hypertension, and depression. We established a 90-day all-cause readmission rate of 18.9 % for TDH. There was no difference in readmission based on patients' initial neurological presentation. Non-surgical treatment was identified as an independent risk factor for readmission, suggesting that timely surgical interventions may reduce the risk of readmission. Medicare insurance, hypertension and depression were also identified as independent risk factors.

Readiness for the Next Pandemic: A Nurse Practitioner-Driven COVID-19 Management Model for Kidney Transplant Recipients.

With the rise of virulent pathogens, the transplant community faces unprecedented challenges in caring for immunocompromised patients. Effective diagnosis, treatment, and follow-up are essential, with prompt immunosuppression adjustment and hospitalization for decompensated patients being critical for survival. Our study aimed to determine if a nurse practitioner-driven care model improves outcomes for kidney transplant recipients who contracted COVID-19. We conducted a retrospective study of kidney transplant patients who contracted COVID-19 (N = 101) from April 1, 2020 to April 30, 2021. Patients were classified into 2 groups: those presenting to the emergency department with COVID-19 symptoms and those diagnosed with COVID-19 and followed by nurse practitioners. Nurse practitioners monitored this second group daily via telephone and/or video call. They provided symptom assessment, immunosuppression adjustment, health counseling, and emotional support. Patients who were identified as decompensating had admissions arranged to the nearest hospital or our transplant center. In the intervention group (n = 66), immunosuppression was adjusted more rapidly (4.5 days vs 7 days), leading to shorter illness duration (17 days vs 26 days), fewer acute kidney injuries (50.0% vs 68.6%), lower readmission rates (5.0% vs 20%), and better survival (97.0% vs 77.1%). As we have more preventive and treatment options for COVID-19, prompt interventions and close monitoring as demonstrated in our model may be key to achieving health outcomes including graft and patient survival. Our strategies can be applicable in instances of future outbreaks of virulent pathogens and help protect and save lives within our kidney transplant patient population.

Surgical Trends in Use of Lumbar Disk Arthroplasty Versus Lumbar Fusion From 2010 to 2021.

Lumbar disk arthroplasty (LDA) is a relatively novel procedure with limited indications and use in the United States, especially relative to lumbar fusion (LF). This study aimed to determine surgical trends between LDA versus LF over the past 10 years to quantify absolute/relative surgical volume over time and compare baseline patient demographics, readmission, 2-year revision rates, and costs-of-care. A total of 714,268 patients were identified from a nationwide database who underwent LF (n = 710,527) or LDA (n = 3,741) from 2010 to 2021. The percentage of patients managed by each surgical procedure was calculated overall and subdivided annually. Baseline demographics were compared between surgical groups, comparing postoperative readmission rates and 2-year revision rates. Linear regression modeling was done to evaluate trends/differences in procedural volume by year. Beginning in 2010 to 2011, LDA constituted 1.0% of procedures, before the number/proportion of LDA procedures to LF has slowly dropped (1% in 2010 to 0.6% in 2021, P > 0.05). Patients undergoing LDA were younger (42.7 vs. 60.9 years, P < 0.0001) with a higher male proportion (50.9 vs. 42.8, P < 0.0001) and a lower Elixhauser Comorbidity Index (2.5 vs. 4.6, P < 0.0001). Patients undergoing LDA had lower rates of readmission (3.8 vs. 7.6%, P < 0.0001). Both LDA and LF average same-day reimbursements elevated sharply from 2010 to 2015 before decreasing to values lower than initially at 2010, with LF demonstrating a greater reduction in costs ($10,600 vs. $2,600, P < 0.05), although LDA remains cheaper ($2,900 vs. $5,300, P < 0.05). The surgical volume of LDA has remained steady while dropping in proportion relative to LF over the past decade. Although patients undergoing LDA are younger and have both fewer baseline demographic comorbidities and lower readmission rates, surgeons remain hesitant to perform this procedure over LF. Retrospective Cohort Study, Level III Evidence.

Catheter Ablation or Surgical Therapy in Severe Atrial Functional Mitral Regurgitation Caused by Long-Standing Persistent Atrial Fibrillation-Propensity Score Analysis.

