Median Hospital Length Of Stay Research Articles

Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID-19 patients.

ObjectiveThe Rapid Emergency Medicine Score (REMS) has not been widely studied for use in predicting outcomes of COVID‐19 patients encountered in the prehospital setting. This study aimed to determine whether the first prehospital REMS could predict emergency department and hospital dispositions for COVID‐19 patients transported by emergency medical services.MethodsThis retrospective study used linked prehospital and hospital records from the ESO Data Collaborative for all 911‐initiated transports of patients with hospital COVID‐19 diagnoses from July 1 to December 31, 2020. We calculated REMS with the first recorded prehospital values for each component. We calculated area under the receiver operating curve (AUROC) for emergency department (ED) mortality, ED discharge, hospital mortality, and hospital length of stay (LOS). We determined optimal REMS cut‐points using test characteristic curves.ResultsAmong 13,830 included COVID‐19 patients, median REMS was 6 (interquartile range [IQR]: 5‐9). ED mortality was <1% (n = 80). REMS ≥9 predicted ED death (AUROC 0.79). One‐quarter of patients (n = 3,419) were discharged from the ED with an optimal REMS cut‐point of ≤5 (AUROC 0.72). Eighteen percent (n = 1,742) of admitted patients died. REMS ≥8 optimally predicted hospital mortality (AUROC 0.72). Median hospital LOS was 8.3 days (IQR: 4.1‐14.8 days). REMS ≥7 predicted hospitalizations ≥3 days (AUROC 0.62).ConclusionInitial prehospital REMS was modestly predictive of ED and hospital dispositions for patients with COVID‐19. Prediction was stronger for outcomes more proximate to the first set of emergency medical services (EMS) vital signs. These findings highlight the potential value of first prehospital REMS for risk stratification of individual patients and system surveillance for resource planning related to COVID‐19.

Perioperative factors affecting the length of hospital stay after cesarean section of pregnant women with heart disease

Objective: To explore the related factors influencing the length of hospital stay(LOS) of pregnant women with heart disease (PWHD) after cesarean section. Methods: A total of 306 patients with PWHD who underwent cesarean section from January 2012 to March 2019 were collected. Among them, 203 patients had not undergone heart surgery (uncorrected group) and 103 patients who had undergone heart surgery (corrected group) during the same period. Demographic, perioperative and postoperative data were recorded. Predictors associated with postoperative LOS were determined using univariate and multivariate linear regression analysis models. Results: (1) The median LOS after cesarean section in the uncorrected group was 6 days (5-8 days). The results of univariate linear regression analysis showed that 38 parameters had significant impact on LOS (P<0.05). The results of multivariate linear regression analysis showed that 5 parameters were independent risk factors for prolonged LOS in the uncorrected group; among them, the median LOS in uncorrected group with hypertensive disorders of pregnancy was 3 days longer than that in patients with PWHD alone [7 days (5-8 days) vs 4 days (4-5 days), β=0.195, P=0.001]; the median LOS in uncorrected group with high serum creatinine was 3 days longer than normal patients [7 days (5-13 days) vs 4 days (4-5 days), β=0.145, P=0.015]; the LOS of patients who chose general anesthesia was 2 days longer than that of patients who chose spinal anesthesia [6 days (4-8 days) vs 4 days (4-5 days), β=0.154, P=0.007]; the LOS of patients with postoperative pulmonary infection was 4 days longer than that of patients without pulmonary infection [8 days (5-15 days) vs 4 days (4-5 days), β=0.269, P<0.01]; the LOS of patients who admitted to ICU after surgery was 2 days longer than that not admitted patients [6 days (5-8 days) vs 4 days (4-5 days), β=0.268, P<0.01]. (2) The median LOS after cesarean section in corrected group was 4 days (4-5 days). The results of univariate linear regression analysis showed that 8 parameters had significant impact on the LOS (all P<0.05). The results of multivariate linear regression analysis showed that 2 parameters, which were American Society of Anesthesiologists (ASA) grade (β=0.198, P=0.028) and intraoperative blood loss (β=0.285, P=0.003), were the independent risk factors for prolonged LOS in corrected group. Conclusion: Preoperative with hypertensive disorders of pregnancy, preoperative creatinine increase, intraoperative general anesthesia, postoperative pulmonary infection, and postoperative admission to ICU are independent predictors of prolonged LOS in uncorrected patients with PWHD; ASA classification and intraoperative bleeding are independent predictor of prolonged postoperative LOS in patients with corrected PWHD.