There is no consensus on the treatment strategy for patients with severe atrial functional mitral regurgitation combined with heart failure (HF), with a lack of comparative studies in patients with long-standing persistent atrial fibrillation and severe atrial functional mitral regurgitation. We aim to compare mitral valve repair combined with the maze procedure with catheter ablation in patients with severe atrial functional mitral regurgitation due to long-standing persistent atrial fibrillation. Patients with severe atrial functional mitral regurgitation and long-standing persistent atrial fibrillation were included in this retrospective cohort study. Surgical patients underwent mitral valve repair combined with the Cox maze procedure, whereas catheter patients underwent catheter radiofrequency ablation. Mortality, atrial fibrillation recurrence, and HF readmission were assessed using overlap propensity score weighting. Then, between 2018 and 2022, we identified 302 patients: 215 in the surgical group and 87 in the catheter group. There were significant differences in the baseline characteristics between groups. The surgical group had lower rates of atrial fibrillation recurrence (P=0.03), HF readmission (P=0.03), and mitral regurgitation grade >2 at discharge (P<0.01) and follow-up (P<0.01). However, there were no significant differences in the 5-year freedom from death (log-rank P=0.87), atrial fibrillation recurrence (log-rank P=0.36), or HF readmission rates (log-rank P=0.18). Compared with surgical patients, the catheter group had higher atrial fibrillation recurrence and HF readmission rates; however, the difference was not significant after overlap propensity score weighting. Although the proportion of patients with significant mitral regurgitation at the last follow-up was higher after catheter ablation, most patients still showed an effective decrease in mitral regurgitation severity.

Comparing surgical readmission, in-hospital complications, and charges between total hip arthroplasty and hemiarthroplasty for geriatric femoral neck fractures.

For displaced femoral neck fractures (FNFs) in geriatric patients, there remains uncertainty regarding the effect of total hip arthroplasty (THA) compared with hemiarthroplasty (HA) in the guidelines. We aimed to compare 90-day surgical readmission, in-hospital complications, and charges between THA and HA in these patients. The Hospital Quality Monitoring System was queried from 1 January 2013 to 31 December 2019 for displaced FNFs in geriatric patients treated with THA or HA. After propensity score matching, which identified 33,849 paired patients, outcomes were compared between THA and HA using logistic and linear regression models. The HA group had a lower incidence of 90-day surgical readmission than the THA group (odds ratio (OR) 0.75 (95% CI 0.68 to 0.83)). Meanwhile, the HA group had lower incidence of dislocation (OR 0.42 (95% CI 0.33 to 0.52)), aseptic loosening (OR 0.50 (95% CI 0.38 to 0.66)), and joint pain (OR 0.63 (95% CI 0.40 to 0.98)), but a higher incidence of periprosthetic fracture (OR 1.41 (95% CI 1.07 to 1.87)) for readmission, compared to the THA group. The incidence of in-hospital complications did not differ significantly between the two groups. Moreover, the HA group had lower mean charges than the THA group (47,578.29 Chinese Yuan (CNY) (SD 20,069.71) vs 57,641.00 CNY (SD 21,524.07)). When considering 90-day surgical readmission rate, in-hospital complications, and mortality, HA resulted in a significantly lower surgical readmission rate within 90 days compared to THA, despite the patients being older and having a higher Charlson Comorbidity Index.

Diagnostic stewardship and dermatology consultation in cellulitis management: a systematic literature review and meta-analysis.

Cellulitis is a common skin infection often requiring antibiotic treatment. However, misdiagnosis and inappropriate antibiotic use contribute to antibiotic resistance and healthcare costs. We aimed to evaluate the impact of dermatology consultation on treatment modification in patients with suspected cellulitis and to determine whether dermatologists' evaluation can be used as a reference to diagnose suspected cellulitis. We explored MedLine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane CENTRAL, Web of Science, and Scopus and Embase, including publications from database inception to July 25, 2023. Studies were included if they evaluated treatment modifications involving the use of antibiotics for patients with suspected cellulitis with and without dermatology consultation. We excluded comments or reviews, pilot studies, and studies without a non-dermatology control group, treatment modifications, the use of antibiotics, or patients with cellulitis. Of the 49 full-text articles, 14 studies met the selection criteria.This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Of five independent reviewers (GYC, IP, MG, MKH, and AMRP), two abstracted data for each article using a standardized abstraction form. We used the Downs and Black scale to evaluate study quality. Subgroup analysis was conducted regarding readmission rate within 30 days for two independent populations seen by a non-dermatologist physician or a dermatologist. We employed random-effects models to obtain pooled mean differences. Heterogeneity was assessed using the I-squared value. The impact of dermatology consultation on treatment modification involving antibiotics in patients with suspected cellulitis and readmission rates in 30 days. Dermatology consultation changed initial treatment plans involving antibiotics from 47 to 96% of the time, improving diagnostic accuracy and, consequently, antibiotic stewardship of cellulitis. Dermatology consultation was not significantly associated with lower readmission rates in 30 days (pooled OR = 0.56, 95% CI: 0.25 to 1.25, I2 = 0%). Dermatology consultation in patients with suspected cellulitis may improve diagnosis and management, thereby reducing antibiotic misuse, unnecessary tests, and prolonged hospitalizations.

Effectiveness of the enhanced recovery after surgery (ERAS) program after lobectomy for lung cancer: a single-center observational study using propensity score matching in Vietnam.

Postoperative complications and extended length of stays (LOS) following lobectomy for non-small cell lung cancer (NSCLC) remain significant healthcare and economic burdens, especially in developing countries with limited resources. This study evaluated the effectiveness of enhanced recovery after surgery (ERAS) protocols in addressing these issues. This observational study compared two groups of patients, utilizing a prospective arm for ERAS and a retrospective arm for routine care. Outcomes measured included postoperative LOS, complications, re-operations, and re-admissions. Propensity score matching (PSM) was used to adjust for potential confounders between the two groups. Among 197 NSCLC patients (98 in the ERAS group and 99 in the routine care group), the PSM resulted in 63 patients in each group. After PSM, the ERAS group experienced a significantly shorter postoperative LOS compared to the routine group (median: 4.6 vs. 5.1 days, P=0.01). There were no significant differences in postoperative complication and re-operative rates between the two groups. However, the ERAS group had a significantly lower postoperative 30-day re-admission rate of 1.6%, compared to 14.3% in the routine care group (P=0.02). In NSCLC patients who underwent lobectomy, ERAS protocols improve postoperative outcomes by reducing LOS and re-admission rates. Therefore, ERAS should be considered a replacement for routine protocols in developing countries to minimize healthcare and economic burdens.

Quality of care of oncological patients with home parenteral nutrition

PurposeTransferring adult cancer patients from the hospital to the home environment for home parenteral nutrition (HPN) can be challenging. There is limited real-world data on how those affected perceive this situation. Our aim was to assess the quality of life (QoL) on HPN and the benefits and burdens from the cancer patient's perspective.MethodsThis observational study from Germany examined the QoL on HPN on the basis of the Functional Assessment of Cancer Therapy – G questionnaire (FACT-G). The benefits and burdens of HPN were assessed using predefined questions and answers tailored to the situation of this patient group.Results139 adults with advanced solid tumors in a palliative setting at 10 hospitals in Germany were eligible for the study. The follow-up was 12 weeks. At week 4, the Least-square (LS) mean (95% CI) change from baseline in the total FACT-G score was 0.9 (-2.4; 4.2) points, indicating QoL stability. HPN was associated with few complications, with a low rate of hospital readmission due to catheter-related issues (3.8%; n = 5). In the patient assessment of the benefits of HPN, the LS mean values at Week 4 ranged between 7.6 and 8.5 on a 10-point Likert scale. The most commonly perceived burden was "restricted mobility".ConclusionWith thorough preparation for home parenteral nutrition, the transition from hospital to home care environment works well. QoL is largely maintained through HPN, and cancer patients perceive this situation as not or minimally burdensome alongside their underlying disease, although many patients found the limited mobility to be a burden.Trial Registration numberNCT03425435 / Date of registration: February 01, 2018.

Beyond the operating room: Comparing surgical outcomes of a public insurance programme in Khyber Pakhtunkhwa