A Nomogram Prediction of Length of Hospital Stay in Patients with COVID-19 Pneumonia: A Retrospective Cohort Study.

Assessing the length of hospital stay (LOS) in patients with coronavirus disease 2019 (COVID-19) pneumonia is helpful in optimizing the use efficiency of hospital beds and medical resources and relieving medical resource shortages. This retrospective cohort study of 97 patients was conducted at Beijing You'An Hospital between January 21, 2020, and March 21, 2020. A multivariate Cox proportional hazards regression based on the smallest Akaike information criterion value was used to select demographic and clinical variables to construct a nomogram. Discrimination, area under the receiver operating characteristic curve (AUC), calibration, and Kaplan–Meier curves with the log-rank test were used to assess the nomogram model. The median LOS was 13 days (interquartile range [IQR]: 10–18). Age, alanine aminotransferase, pneumonia, platelet count, and PF ratio (PaO2/FiO2) were included in the final model. The C-index of the nomogram was 0.76 (95%confidence interval [CI] = 0.69–0.83), and the AUC was 0.88 (95%CI = 0.82–0.95). The adjusted C-index was 0.75 (95%CI = 0.67–0.82) and adjusted AUC 0.86 (95%CI = 0.73–0.95), both after 1000 bootstrap cross internal validations. A Brier score of 0.11 (95%CI = 0.07–0.15) and adjusted Brier score of 0.130 (95%CI = 0.07–0.20) for the calibration curve showed good agreement. The AUC values for the nomogram at LOS of 10, 20, and 30 days were 0.79 (95%CI = 0.69–0.89), 0.89 (95%CI = 0.83–0.96), and 0.96 (95%CI = 0.92–1.00), respectively, and the high fit score of the nomogram model indicated a high probability of hospital stay. These results confirmed that the nomogram model accurately predicted the LOS of patients with COVID-19. We developed and validated a nomogram that incorporated five independent predictors of LOS. If validated in a future large cohort study, the model may help to optimize discharge strategies and, thus, shorten LOS in patients with COVID-19.

Analysis of demographics and outcomes of surgical resection in the CNS of patients with melanoma.

e21534 Background: Patients with melanoma frequently develop central nervous system metastases. Oligometastatic disease is often treated either by surgical resection or by stereotactic radiotherapy. This study investigates the trends and clinical outcomes of patients with melanoma who have undergone surgical procedures on the central nervous system during their hospitalization. Methods: A retrospective cohort study was performed based on admissions of adult patients who underwent craniectomy/surgical resection for metastatic melanoma from 2002 -2014 using the Nationwide Inpatient Sample database. The primary outcome measure was all-cause in-hospital mortality. Secondary outcomes included length of hospital stay(LOS) and discharge disposition (home/home with health care and skilled nursing facilities/long term acute care (SNF/LTAC)). Factors associated with in-hospital mortality were examined by multivariable logistic regression. We adjusted for patient and hospital characteristics, payer, and comorbid conditions. We also examined trends of mortality for the study years. P was kept at 0.05. Results: There were an estimated 5972 discharges of patients with melanoma undergoing craniectomy/surgical resection during the study period. Patients undergoing surgical interventions were typically males (69%) and whites (79%). 98% of procedures were performed at teaching hospitals. Unadjusted all-cause in-hospital mortality was 3.1%. There was no significant difference in mortality over 13 years. Age, gender, and race were not associated with increased in-hospital mortality. Median LOS was 5 days (IQR 3-9 days). LOS was longer in elderly and those with higher Charlson co-morbid index. Of the survivors, 76% were discharged to home or with home healthcare while 24% were discharged to SNF/LTAC. Patients with age &gt; 65 (OR 2.9; 95%CI 2.2-3.9, p &lt; 0.001) and those with higher Charlson co-morbid index (OR 1.2; 95%CI 1.1-1.3) had higher odds for being discharged to SNF/LTAC. Conclusions: Patients who undergo craniectomy/surgical resection for melanoma have a low in-hospital mortality rate. One quarter of patients are discharged to SNF/LTAC.

Morning Discharges and Patient Length of Stay in Inpatient General Internal Medicine.

Many initiatives seek to increase the number of morning hospital discharges to improve patient flow, but little evidence supports this practice. To determine the association between the number of morning discharges and emergency department (ED) length of stay (LOS) and hospital LOS in general internal medicine (GIM). Multicenter retrospective cohort study involving all GIM patients discharged between April 1, 2010, and October 31, 2017, at seven hospitals in Ontario, Canada. The primary outcomes were ED LOS and hospital LOS, and secondary outcomes were 30-day readmission and in-hospital mortality. The number of morning GIM discharges (defined as the number of patients discharged alive between 8:00 AM and 12:00 PM) on the day of each hospital admission was the primary exposure. Multivariable regression models were fit to control for patient characteristics and situational factors, including GIM census. The sample included 189,781 patient admissions. In total, 36,043 (19.0%) discharges occurred between 8:00 AM and 12:00 PM. The average daily number of morning discharges and total discharges per hospital was 1.7 (SD, 1.4) and 8.4 (SD, 4.6), respectively. The median ED LOS was 14.5 hours (interquartile range [IQR], 10.0- 23.1), and the median hospital LOS was 4.6 days (IQR, 2.4-9.0). After multivariable adjustment, there was not a significant association between morning discharge and hospital LOS (adjusted rate ratio [aRR], 1.000; 95% CI, 0.996-1.000; P = .997), ED LOS (aRR, 0.999; 95% CI, 0.997-1.000; P = .307), 30-day readmission (aRR, 1.010; 95% CI, 0.991-1.020; P = .471), or in-hospital mortality (aRR, 0.967; 95% CI, 0.920-1.020; P = .183). The lack of association between morning discharge and LOS was generally consistent across all seven hospitals. At one hospital, morning discharge was associated with a 1.9% shorter ED LOS after multivariable adjustment (aRR, 0.981; 95% CI, 0.966-0.996; P = .013). The number of morning discharges was not significantly associated with shorter ED LOS or hospital LOS in GIM. Our findings suggest that increasing the number of morning discharges alone is unlikely to substantially improve patient throughput in GIM, but further research is needed to determine the effectiveness of specific interventions.

Enhanced Recovery After Surgery can Improve Patient Outcomes and Reduce Hospital Cost of Gastrectomy for Cancer in the West: A Propensity-Score-Based Analysis

BackgroundData on ERAS for gastrectomy are scarce, and the majority of the studies come from Eastern countries. Patients in the West are older and suffer from more advanced tumors that impair their clinical condition and often require neoadjuvant treatment. This retrospective study assessed the feasibility and safety of an Enhanced Recovery After Surgery (ERAS) protocol for gastrectomy in a Western center.MethodsWe conducted a single-center study of 351 patients operated for gastric cancer: 103, operated from January 2015 to December 2016, followed the standard pathway, while 248, operated from January 2017 to December 2019, followed the ERAS program. The primary outcomes considered were length of hospital stay (LOS) and direct costs. Secondary outcomes were 90-day morbidity and mortality, readmission rate, and compliance with ERAS items. A propensity score (PS) was built on confounding variables.ResultsCompliance with ERAS items after the program was ≥ 70%. Univariable analysis evidenced a 2-day median reduction in LOS and a median cost reduction of €826 per patient in the ERAS group. PS-based multivariable analysis confirmed a significant, 2-day decrease in median LOS and a €1097 saving after ERAS introduction. Ninety-day mortality decreased slightly in ERAS group, while complications and readmissions did not change significantly. When complications were included in the multivariable analysis, ERAS retained its significance, although the effects on LOS and cost were blunted to a median reduction of 1 day and €775, respectively.ConclusionsERAS for gastrectomy improved patients’ recovery and reduced hospital costs without changes in morbidity, mortality, or readmission.

Clinical Outcomes of COVID-19 Patients Treated with Convalescent Plasma or Remdesivir Alone and in Combination at a Community Hospital in California’s Central Valley

The purpose of this study was to compare how treatment with convalescent plasma (CP) monotherapy, remdesivir (RDV) monotherapy, and combination therapy (CP + RDV) in patients with COVID-19 affected clinical outcomes. Patients with COVID-19 infection who were admitted to the hospital received CP, RDV, or combination of both. Mortality, discharge disposition, hospital length of stay (LOS), intensive care unit (ICU) LOS, and total ventilation days were compared between each treatment group and stratified by ABO blood group. An exploratory analysis identified risk factors for mortality. Adverse effects were also evaluated. RDV monotherapy showed an increased chance of survival compared to combination therapy or CP monotherapy (p = 0.052). There were 15, 3, and 6 deaths in the CP, RDV, and combination therapy groups, respectively. The combination therapy group had the longest median ICU LOS (8, IQR 4.5-15.5, p = 0.220) and hospital LOS (11, IQR 7-15.5, p = 0.175). Age (p = 0.036), initial SOFA score (p = 0.013), and intubation (p = 0.005) were statistically significant predictors of mortality. Patients with type O blood had decreased ventilation days, ICU LOS, and total LOS. Thirteen treatment-related adverse events occurred. No significant differences in clinical outcomes were observed between patients treated with RDV, CP, or combination therapy. Elderly patients, those with a high initial SOFA score, and those who require intubation are at increased risk of mortality associated with COVID-19. Blood type did not affect clinical outcomes.