Objective: To estimate the utilization of public insurance for surgical interventions in Khyber Pakhtunkhwa, Pakistan, andcompare surgical outcomes between insured and uninsured patients. Methods: We retrospectively extracted data from one public and three private tertiary hospitals of Khyber Pakhtunkhwa(KP) that are empanelled under the Sehat Card Plus (SCP) Programme. Secondary Data was collected for a period of 16months, from 1st June 2021 to 30th September 2022 both electronically and manually. The data collection process tookplace from October 2022 to December 2022. Patients undergoing exploratory laparotomy, lower (uterine) segmentcaesarean section (LSCS), or open reduction internal fixation (ORIF) of fractures were included. Extracted data includeddemographic details, payment status (SCP user/non-user), and surgical outcomes [in-hospital mortality, length of stay (LOS),14- and 30-day readmission]. Multivariable regression models were created to determine the association of SCP use withsurgical outcomes. Results: Records of 1,853 patients were analysed. The mean age was 28.74±12.75 years. A total of 582 (31.41%) patientsutilized SCP for their treatment,429 (73.71%) of whom underwent LSCS. Overall mortality rate was 17 (0.92%). Comparedwith SCP non-users, SCP users had a significantly higher LOS (standardised beta: 0.52, 95% CI: 0.08-0.97) and lower 14-dayreadmission rate (OR: 0.64, 95% CI: 0.41-1.00). However, no significant difference was observed for 30-day readmission. Conclusion: Significantly prolonged LOS in SCP users can lead to over-utilisation of available assets. However, a lower 14-day readmission rate was also noted among the SCP users. To ensure optimal outcomes among patients and adequate useof resources, continuous monitoring and changes are required for such public insurance programmes in low-resourcesettings. Keywords: Health insurance, National health programs, Universal health insurance, Treatment outcome

Higher complication and readmission rates after total knee arthroplasty with discharge to inpatient facility vs. home: a propensity score matched analysis

IntroductionThe purpose of this retrospective cohort study was to assess differences in complication rates, early readmission rates, and reasons for readmission following TKA based on discharge destination. Secondarily, we aimed to identify independent risk factors for developing any adverse event (AAE) in the 30-day postoperative period.MethodsThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) was filtered using current procedural terminology (CPT) codes to identify patients undergoing TKA from 2015 to 2020. Patients were divided into three cohorts based on discharge destination: home, skilled nursing facility (SNF), or inpatient rehabilitation facility (IRF). Propensity score matching was used to account for confounding variables. Statistical analysis was conducted using one-way analysis of variance (ANOVA), Chi-square tests, and multivariable logistic regression.Results352,824 patients were initially identified with 303,375 discharged home, 31,635 discharged to SNF, and 17,814 discharged to IRF. Following propensity score matching, there were 5,000 patients in each cohort. Regarding postoperative complications, the home cohort had significantly a lower readmission rate (p = 0.01) and rate of any adverse event (p < 0.001) when compared to the IRF and SNF cohorts. The IRF cohort had a significantly higher rate of AAE than the SNF cohort or the home cohort. On multivariable analysis, increasing age, increasing BMI, increasing length of hospital stay, male sex, American Society of Anesthesiologists (ASA) classification four, and history of COPD were all found to be independent risk factors for developing AAE.ConclusionsThis study demonstrates that patients who are discharged to a rehabilitation facility or SNF following TKA experienced significantly higher rates of readmission and postoperative complications than patients discharged home, even after controlling for baseline demographic differences and comorbidities. Given the high financial burden associated with these facilities, it is important for physicians to consider these potential impacts on outcomes when determining patient disposition following TKA.

Investigating the Effectiveness of Enhanced Recovery after Surgery (ERAS) Protocols in Improving Postoperative Outcomes and Reducing Hospital Readmission Rates in Patients Undergoing abdominal Surgery

ABSTRACT Objectives: The main objective of the study is to determine the effectiveness of enhanced recovery after surgery (ERAS) protocols in improving postoperative outcomes and reducing hospital readmission rates in patients undergoing abdominal surgery. Materials and Methods: This study involves a total of 650 patients who were divided into two groups: the intervention group, which received care according to ERAS protocols, and the control group, which received standard postoperative care. Patients aged &gt;18 years and scheduled for elective abdominal surgery were included in the study. Results: The mean age of patients in ERAS group were 56.4 ± 12.3 years, while in the standard care group 57.1 ± 11.8 years. Out of 650 patients, there were 339 male and 311 female. Patients were selected from different surgery departments. The ERAS group had lower 30-day readmission rates (6.2% vs. 15.4%), quicker mobilization (12.5 vs. 24.8 hours), and faster resumption of oral intake (8.6 vs. 18.2 hours). Pain levels were lower (VAS 3.1 vs. 5.8), and patient satisfaction was higher (89% vs. 74%) in the ERAS group, with all differences being statistically significant. Conclusion: It is concluded that ERAS protocols significantly improve postoperative outcomes, including reducing complications, shortening hospital stays, and lowering readmission rates for patients undergoing elective abdominal surgery.

Comparative Study Between Medical/Surgical Intensive Care Units vs. Mixed Intensive Care Units in Key Performance Indicators.