Laparoscopic distal gastrectomy in old-old patients: the first Western experience.

This is the first Western study presenting short-term results on patients older than 80years affected by gastric cancer and treated with laparoscopic distal gastrectomy. A multicentre prospective database on patients suffering from distal gastric cancer with age of ≥ 80 undergone to distal gastrectomy was analysed retrospectively. End points were length of hospital stay (LoS) after surgery, and times to stool passage and solid diet initiation, as well as postoperative complications. Univariate analysis of the differences between "laparoscopic" and "open" groups was performed with non-parametric tests. Forty-six patients (median age: 83years, median CCI: 5) undergone to distal gastrectomy were analysed. Seventeen out 46 patients (36.9%) underwent laparoscopic distal gastrectomy and extended lymphadenectomy was achieved in 25 cases (25/46, 54.3%). Median number of removed and examined nodes was higher in laparoscopic than in open group. Median LoS was significantly lower in the laparoscopic group (8 vs. 11days). Complications occurred in 12 patients (26.1%): no significant differences between the two groups. There was a significant difference between the two surgical approaches in term of times for stool passage. Laparoscopic approach seems to reduce the effect of the surgical trauma without compromising lymphadenectomy also in octogenarian patients with distal gastric cancer.

Early Outcomes of Surgical Stabilisation of Traumatic Rib Fractures: Single-Center Review With a Real-World Evidence Perspective

BackgroundRandomized controlled trials have demonstrated that surgical stabilization of rib fractures (SSRF) in selected trauma patients is associated with potential benefits. This study evaluates the real-world outcomes of SSRF since its implementation at Westmead Hospital, Australia. We hypothesize these outcomes to be similar to that reported by best-evidence in the literature. Materials and methodsA retrospective analysis of data on all consecutive SSRF performed between January 2013 to December 2018 was completed. ResultsSixty-three patients (54 male; average age 55.9 ± 14.1 y) with median ISS 24 (IQR 17;30) underwent SSRF. Thirty-seven patients were admitted to Intensive Care Unit (ICU), with median ICU length of stay (LOS) 10.0 (5.0-17.0) d. Median hospital LOS was 15.5 (10.0-24.8) d. Fifty-five (87.3%) patients did not have any surgery-specific complications. The highest observed surgical morbidity was wound infection (n = 4, 4.7%). There was one mortality after rib fixation that was not related to surgery. SSRF within 3 d of hospital presentation in ventilated patients with flail chest was associated with significantly reduced median ICU LOS (3.0 [2.0;4.0] versus 10.0 [9.3;13.0] d; P = 0.03). Early (2013-2015) versus late (2015-2018) phase SSRF implementation demonstrated no significant difference in outcome variables. ConclusionExperience with SSRF demonstrates early outcomes similar to best-evidence in the existing literature. As a quality assurance tool, ongoing evaluation of real-world data is needed to ensure that outcomes remain consistent with benchmarks available from best-evidence.

A service evaluation on the use of digital chest drains following thoracic surgery on postoperative mobilisation and time on physiotherapy caseload

Introduction Chest drains are required following thoracic surgery but their presence can cause people pain, limit postoperative mobility and increase hospital length of stay (LOS). The use of portable digital chest drains can promote early postoperative mobilisation, reduce drain duration and hospital LOS. In our hospital, digital chest drains were introduced in February 2017 for use with patients following thoracic surgery performed by one thoracic surgeon. Other surgeons continued to use under water seal (UWS) drains. Aims To explore whether the use of digital chest drains allowed earlier postoperative mobilisation, compared with UWS drains. To explore whether the use of digital chest drains reduced time on physiotherapy caseload, chest drain duration and hospital LOS. Method A retrospective service evaluation was conducted in a UK teaching hospital. Data were collected for a six month period for all patients following thoracic surgery referred to physiotherapy. Data were analysed using descriptive statistics and statistical tests. Results Median day first mobilised postoperatively was statistically significantly shorter for the digital drain group (day 1) compared to the UWS drain group (day 3) (observed median difference 1, 95% CI 1 to 2 p = 0.0001). Time on physiotherapy caseload was statistically significantly shorter for the digital drain group (4 days) compared to the UWS drain group (5 days) (Observed median difference 1, 95% CI 1 to 2 p = 0.02). There was no statistically significant difference in median chest drain duration between the digital drain group (2 days) and the UWS group (3 days) (observed median difference 1, 95% CI 0 to 0 p = 0.91). Median hospital LOS was shorter for the digital drain group (5 days) compared to the UWS group (6 days) however this difference did not reach statistical significance (observed median difference 1, 95% CI 0 to 1 p = 0.06). Conclusion The use of digital chest drains with inbuilt suction enabled individuals to mobilise on the first day following thoracic surgery, thereby facilitating earlier liberation from the bed space and reducing the potential for known effects of immobilisation. The use of digital chest drains also facilitated earlier discharge from physiotherapy. In this service evaluation there was no significant difference in chest drain duration or hospital LOS between individuals with digital drains and those with UWS drains.

Delayed hospital admission for traumatic hip fractures during the COVID-19 pandemic

BackgroundConcerns of contracting the highly contagious disease COVID-19 have led to a reluctance in seeking medical attention, which may contribute to delayed hospital arrival among traumatic patients. The study objective was to describe differences in time from injury to arrival for patients with traumatic hip fractures admitted during the pandemic to pre-pandemic patients.Materials and methodsThis retrospective cohort study at six level I trauma centers included patients with traumatic hip fractures. Patients with a non-fall mechanism and those who were transferred in were excluded. Patients admitted 16 March 2019–30 June 2019 were in the “pre-pandemic” group, patients were admitted 16 March 2020–30 June 2020 were in the “pandemic” group. The primary outcome was time from injury to arrival. Secondary outcomes were time from arrival to surgical intervention, hospital length of stay (HLOS), and mortality.ResultsThere were 703 patients, 352 (50.1%) pre-pandemic and 351 (49.9%) during the pandemic. Overall, 66.5% were female and the median age was 82 years old. Patients were similar in age, race, gender, and injury severity score. The median time from injury to hospital arrival was statistically shorter for pre-pandemic patients when compared to pandemic patients, 79.5 (56, 194.5) min vs. 91 (59, 420), p = 0.04. The time from arrival to surgical intervention (p = 0.64) was statistically similar between groups. For both groups, the median HLOS was 5 days, p = 0.45. In-hospital mortality was significantly higher during the pandemic, 1.1% vs 3.4%, p = 0.04.ConclusionsWhile time from injury to hospital arrival was statistically longer during the pandemic, the difference may not be clinically important. Time from arrival to surgical intervention remained similar, despite changes made to prevent COVID-19 transmission.

Unexpected clinical outcomes following the implementation of a standardised order set for hepatic encephalopathy

ObjectiveWe evaluated the effect on clinical outcomes of implementing a standardised inpatient order set for patients admitted with hepatic encephalopathy (HE).MethodsA retrospective review of patients with cirrhosis admitted with HE....

LENGTH OF HOSPITAL STAY OF ORTHOPAEDIC INPATIENTS IN A TERTIARY CARE TEACHING HOSPITAL IN NEPAL

Background: Length of Hospital Stay (LOHS) can have important effects on the cost of treatment and patient outcomes. The aim of this study was to determine the length of hospital stay among orthopaedic inpatients and assess its association with different socio-demographic and clinical factors. Methods: A retrospective study was conducted at College of Medical Sciences and Teaching Hospital, Nepal, wherein, clinical records of patients admitted and treated as inpatients between January and December 2019 were retrieved. Demographic data, diagnosis, treatment details, LOHS, co-morbidities, treatment modality and mode of payment were documented and data was analyzed using SPSS software 16.0. Median was calculated for skewed continuous data and frequency analysis was done for categorical variables. P value &lt;0.05 was considered statistically significant. Results: In a total of 1248 patients with mean age of 33.8±18.7 years, 72.4 % (n=904) were male. Most of them (34.9%, n=435) were students and majority (62.5%, n=780) were from outside Chitwan. The median LOHS was 5.0 (3.0–10.0) days. It was significantly greater in cases from outside Chitwan, those with trauma, infection, associated injury, and complications (p&lt;0.05). Moreover, there was significant difference in LOHS among various age quintiles, occupations, fracture types, modes of payment and treatment modalities (p&lt;0.05). However, LOHS did not differ significantly between patients with or without co-morbidity and gender (p&gt;0.05). Conclusions: This study identified that the LOHS was significantly associated with various clinico demographic factors except gender and co-morbidity. More studies can be conducted to assess the relationships further.