Background This comparative study evaluates the performance of medical/surgical and mixed intensive care units (ICUs) at a tertiary care university hospital in Riyadh, Saudi Arabia, using key performance indicators (KPIs). Since its establishment in 1982, the hospital has provided comprehensive medical services, including specialized, closed-model ICUs, including medical, surgical, and pediatric ICUs. In 2021, these ICUs transitioned to a mixed ICU model to enhance efficiency and patient care. This study aims to assess the impact of this transition on various KPIs, including mortality rate, ICU length of stay (LOS), bed occupancy rate (bOR), ICU readmission rate within 48 hours, unplanned extubation, glycemic control, and delayed ICU discharge. Methodology Data from 2018 to 2022 were analyzed, comparing the separate medical and surgical ICUs model (2018-2020) with the mixed ICU model (2021-2022). Statistical analyseswere performed, including independent t-tests and analysis of variance (ANOVA),to determine significant differences between the ICU models. Results The transition to the mixed ICU model significantly improved several KPIs. The standardized mortality ratio (SMR) decreased from 0.575 in the specialized ICU model to 0.399 in the mixed ICU model, reflecting a marked improvement in patient outcomes. The average LOS also reduced from 4.989 days in the specialized ICUs to 4.481 days in the mixed ICU model. Additionally, the bOR significantly dropped from 91.00% to 72.08% (P = 0.000), enhancing resource efficiency. Readmission rates within 48 hours were reduced from 0.883 to 0.475 and delayed ICU discharge rates also improved, falling from 34.59% to 23.31%.Our findings revealed that the mixed ICU model outperformed the specialized ICU in most KPIs, reflecting notable enhancements inoperational efficiency and patient outcomes. Conclusions The transition to a mixed ICU model led to significant improvements in KPIs, including reductions in mortality rate and average LOS, alongside enhanced bOR and lower readmission rates within 48 hours. Delayed ICU discharge rates and glycemic control also showed notable positive changes. These improvements likely stem from the interdisciplinary expertise and flexibility of the mixed ICU environment, which supports better resource allocation and patient care. The study underscores the potential of mixed ICUs to optimize both clinical outcomes and operational efficiency in hospitals. Implementing such models can serve as a robust strategy for improving ICU performance. However, further research is needed to evaluate the long-term effects and assess the applicability of this model in diverse healthcare settings to fully validate its benefits.

Ambulatory management of acute uncomplicated diverticulitis (AmbUDiv study): a multicentre, propensity score matching study

IntroductionRecent studies have suggested that ambulatory management is feasible for acute uncomplicated diverticulitis (AUD); however, there is still no consensus regarding the most appropriate management settings. This study presents a multi-centre experience of managing patients presenting with AUD, specifically focusing on clinical outcomes and comparing ambulatory treatment with in-patient management.MethodsA retrospective multi-centre study was conducted across four hospitals in the UK and included all adult patients with computed tomography (CT) confirmed (Hinchey grade 1a) acute diverticulitis over a 12-month period (January – December 2022). Patient medical records were followed up for 1-year post-index episode, and outcomes were compared between those treated through the ambulatory pathway versus inpatient treatment using 1:1 propensity score matching (PSM). All statistical analysis was performed using the R Foundation for Statistical Computing, version 4.4.ResultsA total of 348 patients with Hinchey 1a acute diverticulitis were included (260 in-patients; 88 ambulatory pathway), of which nearly a third (31.3%) had a recurrent disease. Inpatient management was dominant (74.7%), with a median of 3 days of hospital stay. PSM resulted in 172 patients equally divided between the two care settings. Ambulatory management was associated with a lower readmission rate (P = 0.02 before PSM, P = 0.08 after PSM), comparable surgical (P = 0.57 before PSM, 0% in both groups after PSM) and radiological interventions (P = 0.99 before and after PSM) within one year. In both matched and non-matched groups, a strong association between readmissions and inpatient management was noted in univariate analysis (P = 0.03 before PSM, P = 0.04 after PSM) and multivariate analysis (P = 0.02 before PSM, P = 0.03 after PSM).ConclusionOur study supports the safety and efficacy of managing patients with AUD through a well-designed ambulatory care pathway. In particular, hospital re-admission rates are lower and other outcomes are non-inferior to in-patient treatment. This has implications for substantial cost-savings and better utilisation of limited healthcare resources.