Annual prevalence, characteristics, and outcomes of intensive care patients with skin or soft tissue infections in Australia and New Zealand: A retrospective cohort study between 2006-2017

BackgroundThere are limited published data on the epidemiology of skin and soft tissue infections (SSTIs) requiring intensive care unit (ICU) admission. This study intended to describe the annual prevalence, characteristics, and outcomes of critically ill adult patients admitted to the ICU for an SSTI. MethodsThis was a registry-based retrospective cohort study, using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database for all admissions with SSTI between 2006 and 2017. The inclusion criteria were as follows: primary diagnosis of SSTI and age ≥16 years. The exclusion criteria were as follows: ICU readmissions (during the same hospital admission) and transfers from ICUs from other hospitals. The primary outcome was in-hospital mortality, and the secondary outcomes were ICU mortality and length of stay (LOS) in the ICU and hospital with independent predictors of outcomes. ResultsAdmissions due to SSTI accounted for 10 962 (0.7%) of 1 470 197 ICU admissions between 2006 and 2017. Comorbidities were present in 25.2% of the study sample. The in-hospital mortality was 9% (991/10 962), and SSTI necessitating ICU admission accounted for 0.07% of in-hospital mortality of all ICU admissions between 2006 and 2017. Annual prevalence of ICU admissions for SSTI increased from 0.4% to 0.9% during the study period, but in-hospital mortality decreased from 16.1% to 6.8%. The median ICU LOS was 2.1 days (interquartile range = 3.4), and the median hospital LOS was 12.1 days (interquartile range = 20.6). ICU LOS remained stable between 2006 and 2017 (2.0–2.1 days), whereas hospital LOS decreased from 15.7 to 11.2 days. Predictors for in-hospital mortality included Australian and New Zealand Risk of Death scores [odds ratio (OR): 1.07; confidence interval (CI) (1.05, 1.09); p < 0.001], any comorbidity except diabetes [OR: 2.00; CI (1.05, 3.79); p = 0.035], and admission through an emergency response call [OR: 2.07; CI (1.03, 4.16); p = 0.041]. ConclusionsSSTIs are uncommon as primary ICU admission diagnosis. Although the annual prevalence of ICU admissions for SSTI has increased, in-hospital mortality and hospital LOS have decreased over the last decade.

Integration of a patient-centred MUO/CUP service within a new acute oncology service: challenges and rewards

Holistic approach to the clinical management pathway for malignancy of undefined primary origin (MUO)/carcinoma of unknown primary (CUP) patients remains an unmet clinical need. To address this, an MUO/CUP service was implemented during conception of a new acute oncology service (AOS). Over a comparable 17 months' duration, patient outcomes pre-MUO/CUP service implementation was retrospectively analysed and compared prospectively with post-service implementation database. Performance measures of MUO/CUP service were compared against national recommendations. In the retrospective cohort (n=32), median age was 71.5 years and median length of hospital stay (LOS) was 11.25 days. In the prospective cohort (n=42), median age was 75.5 years, median LOS was 7.75 days (p=0.037). Post-service implementation, 100% patients were discussed in MUO/CUP multidisciplinary team meeting; 96% of inpatient referrals were reviewed by oncology within 24-48 hours. In the prospective group, median overall survival (OS) was 73 days vs 35 days in the retrospective group (p=0.045; hazard ratio (HR) 1.61). Out of 20 patients suitable for anti-cancer treatment in the prospective group, 85% were treated within 31 days from the decision-to-treat; 90% were treated within 62 days of referral. Within the prospective group, median OS was 214 days in the treated sub-group, compared with 44 days in patients receiving best supportive care only (p<0.0001; HR 3.19). Timely specialised input from AOS with a dedicated MUO/CUP team can achieve enhanced patient-centred and healthcare-centred outcomes, both in terms of survival and hospital stay. However, heterogeneity in both retrospective and prospective study groups, as well as discrepancies in coding, makes direct comparison between both groups challenging.

Abstract P575: Impaired Distal Perfusion Predicts In-Hospital Outcome in Patients With Symptomatic Middle Cerebral Artery Stenosis

Background: Perfusion imaging is increasingly used to risk stratify patients with symptomatic intracranial stenosis. Length of hospital stay (LOS) in patients with ischemic stroke is a surrogate marker of increased morbidity. We aim to determine the association between perfusion delay on T max (&lt; 4 sec, 4-6 sec, and &gt; 6 sec) on perfusion weighted imaging and LOS in patients with symptomatic middle cerebral artery (MCA) stenosis. Methods: We included consecutive patients with left MCA stenosis admitted with ischemic stroke or TIA &lt;7 days from onset who underwent perfusion imaging (CT or MR perfusion) processed with RAPID software. We excluded patients with core infarct ≥ 30 mL. Perfusion mismatch was divided into three groups: mismatch volume ≥ 15 mL based on T max &gt; 6 sec delay, mismatch volume ≥ 15 mL based on T max 4-6 sec delay, and neither of the above mismatch patterns. The primary outcome was LOS, both as a continuous variable and categorical (≥ 7 days (prolonged LOS) vs. &lt;7 days). Results: 179 out of 194 patients met the inclusion criteria; mean age was 70.2 ± 15.4 years, 53.1% were women, median (IQR) NIHSS was 4 (1-9); 83.2% underwent MR perfusion; 38.5% had a mismatch volume ≥ 15 mL based on T max &gt; 6 sec and 31.3% had a mismatch volume ≥ 15 mL based on T max 4-6 sec and the median (IQR) LOS was 4 days (2-8). After adjusting for age and NIHSS, T max &gt; 6 sec mismatch definition was associated with prolonged LOS (OR 2.90 95% CI 1.06-8.18; p=0.039) but T max 4-6 sec definition was not (OR 1.45 95% CI 0.46-4.58, p=0.528), without any interaction based on perfusion imaging modality (p interaction = 0.568). We found similar associations when LOS was considered as a continuous variable for T max &gt; 6 sec (β coefficient=2.01, 95% CI 0.05-3.97, p=0.044) and T max 4-6 sec (β coefficient=1.24, 95% CI -0.85-3.34, p=0.244). In receiver operating curves, the optimal mismatch volume for T max &gt; 6 sec was 10 mL (sensitivity 0.61 and specificity 0.63) whereas for T max 4-6 sec it was 39 mL (sensitivity 0.61 specificity 0.56). Conclusion: In patients with recently symptomatic MCA stenosis, the T max &gt; 6 sec definition for mismatch, but not T max 4-6 sec, is associated with prolonged LOS. Prospective studies are needed to validate our findings and define the optimal mismatch threshold in patients with symptomatic MCA stenosis.

Fast track dialysis: Improving emergency department and hospital throughput for patients requiring hemodialysis.

To describe the impact of a novel communication and triage pathway called fast track dialysis (FTD) on the length of stay (LOS), resource utilization, and charges for unscheduled hemodialysis for end stage renal disease (ESRD) patients presenting to the emergency department (ED). Prospective and retrospective cohorts of ESRD patients meeting requirements of routine or urgent hemodialysis at a tertiary academic hospital from September 25th, 2016 to September 25th, 2018 in 1 year cohorts. Two sample t-tests were used to compare most outcomes of the cohorts with a Mann-Whitney U test used for skewed data. Nephrology group outcomes were analyzed by two-way ANOVA and Kruskal-Wallis and chi-square tests. There were 98 encounters in the historical cohort and 143 encounters in the fast track dialysis cohort. FTD had significantly lowered median ED LOS (4.05h, vs 5.3h, p<0.001), median hospital LOS (12.8h vs 27h, p<0.001), time to hemodialysis (4.78h vs 7.29h, p<0.001), and median hospital charges ($26,040 vs $30,747, p<0.016). The FTD cohort had increased 30 day ED return for each encounter compared to the historical cohort (1.85 visits vs 0.73 visits, p<0.001), however no significant increase in 1year ED visits (6.52 visits vs 5.80, p=0.4589) or 1 year readmissions (5.89 readmissions vs 4.81 readmissions, p=0.3584). Most nephrology groups had significantly lower time to hemodialysis order placement and time to start hemodialysis. A multidisciplinary approach with key stakeholders using a standard pathway can lead to improved efficiency in throughput, reduced charges, and hospital resource utilization for patients needing urgent or routine hemodialysis. A study with a dedicated geographic observation unit for protocolized short stay patients including conditions ranging from low risk chest pain to transient ischemic events that incorporates FTD patients under this protocol should be considered.

Earlier consultation of patients to the nutrition support unit is associated with lowers length of hospital stay

Objective: Owing to the increasing awareness regarding malnutrition, the number of nutrition support units has increased. However, given that a limited number of healthcare professionals work in the field of malnutrition area, strategies to increase the number of these healthcare professionals are warranted. To investigate the relationship between length of hospital stay (LOS) and the consultation time, defined as the duration between hospitalization and consultation to the nutrition support team. Methods: Total 337 patients who consulted our team and were given enteral and/or parenteral nutritional support were enrolled. General characteristics, reasons for admission, consultation time, nutritional support method, and LOS were examined. The correlation between LOS and consultation time was investigated. Factors that were independently associated with the LOS were analyzed using a linear regression analysis model. Results: The median patient age was 76 y (18–95 y); 53.7% of them were men, and 49.3% had at least one co-morbidity. The wards from which the patients consulted our team were intensive care (61.4%), non-surgical (32.6%), and surgical (5.9%) units. Further, 78% of the patients were at nutritional risk at the time of admission. The median LOS was 28 d (0–261 d). The median consultation time was 8 d (0–112 d). There was a significant, moderate, positive correlation between consultation time and LOS (r=0.531; p&lt;0.001). Pressure ulcer, consultation time, nutritional risk, parenteral nutrition, and gastrostomy were independent factors associated with the LOS in the linear regression analysis model. Conclusion: Early detection and management of malnutrition in hospitalized patients may offer benefit in terms of LOS. Our study showed that the earlier the patients are consulted by the nutrition support team, the lower is their LOS and vice versa.

Correlation of Intraoperative End-Tidal Carbon Dioxide Concentration on Postoperative Hospital Stay in Patients Undergoing Pylorus-Preserving Pancreaticoduodenectomy.

BackgroundHypocapnia has been traditionally advocated during general anesthesia, even though it may induce deleterious physiological effects that result in unfavorable outcomes in patients. This study investigated the association between intraoperative end-tidal carbon dioxide (EtCO2) and length of hospital stay (LOS) in patients who underwent pylorus-preserving pancreaticoduodenectomy (PPPD).MethodsThe medical records of 759 patients from 2006 to 2015 were reviewed. The patients were divided into two groups based on the mean EtCO2 value during general anesthesia: the hypocapnia group (< 35 mmHg) and the normocapnia group (≥ 35 mmHg). The primary outcome was LOS between the groups. Secondary outcomes included the length of intensive care unit (ICU) stay, postoperative 30-day, 1-year, and 2-year mortality, and perioperative factors associated with LOS.ResultsA total of 727 patients were finally analyzed. The median LOS of the hypocapnia group was significantly longer than that of the normocapnia group (22 days vs. 18 days, respectively; p < 0.001). Postoperative mortality did not differ between the groups. Cox regression analysis revealed that hypocapnia was an independent risk factor for longer LOS (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.37–1.89; p < 0.001). Age and postoperative pancreatic fistula were also risk factors for a longer LOS.ConclusionsIt was concluded that low levels of intraoperative EtCO2 during general anesthesia were associated with an increased LOS for patients undergoing PPPD.

The U.S. National Trend for Retinopathy of Prematurity.

The use of supplemental oxygen in premature infants is essential for survival. However, its use has been associated with unintended complications. The restricted use of oxygen is associated with increased mortality and necrotizing enterocolitis (NEC), whereas its liberal use is associated with increased risk for retinopathy of prematurity (ROP). Although there is no clear consensus on the acceptable oxygen saturation range, clinicians have recently become more liberal with the use of oxygen. We aim to assess (1) the national trends for ROP in very low birth weight preterm infants, and (2) the associated trends in mortality, NEC, intraventricular hemorrhage (IVH), and length of hospital stay (LOS). We analyzed deidentified patient data from the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) from 2002 to 2017. All infants with gestational age ≤32 weeks and birth weight <1,500 g were included. Trends in ROP, severe ROP, mortality, NEC, IVH, severe IVH, and LOS were analyzed using Jonckheere-Terpstra test. A total of 818,945 neonates were included in the study. The overall mortality was 16.2% and the prevalence of ROP was 17.5%. There was a significant trend for increased ROP over the years (p < 0.001). Severe ROP was also significantly increased (p < 0.001). This was associated with a significant trend for increased median LOS in survived infants (p < 0.001). Mortality was significantly decreased (p < 0.001), whereas NEC and severe NEC did not change over time (p = 0.222 and p = 0.412, respectively). There is a national trend for increased ROP and severe ROP over the 16 years of the study period. This trend was associated with a significant increase in the LOS in survived infants without change in NEC. · Prevalence of ROP and severe ROP has increased in VLBW infants over the 16-year study period.. · The prevalence of NEC did not change over the same time period.. · Increased ROP and severe ROP were consistent in all three GA and BW subgroups..